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Insights from #WEDI25

Posted on May 25, 2016 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 week I’ve been spending time at the WEDI annual conference in Salt Lake City. I’ve never been to a conference with a more diverse set of attendees. I’ve really enjoyed the diversity of attendees and perspectives that were at the conference. I was a little disappointed (but not really surprised) that clinicians weren’t part of the event. I understand why it’s hard to get them to attend an event like this, but it’s unfortunate that the physician voice isn’t part of the discussion.

Here’s a quick list of some insights I tweeted during the conference which could be useful to you:

E-patient Update: Remote Monitoring Leaves Me Out of The Loop

Posted on May 24, 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.

As some readers may recall, I don’t just write about digital health deployment — I live it. To be specific, my occasional heart arrhythmia (Afib) is being tracked remotely by device implanted in my chest near my heart. My cardiac electrophysiologist implanted the Medtronic device – a “loop recorder” roughly the size of a cigarette lighter though flatter — during a cardiac ablation procedure.

The setup works like this:

  • The implanted device tracks my heart rhythm, recording any events that fit criteria programmed into it. (Side note: It’s made entirely of plastic, which means I need not fear MRIs. Neat, huh?)
  • The center also includes a bedside station which comes with a removable, mouse shaped object that I can place on my chest to record any incidents that concern me. I can also record events in real time, when I’m on the road, using a smaller device that fits on my key ring.
  • Whether I record any perceived episodes or not, the bedside station downloads whatever information is stored in the loop recorder at midnight each night, then transmits it to the cardiac electrophysiologist’s office.
  • The next day, a tech reviews the records. If any unusual events show up, the tech notifies the doctor, who reaches out to me if need be.

Now, don’t get me wrong, this is all very cool. And these devices have benefited me already, just a month into their use. For example, one evening last week I was experiencing some uncomfortable palpitations, and wondered whether I had reason for concern. So I called the cardiac electrophysiologist’s after-hours service and got a call back from the on-call physician.

When she and I spoke, her first response was to send me to my local hospital. But once I informed her that the device was tracking my heart rhythms, she accessed them and determined that I was only experiencing mild tachycardia. That was certainly a relief.

No access for patients

That being said, it bugs me that I have no direct access to this information myself. Don’t get me wrong, I understand that interacting with heart rhythm data is complicated. Certainly, I can’t do as much in response to that information as I could if the device were, say, tracking my blood glucose levels.

That being said, my feeling is that I would benefit from knowing more about how my heart is working, or failing to work appropriately in the grand scheme of things, even if I can’t interpret the raw data of the device produces. For example, it would be great if I could view a chart that showed, say, week by week when events occurred and what time they took place.

Of course, I don’t know whether having this data would have any concrete impact on my life. But that being said, it bothers me that such remote monitoring schemes don’t have their core an assumption that patients don’t need this information. I’d argue that Medtronic and its peers should be thinking of ways to loop patients in any time their data is being collected in an outpatient setting. Don’t we have an app for that, and if not, why?

Unfortunately, no matter how patients scream and yell about this, I doubt we’ll make much progress until doctors raise their voices too. So if you’re a physician reading this, I hope you’re willing to get involved since patients deserve to know what’s going on with their bodies. And if you have the means to help them know, make it happen!

The Power Of Presenting Health Data In Context

Posted on May 23, 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.

Today I read an interesting article on the 33 charts blog, written by the thoughtful pediatrician Bryan Vartabedian. In the article, Dr. Vartabedian describes an encounter with data at Texas Children’s Hospital:

When I walked into the patient’s room, I found this: A massive wall-mounted touchscreen at the foot of the bed with all of the patient’s critical data beautifully displayed…All of the patient’s Epic data is right there in real-time. Ins and outs, blood gases and trending art line readings in beautiful graphic display. And what isn’t there is accessible by with the poke of a finger.

He goes on to suggest that by displaying the data in this way, the hospital is changing how care is delivered:

The concept of decentralized, contextually-appropriate channeling of information is beginning to disrupt the clinical encounter. As ambient interfaces infiltrate the clinical environment, the right data will increasingly find us and our patients precisely at the point of care where it’s actionable.

I really enjoyed reading this piece, as it bottom-lined something I’ve had difficulty articulating. It made me realize that I’ve been wondering if the data that’s awkward to use on a laptop or PC can be used to greater effect elsewhere. After all, it’s not that doctors dislike access to EMR data — it’s just that they dislike the impact EMRs have on their work habits.

It’s not just workflow

Much of the discussion about fostering EMR adoption by physician focuses on improving user interfaces and workflow. And that is a legitimate line of inquiry. After all, healthcare organizations will never see the full benefits of their EMR investment unless clinicians can actually use them.

But Dr. Vartabedian makes the useful point that putting such data in the right context is also critical. Sure, making sure clinicians can get to clinical data via smart phone and tablet is a step in the right direction, as it allows them to use it in a more flexible manner. But ultimately, the data is the most useful when it’s presented in the right form, one which also allows patients to consume it.

For some clinical settings, the large touchscreen display he describes may be appropriate. For others, it might be a bedside tablet that the patient and doctor can share. Or perhaps the best approach for presenting healthcare data contextually hasn’t been invented yet. But regardless of what technology works best, organizing health data and presenting it in the right context is a powerful strategy.

Creating context is possible

Of course, talking about providing contextual healthcare data and delivering it are two different things. The presentation that works for Dr. Vartabedian may not work for other clinicians, and developing the unified data set needed to fuel these efforts can be taxing. Not only that, developing the right criteria for displaying contextual data could a major challenge.

Still, the tools needed to create the right context for EMR data delivery exist now, including interactive health tracking devices, smartphone apps and tablets. Meanwhile, these devices and platforms are delivering an ever-richer data set to clinicians. Toss in data from remote monitoring devices in the options multiply. What’s more, phones with GPS functions can provide location-based data dynamically.

Sure, it may not be practical to tackle this problem while your EMR implementation is young. But it would be smart to at least turn your imagination loose. If Dr. Vartabedian is right, putting data in context soon be a requirement rather than an option, and it’s best to be prepared.

3 Benefits of Virtual Care Infographic

Posted on May 20, 2016 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.

The people at Carena have put out an infographic that looks at 3 ways virtual clinics are improving care quality. I’d like to see better sources since most of the sources for the data in this infographic come from virtual care providers. However, it’s also interesting to look at the case virtual care providers are making so we can test if they’re living up to those ideals.

What do you think of these 3 benefits? Are they achievable through virtual care?

3 Ways Virtual Clinicals are Improving Care Quality

Telemedicine Rollouts Are Becoming More Mature

Posted on May 19, 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.

For a long time, telemedicine was a big idea whose time had not come. Initially, the biggest obstacles providing video consults was consumer bandwidth. Once we got to the point that most consumers had high-speed Internet connections, proponents struggled to get commercial insurers and federal payers to reimburse providers for telemedicine. We also had to deal with medical licensure which most companies are dealing with by licensing their providers across multiple states (Crazy, but workable). Now, with both categories of payers increasingly paying for such services and patients increasingly willing to pay out of pocket, providers need to figure out which telemedicine business models work.

If I had to guess, I would’ve told you that very few providers have reached the stage where they had developed a fairly mature telemedicine service line. But data gathered by researchers increasingly suggests that I am wrong.

In fact, a new study by KPMG found that about 25% of healthcare providers have implemented telehealth and telemedicine programs which have achieved financial stability and improved efficiency. It should be noted that the study only involved 120 participants who reported they work for providers. Still, I think the results are worth a look.

Despite the success enjoyed by some providers with telemedicine programs, a fair number of providers are at a more tentative stage. Thirty-five percent of respondents said they didn’t have a virtual care program in place, and 40% had said they had just implemented a program. But what stands out to me is that the majority of respondents had telehealth initiatives underway.

Twenty-nine percent of survey respondents said that one of the key reasons they were in favor of telehealth programs is that they felt it would increase patient volumes and loyalty. Other providers have different priorities. Seventeen percent felt that implement the telehealth with help of care coordination for high-risk patients, another 17% said they wanted to reduce costs for access to medical specialists, and 13% said they were interested in telemedicine due to consumer demand.

When asked what challenges they faced in implementing telehealth, 19% said they had other tech priorities, 18% were unsure they had a sustainable business model, and 18% said their organization wasn’t ready to roll out a new technology.

As I see it, telemedicine is set up to get out of neutral and pull out of the gate. We’re probably past the early adopter stage, and as soon as influential players perfect their strategy for telemedicine rollouts, their industry peers are sure to follow.

What remains to be seen is whether providers see telemedicine as integral to the care they deliver, or primarily as a gateway to their brick-and-mortar services. I’d argue that telemedicine services should be positioned as a supplement to live care, a step towards greater continuity of care and the logical next step in going digital. Those who see it as a sideline, or a loyalty builder with no inherent clinical value, are unlikely to benefit as much from a telemedicine rollout.

Admittedly, integrating virtual care poses a host of new technical and administrative problems. But like it or not, telemedicine is important to the future of healthcare. Hold it is at arms’ length to your peril.

Physician Transparency List

Posted on May 13, 2016 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.

One of the most progressive thinkers in healthcare social media is Ed Bennett. He’s most famous for the Hospital Social Media list that Ed started back in 2009. That list was an eye opener for many hospitals that were debating how and if they should take part in social media. That list is still alive and is owned and managed by The Mayo Clinic Center for Social Media.

Ed Bennett recently announced a new list that looks at healthcare organizations who are publishing patient comments and ratings for their physicians. He currently has 29 healthcare organizations on the list, but I agree that this will likely grow similar to how his hospital social media list grew from 150 hospitals to 1500. If you’re organization is publishing your physician’s ratings and patients comments on your website, you can reach out to Ed and get your organization on the list as well.

Physician Profiles with Physician Ratings and Patient Comments List

I also find it interesting that Ed is listing the “implementation vendors” that do survey and web integration services. Here’s who he has listed so far:

Nice work Ed, putting this together. It’s always interesting how something like a list can move people to change. I have a feeling we’ll have a move towards more physician transparency happening across the industry thanks to Ed’s latest list. Nice work Ed!

Ditching Your EHR Just Isn’t Practical Regardless of Practice Model

Posted on May 12, 2016 I Written By

The following is a guest blog post by Tom Giannulli, MS, MD and CMO at Kareo.
Tom Giannulli - Kareo EHR
A recent piece by Anne Zieger on EMR & EHR opened up the discussion regarding whether or not direct primary care (DPC) physicians can or should ditch their electronic health record (EHR). And, this isn’t the first time the topic has surfaced. Other blogs have suggested that since EHRs are really just a means to gather documentation for insurance claims, DPC doctors don’t need them. Further, they offer other arguments against EHRs—like poor workflow and patient experience—however, the focus was really around insurance.

Yet, this is not a reason in and of itself for why DPC physicians should give up their EHRs. One role of an EHR is to improve documentation and coding to ensure physicians get paid. This is a good thing for DPC physicians, as well as traditional practices. The majority of DPC physicians use more than one payment model within their practice, meaning many also bill insurance for at least some patients.

A study conducted in 2015 showed that only 28% of physicians who used a DPC, concierge or other membership model in their practice had their entire patient panel on that model. The rest used it for some, but not all, patients. In fact, the largest group—37%—had 25% or less of their patients on a membership payment model. That said, insurance billing continues to be a challenge that those practices must navigate. An EHR can help them get paid correctly. It can also help them report for quality initiatives, like Meaningful Use and PQRS, prepare for the newly proposed MACRA ruling, and allow them to bill for chronic care management (CCM) services, while also improving patient experience and outcomes.

Independent practices understand that as we move forward in healthcare, a single payment model won’t do the trick. They need to be nimble and open to many options from fee-for-service to DPC to Virtual ACOs and other value-based reimbursement programs. The agile medical practices will be the ones that thrive in the long term. They are looking both at reimbursement models and industry changes, as well as increasing patient demands, such as increased connectivity, price transparency and improved patient access.

Using the EHR, Regardless of Practice Model

This is why even for those DPC practices that do go all in and don’t bill insurance, an EHR is essential. Many DPC practices offer largely primary care services with a focus on prevention and wellness. The right EHR can enable not only visit documentation but preventive care alerts and quick access to patient education. With a truly mobile EHR, physicians can engage patients face-to-face and share information in real time.

With the addition of integrated patient engagement features, such as telemedicine, self-care instructions and videos, tracking of wearable devices, and secure messaging through a portal, patients and their caregivers can stay in sync with their providers. This is an added level of convenience that DPC practices should support. Moreover, patient engagement components can be a critical part of managing wellness when studies show that most patients forget what their physician said after they leave the office. Keeping patients well means keeping the lines of communication open and a portal can play an important role.

Not only have patients expressed that they are more loyal to a physician who offers a portal (for the reasons stated above), but they have also said they like features like electronic prescribing. In fact, over 75% of patients have said they prefer an EHR to paper charts. Beyond the desire of patients, many states are beginning to mandate not just standard ePrescribing but also electronic prescribing for controlled substances. DPC physicians will not be exempt from rules like these.

There’s no other option but the EHR

It’s true that you can piece together just the technology features you want for your practice by combining several systems. However, the blog post referenced above seemed to suggest you could use an alternate system to an EHR. If you pick and choose features here and there, wouldn’t that mean more work entering data into a bunch of disparate systems? Or, logging into several different platforms translating to added time and less secure environments. One for ePrescribing, one for scheduling and reminders, one for the patient portal and maybe another one for patient collections?

There are cloud-based EHRs today that can offer most, if not all, of this in a single platform. One platform means one patient database, one login, and one easy-to-access system for all employees. And for DPC practices with small staff, no duplicate data entry or tedious jumping from system to system. In addition, a single end-to-end system that can support all the needs of a practice also means the practice can be positioned for flexibility. For example, if a DPC practice decides to accept insurance again or try another payment model, you’ll have the solutions you need without making significant changes to your workflow.

EHRs may not be perfect, but they are improving in their ability to meet increasing consumer demands and changing government regulation. Moving forward, more progressive EHR platforms will continue to offer add-on partners or native capabilities to solve consumer-centric needs. As the types of practice models change and evolve, the need for a core EHR should remain a constant, while additional features will vary. Thus, the flexibility and configurability of the EHR platform is critical to enabling long term success.

Full Disclosure: Kareo is an advertiser on this site.

Health Data Virtual Reality Demo

Posted on May 11, 2016 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.

Ever since I saw the latest demo of virtual reality at CES, I’ve become a big fan. I think there’s so much potential opportunity to take a look at things from a different angle. I think we’ve barely begun to rethink what it means for us. I’m not sure we’ll have one in every household the way we do our cell phones, but then again Google Cardboard is pretty cheap and inexpensive to share.

Mass appeal or not, we’re going to see useful implementations of virtual reality in healthcare. Of that I’m sure. With that in mind, I’m always interested by companies that are experimenting with the technology in healthcare. In this case, here’s a short demo from Mana Health.

I have a feeling we’re going to look back at this basic implementation even a few years from now and laugh at its simplicity. Although, that was the case with every tech revolution. Have you ever looked back at Windows 3.1 or various websites on the Waybackmachine when the internet first began?

Obviously this demo illustrates that we’re still in the very early days of virtual reality. Although, it’s fun to get the mind to start thinking about a new interface.

Pharma’s EHR Opportunity – We Need to Be Involved

Posted on May 9, 2016 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 recently came across a great article talking about marketers need to decode the EHR for Pharma. It’s been really interesting to see the evolution on pharma’s relationship with EHR software. No doubt they’ve all always seen a tremendous opportunity, but they’ve all treaded lightly because of the possible undue influence on a provider.

The article did make an interesting comparison between how pharma approaches EHR and how they approached social media in the past:

Their pervasiveness has raised eyebrows throughout pharma. What’s happening with EHR “reminds me of the early days of being in the digital center of excellence [DCOE],” Flaiz recalled. “Social was exploding. It belonged to corporate comms, brands, PR — there wasn’t anyone who didn’t think they owned it.”

The same thing is happening now with EHR, but with a different cast of characters: trade, pricing, medical affairs, R&D, marketing, and the DCOE — all want a piece, she said.

I also love that the article frankly states that agencies will focus on placing banners and messaging and that marketers will need to focus on a much deeper approach to marketing pharma in an EHR. In fact they outline the other EHR Opportunities for pharma that pharma marketing professionals should consider: clinical decision support, integration with the hub and patient-assistance programs, patient engagement and education, and scraping it for other information of value.

I’m sure that many readers of this don’t like this discussion at all. No doubt many feel like pharma shouldn’t have any relationship with an EHR vendor. That’s naive since pharma already has relationships with many EHR vendors. It’s a mistake for us to put a blind eye to this topic.

Yes, we need to proactive in talking about how EHR vendors should work with pharma and how they should not work with pharma. If we’re not involved in the conversation, we’ll miss out on the opportunity to shape the discussion.

Plus, not all pharma interaction with EHRs is bad. It can be a really good thing as long as what’s being done is transparent. Plus, the reality is that pharma is going to have an influence on doctors. Why not have that work done in an EHR where you can know what influence pharma is having on the doctor? Pharma and EHR vendors will work together. The question is how much we’re going to know about their involvement.

Making Health Data Patient-Friendly

Posted on May 6, 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.

Most of the efforts designed to make healthcare processes more transparent hope to make patients better shoppers. The assumption is that better-informed patients make better decisions, and that ultimately, if enough patients have the right data they’ll take steps which improve outcomes and lower the cost of care. And while the evidence for this assumption is sparse, the information may increase patient engagement in their care — and hopefully, their overall health.

That’s all well and good, but I believe too little attention has been paid to another dimension of transparency. To wit, I’d argue that it’s more than time to present patients with clinical data on a real- or near-real-time basis. Yes, shopping for the right doctor is good, but isn’t it even more important for patients to see what results he or she actually gets in their particular medical case?

Patients rarely get a well-developed look at their clinical data. Patient portals may offer access to test and imaging results from today through 10 years ago — my health system does — but offer no tools to put this data in context. If a patient wants to take a good look at their health history, and particularly, how test results correlate with their behavior, they’ll have to map the data out themselves. And that’s never going to work for your average patient.

Of course, there are obstacles to making this happen:

  • Physicians aren’t thrilled with the idea of giving patients broad healthcare data access. In fact, more than one doctor I’ve seen wouldn’t let me see test results until he or she had “approved” them.
  • Even if you set out to create some kind of clinical data dashboard, doing so isn’t trivial, at least if you want to see patients actually use it. Significant user testing would be a must to make this approach a success.
  • To my knowledge, no EMR vendor currently supports a patient dashboard or any other tools to help patients navigate their own data. So to create such an offering, providers would need to wait until their vendor produces such a tool or undertake a custom development project.

To some extent, the healthcare IT industry is already headed in this direction. For example, I’ve encountered mobile apps that attempt to provide some context for the data which they collect. But virtually all healthcare apps focus on just a few key indicators, such as, say calorie intake, exercise or medication compliance. For a patient to get a broad look at their health via app, they would have to bring together several sets of data, which simply isn’t practical.

Instead, why not give patients a broad look at their health status as seen through the rich data contained in an EMR? The final result could include not only data points, but also annotations from doctors as to the significance of trends and access to educational materials in context. That way, the patient could observe, say, the link between blood pressure levels, exercise, weight and med compliance, read comments from both their cardiologist and PCP on what has been working, and jump to research and education on cardiovascular health.

Ultimately, I’d argue, the chief obstacle to creating such an offering isn’t technical. Rather, it’s a cultural issue. Understandably, clinicians are concerned about the disruption such approaches might pose to their routine, as well as their ability to manage cases.

But if we are to make patients healthier, putting the right tools in their hands is absolutely necessary. And hey, after paying so much for EMRs, why not get more value for your money?

P.S. After writing this I discovered a description of a “digital health advisor” which parallels much of what I’m proposing. It’s worth a read!