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I Really Don’t Want to Be Your “Worst” Patient

Posted on April 29, 2016 I Written By

The following is a guest blog post by M. Maxwell Stroud, Lead Consultant at Galen Healthcare Solutions.
Max - Healthcare IT
“I really don’t want to be your “worst” patient. Really, I don’t.”  These are the words that I think to myself as I prepare to ask my new specialist if he has interfaces with either of the hospital labs in my hometown 40 miles away.  My provider humors me and lets me know that if I go to one lab he will get a fax, and another and he will be able to view the results in a portal.  Sigh.

I have for a long time kept all of my care to one healthcare organization in town – in part because I am a firm believer in one chart for one person and I personally don’t want to have to deal with the mess of coordinating all of my records or manually schlepping things from office to office.  I love the concept of “one source of truth” and I know how far away we really are from that.  So why venture out of town and (gasp) to different healthcare organization?  Because that is where the best specialist was that was seeing new patients and mine had left town.

As a patient, I get to make that choice.  I get to decide where I get my care – as I should.  I also make the choice knowing that it will result in me having two distinct medical records in orgs 40 miles away from each other.  I also know that it means I am, at times, going to have to put on my advocacy hat and make sure that my records are correct, that my labs got where they need to go and that everyone has the information that they need so that I can get the best care.

Wait. What?  The patient is the only person in this continuum of care who is making sure the right person has the right data at the right time?  Yep.  Some might say that I am a control freak or that I need to relax a little – but I am informed by the life experiences of the patients that have been a part of my life.  I have seen what happened when my father got admitted to the hospital without an accurate medlist available.  I have seen the binder that my sister has to carry with her on the train that has her MRIs and PET scans to take to her next oncology appointment in the city.

It blows my mind that just a little over a month ago I was at the largest healthcare IT conference in the country (HIMSS16) discussing interoperability, and now I am on the phone with the nurse at the clinic because she cannot find my lab results … “Oh wait” she says “they are in the print and scan pile.”  Great.  Just great.

I have heard the argument that patients are not interested in their data.  There is a chance I could be an outlier – I live my life in a world of health data and I am acutely aware of how it is used in my care and the care of others.  I really think the truth is you don’t know how important it is to you until it becomes important to you.  One life event, one family member’s crisis, one rare diagnosis – and you begin to understand that you are the most important person in your own healthcare.

We have centered record keeping around the physical location of care.  This makes sense when you think historically.  Patients used to be less mobile, receive care locally and lived locally.  Additionally, the role of the “legal medical record” is a legal representation of the care provided and decisions made by a healthcare organization.  Organizations still need to document medical decision making, but patients are becoming more and more mobile.  People move from city to city, or even within health networks in the same town.  In the digital age, even if the legal medical record lives with the provider —  the data needs to follow the patient.

We can do better by patients and consumers.  The information is there, it is just not yet connected in the way that will make it available, actionable and meaningful to everyone who needs it.  It’s not just about finding an easy button to import discrete data, but also a culture change.  Truly putting the patient at the center of the data is simultaneously mission critical and more than a little revolutionary.

About M. Maxwell Stroud
M. Maxwell Stroud, MSW MSW is a Lead Consultant at Galen Healthcare Solutions with a professional background in both healthcare and social work. Max has been consulting in Health IT for over 8 years.  She has worked with every aspect of health IT in ambulatory care including facilitating clinics through the transition from paper to electronic formats, supporting teams through major system-wide upgrades as well as add-on implementations and integration projects.       Max has a passion for collaborative process and building processes that bring all stakeholders to the table to build systems that meet the needs of the business organization, the providers and the patients.  Max can be found on Twitter at @MMaxwellStroud

Lessons Learned from Patient Engagement Efforts in Louisiana

Posted on April 28, 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.

We recently sat down to talk with Jamie Martin and Linda Morgan from the Louisiana Health Care Quality Forum (LHCQF) about their efforts to promote patient engagement in Louisiana. They’ve taken a unique approach to encouraging the use of health IT and getting patients engaged in their healthcare and so we wanted to share their lessons and experience with the rest of the world.

In our conversation we talk about what is patient engagement, the importance of having providers ready for patients that want to engage, different approaches to promoting patient engagement statewide, the proliferation of portals and the challenge that provides, and the value of incorporating patients into all of your efforts through a patient advisory board. If these topics interest you, then you’ll enjoy this chat with Jamie Martin and Linda Morgan.

Unfortunately, we had a little tech issue half way through our chat, so you only get the first 30 minutes above, but there’s plenty of meat in that 30 minutes. Luckily that was the majority of the chat, but I’m sure we’ll have Linda and Jamie back again to talk to us about their ongoing efforts and other things like the risque ad option they considered using but didn’t. Of course, their bosses might be glad that part got cut off. Either way, it’s great seeing people so passionate about improving healthcare in their state.

Why We Store Data in an EHR

Posted on April 27, 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.

Shereese Maynard offered this interesting stat about the data inside an EHR and how that data is used.


I then made up this statistic which isn’t validated, but I believe is directionally accurate:


Colin Hung then validated my tweet with his comment:

It’s a tricky world we live in, but the above discussion is not surprising. EHRs were created to make an office more efficient (many have largely failed at that goal) and to help a practice bill at the highest level. In the US, you get paid based on how you document. It’s safe to say that EHR software has made it easier to document at a higher level and get paid more.

Notice that the goals of EHR software weren’t to improve health outcomes or patient care. Those goals might have been desired by many, but it wasn’t the bill of goods sold to the practice. Now we’re trying to back all this EHR data into health outcomes and improved patient care. Is it any wonder it’s a challenge for us to accomplish these goals?

When was the last time a doctor chose an EHR based on how it could improve patient care? I think most were fine purchasing an EHR that they believed wouldn’t hurt patient care. Sadly, I can’t remember ever seeing a section of a RFP that talks about an EHRs ability to improve patient care and clinical outcomes.

No, we store data in an EHR so we can improve our billing. We store data in the EHR to avoid liability. We store data in the EHR because we need appropriate documentation of the visit. Can and should that data be used to improve health outcomes and improve the quality of care provided? Yes, and most are heading that way. Although, it’s trailing since customers never demanded it. Plus, customers don’t really see an improvement in their business by focusing on it (we’ll see if that changes in a value based and high deductible plan world).

In my previous post about medical practice innovation, Dr. Nieder commented on the need for doctors to have “margin in their lives” which allows them to explore innovation. Medical billing documentation is one of the things that sucks the margins out of a doctor’s life. We need to simplify the billing requirements. That would provide doctors more margins to innovate and explore ways EHR and other technology can improve patient care and clinical outcomes.

In response to yesterday’s post about Virtual ACO’s, Randall Oates, MD and Founder of SOAPware (and a few other companies), commented “Additional complexity will not solve healthcare crises in spite of intents.” He, like I, fear that all of this value based reimbursement and ACO movement is just adding more billing complexity as opposed to simplifying things so that doctors have more margin in their lives to improve healthcare. More complexity is not the answer. More room to innovate is the answer.

The Virtual ACO

Posted on April 26, 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.

“Virtual ACOs may be the next big thing for small practices,” says our host Dr. Tom. “I want to talk about how independent practices can lead and not just follow the shift to value-based care.”

Who here has looked at or talked to someone about virtual ACOs?

My guess is that most small practices haven’t really heard about it. Maybe it has to do with most doctors being too busy to consider other innovation. I’ll admit that the idea of a virtual ACO is a new one to me and so I was interested in the discussion that Dr. Tom from Kareo led on virtual ACOs.

The concept of a virtual ACO makes sense. Basically use technology to provide coordinated care across the care system. In fact, that’s what most patients think is already happening with their care, but we know it’s generally not happening. We all know it should and most doctors would embrace the ability to have the right information in the right place so that their patients get the right care. I don’t know anyone who’s against that principle.

However, as was pointed out in the chat linked above, the financial model for a virtual ACO is up in the air. There’s no clear financial model that makes sense. The care model makes sense, but the financial model is a mess.

Dr. Tom did make this assertion in the virtual ACO discussion:

Although S. Turner Dean responded with something we’ve talked about quite a few times before:

I love Dr. Tom’s optimism that this new world of value based reimbursement simplifying things, but I’m not sure it will be any simpler than fee for service. That’s not even taking into account the fact that we have the whole infrastructure set up to handle fee for service and that we know how it works. Set that aside and I’m still not sure that a virtual ACO would be any less complicated than our current fee for service world.

What do you think of the concept of a virtual ACO? Will it simplify medicine? Will it help doctors love their work again? Will it help the independent physician practice survive?

Full Disclosure: Kareo is an advertiser on this blog.

Bill Could Cut Meaningful Use Reporting Period Drastically

Posted on April 25, 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.

A bill has been filed in Congress that would slash the Meaningful Use reporting period from one year to 90 days. This seems to be a challenge to CMS, which has reportedly held firm in the face of pressure to cut the reporting period on its own.

Supporters of the bill, which is backed by a broad coalition of industry trade groups, argue that a 365-day reporting period is unduly burdensome for providers, and will become even more awkward as MACRA requirements fall into place. Cutting the reporting period “will continue the significant progress providers are making to harness the use of technology to succeed in new payment and care delivery models,” argued a coalition of such groups in a letter sent to CMS last month.

That being said, it’s not clear how the structure of Meaningful Use incentives will play out under MACRA. So the reporting period change may or may not be as relevant as it might have been before the MACRA rules were set to be announced.

CMS leaders have said that the upcoming Merit-Based Incentive Payment System (MIPS) – which will probably fall in place under MACRA in 2017 — is designed to unify incentive payments. Specifically, it integrates existing MU, PQRS and Value-Based Payment Modifier programs. MIPS payments will be based on a weighted score rating providers on four factors: quality (30%), resource use (30%), Meaningful Use (25%) and clinical practice improvement activities (15%). This suggests that a focus on reporting requirements is probably a matter of closing the barn door after the horse has left the stable.

On the other hand, since Meaningful Use isn’t going away completely, maybe cutting the reporting period required is necessary. If providers are being rated on a set of factors of which MU is just a part, reporting for an entire year could certainly impose an administrative burden. Why set providers up to fail by forcing them to overextend their resources on reporting?

I believe that reducing Meaningful Use requirements is a sensible step to take at this point. While there are probably those who would argue the point, I submit that MU has been pretty successful in motivating providers to rethink their relationship with HIT, and has even help a subset to completely rethink how they deliver care. Now, it’s time to move the ball forward, to a more holistic approach that goes beyond regulating care processes.

Admittedly, it’s possible that cutting the reporting period, or otherwise shifting the emphasis away from regulating HIT use, might cause some providers to slack off in some way. But to my way of thinking, that’s a risk we need to take. After investing many billions of dollars on promoting smart HIT use, we have to assume that we’ve done what we can, and focus on smart quality measures. With any luck, the new measures will work better for everyone involved.

How Many Doctors Take Time to Explore New Practice Innovations?

Posted on April 22, 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.

Over the 10 years I’ve spent blogging about healthcare IT, I’ve had the chance to talk to more doctors than I can count. For the most part, I’ve been impressed by how incredible these doctors are and their desired to provide amazing care to their patients. Their desire to do the right thing for their patients is powerful and gives me a lot of hope for the future of healthcare.

While I think that most doctors hearts are in the right place, I fear that most of them don’t spend enough time thinking and planning for the future of their practice. When does a doctor spend time exploring new innovative opportunities to improve their practice? When does a doctor have time to try out new approaches or to think deeply about how they could improve the patient experience?

There are a few doctors that can spend time thinking about these types of things. They work for large health systems as employed doctors. Sure, they’re busy too, but do generally have less to worry about. However, these doctors have almost no power to implement or test and changes to the way they practice medicine and the patient experience.

I’m not really blaming doctors for this problem. I realize that they’re super busy people. I’m sure many of them would love the opportunity to spend time reinventing the practice of medicine and the patient experience. If they had the opportunity, they’d happily take it. The problem is that most of them don’t think they can get off the proverbial hamster wheel that requires them to see patients in 15 minute increments.

I think this is a problem and I don’t see any easy fixes.

If you’re a small practice, when was the last time you implemented something that really transformed the way you practice medicine for the better? When was the last time you implemented something that wasn’t part of a government mandate? When was the last time that you spent time talking with your patients about their experience at your clinic and ways that you could make it better?

I’m sorry to say that I think the answers would all reflect the reality in healthcare that we don’t spend enough time on progressing the practice of medicine. I’m sure that some doctors would argue that they’re fine with the status quo. They don’t see a reason to change. Short term that strategy could work. Long term I think that approach will come up wanting.

Penn And Teller Do a Video Explaining Why Vaccinations Are So Valuable

Posted on April 21, 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.

Sometimes it takes 2 magicians to explain something so that America understands an important health issue (Yes, that sentence doesn’t feel right, but check out the video anyway). In this case, it’s Penn and Teller explaining why vaccinations are so valuable and every child/person should get them. (Note: There’s a bit of vulgar language)

The power of a well done video is amazing (See also this doctor who raps). At the NAB conference this week I heard someone talking about virtual reality and they made this incredible point. A producer creating a video on a 2D screen can make you want to watch the video. The point being that it’s the content that matters much more than the screen. Sure, a nice big screen or virtual reality is great, but it’s the content that really matters. We’re going to learn a lot about this as more and more healthcare videos are created.

New Payment Model Pushes HIT Vendors To Collaborate

Posted on April 20, 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.

CMS has launched a new program designed to shift more risk to and offer more rewards to primary care practices which explicitly requires HIT vendors to be involved at advanced stages. While the federal government has obvious done a great deal to promote the use of HIT in medical practices, this is the first I’ve seen where HHS has demanded vendors get involved directly, and I find it intriguing. But let me explain.

The new Comprehensive Primary Care Plus payment scheme – which builds upon an existing model – is designed to keep pushing risk onto primary care practices. CMS expects to get up to 5,000 practices on board over the next five years, spanning more than 20,000 clinicians serving 25 million Medicare beneficiaries.

Like Medicare payment reforms focused on hospitals, CPC+ is designed to shift risk to PCPs in stages. Track 1 of the program is designed to help the practices shift into care management mode, offering an average care management fee of $15 per beneficiary per month on top of fee-for-service payments. Track 2, meanwhile, requires practices to bear some risk, offering them a special hybrid payment which mixes fee-for-service and a percentage of expected Evaluation & Management reimbursement up front. Both tracks offer a performance-based incentive, but risk-bearing practices get more.

So why I am I bothering telling you this? I mention this payment model because of an interesting requirement CMS has laid upon Track 2, the risk-bearing track. On this track, practices have to get their HIT vendor(s) to write a letter outlining the vendors’ willingness to support them with advanced health IT capabilities.

This is a new tack for CMS, as far as I know. True, writing a letter on behalf of customers is certainly less challenging for vendors than getting a certification for their technology, so it’s not going to create shockwaves. Still, it does suggest that CMS is thinking in new ways, and that’s always worth noticing.

True, it doesn’t appear that vendors will be required to swear mighty oaths promising that they’ll support any specific features or objectives. As with the recently-announced Interoperability Pledge, it seems like more form than substance.

Nonetheless, my take is that HIT vendors should take this requirement seriously. First of all, it shines a spotlight on the extent to which the vendors are offering real, practical support for clinicians, and while CMS may not be measuring this just yet, they may do so in the future.

What’s more, when vendors put such a letter together in collaboration with practices, it brings both sides to the table. It gives vendors and PCPs at least a marginally stronger incentive to discuss what they need to accomplish. Ideally – as CMS doubtless hopes – it could lay a foundation for better alignment between clinicians and HIT leaders.

Again, I’m not suggesting this is a massive news item, but it’s certainly food for thought. Asking HIT vendors to stick their necks out in this way (at least symbolically) could ultimately be a catalyst for change.

Digital Disease Management Tools Aren’t Too Popular

Posted on April 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.

Despite having a couple of chronic illnesses, I don’t use disease management tools and apps, even though I’m about as digital health-friendly as anyone you can imagine. So I guess the results of the new survey, suggesting that I’m not alone, shouldn’t come as a surprise.

The study was conducted by HealthMine, which recently surveyed 500 insured consumers to find out whether they used digital health devices and apps. Researchers found that while 59% of respondents suffer from chronic conditions, only 7% of these individuals used a disease management tool.

This was the case despite the fact that 50% reported using fitness/activity trackers or apps, and that 52% of respondents were enrolled in a wellness program. Not only that, two thirds of those involved in a wellness program said their program offered incentives for using digital health tools.

Disease management tools may not be in wide use, but that doesn’t mean that the consumers weren’t prepared to give digital health a try. When they drilled down further, HealthMine researchers learned that in addition to the half of respondents that used fitness trackers, consumers were interested in a wide variety of digital health options. For example, 46% used food/nutrition apps, 39% used weight loss apps, 38% used wearable activity tracker apps, 30% used heart rate apps, 28% used pharmacy apps, and 22% used patient portals or sleep apps.

To get consumers interested in disease management tools, it might help to know what motivates them to pick up any digital health app for their use. The biggest motivators cited were desire to know their numbers (42%), followed by improving their health (26%), the knowledge that someone on the other side of the app is tracking results (19%), and incentives for using the app (10%). (It’s worth noting that while incentives weren’t the biggest motivator to use digital health tools, 91% of respondents said that incentives would motivate them to use digital health tools more often.)

All that being said, I think I know what’s wrong here. In my experience, the apps consumers reported using are directed at helping consumers handle problems which, though complex, can be addressed in part by measuring a few key indicators. For example, achieving fitness is a broad and multifactorial goal, but counting steps is simple to do and simple to grasp. Or take food/dieting apps: eating properly can be a life’s work, but drawing on a database to dig out carb counts isn’t such a big deal.

On the other hand, managing a chronic illness may call for data capture, interaction with existing databases, monitoring by a skilled outside party and expert guidance. Pulling all of these together into a usable experience that consumers find helpful — much less one that actually transforms their health — is far more difficult than, say, tracking calories in and calories burned.

I’d argue that truly effective disease management tools, which consumers would truly find useful, calls for institutional commitment by vendors or providers that neither is ready to supply. But if disease management tools came with a particularly intuitive interface, a link to live providers and perhaps more importantly, education as to why the items being tracked matter, we might get somewhere.

Heads Up Health Displays Everywhere…Yes Everywhere!

Posted on April 18, 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.

Today I’ve started the first day at the NAB conference in Las Vegas. It’s a unique conference that showcases the best in broadcast media. There’s a lot of things that are of interest to healthcare. One of those things is the variety of displays that are being used to stream the various broadcast media. It’s not hard to see the hospital or home of the future that’s essentially one big electronic display of information.

With that as a backdrop, I was intrigued to read about this electronic tattoo that turns your skin into a screen:

It still has a ways to go before you’ll find it in a hospital or doctor’s office near you. However, it’s fascinating to see how we’re literally working on ways to have a display everywhere. In healthcare that’s really exciting. Plus, the tattoo includes a health sensor as well. Imagine if in a hospital or doctors visit you had one of these “tattoos” that was always showing your vital signs. Would be nice to have all of that information available. No doubt it would be streamed to your EHR or other data store in the cloud.

As this technology progresses it’s not hard to see that these tattoo displays could be a great way for your healthcare team to communicate messages to you. Add a few sensors and/or voice and you’ll be able to communicate back with them. Pretty powerful since some patients can’t lift a smart phone, but they might be able to lift their arm. Or if they can’t life their arm, they could have it left in a position where they could see it.

Getting the right health information communicated to the right people at the right time is going to be a major theme going forward in healthcare IT. We’re already working on it from a hundred different angles, but I think most of us can’t even imagine how much better this communication and data sharing will be over the next 5-10 years.