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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.

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.

EHRs Weren’t Designed to Influence the Practice of Medicine

Posted on April 15, 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 was going through some old notes from a conference and found an interesting note from a meeting I had with Ensocare at ANI 2014 (Yep, I have lots of notes like this that I’m enjoying reading) that said, “EHRs were never designed to influence the practice of medicine.” Obviously this much later I’m not sure of the context of the comment, but it still really resonates with me today. I assume Ensocare’s perspective was that EHRs weren’t designed to influence care, but that’s what they were trying to accomplish.

It’s a fascinating observation which makes me wonder how many healthcare IT companies goals are to truly influence care. It calls back to my post last month about what it really takes to move the needle in healthcare IT. It’s kind of amazing to think that EHR software wasn’t designed to move the clinical care needle. You could argue that they wanted to move the business process automation needle. You could also argue that EHRs moved the reimbursement needle. Although the problem with moving the reimbursement needle is that it might be great for doctors to get paid more than they were before, but that translates to increased costs to the healthcare system as a whole. I think we’ve largely seen that play out and now they’re trying to deal with it.

As I said in the post linked above, I think that some EHR vendors have backed themselves into a place where they can influence the practice of medicine. However, very few of them were designed to really influence the practice of medicine. It was much easier to solve the business process automation issues and plenty of money to be made by doing so. It’s much harder to actually improve the practice of medicine.

Looking forward, I’m thinking about what type of software company could come along that would disrupt the current batch of EHR software. We could have some technology or mix of technology that continues along the business process automation path. Don’t underestimate the power of a solution like this. However, I wonder what mix of technology solutions could really influence the practice of medicine. Imagine an “EHR” software that was so useful and so powerful that if you chose not to use it you’d be at major risk for medical malpractice.

That’s a really high bar to achieve. However, once you get over that bar, it makes it hard for competitors to enter that space. So, it would be worth the effort. My only fear is that given the current climate, would anyone believe a company that says they’ve created something that will dramatically improve patient care?

In the first crop of EHR software I believe there was a disconnect in the marketing. I don’t think many EHR vendors claimed to improve patient care. They didn’t need to claim it. However, the disconnect was that many of those that purchased EHR software drew their own conclusions on an EHR’s ability to improve patient care. Now, most of these people have been burnt by the idea that an EHR could truly improve patient care. That’s going to be a hard perception to change.

Coming full circle, I imagine that’s why Ensocare and hundreds of other companies that really do want to use technology to move the needle on patient care aren’t calling their solutions EHR software. They have to use a different brand. All of that said, I’m interested in finding more health IT companies that are brave enough to take on the challenge of improving patient care. Which companies do you know that are working on this goal?

Direct Primary Care Docs And EMRs

Posted on April 14, 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 those that haven’t stumbled upon it, direct primary care is an emerging model for changing the relationship between primary care docs and their patients. Under this model, patients pay primary care practices a flat fee per month which covers all services they use during that month. From what I’ve seen, fees are typically between $50 and $100 per month, depending on the patient’s age.

The key to this model — which borrows from but is emphatically not a concierge set-up — is taking insurance companies out of the relationship. And investors seem to be excited about this approach, with VC money flowing into DPC companies and startups like Turntable Health, which is backed by Zappos.com CEO Tony Hsieh.

I bring this up because I wanted to lay out a theory and see what you folks think. The theory doesn’t come from me; it was tossed out in a blog item by Twine Health, which makes a collaborative care platform. In the item, Twine blogger Chris Storer argues that the DPC movement is enabling doctors to junk their EMRs, which he suggests have been put in place to handle insurance documentation.

While the notion is self-serving, given that Twine seemingly wants to replace EMRs in the healthcare continuum, I thought it gave rise to an interesting thought experiment. Are EMRs mostly a tool to placate insurance companies? It’s worth considering. While Twine may or may not offer a solution, it’s hard to argue that existing EMRs “have empowered both physicians and patients in developing relationships that result in better healthcare outcomes.”

In the blog item, Storer argues that primary care practices largely use EMRs as a means of capturing data, and by doing so meeting insurance claims requirements. Though he offers no evidence to this effect, Storer suggests that DPC practices are dumping EMRs to focus better on patient care. There’s actually at least one direct-primary-care oriented EMR on the market (atlas.md, which is backed by a DPC practice in Wichita, KS), but that doesn’t prove the blogger wrong.

For Twine and its ilk, the question seems to be whether switching from EMRs to another care management model would actually improve the patient experience in and of itself. I’m sure that Twine (and others who consider themselves competitors) believe that it will.

As I see it, though, they’re talking around some key issues. no matter how user-friendly a platform is, No how laudable its goals are, I doubt that even a direct primary care practice unfettered by insurance requirements could seamlessly shift their practice to a platform such this. And no matter how good next-gen collaborative tools are — and I’m optimistic about them, as a category — the workflow issues which have alienated patients in the EMR age won’t go away entirely.

So while I’ll believe that DPC practices want to pitch their EMR, my guess is that the odds of their replacing it with an alternative platform are slim. Now, if collaborative care players catch practices when they’re being formed, that may be a different story. But for now my guess is that any practice that has an EMR in place is unlikely to dump it for the time being. The alternatives (including going back to paper charts) are unlikely to make sense.