Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

HealthTap Offerings Track the Evolution of Health Care

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

August 15, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Hospital CIOs Cutting Back on Non-Essential Projects

Generally speaking, cutting back on IT projects and spending is a tricky thing. In some cases spending can be postponed, but other times, slicing a budget can have serious consequences.

One area  where cutting budgets can cause major problems is in preparing to roll out EMRs, especially cuts to training, which can lead to problems with rollouts, resentment, medical mistakes, system downtime due to mistakes and more.  Also, skimping on training can lead to a domino effect which results in the exit of CEOs and other senior leaders, which has happened several times (that we know of) over the past couple of years.

That being said, sometimes budgetary constraints force CIOs to make cuts anyway, reports FierceHealthIT Increasingly projects other than EMRs are falling in priority.

A recent survey of hospital technology leaders representing 650 hospitals nationwide published by HIMSS underscores this trend. Respondents told HIMSS said that despite increases in IT budgets, they still struggled to complete IT projects due to financial limitations. In fact, 25 percent said that financial survival was their top priority.

What that comes down to, it seems, is that promising initiatives fall by the roadside if they don’t contribute to EMR success.  For example, providers are stepping back from HIE participation because they feel they can’t afford to be involved, according to a HIMSS Analytics survey published last fall.

Instead, hospitals are taking steps to enhance and build on their EMR investment. For example, as FierceHealthIT notes, Partners HealthCare recently chose to pull together all of its EMR efforts under a single vendor.  In the past, Partners had used a combo of homegrown systems and vendor products, but IT leaders there  felt that this arrangement was too expensive to continue, according to Becker’s Hospital Review.

This laser focus on EMRs may be necessary at present, as the EMR is arguably the most mission-critical software hospitals have in place at the  moment. The question, as I see it, is whether this will cripple hospitals in the future. Eventually, I’d argue, mobile health will become a priority for hospitals and medical practices, as will some form of  HIE participation, just to name the first two technologies that come to mind. In three to five years, if they don’t fund initiatives in these areas, hospitals may look  up and find that they’re hopelessly behind .

July 10, 2014 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 @annezieger on Twitter.

Health Datapalooza 2014 Recap

The Health Datapalooza conference is ripe with opportunities to inspire and be inspired.  At any given session or lunch, the developer of an emerging app is seated at your left, and the winner of some other developer challenge a few years ago is on your right.  The vibe is a bit frenetic, in a good way.

At this conference, data geeks get right down to the business of discussing controversial and innovative healthcare data issues.  Nothing is watered down.  Even the Director of NIH Francis Collins, whom everyone wanted to hear play his guitar and sing, charged right in with data-rich graphs and statistics.  Jeremy Hunt of the UK offered sobering yet transparent error figures, encouraging the use of data to learn from and improve upon our safety practices at the point of care.  Keynotes from Jonathan Bush and Todd Park alleviated any need for caffeine, even though there was plenty on hand.  Countless application developers told truly compelling stories of their solutions.  Kathleen Sebelius challenged us to reconsider “the way we’ve always done it”.

What’s not to love?

I had hoped we would dive deeper into interoperability issues such as consistent data transport and payload standards.  Or, how a sensitive dependence on initial conditions such as protocol specifications, as in chaos theory, can lead to unexpected behaviors in pairwise HISP (Direct Exchange service provider) interoperability, seemingly at random.  Our data needs to be free to move about the care continuum, in order to be the most useful to us.  Gamification was suggested as a way to help patients adhere to medications.  Perhaps it could also encourage Healthcare IT companies to better adhere to specifications?

Silo was another buzzword that was used a lot last week.  That is to say, it’s a buzzword you don’t want to be associated with.  It was reassuring that we’ve set expectations properly around interoperability.  Fortunately, silos are going the way of the beeper and the booth babe.

There were some well-received promises of intense BlueButton promotion in the fall by Dr. Oz and several others.  I was also really encouraged to see the BlueButton Toolkit site preview on Sunday.  Look for more information about this when it goes live, and be sure to send Adam Dole your suggestions.  Great work, Adam!

Maybe next year at Health Datapalooza, we’ll talk about structuring the data collected by wearable devices, since we certainly heard this year about how integral to wellness quantified self is expected to be.  Quantified self and interoperability might even be considered as separate award categories in the Code-A-Palooza contest next year.  This could lead to more diversity and creativity in developers’ solutions, while helping to spur patient engagement and data transfer.

Countless examples of knowledge gleaned from large datasets, that could be used to make better medical decisions, were cited.  But this information hasn’t yet been integrated into day to day clinical workflow in a way that’s helpful to individual patients.  There’s no single source of individualized, analytics-enabled tools for patients to guide medical decision-making today.  But there will be!

June 9, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that's part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

Digital Therapeutics

Here’s a new term for you to consider: digital therapeutics. I guess I could add it to the list I polled about earlier: Digital Health, Connected Health, Wireless Health, Mobile Health, and Telehealth. By the way, the poll results are showing a mix basket when it comes to using these terms. Digital Health leads the way with mobile health following pretty closely behind and connected health with quite a few votes.

I don’t think adding digital therapeutics to the ring helps to clear up the confusion of terms, but I think it can open us open to a new way of thinking when it comes to how we use digital in healthcare. I’ve long loved the idea of prescribing an app and digital therapeutics is along those same lines. Can we prescribe a digital therapy that will help improve a patient?

Since we’re throwing out new terms that stretch our thinking, how about the ideas of digital chemistry and digital biology. I like these because they suggest a rigor in their study and understanding like you might see in chemistry and biology. I think it’s fair to say that the very best healthcare IT companies are going to be digging into the digital chemistry and digital biology world.

Once you start digging into these areas though, you better be ready for the FDA regulation that comes with therapeutics. I’ve written quite a bit about EHR and FDA regulation and this is why I don’t think EHR vendors will be digging into this type of digital therapeutics. Instead, I think the EHR will stick to being the database of healthcare.

In a recent video interview I did with Alan Portela, he made a really good point about the transition to really smart mobile health technologies that start to suggest treatment (some might call that a shift to digital therapeutics). The problem with many mobile health technologies that have avoided FDA clearance is that they won’t be able to do digital therapeutics. It will take a company that’s FDA cleared and understands that process to put these type of digital “treatments” into place.

I’m excited about the potential for digital therapeutics (or whatever word you prefer). This will change the way we look at healthcare and that will be a very good thing.

May 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Will Telemedicine Really Lower Costs?

I was talking with the mobile health lead at one of the large telcom providers recently and we had a good discussion about telemedicine and its possible impact for good or bad on healthcare. She asked a really good question, “Will telemedicine lower the cost of healthcare or just add new touch points?

The translation to that question is whether telemedicine will replace other healthcare costs or if it will just create new healthcare costs that never existed before. I should say that her feeling was that telemedicine would end up lowering costs, but the question is well worth asking. In fact, even if the answer is that telemedicine will lower healthcare costs, there are many on the payer side of the equation that aren’t as confident.

The reality is that a telemedicine visit likely could raise costs. The idea of having to uproot yourself, go to the doctors office, wait in the waiting room, wait in the exam room, etc is a really big deterrent that stops many of us from going to the doctors. The idea that I could click on a link and see a doctor from the comfort of my own home with no wait times (or at least I’m waiting at home where I can get other things done) will definitely cause us to see the doctor more often.

This means that the real question isn’t whether telemedicine will increase the number of visits to the doctor (and more visits equals more costs). Let’s assume that we do see the doctor more often in a telemedicine enabled world. This then begs the question of whether these extra visits will reduce the long term costs of healthcare.

Using our assumptions above, it suggests that we’ll visit the doctor earlier under telemedicine than we would today. Could these early visits catch a disease earlier? Could these early visits avoid a hospitalization or other expensive healthcare cost? Could early treatment of an issue prevent someone from having a visit (or dozens of visits) later? Looking at it from a different angle, can telemedicine make a doctor more efficient?

This impact won’t likely happen immediately, but is the long term hope of what telemedicine can become and how it could lower healthcare costs. I personally lean towards telemedicine being able to realize these goals. Although, we won’t know until we figure out the way to reimburse a doctor for a telemedicine visit. Not to mention overcoming the physician licensing issues with telemedicine. Each of those will happen though and then we’ll really know if telemedicine lowers the costs of healthcare or not.

May 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Digital Health, Connected Health, Wireless Health, Mobile Health, Telehealth – You Choose

Neil Versel posted a great poll asking people which term they prefer. You can vote on it below:

I usually don’t dig into the terminology and branding side of things. At the end of the day, for me it’s all about making sure that we understand each other. If you call something digital health or connected health or mobile health, they’re all the same genre of item. To be honest, I mostly ignore all of those words and want to know what the application actually does.

However, Neil brought up a good point in his post about the lack of consensus in his poll. Here’s his summary of the poll results:

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

Consensus in healthcare is really hard. I’m reminded of what someone at the Dell Healthcare Think Tank event I participated in said, “Healthcare is second only to florists when it comes to market fragmentation.” It’s like steering a ship with hundreds of rudders all pointing different directions. Certainly not an easy task and not something I see changing soon.

May 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

NFL EMR and Patient Generated Data


We wrote previously about the NFL using eCW, but this tweet seemed appropriate on the day of the super bowl. It was interesting to think that they have multiple video angles available of the injury. I wonder how/if that changes the assessment of the injury by the doctor.


This is a great image and does show the partial disconnect between those using smart devices to track themselves and the sick patients who could really benefit from them. Word on the street is that the latest iOS8 from Apple will have a bunch of health and fitness tracking built in along with a new app called Healthbook. I’ve been waiting for the smartphone to basically do what all these other external tracking devices are doing. If Apple hops in, then we’ll see that happen.

February 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Epic EMR Training, Glucometer Workflow, New Media Meetup & MU Success


I think this is true for all EMR software, but particularly so for Epic. It’s always amazing how many skimp on EMR training and then pay the price for it later.


It’s a little hard to see, but illustrates the challenge associated with connecting these external data devices. It’s going to take a while for this to be commonplace and normal. I do find it interesting that they’re using Direct and the hardest interface to build (sending info to the EHR) is “Out of Pilot Scope.” I guess they don’t want to take on the hard stuff in the pilot.

These next 2 tweets are a little self serving since they point to posts on my EMR and HIPAA site. If you’re not subscribed to that site, you should go and do that now. Plus, one of these tweets is about a party at HIMSS, so I don’t imagine I’ll get any complaints there.


I hope to see many of you at HIMSS 2014!


I appreciate Dr. Webster recognizing this as a good one. While I’m biased, I think it’s a really important topic that needs more discussion. Although, I’m pretty sure it won’t be getting me an invite to any ONC dinner parties.

January 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

My #BlueButton Patient Journey – Laying the Groundwork

After taking the Blue Button Pledge, my next step is to get proactive with my medical records. As I may have mentioned in a previous post, I currently see four different doctors throughout the year. Three of those offer a patient portal. Two of them are in the same practice, and therefore use the same portal. Confused yet?

I think the key to being an engaged patient is to first make sure I can log in to each of these portals. I create bookmarks for them as well. I also make sure I know how to navigate through them and that all of my information is correct and up to date. I take care of the first two items by either looking back at papers given to me during my last office visit, or calling my PCP’s office to ask for a pin code.

Once I’ve looked through my information in each portal (powered by Cerner and athenahealth, respectively), I decide to go even further by messaging my PCP to let her know how my visit to a specialist went. If I don’t let her know now, I might forget many of the details when I see her again towards the end of the year. While I’m in there, I decide to look at my past bills to see why I’m still getting one for a balance I’m pretty sure I paid at my last office visit.

bluebuttondownload

Once those details are seen to, I decide to check out the portal used by two of my other doctors because I seem to remember seeing a Blue Button icon on one of the screens during my last log in. Sure enough, there is a link to “View, download or transmit health data.” Clicking this link takes me to a screen where I can “Support the Blue Button® initiative by downloading your health data and storing it in your personal records.”

I hit download and save them on my computer, but then I’m left wondering, “Now what?” I suppose uploading them to a thumb drive and taking them to whatever provider I see next might be helpful. But I have the sneaking suspicion they’d still prefer paper. Since my PCP’s portal doesn’t offer a Blue Button link to download my data, I decide to message my PCP again to let her know I’d like to see this offered. I wonder if she’ll appreciate the comment, and if she’s gotten the request from other patients.

I feel like my next step should be uploading my health data into some kind of personal health record, but which one? Where do I even start when it comes to selecting something like that? Honestly, the data entry involved with PHRs is off putting to me, which is probably why I haven’t created one up to this point.

What has worked for you and your family? Providers, are there PHRs you find easier to work with (assuming you interact with them at all?) I’d appreciate any reader suggestions and advice you’d care to give via the comments below.

January 16, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Consumers Are Ready For Wearable Tech

Though they’re pretty, interesting and fun, I’ve never taken wearable devices that seriously as a force that could have impact on healthcare delivery in the here and now.  Well, it seems that I was wrong.  While it’s not certain that the health system can afford these devices — they don’t exactly come in at an easy consumer price point — it seems consumers are ready to use them if given the chance.

According to a new study by Accenture, more than half of consumers “are interested in buying wearable technologies such as fitness monitors for tracking physical activity in managing their personal health,” according to a report in Health IT Outcomes.

According to Accenture, consumers were primarily interested in devices like smart watches and wearable smart glasses such as Google Glass, even though these devices are not yet available commercially.  Consumers were also very interested in phablets, an emerging device category combining smart phone and tablet PC functions.

I can’t help think that this is a very positive trend.  For one thing, consumer wearables can be an important gateway to remote patient monitoring, something that’s less likely with devices that are used and put aside, like wired glucose monitors, pulse oximeters and blood pressure cuffs.

What’s more, wearables can fit into a healthcare ecosystem in which devices talk to one another and other wireless systems (such as their desktop, laptop or smart phone), whereas the other smart devices I’ve mentioned have less flexibility in that arena.

So, who pays for the wearables?  At least at first, it will probably make more sense for providers to invest in these devices and use them to conduct tests of remote patient monitoring and its impact on care.

But as consumers pick up the wearables themselves, providers might want to focus on building a network which seamlessly integrate these devices, as it seems almost a given that consumers will buy them when they’re available and affordable.  It will take years to get that right, so now it’s probably time to start. Get prepared for the Internet of everything!

January 15, 2014 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 @annezieger on Twitter.