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E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT

Posted on May 19, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Usually, particularly when I have complaints, I don’t name the providers or vendors who serve my healthcare needs, largely because I don’t want to let my personal gripes overshadow my analysis of a particular health IT issue.

That being said, I thought I’d veer from that rule today, as I wanted to share some details on how Kaiser Permanente, my new provider and health plan, supports consumers with health IT functions. Despite having started with Kaiser – in this case the DC metro division – less than a week ago, being an e-patient I’ve had my hands all over its Web – and mobile-based options for patients.

I’m not going to say the system is perfect by any means. There are some blind alleys on the web site, and some problems in integrating clinical information into consumer records, but so far their set-up largely seems thoughtful and well-managed.

Having allegedly spent $4 billion plus on its Epic rollout, it’s hard to imagine how Kaiser could have realized that big a return even several years later, but it seems that the healthcare giant is at least doing many of the right things.

Getting enrolled

My first contact with Kaiser, after signing up with Healthcare.gov, was a piece of snail-mail which provided us with our insurance cards and a summary of our particular coverage. The insurance cards included my health plan ID/medical record number.

To enroll on the core Kaiser site, kp.org, I had to supply the record number, my birth date and a few other basic pieces of information. I also downloaded the KP app, which offers a far-more-elegant interface to the same functions.

Medical appointments

Once logged in, it was easy to choose a primary care doctor and OB/GYN by searching the site and clicking a selection button. If you wished you could review physician profiles and educational history as well as testimonial quotes from patients about that doctor before you chose them.

Having chosen a doctor, booking an appointment with them online was easy.  As with Zocdoc.com, you entered a range of dates for a possible consult, then chose the slot that worked for you. And if you need to cancel one of those appointments, it’s easy to do so online.

Digital communication

I was glad to see that the Kaiser portal allows you to email your doctor directly, something which is less common than you might think. (My last primary care group wouldn’t even put their doctors on the phone.)

Not only that, everyone I’ve talked to at KP so far– three medical appointments, as I was playing catch-up — has stressed that the email function isn’t just for show. My new providers insisted that they do answer email messages, and that I shouldn’t hesitate to write if I have questions or concerns.

Another way KP leverages digital communications is the simple, but effective, device of texting me when my prescriptions are due for a refill. This may not sound like much, but convenience matters! (I can also check med reminders by logging in to a custom KP meds app.)

Data sharing

Given that everyone at Kaiser uses the same Epic EMR, clinicians are of course more aware of what their colleagues are doing than my past gaggle of disconnected specialists. They seem quite serious about reading this history before seeing me, something which past physicians haven’t always done, even if I was previously seen by someone else in their practice.

KP also uses Epic’s Care Everywhere function, which allows them to pull in a limited summary of care from other Epic-based providers. While Care Everywhere has limits, the providers are making use of what they can.

One small wrinkle was that prior to two of my visits, I filled out a questionnaire online and when asked to submit it to my electronic patient record, did so. Nonetheless, I was asked to fill out the same questionnaire again, on paper, when I saw a specialist.

Test results

KP seems to be set up appropriately to share standard test results. However, I’ve already had one test, a mammogram, and in doing so found out that their data sharing infrastructure isn’t quite complete.

After being scanned, I was told that I’d receive my results via snail-mail, in about two weeks. I’m glad that this was a routine screening, rather than a test to investigate something scary, as I would have been pretty upset with this news if I was worried.

My conclusions

I don’t want to romanticize Kaiser’s consumer HIT services. After all, looked at one way, KP is only doing what integrated health systems are supposed to do, and not without at least a few hitches.

Still, at least on first view, on the whole I’m pretty happy with how Kaiser’s interactive functions are deployed, as well the general attitude staff members seem to have about consumer use of HIT tools. Generally speaking, they seem to encourage it, and for someone like me that’s quite welcome.

As I see it, if providers outside of the Kaiser bubble were as married to a shared infrastructure as KP providers are, my care would be much improved. Let’s see if I still if I still feel that way after the new health plan smell has worn off!

Dogged By Privacy Concerns, Consumers Wonder If Using HIT Is Worthwhile

Posted on May 17, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I just came across a survey suggesting that while we in the health IT world see a world of possibilities in emerging technologies, consumers aren’t so sure. The researchers found that consumers question the value of many tech platforms popular with health execs, apparently because they don’t trust providers to keep their personal health data secure.

The study, which was conducted between September and December 2016, was done by technology research firm Black Book. To conduct the survey, Black Book reached out to 12,090 adult consumers across the United States.

The topline conclusion from the study was that 57 percent of consumers who had been exposed to HIT through physicians, hospitals or ancillary providers doubted its benefits. Their concerns extended not only to EHRs, but also to many commonly-deployed solutions such as patient portals and mobile apps. The survey also concluded that 70 percent of Americans distrusted HIT, up sharply from just 10 percent in 2014.

Black Book researchers tied consumers’ skepticism to their very substantial  privacy concerns. Survey data indicated that 87 percent of respondents weren’t willing to divulge all of their personal health data, even if it improved their care.

Some categories of health information were especially sensitive for consumers. Ninety-nine percent were worried about providers sharing their mental health data with anyone but payers, 90 percent didn’t want their prescription data shared and 81 percent didn’t want information on their chronic conditions shared.

And their data security worries go beyond clinical data. A full 93 percent responding said they were concerned about the security of their personal financial information, particularly as banking and credit card data are increasingly shared among providers.

As a result, at least some consumers said they weren’t disclosing all of their health information. Also, 69 percent of patients admitted that they were holding back information from their current primary care physicians because they doubted the PCPs knew enough about technology to protect patient data effectively.

One of the reason patients are so protective of their data is because many don’t understand health IT, the survey suggested. For example, Black Book found that 92 percent of nurse leaders in hospital under 200 beds said they had no time during the discharge process to improve patient tech literacy. (In contrast, only 55 percent of nurse leaders working in large hospitals had this complaint, one of the few bright spots in Black Book’s data.)

When it comes to tech training, medical practices aren’t much help either. A whopping 96 percent of patients said that physicians and staff didn’t do a good job of explaining how to use the patient portal. About 40 percent of patients tried to use their medical practice’s portal, but 83 percent said they had trouble using it when they were at home.

All that being said, consumers seemed to feel much differently about data they generate on their own. In fact, 91 percent of consumers with wearables reported that they’d like to see their physician practice’s medical record system store any health data they request. In fact, 91 percent of patients who feel that their apps and devices were important to improving their health were disappointed when providers wouldn’t store their personal data.

Could AI And Healthcare Chatbots Help Clinicians Communicate With Patients?

Posted on April 25, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

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

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

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

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

Scheduling and administration

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

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

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

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

Diagnosis and triage

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

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

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

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

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

E-Patient Update: Doctors Need To Lead Tech Charge

Posted on April 7, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Doctors, like any other group of people, vary in how comfortable they are with technology. Despite the fact that their job is more technology-focused than ever before, many clinicians use tech tools because they must.

As a result, they aren’t great role models when it comes to encouraging patients to engage with portals, try mobile apps or even pay their healthcare bills online. I too am frustrated when doctors can’t answer basic tech questions, despite my high comfort level with technology. I like to think that we’re on the same page, and I feel sort of alienated when my doctors don’t seem to care about the digital health advantage.

This needs to change. Given the extent to which technology permeates care delivery, physicians must become better at explaining how basic tech tools work, why they’re used and how they benefit patients.

Below, I’ve listed three tools which I consider to be critical to current medical practices, based on both my patient experiences and my ongoing research on health IT tools. To me, knowing something about each of them is unavoidable if doctors want to keep up with trends and improve patient care.

The top three tools I see as central to serving patients effectively are:

  • Patient portals: This is arguably the most important technical option doctors can share with patients. To get the most value out of portals, every doctor – especially in primary care – should be able to explain to patients why accessing their data can improve their health and lives.
  • Connected health: For a while, connected health/remote monitoring solutions were a high-end, expensive way to track patient health. But today, these options are everywhere and accessible virtually anyone. (My husband bought a connected glucose monitor for $10 a few weeks ago!) If nothing else, clinicians should be able to explain to patients how such devices can help tame chronic diseases and prevent hospitalizations.
  • Mobile apps: While few apps, if any, are universally trusted by doctors, there’s still plenty of them which can help patients log, measure and monitor important data, such as medication compliance or blood pressure levels. While they don’t need to understand how mobile apps work, they should know something of why patients can benefit from using them.

Of course, this list is brief, but it’s a decent place to start. After all, I’m not suggesting that physicians need to get a master’s in health IT to serve patients adequately; I’m just recommending that they study up and prepare to guide their patients in using helpful tools.

Ultimately, it’s not as important that clinicians use or even have a deep understanding of digital health tools, health bands, smartwatches, sensor-laden clothing or virtual reality. They don’t have to understand cybersecurity or know how to reboot a server. They just have to know how to help patients navigate the healthcare world as it is.

By this point, in fact, I’d argue that it’s irresponsible to avoid learning about technologies that can help patients manage their health. Bear in mind that even if they don’t act like it, even confident, experienced patients like me truly admire our doctors and take what they say seriously. So if I am enthusiastic about using tech tools to manage my health, but my doctor’s eyes glaze over when I talk about them, even I feel a bit discouraged. So why not learn enough to encourage me on my journey?

E-Patient Update: Give Us Patient Data Analytics

Posted on March 24, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The other day, I sat down with my husband to check out the features of his new connected glucose monitor. My husband, a Type 2 diabetic, had purchased the Accu-Chek Aviva Connect, which when synched with a computer, displays readings data on the web.

After synching up his results with his desktop via Bluetooth, he entered a web portal and boom! There was a two-week history of his readings, with data points organized by what times they were taken. As part of its dashboard, the portal also displayed the highest and lowest readings taken during the time period, as well as citing the average difference between high and low readings (the size of the delta).

By going over this data, we were able to learn a few things about his current disease management efforts. For example, we saw that virtually all of the highest readings were taken between 6PM and 9PM, which helped him identify some behaviors that he could change.

Of course, for the professionals reading this, none of these features are all that impressive. In fact, they’re practically kid’s stuff, though I imagine his endocrinologist will get at least some benefit from the charts.

But I’m here to tell you that as patient data management goes, this is off-the-charts cool. After all, neither of us has had a chance to track key health metrics and act on them, at least not without doing our own brute number crunching with a spreadsheet. As you can imagine, we greatly prefer this approach.

Unfortunately, few patients have access to any kind of analytics tools that put our health data in context. And without such tools most of us don’t get much benefit out of accessing the data. It’s time for things to change!

Upgrade the portal

One of the most common ways patients access their health data is via a provider portal. Most commonly, portals display the results of diagnostic tests, including lab tests and the text of imaging results.

Sharing this data is a step in the right direction, but it’s not likely to empower patients on its own. After all, even an experienced clinician would find it difficult to make sense of dozens (or in the case of chronically-ill patients like me, hundreds) of test results.  Even if the portal provided educational material on each test, it may be too much information for a patient to absorb.

On the other hand, patients could do a lot with their data if it was displayed in a patient-friendly manner. The possibilities for improving data display are manifold. They include:

  • Displaying tests relating to specific concern (such as thyroid levels) in sequence over time
  • Offer a chart comparing related data points, such as blood pressure levels and cardiac functioning or kidney functioning paired with blood glucose levels
  • Display only outlier test values, along with expected ranges, and link to an explanation of what these values might mean
  • Have the portal auto-generate a list of questions patients should ask their doctor, based on any issues suggested by test data

By provider standards, these displays might be fairly mundane. But speaking as a patient, I think they’d be very valuable. I am compulsive enough to check all of my health data and follow up with questions, but few patients are, and any tools which helped them decide what action to take would represent a big step forward.

It would be even more useful if patients could upload results from health bands or smartwatches and cross-reference that data with testing results. But for the short term, it would be enough to help patients understand the data already in the system.

Giving patients more power

At first, some providers might object to giving patients this much information, as odd as it may sound. I’ve actually run into situations where a practice won’t share test data with a patient until the doctor has “approved” the results, apparently because they don’t want patients to be frightened by adverse information.

But if we want to engage patients, providers have to give give patients more power. If nothing else, we need a better way to look at our data, and learn how we can respond effectively.

To be fair, few providers will have the resources in-house to add patient data analytics tools to portals. Their vendors will have to add upgrades to their portal software, and that’s not likely to happen overnight. After all, while the technical challenges involved are trivial, developers will need to decide exactly how they’re going to analyze the data and what search capabilities patients should have.

But there’s no excuse for letting this issue go, either. If providers want patients to engage in their healthcare process, helping them understand their health data is one of the most important steps they can take. Expecting patients to dive in and figure it out themselves is unlikely to work.

GAO: HHS Should Tighten Up Its Patient Data Access Efforts

Posted on March 23, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The Government Accountability Office has issued a new report arguing, essentially, that while its heart is in the right place, HHS isn’t doing enough to track the effectiveness of patient health data access efforts. The report names ONC as arguably the weakest link here, and calls on the HHS-based organization to track its outreach programs more efficiently.

As readers know, CMS has spent a vast sum of money (over $35 billion at this point) to support health IT adoption and health data access. And while these efforts have spilled over to some patients, it’s still an uphill battle getting the others to access their electronic health information, the GAO report says.

Moreover, even patients that are accessing data face some significant challenges, including the inability to aggregate their longitudinal health information from multiple sources into a single, accessible record, the agency notes. (In other words, patients crave interoperability and data integration too!)

Unfortunately, progress on this front continues to be slow. For example, after evaluating data from the 2015 Medicare EHR Program, GAO researchers found that few patients were taking a look at data made available by their participating provider. In fact, while 88 percent of the program’s hospitals gave patients access to data, only 15 percent of patients actually accessed the information which was available.  When professionals provided patients with data access, the number of patients accessing such data climbed to 30 percent, but that’s not as big a delta as it might seem, given that 87 percent of such providers offered patient data access.

Patient reluctance to dive in to their EHI may be in part due to the large number of differing portals offered by individual providers. With virtually every doctor and hospital offering their own portal version, all but the most sophisticated patients get overwhelemed. In addition to staying on top of the information stored in each portal, patients typically need to manage separate logins and passwords for each one, which can be awkward and time-consuming.

Also, the extent of data hospitals and providers offer varies widely, which may lead to patient confusion. The Medicare EHR Program requires that participants make certain information available – such as lab test results and current medications – but less than half of participating hospitals (46 percent) and just 54 percent of healthcare professionals routinely offered access to clinician notes.

The process for sharing out patient data is quite variable as well. For example, two hospitals interviewed by the GAO had a committee decide which data patients could access. Meanwhile, one EHR vendor who spoke with the agency said it makes almost all information available to patients routinely via its patient portal. Other providers take the middle road. In other words, patients have little chance to adopt a health data consumption routine.

Technical access problems and portal proliferation pose significant enough obstacles, but that’s not the worst part of the story. According to the GAO, the real problem here is that ONC – the point “man” on measuring the effectiveness of patient data access efforts – hasn’t been as clear as it could be.

The bottom line, for GAO, is that it’s time to figure out what enticements encourage patients to access their data and which don’t. Because the ONC hasn’t developed measures of effectiveness for such patient outreach efforts, parent agency HHS doesn’t have the information needed to tell whether outreach efforts are working, the watchdog agency said.

If ONC does improve its methods for measuring patient health data access, the benefits could extend beyond agency walls. After all, it wouldn’t hurt for doctors and hospitals to boost patient engagement, and getting patients hooked on their own data is step #1 in fostering engagement. So let’s hope the ONC cleans up its act!

E-Patient Update: A Missed Opportunity For Primary Care Collaboration

Posted on March 3, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Tell me if you’ve run into the following.

You call your primary care doctor to set an appointment, wading through the inevitable voice-response prompts and choosing the right number to reach a clerk. You wait on hold for a while – perhaps a LONG while – and finally get a clerk.

The clerk asks why you’re booking an appointment, and you name a problem. The clerk says she needs to consult a nurse about the problem before she books you, so you wait on hold while she calls the nurse. Of course, the nurse is too busy to answer her phone, so you leave her a voicemail message.

The next day she finally calls back and tells you a standard appointment will be fine. Yay.

This might sound like an incredibly twisty process, but this is exactly how it works at my PCP office. And the truth is that I’ve been run through a similar mill before by other primary care practices of this size.

In theory, many of these problems would go away if my PCP office simply took advantage of the scheduling tools its portal already offers. But for some reason its leaders don’t seem to value that function much; in fact, when it went offline for a while the practice didn’t seem to know.

But there are alternatives to this crazy workflow pattern that don’t require the re-invention of the lightbulb. In fact, all it would take is adding a few functions to the portal to make progress.

Gathering the threads

From what I can see, the key to streamlining this type of process is to gather these threads together. And it doesn’t take much imagination to picture how that would work.

What if my initial contact with the practice wasn’t via phone, but via more sophisticated interface than a calendaring app? This interface should ask patients what prompts their requested visit, and offer a pulldown menu providing a list of standard situations and conditions.

If a patient chooses a condition that might be hazardous, the system would automatically kick the request to a nurse, who can email or call the patient directly, possibly avoiding hit-or-miss phone tag. Or the practice could provide the nurse with a secure messaging client to use in connecting with clients on the go.  Using such an app, the nurse could even conference in the doctor as needed.

Meanwhile, if a patient wants to get a provider’s opinion on their condition – whether they should wait and see what happens, go to urgent care, make an appointment or hit the ED – the same interface could route the request to the provider on call. If the patient can be treated effectively with a basic appointment, the clinician routes the request to the front desk, with a request that the clerk schedule an appointment. The clerk reaches out to the patient, which means the patient (me!) doesn’t have to call in and wait for an age while the clerk handles other issues.

The same process would also work well for medication refill and referral requests, which my practice now handles in the same cumbersome, time-wasting manner. Not only that, automating such requests would leave an audit trail, which doesn’t exist at present.

Pursuing the obvious

What bugs me about all of this is that if I can imagine this, anyone in healthcare could — it’s a massive case of pursuing the obvious. Though I’m an HIT fan, and I follow the industry closely, I’m no programmer or engineer. I’m just somebody who wants to do my business effectively. Surely my PCP does too?

Of course, I know that just because an approach is possible, it doesn’t mean that it will be easy to implement. Not only that, only the largest and most prosperous practices have enough clout to demand that vendors develop such features. So it may not be as easy as it should be to put them in place.

Still, I see a crying need here, or perhaps one might call it an opportunity.  If we arm primary care doctors – who will play a steadily-growing role in next-gen systems – with better workflow options, every part of the system will benefit.

E-Patient Update: Hey Government, Train Patients Too!

Posted on February 10, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently I got a most interesting email from the ONC and A-list healthcare educator Columbia University. In the message, it offered me a free online course taught by Columbia’s Department of Biomedical Informatics, apparently paid for by ONC funding. (Unfortunately, they aren’t giving away free toasters to students, or I definitely would have signed up. No wait, I’m sorry, I did register, but I would have done it faster for the toaster.)

The course, which is named Health Informatics For Innovation, Value and Enrichment) or HI-FIVE, is designed to serve just about anyone in healthcare, including administrators, managers, physicians, nurses, social workers an care coordinators. Subjects covered by the course include all of the usual favorites, including healthcare data analytics, population health, care coordination and interoperability, value-based care and patient-centered care.

If I seem somewhat flippant, it’s just because the marketing material seemed a little…uh…breathlessly cheery and cute given the subject. I can certainly see the benefits of offering such a course at no cost, especially for those professionals (such as social workers) unlikely to be offered a broader look at health IT issues.

On the other hand, I’d argue that there’s another group which needs this kind of training more – and that’s consumers like myself. While I might be well-informed on these subjects, due to my geeky HIT obsession, my friends and family aren’t. And while most of the professionals served by the course will get at least some exposure to these topics on the job, my mother, my sister and my best girlfriend have essentially zero chance of finding consumer-friendly information on using health IT.

Go where the need is

As those who follow this column know, I’ve previously argued hard for hospitals and medical groups to offer patients training on health IT basics, particularly on how to take advantage of their portal. But given that my advice seems to be falling on deaf ears – imagine that! – it occurs to me that a government agency like ONC should step in and help. If closing important knowledge gaps is important to our industry, why not this particular gap. Hey, go where the need is greatest.

After all, as I’ve noted time and again, we do want patients to understand consumer health IT and how to reap its benefits, as this may help them improve their health. But if you want engagement, folks, people have to understand what you’re talking about and why it matters. As things stand, my sense is that few people outside the #healthit bubble have the faintest idea of what we’re talking about (and wouldn’t really want to know either).

What would a consumer-oriented ONC course cover? Well, I’m sure the authorities can figure that out, but I’m sure education on portal use, reading medical data, telemedicine, remote monitoring, mobile apps and wearables wouldn’t come amiss. Honestly, it almost doesn’t matter how much the course would cover – the key here would be to get people interested and comfortable.

The biggest problem I can see here is getting consumers to actually show up for these courses, which will probably seem threatening to some. It may not be easy to provoke their interest, particularly if they’re technophobic generally. But there’s plenty of consumer marketing techniques that course creators could use to get the job done, particularly if you’re giving your product away. (If all else fails, the toaster giveaway might work.)

If providers don’t feel equipped to educate patients, I hope that someone does, sometime soon, preferably a neutral body like ONC rather than a self-interested vendor. It’s more than time.

E-Patient Update:  Portal Confusion Undermines Patient Relationships

Posted on February 3, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I’m not surprised that some medical practice staffers and doctors seem uncomfortable with their EMR system and portal. After all, they’re not IT experts, and smaller practices might not even have any full-time IT staffers to help. That being said, if they hope to engage patients with their healthcare, they need to do better.

I’m here to argue that training staff and doctors to help patients with portal use is not only feasible, it’s important to customer service, care quality and ultimately a practice’s ability to manage populations. If you accept the notion that patients must engage with their health, you can’t leave their data access to chance. Everyone who works with patients must know the basics of portal access, or at least be able to direct the patient immediately to someone that can help.

Start with the front line

If I have problems with accessing a practice portal, the first person I’m likely to discuss it with is someone on the front lines, either via the phone or during a visit. But front office staffers seldom seem to know Thing One about the portal, including how to access it or even where to address a complaint if I have one.  But I think practices should do at least the following:

* Train at least one front-desk staffer on how to access the portal, what to do when common problems occur and how to use the portal’s key functions. Training just one champion is probably enough for smaller practices.

* Create a notebook in which such staffers log patient complaints (and solutions if they have one). This will help the practice respond and address any technical issues that arise, as well making sure they don’t lose track of any progress they’ve made.

* Every front desk staffer (and every doctor) should have a paper handout at hand which educates patients on key portal functions, as well as the name of the champion described above.  Also, the practice should provide the same information on a page of their site, allowing a staffer to simply email the link to patients if the patient is calling in with questions.

* All doctors should know about the champion(s), and be ready to offer their name and number to patients who express concerns about EMR/portal access. They should also keep the handout in their office and share it when needed.

Honestly, I don’t regard any of these steps as a big deal. In fact, I see them as little more than common sense. But I haven’t encountered a single community practice that does any of them, or even pursued their own strategies for educating patients on their portal.

Maximizing your investment

For those reading this who think these steps – or your own version – are too much trouble, think again. There’s plenty of reason to follow through on patient portal support.  After all, if nothing else, you’ve probably spent a ton of money on your EMR and portal, so why not maximize the value it offers?

Also, you don’t want to frustrate patients needlessly when a little bit of preparation and education could make such a difference. Maybe this wasn’t the case even a few years ago, but today, I’d submit, helping patients access their data is nothing more than good customer service. Given the competition every provider faces, why would you ignore a clear opportunity to foster patient loyalty?

Bear in mind that a little information goes a long way with patients like me. You don’t have to write a book to satify me – you just have to help me succeed. Just tell me what to do and I’ll be happy. So don’t miss a chance to win me over!

The Digital Health Biography: There’s A New Record In Town

Posted on January 18, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Few of us would argue that using EMRs is not a soul-sucking ordeal for many clinicians. But is there any alternative in sight? Maybe so, according to Robert Graboyes and Dr. Darcy Nikol Bryan, who are touting a new model they’ve named a “digital health biography.”

In a new article published in Real Clear Health, Graboyes, an economist who writes on technology, and Bryan, an OB/GYN, argue that DHBs will be no less than “an essential component of 21st century healthcare.” They then go on to describe the DHB, which has several intriguing features.

Since y’all know what doctors dislike (hate?) about EMRs, I probably don’t need to list the details the pair shares on why they generate such strong feelings. But as they rightly note, EMRs may take away from patient-physician communication, may be unattractively designed and often disrupt physician workflow.

Not only that, they remind us that third parties like insurance companies and healthcare administrators seem to get far more benefits from EMR content than clinicians do. Over time, data analytics efforts may identify factors that improve care, which eventually benefits clinicians, but on a transactional level it’s hard to dispute that many physicians get nothing but aggravation from their systems.

So what makes the DHB model different? Here’s how the authors lay it out:

* Patients own the DHB and data it contains
* Each patient should have only one DHB
* Patient DHBs should incorporate data from all providers, including PCPs, specialists, nurse practitioners, EDs, pharmacists and therapists
* The DHB should incorporate data from wearable telemetry devices like FitBits, insulin pumps and heart monitors
* The DHB should include data entered by patients, including family history, recollections of childhood illness, fears and feelings
* DHB data entry should use natural language rather than structured queries whenever possible
* The DHB should leverage machine learning to extract and organize output specific to specific providers or the patient
* In the DHB model, input and output software are separated into different categories, with vendors competing for both ends separately on functionality and aesthetics
* Common protocols should minimize the difficulty and cost of shifting from one input or output vendor to the other
* The government should not mandate or subsidize any specific vendors or data requirements
* DHB usage should be voluntary, forcing systems to keep proving their worth or risk being dumpted
* Clinical applications shouldn’t be subservient to reimbursement considerations

To summarize, the DHB model calls for a single, patient-controlled, universal record incorporating all available patient health data, including both provider and patient inputs. It differ significantly from existing EMR models in some ways, particularly if it separated data input from output and cut vendors out of the database business.

As described, this model would eliminate the need for separate institutions to own and maintain their own EMRs, which would of course stand existing health IT structures completely on their head. Instead of dumping information into systems owned by providers, the patient would own and control the DHB, perhaps on a server maintained by an independent intermediary.

Unfortunately, it’s hard to imagine a scenario in which providers would be willing to give up control to this great an extent, even if this model was more effective. Still, the article makes some provocative suggestions which are worth discussing. Do you think this approach is viable?