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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?

E-Patient Update:  The Virtues, And Failings, Of Doctor-Patient Email

Posted on January 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.

Lately, I’ve been thinking about my experiences with emailing my providers. I’m certainly grateful that this channel is now available, as I’ve used it to manage some important health problems. That being said, there’s also some new challenges to address when reaching out to your clinician.

Some of the important benefits I’ve gotten from emailing my doctors include:

  • Cutting out middlemen: If I want to communicate with my PCP outside of a medical visit, I have to call, wait on hold for the receptionist to answer, then wait for a nurse to find out what I want, who might get back to me if she can track down the doctor. Email communication bypasses the whole bureaucracy, which I love.
  • Quick solutions: If a doctor is at all wired, she may be able to shoot quick responses to basic questions (“Do I need to schedule a follow-up?”) far more quickly than if I’m at the end of a voice-message queue. Of course, the more email she has the longer it may take to respond, but responding to my email is still quicker than a phone conversation in most cases.
  • Messaging during off hours: If I want to communicate with a doctor, but the issue isn’t critical, I can write to them anytime I’d like – even while I’m eating a 3AM snack! I don’t have to wait until office hours, when I’m likely to be juggling other workaday issue and forget to reach out.

But there are also disadvantages to emailing my doctors, and they’re significant:

  • Problems with communication: A few times, I’ve been in situations where emailing doctors created confusion rather than clarifying things. For example, one specialist sent me an email suggesting an appointment slot, and though I never confirmed, he still considered the slot booked (and charged me for missing it)! That was a relatively petty problem, but if there was a similar level of misunderstanding about a clinical matter it could have been much worse.
  • Unclear expectations: If you call a medical practice’s service overnight for help with a serious problem, you can be pretty sure the on-call doc will call back. But when you email a doctor, it’s not clear what you can expect. There’s no formal rule – or even best practices guidelines, as far as I know – governing how quickly doctors should answer emails, what issues they’re willing to tackle via this medium or how they should handle email responses when they’re on vacation or ill (ask a colleague or nurse to monitor their inbox?)
  • Lack of context: In most cases, the email messages I’ve gotten from doctors resemble text messages rather than letters. Sometimes that’s enough, but in other cases I wish I could get more context on, say, why they’re recommending a med or suggesting I get screened at an emergency department.

Without a doubt, being able to email doctors is a good thing. However, I think it will work better for both sides if doctors have tools that help them manage multichannel conversations with patients.

Specifically, I believe doctors need access to a secure messaging portal, one which offers not only a unified inbox but also tools for prioritizing messages, perhaps using AI to identify urgent issues, and automates routine tasks. Ideally, it would identify patients by their name or email address, and pop up a patient status summary for those with urgent concerns — and yes, this would probably require EMR integration, but why not? (Feel free to write me at anne@ziegerhealthcare.com if something like this already exists!)

The last thing we need is for patient emails to become one more cause of physician burnout. So let’s give doctors the tools they need to manage the messaging process effectively and stay connected with patients who need them most. In fact, what if we made the messaging so effective that it saved them time over a voicemail message?

E-Patient Update:  When Your Tech Fails, Own It!

Posted on December 30, 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.

I am reasonably comfortable with my primary care practice which, though not exactly chi-chi – no latte machine in the lobby! — does a reasonably good job with the basics of scheduling, payment, referrals and the like.  And I also like that my PCP is part of a multispecialty group linked together by an athenahealth EMR and portal, which makes it easier to coordinate my care.

But recently, I’ve run into some technical problems with the practice portal, repeatedly and inconveniently. And rather than take action, apologize or even acknowledge the problem on an executive level, the group appears to be doing nothing whatsoever to address the issue.

The issue I’m having is that while the portal is supposed to let you schedule appointments online, my last two didn’t show up in the group’s live schedule. This may not sound like a big deal, but it is. One of the appointments was to see a neurologist for help with blinding migraines, and trying to attend the non-existent meeting was a nightmare.

Because I needed my neurologist, I scraped myself out of bed, put on an eye mask to avoid extra light exposure – migraine makes you terribly light-sensitive – and had my husband guide me to the car. But when I walked into the lobby (peeking out from under the mask to avoid crashing into things) I was told that they had nothing for me on the schedule.

Almost crying at this point, and with migraine-induced tears streaming down my cheeks, I begged them to squeeze me in, but they refused. To add insult to injury, they all but told me that it must have been my fault that the appointment booking didn’t take. There was no “I’m sorry this happened” whatsoever, nor any suggestion that their technology might be glitchy. If I hadn’t been so sick I might have gotten into a screaming match with the supercilious receptionist, but given my condition I just slinked away and went back to bed.

I’ve since learned, from a much nicer clerk at the affiliated primary care practice, that the group has been getting scores of calls from similarly aggrieved patients whose time had been wasted – and health needs unmet. “Tell the doctor, so she can tell the practice management committee,” she told me. “This is happening all the time.”

Of course, because I write about health IT, I realize that practice leaders may be struggling with issues that defy an easy fix, but I’m still disappointed with their failure to respond publicly. There are many steps they could have taken, including:

* Putting a warning on their practice website, and (if possible) the portal that the scheduling function has issues and to double-check that their appointment registered
* Disabling the scheduling function entirely until they’re reasonably certain it works
* Putting a sign in on the practice’s front desk alerting patients about the problem
* Updating the practice’s “hold” message with an advisory

And that’s just what came to mind immediately. They could do postcards, email messages, letters, robocalls…I don’t care if they drive around town with a guy who shouts the message into a megaphone. I just want expect them to take responsibility and treat my time and health with respect. Sure, tech will go south, but if it does, own it! There’s no excuse for ignoring problems like these.

E-Patient Update: Patient-Doctor Communication Still Needs an Update

Posted on December 2, 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 few weeks ago, I called my PCP’s after-hours line to address an urgent medical concern. The staff at the answering service took my name, reached out to the doctor on call and when he was ready, connected him to me.

While this procedure was entirely standard, as always I found it a bit offputting, as to me it implies that I can’t be trusted to use the doctor’s cell phone number with some discretion. Don’t get me wrong, part of me understands why the doctors in this practice preferred to preserve their privacy and select when they want to speak to patients. On the other hand, however, it makes me uneasy, as I already have a very superficial relationship with my PCP and this approach doesn’t help.

While this is very much an old-school problem, to me it points to a larger one which has largely gone unnoticed as we plunge forward with the evolution of health IT. In theory, we are living in a far more connected world, one which puts not only family and friends but the professionals we work with on far more of a one-to-one basis with us. In practice, however, I continue to feel that patient-doctor communication has benefited from this far less than one might think.

I know, you’re going to point out to me how many doctors are using portals to email with patients these days, and how some even text back and forth with us. I’ve certainly been lucky enough to benefit from the consideration of providers who have reached out via these channels to solve urgent problems. And I know some health organizations — such as Kaiser Permanente — have promoted a culture in which doctors and patients communicate frequently via its portal.

The thing is, I think Kaiser’s experience is the exception that proves the rule. Yes, my doctors have indeed communicated with me directly via portals or cell. But the email and text messages I’ve gotten from them are typically brief, almost pointillistic, or if longer and more detailed, typically written days or even weeks after the original request on my end. In other words, these communications aren’t a big improvement over what they could accomplish with an old-fashioned phone call – other than being asynchronous communication that doesn’t require we hook up in real-time.

In saying this, I’m not faulting the clinicians themselves. Nobody can communicate with everyone all the time, particularly doctors with a large caseload. And I’m certainly not suggesting that I expect them to be Facebook buddies with me and chat about the weather. But it is worth looking at the way in which these communication technologies have seemingly failed to enrich the communication between patient and doctor in many cases.

Until we develop a communication channel for patients and doctors which offers more of the benefits of real-time communication — while helping doctors manage their time as they see fit — I think much of the potential of physician-patient communication by Internet will be wasted. I’m not sure what the solution is, but I do hope we find one.

Portals May Not Reduce Calls To Medical Practices

Posted on November 16, 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.

Initially, patient portals were rolled out to give patients access to their core medical information, with the hope that a more educated patient would be more likely to take care of their health. Over time, features like appointment setting and the ability to direct-email providers were added, with some backers predicting that they would make practices more efficient. And since providers began rolling out nifty new interactive portals, anecdotes have piled up suggesting that they are delivering the goods.

However, a new study suggests that this might not be the case — or at least not always. The researchers behind the study, published in the Journal of the American Board of Family Medicine, had predicted that when patients got access to a full-featured portal, clinic staffers’ workload would be cut. But they did not achieve the results they had expected.

The researchers, who were from the Oregon Health & Science University in Portland, compared portal adoption rates and the number of telephone calls received at four clinics affiliated with a university hospital between February and June 2014.

They found that despite growing adoption rates of the portal at all four clinics, call volumes actually increased at two of the clinics, which included a commercial, community-based health center and a university-based health center. Meanwhile, call volume stayed level at the two other clinics, a rural health center and a federally-qualified health center. In other words, in no case did the volume of phone calls fall.

The researchers attempted to explain the results by noting that it might take a longer time than the study embraced for the clinics to see portals reduce their workload. Also, they suggested that while the portal didn’t seem to reduce calls, it might be offering less-concrete benefits such as increased patient satisfaction.

What’s more, they said, the study results might have been impacted by the fact that all four clinics were implementing a patient centered medical home model. They seemed to think that PCMH requirements for care coordination and quality improvement initiatives for chronic illness, routine screenings and vaccinations might have increased the complexity of the patients’ needs and encouraged them to phone in for help.

As I have noted previously, patients seldom see your portal the way you do. In that previous article, I described my largely positive — but still somewhat vexing – experience using the Epic MyChart portal as a patient. In that case, while I could access all of the data held within the health system behind the EMR pretty easily, getting the health system employees to integrate outside data was a hassle and a half.

In the case described in the study, it sounds like the portal may not have been designed with patient workflow in mind. With the practices rolling out a patient-centered medical home model, the portal would have to support patients in activities that went well beyond standard appointment setting and even email exchanges with clinicians. And presumably, it didn’t.

Bottom line, I think it’s good that this research has led to questions about whether portals actually make make medical practices more efficient. While there is plenty of anecdotal evidence suggesting that they do — so much that investing in portals still makes sense — it’s good to see questions about their benefits looked at with some rigor.