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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.

E-Patient Update: The Joy Of Health Data Synchronization

Posted on October 7, 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.

Today, I realized that I’m a lucky girl. So lucky, in fact, that I get to have most of my health data accessible through one interface. No, I can’t access all of the data through a single interface — if that were true I’d be extraordinarily fortunate — but for day-to-day purposes I’m pretty close.

How does this happen, you ask? Well, actually it’s something fairly simple in principle, but powerful in action. I’ve fallen into a network.

I have been seen, now, by three physicians’ offices which are part of Privia Medical Group. Privia is a multi-specialty network of physicians who use the practice management and population tools provided by parent company Privia Health.

Because she’s part of the multi-specialty network, my primary care physician was able to refer me to two other specialists in the group with confidence and ease. But because she is part of a network of independent practices, rather than a group of employed physicians, I feel confident that she’s not unduly pressured to refer to these other providers. (I am definitely not a fan of staff model HMOs like Kaiser, which give you far too little choice of physicians and far too few means of recourse if you don’t like your provider.)

Just as importantly, at least to an e-patient geek like myself, I’ve learned that all Privia Medical Group specialists work with the same athenahealth portal. So when I log in to read the notes for one visit, I get to review the others as well, through a single sign-in.

Because members of Privia work with the same portal, I get the (sadly) unusual pleasure of looking at past and future appointments for multiple specialists as well as primary care on a single page.

Meanwhile, and this is of course critical, the provider I saw this morning had all the key details he needed about previous care, including an updated medication list, via a shared EMR. It always amazes me how hard it seems to be to give providers access to important details like this, but as readers know it’s still unusual independent offices share information fluidly.

While this is mostly good news story, it’s bit of a downer too, because it shouldn’t be such a treat to have your doctors share your information. Still, the fact remains that this is a high level of data sharing performance. The Privia set-up is a sure-as-shootin’ cure for my recent case of hyperportalotus, a nasty condition in which patients are beset with multiple incompatible portals by their providers.

Now, I still have to deal with two other portals (both instances of Epic MyChart) if I want to review my hospital care notes. But if I can be view all of my outpatient encounters with PCPs and specialists AND be reminded of routine care I might need (such as a flu shot), schedule and reschedule with my providers and pay any remaining bills I’m pretty darned happy.

Providers Often Choose Low-Tech Collection Solutions

Posted on October 6, 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.

As most providers know, it’s harder to collect money from the patient once they’ve walked out the door. This has always been an issue, but is particularly important today given that patients are being asked to bear an increasingly larger percentage of their healthcare bill.

In some cases, providers solve this problem by having their staff reach out directly via phone, rather than relying entirely on paper billing. Others address these issues with technology solutions such as offering payment options via a web portal. And of course, some providers do both.

But the question remains, which combination is most likely to boost collections efficiently without losing patients in the process? And it’s this question, which underlies all those other considerations, which a new study hopes to address. When reading the results, it’s good to bear in mind that the sponsor, BillingTree, is a payment technology firm and therefore has a bias, but the survey data was interesting nonetheless.

First, a look at providers’ collections challenges. Respondents told BillingTree that compliance and collecting payments once the patient has left the building were concerns, along with knowing the correct amount to bill after insurance and addressing the client’s ability to pay. Perhaps the biggest issues were a lack of payment channels – be they staffers, interactive voice response or website tech — and disputes over the amount billed.

According to BillingTree researchers, few respondents were using Web or automated phone payment collection technologies to bring in these missing dollars. While 93.9% accepted online and mail payments, and 86.7% said they accepted payments over the phone via a live agent, only 66.7% provided a web portal payment option, and just 6.7% offered the ability to pay via an interactive voice response system. Rather than add new technologies, respondents largely said that they intended to improve collections by adding staff members or outsourcing part of their collection operations.

On the other hand, technology plays a somewhat bigger part in providers’ future plans for collections. Over the next 12 months, 20% said they planned to begin accepting payments via a web portal, and 13.3% intend to add an IVR system to accept payments. Meanwhile, the 26.7% of providers who are planning to outsource some or all of their collections are likely to benefit indirectly from these technologies, which are common among payment outsourcers, BillingTree noted.

Among those providers that did offer phone or web-based payment options, one-fifth chose to add a convenience fee to the transaction. BillingTree researchers noted that given the low adoption of such technologies, and concerns about regulatory compliance, such fees might be unwise. Nonetheless, the data suggest that collection of such fees increase over time.

All this being said, the BillingTree study doesn’t look at perhaps the most critical technology issue providers are struggling to address. As a recent American Medical Association survey recently concluded, providers are quite interested in tools that link to their EMR and help them improve their billing and reimbursement processes.

Focusing on revenue cycle management issues at the front end of the process makes sense. After all, while patients are being forced to take on larger shares of their medical costs, insurers are still more reliable sources of income. So while it makes sense for providers to track down patients who leave without having paid their share of costs, focusing the bulk of their technology dollars on improving the claims process seems like a good idea.

E-Patient Update: A Bad Case Of Hyperportalotus

Posted on September 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.

Lately, the medical profession has seen an increasing incidence of a new condition tentatively identified as “hyperportalotus” — marked by symptoms of confusion, impatience, wasted time and existential dread. Unlike many newly-identified medical problems, the cause for this condition is well understood. Patient simply have too many portals being thrust at them.

As a patient with a few chronic illnesses, I see several specialists in addition to a primary care doctor. I’ve also been seen recently at a community hospital, as well as an urgent care center run by a different health system. I have access to at least seven portals, each, as you probably guessed, completely independent of each other.

Portals in play in my medical care include two instances of Epic’s MyChart, the Allscripts FollowMyHealth product and an athenahealth portal. (As an aside, I should say that I’ve found that I like athenahealth’s product the most, but that’s a story for another day.)

Because I am who I am – an e-patient dedicated to understanding and leveraging these tools – I’m fairly comfortable working with my providers on this basis. I simply check in with the portal run by a given practice within a few days of my visit, review reports and lab results and generally orient myself to the flow of information.

Too Much Information
So, if I can easily access and switch between various portals, what’s the big deal? After all, signing up for these portals is relatively simple, and while they differ in how they are organized, their interfaces are basically the same.

The problem is (drumroll…) that most patients aren’t like me. Many are overwhelmed by their contact with the medical system and feel reluctant to dig into more information between visits. Others may not feel confident that they understand the portals and shy away reflexively.

Take the case of my 70-something father. My dad is actually pretty computer-savvy, having worked in the technology business for many years. (His career goes all the way back to the days of punch cards.) But even he seems averse to signing up for MyChart, which is used by the integrated health system that provides all of his inpatient and outpatient care.

Admittedly, my father has less contact with doctors and hospitals than I do, so his need to review medical data might be less than mine. Nonetheless, it’s a shame that the mechanics of signing up for and using a portal are intimidating to both he and my mother.

A Common Portal
All this being said, the question is what we can do about it. I have a theory, and would love to know what you think of it.

What if we launched an open source-based central industry portal to which all other portals could publish basic information?  This structure would take proprietary vendors’ interest in controlling data out of the picture. Also, with the data being by its very nature limited (as consumers never get the whole tamale) it would answer objections by providers who feel that they’re giving away the store with the patient data.

Of course, I can raise immediate and powerful objections to my own proposal, the strongest of which is probably that we would have to agree on a single shared standard for publishing this data to the central megaportal. (And we all know how that usually works out.)

On the other hand, such approach has much to recommend it, including better care coordination and hopefully, stronger patient engagement with their health. Maybe I’m crazy, but I have a feeling that this just might work. Heck, maybe my father would bother looking at his own medical information if he didn’t have to develop hyperportalotus to do it.