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In What Seems Like An Effort To Make Nice, eClinicalWorks Joins OpenNotes Initiative

Posted on October 12, 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.

eClinicalWorks has decided to try something new. The health IT vendor has announced that it will support the OpenNotes project, an initiative in which doctors share their notes with patients.

As most readers will know, it recently came to light that eClinicalWorks had gotten itself into some very hot water with the feds. eCW was forced to pay a $155 million settlement when the U.S. Department of Justice concluded that it had faked compliance with EMR certification standards.

Now, perhaps in an effort to make nice, eCW is making it possible for its customers to share visit notes using its patient portal. Actually, to be precise, the patient portal already had the ability to offer visit summaries to patients, but OpenNotes capabilities enhance these summaries with additional information.

OpenNotes, for its part, got its start in 2010, when Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center decided to study the effects of letting patients read their medical notes via a portal.

The study, the results of which were published in the Annals of Internal Medicine in 2012, concluded that patients approved of note-sharing wholeheartedly, felt more in control of their care and had an easier time with medication adherence. Also, while some doctors reported changing documentation during this process, the study also found that doctors saw no significant changes in workload.

Perhaps most telling, at the end of the process 99% of patients wanted OpenNotes to continue, and none of the participating doctors opted out. A movement had been launched.

Since then, a long list of organizations has come on board to drive implementation of open notes, including Kaiser Permanente Northwest, Providence Health System, Salem Health and Oregon Health and Science University. This year, OpenNotes announced that 16 million Americans now had access to their medical notes online.

Back in 2012, I asked readers whether OpenNotes would eventually influence EMR design. Today, I would suggest that the answer is both “yes” and “no.”

On the one hand, I have little doubt that the project helped to advance the notion that patients should have on-demand access to their healthcare information, and moreover, to use it in managing their care. While some doubted this approach would work, OpenNotes can now be said to have sold the idea that health data transparency is a good idea. While the initiative had its doubters at its outset, today patient record access is far better accepted.

On the other hand, eClinicalWorks is the first EMR vendor I’m aware of to explicitly announce its support for OpenNotes. While it’s hard to tell what this means, my guess is that its competitors don’t see a need to take a position on the matter. While vendors are certainly being forced to take patient-facing data access into account, we clearly have a long way to go.

A Look At Share Everywhere, Epic’s Patient Data Sharing Tool

Posted on September 28, 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, it looks like Epic has begun to try and demonstrate that it’s not selling a walled garden. Honestly, I doubt it will manage to convince me, but I’m trying to keep an open mind on the matter. I do have to admit that it’s made some steps forward.

One example of this trend is the launch of App Orchard, a program allowing medical practices and hospitals to build customized apps on its platform. App Orchard also supports independent mobile app developers that target providers and patients.

Marking a break from Epic’s past practices, the new program lets developers use a FHIR-based API to access and Epic development sandbox. (Previously, Epic wouldn’t give mobile app developers permission to connect to its EMR unless a customer requested permission on its behalf.) We’ll have to keep an eye on the contracts they require developers to sign to see if they’re really opening up Epic or not.

But enough about App Orchard. The latest news from Epic is its launch of Share Everywhere, a new tool which will give patients the ability to grant access to their health data to any provider with Internet access. The provider in question doesn’t even have to have an EHR in place. Share Everywhere will be distributed to Epic customers at no cost in the November update of its MyChart portal.

Share Everywhere builds on its Care Everywhere tool, which gives providers the ability to share data with other healthcare organizations. Epic, which launched Care Everywhere ten years ago, says 100% of its health system customers can exchange health data using the C-CDA format.

To use Share Everywhere, patients must log into MyChart and generate a one-time access code. Patients then give the code to any provider with whom they wish to share information, according to a report in Medscape. Once they receive the code, the clinician visits the Share Everywhere website, then uses the code once they verify it against the patient’s date of birth.

As usual, the biggest flaw in all this is that Epic’s still at the center of everything. While patients whose providers use Epic gain options, patients whose health information resides in a non-Epic system gain nothing.

Also, while it’s good that Epic is empowering patients, Direct record sharing seems to offer more. After all, patients using Direct don’t have to use a portal, need not have any particular vendor in the mix, and can attach a wide range of file formats to Direct messages, including PDFs, Word documents and C-CDA files. (This may be why CHIME has partnered with DirectTrust to launch its broad-based HIE.)

Participating does require a modest amount of work — patients have to get a Direct Address from one of its partners — and their provider has to be connected to the DirectTrust network. But given the size of its network, Direct record sharing compares favorably with Share Everywhere, without involving a specific vendor.

Despite my skepticism, I did find Share Everywhere’s patient consent mechanism interesting. Without a doubt, seeing to it that patients have consented to a specific use or transmission of their health data is a valuable service. Someday, blockchain may make this approach obsolete, but for now, it’s something.

Nonetheless, overall I see Share Everywhere as evolutionary, not revolutionary. If this is the best Epic can do when it comes to patient data exchange, I’m not too impressed.

What’s Involved In Getting To EHR 2.0?

Posted on September 22, 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.

While the current crop of EHRs have (arguably) served a useful purpose, I think we’d all agree that there’s a ton of room for improvement. The question is, what will it take to move EHRs forward?

Certainly, we face some significant obstacles to progress.

There are environmental factors in play, such as reimbursement issues.

There’s the question of what providers will do with existing EHR infrastructure, which has cost them tens or even hundreds of millions of dollars if next-gen EHRs call for a new technical approach.

Then, of course, there’s the challenge of making the darn things usable by real, human clinicians. So far, we simply haven’t gotten anything that solves that issue yet.

That doesn’t mean people aren’t considering the issue, however. One health IT leader that’s stepped up to the plate is Dr. John Halamka, chief information officer of the Beth Israel Deaconess Medical Center and CIO and dean for technology at Harvard Medical School.

In his Life As Healthcare CIO, Halamka lays out the changes he sees as driving the shift to EHR 2.0. Here are some of his main points:

  • Regulators are shifting their focus from prescribing certain types of EHR functionality to looking at results technology achieves. This supports the healthcare industry’s movement from a data recording focus to an outcomes focus.
  • With doctors being pulled in too many directions, it will take teams to maintain patient health, this calls for a new generation of communication and groupware tools. These tools should include workflow integration, rules-based escalation messages, and routing based on time of day, location, schedules, urgency, and licensure.
  • With value-based purchasing gradually becoming the norm, EHRs need new capabilities. These should include the ability to document care plans and variation from those plans, along with outcomes reported from patient-generated healthcare data. Eventually, this will mean the dawn of the Care Management Medical Record, which enrolls patients and protocols based on their condition then ensures that patients get recommended services.
  • EHRs must be more usable. To accomplish this, it’s helpful to think of EHRs as platforms upon which entrepreneurs can create add-on functionality, along the lines of apps that rest on top of mobile operating systems.
  • Next-gen EHRs need to become more consumer-driven, making patients an equal member of the care team. Although existing EHR models do have patient portals, they aren’t robust enough to connect patients fully with their care, and they don’t include tools helping patients navigate their care system.

As far as I can tell, Dr. Halamka has covered the majority of issues we need to address in transitioning to new EHR models. I was also interested to learn that regulatory bodies have begun to “get it” about the limitations of demanding certain functions be included in an EHR system.

I’m still left with one question, however. How does interoperability fit into this picture? Can we even get to the next generation of EHRs without answering the question of how they share data between one another? To me, it’s clear that the answer is no, we can’t leave this issue aside.

Other than that, though, I found Dr. Halamka’s analysis to be fairly comforting. Nothing he’s described is out of reach, unless, of course, vendors won’t cooperate. I think that as providers reach the conclusions he has, they’ll demand the kind of functionality he’s outlined, and vendors will have no choice but to pony up. In other words, there might actually be light at the end of the EHR tunnel.

Should EMR Vendors Care If Patients Get Their Records?

Posted on August 11, 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.

Not long ago, Epic CEO Judy Faulkner and former Vice President Joe Biden reportedly butted heads over whether patients need and can understand their full medical records. The alleged conversation took place at a private meeting for Cancer Moonshot, a program with which Biden has been associated since his son died of cancer.

According to a piece in Becker’s Health IT & CIO Review, Faulkner asked Biden why patients actually needed their full medical records. “Why do you want your medical records? They’re a thousand pages of which you understand 10,” she is said to have told Biden.

Epic responded to the widely-reported conversation with a statement arguing that Faulkner had been quoted out of context, and that the vendor supported patients’ rights to having their entire record. Given that Becker’s had the story third-hand (it drew on a Politico column which itself was based on the remarks of someone who had been present at the meeting) I have little difficulty believing that something was lost in translation.

Still, I am left wondering whether this piece had touched on something important nonetheless. It raises the question of whether EMR vendor CEOs have the attitude towards patient medical record access Faulkner is portrayed as having.

Yes, I suspect virtually every EMR vendor CEO agrees in principle that patients are entitled to access their complete records. Of course, the law recognizes this right as well. However, do they, personally, feel strongly about providing such access? Is making patient access to records easy a priority for them? My guess is “no” and “no.”

The truth is, EMR vendors — like every other business — deliver what their customers want. Their customers, providers, may talk a good game when it comes to patient record access, but only a few seem to have made improving access a central part of their culture. In my experience, at least, most do what medical records laws require and little else. It’s hard to imagine that vendors spend any energy trying to change customers’ records practices for the better.

Besides, both vendors and providers are used to thinking about medical record data as a proprietary asset. Even if they see the necessity of sharing this information, it probably rubs at least some the wrong way to ladle it out at minimal cost to patients.

Given all this background, it’s easy to understand why health IT editors jumped on the story. While she may have been misrepresented this time, it’s not hard to imagine the famously blunt Faulkner confronting Biden, especially if she thought he didn’t have a leg to stand on.

Even if she never spoke the words in question, or her comments were taken out of context, I have the feeling that at least some of her peers would’ve spoken them unashamedly, and if so, people need to call them out. If we’re going to achieve the ambitious goals we’ve set for value-based care, every player needs to be on board with empowering patients.

USAA Tapping EHR To Gather Data From Life Insurance Applicants

Posted on August 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.

I can’t believe I missed this. Apparently, financial giant USAA announced earlier this year that it’s collecting health data from life insurance applicants by interfacing with patient portals. While it may not be the first life insurer to do so, I haven’t been able to find any others, which makes this pretty interesting.

Usually, when someone applies for life insurance, they have to produce medical records which support their application. (We wouldn’t want someone to buy a policy and pop off the next day, would we?) In the past, applicants have had to push their providers to send medical records to the insurer. As anyone who’s tried to get health records for themselves knows, getting this done can be challenging and is likely to slow down policy approvals.

Thanks to USAA’s new technology implementation, however, the process is much simpler. The new offering, which is available to applicants at the Department of Veterans Affairs and Department of Defense, allows consumers to deliver their health data directly to the insurer via their patient portal.

To make this possible, USAA worked with Cerner on EHR retrieval technology. The technology, known as HealtheHistory, supports health data collection,  encrypts data transmission and limits access to EHR data to approved persons. No word yet as to whether Cerner has struck similar deals elsewhere but it wouldn’t surprise me.

USAA’s new EHR-based approach has paid off nicely. The life insurer has seen an average 30-day reduction in the time it takes to acquire health records for applicants, and though it doesn’t say what the average was back in the days of paper records, I assume that this is a big improvement.

And now on to the less attractive aspects of this deal. I don’t know about you, but I see a couple of red flags here.

First, while life insurers may know how to capture health data, I doubt they’re cognizant of HIPAA nuances. Even if they hire a truckload of HIPAA experts, they don’t have much context for maintaining HIPAA compliance. What’s more, they rarely if ever have to look a patient in the face, which serves as something of a natural deterrent to provider data carelessness.

Also, given the industry’s track record, is it really a good idea to give a life insurer that much data? For example, consider the case of a healthy 36-year-old woman with no current medical issues who was denied coverage because she had the BRCA 1 gene. That gene, as some readers may know, is associated with an increased risk of breast and ovarian cancer.

The life insurer apparently found out about the woman’s makeup as part of the application process, which included queries about genetic information. Apparently, the woman had had such testing, and as a result had to disclose it or risk being accused of fraud.

While the insurer in question may have the right, legally, to make such decisions, their doing so falls into a gray area ethically. What’s more, things would get foggier if, say, it decided to share such information with a sister health insurance division. Doing so may not be legal but I can easily see it happening.

Should someone’s genes be used to exclude them life or health insurance? Bar them from being approved for a mortgage from another sister company? Can insurers be trusted to meet HIPAA standards for use of PHI? It’ll be important to address such questions before we throw our weight behind open health data sharing with companies like USAA.

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

Posted on July 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.

As some of you may recall, I recently wrote a positive review of Kaiser Permanente’s use of consumer-facing health IT. (Kaiser Permanente is both my health insurer and provider.) Their offerings have a number of strengths including:

  • Interfaces: The kp.org site is decent, and the KP app highly usable
  • Access to care: Booking medical appointments is easy, as is cancelling them
  • Responsiveness: Physicians are quick to replay to email via the Kaiser portal
  • Connectedness: Thanks to being on a shared Epic platform, every provider knows my history (at least for the time I’ve spent within the KP system, which is pretty useful)

At the time, I also noted that I had a few minor concerns about the portal features and whatnot, but I was still a fan of KP’s setup.

By and large, my perceptions of Kaiser’s consumer health IT strengths haven’t changed. However, after a couple of months in the system, I’ve gotten a good look at its weaknesses as well. And I thought you might be interested in the problems Kaiser faces in connecting consumers, particularly given its use of best practices in many cases.

All told, these weaknesses suggest that over more than ten years after its Epic rollout, KP leaders still haven’t put their entire consumer health IT strategy in place. Here are a couple of my concerns.

Specialist appointments aren’t integrated

The biggest gripe I have with Kaiser’s interactive tools is that while I can schedule PCP appointments myself, I haven’t been able to set specialist appointments without speaking to a real live person. (My primary care doctor seems to be able to access specialist schedules and set appointments with them on my behalf.)

This may work for someone with no significant health problems, but creates a significant burden for me. After all, as someone with multiple chronic illnesses, I schedule a lot of specialist consults. You don’t realize how much time it takes to set each appointment with a clerical person until you’ve done it for five times in a week.  Try it sometime.

You might assume that this is a rationing measure, as organizations like KP are pretty strict about limiting access to specialist care. The truth is, that doesn’t seem to be the case. At least when it comes to my primary care physician (a big shout out to my PCP, Dr. Jason Singh) it doesn’t seem to be unduly hard to get access to specialists when needed.

No, I have concluded that the reason I can’t schedule specialist appointments online is that KP still hasn’t gotten their act together on this front. My guess is that the specialist systems live in some kind of silo, one that KP hasn’t managed to break down yet.

Mobile and web tools clash

As noted above, I’m largely satisfied with both KP’s consumer portal and its mobile app. True, the website sprawls a bit when it comes to presenting static content — such as physician bios — but the portal itself works fine. The mobile app, meanwhile, is great to use, as it presents my choices clearly and uses screen real estate effectively.

That being said, it annoys the heck out of me that there are minor but seemingly pointless, differences between how the portal and the mobile app function. It would be one thing the app was a shrunken down version of the website, offering a parallel but more limited version of available functions, but that isn’t how it works.

Instead, the services accessible through the portal and via the mobile app vary in small but irritating ways. For example, when emailing providers, you must choose a prewritten subject line from a drop-down menu. And I don’t know why, but the list of subjects available on the web portal version varies significantly from the list of subjects you can access via the mobile app.

There may be a rational reason for this. And mine may sound like a petty objection. But when you’re trying to address something as important as your healthcare, you want to know what’s going on with every detail.

I’d identify other ways in which the app and website portal vary, but I don’t have any other examples I can recall. And that’s the whole point. You don’t remember how the site and/or portal function until you stumble into another incompatibility. You roll your eyes and move on, but you see them again and waste one more spark of energy being annoyed.

It’s all about tradeoffs

So, you might ask if there’s any broad lesson to be taken from this. Honestly, probably not. I don’t like that KP’s tools pose these problems, but they don’t strike me as unusual.

And do my criticisms have any meaning for other healthcare organizations? Nothing more than a reminder that patients will take note of even small problems in your health IT execution, particularly when it comes to tools they rely upon to get things done.

In the end, of course, it’s all about trade-offs, as with any other industry. I don’t know whether KP chose to prioritize a potentially dangerous problem in provider-facing technologies over consumer quibbles, or just don’t know what’s going on. Perhaps they know and have added the fix to a long list of pending projects, or perhaps they don’t have their act together.

Still, lest it is lost in the discussion, remember I’m the customer, and I really don’t care about your IT problems. I just want to have tools that work every time and simplify my life.

So this is my official challenges to Kaiser leadership. For Pete’s sake, KP, would you please help me cut down on the specialist phone calls? Perhaps you could create a centralized specialist appointment call center, or use carrier pigeons, or let me suss out their schedules using my vast psychic powers — hey, they’re all options. Or maybe, just maybe, you can let me schedule the appointments online. Your call.

The EMR Vendor’s Dilemma

Posted on June 6, 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.

Yesterday, I had a great conversation with an executive at one of the leading EMR vendors. During our conversation, she stressed that her company was focused on the future – not on shoring up its existing infrastructure, but rather, rebuilding its code into something “transformational.”

In describing her company’s next steps, she touched on many familiar bases, including population health, patient registries and mobile- first deployment to support clinicians. She told me that after several years of development, she felt her company was truly ready to take on operational challenges like delivering value-based care and conducting disease surveillance.

All that being said – with all due respect to the gracious exec with whom I spoke – I wouldn’t want to be a vendor trying to be transformed at the moment. As I see it, vendors who want to keep up with current EMR trends are stuck between a rock and a hard place.

On the one hand, such vendors need to support providers’ evolving health IT needs, which are changing rapidly as new models of care delivery are emerging. Not only do they need to provide the powerhouse infrastructure necessary to handle and route massive floods of data, they also need to help their customers reach and engage consumers in new ways.

To do so, however, they need to shoot at moving targets, or they won’t meet provider demand. Providers may not be sure what shape certain processes will take, but they still expect EMR vendors to keep up with their needs nonetheless. And that can certainly be tricky these days.

For example, while everybody is talking about population health management, as far as I know we still haven’t adopted a widely-accepted model for adopting it. Sure, people are arriving at many of the same conclusions about pop health, but their approach to rolling it out varies widely.  And that makes things very tough for vendors to create pop health technology.

And what about patient engagement solutions? At present, the tools providers use to engage patients with their care are all over the map, from portals to mobile apps to back-end systems using predictive analytics. Synchronizing and storing the data generated by these solutions is challenging enough. Figuring out what configuration of options actually produces results is even harder, and nobody, including the savviest EMR vendors, can be sure what the consensus model will be in the future.

Look, I’m aware that virtually all software vendors face this problem. It’s difficult as heck to decide when to lead the industry you serve and when to let the industry lead you. Straddling these two approaches successfully is what separates the men from the boys — or the girls from the women — and dictates who the winners and losers are in any technology market.

But arguably, health IT vendors face a particularly difficult challenge when it comes to keeping up with the times. There’s certainly few industries are in a greater state of flux, and that’s not likely to change anytime soon.

It will take some very fancy footwork to dance gracefully with providers. Within a few years, we’ll look back and know vendors adapted just enough.

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.