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Consumers Take Risk Trading Health Data For Health Insurance Discounts

Posted on August 28, 2015 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.

When Progressive Insurance began giving car owners the option of having their driving tracked in exchange for potential auto insurance discounts, nobody seemed to raise a fuss. After all, the program was voluntary, and nobody wants to pay more than they have to for coverage.

Do the same principles apply to healthcare? We may find out. According to a study by digital health research firm Parks Associates, at least some users are willing to make the same tradeoff. HIT Consultant reports that nearly half (42%) of digital pedometer users would be willing to share their personal data in exchange for a health insurance discount.

Consumer willingness to trade data for discounts varied by device, but didn’t fall to zero. For example, 35% of smart watch owners would trade their health data for health insurance discounts, while 26% of those with sleep-quality monitors would do so.

While the HIT Consultant story doesn’t dig into the profile of users who were prepared to sell their personal health data today — which is how I’d describe a data-for-discount scheme — I’d submit that they are, in short, pretty sharp.

Why do I say this? Because as things stand, at least, health insurers would get less than they were paying for unless the discount was paltry. (As the linked blog item notes, upstart health insurer Oscar Insurance already gives away free Misfit wearables. To date, though, it’s not clear from the write-up whether Oscar can quantify what benefit it gets from the giveaway.)

As wearables and health apps mature, however, consumers may end up compromising themselves if they give up personal health data freely. After all, if health insurance begins to look like car insurance, health plans could push up premiums every time they make a health “mistake” (such as overeating at a birthday dinner or staying up all night watching old movies). Moreoever, as such data gets absorbed into EMRs, then cross-linked with claims, health plans’ ability to punish you with actuarial tables could skyrocket.

In fact, if consumers permit health plans to keep too close a watch on them, it could give the health plans the ability to effectively engage in post-contract medical underwriting. This is an unwelcome prospect which could lead to court battles given the ACA’s ban on such activities.

Also, once health plans have the personal data, it’s not clear what they would do with it. I am not a lawyer, but it seems to me that health plans would have significant legal latitude in using freely given data, and might even be seen to sell that data in the aggregate to pharmas. Or they might pass it to their parent company’s life or auto divisions, which could potentially use the data to make coverage decisions.

Ultimately, I’d argue that unless the laws are changed to protect consumers who do so, selling personal health data to get lower insurance premiums is a very risky decision. The short-term benefit is unlikely to be enough to offset very real long-term consequences. Once you’ve compromised your privacy, you seldom get it back.

I Have Seen The Portal, And It Is Handy

Posted on July 14, 2015 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.

After writing about EMRs/EHRs and portals for many years, I’ve finally begun using an enterprise-class portal to guide my own care. Here’s some of my impressions as an “inside” (EMR researcher) and “outside” (not employed as a provider) user of this tool. My conclusion is that it’s pretty handy, though it’s still rather difficult to leverage what I’ve learned despite being relatively sophisticated.

First, some background. I get most of my care from northern Virginia-based Inova Health System, including inpatient, primary care, imaging and specialist care. Inova has invested in a honking Epic installation which links the majority of these sites together (though I’ve been informed that its imaging facilities still aren’t hooked up to core medical record. D’oh!) After my last visit with an Inova doctor, I decided to register and use its Epic portal.

Epic’s MyChart has a robust, seemingly quite secure process for registering and accessing information, requiring the use of a long alphanumeric code along with unique personal data to establish an account. When I had trouble reading the code and couldn’t register, telephone-based tech support solved the problem quickly.  (Getting nearsighted as I move from middle- to old-aged!)

Using MyChart, I found it easy to access lab results, my drug list and an overview of health issues. In a plus for both me and the health system, it also includes access to a more organized record of charges and balances due than I’ve been able to put together in many years.

When I looked into extracting and sharing the records, I found myself connected to Lucy, an Epic PHR module. In case you’ve never heard of it (I hadn’t) here’s Epic’s description:

Lucy is a PHR that is not connected to any facility’s electronic medical record system. It stays with patients wherever they receive care and allows them to organize their medical information in one place that is readily accessible. Patients can enter health data directly into Lucy, pull in MyChart data or upload standards-compliant Continuity of Care Documents from other facilities.

As great as the possibility of integrating outside records sounds, that’s where I ran into my first snag. When I attempted to hook up with the portal for DC-based Sibley Memorial Hospital — a Johns Hopkins facility — and integrate the records from its Epic system into the Inova’s Lucy PHR, I was unable to do so since I hadn’t connected within 48 hours of a recent discharge. When I tried to remedy the situation, an employee from the hospital’s Health Information Management department gave me an unhelpful kiss-off, telling me that there was no way to issue a second security code. I was told she had to speak to her office manager; I told her access to my medical record was not up for a vote, and irritated, terminated the call.

Another snag came when I tried to respond to information I’d found in my chart summary. When I noted that one of my tests fell outside the standard range provided by the lab, I called the medical group to ask why I’d been told all tests were normal. After a long wait, I was put on the line with a physician who knew nothing about my case and promptly brushed off my concerns. I appreciate that the group found somebody to talk to me, but if I wasn’t a persistent lady, I’d be reluctant to speak up in the future given this level of disinterest.

All told, using the portal is a big step up from my previous experiences interacting with my providers, and I know it will be empowering for someone like myself. That being said, it seems clear that even in this day and age, even a sophisticated integrated health system isn’t geared to respond to the questions patients may have about their data.

For one thing, even if the Lucy portal delivers as promised, it’s clear that integrating data from varied institutions isn’t a task for the faint of heart. HIM departments still seem to house many staffers who are trained to be clerks, not supporters of digital health. That will have to change.

Also, hospitals and medical practices must train employees to enthusiastically, cheerfully support patients who want to leverage their health record data. They may also want to create a central call center, staffed by clinicians, to engage with patients who are raising questions related to their health data. Otherwise, it seems unlikely that they’ll bother to use it.

Taking a New Look at the Lamented Personal Health Record: Flow Health’s Debut

Posted on June 8, 2015 I Written By

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

After the disappointing lack of adoption suffered by Google Health and Microsoft HealthVault, many observers declared personal health records (PHRs) a non-starter, while others predicted that any progress toward personal control over health data would require a radically new approach.

Several new stabs at a PHR are emerging, of which Flow Health shows several promising traits. The company tries to take advantage of–and boost the benefits of–advances in IT standards and payment models. This article is based on a conversation I had with their general counsel, David Harlow, who is widely recognized as the leading legal expert in health IT and health privacy and who consults with companies in those spaces through the Harlow Group.

Because records are collected by doctors, not patients, the chief hurdle any PHR has to overcome is to persuade the health care providers to relinquish sole control over the records they squirrel away in their local EHR silos. Harlow believes the shift to shared risk and coordinated care is creating the incentive for doctors to share. The Center for Medicare & Medicaid Services is promising to greatly increase the role of pay-for-value, and a number of private insurers have promised to do so as well. In short, Flow Health can make headway if the tangible benefit of learning about a patient’s recent hospital discharge or treating chronic conditions while the patient remains at home start to override the doctor’s perception that she can benefit by keeping the patient’s data away from competitors.

The next challenge is technically obtaining the records. This is facilitated first by the widespread move to electronic records (a legacy of Meaningful Use Stage 1) and the partial standardization of these records in the C-CDA. Flow Health recognizes both the C-CDA and Blue Button, as well as using the Direct protocol to obtain records. Harlow says that FHIR will be supported when the standard settles down.

But none of that is enough to offer Flow Health what the doctors and patients really want, which is a unified health record containing all the information given by different providers. Therefore, like other companies trying to broaden access to patient data, Flow Health must deal with the problem that Dr. Eric Topol recently termed the Tower of EMR Babel. They study each format produced by different popular EHRs (each one using the C-CDA in slightly incompatible ways) and convert the data into a harmonized format. This allows Flow Health to then reconcile records when a diagnosis, a medication list, or some other aspect of the patient’s health is represented differently in different records.

What’s next for Flow Health? Harlow said they are preparing an API to let third parties add powerful functionality, such as care coordination and patient access from any app of their choice. Flow Health is already working closely with payers and providers to address workflow challenges, thus accelerating the aggregation of patient health record data for access and use by clinicians and patients.

A relative of mine could have used something like Flow Health recently when her eye doctor referred her to the prestigious Lahey Clinic in the Boston area. First of all, the test that led to the referral had to be repeated at the Lahey Clinic, because the eye doctor did not forward test results. Nor did anyone provide a medication list, so the Lahey Clinic printed out a five-year old medication list that happened to hang around from a visit long ago and asked her to manually update it. There was also confusion about what her insurer would cover, but that’s a different matter. All this took place in 2015, in the country’s leading region for medical care.

It seems inevitable that–as Flow Health hopes–patients will come to demand access to their medical records. A slew of interesting experiments will proliferate, like Flow Health and the rather different vision of Medyear to treat health information like a social network feed. Patient-generated data, such as the output from fitness devices and home sensors, will put yet more pressure on health care providers to take the patient seriously as a source of information. And I’ll continue to follow developments.

Cracking Open the Shell on the Personal Health Record

Posted on November 5, 2014 I Written By

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

The concept of maintaining your own health data enjoyed a brief flurry of activity a few years ago with Google Health (now defunct) and Microsoft HealthVault (still active but not popular). It has gotten a second chance with Apple HealthKit, Google Fit, and other corporate offerings explicitly tied in with the convenience of mobile devices. Microsoft itself has galvanized HealthVault with a Microsoft Health initiative similar to Apple’s HealthKit. Recently I’ve been talking to health care reformers about the business and political prospects for personal health records (PHRs).

Patient access to data was enshrined as a right back when HIPAA was passed and is still championed by the US government through Meaningful Use (whose Stage 3 may well focus on it) and other initiatives, and has been endorsed by the industry as well. But this requirement won’t be satisfied by the limited patient portals that hospitals and clinics are hanging out on the Web. Their limitations include:

  • Many provide only viewing data, not downloading or transmitting it (all of these are mandated by Meaningful Use).
  • Data maintained by providers can’t easily be combined into a holistic, comprehensive view, which is what providers need to provide good care.
  • Data on portals is usually a thin sliver of all the data in the record: perhaps prescriptions, appointments, and a few other bare facts without the rich notes maintained by clinicians.
  • You can’t correct errors in your own data through a portal.
  • Clinicians rarely accept data that you want to put in the record, whether personal observations or output from fitness devices and other technical enhancements.

All these problems could be solved by flexible and well-designed personal health records. But how does the health care field navigate the wrenching transition to giving people full control over their own data?

Dr. Adrian Gropper has investigated PHRs for years and even considered building a simple device to store and serve individual’s health data. Now he says, “I can’t recall any physician in my medical society that has ever said they wished their patient had a PHR. Nor do I, after many years on the Society for Participatory Medicine list, ever recall a patient praising the role of their PHR in their care. Today’s PHRs are clinically irrelevant.”

This is not a condemnation of PHRs, but of the environment in which vendors try to deploy them. Many health reformers feel that several aspects of this care environment must evolve for PHRs to be accepted:

  • PHR data must become appealing to doctors. This means that device manufacturers (and perhaps patients themselves) must demonstrate that the data is accurate. Doctors have to recognize value in receiving at least summaries and alerts. Many benefits can also accrue from collecting vital statistics, behavioral data, and other aspects of patients’ daily lives.
  • The doctor’s EHR must seamlessly provide data to the patient, and (we hope) seamlessly accept data from the patient–data that the doctor acts on. Currently, most manufacturers store the data on their own sites and offer access through APIs. Another programming step is required to get the data into the PHR or the doctor’s EHR.
  • Clinicians have to agree on how to mark and collect the provenance of data. “Provenance” deals with assertions such as, “this data was generated by a Fitbit on October 10, 2014” or “this diagnosis was challenged by the patient and changed on August 13, 2010.”
  • Add-on services must make the data interesting and usable to both patients and physicians. For instance, such apps can alert the patient, clinician, or family members when something seems wrong, let them visualize data taken from the PHR and EHR over time, get useful advice by comparing their data to insights from research, and track progress toward the goals they choose.

“A critical force in increasing consumer engagement in digital health is the development of compelling, easy to use tools that make it simple to collect, understand and use health information to reach the goals consumers define for themselves, whether that’s managing a chronic condition, saving money, or fitting into their ‘skinny jeans’,” writes Lygeia Ricciardi, former director of the Office of Consumer e-Health at the ONC. “In an age of ‘one click purchasing,’ it must become incredibly easy for patients to access and share their own health information digitally–if it’s too complex or time consuming, most people probably won’t do it.”

In addition to sheer inertia, a number of disincentives keep PHRs from congealing.

  • Many doctors are afraid of letting patients see clinical notes, either because the patient will ask too many questions or will be upset by the content.
  • Hospitals and clinics want control over records so that patients will return to them for future treatment.
  • Marketing firms live off of rich data lodes on our health data.
  • Other organizations with dubious goals, commercial and governmental, want to track us so they can deny us insurance or control our lives in other ways.

Wait–what about the patients themselves? Why haven’t they risen up over the past several years to demand control over their data? Well, maintaining your health data is intimidating. The data is highly detailed and full of arcane medical concepts and terminology. Most patients don’t care until they really need to–and then they’re too sick and disabled to form an effective movement for patient control.

Still, several leaders in health care believe that a viable business model can be built on PHRs. The spark of hope comes from the success of apps that make people pay for privacy, notably SnapChat and Whatsapp. Although some sloppy privacy practicies render these services imperfect, their widespread use demonstrates that people care about protecting their personal data.

Private storage can be offered both in the cloud and by personal devices, using standardized services such as Direct and Blue Button. These will start out as high-end services for people who are affluent and have particular concerns about storing their own data and choosing how it is shared. It will then become commoditized and come down in price.

What about people who can’t afford even the modest prices for cloud storage? They can turn patient data into a civil rights issue. There’s a potent argument that everyone has the right to determine who can get access to their health data, and a right to have data generated during their daily lives taken into account by doctors.

We don’t need one big central service–that’s insecure and subject to breaches. Multiple services and distributed storage reduce security risks.

We’ll see change when a substantial group of people start to refuse to fill out those convoluted forms handed to them as them enter a clinic, saying instead, “Get it from my web site before you treat me.” Before that protest begins, there’s a lot of work in store for technologists and businesses to offer patients a usable record system open to the wide range of data now available for health.

Microsoft Joins Battle for Wearables Market

Posted on November 4, 2014 I Written By

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

Following the lead of several other companies big and small, Microsoft has jumped into the wearables healthcare market with a watch, a fitness tracker and a cloud-based platform that condenses and shares data.

It’s little wonder. After a few years of uncertainty, it seems pretty clear that the wearables market is taking off like a rocket. In fact, 21% of US consumers own such a device, according to research by PricewaterhouseCoopers. That’s slightly higher that the number of consumers who bought tablets during the first two years after they launched, PwC reports. Not only Microsoft, but Apple and Samsung, as well as smaller players with a high profile — such as Fitbit — are poised to take the sector by storm.

Microsoft’s new entry is called Microsoft Health, a platform letting users store health and fitness data. The date in question is collected by a Microsoft Health app, available on Android, iOS and Windows Phone. The platform also gathers data generated from the Microsoft Band, a smart and designed to work with Microsoft’s new platform.

The idea behind pulling all of this data into a single platform is to integrate data from different devices and services in a smart way that allows consumers to generate insights into their health. The next step for Microsoft Health, execs say, is to connect all of that data in the platform to the tech giant’s HealthVault, a Web-based PHR, making it easier for people to share data with their healthcare providers.

Other tech giants are making their own wearables plays, of course. Google, for example, has released Google Fit, a fitness-based app designed to help users track physical activity. Google’s approach is  Android smart phones, relying on sensors built into the smart phones to detect if the user is walking, running or biking. Users can also connect to devices and apps like Noom Coach and Withings.

Apple, for its part, has launched HealthKit, its competing platform for collecting data from various health and fitness apps.  The data can then be accessed easily by Apple users through the company’s Health app (which comes installed on the iPhone 6.) HealthKit is designed to send data directly to hospital and doctor charts as well. It also plans to launch a smart watch early next year.

While there’s little doubt consumers are interested in the wearables themselves, it’s still not clear how enthusiastic they are about pulling all of their activity onto a single platform. Providers might be more excited about taming this gusher of data, which has proved pretty intimidating to doctors already overwhelmed with standard EMR information, but it remains to be seen whether they’ll find fitness information to be helpful.

All told, it looks like there will be a rollicking battle for the hearts and minds of wearables consumers, as well as the loyalty of providers.  As for me, I think it will be a year or two, at minimum, before we get a real sense of what consumers and providers really want from these devices.

The Other Talk: EHRs and Advance Medical Directives

Posted on September 11, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

The Other Talk: EHRs and Advance Medical Directives

Most of us who have adult children can remember that awkward talk we had about life’s origins. We thought, whew, that’s done. Alas, there’s yet another talk. This time it’s with those adult children and it’s about you.

This one’s covered in Tim Prosch’s and AARP’s book, The Other Talk. The talk, or more accurately the process is how you want to spend the rest of your life.

The Other Talk

It’s about your money, where and how you’ll live and your medical preferences. It’s just as hard, if not harder, than the old talk because:

  • It’s hard to admit that you won’t be around forever and your independence may start to ebb away.
  • You don’t want to put your kids on the spot with difficult decisions.
  • Your children may be parents coping with their own problems. You don’t want to add to their burdens.
  • You’ve been a source of strength, often financial as well as emotional. That’s hard to give up.

Prosch and AARP want to make it easier on everyone to deal with these issues.

He covers many topics, but for those of us who live in the EHR world one is of significant importance: Medical directives.

Prosch explains directives and simply says you should give them to your doctor. Easier said, etc. Today, that means not only your PCP, but also making sure that hospitalists etc., know what you want. While the Meaningful Use program helps a bit. It’s still going to take some doing.

Medical Directives and EHRs

EHR MU1 recognizes directives’ importance requiring that they be accounted for:

More than 50% of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient department have an indication of an advance directive status recorded.

This means that the EHR has to have the directives. However, MU 1 only goes halfway to what’s needed. It’s what the EHR does with directives that’s unsaid.

If the EHR treats a directive as a miscellaneous document, odds are it won’t be known, let alone followed when needed. To be used effectively, an EHR needs a specific place for directives and they should be readily available. For example, PracticeFusion recently added an advance directives function. That’s not always the case.

Practice Fusion: Advanced Medical Directives

Googling for Directives

To see how about twenty popular EHRs treat directives, I did a Google site search, on the term directive. I got hits for a directives function only from four EHRs:

  • Athenahealthcare
  • Cerner
  • Meditech
  • PracticeFusion

All the others, Allscripts, Amazing Charts, eClinicalWorks, eMDs, McKesson, etc., were no shows. Some listed the MU1 requirement, but didn’t show any particular implementation.

Directives: More Honored in the Breech

This quick Google search shows that the EHR industry, with a few exceptions, doesn’t treat directives with the care they deserve. It should also serve as a personal warning.

If you already have directives or do have that talk with your family, you’ll need to give the directives to your PCP. However, you should also give your family copies and ask them to go over them with your caregivers.

Some day, EHRs may handle medical directives with care, but that day is still far off. Until then, a bit of old school is advisable.

Do We Really Like the JASON Recommendations for Interoperable Health Data?

Posted on August 28, 2014 I Written By

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

The health IT community has been abuzz over the past few months about a report released by the Agency for Healthcare Research and Quality. Although the report mostly confirmed thoughts that reformers in the health IT space have been discussing for some time, seeing it aired in an official government capacity was galvanizing. The Office of the National Coordinator has held several forums about the report, known by the acronym JASON, and seems favorably inclined toward its recommendations.

Even though only four months have passed since its publication, we can already get some inkling of how it will fare at the ONC, which is going through major realignment of its own. And to tell the truth, I don’t see much happening with the JASON recommendations. In this article I’ll look at what I see to be its specific goals, and what I’ve heard regarding their implementation:
Read more..

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 I Written By

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

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

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

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

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

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

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

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

Other new features tied in to the HealthTap services include:

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

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

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

What Does Direct Messaging Look Like for MU2?

Posted on June 11, 2014 I Written By

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

I’m often asked what EHR integrations of Direct are supposed to look like.  In the simplest sense, I liken it to a Share button and suggest that such a button—typically labeled “Transmit”—be placed in context near the CCDA that’s the target of the transmit action, or in a workflow-friendly spot on a patient record screen.

Send a CCD Using Direct Messaging

Send CCD using Direct in OpenEMR

The receive side is similarly intuitive: the practice classifies how their incoming records are managed today and we map that process to one or more Direct addresses.  If we get stuck, I ask, “What is the workflow for faxes today–how many fax numbers are there, and how are they allocated?”  This usually helps clear things up:  as a starting point, a Direct address can be assigned to replace each fax endpoint.

The address structure raises an important question, because it is tightly tied to the Direct messaging user interface.  Should there be a Direct address for every EHR user?  Provider?  Department? Organization?  A separate address for the patient portal?  A patient portal that spans multiple provider organizations? One for every patient?

The rules around counting Direct messages for Transitions of Care (ToC) attestation do not require each provider to have their own Direct address, as long as the EHR can count transactions correctly for attestation.  As far as meaningful use is concerned, any reasonable address assignment method should be acceptable in ToC use cases (check the rules themselves, for full details).  Here are some examples.

records@orthodocs.ehrco-example.com is clearly an address that could be shared by multiple users, though it could be used by just one person, and might be used for both transitions of care and patient portal transmit.

janesmith@orthodocs.hisp-example.com could also be dual-purpose.  Jane might be the only authorized user of this address, or this address may be managed by a group of people at her practice that does not necessarily even include Jane.  Alternatively, this address could be used for Jane’s ToC transactions, while a patientportal@someother.domain-example.com address could be used for patient portal transmit.

So, any of the options proposed above are possible conventions for assigning Direct addresses.  Also, a patient does not need their own Direct address to Transmit from as part of the View, Download, Transmit measure (170.314(e)(1)), but might have their own address to transmit to.  Note that adding a little extra data can elevate a View, Download, Transmit implementation to BlueButton+ status.

It makes sense for patients and providers to have their own Direct addresses if they are using Direct for Secure Messaging – 170.314(e)(3) – for which Direct is an optional solution.  Or, if patients have their own Personal Health Record (PHR) and Direct address, Direct is a great way to deliver data to the PHR.  Incidentally, there are free services such as Microsoft HealthVault and many others that issue patient Direct addresses.

Direct addresses are nearly indistinguishable from regular email addresses, but a word of caution: Direct is incompatible with regular email, and has additional requirements beyond traditional S/MIME.  Although it’s not a requirement, you’ll often find the word “direct” somewhere in the domain part of a Direct address, to help distinguish a regular email address from a Direct address.

Now that you know what Direct is, and what Direct Messaging and Direct addresses look like, I’m sure you’ll start noticing Direct popping up in more and more places.  So, be a not-so-early adopter and go get yourself a Direct address!

#HIMSS14 Highlights: Enthusiasm for Patient Engagement

Posted on March 7, 2014 I Written By

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

Patient engagement solutions abounded at HIMSS14, though their levels of sophistication varied. Like many other commentators, I felt this was a big jump in interest over last year. It will be interesting to see if this level sustains into 2015, and how the same products will mature come HIMSS15 in Chicago.

The theme of engagement was heard most loudly in several educational sessions I attended. I was happy to pre-register for an Orion Health / ePatient Dave event; and make time at the last minute to attend a live demo of the new Blue Button Connector, and a brief presentation by Regina Holliday, founder of the Walking Gallery.

I believe ePatient Dave (aka Dave deBronkart) has been at this awhile, but the Orion Health lunch and learn I attended was my first opportunity to hear him tell his story live. And what a compelling story it was! It certainly resonated with the audience of about 75, and I couldn’t help but wonder why he wasn’t up on stage in a “From the Top” session. The theme that ran throughout his presentation and audience questions was the need for online patient communities, and the subsequent need for providers to let their patients know about them. Websites like PatientsLikeMe.com and Sharecare.com were brought up as interesting resources.

epatientdavewp

I headed from there to the exhibit hall, where HIMSS had set up a very nice learning gallery, complete with comfy chairs, swivel desktops and a nice presentation area. Lygeia Ricciardi spent a good 20 minutes going through the new Blue Button Connector website, which you can find here: http://bluebuttonconnector.healthit.gov/. While not a true, live demo, she did offer several screenshots, and was very forthcoming about the ONC’s plans and goals for the site. Apparently they see it as almost a marketing tool, similar to the Energy Star label you see on just about every appliance these days. The Blue Button symbol will hopefully come to be recognized as an endorsement of easy access to patient data. She was frank in saying that it’s not a panacea, but will be a powerful tool in the hands of consumers, and developers who choose to take advantage of its open source code and bake it into their own apps.

bluebuttonwp

It is literally a connector. The new website simply allows patients to connect to third parties that may house their medical records, such as payers, pharmacy, labs, physicians or hospitals, immunization registries and health information exchange portals. Knowing I already have a provider that participates in Blue Button via their athenahealth patient portal, I went through the “Physician or Hospital” steps to see how the Connector worked. I didn’t see my physician listed, so I’ll likely send an email to bluebutton@hhs.gov. The Connector is in beta right now, and Riccardi mentioned they are very interested in gathering as much user feedback as possible during this process, so I encourage you to check it out and drop them a comment or two.

I was back at the Learning Gallery the next afternoon to hear Regina Holliday of the Walking Gallery speak, and she did not disappoint. Like a preacher that just can’t stay in the pulpit, Regina passionately talked about the power patients have when they come together and demand change. It was my first time hearing her speak live and I was not disappointed. It was a powerful sight to see close to 30 Walking Gallery members stand up at the end of her session and show their jackets. Why they were not on a larger stage in front of a capacity audience is beyond me.

walkinggallery

That’s it for my notes from HIMSS. Next up on my conference dance card is the Healthcare IT Marketing and PR Conference, taking place April 7-8 in Las Vegas, and hosted by Healthcarescene.com. I hope to see you there!