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Accountable Care HIT Spending Growing Worldwide

Posted on November 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.

A new market research report has concluded that given the pressures advancing the development of accountable care models, the market for solutions serving ACOs should expand worldwide, though North America is likely to lead the segment for the near future.

The report, by research firm Markets & Markets, covers a wide range of technologies, including EHRs, healthcare analytics, HIE, RCM, CDSS, population health, claims management and care management. It also looks at delivery mode, e.g. on premise, web and cloud and end-user, which includes providers and payers. So bear that in mind when you look at these numbers. That being said, providers accounted for the largest share of this niche last year, and should see the highest growth in the sector over the next five years.

Broadly speaking, Markets & Markets reports that the accountable care solutions market grew a healthy growth rate during the last decade. Researchers there expect to see this market grow at a CAGR of 16.6% over the next five years, to hit $18.86 billion by 2021.

When it comes to leaders in the sector, researchers identify Cerner, IBM, Aetna and Epic as leaders in the current ACO solutions market and probable future winners between 2016 and 2021. Other major players in the space include UnitedHealth Group, Allscripts, McKesson, Verisk Health, Zeomega, eClinicalWorks and NextGen. Given how broadly they define this category, I’m not sure how important this is, but there you have it.

According Markets & Markets, the growth of the ACO solutions market worldwide is due to forces we know well, including shifting government regulations, the rollout of initiatives shifting financial risk from payers to providers, the demand to slow down healthcare cost increases in the advance of IT and big data capabilities. (Personally, I’d add the desire of health systems – ACO-affiliated or not – to differentiate themselves by performing well at the population health level.)

If your view is largely US-centric, as is mine, you might be interested to note that the trend towards ACO-like entities in the Asia-Pacific and Latin American regions is expanding, the researchers report. Most specifically, Markets & Markets researchers found that there is notable growth occurring in Asian countries, which, it reports, are modifying regulations and monitoring the implementation of procedures, policies and guidelines to promote innovation and commercialization. This has led to an increasing number of hospitals and academic institutions interested in the sector, along with a government focus on implementing health IT solutions and infrastructure – factors likely to generate an expanding ACO solutions market there.

After reading all of this, the question I’m left with is whether there’s any point in differentiating an “ACO” specific player as these researchers have. Maybe I’m playing with words too much hear, but wouldn’t it be more accurate to say that the definition of health system infrastructure is evolving, whether it’s part of an ACO as such or not?

E-Patient Update: Time To Share EMR Data With Apps

Posted on November 18, 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.

Like most Americans, I’ve used many a health-related app, in categories including vitals tracking, weight control, sleep management, medication management and exercise tracking. While I’ve continued to use a few, I’ve dropped most after a few uses because they didn’t contribute anything to my life.

Now, those of you who are reading this might assume that I lost interest in the apps because they were poorly designed. I admit that this was true in some cases. But in others, I’ve ceased to use the apps because the data they collect and display hasn’t been terribly useful, as most of it lives in a vacuum. Sure, I might be able to create line graph of my heart rate or pulse ox level, but that’s mildly interesting at best. (I doubt physicians would find it terribly interesting either.)

That being said, I believe there is a way healthcare organizations can make the app experience more useful. I’d argue that hospitals and clinics, as well as other organizations caring for patients, need to connect with major app developers and synch their data with those platforms. If done right, the addition of outside data would enrich the patient experience dramatically, and hopefully, provide more targeted feedback that would help shape their health behaviors.

How it would work

How would this work? Here’s an example from my own life, as an e-patient who digitally manages a handful of chronic, sometimes-complex conditions.

I have tested a handful of medication management apps, whose interfaces were quite different but whose goals seem to be quite similar — the primary one being to track the date and time each medicine on my regimen was taken. In each case, I could access my med compliance history rather easily, but had no information on what results my level of compliance might have accomplished.

However, if I could have overlaid those compliance results with changes in my med regimen, changes in my vital signs and changes in my lab values, I have a better picture of how all of my health efforts fit together. Such a picture would be far more likely to prompt changes in my health behavior than uncontextualized data points based on my self-report alone.

I should mention that I know of at least one medication management app developer (the inspiration for this essay) which hopes to accomplish just this result already, and is hard at work enriching its platform to make such integration possible. In other words, developers may not need much convincing to come on board.

The benefits of added data

“Yes,” I hear you saying, “but why should I share my proprietary data?” The answer is fairly simple; in the world of value-based reimbursement, you need patients to get and stay well, and helping them better manage their health fits this goal.

Admittedly, achieving this level of synchronization between apps and provider data won’t be simple. However, my guess is that it would be easier for app developers to import, say, pharmacy or EMR data than the other way around. After all, app platforms aren’t at the center of nearly as many overlapping data systems as a health organization or even a clinic. While they might not be starting from zero, they have less bridges to build.

And once providers have synchronized key data with app developers, they might be able to forge long-term partnerships in which each side learned from the exchange. After all, I’d submit that few app developers would turn up the chance to make their data more valuable — at least if they have bigger goals than displaying a few dots on a smartphone screen.

I realize that for many providers, doing this might be a tall order, as they can’t lose their focus on cultivating their own data. But as a patient, I’d welcome working with any provider that wanted to give this a try. I think it would be a real win-win.

AMA Urges Med Schools To Cover Health IT Basics

Posted on November 17, 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.

Despite the nearly universal use of health IT tools in medical practice today, the majority of med students make it through their medical school experience without having much exposure to such tools. In an effort to change this, the AMA is launching a new textbook designed to give med students at least a basic exposure to critical health IT topics.

To create the textbook, the AMA collaborated with its 32-school Accelerating Change in Medical Education Consortium. The collaboration generated a new “pillar” of medical education it dubs Health Systems Science, which members concluded should be taught alongside of basic and clinical sciences. This follows a recent study by the AMA concluding that its practicing physician members are quite interested in digital health.

In addition to covering key business concepts such as value in healthcare, patient safety, quality improvement, teamwork/team science and leadership, socio-ecological determinants of health, healthcare policy and health care economics, the textbook also addresses clinical informatics and population health.  And an AMA press release notes that many schools within the Consortium will soon use the textbook with the students, including Penn State College of Medicine and Brown University’s Warren Alpert Medical School.

The Brown program, for example, which received a $1 million AMA grant to support the change in this curriculum, has created a Primary Care-Population Medicine program. The program awards graduates both a Doctor of Medicine and a Master of Science in Population Medicine. The AMA describes this program is the first of its kind in the US.

It’s interesting to see that the AMA has stepped in and funded this project, partly because it seems to have been ambivalent about key health IT tools in the past, but partly because I expect to see vendors doing something like this. Honestly, now that I think about it, I’m surprised there isn’t a Cerner grant for the most promising clinical informatics grad, say, or the eClinicalWorks prize sponsoring a student’s medical training. Maybe the schools have rules against such things.

Actually, this is a rare situation in which I think getting vendors involved might be a good idea. Of course, med students wouldn’t benefit particularly from being trained exclusively on one vendor’s interface, but I imagine schools could organize regular events in which med school students had a chance to learn about different vendors’ platforms and judge the strengths and weaknesses of each on their own.

I guess what I’m saying is that while obtaining an academic understanding of health IT tools is great, the next step is to have med students get their hands on a wide variety of health IT tools and play with them before they’re on the front lines. That being said, adding pop health any clinical informatics is a step in the right direction

Physician Calls For Widespread Patient Data Ownership

Posted on October 26, 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.

At present, patients anywhere in the United States are entitled to access their patient records, but the records are typically controlled by providers. New Hampshire is the only state which provides citizens with legal ownership of the health information, notes Eric Topol, MD.

“That’s completely wrong. That has to get fixed,” said Topol, who spoke at the MedCity ENGAGE show last week. “It should be your data.”  In fact, he calls patient data ownership “a civil right that’s yet to be granted.”

Patient data ownership rules vary across the U.S. In many states, including Washington, Idaho, North Dakota, Minnesota, Wisconsin, Michigan, New York, Maine, Pennsylvania, and Nevada, there was no law in place as of mid-2015 which specified whether patients are providers owned or had property rights medical records. But in a large number of additional states, including Oregon, California, Texas, Georgia and New Mexico, state laws specifically state that the hospital or physician owns the medical record.

Long before EMRs went into wide use, ownership of medical records would occasionally come into dispute, such as when a practice went out of business or a hospital was acquired. The historic lack of clear case law governing such transactions would occasionally lead to major legal controversies during such transitions.

Today, the stakes are even higher, contends Topol, who serves as director of the Scripps Translational Science Institute at San Diego-based Scripps Health. To realize the benefits of “individualized medicine” – Topol’s term for “precision medicine” — patients will have to control their health data, he said.

“We are going to be leaving population medicine – where it’s one size fits all — in favor of individualized medicine,” Topol told the audience. With individualized medicine, patients drive their own care, he said.

The current centralized model of health data ownership actually poses a risk to patients, Topol argues, given the ripe, financially-attractive lure that big databases pose. “We need to decentralize this data because the more it’s amassed, the more it’s going to be hacked,” he contends.

So what of Topol’s vision for “individualized medicine”? Well, here’s how I see it. Topol’s comments are interesting, but it seems to me that there’s an inherent contradiction between one half of his arguments and the other.

If by talking about individualized medicine, he’s referring to what is otherwise known as precision medicine, I’m not sure how we can pull it off without building big databases. After all, you don’t gain broad understandings of how, say, a cancer drug works without crunching numbers on thousands or millions of cases. So while giving consumers more power over the medical records makes sense, I don’t see how we could fail to aggregate them to some degree at least.

On the other hand, however, it does seem absurd to me that patients should ever lack the right to retrieve all of the records from the custody of a provider, particularly if the patient alleges malpractice or some form of malfeasance. If we want patients to engage with their health, owning the documentation on the care they received strikes me as an absolutely necessary first step.

Creating Healthcare Interoperability Bundles

Posted on October 25, 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.

At this point in the evolution of healthcare data, you’d think it would be easy to at least define interoperability, even if we can’t make it happen. But the truth is that despite the critical importance of the term, we still aren’t as clear as we should be on how to define it. In fact, the range of possible solutions that can be called “interoperable” is all over the map.

For example, a TechTarget site defines interoperability as “the ability of a system or a product to work with other systems or products without special effort on the part of the customer.” When defined down to its most basic elements, even passive methods of pushing data from one to another count is interoperability, even if that data doesn’t get used in clinical care.

Meanwhile, an analysis by research firm KLAS breaks interoperability down into four levels of usefulness, ranked from information being available, to providers having the ability to locate records, to the availability of clinical view to this data having an impact on patient care.

According to a recent survey by the firm, 20% of respondents had access to patient information, 13% could easily locate the data, 8% could access the data via a clinical view and just 6% had interoperable data in hand that could impact patient care.

Clearly, there’s a big gap between these two definitions, and that’s a problem. Why? Because the way we define baseline interoperability will have concrete consequences on how data is organized, transmitted and stored. So I’d argue that until we have a better idea of what true, full interoperability looks like, maybe we should map out interoperability “bundles” that suit a given clinical situation.

A Variety of Interoperabilities

For example, if you’re an ACO addressing population health issues, it would make sense to define a specific level of interoperability needed to support patient self-management and behavioral change. And that would include not only sharing between EMR databases, but also remote monitoring information and even fitness tracking data. After all, there is little value to trying to, say, address chronic health concerns without addressing some data collected outside of clinic or hospital.

On the other hand, when caring for a nursing home-bound patient, coordination of care across hospitals, rehab centers, nurses, pharmacists and other caregivers is vital. So full-fledged interoperability in this setting must be effective horizontally, i.e. between institutions. Without a richly-detailed history of care, it can be quite difficult to help a dependent patient with a low level of physical or mental functioning effectively. (For more background on nursing home data sharing click here.)

Then, consider the case of a healthy married couple with two healthy children. Getting together the right data on these patients may simply be a matter of seeing to it that urgent care visit data is shared with a primary care physician, and that the occasional specialist is looped in as needed. To serve this population, in other words, you don’t need too many bells and whistles interoperability-wise.

Of course, it would be great if we could throw the floodgates open and share data with everyone everywhere the way, say, cellular networks do already. But given that such in event won’t happen anytime in the near future, it probably makes sense to limit our expectations and build some data sharing models that work today.

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.

E-Patient Update:  Keeping Data From Patients Has Consequences

Posted on September 20, 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.

Given who I am – an analyst and editor who’s waist-deep in the health IT world – I am primed to stay on top of my health data, including physician notes, lab reports, test results and imaging studies. Not only does it help me talk to my doctors, it gives me a feeling of control which I value.

The thing is, I’m not convinced that most physicians support me in this. Time and again, I run into situations where I can’t see my own health information via a portal until a physician “approves” the data. I’ve written about this phenomenon previously, mostly to wring my hands at the foolishness of it all, but I see the need to revisit the issue.

Having given the matter more thought, I’ve come to believe that withholding such data isn’t just unfortunate, it’s harmful. Not only does it hamper patients’ efforts to manage their own care effectively, it reveals attitudes which are likely to hold back the entire process of transforming the health system.

An Example of Delayed Health Data
Take the following example, from my own care. I was treated in the emergency department for swelling and pain which I feared might be related to a blood clot in my leg. The ED staff did a battery of tests, including an MRI, which concluded that I was actually suffering from lumbar spine issues.

Given that the spinal issue was painful and disabling, I made an appointment for follow up with a spine specialist for one week after the ED visit. But despite having signed up with the hospital’s portal, I was unable to retrieve the radiologist’s report until an hour before the spine specialist visit. And without that report the specialist would not have been able to act immediately to assist me.

I don’t know why I was unable to access the records for several days after my visit, but I can’t think of a reason why it would have made sense to deprive me of information I needed urgently for continued care. My previous experience, however, suggests that I probably had to wait until a physician reviewed the records and released them for my use.

Defeating the Purpose
To my way of looking at things, holding back records defeats the purpose of having portals in the first place. Ideally, patients don’t use portals as passive record repositories; instead, they visit them regularly and review key information generated by their clinical encounters, particularly if they suffer from chronic illnesses.

It’d be a real shame if conservative attitudes about sharing unvetted tests, imaging or procedure data undercut the benefits of portals. While it’s still not entirely clear how we’re going to engage patients further in managing their health – individually or across a population – portals are emerging as one of the more effective tools we’ve got. Bottom line, patients use them, and that’s a pretty big deal.

I’m not saying that patients have never overreacted to what looked like a scary result and called their doctor a million times in a panic. (That seems to be the scenario doctors fear, from conversations I’ve had over time.) But my guess is that it’s far less common than they think.

And in their attempts to head off a minor problem, they’re discouraging patients from getting involved with their care, which is what they need patients to do as value-based care models emerge. Seems like everyone loses.

Sure, patients may struggle to understand care data and notes at first, but what we need to do is educate them on what it means. We can’t afford to keep patients ignorant just to protect turf and salve egos.

What Do Med Students Need To Know About EMRs?

Posted on August 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.

Recently, I was asked to write an introduction to EMRs, focusing on what medical students needed to know in preparation for their future careers. This actually turned out to be a very interesting exercise, as it called for balancing history with the future, challenges with benefits and predictable future developments with some very interesting possibilities. Put another way, the exercise reminded me that any attempt to “explain” EMR technology calls for some fancy dancing.

Here’s some of the questions I tackled:

  • Do future doctors need to know more about how EMRs function today, or how they should probably function to support increasingly important patient management approaches like population health?
  • Do med students need to understand major technical discussions – such as the benefits of FHIR or how to wrangle Big Data – to perform as doctors? If so, how much detail is helpful?
  • How important is it to prepare med students to understand the role of data generated outside of traditional patient care settings, such as wearables data, remote monitoring and telemedicine consults? What do they need to know to prepare for the gradual integration of such data?
  • What skills, attitudes and practices will help physician trainees make the best use of EMRs and ancillary systems? And how should they obtain that knowledge?

These questions are thornier than they may appear at first glance, in part because there no hard-and-fast standards in place as to how doctors who’ve never run a practice on paper charts should conduct themselves. While there have been endless discussions about how to help doctors adopt an EMR for the first time, or switch from one to the other, I’m not aware of a mature set of best practices available to med students on how next-gen, health IT-assisted practices should function.

Certainly, offering med school trainees a look at the history of EMRs makes sense, as understanding the reasons early innovators developed the first systems offers some interesting insights. And introducing soon-to-be physicians to the benefits of wearable or remote monitoring data makes sense. Physicians will almost certainly improve the care they deliver by understanding EMRs then, now and their near-term evolution as data sources.

On the other hand, I’m not sure it makes sense to indoctrinate med students in today’s take on evolving topics like population health management or interoperability via FHIR. These paradigms are evolving so rapidly that pinning down a set of teachable ideas may be a disservice to these students.

Morever, telling students how to think about EMRs, or articulating what skills are needed to manage them, might actually be a bad idea. I’m optimistic enough to think that now that the initial adoption frenzy funded by HITECH is over, EMRs will become far more usable and physician-shapeable over the next few years, allowing new docs to adapt the tool to them rather than adapt to the tool.

All that being said, educating med students on EMRs and health IT ancillary tools is a great idea. I just hope that such training encourages them to keep learning well after the training is over.

CommonWell and Healthcare Interoperability

Posted on June 27, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: In case you missed the live interview, you can watch the recorded interview on YouTube below:

2016 June - CommonWell and Healthcare Interoperability-headshots

For our next Healthcare Scene interview, we’ll be sitting down with Scott Stuewe, Director at Cerner Network and Daniel Cane, CEO & Co-Founder at Modernizing Medicine on Wednesday, June 29, 2016 at 3 PM ET (Noon PT). Cerner was one of the Founding Members of CommonWell and Modernizing Medicine just announced they were joining CommonWell. No doubt these diverse perspectives will provide an engaging discussion about the work CommonWell is doing to improve healthcare data sharing.

You can join my live conversation with Scott Stuewe and Daniel Cane and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Wednesday, June 29, 2016 at 3 PM ET (Noon PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’re hoping to include as many people in the conversation as possible. The discussion will be recorded as well and available on this post after the interview.

As we usually do with these interviews, we’ll be doing a more formal interview with Scott Stuewe and Daniel Cane for the first ~30 minutes of this conversation. Then, we’ll open up the floor for others to ask questions or join us on camera. CommonWell has become a big player in the healthcare interoperability space with most of the major EHR vendors involved, so we’re excited to learn more about what’s happening with CommonWell.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

When Did A Doctor Last Worry About Social Determinants of Health (SDOH)?

Posted on June 16, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve heard over and over the importance of social determinants of health (SDOH) and their impact on healthcare costs. The concept is fascinating and challenging. There are thousands of examples. A simple one to illustrate the challenge is the patient who arrives at the emergency room with a fever. The doctor treats the fever and then sends them back to their home where they have no heat and are likely to get sick again.

I ask all the doctors that read this blog, when was the last time you worried about these various social determinants of health (SDOH) in the care you provided a patient?

I’ll be interested to hear people’s responses to this question. I’m sure it would create some incredible stories from doctors who really care about their patients and go above and beyond their job duties. In fact, it would be amazing to hear and share some of these stories. We could learn a lot from them. However, I’m also quite sure that almost all of those stories would end with the doctor saying “I wasn’t paid to help the patient this way but it was the right thing to do.”

Let me be clear. I’m not blaming doctors for not doing more for their patients. If I were a doctor, I’m sure I’d have made similar decisions to most of the doctors out there. They do what they’re paid to do.

As I’ve been sitting through the AHIP Institute conference, I’m pondering on if this will change. Will value based reimbursement force doctors to understand SDOH or will they just leave that to their health system or their various software systems to figure it out for them?

I’m torn on the answer to that question. A part of me thinks that most doctors won’t want to dive into that area of health. Their training wasn’t designed for that type of thinking and it would be a tough transition of mindset for many. On the other hand, I think there’s a really important human component that’s going to be required in SDOH. Doctors have an inherent level of trust that is extremely valuable with patients.

What do you think of SDOH? Will doctors need to learn about it? Will the systems just take care of it for them?