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E-Patient Update: All I Want For 2017

Posted on January 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.

Over the past year, I’ve done a lot of kvetching about the ways in which I think my e-relationships with doctors and hospitals have fallen short. I don’t regret doing so, but I think it’s just as important to focus on the future. So without further ado, here’s a list of ways in which providers could improve their digital interactions with me and my fellow patients during the coming year:

  • Have consistent policies and operations: Over time, I’ve found that many providers don’t seem to keep track of what they say about e-services such as portals and telemedicine visits. Others do little to let you know whether, say, doctors respond to email and how long it may take for them to do so. All of this creates patient confusion. This year, please be consistent in what you do and how you do it.
  • Create channels for patient feedback: As you may recall, I recently trashed a practice that didn’t respond to patient complaints about a broken appointment-making function on its site, and noted that all could have been avoided if patient objections had gotten routed to practice administrators sooner. Let’s make sure this doesn’t happen anymore. This year, make sure your patients don’t face this kind of frustration; create formal channels for patient technical feedback and have a process for escalating their concerns quickly.
  • Give us more access: While patients do have access to some data from their medical records, most of the time we still have to jump through onerous hoops if we need a complete record. Given that it’s all digital these days, this is very hard for us to understand, so fix this process. (And by the way, don’t pile on $2.50 per page charges when you produce a digitally-produced patient record; not only is it insulting and predatory, if that fee doesn’t reflect the costs of sharing the record it may be illegal in many states.)
  • Give us more control: Particularly when, like me, you have more than one chronic condition to manage, it gets very tiring to deal with the policies of multiple institutions when you want the big picture. We want more control of our records!  We’ll be much happier (and possibly healthier) if we have ways to compile complete record sets of our own.
  • Take us seriously: The following is not just an e-patient concern, but it still applies. Too often, when I raised a concern (“Why do you say I don’t have an appointment when I made one online?”) I’ve gotten a blank stare or defensive posturing. This year, providers, please take our digital problems as seriously as other any problems we face in interacting with you. We do!

As I look at this list, I think it’s interesting that I have no temptation to suggest one technology or another (though as your faithful scribe I’ve seen many intriguing options). The truth is, I’d submit, that most providers should get their social and operational ducks in a row before they roll out sophisticated patient engagement platforms or roll out major telehealth initiatives. Just make sure everything works, and everybody cares, and you’ll be off to a better start.

Patients Frustrated By Lack Of Health Data Access

Posted on January 3, 2017 I Written By

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

A new survey by Surescripts has concluded that patients are unhappy with their access to their healthcare data, and that they’d like to see the way in which their data is stored and shared change substantially.  Due to Surescripts’ focus on medication information management, many of the questions focus on meds, but the responses clearly reflect broader trends in health data sharing.

According to the 2016 Connected Care and the Patient Experience report, which drew on a survey of 1,000 Americans, most patients believe that their medical information should be stored electronically and shared in one central location. This, of course, flies in the face of current industry interoperability models, which largely focus on uniting countless distributed information sources.

Ninety-eight percent of respondents said that they felt that someone should have complete access to their medical records, though they don’t seem to have specified whom they’d prefer to play this role. They’re so concerned about having a complete medical record that 58% have attempted to compile their own medical history, Surescripts found.

Part of the reason they’re eager to see someone have full access to their health records is that it would make their care more efficient. For example, 93% said they felt doctors would save time if their patients’ medication history was in one location.

They’re also sick of retelling stories that could be found easily in a complete medical record, which is not too surprising given that they spend an average of 8 minutes on paperwork plus 8 minutes verbally sharing their medical history per doctor’s visit. To put this in perspective, 54% said that that renewing a driver’s license takes less work, 37% said opening a bank account was easier, and 32% said applying for a marriage license was simpler.

The respondents seemed very aware that improved data access would protect them, as well. Nine out of ten patients felt that their doctor would be less likely to prescribe the wrong medication if they had a more complete set of information. In fact, 90% of respondents said that they felt their lives could be endangered if their doctors don’t have access to their complete medication history.

Meanwhile, patients also seem more willing than ever to share their medical history. Researchers found that 77% will share physical information, 69% will share insurance information and 51% mental health information. I don’t have a comparable set of numbers to back this up, but my guess is that these are much higher levels than we’ve seen in the past.

On a separate note, the study noted that 52% of patients expect doctors to offer remote visits, and 36% believe that most doctor’s appointments will be remote in the next 10 years. Clearly, patients are demanding not just data access, but convenience.

American Well Deal Adds Remote Physical Exams To Its Offerings

Posted on December 9, 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.

Telehealth provider American Well has partnered with a vendor allowing patients to conduct and transfer data from their own basic physical exam during telemedical consults.

The partner, TytoCare, offers an “examination platform” allowing patients to do their own medical examination of the heart, lungs, abdomen, ears, throat, skin and temperature at home, then share the information with the clinician before or during their virtual visit.

Tyto’s consumer platform TytoHome, which is priced at $299, combines a digital stethoscope, otoscope, thermometer and examination camera. The company also offers a model, TytoPro, designed for professional use, which offers extended battery life, a headset for listening to heart and lung sounds, initial set of disposables for the otoscope and tongue depressor, and software designed specifically for clinician use. The company doesn’t say what the Pro technology costs.

Tyto’s software platform, meanwhile, offers cloud-based secure digital exchange of clinical data and a clinical repository. The company says it can integrate with most EHR systems as part of its TytoLink integration services. It doesn’t say what those integration services will cost, but it seems likely that they don’t come free.

At least at the outset, the partners plan to deliver services to health systems and employers, but without a doubt plans to scale beyond this. And they’re likely to have the resources to do so. American Well has established a foothold in telemedicine, while Tyto Care has received over $19 million in funding to date from investors that include Walgreens.

It’s worth noting at this point that TytoCare is far from the only player in the market offering remote examination tools. For example, I’m familiar with at least one vendor, MedWand Digital Health, offering a similar bundle of remote examination technologies. The MedWand platform lets consumers measure their heart rate or pulse or pulse ox level, listen to their heart, lungs or abdomen, look into their mouth, throat and ears, examine their skin and take the temperature. It can also integrate with other remote monitoring tools, such as connected glucometers of blood pressure monitors. It sells for $249.

And MedWand, like TytoCare, has venture backing, in this case from a technical partner. The company recently received a “major” investment from the venture arm for Maxim Integrated Products, which designs, manufactures and sells semiconductor products.

In my opinion, however, American Well may have a meaningful advantage over other competitors, as it appears to have fairly strong connections with health plans and health systems. The telehealth vendor has partnerships with more than 170 health plans and systems, and has created an enterprise telehealth platform designed to connect with providers’ clinical information systems.

While a company like MedWand may be better position to scale up a consumer technology offering — given backing by a semiconductor maker — over the near term I’d argue that better to be on good terms with those delivering and financing care. Right now, my guess is that very few consumers are willing to sink almost $300 into a home telehealth platform, even if they occasionally use telemedicine services, but this seems little doubt that health systems and health plans see the value of offering such services in a sophisticated way.

If I were either of these companies — or one of their competitors — I’d try to employers, health plans and health systems to buy and place the devices in the homes of chronically ill or high risk patients. But I don’t know if that’s in their plans. Let’s see how the next 12 months go.

How IRIS Puts the Real Triple Aim of Healthcare In Action

Posted on November 22, 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.

As I’ve been doing my Fall Healthcare IT Conference tour, I’ve had the chance to meet with hundreds of companies and thousands of people working to improve healthcare. While all this travel takes its toll, I also come away from all of these meetings invigorated by the quality of people and their desire to make healthcare better. That’s true almost across the board.

While most of the solutions I see are an evolution of something I’ve seen before, every once in a while I meet with a company that’s really impacting healthcare in a unique and interesting way. I found just such a case when I met with Patrick Cresson from IRIS – Intelligent Retinal Imaging Systems.

On face value, many might look at IRIS as just another diabetic retinopathy exam that’s been done by ophthalmologists forever. While this is true, what makes IRIS unique is that they have an FDA cleared exam that can be done in the primary care setting as opposed to being referred to an ophthalmologist. As Patrick pointed out to me, of all the diabetic screenings that need to be done for diabetic patients can be done in the primary care setting except for the retinal exam. At least that was the case before IRIS brought those exams to the primary care setting.

A look at the numbers is quite telling. There are 116 million patients with diabetes or pre-diabetes and that number is increasing every day. It’s estimated that 30 million diabetes patients get referred for an eye exam every year and 19 million diabetes patients do not get the annual retinal exam. There are plenty of reasons why this is the case, but it’s not hard to see why this happens. The same thing happens with referrals across healthcare. Diabetic patients that can’t tell any difference in their eyesight are unlikely to keep going back for an annual retinal exam. Who really wants to go to the pain of scheduling an appointment for what doesn’t seem to be an issue? So, they don’t.

The problem with this thinking is that diabetic retinopathy is asymptomatic. The only way to know if you’re heading for trouble is to have a retinal exam. The good news is that early detection can solve the problem and literally save diabetic patients’ eyesight. I know this first hand since it saved my grandfather’s eyesight.

This is the compelling story that IRIS tells as it pushes the retinal exam into the primary care setting where they can ensure patients are getting the early screenings they’ve so often missed in the past. This plays out in the numbers. Over the past 3 years, IRIS has performed 120,000 diabetic retinopathy exams which resulted in 56,000 patients identified with a pathology and 11,600 patients saved from potential blindness.

While this type of early detection can help healthcare organizations HEDIS compliance, I’m intrigued by the way IRIS straddles the fee for service and value based care worlds. I’ve seen very few models that get a primary care provider paid in the fee for service world, but also work to significantly lower the costs of healthcare in a value based care world. However, that’s exactly what you get from IRIS’s early screening exams.

What’s also fascinating to consider about IRIS is ophthalmologists’ response. It’s easy to see how many ophthalmologists could be afraid of diabetic retinal exams being done in the primary care setting and not in the ophthalmologists’ offices. That’s taking business away from them. While this is true, it’s also easy to see how an increase in retinal exams will drive more previously undiagnosed higher acuity exams, surgeries and interventions to ophthalmologists. Every ophthalmologist I know would much rather do a higher acuity surgery than a basic diabetic retinopathy exam. That’s the reality that IRIS creates since it’s an FDA cleared exam for diabetic retinopathy, but it’s only a screening tool for other eye diseases that require a full exam by an ophthalmologist.

Stories like IRIS are why I love blogging about healthcare IT. IRIS is changing healthcare as we know it by reducing healthcare costs, improving the patient experience, and getting doctors paid. That’s the real triple aim of healthcare in action.

E-Patient Update: Bringing mHealth To The People

Posted on November 11, 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, it’s standard for patients to travel to a central hub of some kind, spend as much as a half hour in the lobby and fill out a few minutes of paperwork to get a maximum of 15 minutes of time with their doctor. But thankfully, we’ve come to a time when care can return to the home. And it’s time we take full advantage of that fact.

I’d argue that it’s long overdue to bring the medical visit back to patient homes, not just for those in need of chronic care, but for all patients who are less than markedly stable. If we’re not quite at the point where we can provide every standard primary care service in a home, we’re pretty close, and it should be our goal to close the gap.

Consumers want convenience
While it might not be practical to roll out the service to everyone at once, we could start with patients who are healthy, but in higher risk categories due to age or condition. My mother comes to mind. At age 74, she has a history of cardiac arrhythmia, is slightly overweight and suffers from joint problems. None of these may pose an immediate risk to her health, but they are part of the complex process of aging for her, and all that goes with it.

I believe her health would be managed better if someone saw her “in her element,” taking care of my disabled brother, rushing around cooking dinner and climbing stairs. It would also be easier for clinicians to show her health information at her kitchen table, and get her engaged with making progress. (Kitchen tables are inherently less intimidating.)

Besides, there’s the issue of travel. Often, she finds it taxing to get organized and get to medical appointments, which take place 20 minutes away at the offices of her local health system. “I wish someone would bring a van with testing devices like an x-ray machine in it, bring their tablets into my house and do the check up at home,” she says. “There’s no reason for me to do all the traveling.” And believe me, folks, if a technophobe like my mom — who won’t touch a computer — is wondering why her physicians aren’t making better use of mobile healthcare tools, you can bet other patients are.

Mobile satisfaction
If you’re a health leader reading this, you may be flinching at the idea of reorganizing your services to hit the road. But it’s worth doing, particularly now that patients are demanding mobile health access. After all, rolling out a mobile-enhanced door to door primary care service would be an unbeatable way to differentiate yourself from your competitors and enhance patient satisfaction.

I believe that whatever investments you have to make would be modest in comparison to the benefits your patients would realize. If you come to them, not only are you getting to know them better, and as a result, you’re likely to improve care quality.

Now, I understand that if you’re traveling, you probably can’t pack four patient encounters into an hour, and that is certainly a financial consideration. But I believe patients would pay more to see their very own doctor (not a stranger, as with some startups) visit them at home. More importantly, I’d argue, a reworked system that puts patients at the center of their care would eventually save money, time and lives which is where value based reimbursement is headed anyway.

Point Of Care Testing Expansion Poses Data Management Challenges

Posted on November 3, 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.

With the advent of remote monitoring and other mHealth tools, the treatment process is again moving out towards the perimeter, perhaps not with a full return to house calls, but certainly a far greater emphasis on providing care in the field. And that will pose some new data collection and management challenges with their own unique character.

Collecting results from these devices won’t be difficult in and of itself. But we should think about how testing results vary from other types of physician-generated and patient-generated data before we pour it into existing oceans of clinical data.

A revolution in the wings
While you may not be familiar with the point of care diagnostics market, it’s definitely worth a look. The POC diagnostics industry, which includes both professional point of care testing and consumer options, should be worth almost $40 billion within five years, according to research firm Markets and Markets.

Over the next five years, a wide range of new POC options are likely to emerge, in categories that include ultrasound and other imaging, blood tests, cardiovascular imaging and more, Markets and Markets reports. And the devices that fuel this revolution are far more capable than a testing strip in a box; they’re emerging in a world where health advances are almost always found somewhere along the digital spectrum.

Want an example? Consider Scanadu Urine, a urine test kit designed to help monitor maternal and women’s health. The product package does include an old-fashioned paddle to dip in a urine sample, but it doesn’t stop there. Once the user dips the disposable paddle into the sample, they use the Scanadu app and their smartphone to read and interpret color changes on the paddle. Then, they can display, store or share the results via the app. Like many of its competitors, parent company Scanadu hasn’t gotten FDA approval for this or its other health monitoring devices, but that’s in the works.

Other niches already have multiple FDA-approved entrants, such as the mobile ultrasound category, but also emerging smartphone-based competitors such as Clarius Mobile Health. Like Scanadu Urine, Clarius isn’t FDA-approved yet, but the company reports that approval is pending.

As long as these devices remain unapproved by the FDA, they’ll stay in the background. But once devices like these get approved and start hitting the market, they should shake up the healthcare industry. After all, they don’t just empower consumers doing routine tests, they should also make it possible for patients to share important, reliable testing results to telemedicine doctors more or less in real time.

Managing POC data

Eventually, POC diagnostics data – even devices aimed almost exclusively at consumers — will become a completely standard part of the clinical diagnostic process. This much seems obvious. After all, if we want patients to engage with their health, putting powerful, reliable urine testing devices in their hands makes as much sense as giving them a connected glucose monitor, doesn’t it?

That being said, managing and integrating this data into patient data warehouses poses some unique challenges.

For example, how do providers weight the importance of various data streams when integrating them into databases?  After all, some devices are FDA-approved and some are not; some tests are administered by consumers and some by mobile professionals; some data comes from hospital- or clinic-provided remote monitoring devices and some from consumer-grade wearables or sensors.

Another question is how we’ll integrate these results. Even if we were to treat all data as equal (consumer- and professional-grade testing devices alike) do we have to integrate it in real time? Do we only do analysis and data dumps POC data into a big pool, do we pair it with other relevant data as needed or ignore it unless it seems immediately relevant?  We need to figure this out.

Bottom line, it’s probably smart to handle these data streams differently, but figuring out how to do so will be a challenge. We’ll have to develop algorithms for sorting this data soon, or risk being overwhelmed.

Talking Health Transformation at the First Ever #ATAChat

Posted on October 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.

telemedicine-twitter-chat-ata

I’m excited to be the first host of the newly launched #ATAChat organized by the American Academy of Telemedicine. I was lucky to run into Nathaniel Lacktman, an expert legal resource on telehealth, at a recent conference and from that meeting it led to the opportunity for Healthcare Scene to host the first American Telemedicine Association Twitter chat.

For the first Twitter chat, we left the conversation pretty open ended to cover a variety of innovations and transformations happening in healthcare and telehealth. I imagine future ATA Chats will dive deeper into the challenges of telehealth and healthcare transformation. If you have an interest in this area, come and share your insights in what you see happening and things you’re working on. Plus, you’ll be able to learn and connect with a wide variety of other healthcare innovators.

To join the #ATAChat on Twitter, just search for the #ATAChat hashtag on Wednesday, November 9, 2016 at 2 PM ET (11 AM PT). We’ll post the following 5 questions over the hour long chat:

  1. What role should technology play in healthcare and innovation?
  2. What are some of the most exciting ways providers are using virtual care to deliver services?
  3. How is telehealth changing the role of healthcare professionals’ “human touch”, and is it a good thing for patients?
  4. What are the biggest barriers to healthcare innovation and what solutions can we use to navigate them?
  5. What are the best opportunities and areas of unmet need for telehealth and virtual care in the next 3 years?

If you have an insight, question, or comment, just add #ATAChat to your tweets and everyone that’s following along will see it. We hope to make it a really interactive discussion. Plus, it’s always fun to meet new and interesting people that you can connect with on social media.

I look forward to seeing everyone at the #ACAChat on Wed November 9th!

AMA Touts Physician Interest In Digital Health Tools

Posted on October 13, 2016 I Written By

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

A few months ago, the group’s annual meeting, American Medical Association head Dr. James Madara ignited a firestorm of controversy when he suggested that many direct to consumer digital health products, apps and even EMRs were “the digital snake oil of the early 21st century.” Madara, who as far as I can tell never backed down completely from that statement, certainly raised a few hackles with his pronouncement.

Now, the AMA has come out with the results of physician survey whose results suggest that community doctors may be more excited about digital health’s potential than the AMA leader. The survey found that physicians are optimistic about digital health, though some issues must be addressed before they will be ready to adopt such technologies.

The study, which was backed by the AMA and conducted by research firm Kantar TNS, surveyed 1,300 physicians between July 7 and 18. Its content addressed a wide range of digital health technologies, including mobile apps, remote monitoring, wearables, mobile health and telemedicine.

Key findings of the study include the following:

  • While physicians across all age groups, practice settings and tenures were optimistic about the potential for digital health, their level of enthusiasm was greater than their current adoption rates.
  • The majority of physicians surveyed (85% of respondents) believe that digital health solutions can have a positive impact on patient care.
  • Physicians reported that they were optimistic a digital health can reduce burnout, while improving practice efficiency, patient safety and diagnostic capabilities.
  • Physicians said liability coverage, data privacy and integration of digital health tools with EMR workflows were critical to digital health adoption, as well as the availability of easy-to-use technologies which are proven to be effective and reimbursement for time spent conducting virtual visits.

All told, physicians seem willing to use digital health tools if they fit into their clinical practice. And now, it seems that the AMA wants to get out ahead of this wave, as long as the tools meet their demands. “The AMA is dedicated to shaping a future when digital health tools are evidence based, validated, interoperable, and actionable,” said AMA Immediate Past President Steven J. Stack, M.D

By the way, though it hasn’t publicized them highly, the AMA noted that it has already dipped its oar into several digital health-related ventures:

  • It serves as founding partner to Health2047, a San Francisco-based health care innovation company that combines strategy, design and venture disciplines.
  • It’s involved in a partnership with Chicago-based incubator MATTER, to allow entrepreneurs and physicians to collaborate on the development of new technologies, services and products in a simulated health care environment.
  • It’s collaborating with IDEA Labs, a student-run biotechnology incubator, that helps to support the next generation of young entrepreneurs to tackle unmet needs in healthcare delivery and clinical medicine.
  • It’s playing an advisory role to the SMART project, whose key mission is the development of a flexible information infrastructure that allows for free, open development of plug-and-play apps to increase interoperability among health care technologies, including EHRs, in a more cost-effective way.
  • It’s involved in a partnership with Omada Health and Intermountain Healthcare that has introduced evidence-based, technology-enabled care models addressing prediabetes.

Personally, I have little doubt that this survey is a direct response to the “snake oil” speech. But regardless of why the AMA is seeking a rapproachment with digital health players, it’s a good thing. I’m just happy to see the venerable physicians’ group come down on the side of progress.

 

One Example Of An Enterprise Telehealth System

Posted on August 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.

While there’s a lot of talk about how telehealth visits need to be integrated with EMRs, I’m not aware of any well thought-out model for doing so. In the absence of such standardized models, I thought it worth looking at the approach taken by American Well, one of a growing list of telehealth firms which are not owned by a pre-existing provider organization. (Other examples of such telemedicine companies include MD Live, Teladoc and Doctor on Demand.)

American Well is now working with more than 170 health plans and health systems to streamline and integrate the telehealth process with provider workflows. To support these partners, it has created an enterprise telehealth platform designed to connect with providers’ clinical information systems, according to Craig Bagley, director of sales engineering for the firm.

Bagley, who recently hosted a webinar on EMR/telehealth integration for AW, said its system was designed to let providers offer telehealth consults labeled with their own brand name. Using its system, patients move through as follows, he said:

  • First, new patients sign up and enter their insurance information and demographics, which are entered into AW’s system.
  • Next, they are automatically connected to the provider’s EMR system. At that point, they can review their clinical history, schedule visits and get notifications. They can also contact their doctor(s).
  • At this point, they enter the telehealth system’s virtual “waiting room.” Behind the scenes, doctors can view the patients who are in the waiting room, and if they click on a patient name, they can review patient information collected from the EMR, as well as the reason for the visit.

Now, I’m not presenting this model as perfect. Ultimately, providers will need their EMR vendors to support virtual visits directly, and find ways to characterize and store the video content generated by such visits as well. This is becoming steadily more important as telemedicine deployments hit their stride in provider organizations.

True, it looks like AW’s approach helps providers move in this direction, but only somewhat. While it may do a good job of connecting patients and physicians to existing clinical information, it doesn’t sound as though it actually does “integrate” notes from the telehealth consult in any meaningful way.

Not only that, there are definitely security questions that might arise when considering a rollout of this technology. To be fair, I’m not privy to the details of how AW’s platform is deployed, but there’s always HIPAA concerns that come up when an outside vendor like AW interacts with your EMR. Of course, you may be handing off clinical information to far less healthcare-focused vendors under some business associate contracts, but still, it’s a consideration.

And no matter how elegant AW’s workaround is – if “workaround” is a fair word – it’s still not enough yet. It’s going to be a while before players in this category serve as any kind of a substitute for EMR-based conferencing technology which can document such visits dynamically.

Nonetheless, I was interested to see where AW is headed. It looks like we’re just at the start of the enterprise-level telemedicine system, but it’s still a much-needed step.

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.