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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.

The Value Of Pairing Machine Learning With EMRs

Posted on January 5, 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.

According to Leonard D’Avolio, the healthcare industry has tools at its disposal, known variously as AI, big data, machine learning, data mining and cognitive computing, which can turn the EMR into a platform which supports next-gen value-based care.

Until we drop the fuzzy rhetoric around these tools – which have offered superior predictive performance for two decades, he notes – it’s unlikely we’ll generate full value from using them. But if we take a hard, cold look at the strengths and weaknesses of such approaches, we’ll get further, says D’Avolio, who wrote on this topic recently for The Health Care Blog.

D’Avolio, a PhD who serves as assistant professor at Harvard Medical School, is also CEO and co-founder of AI vendor Cyft, and clearly has a dog in this fight. Still, my instinct is that his points on the pros and cons of machine learning/AI/whatever are reasonable and add to the discussion of EMRs’ future.

According to D’Avolio, some of the benefits of machine learning technologies include:

  • The ability to consider many more data points than traditional risk scoring or rules-based models
  • The fact that machine learning-related approaches don’t require that data be properly formatted or standardized (a big deal given how varied such data inflows are these days)
  • The fact that if you combine machine learning with natural language processing, you can mine free text created by clinicians or case managers to predict which patients may need attention

On the flip side, he notes, this family of technologies comes with a major limitation as well. To date, he points out, such platforms have only been accessible to experts, as interfaces are typically designed for use by specially trained data scientists. As a result, the results of machine learning processes have traditionally been delivered as recommendations, rather than datasets or modules which can be shared around an organization.

While D’Avolio doesn’t say this himself, my guess is that the new world he heralds – in which machine learning, natural language processing and other cutting-edge technologies are common – won’t be arriving for quite some time.

Of course, for healthcare organizations with enough resources, the future is now, and cases like the predictive analytics efforts going on within Paris public hospitals and Geisinger Health System make the point nicely. Clearly, there’s much to be gained in performing advanced, liquidly-flowing analyses of EMR data and related resources. (Geisinger has already seen multiple benefits from its investments, though its data analytics rollout is relatively new.)

On the other hand, independent medical practices, smaller and rural hospitals and ancillary providers may not see much direct impact from these projects for quite a while. So while D’Avolio’s enthusiasm for marrying EMRs and machine learning makes sense, the game is just getting started.

Patient Engagement Discussion on the eCW Podcast

Posted on January 4, 2017 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 was recently asked to take part in the newly launched eCW podcast. Having done so many interviews for Healthcare Scene myself, it was fun to have the tables turned and be interviewed. The majority of our discussion was about patient engagement and they broke it up into 2 parts. If you’re interested in patient engagement, check out the 2 part interview below.

The Future of Patient Engagement: A Discussion with John Lynn from Healthcarescene.com Part 1

The Future of Patient Engagement: A Discussion with John Lynn from Healthcarescene.com Part 2

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.

MACRA is Required by Law to Be Budget Neutral – What’s The Impact? – MACRA Monday

Posted on January 2, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

In my last post on MIPS benefits and the “Pick Your Pace” options, I published an old slide which highlighted the potential positive and negative payment adjustments under MIPS. Thanks to Lynn Scheps from SRSsoft (she also wrote our previous Meaningful Use Monday series of blog posts), it was pointed out to me that there’s one big caveat to how much positive payment adjustment you’d receive under MIPS. I don’t know how I missed it on page 1282-1286 of the final rule. It was such an important point, that I wanted to dive into all the details in a MACRA Monday post of its own.

This all gets pretty technical, pretty quickly, but we’ll try to make this as simple to understand as possible. The core issue at hand is that the MACRA program has to be budget neutral. This means that the MACRA penalties have to offset any MACRA benefits that are paid to participants. Since Pick Your Pace has made it so very few practices will receive the 4% MACRA penalty, that means that there won’t be as big of a pool of incentives available to those who do participate in MACRA.

The math gets pretty complicated, but this chart illustrates how the adjustments you receive could be effected by the need to make the program budget neutral:

This chart is illustrative, but I also believe that it’s a decent representation of what’s likely to happen given the lack of MIPS penalties that will be assessed. If the chart is accurate, most MIPS participants will receive less than a 1% incentive and exceptional performers will be less then 2.4%. That’s quite a big difference between the 4% that was originally discussed.

Now remember that CMS was stuck in a tough position. They had a legal requirement to make it budget neutral. They could have continued with the 4% positive payment adjustment, but that would mean that a whole bunch of practices would get a 4% negative payment adjustment. Instead, they chose to do Pick Your Pace to give people a chance to avoid the penalties. Now those people are happy, but exceptional performers pay the price because there’s no budget to reward the exceptional performers.

At least this is how I read the legalese. If anyone has any other nuances I missed, please let us know in the comments. Next week we’ll start diving into more of the MIPS Categories and changes to the MIPS Composite Score.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update:  When Your Tech Fails, Own It!

Posted on December 30, 2016 I Written By

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

I am reasonably comfortable with my primary care practice which, though not exactly chi-chi – no latte machine in the lobby! — does a reasonably good job with the basics of scheduling, payment, referrals and the like.  And I also like that my PCP is part of a multispecialty group linked together by an athenahealth EMR and portal, which makes it easier to coordinate my care.

But recently, I’ve run into some technical problems with the practice portal, repeatedly and inconveniently. And rather than take action, apologize or even acknowledge the problem on an executive level, the group appears to be doing nothing whatsoever to address the issue.

The issue I’m having is that while the portal is supposed to let you schedule appointments online, my last two didn’t show up in the group’s live schedule. This may not sound like a big deal, but it is. One of the appointments was to see a neurologist for help with blinding migraines, and trying to attend the non-existent meeting was a nightmare.

Because I needed my neurologist, I scraped myself out of bed, put on an eye mask to avoid extra light exposure – migraine makes you terribly light-sensitive – and had my husband guide me to the car. But when I walked into the lobby (peeking out from under the mask to avoid crashing into things) I was told that they had nothing for me on the schedule.

Almost crying at this point, and with migraine-induced tears streaming down my cheeks, I begged them to squeeze me in, but they refused. To add insult to injury, they all but told me that it must have been my fault that the appointment booking didn’t take. There was no “I’m sorry this happened” whatsoever, nor any suggestion that their technology might be glitchy. If I hadn’t been so sick I might have gotten into a screaming match with the supercilious receptionist, but given my condition I just slinked away and went back to bed.

I’ve since learned, from a much nicer clerk at the affiliated primary care practice, that the group has been getting scores of calls from similarly aggrieved patients whose time had been wasted – and health needs unmet. “Tell the doctor, so she can tell the practice management committee,” she told me. “This is happening all the time.”

Of course, because I write about health IT, I realize that practice leaders may be struggling with issues that defy an easy fix, but I’m still disappointed with their failure to respond publicly. There are many steps they could have taken, including:

* Putting a warning on their practice website, and (if possible) the portal that the scheduling function has issues and to double-check that their appointment registered
* Disabling the scheduling function entirely until they’re reasonably certain it works
* Putting a sign in on the practice’s front desk alerting patients about the problem
* Updating the practice’s “hold” message with an advisory

And that’s just what came to mind immediately. They could do postcards, email messages, letters, robocalls…I don’t care if they drive around town with a guy who shouts the message into a megaphone. I just want expect them to take responsibility and treat my time and health with respect. Sure, tech will go south, but if it does, own it! There’s no excuse for ignoring problems like these.

Healthcare Trade Groups Join To Evaluate mHealth Apps

Posted on December 29, 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 group of leading healthcare organizations, including HIMSS, the American Medical Association, the American Heart Association and DHX Group, have come together to evaluate mHealth apps. The new organization, which calls itself Xcertia, says members came together to foster knowledge about clinical content, usability, privacy, security and evidence of efficacy for such apps.

It’s hardly surprising that that healthcare groups would want to take a stand on the issue of health app quality. According to a study published late last year by the IMS Institute for Healthcare Informatics, there are at least 165,000 mHealth apps available on the iTunes and Android stores.

But what percentage of those apps are worth using? Nobody really knows. It’s hard to tell after casual use which apps are useful and which don’t live up to their hype, which protect patient privacy and which leave data open to prying eyes, and particularly, which offer some form of clinical benefit and which just waste people’s time. And without a set of formal standards by which to judge, it’s very hard to compare one with the other in a meaningful way.

This uncertainty is holding back mHealth adoption by doctors. According to a recent survey by the AMA, physicians are interested in using apps and related tools – in fact, 85% told researches that digital health solutions can have a positive impact on patient care – they’re also reluctant to “prescribe” apps until they understand them better. (There’s also a group of doctors I’ve encountered who say that until mobile apps are FDA-approved, they won’t take them seriously, but that may be another story.)

In late November, attendees at a recent AMA meeting moved the mHealth puck up the ice a little bit, adopting a set of proposed set best principles for mobile health design. The criteria they adopted for mobile apps and devices included that they should follow evidence-based practice guidelines, support data portability and interoperability, and have a clinical evidence base to support their use. But these guidelines are hardly specific enough to help doctors decide which apps to adopt.

So far, all Xcertia is willing to say about its plans is that it plans to develop a framework of principles that will “positively impact the trajectory of the mobile health app industry.” The guidelines should help both consumers and clinicians choose mHealth apps, the group reports.

Let’s hope those guidelines are less ho-hum than those coming out of the AMA meeting – after all, it certainly would be good if developers and providers had concrete standards upon which they could base their app efforts.

Is Lack of Security the Death Knell of Cloud Companies?

Posted on December 28, 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.

In the eternal discussion of what’s more secure: cloud or in house, it was recently pointed out to me why many people now believe that a cloud company is more secure than anything you would implement in house. Here’s the reason: If a cloud company gets breached, they’re dead.

I think this is true. At least it’s true in healthcare. I don’t know many healthcare organizations that would select a cloud healthcare IT company that had just been breached. Not many. If you’re a healthcare cloud company and you get breached, your future is basically over as a company. There might be a few that could survive if they have enough money, if there are mitigating circumstances, etc, but that’s going to be pretty rare.

With this in mind, it’s easy to understand why a cloud based healthcare company is going to invest to ensure they don’t get breached. No startup founder or health IT company CEO wants to put their blood, sweat, and tears into a company that gets blown up because they didn’t address proper security and get breached.

What happens if a healthcare organization gets breached? If you’ve ever been there, it’s not a fun experience. It’s embarrassing. This is particularly true if your breach is large enough (500 or more individuals) to end up on the HHS Wall of Shame. I mean the HHS Breach Portal. Yes, there are often even fines associated with a breach as well. It’s not pretty and it’s not fun. However, most healthcare organizations that get breached continue practicing like usual. Sure, they likely make an investment in some more security, a proper risk assessment, etc, but the company still continues providing healthcare services like usual.

Fear isn’t always the best driver in life, but it can be a good one. Cloud healthcare companies have a healthy fear of being breached because their company’s future depends on it. That’s a powerful motivator to make sure you avoid breaches. I’m sorry to say that most healthcare organizations don’t have this same fear and motivation. Most of them still employ what I call the “Just Enough” approach to security and privacy. Note that it’s “Just Enough” to sleep at night as opposed to “Just Enough” to be secure. There’s a difference.

No doubt there are exceptions to the above on both sides of the aisle. Some cloud healthcare companies don’t do a good job securing their technology. Some healthcare organizations do a really excellent job securing their organizations. However, as a rule, I think it’s fair to say that most cloud healthcare companies are more secure than hosting something in house.

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 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.

Two formerly competitive health data interoperability groups have agreed to work together to share data with each others’ members. CommonWell Health Alliance, which made waves when it included Cerner but not Epic in its membership, has agreed to share data with Carequality, of which Epic is a part. (Of course, Epic said that it chose not to participate in the former group, but let’s not get off track with inside baseball here!)

Anyway, CommonWell was founded in early 2013 by a group of six health IT vendors (Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth.) Carequality, for its part, launched in January of this year, with Epic, eClinicalWorks, NextGen Healthcare and Surescripts on board.

Under the terms of the deal, the two will shake hands and play nicely together. The effort will seemingly be assisted by The Sequoia Project, the nonprofit parent under which Carequality operates.

The Sequoia Project brings plenty of experience to the table, as it operates eHealth Exchange, a national health information network. Its members include the AMA, Kaiser Permanente, CVS’s Minute Clinic, Walgreens and Surescripts, while CommonWell is largely vendor-focused.

As things stand, CommonWell runs a health data sharing network allowing for cross-vendor nationwide data exchange. Its services include patient ID management, record location and query/retrieve broker services which enable providers to locate multiple records for patient using a single query.

Carequality, for its part, offers a framework which supports interoperability between health data sharing network and service providers. Its members include payer networks, vendor networks, ACOs, personal health record and consumer services.

Going forward, CommonWell will allow its subscribers to share health information through directed queries with any Carequality participant.  Meanwhile, Carequality will create a version of the CommonWell record locator service and make it available to any of its providers.

Once the record-sharing agreement is fully implemented, it should have wide ranging effects. According to The Sequoia Project, CommonWell and Carequality participants cut across more than 90% of the acute EHR market, and nearly 60% of the ambulatory EHR market. Over 15,000 hospitals clinics and other healthcare providers are actively using the Carequality framework or CommonWell network.

But as with any interoperability project, the devil will be in the details. While cross-group cooperation sounds good, my guess is that it will take quite a while for both groups to roll out production versions of their new data sharing technologies.

It’s hard for me to imagine any scenario in which the two won’t engage in some internecine sniping over how to get this done. After all, people have a psychological investment in their chosen interoperability approach – so I’d be astonished if the two teams don’t have, let’s say, heated discussions over how to resolve their technical differences. After all, it’s human factors like these which always seem to slow other worthy efforts.

Still, on the whole I’d say that if it works, this deal is good for health IT. More cooperation is definitely better than less.

Slick Setups to Make Your Health Clinic’s Processes Simple

Posted on December 26, 2016 I Written By

The following is a guest blog post by Eileen O’Shanassy.

Medical technologies have come a long way since the days of manual appointment and check-in books, clip-board health information, gathering forms, and huge patient medical chart walls. Today, health clinics can enjoy far more simple and efficient processes with only a few changes to traditional methods of providing healthcare. Consider these following four easy-to-use and inexpensive technologies for your own health clinic.

Touchscreen Check-In Desks
You do not have to pay your front office staff any longer to check in patients. With this slick setup, a patient walks up to a desk that features a wide, large LCD monitor located inside the waiting room or near the receptionist’s desk. Instructions at this touchscreen check-in desk explain to the patient that they only need to tap the screen and then tap out the letters of their name using large virtual buttons to check themselves into your clinic. In some clinics that offer a variety of diagnostic and treatment services, patients also select a clinic area.

Health Information Kiosks
A lot of front office staff time is wasted every day providing patients with information that is already available on your clinic’s website or local affiliated health system’s site. With the slick setup of a health information kiosk, your front office staff can direct patients to the kiosk and return to other tasks. Beyond information about the services offered at your clinic and local healthcare systems, health information kiosks can also be set up to provide patients local news and weather conditions, health and safety tips, emergency alerts, and even details about local restaurants and businesses.

Identification Scanning Software
One of the slowest processes at a clinic with new patients is establishing a record that contains accurate personal and health information. Some healthcare systems now provide clinics with the ability to quickly access information about patients already in their medical data storage programs. This is done electronically via scanning software that can be used with a patient’s driver’s license, medical insurance card, or a special system healthcare card. This type of slick setup also makes it possible for your clinic to save important information about a patient who is entirely new to the area and share it with local specialists and their staff members in hospital and other facilities.

These are only a few examples of the types of slick setups that can make traditional processes in your health clinic simple. These and other cutting edge methods can also result in positive testimonials that attract more new patients to your clinic.

About Eileen O’Shanassy
Eileen O’Shanassy is a freelance writer and blogger based out of Flagstaff, AZ. She writes on a variety of topics and loves to research and write. She enjoys baking, biking, and kayaking. Check out her Twitter @eileenoshanassy. For more information on medical data storage and new technology check out Health Data Archiver.