Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Patient Engagement Distracts the Health Care Field From Reform (Part 2 of 2)

Posted on January 12, 2016 I Written By

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

The previous segment of this article looked at the movement for patient engagement, or the patient experience. Now I’ll highlight a true reform in the health care system.

Patients Left Out in the Cold
What activist patients and doctors have been demanding for years is not engagement or a better experience, but a central role for the patient in choosing treatment and carrying it out when they leave the doctor’s office. Patient empowerment is the key to all the things doctors profess to care about, such as preventing readmissions. It’s even more critical with chronic diseases that have a lifestyle component, such as congestive heart failure and diabetes.

Some patients come to the clinical setting endowed with more education than others, or a personality suited to pushing back and demanding rights. But some fight for years for such basics as access to their records. I was dejected to read just a few weeks ago of an attempt to improve care in Rhode Island, endorsed no less by the American College of Physicians, that boasts about giving access to everybody except the patient to health records.

The American College of Physicians is concerned about the hypothetical patient who “doesn’t know the name of the peach-colored pill that the orthopedist prescribed.” That particular patient is clearly not asking for empowerment. But millions do keep track of their medications and deserve equal knowledge about the rest of the information about their medical condition. If the peach-colored pill had been recorded in a patient health record, accessible to the patient (or a responsible care-giver) wherever she goes, all the complex Health Information Exchange infrastructure praised in the article could go by the wayside. Another article describes an emerging PHR solution.

Another recent example of the disdain for patients comes in a complaint by AHIMA about the difficulties of matching records for a single patient. Duplicate records are undeniably a serious problem (as is information mistakenly entered in a different person’s record). But instead of recognizing the obvious solution of a PHR, all they can come up with is a universal identifier (which is a privacy risk as well as a target for security attacks) and more determined efforts to match patients the old-fashioned way.

Empowered patients have control over their own information. Doctors guide them to make reasonable choices that affect their health, which includes sharing those records. Empowered patients set their own goals and timetables. A grant of power and information to patients will inevitably empower and inform the other health professionals with whom those patients interact, leading to a learning health system and a true team approach to care.

What’s the difference?
As I eventually admitted, the movement for patient engagement offers many good ideas that can contribute not only to a better experience in the health care center but to patient empowerment and better outcomes. What I complain about is the motive behind patient engagement.

Let’s take patient portals. To proponents of patient engagement, it serves a few purposes related to public relations. The portal hopefully:

  • Indulges people’s preference for fast information, endearing them to the practice

  • Keeps them more “engaged,” meaning that they’ll come back and spend more money at the health care center.

  • Delivers information in more appealing ways (such as through video, when practices use it).

  • Takes routine tasks off the shoulders of staff, freeing them to do other things that improve the patient experience.

This poverty of vision is why most portals lack useful information that patients can use to actually improve their care. Discharge instructions are usually a crumpled page. Doctor notes are hidden away, available to malicious attackers more easily than to patients. Medical codes and raw numbers appear on the portal without further elucidation.

Modern health facilities use web sites along with text messaging, old-fashioned phone calls, and other tools as part of a strategy to keep patients on their treatment plans. They may have full discharge instructions, along with instructional videos for such important tasks as changing bandages, on a patient’s personal site. The patient is encouraged to report her progress along with any setbacks, and gets quick feedback when there is a change. Many face-to-face visits can be averted, and patients who can update their caretakers without leaving home are less likely to exhaust themselves at vulnerable times. The patient’s family members can easily keep up with changes and find out what they need to do, as can other professionals working on the case.

For every element of empowerment, there is a tawdry alternative that can be offered as “engagement.” That’s the risk in the patient experience movement. Unless the health care institutions start out with the philosophy of empowerment, it’s just another distraction from the work we need to do.

Patient Engagement Distracts the Health Care Field From Reform (Part 1 of 2)

Posted on January 11, 2016 I Written By

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

One can derive a certain sense of entertainment, along with a discomfort comparable to the unending alarms one hears in the background of a hospital ward, when one sees an industry fumble over a critical task and seek desperately for a solution that takes the heat off of them while freeing them from the thoroughgoing cultural and organizational change that the crisis clearly calls for. If you haven’t figured out the issue I’m talking about yet, it’s the hot topic in health care circles these days: patient engagement.

Patient engagement is starkly counterposed to patient empowerment, which is the demand issued by the activists most engaged in health care these days. This article will look at the overlap and differences.

The Elusive Hunt for the Happy Patient
Doctors and administrators must be annoyed at having take time away from busy schedules to learn new bedside manners, but articles pour out on web sites almost daily telling them they need to do so. Typical titles are Social Media 101 For Healthcare CXOs and 5 Elements of a Successful Patient Engagement Strategy. A whole new job description has been even created: the patient experience officer, adding another expensive office to the hospital bureaucracy (with a concomitant rise in hospital costs, I’m sure).

I’ll double back later and admit that many of recommended strategies could help improve care. But an initial indulgence in cynicism is still justified.

Atul Gawande contributed to the fervor for treating patients as customers through his notorious ode to the Cheesecake Factory. The strengths and weaknesses of that comparison have been intelligently analyzed by numerous articles, such as ones in Forbes and KevinMD.

Another commentary shrewdly notes that clinicians themselves suppress patient engagement through problems ranging from lack of record sharing to opaque pricing.

One can sympathize with clinical administrators caught up in the rating frenzy that has overtaken everything we buy and every institution with which we interact. People seem to listen to other people’s rants over long waits or snippy receptionists when choosing which doctor to call (that is, people, lucky enough to have a choice of doctors–a topic beyond the scope of this article). The Department of Health and Human Services has legitimized the concern for patient ratings with its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, introduced in 2006. CMS uses a hospital’s score while determining its Medicare pay rate for inpatient care. (There’s help yet again for beleaguered administrators: Five Tips to Improve Your HCAHPS Scores).

OK, patient experience is important. I certainly couldn’t argue against empathy or compassion. One study found that communicating well with patients contributes more than other “quality measures” to reducing hospital readmissions. The critical issue of patient access to records will be addressed in my next section. More minor improvements to the patient experience can have ripple effects–for instance, moving them through the waiting room and examination faster reduces their risk of picking up infections. Even the snippy receptionist contributes to stress that’s bad for health, or discourages a patient from making an important follow-up visit.

But patient experience does not equal good care. As highlighted in an article in the Atlantic Magazine, patients are easily misled by superficial conveniences. Real improvement in care, the article says, comes from more nurses and a better working environment.

If people are dropping right and left from bugs picked up in restaurants (as they did in a number of Chipotle outlets), we wouldn’t be asking customers to rate the foam on their coffees or whether the waiters smiled at them. We’d be instituting a strong restaurant inspection regimen.

That’s the position of our hospitals and clinics. We have much worse things to worry about than the lengths of time spent in the waiting room. But if we want a focus on patients, there’s another way to do it that I’ll discuss in the next segment of the article.

Fee for Service is Dead

Posted on July 9, 2013 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 a recent call with the Collaborative Health Consortium, Mark Blatt, MD, Director of Intel Health made some pretty strong statements as a front end to the Healthcare Unbound conference happening this week. In his comments he essentially predicts the end of Fee-For-Service, calling it a dinosaur that will not survive and saying that “this is like a 30-day eviction notice…and it’s happening faster than anyone thinks.”

I find this really interesting because he’s the second high level leader in healthcare that I’ve heard say that the switch away from Fee for Service is happening faster than any of us realize. I wonder what the consequences will be of us not realizing this change is happening. Plus, the odd thing is that we can all see this change happening. Is is that we’re just not understanding the consequences the change will have on the healthcare business?

I also was really intrigued with Mark Blatt’s list of thing you need for a successful transition from Fee for Service:
1. Patient empowerment
2. Mobilize data
3. Share data
4. Gather and store data

When I first considered this list, I realized that EHR could help to enable all of these things. In many ways it already is working to make many of these things possible in an organization. Without the EHR’s involvement, many of these objectives will fall flat.

Although, I also realize that many of these objectives require something outside of the EHR. Will they eventually integrate with the EHR, that’s the vision of some EHR vendors. However, I believe it will take years for us to get there. Until we get there, I think it’s going to create a really tough integration challenge for organizations.

You can hear all of Mark Blatt’s comments in the video below.