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!

GAO: HHS Should Tighten Up Its Patient Data Access Efforts

Posted on March 23, 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 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.

The Government Accountability Office has issued a new report arguing, essentially, that while its heart is in the right place, HHS isn’t doing enough to track the effectiveness of patient health data access efforts. The report names ONC as arguably the weakest link here, and calls on the HHS-based organization to track its outreach programs more efficiently.

As readers know, CMS has spent a vast sum of money (over $35 billion at this point) to support health IT adoption and health data access. And while these efforts have spilled over to some patients, it’s still an uphill battle getting the others to access their electronic health information, the GAO report says.

Moreover, even patients that are accessing data face some significant challenges, including the inability to aggregate their longitudinal health information from multiple sources into a single, accessible record, the agency notes. (In other words, patients crave interoperability and data integration too!)

Unfortunately, progress on this front continues to be slow. For example, after evaluating data from the 2015 Medicare EHR Program, GAO researchers found that few patients were taking a look at data made available by their participating provider. In fact, while 88 percent of the program’s hospitals gave patients access to data, only 15 percent of patients actually accessed the information which was available.  When professionals provided patients with data access, the number of patients accessing such data climbed to 30 percent, but that’s not as big a delta as it might seem, given that 87 percent of such providers offered patient data access.

Patient reluctance to dive in to their EHI may be in part due to the large number of differing portals offered by individual providers. With virtually every doctor and hospital offering their own portal version, all but the most sophisticated patients get overwhelemed. In addition to staying on top of the information stored in each portal, patients typically need to manage separate logins and passwords for each one, which can be awkward and time-consuming.

Also, the extent of data hospitals and providers offer varies widely, which may lead to patient confusion. The Medicare EHR Program requires that participants make certain information available – such as lab test results and current medications – but less than half of participating hospitals (46 percent) and just 54 percent of healthcare professionals routinely offered access to clinician notes.

The process for sharing out patient data is quite variable as well. For example, two hospitals interviewed by the GAO had a committee decide which data patients could access. Meanwhile, one EHR vendor who spoke with the agency said it makes almost all information available to patients routinely via its patient portal. Other providers take the middle road. In other words, patients have little chance to adopt a health data consumption routine.

Technical access problems and portal proliferation pose significant enough obstacles, but that’s not the worst part of the story. According to the GAO, the real problem here is that ONC – the point “man” on measuring the effectiveness of patient data access efforts – hasn’t been as clear as it could be.

The bottom line, for GAO, is that it’s time to figure out what enticements encourage patients to access their data and which don’t. Because the ONC hasn’t developed measures of effectiveness for such patient outreach efforts, parent agency HHS doesn’t have the information needed to tell whether outreach efforts are working, the watchdog agency said.

If ONC does improve its methods for measuring patient health data access, the benefits could extend beyond agency walls. After all, it wouldn’t hurt for doctors and hospitals to boost patient engagement, and getting patients hooked on their own data is step #1 in fostering engagement. So let’s hope the ONC cleans up its act!

External Incentives Key Factor In HIT Adoption By Small PCPs

Posted on January 25, 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 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 study appearing in The American Journal of Managed Care concludes that one of the key factors influencing health IT adoption by small primary care practices is the availability of external incentives.

To conduct the study, researchers surveyed 566 primary care groups with eight or fewer physicians on board. Their key assumption, based on previous studies, was that PCPs were more likely to adopt HIT if they had both external incentives to change and sufficient internal capabilities to move ahead with such plans.

Researchers did several years’ worth of research, including one survey period between 2007 and 2010 and a second from 2012 to 2013. The proportion of practices reporting that they used only paper records fell by half from one time period to the other, from 66.8% to 32.3%. Meanwhile, the practices adopted higher levels of non-EMR health technology.

The mean health IT summary index – which tracks the number of positive responses to 18 questions on usage of health IT components – grew from 4.7 to 7.3. In other words, practices implemented an average of 2.6 additional health IT functions between the two periods.

Utilization rates for specific health IT technologies grew across 16 of the 18 specific technologies listed. For example, while just 25% of practices reported using e-prescribing tech during the first period of the study, 70% reported doing so during the study’s second wave. Another tech category showing dramatic growth was the proportion of practices letting patients view their medical record, which climbed from one percent to 19% by the second wave of research.

Researchers also took a look at the impact factors like practice size, ownership and external incentives had on the likelihood of health IT use. As expected, practices owned by hospitals instead of doctors had higher mean health IT scores across both waves of the survey. Also, practices with 3 to 8 physicians onboard had higher scores than those were one or two doctors.

In addition, external incentives were another significant factor predicting PCP technology use. Researchers found that greater health IT adoption was associated with pay-for-performance programs, participation in public reporting of clinical quality data and a greater proportion of revenue from Medicare. (Researchers assumed that the latter meant they had greater exposure to CMS’s EHR Incentive Program.)

Along the way, the researchers found areas in which PCPs could improve their use of health IT, such as the use of email of online medical records to connect with patients. Only one-fifth of practices were doing so at the time of the second wave of surveys.

I would have liked to learn more about the “internal capabilies” primary care practices would need, other than having access to hospital dollars, to get the most of health IT tools. I’d assume that elements such as having a decent budget, some internal IT expertise and management support or important, but I’m just speculating. This does give us some interesting lessons on what future adoption on new technology in healthcare will look like and require.

Health IT Costs, Health IT Adoption, HIE and CommonWell – Pre #HITsm Thoughts

Posted on June 28, 2013 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last week I took the #HITsm Chat topics and created a blog post about Healthcare Unbound. I enjoyed creating the post so much that I decided to do it again this week. Not to mention I’ll be on the road to Utah during this week’s chat and won’t be able to participate. (Side Note: If you live in Utah and want to do lunch, I’d love to meet and talk EMR or health IT. I’ll be in Hawaii in July if you want to do the same.)

The chat topics make perfect discussion items. Plus, I love that I have more of an opportunity to really dig into the topics in a blog post. You can’t dig in quite as much in 140 characters.

Topic 1: Costs vs benefits. Will high costs always be the #1 barrier cited to #healthIT adoption?
We’ve seen an enormous shift in the cost of healthcare IT since I first started blogging about EMR 8 years ago. Cost use to be a much bigger issue when the cheapest EMR software you could find was about $30,000+ per doctor (in the ambulatory space). Plus, they expected you to pay the entire lump sum payment up front (many did offer financing). These days the cost of EMR software has dropped dramatically and fewer and fewer EHR vendors are using the lump sum payment model. This change means that costs are much more in line with a practice’s revenue.

These days, I’d say that those who use cost as the reason for not adopting health IT are really just using it as an excuse not to do it. There are a few rural providers where cost is more than just an excuse, but those are pretty few and far between. I’m not saying that cost isn’t an important part of any health IT project, but I’ve most often seen cost used as a mask for other reasons people don’t want to implement health IT. The most common reason is actually just a general resistance to change.

Topic 2: Why does ePrescribing have such widespread acceptance while #telehealth adoption is so low?
If providers could be reimbursed for telehealth, adoption would be high.

It is ironic that doctors don’t really get reimbursed for ePrescribing, but they do it at a high level. Although, the doctor does get reimbursed for the visit that generates the need for the prescription. A deeper investigation of why ePrescribing has had good adoption would be interesting. Certainly there are many doctors who miss their sig pad. However, once you have to record the prescription in the EHR, you might as well ePrescribe it.

Plus, there are some obvious reasons why ePrescribing is better. Whether it’s replacing the unreadable prescriptions or the drug to drug and allergy interaction checking that’s built into every ePrescribing platform, the benefits can be understood quickly.

The sad thing is that the benefits of Telehealth can be seen quickly as well, but you can’t get paid to do it.

Topic 3: #HIE as a noun or a verb? Does negative press for HIE org$ hinder health data exchange as a whole?
HIE is currently more of a noun than a verb. Verbs require action and we’re not seeing enough HIE action.

In some ways negative press could discourage healthcare organizations from participating in an HIE organization. However, negative press about HIE’s weaknesses can also put pressure on healthcare organizations to finally step up to the plate and have more HIE action and less HIE talk.

The biggest hindrance to HIE is business model, and good or bad press won’t do much to change that.

Topic 4: Is #CommonWell just a bully in a fairy godmother costume?
I love this question mostly because I sent the tweet that inspired it. Although, a smart health IT PR/marketer was the one who said it to me.

It’s a little too early to tell if the fairy godmother costume that CommonWell has on is real or fake. I think there path is paved with good intentions, but will the almighty dollar get in the way of them realizing these good intentions? I don’t know. I’m hopeful that it will be a success. I’m also glad that at least the conversations are happening. That’s a step forward from where we were before CommonWell.

Topic 5: Open forum: What #HealthIT topic had your attention this week?
There are so many topics that I discuss each week, but I think I’m most excited by the project announced this week to create a Common Notice of Privacy Practices. I hope their crowdfunding is successful and they get a lot of great healthcare organizations on board with what they’re doing. I also found the Vitera Healthcare acquisition of Success EHS quite interesting. EMR is slowly but surely consolidating.