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EHRs Weren’t Designed to Influence the Practice of Medicine

Posted on April 15, 2016 I Written By

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

I was going through some old notes from a conference and found an interesting note from a meeting I had with Ensocare at ANI 2014 (Yep, I have lots of notes like this that I’m enjoying reading) that said, “EHRs were never designed to influence the practice of medicine.” Obviously this much later I’m not sure of the context of the comment, but it still really resonates with me today. I assume Ensocare’s perspective was that EHRs weren’t designed to influence care, but that’s what they were trying to accomplish.

It’s a fascinating observation which makes me wonder how many healthcare IT companies goals are to truly influence care. It calls back to my post last month about what it really takes to move the needle in healthcare IT. It’s kind of amazing to think that EHR software wasn’t designed to move the clinical care needle. You could argue that they wanted to move the business process automation needle. You could also argue that EHRs moved the reimbursement needle. Although the problem with moving the reimbursement needle is that it might be great for doctors to get paid more than they were before, but that translates to increased costs to the healthcare system as a whole. I think we’ve largely seen that play out and now they’re trying to deal with it.

As I said in the post linked above, I think that some EHR vendors have backed themselves into a place where they can influence the practice of medicine. However, very few of them were designed to really influence the practice of medicine. It was much easier to solve the business process automation issues and plenty of money to be made by doing so. It’s much harder to actually improve the practice of medicine.

Looking forward, I’m thinking about what type of software company could come along that would disrupt the current batch of EHR software. We could have some technology or mix of technology that continues along the business process automation path. Don’t underestimate the power of a solution like this. However, I wonder what mix of technology solutions could really influence the practice of medicine. Imagine an “EHR” software that was so useful and so powerful that if you chose not to use it you’d be at major risk for medical malpractice.

That’s a really high bar to achieve. However, once you get over that bar, it makes it hard for competitors to enter that space. So, it would be worth the effort. My only fear is that given the current climate, would anyone believe a company that says they’ve created something that will dramatically improve patient care?

In the first crop of EHR software I believe there was a disconnect in the marketing. I don’t think many EHR vendors claimed to improve patient care. They didn’t need to claim it. However, the disconnect was that many of those that purchased EHR software drew their own conclusions on an EHR’s ability to improve patient care. Now, most of these people have been burnt by the idea that an EHR could truly improve patient care. That’s going to be a hard perception to change.

Coming full circle, I imagine that’s why Ensocare and hundreds of other companies that really do want to use technology to move the needle on patient care aren’t calling their solutions EHR software. They have to use a different brand. All of that said, I’m interested in finding more health IT companies that are brave enough to take on the challenge of improving patient care. Which companies do you know that are working on this goal?

Health IT at SXSW – What Can Healthcare Learn?

Posted on March 14, 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.

It’s been fun to watch the evolution of healthcare at SXSW. When I first went 4 years ago (wow, I can’t believe that was 4 years ago), healthcare was just trying to find its place in the mass of a conference that is SXSW. I was one of the judges for the health IT startup pitch competition and healthcare had graduated to having its own campus at SXSW. However, the sessions were pretty light and there weren’t that many of the people you’d expect in healthcare IT to be there.

4 years later, some of the people you’d really want at the event aren’t there, but some very interesting startup healthcare IT companies are at the event. Plus, thanks to things like IoT (Internet of Things) and the interest in wearables, SXSW has done a good job featuring many of the health tech startup companies which fit into those larger trends. In fact, health is often one of the biggest parts of these larger trends.

There are so many healthcare IT conferences out there to choose from so I understand why many in healthcare don’t venture to the insanity that is SXSW. Plus, I think that it’s hard for many in healthcare to realize that SXSW is more than just a music festival (something that’s not been true for a long time) and more importantly to convince their bosses that they’re not just going to Austin to have fun.

I personally think that some of the ethos and culture of SXSW are what’s needed in healthcare. One of the key experiences that SXSW tries to cultivate is the mixing of various creative cultures in order to spark new and surprising creativity. That means that sometimes a tech startup entrepreneur will be spending time with a musician or film executive. This mixing of cultures can lead each person to surprising new insights into their business. The startup entrepreneur might find a new way to attract an audience for their product based on something the musician does to spread his music. The musician might learn about new tech that could create new layers to their music from the startup entrepreneur. You get the idea.

Healthcare could benefit from some outside influence. Just to be clear. This doesn’t mean that you throw out the culture that you know. Definitely not. It does mean you get exposure to another culture that can help expand your thinking. Over time we all get somewhat narrow minded in our thinking. Exposure to new ideas helps to expand our minds.

The same is even true within different departments in healthcare. How often does your lab interact with radiology or radiology with your ED or your pharmacy with your clinicians? If you work in a hospital you know what I’m talking about. We get stuck in our ruts and often don’t leave them. It’s nice and comfortable in our ruts and so we don’t see why we should leave them. That’s poison to an organization that wants to innovate. Take a lesson from SXSW and cultivate experiences and opportunities for different cultures to mix and learn from each others unique perspectives and experiences.

Modern Information Technology Endorsed by Government Health Quality Agency

Posted on April 22, 2014 I Written By

The following is a guest blog post by Andy Oram, writer and editor at O’Reilly Media.

If you want to see a blueprint for real health reform, take the time to read through the white paper, “A Robust Health Data Infrastructure,” written by an independent set of experts in various areas of health and information technology. They hone in, more intently than any other official document I’ve seen, on the weaknesses of our health IT systems and the modernizations required to fix them.

The paper fits very well into the contours of my own recent report, The Information Technology Fix for Health. I wish that my report could have cited the white paper, but even though it is dated November 2013, it was announced only last week. Whether this is just another instance of the contrasting pace between technologists and a government operating in a typically non-agile manner, or whether the paper’s sponsor (the Agency for Healthcare Research and Quality) spent five months trying to figure out what to do with this challenging document, I have no way of knowing.

The Robert Wood Johnson Foundation played an important role organizing the white paper, and MITRE, which does a lot in the health care space, played some undescribed role. The paper’s scope can almost be described as sprawing, with forays into side topics such as billing fraud, but its key points concern electronic health records (EHRs), patient ownership of information, and health data exchange.

Why do I like this white paper so much? Two reasons. First, it highlights current problems in health information technology. The authors:

  • Decry “the current lack of interoperability among the data resources for EHRs” as leading to a “crippled” health data infrastructure (p. 2), and demand that “EHR software vendors should be required to develop and publish APIs for medical records data, search and indexing, semantic harmonization and vocabulary translation, and user interface applications” (p. 44).

  • Report with caution that “The evidence for modest, but consistent, improvements in health care quality and safety is growing.” Although calling these “encouraging findings,” the authors can credit only “the potential for improved efficiency” (p. 2 of the paper).

  • Warn that the leading government program to push health care providers into a well-integrated health care system, Meaningful Use, fails to meet its goals “in any practical sense.” Data is still not available to most patients, to biomedical researchers, or even to the institutions that currently exchange it except as inert paper-based documents (p. 6). The authors recommend fixes to add into the next stage of Meaningful Use.

  • Lament the underpopulated landscape of business opportunities for better interventions in patient care. “Current approaches for structuring EHRs and achieving interoperability have largely failed to open up new opportunities for entrepreneurship and innovation” (p. 6).

Second, the paper lays out eminently feasible alternatives. The infrastructure they recommend is completely recognizable to people who have seen how data exchange works in other fields: open standards, APIs, modern security, etc. There is nothing surprising about the recommendations, except that they are made in the context of our current disfunction in handling health information.

A central principle in the white paper is that “the ultimate owner of a given health care record is the patient him/herself” (p. 4), a leading demand of health reformers and a major conclusion in my own report. Patient control solves at one stroke the current abuse of patient data for marketing, and allows patients to become partners in research instead of just subjects.

The principle of patient control leads to data segmentation, a difficult but laudable attempt to protect the patient from bias or exploitation. Patients may want to “restrict access to certain types of information to designated individuals or groups only (e.g., mental health records, family history, history of drug abuse) while making other types of information more generally available to medical personnel (e.g., known allergies, vaccination records, surgical history)” (p. 33).

This in turn leads to the most novel suggestion in the paper, the notion of a “patient privacy bundle.” Because most people have trouble deciding how to protect sensitive parts of their records, and don’t want to cull through all their records each time someone asks for research data, the health care field can define privacy policies that
meet common needs and let patients make simple choices. Unfortunately, a lot of hurdles may make it unfeasible to segment data, as I have pointed out.

Other aspects of the white paper are also questionable, such as their blithe suggestion that patients offer deidentified data to researchers, although this does appeal to some patients as shown by the Personal Genome Project. (By the way, the authors of the white paper mischaracterized that project as anonymous.) Deidentification expert Khaled El Emam (author of O’Reilly’s Anonymizing Health Data) pointed out to me that clnical and administrative data involves completely different privacy risks from genomic data, but that the white paper fails to distinguish them.

I was a bit disappointed that the paper makes only brief mentions of patient-generated data, which I see as a crucial wedge to force open a provider-dominated information system.

The paper is very research-friendly, though, recognizing that EHRs “are already being supplemented by genomic data, expression data, data from embedded and wireless sensors, and population data gleaned from open sources, all of which will become more pervasive in the years ahead” (p. 5). Several other practical features of health information also appear. The paper recognizes the strains of storing large amounts of genomics and related “omics” data, pointing out that modern computing infrastructures can scale and use cloud computing in a supple way. The authors also realize the importance of provenance, which marks the origin of data (p. 28).

Technologists are already putting in place the tools for a modern health IT system. The white paper did not mention SMART, but it’s an ideal API–open source, government-sponsored, and mature–through which to implement the white paper’s recommendations. The HL7 committee is working on a robust API-friendly standard, FHIR, and there are efforts to tie SMART and FHIR together. The Data Distribution Service has been suggested as a standard to tie medical devices to other data stores.

So the computer field is rising to its mission to support better treatment. The AHRQ white paper can reinforce the convictions of patient advocates and other reformers that better computer systems are feasible and can foster better patient interventions and research.

5 Health IT Marketing Resources You Didn’t Know You Needed – #HITMC

Posted on April 9, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

The inaugural Healthcare IT Marketing and PR Conference concluded with tears of gratitude, many tweets of thanks and too many takeaways to list here. (I suggest you check out the #HITMC tweet stream before it disappears, or watch the recorded sessions, which will soon be available via the conference website.) I will take a moment to highlight several marketing resources and tools that I heard about from attendees and speakers – services and solutions actual HIT marketing professionals rely on to more easily create engaging campaigns that connect with prospects and customers on a Human2Human level.

TheShortCutts.com
Don’t know who Matt Cutts is? Neither did I until I attended Kristine Schachinger’s session on the realities and myths of SEO. Cutts is the man at Google who can make or break a website’s Google rankings. Officially, he is head of Google’s webspam team. No matter how you refer to him, he’s certainly worth paying attention to, especially if SEO is your thing. The folks behind ShortCutts.com provide easy to understand interpretations of Cutts’s videos, which he produces prolifically to help “struggling site owners understand their site in search.”

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Smartsheets.com
Smartsheets seem to be about helping users better manage workflows via online tools that allow you to “assign tasks, attach files, share sheets, view timelines, set alerts, create rollups and go mobile.” It features specific marketing templates for event marketing, campaign tracking and product launches. I’m not quite sure how it works, only that it came highly recommended from the HITMC community. I also found this article from my local paper on the way Northeast Georgia Medical Center’s paramedics and cardiologists have used Smartsheets to improve cardiac care.

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Whiteboard Animated Videos from JillAddison.com
One attendee recommended Jill Addison as her go to source for high quality yet cost-effective animated whiteboard videos.

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Abukai.com
Abukai provides a free service that lets you snap photos of your receipts with your phone, and then automatically dump them into an expense report – perfect for healthcare IT marketers on the go.

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Rev.com
Do you have any idea how laborious it is to transcribe a phone interview? It’s extremely time consuming, and can often cost big bucks to outsource. Imagine my pleasant surprise when someone mentioned Rev.com, which provides transcription services at $1 a minute. That is incredibly inexpensive, and worth its weight in gold if you’re in a time crunch.

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The Health IT Marketing and PR Community on LinkedIn
“A community of health IT marketing and healthcare IT PR professionals. First started after the inaugural Health IT Marketing and PR Conference as a place to collaborate with colleagues across the health IT marketing & PR community, but welcome to anyone interesting in healthcare IT marketing and PR.” This should serve as a great resource, and I’ve already submitted a discussion around a question I didn’t get a chance to ask panelists from Agency Ten22.

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Barriers and Pathways to Healthcare IT

Posted on April 3, 2014 I Written By

The following is a guest blog post by Andy Oram, writer and editor at O’Reilly Media.

Those who follow health IT for a long time can easily oscillate between overenthusiasm and despair. Electronic records will bring us into the 21st century! No, electronic records just introduce complexity and frustration! Big data will find new cures! No, our data’s no good!

Indeed, a vast gulf looms between the demands that health reformers make on information technology and the actual status of that technology. But if we direct a steady vision at what’s available to us and what it provides, we can plan a path to the future.

This is the goal of a report I recently wrote for O’Reilly Media: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. As part of a comprehensive overview, it dissects the issues on some topics that often appear on this blog:

  • Patient empowerment. After looking at the various contortions hospitals go through to provide portals and pump up patients’ interest in following treatment regimes, I conclude that the best way to get patients involved in their care is to leave their data in their own hands.

    But wresting data out of doctors’ grip will be heavy exercise. Well aware that previous attempts at giving patients control over data (Google Health and Microsoft HealthVault) have shriveled up, and that new efforts by Box and Apple seem to be taking the same path, I suggest a way forward by encouraging people to collect health data that will hopefully become indispensable to doctors.

  • What’s wrong with current EHRs? We know that doctors grab any opportunity handed them to complain about their EHRs. Even more distressing, the research bears out their pique; my report cites examples from the medical literature finding only scattered benefits from EHRs. Sometimes their opacity and awkward interfaces contribute to horrific medical errors.

    One might think that nobody is actually getting what they want from their EHR, but in fact plenty of providers are quietly enjoying their records–success has a lot to do with their preparation and whether they take the extra effort to make effective use of data gathered by the EHRs.

    New interfaces such as tablets, convenient storage in the cloud, and agile programming may be producing a new crop of EHRs that will meet the needs of more clinicians. But open source software would lead to the most widespread advances, enabling more customization and a better response to bug reports.

  • The viability of ACOs. Accountable care, pretty much a synonym for the notion of pay-for-value, is on the agendas of nearly all payers, from CMS on down. It certainly makes sense to combine data and keep close tabs on people as they move from one institution to another. But it’s really a job to be done on a national level, or at least a regional one. Can a loose collection of hospitals and related institutions muster the data and the resources to analyze patient data, created viable health information exchanges, and perform data analysis? I don’t think the current crop of ACOs will meet their goals, but they’ll provide valuable insights while they try.

  • Can standards such as ICD-10 improve the data we collect? What about the promise of new standards, such as FHIR? I’m a big believer in standards, but I’ve seen enough of them fail to know they must be simple, lithe, and unambiguous.

    That doesn’t characterize ICD-10 to be sure. Perhaps it does pretty well in the unambiguous department. But like most classifications, it’s a weak representation of the real world: a crude hierarchy trying to reflect many vectors of interlocking effects–for instance, the various complications associated with diabetes. And although ICD-10 may lead to more precise records, the cost of conversion is so burdensome that the American Medical Association has asked the government to just let doctors spend their money on more pressing needs. The conversion has also been ruthlessly criticized on the EMR & EHR site.

    FHIR is a radical change of direction for the HL7 standards body. For the first time, a standard is being built from the ground up to be web-friendly as well as sleek. It currently looks like a replacement for C-CDA, so I hope it is extended to hold patient-generated data. What we don’t need is another hundred vendors going off to create divergent formats.

    For real innovation, we should look to the open SMART Platform. Its cleverness is that it functions as a one-way valve channeling data from silo’d EHRs at health providers to patient-controlled sites.

We need to know what current systems are capable of contributing to innovative health solutions, and when to enhance what we have versus seeking a totally disruptive solution. I look forward to more discussion of these trends. Comment on this article, write your own articles on the topics in the report, and if you like, comment to me privately by writing to the infofix alias @ the oreilly.com domain.

Taking the Anxiety out of Healthcare IT (and Cost of Care)

Posted on March 21, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I’m prone to anxiety when it comes to unexplained aches and pains, though I tend to internalize it in an effort to not come across as a hypochondriac. I’m sure I let my inner, extreme worrier come through just a tad during a recent doctor’s appointment. I was visibly relieved to learn that what I had been quietly fretting about for weeks was in fact quite normal. My relief must have been extremely visible, because my doctor was quick to explain that what patients often consider irregular, doctors treat as run of the mill. What I lose sleep over, they don’t bat an eye at. (If only her practice offered a patient portal with secure email, so that we could correspond about my health at our leisure.)

She then told me of a recent trip to the doctor with her mother, and that she had a newfound appreciation for the patient’s side of the visit as she saw things from her mother’s point of view. It was quite refreshing to hear. I might temper my anxiety before my next appointment by playing this mobile game, should it ever be made available in the app store. According to a recent study published in Clinical Psychological Science, 25 minutes of play reduces levels of stress and anxiety. Researchers are looking to see if the effects are the same with shorter bursts of playtime. It’s got to be a cheaper (and healthier) alternative than a prescription for Xanax, right?

Speaking of healthcare costs, I read with interest the news that not only did Castlight Health’s IPO perform better than expected, but that it also partnering with the Leapfrog Group to analyze hospital survey data. Castlight seems poised for success because it is striving to do what healthcare desperately needs done – to bring transparency to and better understanding of healthcare costs in this country. With the Leapfrog project, it seems they are set on tackling quality, safety and patient satisfaction, too. It would be nice, as a patient, to have one trusted resource to go to for consumer-friendly healthcare information so that we could make smart decisions for our families and ourselves.

It would be interesting for a company like Castlight to combine financial, quality, safety and satisfaction data with a notation as to whether hospitals and physicians use EHRs. I noticed that recent results from the latest NCHS Data Brief from CDC show that 42.8% of physicians in Georgia have EHRs – not significantly different than the national average, according to NCHS survey findings. Only nine states ranked above the national average for EHR usage.

I’m off on a tangent here, but I have to ask, when will all 50 states get above 50%? When will everyone be above the national average? With budgets tightening, hospitals closing, and IT deadlines looming, I have a feeling it will be later rather than sooner – if at all.

What do you think? When will your state reach 100%? How do you relieve stress before a doctor’s visit? Would knowing a physician had competitive prices and secure messaging impact your decision to book an appointment? Please share your thoughts in the comments below.

#HIMSS14 Highlights: Enthusiasm for Patient Engagement

Posted on March 7, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Patient engagement solutions abounded at HIMSS14, though their levels of sophistication varied. Like many other commentators, I felt this was a big jump in interest over last year. It will be interesting to see if this level sustains into 2015, and how the same products will mature come HIMSS15 in Chicago.

The theme of engagement was heard most loudly in several educational sessions I attended. I was happy to pre-register for an Orion Health / ePatient Dave event; and make time at the last minute to attend a live demo of the new Blue Button Connector, and a brief presentation by Regina Holliday, founder of the Walking Gallery.

I believe ePatient Dave (aka Dave deBronkart) has been at this awhile, but the Orion Health lunch and learn I attended was my first opportunity to hear him tell his story live. And what a compelling story it was! It certainly resonated with the audience of about 75, and I couldn’t help but wonder why he wasn’t up on stage in a “From the Top” session. The theme that ran throughout his presentation and audience questions was the need for online patient communities, and the subsequent need for providers to let their patients know about them. Websites like PatientsLikeMe.com and Sharecare.com were brought up as interesting resources.

epatientdavewp

I headed from there to the exhibit hall, where HIMSS had set up a very nice learning gallery, complete with comfy chairs, swivel desktops and a nice presentation area. Lygeia Ricciardi spent a good 20 minutes going through the new Blue Button Connector website, which you can find here: http://bluebuttonconnector.healthit.gov/. While not a true, live demo, she did offer several screenshots, and was very forthcoming about the ONC’s plans and goals for the site. Apparently they see it as almost a marketing tool, similar to the Energy Star label you see on just about every appliance these days. The Blue Button symbol will hopefully come to be recognized as an endorsement of easy access to patient data. She was frank in saying that it’s not a panacea, but will be a powerful tool in the hands of consumers, and developers who choose to take advantage of its open source code and bake it into their own apps.

bluebuttonwp

It is literally a connector. The new website simply allows patients to connect to third parties that may house their medical records, such as payers, pharmacy, labs, physicians or hospitals, immunization registries and health information exchange portals. Knowing I already have a provider that participates in Blue Button via their athenahealth patient portal, I went through the “Physician or Hospital” steps to see how the Connector worked. I didn’t see my physician listed, so I’ll likely send an email to bluebutton@hhs.gov. The Connector is in beta right now, and Riccardi mentioned they are very interested in gathering as much user feedback as possible during this process, so I encourage you to check it out and drop them a comment or two.

I was back at the Learning Gallery the next afternoon to hear Regina Holliday of the Walking Gallery speak, and she did not disappoint. Like a preacher that just can’t stay in the pulpit, Regina passionately talked about the power patients have when they come together and demand change. It was my first time hearing her speak live and I was not disappointed. It was a powerful sight to see close to 30 Walking Gallery members stand up at the end of her session and show their jackets. Why they were not on a larger stage in front of a capacity audience is beyond me.

walkinggallery

That’s it for my notes from HIMSS. Next up on my conference dance card is the Healthcare IT Marketing and PR Conference, taking place April 7-8 in Las Vegas, and hosted by Healthcarescene.com. I hope to see you there!

#HIMSS14 Highlights: the Snail’s Pace of Interoperability

Posted on February 26, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Ah, HIMSS. The frenetic pace. The ridiculously long exhibit hall. The aching feet. The Google Glass-ers. As I write this, day three for me is in full swing and I’ve finally managed to find some time to reflect on what I’ve seen, which includes a ridiculously long taxi queue at the airport, more pedicabs than I can count, beautiful weather and lots of familiar faces, which is what makes HIMSS so much fun. I’ve heard lots of buzzwords and sales talk, and seen only about an eighth of the exhibit hall, barely scratching the surface of what’s out there on the show floor.

Several common themes stand out based on the sessions and events I’ve been to, and the passions of those I’ve encountered. Whether it’s vendor breakfasts, social networking functions, exhibit elevator pitches or educational sessions, interoperability and engagement are still the buzzwords to beat. This particular HIMSS has given me a different perspective on each, and offered new insight into what’s happening with the Blue Button Connector. I’ll cover each of these in HIMSS Highlights posts over the next several weeks, starting with interoperability.

The industry seems far more realistic this year regarding interoperability – downright frustrated by the slow pace at which such a lofty goal is proceeding. Industry experts Brian Ahier and Shahid Shah perhaps expressed it best during a lively panel discussion at the Surescripts booth:

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Putting vendors’ feet to the fire will certainly initiate a quick and painful reaction, but probably not a sustainable one. True momentum will occur only when providers get singed a bit, too. Panelist comments at a Dell / Intel breakfast on analytics for accountable care brought this into sharper focus for me. The fact that too many disparate EMRs (and thus too many vendors poised to cause inertia) are making it hard for analytics to successfully be adopted and utilized at an enterprise level, highlights a bigger problem related to hindsight and strategy.

From my perspective – that of an industry observer and commentator – it seems many providers felt compelled to purchase EMRs because the federal government offered them money to do so, and hopefully just as many were optimistic about the role technology would play in positively affecting patient outcomes. Vendors saw a great business opportunity and moved quickly to develop systems that met Meaningful Use criteria (not necessarily going for best-fit as related to workflow needs and usability). Neither group truly knew what they were in store for, especially regarding longer term plans for health information exchange.

Providers now find themselves wanting to move forward with health information exchange and greater interoperability, but slowed down by the very IT systems they were so insistent on purchasing just a few years ago. Vendors (some more than others) are hesitant to crack open their products to allow data to truly flow from one system to another, and who can blame them? The EMR market, in particular, is poised to shrink, which begs the question, who will survive? What companies will be around at HIMSS 15 and 16? Those who keep their systems siloed, like Epic? Or those who are trying to break down the silos, such as Common Well Alliance members like athenahealth and Greenway?

It makes me wonder if providers wouldn’t have been better served with just had a handful of EMRs to choose from around the time of HITECH, all guaranteed to evolve as needed and play nicely with each other in the interest of health information exchange. Too many options have caused too many barriers. That’s not just my opinion, by the way. I’m willing to bet that a sizeable chunk of the 37,537 HIMSS 14 attendees would agree with me.

Do you disagree? Are providers (and patients) better served by more IT options than less? Let me know your thoughts, and impressions of interoperability advancement at HIMSS, in the comments below.

Survey Takers Show No Love for EMRs

Posted on February 13, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Just in time for Valentine’s Day … in case it hasn’t crossed your device or desk, Modern Economics – a self-described web community for health professionals – recently released the results of a survey that attempted to gauge physicians’ satisfaction with EHRs. Of the nearly 1,000 folks polled, nearly 70% concluded their investment in EHRs had not been worth it. Other stats included:

  • 67% are dissatisfied with system functionality
  • 65% indicated systems resulted in financial losses
  • 45% indicated patient care is worse
  • 69% indicated care coordination has not improved
  • 73% of largest practices would not purchase current system

These numbers certainly reflect what many in the industry have been saying for the last few years, but I find the statistics related to care incredibly high. My friends over at HISTalk.com reported that survey takers were “self-selected,” so I have to wonder if the entire field of respondents was skewed to the negative from the beginning.

I came across an interesting tweet exchange about the survey results:

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I’m no expert, but I definitely think the horse has left the barn, and that if a more impartial survey were done, we’d find more providers satisfied with EHRs and their impact on patient care.

In Blue Button news, I came across several articles this week announcing that leading pharmacies and retailers have joined the Blue Button movement. According to HealthIT.gov, these organizations are “committing to work over the next year towards standardizing patient prescription information to fuel the growth of private-sector applications and services that can add value to this basic health information.”

It’s encouraging to see businesses like Walgreens and Kroger – two places I shop at –  pledge to bring more awareness of health data to their customers. Perhaps my next post will shed light on how these businesses will accomplish their Blue Button goals.

My #BlueButton Patient Journey: PHRs & the Plight of Patient Surveys

Posted on February 7, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Ah, the CAHPS Survey … how I love filling them out with a freshly sharpened #2 pencil. How I love digging through that kitchen junk drawer we all have to find a stamp. How I love placing that return envelope in the metal box at the top of my driveway (after I dust the cobwebs off, of course).

All jokes about the floundering postal system aside, my Blue Button patient journey has made me hyper aware of the potential for non-electronic processes to become digitized. In the case of patient satisfaction surveys, I ask not only, why not? But also, why hasn’t it already been done?

The CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey is produced by the Agency for Healthcare Research and Quality, and was designed to provide healthcare facilities with a way to measure and improve the patient experience. As an engaged patient (and a busy, working mom), my experience would be improved if I were offered the convenient alternative of taking CAHPS surveys online.

I realize I’m getting more into user experience than necessarily discussing the Blue Button initiative, but I feel the two are ultimately a means to the same end – more engaged patients, more effective care and better outcomes.

I think it would be great if I could check a box during the set up of my profile in the patient portal that alerts my provider to the fact that I do or don’t want to take surveys online. The paper option will still be preferable to some, but it would be nice to have the choice right off the bat. Perhaps this is already being done and I just haven’t experienced it yet in my neck of the woods. Let me know in the comments below if you’ve taken patient satisfaction surveys online, and/or via your patient portal, and if it was more convenient/easier to fill out.

In other news, I had a great conversation with David Goldsmith at Dossia about the evolution of that personal health record, which is currently being rolled out through employers. It seems like a really intuitive tool whose only hangup is keeping users engaged once they switch jobs and lose that connection to payer data that originally populated their profile.

Beth Friedman, founder of Agency Ten22 (a founding sponsor of HealthcareScene.com’s upcoming Healthcare IT Marketing & PR Conference), was kind enough to comment on one of my previous Blue Button blogs alerting me to AHIMA’s MyPHR.com, which provides information about getting started with personal health records. (I was happy to find that AHIMA has taken the Blue Button pledge, and has a section devoted to it at this site.)

I found the article, “Quick Guide to Creating a PHR” helpful. It was easy to understand and seems to be written for the average healthcare consumer. I’m surprised that it leans so heavily on paper-based processes, but that’s probably a first step that most people would be comfortable with before moving on to digital processes. I was disappointed that it didn’t offer suggestions for Internet-based PHRs. I’d feel more confident using a particular product if it was endorsed by an association like AHIMA. I’m hoping Beth will let me know if that’s something AHIMA plans to do in the future.