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The Personalization of Healthcare and Healthcare Chatbots

Posted on April 20, 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.

At HIMSS 2017, I did a plethora of videos where I was interviewing people and even more where people were interviewing me. Many of those videos are just now starting to leak out onto the internet. One of those videos where I was interviewed was with the team from Availity. They had a great team there that interviewed a bunch of the HIMSS Social Media Ambassadors including me.

I’ll admit that I was pretty tired when I did this interview at the end of the day, right before the New Media Meetup at HIMSS. However, I think the interview shares some high-level views on what’s happening in healthcare IT and important topics coming out of the conference. Check out the full video to learn the details:

I like that I talked about the personalization of healthcare and then healthcare chatbots in the same video interview. Some people might see these as opposites. How can talking with a healthcare chatbot be more personal than a human?

The answer to that question has two parts. First, a chatbot can quickly analyze a lot more information to personalize the experience than a human can do. Notice that I said personalization and not personal. There’s a subtle but important difference in those two words. Second, I didn’t clarify this in the video, but the healthcare chatbot will not fully replace the care provider. Instead, it will just replace the care provider from having to do the mundane tasks that the providers hate doing. Done correctly, the healthcare chatbot will fee up the providers to be able to focus on providing patients a more personalized and personal experience. That’s something we would all welcome in healthcare.

All of this health data we are amassing on patients is going to make both the healthcare chatbot and the human healthcare provider better able to give you a personalized experience. That’s a great thing.

Since in the video I also recommended that people follow Rasu Shrestha, MD, you may also want to check out the video interview Rasu did with Availity:

I love the idea that we go to conferences to not just learn something, but to unlearn things. Rasu is great!

MACRA and MIPS Training and Resources – MACRA Monday

Posted on March 20, 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.

While we’ve covered a lot of ground in this MACRA Monday series, there are still a lot of details we haven’t covered. I’ve been debating how deep into the weeds of MACRA and MIPS we should go or not as part of this series. We’d love to hear your thoughts.

We’re partially reticent to go really deep, because there’s a lot of great resources out there to dive deeply into MACRA and MIPS. Plus, we don’t see many people doing higher level strategic decision making content that has opinions about what your organization should or shouldn’t do when it comes to MACRA.

If you’re looking for some deeper training on MACRA and MIPS, we’ll highlight a few courses and trainings out there that we know about.

4Med MIPS and MACRA Training
The people at 4Med have a whole series of training for MIPS and MACRA. They have a lot of past experience doing training for meaningful use and PQRS and they’re continuing that with their latest MACRA and MIPS Training. Here’s a look at some of the courses they have coming up (Note: each of these links automatically gives you a discount on each course):

MACRA-MIPS Quality Project Manager – Starts March 29 – A nice course focused on the quality portion of MIPS.

Patient Centered Medical Home (PCMH) Workshop – Starts May 3 – This goes beyond MIPS and MACRA, but is all part of the related trend.

HIPAA Compliance Officer – Starts April 19 – This isn’t really a MIPS and MACRA course, but they require you to do a HIPAA Risk Assessment, so this course could help you make sure you’re ready to fulfill that requirement. Plus, this is a good course given the importance of security in healthcare these days.

4 Med offers a number of other courses including an Advancing Care Information course as well, but it’s not scheduled right now. We’ll update you in the future as those courses are scheduled. Instead of the live training options above, you can also purchase the online version of these courses. If you use the promo code: HITC you’ll get 20% off those online versions.

MIPS Boot Camp
Another option to consider is this MIPS Boot Camp course offered by Jim Tate and Wayne Singer. The course is only 1.5 hours, but Jim is a true expert in this area and so it will be a great starter course. They obviously are trying to push their MyMipsScore™ App, but that might be something useful for readers as well.

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

What Do Doctors Need to Know About MACRA and MIPS? – MACRA Monday

Posted on March 13, 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.

While at the HIMSS 2017 conference, I had a chance to do a video interview with MACRA expert, Alexandria (Alex) J. Goulding, Public Policy Manager at iHealth. We cover a broad range of MACRA topics focused on the practical things that doctors should know about MACRA and MIPS.

You can find the full MACRA video interview at the bottom or click any of the links below to skip to a specific answer:

Do you have other perspectives and insights that you’d add to what Alex Goulding offered above? Please share them in the comments.

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

First Time HIMSS: Parker Redding, Banyan Social

Posted on March 10, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

One of the main themes of HIMSS was using digital tools to manage your patient engagement and social engagement online. Banyan Social was there for their first conference introducing their digital solution for storing patient permissions to post reviews or photos online. I spoke with Parker Redding from Banyan Social. They were a first time Exhibitor at HIMSS and I wanted to hear what their impressions were from the conference.  Banyan Social is a platform with marketing tools for providers including digital storage of HIPAA forms and integration with Google reviews. From their website:  “Extend your reach and grow your practice with real-time reviews, HIPAA-compliant social media posts and automated practice listings.”

What was your first health IT conference like?

“Honestly, I thought it was pretty cool. It was almost overwhelming how many people were there. It was the biggest event I’ve ever been to. It was cool to see how many people are in the Health IT space. We were constantly busy at our booth and with how many people came to our booth we didn’t really have the opportunity to explore in depth. We are unique in the Health IT space and aren’t always the perfect fit for these database guys and those kinds of people but they were always willing to refer us to the right people and who to talk to.

One thing that I liked about this event is that even if they don’t think it’s a good fit everyone is willing to be open and have a conversation. Everyone there is trying to learn more and share knowledge it’s not just “I’m trying to get my CE credits and leave.”  It’s about learning something new – about gaining knowledge.

A lot of the people who were first time exhibitors that we talked to told us how it was crazy how big it was and how many people were there. The conference was really diverse in terms of experts from different countries.  It was cool to see the big EMR or the IBM booth and to see how much effort they put into their space.

What were your goals?

Our main goal was to create partnerships with other companies in the healthcare industry and to learn more about the healthcare IT industry and how our business fits in with this. We wanted to share our HIPAA approved social media app and how doctors/clinics can use social media and reviews to engage patients.

What was your favorite part of HIMSS?

Honestly, speaking with a pediatrician that owns multiple practices the last day and learning about why he’s been in the medical industry.  Learning about how much he cared about his patients and how he knew he could make more money in another industry. It’s amazing to see how passionate people are about healthcare and being positive. He gives up money because he’s passionate about helping with children.

What did you learn about Health IT?

Bunch of nerds.  Just kidding.  I love the nerds and the developers those are my people.

What do you wish you could do differently?

I would bring more people to have at our booth. We had a consistent flow of people stopping to talk with us that we didn’t get to spend the time we wanted to connect with other companies and learn more about the IT healthcare world. You can’t complain about having a busy booth.  I would take an Uber to the conference. Trying to find a parking spot and walking a mile to get to your booth was difficult.

First Time HIMSS: Hospital CEO John Kurvink

Posted on March 7, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

I met John Kurvink from Georgian Bay General Hospital at the Salesforce party at HIMSS this year. We discussed the relative value of a VIP pass vs a regular guest pass. As a hospital CEO, John was wearing a shiny VIP necklace complete with sparkling flashing lights. We found the flashing light wands together and discussed how HIMSS was going for them.

John has the ability to motivate staff and managers to develop their potential and participated in the Intermountain Healthcare video series on healthcare in November 2016.  It was immediately clear that he was there with his team, to maximize the HIMSS experience. I wanted to hear more about the decision making process and differentiating between sales pitches on the exhibitor floor and value for Hopital CFO and CEOs. I asked if I could walk the exhibit floor a bit with their team.  After the show John shared his insights about his first visit to HIMSS.

What was your first health IT conference like?

It was a good experience.  Overwhelming at first.  It took a day to get my conference legs under me.

What were your goals?

See some of the latest health IT projects.  Connect with some of the vendors we do business with.

What was your favorite part of HIMSS?

Networking with other attendees and vendors.  I met some very interesting smart people

What did you learn about Health IT?

There are so many vendors who all appear to be offering the same solutions.  Differentiating between them is a challenge.

What did you learn?

I learned that as a hospital we have lots of options as far as technology solutions.  Need to be very careful before making a commitment.

What was your least favorite part of HIMSS?

Not having a plan which meant I wasted a lot of time walking back and forth arriving late for sessions.

What do people need to know about Health IT from HIMSS?

You need to be sure to have a plan before you arrive.  Know what you want to learn about and focus on executing instead of being caught up with the “new shiny object”.

Many vendors have similar offerings or business solutions and making buying decisions for a hospital or healthcare group can be overwhelming. Brenda and Elizabeth from the Georgian Bay were intelligent and hilarious. Georgian Bay had proposals from patient security partners and other vendors and walking the exhibit floor with John helped me see how vendors interact with Hospital CEOs. They are more aggressive and less technical in their product description. There are more invited dinners with sales pitches. His consideration for his team and ability to see past the “new shiny object” were impressive.

Here’s to many more years of learning with John and his team.

A New MACRA Tools Market – MACRA Monday

Posted on March 6, 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.

One thing we’ve realized writing MACRA Monday is that there’s an insatiable appetite for MACRA right now. Webinar signups are through the roof when it’s on the topic of MACRA and MIPS. MACRA and MIPS training courses are selling like hot cakes. Everyone is trying to get the information they need to deal with MACRA and MIPS.

After talking with many companies at HIMSS, there’s a whole new market being created for tools that help organizations track and attest for MACRA as well. Of course, every EHR vendor is creating a solution for their providers. However, there are a lot of other companies that are looking at this as a big opportunity for them to provide tools to make tracking and reporting MACRA and MIPS easy.

Two companies that I ran into recently in this space are SA Ignite and SPH Analytics.

Both of these companies are focusing on MACRA, APM, and MIPS reporting at the higher end. We’re talking about hospital systems that have 100 medical practices and so they have a few hundred doctors who need to do MACRA reporting. Can you imagine managing that many attestations on Excel or something? That’s why I think these tools are going to become so popular.

A part of me hates that entire companies are being created around government attestation. However, the realist in me understands that these tools are needed by large health systems that have to comply with government requirements or lost a lot of money.

What do you think of this trend? Is it a microcosm of our current healthcare system? Do you know of other tools that can help organizations trying to handle MACRA reporting?

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

Selecting the Right AI Partner in Healthcare Requires a Human Network

Posted on March 1, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

Artificial Intelligence, or AI for short, does not always equate to high intelligence and this can have a high cost for healthcare systems. Navigating the intersection of AI and healthcare requires more than clinical operations expertise; it requires advanced knowledge in business motivation, partnerships, legal considerations, and ethics.

Learning to Dance at HIMSS17

This year I had the pleasure of attending a meetup for people interested in and working with AI for healthcare at the Healthcare Information and Management Systems Society (HIMSS) annual meeting in Orlando, Florida. At the beginning of the meetup Wen Dombrowski, MD, asked everyone to stand up and participate in a partner led movement activity. Not your average trust fall, this was designed to teach about AI and machine leaning while pushing most of us out of our comfort zones and to spark participants to realize AI-related lessons. One partner led and the other partner followed their actions.

Dedicated computer scientists, business professionals, and proud data geeks tested their dancing skills. My partner quit when it was my turn to lead the movement. About half of the participants avoided eye contact and reluctantly shuffled their feet while they half nursed their coffee. But however awkward, half the participants felt the activity was a creative way to get us thinking about what it takes for machines to ‘learn’. Notably Daniel Rothman of MyMee had some great dance moves.

I found both the varying feedback and equally varying willingness to participate interesting. One of the participants said the activity was a “waste of time.” They must have come from the half of the room that didn’t follow mirroring instructions. I wonder if I could gather data about what code languages were the specialty of those most resistant. Were the Python coders bad at dancing? I hope not. My professional training is actually as a licensed foreign language teacher so I immediately corroborated the instructional design effectiveness of starting with a movement activity.

There is evidence that participating in physical activity preceding learning makes learners more receptive and allows them to retain the experience longer. “Physical activity breaks throughout the day can improve both student behavior and learning (Trost 2007)” (Reilly, Buskist, and Gross, 2012). I assumed that knowledge of movement and learning capacity was common knowledge. Many of the instructional design comments Dr. Dombrowski received while helpful, revealed participants’ lack of knowledge about teaching and cognitive learning theory.

I could have used some help at the onset in choosing a dance partner that would have matched and anticipated my every move. The same goes for healthcare organizations and their AI solutions.  While they may be a highly respected institution employing some of the most brilliant medical minds, they need to also become or find a skilled matchmaker to bring the right AI partner (our mix of partners) to the dance floor.

AI’s Slow Rise from Publicity to Potential

Artificial Intelligence has experienced a difficult and flashy transition into the medical field. For example, AI computing has been used to establish consensus with imaging for radiologists. While these tools have helped reduce false positives for breast cancer patients, errors remain and not every company entering AI has equal computing abilities. The battle cry that suggested physicians be replaced with robots seems to have slowed robots. While AI is gaining steam, the potential is still catching up with the publicity.

Even if an AI company has stellar computing ability, buyers should question if they also have the same design for outcome. Are they dedicated to protecting your patients and providing better outcomes, or simply making as much profit as possible? Human FTE budgets have been replaced by computing AI costs, and in some instances at the expense of patient and data security.  When I was asking CIOs and smaller companies about their experiences, many were reluctant to criticize a company they had a non-disclosure agreement with.

Learning From the IBM Watson and MD Anderson Breakup

During HIMSS week, the announcement that the MD Anderson and IBM Watson dance party was put on hold was called a setback for AI in medicine by Forbes columnist Matthew Herper. In addition, a scathing report detailing the procurement process written by the University of Texas System Administration Audit System reads more like a contest for the highest consulting fees. This suggests to me that perhaps one of the biggest threats to patient data security when it comes to AI is a corporation’s need to profit from the data.

Moving on, reports of the MD Anderson breakup also mention mismanagement including failing to integrate data from the hospital’s Epic migration. Epic is interoperable with Watson but in this case integration of new data was included in Price Waterhouse Cooper’s scope of work. If poor implementation stopped the project, should a technology partner be punished? Here is an excerpt from the IBM statement on the failed partnership:

 “The recent report regarding this relationship, published by the University of Texas System Administration (“Special Review of Procurement Procedures Related to the M.D. Anderson Cancer Center Oncology Expert Advisor Project”), assessed procurement practices. The report did not assess the value or functionality of the OEA system. As stated in the report’s executive summary, “results stated herein are based on documented procurement activities and recollections by staff, and should not be interpreted as an opinion on the scientific basis or functional capabilities of the system in its current state.”

With non-disclosure agreements and ongoing lawsuits in place, it’s unclear whether this recent example will and should impact future decisions about AI healthcare partners. With multiple companies and interests represented no one wants to be the fall guy when a project fails or has ethical breaches of trust. The consulting firm of Price Waterhouse Coopers owned many of the portions of the project that failed as well as many of the questionable procurement portions.

I spoke with Christine Douglas part of IBM Watson’s communications team and her comments about the early adoption of AI were interesting. She said “you have to train the system. There’s a very big difference between the Watson that’s available commercially today and what was available with MD Anderson in 2012.”  Of course that goes for any machine learning solution large or small as the longer the models have to ‘learn’ the better or more accurate the outcome should be.

Large project success and potential project failure have shown that not all AI is created equally, and not every business aspect of a partnership is dedicated to publicly shared goals. I’ve seen similar proposals from big data computing companies inviting research centers to pay for use of AI computing that also allowed the computing partner to lease the patient data used to other parties for things like clinical trials. How’s that for patient privacy! For the same cost, that research center could put an entire team of developers through graduate school at Stanford or MIT. By the way, I’m completely available for that team! I would love to study coding more than I do now.

Finding a Trusted Partner

So what can healthcare organizations and AI partners learn from this experience? They should ask themselves what their data is being used for. Look at the complaint in the MD Anderson report stating that procurement was questionable. While competitive bidding or outside consulting can help, in this case it appears that it crippled the project. The layers of business fees and how they were paid kept the project from moving forward.

Profiting from patient data is the part of AI no one seems willing to discuss. Maybe an AI system is being used to determine how high fees need to be to obtain board approval for hospital networks.

Healthcare organizations need to ask the tough questions before selecting any AI solution. Building a human network of trusted experts with no financial stake and speaking to competitors about AI proposals as well as personal learning is important for CMIOs, CIOs and healthcare security professionals. Competitive analysis of industry partners and coding classes has become a necessary part of healthcare professionals. Trust is imperative and will have a direct impact on patient outcomes and healthcare organization costs. Meetups like the networking event at HIMSS allow professionals to expand their community and add more data points, gathered through real human interaction, to their evaluation of and AI solutions for healthcare. Nardo Manaloto discussed the meetup and how the group could move forward on Linkedin you can join the conversation.

Not everyone in artificial intelligence and healthcare is able to evaluate the relative intelligence and effectiveness of machine learning. If your organization is struggling, find someone who can help, but be cognizant of the value of the consulting fees they’ll charge along the way.

Back to the dancing. Artificial does not equal high intelligence. Not everyone involved in our movement activity realized it was actually increasing our cognitive ability. Even those who quit, like my partner did, may have learned to dance just a little bit better.

 

Resources

California Department of Education. 2002. Physical fitness testing and SAT9 Retrieved May 20, 2003, from www.cde.ca.gov/statetests/pe/pe.html

Carter, A. 1998. Mapping the mind, Berkeley: University of California Press.

Czerner, T. B. 2001. What makes you tick: The brain in plain English, New York: John Wiley.

Dennison, P. E. and Dennison, G. E. 1998. Brain gym, Ventura, CA: Edu-Kinesthetics.

Dienstbier, R. 1989. Periodic adrenalin arousal boosts health, coping. New Sense Bulletin, : 14.9A

Dwyer, T., Sallis, J. F., Blizzard, L., Lazarus, R. and Dean, K. 2001. Relation of academic performance to physical activity and fitness in children. Pediatric Exercise Science, 13: 225–237. [CrossRef], [Web of Science ®]

Gavin, J. 1992. The exercise habit, Champaign, IL: Human Kinetics.

Hannaford, C. 1995. Smart moves: Why learning is not all in your head, Arlington, VA: Great Ocean.

Howard, P. J. 2000. The owner’s manual for the brain, Austin, TX: Bard.

Jarvik, E. 1998. Young and sleepless. Deseret News, July 27: C1

Jensen, E. 1998. Teaching with the brain in mind, Alexandria, VA: Association for Supervision and Curriculum Development.

Jensen, E. 2000a. Brain-based learning, San Diego: The Brain Store.

Reilly, E., Buskist, C., & Gross, M. K. (2012). Movement in the Classroom: Boosting Brain Power, Fighting Obesity. Kappa Delta Pi Record, 48(2), 62-66. doi:10.1080/00228958.2012.680365.

The Future of MACRA – MACRA Monday

Posted on February 27, 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.

As mentioned in my previous MACRA Monday post, MACRA was a hot topic at the HIMSS 2017 conference. No doubt it was on pretty much everyone’s minds. A few people I talked to said that there’s an insatiable appetite for MACRA related content and they’re right. It’s amazing how many people still need to learn about MACRA and how many who know the basics still need to get into the nitty gritty. I loved one tweet from the conference that said that the line to the CMS booth was longer than the line for ice cream which is saying something.

Despite all this interest in MACRA, there is a growing rift in how organizations and doctors are approaching MACRA. There seems to be universal hatred of MACRA by doctors. I have yet to find a doctor out there that likes MACRA. The best I’ve found is doctors who don’t like it but don’t have a major issue with it either. If there’s a practicing doctor out there that likes MACRA, I’d love to meet you.

On the other hand, I don’t know a single large organization that is planning to opt out of MACRA. Every organization I’ve talked to is planning to participate in MACRA in some shape or form. They usually argue some mix of the following reasons for their participation:

  • We can’t take the penalties to our reimbursement.
  • The incentives are relatively small, but across 100s of providers that’s a big chunk of change.
  • What happens to our doctors when the MACRA results are put on the physician compare website? We don’t want to take the reputation hit.
  • This is just the start of these programs. If we opt out of them, we’ll just be behind in the future.

These large organizations are going to participate. I just don’t see them with any other options. Plus, if I were being really cynical I would say that a new administrative program from the government is great for administrators’ jobs.

One regular reader of this site, meltoots, makes this passionate plea from the doctor perspective:

You know me John,
CMS is completely unaware of how bad it is out here on the front lines. MACRA is dead. They can try to implement, but it will fail. The front liners that are left have had enough of the fraud of reporting “quality” as a measure of success. Does not work at all. Its a sham. ACOs failing left and right. Does CMS REALLY think that if i report a 100% preop antibiotic rate is quality? We do that 100% already. Do they really think that CPIA is “value” or is it just reporting “value”. Lets get real. All the small practice incentives are going to 11 companies, NOT the actual practices. For “education” and “training” on MACRA. Thanks. Right. There is a HUGE disconnect between CMS/HIT and front line MDs. Again this week 2 more people gave up medicine in our hospital. I’m telling you this is a crisis and cannot be ignored. Its time to unburden MDs from all these distractions, let EHR companies innovate without being shackled to cert requirements. Wash DC cannot solve this. They have set us back 10 years already. Time let go and get out of the way.

The problem is that I think he’s missing the point. CMS does think that MACRA will improve quality. Trying to illustrate that you disagree is likely going to fall on deaf ears.

The comment about MACRA being dead could be taken a lot of different ways. However, I can assure you that it is not dead and not even showing signs of death. Doctors can complain and moan all they want, but if they don’t get their large practice colleagues on board as well, then MACRA will not only survive, it will thrive when it comes to participation numbers.

I personally think that the battle to kill MACRA is a waste of effort since it will likely never happen. Instead, doctors should focus their energy on improving MACRA so that it’s simplified and focused on things that do improve healthcare. Sure, it will never get their 100%, but the all or nothing approach to trying to kill MACRA will likely lead to even worse results (ie. wasted energy and no changes).

What do you think about the future of MACRA? I look forward to hearing your thoughts in the comments.

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

A Missing and Ignored Patient Narrative

Posted on February 24, 2017 I Written By

Janae builds inbound social media sales and marketing plans for healthcare IT companies. Healthcare as a human right. Physician Suicide Loss Survivor. twitter: @coherencemed

Sometimes I feel like the discussion of the patient narrative and open notes make me want to scream.  Step away from the new Health trend and back to improving access for every patient. Patient Experience and specifically Patient Narrative has been a theme of the HIMSS healthcare conference this year, from patient data and records to open notes and patient advocates. I have to admit- I love watching what people have done and what companies think of.

It reminds me of my German class on the Literature of the Holocaust. Our professor stood up and introduced the Holocaust as unique because the German Jews could read and write, so they had records. Without records, the voices of countless have been lost. Their voices died with them. Patient Narrative is similar. It’s teaching us so much about better workflow and records and getting better outcomes. Max Stroud gave a great presentation about her sister’s experience with lung cancer and managing patient records. They both admitted that it was difficult for them despite being well educated and knowledgeable about healthcare.

At HIMSS everyone looks at shiny new products with novelty pens and some alternate universe where it makes sense that we all need another plug in to our electronic medical record to really “make a difference” for patient health.

Right before HIMSS some of my late husband’s medical school classmates came to visit me and go to ongoing education in Park City. I asked them what they thought about patient involvement and one of them discussed the reality of emergency room care in impoverished areas.  They discussed losing faith in patients and how to deal with trauma patients. I remember the jokes about drug seekers. I told them about being at dinner in suburban Utah when an acquaintance casually mentioned we should do Molly on our way to yoga. The doctors I told laughed it off and said Molly really wasn’t that serious. Those narratives aren’t on our health records and the healthcare system is hemorrhaging cost with its lack of ability to treat them. Patients in some rural areas have access to care issues that telehealth doesn’t always bridge the gap for.

Is patient narrative just the next buzzword so we can distract ourselves from poverty and violence and human trafficking and corporate identity theft? Are we just talking louder to drown out the patients that healthcare is failing? Not every company or hospital group can afford to go to HIMSS. Participants have relatively good access to care and a lifestyle of relative privilege. Exhibitors are selling something and it certainly isn’t about the unglamorous parts of medicine.  The undocumented patient narrative will never climb the walls of privilege in a system with an entire industry of payor complexity and government regulation.  There were so many companies and even in telemedicine in rural areas and patient narrative presentations I didn’t see the patient stories like the ones I heard from my friends.

We are distracting ourselves from the complete lack of availability of care for economically disadvantaged patients by geeking out over the shiny data with our fellow zealots.  We can learn new things and find interesting new companies and many places are getting better, but we need a new record and involvement from a group that could never come to HIMSS. A narrative for the illiterate, uninformed, impoverished forgotten stories.

 

Ambulatory EHR Vendors Are Now Distribution Channels

Posted on February 23, 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’ve been thinking about this idea since MGMA and it was illustrated even more deeply at the HIMSS 2017 Annual conference as well. EHR vendors with a reasonably sized user base have made a really big shift. Instead of selling EHR software, they’ve become a really interesting distribution channel.

Sure, you can still go to any of the EHR vendors and buy an EHR. They all can do that and they have some effort to sell EHR, but not really. Instead, you can see that the focus of many EHR software vendors have shifted to retaining their existing customer base and selling them new products. Some of them integrate smartly with the EHR software, but many of them have very little to do with the EHR.

Think about it from the EHR vendor perspective. They could churn their wheels trying to sell EHR software to a bunch of clinics that have basically chosen to not do EHR. Sounds like fun, right? They could also try and get people to switch EHR companies. Another really fun task, right? No, it’s a really challenging thing to do.

Instead of the really hard challenge of selling EHR software to people that don’t want it or don’t like the one they have, they instead sell something of value to their existing user base. It’s no wonder that EHR vendors have chosen to become distribution channels. If you have a sizable user base in a saturated market, it’s much easier to become a distribution channel to your users than it is to try and take users from your competitor.

Does this not describe where we are in the ambulatory EHR market? I’m seeing that play out across a whole lot of EHR vendors. This dynamic will be extremely interesting to watch. It will also be interesting to see what this means for smaller EHR vendors who don’t have a large enough user population to be a good distribution channel.

What do you think of this shift?