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I Really Don’t Want to Be Your “Worst” Patient

Posted on April 29, 2016 I Written By

The following is a guest blog post by M. Maxwell Stroud, Lead Consultant at Galen Healthcare Solutions.
Max - Healthcare IT
“I really don’t want to be your “worst” patient. Really, I don’t.”  These are the words that I think to myself as I prepare to ask my new specialist if he has interfaces with either of the hospital labs in my hometown 40 miles away.  My provider humors me and lets me know that if I go to one lab he will get a fax, and another and he will be able to view the results in a portal.  Sigh.

I have for a long time kept all of my care to one healthcare organization in town – in part because I am a firm believer in one chart for one person and I personally don’t want to have to deal with the mess of coordinating all of my records or manually schlepping things from office to office.  I love the concept of “one source of truth” and I know how far away we really are from that.  So why venture out of town and (gasp) to different healthcare organization?  Because that is where the best specialist was that was seeing new patients and mine had left town.

As a patient, I get to make that choice.  I get to decide where I get my care – as I should.  I also make the choice knowing that it will result in me having two distinct medical records in orgs 40 miles away from each other.  I also know that it means I am, at times, going to have to put on my advocacy hat and make sure that my records are correct, that my labs got where they need to go and that everyone has the information that they need so that I can get the best care.

Wait. What?  The patient is the only person in this continuum of care who is making sure the right person has the right data at the right time?  Yep.  Some might say that I am a control freak or that I need to relax a little – but I am informed by the life experiences of the patients that have been a part of my life.  I have seen what happened when my father got admitted to the hospital without an accurate medlist available.  I have seen the binder that my sister has to carry with her on the train that has her MRIs and PET scans to take to her next oncology appointment in the city.

It blows my mind that just a little over a month ago I was at the largest healthcare IT conference in the country (HIMSS16) discussing interoperability, and now I am on the phone with the nurse at the clinic because she cannot find my lab results … “Oh wait” she says “they are in the print and scan pile.”  Great.  Just great.

I have heard the argument that patients are not interested in their data.  There is a chance I could be an outlier – I live my life in a world of health data and I am acutely aware of how it is used in my care and the care of others.  I really think the truth is you don’t know how important it is to you until it becomes important to you.  One life event, one family member’s crisis, one rare diagnosis – and you begin to understand that you are the most important person in your own healthcare.

We have centered record keeping around the physical location of care.  This makes sense when you think historically.  Patients used to be less mobile, receive care locally and lived locally.  Additionally, the role of the “legal medical record” is a legal representation of the care provided and decisions made by a healthcare organization.  Organizations still need to document medical decision making, but patients are becoming more and more mobile.  People move from city to city, or even within health networks in the same town.  In the digital age, even if the legal medical record lives with the provider —  the data needs to follow the patient.

We can do better by patients and consumers.  The information is there, it is just not yet connected in the way that will make it available, actionable and meaningful to everyone who needs it.  It’s not just about finding an easy button to import discrete data, but also a culture change.  Truly putting the patient at the center of the data is simultaneously mission critical and more than a little revolutionary.

About M. Maxwell Stroud
M. Maxwell Stroud, MSW MSW is a Lead Consultant at Galen Healthcare Solutions with a professional background in both healthcare and social work. Max has been consulting in Health IT for over 8 years.  She has worked with every aspect of health IT in ambulatory care including facilitating clinics through the transition from paper to electronic formats, supporting teams through major system-wide upgrades as well as add-on implementations and integration projects.       Max has a passion for collaborative process and building processes that bring all stakeholders to the table to build systems that meet the needs of the business organization, the providers and the patients.  Max can be found on Twitter at @MMaxwellStroud

Lessons Learned from Patient Engagement Efforts in Louisiana

Posted on March 28, 2016 I Written By

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

UPDATE: Check out the video recording of our interview:

2016 March - Lessons Learned from Patient Engagement Efforts in Louisiana-blog

For our next Healthcare Scene interview, we’ll be chatting with Jamie Martin and Linda Morgan from the Louisiana Health Care Quality Forum (LHCQF) on Wednesday, March 30, 2016 at Noon ET (9 AM PT). After putting on an incredible session on patient engagement at HIMSS, I can’t wait to have LHCQF join me to share many of the experiences and learnings that have taken place in their efforts to promote patient engagement in Louisiana.

You can join my live conversation with Jamie Martin and Linda Morgan and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Wednesday, March 30, 2016 at Noon ET (9 AM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’re hoping to include as many people in the conversation as possible. The discussion will be recorded as well and available on this post after the interview.

As we usually do with these interviews, we’ll be doing a more formal interview with Jamie Martin and Linda Morgan for the first ~30 minutes of this conversation. Then, we’ll open up the floor for others to ask questions or join us on camera. Jamie, Linda and the team at LHCQF have done some phenomenal work in promoting patient engagement in Louisiana. I’m looking forward to learning from their experience and insights so we can see more of it happen across the nation and world.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Hyperportalotus: Condition Whereby Patient Has Too Many Healthcare Acquired Portals

Posted on March 7, 2016 I Written By

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

In case you missed the last day of HIMSS 2016 (which is most of you since the keynote area was pretty empty), you missed a number of interesting keynote sessions and other education sessions. However, as I thought through the sessions that day, this comment from a patient attending one of those sessions really stood out to me:

Based on the reaction of the crowd to this comment and my own experience talking with thousands of doctors and patients, this is a very common problem. Meaningful use encouraged providers to have a patient portal, but this had the unintended side effect of what I’d call portal proliferation.

The patient who commented about her “hyperportalotus” said that she knew that she had portals for most of her providers, but she couldn’t keep track of which provider was on which portal. No doubt she was embarrassed when she couldn’t remember how to log in to that many portals as well. Plus, the last thing any sick person wants to do is go searching through 9 portals to find the one that has the information they need.

What concerns me most about Hyperportalotus is that I don’t think there’s a clear pathway to treating this debilitating problem. There are some treatments that make it better, but the problem still remains and I don’t see a cure for the problem coming anytime soon. Is the government going to come out with a portal non-proliferation treaty? I don’t think so.

Before I get a wave of pitches that you’ve solved this problem, I’ll make it clear that I don’t think the patient being an HIE of one is a scalable solution. That idea might work for some patients, but it won’t work for most. Plus, the complexity of each portal having their own format and design causes so many issues with the concept of the patient being the repository and aggregator of their health information.

I’d love to hear how people think this will play out? We got a bunch of doctors on the portal. Now what?

No,The Patient Isn’t Disrupting Your Workflow!

Posted on February 26, 2016 I Written By

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

Just recently, I had a personal experience which highlighted a serious problem in how hospital staffers handle health IT workflow.

The backstory is as follows. I was dispatched to the emergency department of a local mid-sized community hospital after complaining of chest pain and shortness of breath. (Turned out it was an asthma attack, not a cardiovascular complication, but the on-call doc I spoke with wasn’t taking any chances.)

This hospital ED seems efficient and well-run. Moreover, the clinicians and techs are uniformly attentive, thorough and patient. In other words, I feel safe and well-cared-for there.

That being said, I had a few experiences during this ED visit which I suspect are endemic to the industry. No one of these issues seemed serious in and of themselves, but collectively they gave me the sense that my feedback on what I observed wasn’t welcome.

They included the following:

  • When I called attention to the fact that my blood pressure reading was unusually low (80/60) they dismissed the data as a blip and discouraged further discussion.
  • After the expected EKG to rule out cardiac concerns , staff left the leads attached to my skin to allow further testing if needed. Because the adhesive attaching the leads to my skin came loose now and then, you guessed it, alarms went off. When I suggested that the leads be either reattached or removed, the tech’s response translated to: “Honey, you have no business asking these questions.”
  • When I tried to find the results of the tests they were running via the MyChart app on my phone (yes, they’re an Epic shop), none of them were available, even though the doctors already had them.

None of these issues represent a staggering problem. My blood pressure did normalize, we handled the EKG lead stickiness issue without incident, and I did get my test results as soon as the doctor had them. I got a nebulizer treatment and some feedback on my overall health, and went home feeling much better.

That being said, I still find it unsettling that I was discouraged from taking note of what I saw and heard, and had no access to test results on the spot that would have put many of my concerns to rest.

More broadly, I object strenuously to the “doctor knows best” scenario that played out in this setting, at least where IT workflow was concerned:

  • While I understand completely that nurses and techs are besieged with needless noises and suffer from alarm fatigue, treating my response to those alarms as trivial doesn’t seem appropriate to me.
  • Failing to share data on the spot with me via the portal deprived me of the chance to discuss the data with my ED doctor. Instead, I only got to go over the data very quickly and mechanically with the nurse at discharge.

What bugs me, ultimately, is the intangible sense that I was perceived as a force breaking the IT workflow rather than a participant in it. This incident has convinced me that we need to transform the way HIT systems are designed, in a manner which brings the patient into the process of care. You clinicians need my eyes and ears to be on the case too.

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

Posted on January 11, 2016 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

What Does It Take to Create the Ideal Patient Experience? – #MyIdealPtExp

Posted on December 14, 2015 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 new world of social media has created so many virtual friends for me. Over time I’ve had a chance to meet so many of them in person. While sometimes it’s a disappointment meeting someone in person, I’ve also had the opposite experience. This happened at RSNA when I got a chance to meet Andy DeLaO (@CancerGeek) in person. I’d always been impressed by his insightful tweets over the years. So, I was blown away when he was even more impressive and insightful in person. I love it when that happens.

One of the most impressive things he showed me was his new effort around what he calls My Ideal Patient Experience. He even had these really cool coins to hand out which was a great way for me to remember his concept:
My Ideal Patient Experience
Andy the team behind My Ideal Patient Experience has gone through the research and defined the patient experience using these 4 pillars:

  • Time
  • Trust
  • Transparency
  • Transitions

However, it’s worth considering the connective tissue between all 4 pillars:

Time Leads To Trust, Trust Leads To Transparency , Transparency Leads To Transitions; The 4t’s Lead To Relationships And Success!

Andy and his team have been at this for a while even though they’re just now getting their official patient experience website launched. I love that they’re even keeping track of their stats:

  • 50,850 Patients Impacted
  • 878 Physicians Engaged
  • 46 Clients Worked With
  • 30 Completed Projects

If you’re looking to improve the way you engage with patients or your patient experience, take a second to look at the consulting, market research, healthcare engagement, and education resources they offer. After my experience finally meeting Andy in person, I’m excited to see the impact for good “My Ideal Patient Experience” will have on healthcare. Plus, I look forward to digging into the concepts even more in the future.

Marketing Predicted the Failure of Meaningful Use Stage II Patient Engagement

Posted on June 17, 2015 I Written By

The following is a guest post by John Sung Kim, General Manager of DoctorBase, a Kareo Company.
John Sung Kim
Marketers knew far ahead of CMS and the ONC that certain components of Meaningful Use Stage 2 (MU2) were simply not attainable. Thankfully, one of the original components of MU2, whereby 5% of a provider’s patients have to exchange secure messages, is now being relaxed to the simple ability to have secure messaging as an available option for patients.

When MU2 was first drafted, the original threshold was 10%, which was met with a wave of criticism from vendors, analysts, and providers who pointed out that forcing patients to adopt a new technology was outside of a provider’s control.

Yet, even the subsequently reduced 5% goal was difficult to achieve for most organizations, especially smaller independent practices that were dealing with a confluence of changing competitive markets, new billing codes, and mandated technological updates. Any digital marketer with two years of experience running ad campaigns could have told us this would become the case.

There were several marketing related reasons why 5% (or 1 in 20 patients) was simply not achievable for many practices, even with many modern EHR systems:

  • Activation Energy: Most patient portals are too difficult to register for. It’s a well known marketing rule that the number of fields a user has to fill in to register for a service is inversely proportional to the completion rate. Marketers call the amount of effort that users are required to obtain a desired action on a computer or mobile device the “activation energy.” Quite simply, the activation energy required to register for most patient portals is too high.
  • The Funnel: The most common way that patients look for the address or phone number of a provider is to enter permutations of the doctor’s name in search engines. This is what marketers call the “top of the funnel.” If a patient portal is not optimized for search engines (very few are) patients won’t enter the funnel, in other words—what can’t be seen at the top of a Google search result simply doesn’t exist to the patient.
  • Call to Action: Any modern digital marketing campaign has a “Call to Action,” commonly referred to as a CTA. In healthcare, it’s rare that any brochure, office sign, or practice website has a CTA asking patients to engage or interact, and that’s a shame since colorful, visible (and often large) buttons directing the user to click have interaction rates that are often on an order of magnitude greater than collateral without a clear CTA.
  • Email Marketing: Having worked in both digital health and digital marketing, I know how important collecting email addresses of users is, and how poorly most practices actually do this in a routine fashion. A “typical” small or group practice will have no more than 20% to 25% of their patients’ email addresses. So when a marketer does the math of registering 5% of their users through emails, the true number becomes much larger. For example, a practice with 20% of their panel with an email address would need a 25% engagement rate—not 5%! That’s an incredibly aggressive target, even for the biggest brands and best marketers.

Is it time for the Office of the National Coordinator and CMS to start hiring more marketers?

About John Sung Kim
John Sung Kim is the founder and founding CEO of Five9 (NASDAQ: FIVN) widely recognized as the leading company in the contact center industry. He’s acted as a consultant to numerous startups including LGC Wireless (acquired by ADC), Qualys (NASDAQ: QLYS), RingCentral (NYSE: RNG), Odesk (merger w/ Elance), 6connect (funded by Hummer Winblad) and M5 Networks (acquired by ShoreTel). Follow him @JohnSungKim.

Kareo, the leading provider of cloud-based software and services for independent medical practices, is a sponsor of EMR and EHR. Find out more about Kareo’s award-winning solutions at http://www.kareo.com/.

Bringing the Obvious to the Surface Through Analytics

Posted on May 26, 2015 I Written By

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

Analytics can play many roles, big and small, in streamlining health care. Data crunching may uncover headline-making revelations such as the role smoking plays in cancer. Or it may save a small clinic a few thousand dollars. In either case, it’s the hidden weapon of modern science.

The experience of Dr. Jordan Shlain (@drshlain) is a success story in health care analytics, one that he taking big time with a company called HealthLoop. The new venture dazzles customers with fancy tools for tracking and measuring their customer interactions–but it all started with an orthopedic clinic and a simple question Shlain asked the staff: how many phone calls do you get each week?

Asking the right question is usually the start to a positive experience with analytics. In the clinic’s case, it wasn’t hard to find the right question because Shlain could hear the phones ringing off the hook all day. The staff told him they get some 200 calls each week and it was weighing them down.

OK, the next step was to write down who called and the purpose of every call. The staff kept journals for two weeks. Shlain and his colleagues then reviewed the data and found out what was generating the bulk of the calls.

Sometimes, analytics turns up an answer so simple, you feel you should have known it all along. That’s what happened in this case.

The clinic found that most calls came from post-operative patients who were encountering routine symptoms during recovery. After certain surgeries, for instance, certain things tend to happen 6 to 9 days afterward. As if they had received instructions to do, patients were calling during that 6-to-9-day period to ask whether they symptoms were OK and what they should do. Another set of conditions might turn up 11 to 14 days after the surgery.

Armed with this information, the clinic proceeded to eliminate most of their phone calls and free up their time for better work. Shlain calls the clinic’s response to patient needs “health loops,” a play on the idea of feedback loops. Around day 5 after a surgery, staff would contact the patient to warn her to look for certain symptoms during the 6-to-9-day period. They did this for every condition that tended to generate phone calls.

HealthLoop builds on this insight and attaches modern digital tools for tracking and communications. Patients are contacted through secure messaging on the device of their choice. They are provided with checklists of procedures to perform at home. There’s even a simple rating system, like the surveys you receive after taking your car in to be fixed or flying on an airline.

Patient engagement–probably the most popular application of health IT right now–is also part of HealthLoop. A dashboard warns the clinician which patients to perform each day, surfacing the results of risk stratification at a glance. There’s also an activity feed for each patient that summarizes what a doctor needs to know.

Analytics doesn’t have to be rocket science. But you have to know what you’re looking for, collect the data that tells you the answer, and embody the resulting insights into workflow changes and supporting technologies. With his first experiment in phone call tracking, Shlain just took the time to look. So look around your own environment and ask what obvious efficiencies analytics could turn up for you.

5 Lessons Providers Can Learn from Payers Infographic

Posted on May 1, 2015 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.

ClinicSpectrum has been putting out a whole series of healthcare IT infographics. I recently saw one of them that really caught my eye as it came across my Twitter stream. The infographic offers 5 things providers can learn from payers. I’m sure that concept is a bit unsettling for some providers, but the list is quite intriguing:

  1. Leverage Data to Identify High-Risk Patients
  2. Help Patients Manage Their Meds
  3. Designate a Patient Engagement Advocate
  4. Build Partnerships
  5. Seek Interoperability Opportunities

What do you think about these ideas? Check out the full infographic below for more details:
5 Lessons Learned from Payers
Full Disclosure: ClinicSpectrum sponsors posts on Healthcare Scene.