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Review of “Patient Engagement is a Strategy, Not a Tool” by Colin Hung

Posted on November 24, 2014 I Written By

The following is a guest blog post by Colin Hung (@Colin_Hung), Co-Host of #hcldr and SVP of Marketing at Patient Prompt.
Colin Hung
If Leonard Kish’s new eBook – http://www.hl7standards.com/kish-ebook/”>Patient Engagement is a Strategy, Not a Tool was a song, it would be categorized as a “mashup” – and that’s a good thing.

Never heard a mashup song before? Just go to youtube.com and type it into the search bar and you’ll find thousands (or try this one https://www.youtube.com/watch?v=zbrWu8XyAcM). Mashups are a unique form of music. To make one, DJs will take snippets (called samples) from other songs usually from different artists and combine them into a single piece and in so doing create a whole new song in the process.

When done properly a mashup is both familiar and fresh. It has elements which you know and love yet the composition as a whole feels new. That is exactly what Kish has done in his eBook. He expertly weaves together numerous ideas, themes and approaches from different people and different industries into a single cohesive arrangement.

Kish starts by laying down a central idea that is carried like a melody from page 1 through to the end:

“The key to [patient] engagement in early stages is to get people’s attention and to let them see what’s possible by using the tools available to improve their health. It’s a process and a strategy, not a data set or any one tool”

With that idea track locked in, Kish proceeds to mix in concepts from:

  • Marketing – target audiences, key messages and clear calls-to-action
  • Product Management – inclusive design and agile development
  • Behavioral Science – Maslow’s hierarchy, social interaction and motivation

The eBook starts off strong with a nice definition of patient engagement – a rather amorphous term in healthcare right now –  and gets stronger with examples of successful “attention grabbing” marketing campaigns that could be adopted by healthcare organizations.

One particular statement that stands out:

“Engagement requires what marketers know very well: motivation, context and messaging.”

As a person who works in HealthIT Marketing, I’m tickled by this statement…but I think Kish is giving those of us in Marketing a bit too much credit. Although it is true that marketers should have a good grasp of our target audiences (their needs, wants, motivations and fears) – we are not seers. In fact, it is common for marketers to be a little “off key” when approaching new markets or when working with new products.

Truly successful marketers are the ones who are open to being wrong…and who can quickly adapt their messages/approach based on real data and feedback from the target audience. Like a good DJ, you must read the reaction of the audience and change the tune in order to keep things hopping.

The idea of iterating, fitting engagement into the world of the patient (context) and using feedback are the themes that fill the middle portion of Kish’s eBook. Using anecdotes, quotes and statistics from a wide array of leaders he encourages readers to draw parallels with healthcare and to think critically on how that wisdom from outsiders can be applied successfully in their own organizations.

Fittingly there is a section that draws a parallel between healthcare and music. Kish quotes former Talking Heads singer David Byrne in a particularly memorable and interesting chapter.

The finale is where “Patient Engagement is a Strategy, Not a Tool” shines. Having laid the ground work in the prior chapters on why getting patients’ attention is so critical and how difficult it can be to turn that attention into meaningful behavior change, Kish closes by giving readers 10 concrete steps to follow to “win the attention war” in healthcare:

  1. Know what health problem you are trying to solve
  2. Know whose attention you’re trying to get
  3. Use social tools
  4. Know behavior models and behavioral economics
  5. Focus on goals and narratives
  6. Start Simple
  7. Try something and measure results
  8. Understand context
  9. Take an open approach
  10. Follow an analysis-driven implementation plan

I was hoping for a little more depth from Kish on the Agile approach, especially as it relates to A/B testing, iterative design and high reliance on real-user feedback – something that I believe could DEFINITELY be used in healthcare – but perhaps he is keeping these concepts for his next composition.

Overall, Kish’s eBook is a solid mix of familiar theories/approaches from other industries and new ideas/success stories from within healthcare. It offers insight and practical advice on how to change from a tools-based approach to patient engagement to a process and strategy based one. If you work in healthcare and are involved in your organization’s patient experience, access or engagement initiatives this eBook should be on your reading list.

I am looking forward to Kish’s next release – which I hope drops soon.

“Patient Engagement is a Strategy, Not a Tool” can be downloaded for free courtesy of the good folks at HL7 Standards (http://www.hl7standards.com/kish-ebook/)

Cracking Open the Shell on the Personal Health Record

Posted on November 5, 2014 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://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The concept of maintaining your own health data enjoyed a brief flurry of activity a few years ago with Google Health (now defunct) and Microsoft HealthVault (still active but not popular). It has gotten a second chance with Apple HealthKit, Google Fit, and other corporate offerings explicitly tied in with the convenience of mobile devices. Microsoft itself has galvanized HealthVault with a Microsoft Health initiative similar to Apple’s HealthKit. Recently I’ve been talking to health care reformers about the business and political prospects for personal health records (PHRs).

Patient access to data was enshrined as a right back when HIPAA was passed and is still championed by the US government through Meaningful Use (whose Stage 3 may well focus on it) and other initiatives, and has been endorsed by the industry as well. But this requirement won’t be satisfied by the limited patient portals that hospitals and clinics are hanging out on the Web. Their limitations include:

  • Many provide only viewing data, not downloading or transmitting it (all of these are mandated by Meaningful Use).
  • Data maintained by providers can’t easily be combined into a holistic, comprehensive view, which is what providers need to provide good care.
  • Data on portals is usually a thin sliver of all the data in the record: perhaps prescriptions, appointments, and a few other bare facts without the rich notes maintained by clinicians.
  • You can’t correct errors in your own data through a portal.
  • Clinicians rarely accept data that you want to put in the record, whether personal observations or output from fitness devices and other technical enhancements.

All these problems could be solved by flexible and well-designed personal health records. But how does the health care field navigate the wrenching transition to giving people full control over their own data?

Dr. Adrian Gropper has investigated PHRs for years and even considered building a simple device to store and serve individual’s health data. Now he says, “I can’t recall any physician in my medical society that has ever said they wished their patient had a PHR. Nor do I, after many years on the Society for Participatory Medicine list, ever recall a patient praising the role of their PHR in their care. Today’s PHRs are clinically irrelevant.”

This is not a condemnation of PHRs, but of the environment in which vendors try to deploy them. Many health reformers feel that several aspects of this care environment must evolve for PHRs to be accepted:

  • PHR data must become appealing to doctors. This means that device manufacturers (and perhaps patients themselves) must demonstrate that the data is accurate. Doctors have to recognize value in receiving at least summaries and alerts. Many benefits can also accrue from collecting vital statistics, behavioral data, and other aspects of patients’ daily lives.
  • The doctor’s EHR must seamlessly provide data to the patient, and (we hope) seamlessly accept data from the patient–data that the doctor acts on. Currently, most manufacturers store the data on their own sites and offer access through APIs. Another programming step is required to get the data into the PHR or the doctor’s EHR.
  • Clinicians have to agree on how to mark and collect the provenance of data. “Provenance” deals with assertions such as, “this data was generated by a Fitbit on October 10, 2014″ or “this diagnosis was challenged by the patient and changed on August 13, 2010.”
  • Add-on services must make the data interesting and usable to both patients and physicians. For instance, such apps can alert the patient, clinician, or family members when something seems wrong, let them visualize data taken from the PHR and EHR over time, get useful advice by comparing their data to insights from research, and track progress toward the goals they choose.

“A critical force in increasing consumer engagement in digital health is the development of compelling, easy to use tools that make it simple to collect, understand and use health information to reach the goals consumers define for themselves, whether that’s managing a chronic condition, saving money, or fitting into their ‘skinny jeans’,” writes Lygeia Ricciardi, former director of the Office of Consumer e-Health at the ONC. “In an age of ‘one click purchasing,’ it must become incredibly easy for patients to access and share their own health information digitally–if it’s too complex or time consuming, most people probably won’t do it.”

In addition to sheer inertia, a number of disincentives keep PHRs from congealing.

  • Many doctors are afraid of letting patients see clinical notes, either because the patient will ask too many questions or will be upset by the content.
  • Hospitals and clinics want control over records so that patients will return to them for future treatment.
  • Marketing firms live off of rich data lodes on our health data.
  • Other organizations with dubious goals, commercial and governmental, want to track us so they can deny us insurance or control our lives in other ways.

Wait–what about the patients themselves? Why haven’t they risen up over the past several years to demand control over their data? Well, maintaining your health data is intimidating. The data is highly detailed and full of arcane medical concepts and terminology. Most patients don’t care until they really need to–and then they’re too sick and disabled to form an effective movement for patient control.

Still, several leaders in health care believe that a viable business model can be built on PHRs. The spark of hope comes from the success of apps that make people pay for privacy, notably SnapChat and Whatsapp. Although some sloppy privacy practicies render these services imperfect, their widespread use demonstrates that people care about protecting their personal data.

Private storage can be offered both in the cloud and by personal devices, using standardized services such as Direct and Blue Button. These will start out as high-end services for people who are affluent and have particular concerns about storing their own data and choosing how it is shared. It will then become commoditized and come down in price.

What about people who can’t afford even the modest prices for cloud storage? They can turn patient data into a civil rights issue. There’s a potent argument that everyone has the right to determine who can get access to their health data, and a right to have data generated during their daily lives taken into account by doctors.

We don’t need one big central service–that’s insecure and subject to breaches. Multiple services and distributed storage reduce security risks.

We’ll see change when a substantial group of people start to refuse to fill out those convoluted forms handed to them as them enter a clinic, saying instead, “Get it from my web site before you treat me.” Before that protest begins, there’s a lot of work in store for technologists and businesses to offer patients a usable record system open to the wide range of data now available for health.

6 Physician Website Tips

Posted on October 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 asked to write an article for gMed users about Building a Better Physician Website. It’s an important topic that often gets overlooked by clinics and doctors and something I’ve worked on building physician websites. Here’s the intro to the article:

In this ever changing world, a physician’s website is how a new patient is going to judge that physician’s skills and capabilities. Whether they find their doctor on their insurance list, Google, a physician rating site or from a friend, a large majority of patients are now reviewing websites before scheduling an appointment. What does your website tell your patients about you? Does it portray a doctor who’s still stuck in the 90’s and hasn’t stayed up-to-date with the latest changes in technology? Does it allow a visitor to your website to easily become a patient? Does it make the patient feel like you are the best doctor for them?

I also offer the following 6 tips for physician websites:

  • Make Your Website Beautiful
  • Mobile Optimized Website
  • Engage Potential Patients
  • Engage Existing Patients
  • Online Payment Options
  • Regularly Updated Content

Be sure to read the full article where I go into more detail on each tip. What have you seen with Physician websites?

Full Disclosure: gMed is an advertiser on this site.

Connected Health takes the stage at Partners symposium

Posted on October 28, 2014 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://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The Connected Health Symposium is not one of the larger health conferences, but it is one of the most respected. I met a number of leaders in health IT there who praised it for the conference scope and seriousness, and told me they were glad to see me there covering it.

Many issues in health IT and patient empowerment, however, are best learned not from any conference, but from the tussles and tears of everyday life. Let us hope no reader has undergone the personal experience of having her reports dismissed and of being misdiagnosed, as did several speakers at the conference.

But many of us have spent three hours on the phone with an insurer to approve a single medication shipment, or fought in vain to get the medical records that US law requires providers to give us, or watched our doctor fumble with his new EHR for fifteen minutes while trying to stay engaged with us.

It’s encouraging to see the progress of patient engagement at Massachusetts General Hospital, as reported by Gregg Meyer of Partners Healthcare System (the funder behind the Center for Connected Health that put on the symposium). But can small and rural providers struggling with cash flow join the movement?

These institutions would be comfortable using swyMe, a HIPAA-compliant telemedicine system that allows doctors to interview patients over everyday mobile devices and perhaps avoid a trip to the hospital. swyMe can also transmit audio and video from devices that EMTs can connect up to the phone. (Not many devices with the necessary hardware connectors are on the market, though.)

swyMe was one of the “innovators” highlighted in a conference demo. Jeffrey Urdan, COO of the company that makes it, told me later that he felt “low tech” compared to some of the fancy, expensive devices at the demo. But most of the providers in the US, and elsewhere, are more on swyMe’s level than theirs.

Another hurdle to forming connected teams that serve the patient is interoperability. A sign of the distance we have yet to come can be found in iCancerHealth, a service for cancer patients offered by Medocity. A free app is available to individuals, but the main integrated service is offered through providers or pharma companies doing clinical trials. The service includes such conveniences as medication tracking, treatment plans, a diary, audio and video connections to their physician, and even a way to form communities with other patients.

This is great, but iCancerHealth works with data from only one provider. This can be a limitation even for the few months that cancer patients typically use the service, and could certainly be a problem if the service were expanded to a broader range of illnesses. Similarly, there’s no seamless way to share data with patient communities; it has to be re-entered manually. Enhancing the service to encompass multiple providers would probably require wider adoption of electronic health record standards.

As an example of finding a creative solution to devices that lack interoperability, Mobile Diagnostic Services demonstrated an app that could photograph the display panel of a device, interpret the bars on the display to create digital data, and transmit the values to a health record in the cloud. This is a process well-known to computer programmers from thirty years ago as “screen scraping,” now relevant to the health industry.

One of the strengths of the Connected Health Symposium was the platform it gave to patients and doctors to express their frustrations with the old way of delivering care and the slow pace of change. The testimony could come from entrepreneur Robin Farmanfarmaian, who lost three organs unnecessarily to misdiagnosis, or Sarah Krüg, president of the Society for Participatory Medicine, whose parents died from diseases that might have been caught if the doctors had paid attention to their reported symptoms.

Or the testimony could come from Greg LaGana and Barry Levy, MDs who write and perform in a musical review called Damaged Care that skewers everything about doctors behavior as well as the legal and financial environment in which they have to operate.

Anna MCollister-Slipp, co-founder of Galileo Analytics and a sufferer from type 1 diabetes, regaled us with the dozens of vital sign measurements, treatments, and other details she has to manage on her own manually. She still get lab reports only because her doctor sends them via email (using a private account, so that HIPAA zealots don’t discipline him–the rights and wishes of the patient are supposed to be paramount). Like other conference attendees, though, she reported progress in tools and patient-oriented culture.

Less was heard at the symposium from other sectors of the medical field, but we did hear from Michael of Aetna, Jonathan Bush of athenahealth, and Beverley Bryant of England’s National Health Service. The panel on which Bryant spoke proved to be discouraging. Many of us in the US like to think that other developed nations with their universal health care systems have solved the coordination and interoperability messes that the US is in. But the panelists expressed many familiar frustrations.

I plan to return to the Connected Health Symposium next year, and I’m sure each year will bring a bit of progress toward better communication among staff, better use of patient data, and better integration of tools. The mood at the show was largely positive. But a little probing turned up barriers in the way of the healthcare system we all want.

Which Comes First in Accountable Care: Data or Patients?

Posted on September 30, 2014 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://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The headlines are stark and accusatory. “ACOs’ health IT capabilities remain rudimentary.” “ACOs held back by poor interoperability.” But a recent 19-page survey released by the eHealth Initiative tells two stories about Accountable Care Organizations–and I find the story about interoperability less compelling than another one that focuses on patient empowerment.
Read more..

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 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://radar.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.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

Comical Patient Portal Discussion

Posted on July 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 long been interested in how offices communicate their use of an EHR and patient portal to their patients. Long time readers might remember this EMR Under Construction sign that one office used.

I had a doctor send me this email exchange which isn’t necessarily a great suggestion for a practice, but it does illustrate many physicians view of what’s happening with EHR and patient portals:
Comical Patient Portal Comments
I’ll call back to Carl Bergman’s post asking “Has EHR Become a Bad Brand?” I think many doctors consider the EHR and patient portal as one thing. Of course they’re not always the same, but emails like this illustrate how the patient portal and EHR brand are doing…not so well. Although, my guess is that meaningful use has an even worse image in the eyes of doctors.

What is Direct?

Posted on June 10, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that's part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

John’s Update: Check out the full series of Direct Project blog posts by Julie Maas:

The specialist down the street insists he wants to receive your primary care doctor’s referrals, but only if it’s digital: “Sure, I’ll take your paper file referral sent via fax. But the service will cost an extra $20, to pay the scribe to digitize the record so I can properly incorporate the medical history.”

Does it really sound that far off? Search your feelings, Luke…

Will getting medical treatment using paper records soon be like trying to find somewhere to play that old mix tape you only have on cassette?  Sound crazy?  Try taking an x-ray film to a modern radiology department, and see if they still have a functioning light box anywhere to look at it.  It’s all digital now.

There are, of course, other factors.

Because MU2.

Because nobody, and I mean no small company and no large company, wants to be referred to as a data silo anymore.

Direct Exchange is a way of sending and receiving encrypted healthcare data, and certified EHRs must be able to speak it, beginning this year.  Adoption of Direct is increasing rapidly, and its secure transfer enables patient engagement as well as interoperability between systems that were previously dubbed silos.  Here is a brief overview of where Direct is currently required in the context of MU2 (please refer to certification and attestation requirements directly, for full details):

Certified ambulatory and acute EHRs need to use Direct for Transitions of Care (170.314(b)(1) and (b)(2)). They have to be able to Create a valid CCDA and Transmit it using Direct, and they have to be able to use Direct to Receive, Display, and Incorporate a CCDA. In the proposed MU 2015, the Direct piece may be de-coupled from the CCDA piece and modularized for certification purposes, but the end to end requirement would remain the same.

EHRs or their patient portal partner additionally need to demonstrate during certification that patients can View, Download, and Transmit via Direct their CCDA or a human readable version of it.  Yes, you heard correctly, I said patients.  As in patient engagement.

So, how does a healthcare provider get Direct?

1. Get a Direct account through your Direct-enabled EHR vendor

One way HIT vendors offer Direct is through a partnership with one or more HISPs (OpenEMR, QRS, Greenway, and others).  Others run their own HISPs (Cerner, athenahealth, and others).

2. Get a Direct account through an XD* HISP that’s connected to your EHR

HIT vendors alternatively enable access to Direct through an XD* plug-and-play (mostly) connector.  These “HISP-agnostic” EHRs allow healthcare organizations a choice between multiple XD*-capable HISPs when meeting MU2 measures (MEDITECH, Epic, Quadramed, and other EHRs have implemented Direct this way).  EMR Direct, MaxMD, Inpriva, and a few other HISPs offer XD* HISP services; not every HISP offers XD* service at this time.  Of course, there is a trade-off between this flexibility and the extra legwork required of the practice or hospital in setting up Direct.

3. Get a web-based or email client-based Direct account not tethered to an EHR or Personal Health Record (PHR)

 

Direct doesn’t have to be integrated into an EHR to transfer information digitally. Non-tethered accounts cannot attest to the sending side of (b)(2) nor the receiving side of (b)(1) on their own, but they can be Direct senders and receivers nonetheless, participating in Transitions of Care or data transfer for other purposes.  They may also be used to exchange health data with patients, billing companies, pharmacies, or other healthcare entities who are Direct-enabled. In fact, some very compelling use cases involve systems who may not have their own EHR, but want to receive digital transitions of care—one such example is skilled nursing facilities.

By the way, patients are also an integral part of the Direct ecosystem.  Several PHRs are already Direct-enabled, and more are on the way.

So, go digital and get your Direct address, and begin interoperating in the modern age!

Reality of Patient Engagement Infographic

Posted on April 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 always love a good infographic. Boston Technology has put one out that looks at patient engagement. Which of the numbers on the infographic pops out to you?

Realities of patient engagement

Planning a Successful Patient Engagement Strategy

Posted on April 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

On social media and at events like HIMSS, we hear a lot of discussion about this new trend called patient engagement. While there are certainly new tools to help an organization engage the patient, I don’t think it’s fair to say that patient engagement is a new strategy. Patient engagement has always been considered a good thing in practices and healthcare organizations.

The challenge is that we’ve never rewarded those who actually did engage the patient. Healthcare reimbursement has actually discouraged patient engagement despite providers natural desire to want to engage the patient. Every doctor I know would love to sit down with a patient for an hour and really engage them in their health. Unfortunately, we don’t pay them to do this.

While I don’t think we’ll see an over night transition to hour long visits with our doctors, the move to value based reimbursement will finally start rewarding providers who engage deeply with their patients.

The next question doctors should ask is where to start when it comes to patient engagement in this changing landscape. This whitepaper on 5 Elements of a Successful Patient Engagement Strategy would be a good place to start. It provides a realistic strategy for your organization to consider.

The whitepaper also has this great quote from Leonard Kish:

“If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.”

Those practices that choose to not have a patient engagement strategy are going to fall behind. This won’t be an issue right away, but it will catch up to many practices who don’t see the coming change.