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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://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.

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://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.

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.

Innovative Collaboration on Medication Management and Community Resources

Posted on April 23, 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://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.

Although experts agree that the future of health is coordinated care, it is sorely lacking in the US health care system now. This article focuses on the single, relatively simple issue of medication management. Patients are prescribed barrels of pills, but there is little coordination other than looking for contra-indications and drug interactions–and these often suffer from the caretaker’s not knowing the patient’s full complement of drugs.

Sandra Raup, president of Datuit, points out that all kinds of subtleties get lost when patients are simply told how often to take a medication. For instance, if medications are spaced out throughout the day instead of being being taken all at once when we remember to take them (as so many people do), they may be absorbed more effectively and tolerated by the body. Patients–especially those with lower incomes and less education, who are more likely to be on multiple medications in the first place–need all sorts of support.

Here we come to an interesting twist: coordinated care does not have to be initiated by doctors. Given the doctor shortage and the forces keeping clinicians from adopting new models of treatment, other professionals can take on the long-term goals of improving patient health.

In a pilot ramping up in a residence for low-income seniors and the disabled in Maryland, Connected Health Resources is working with Alfa Specialty pharmacy using its Community Health Gateway to help patients straighten out their medications and keep to their schedules. This works because the pharmacy is in a somewhat unusual position: they have supported this community for some time and have built relationships with patients informally. The Gateway pilot has created a service, using Datuit’s SafeIX public API, that can potentially fulfill these needs with less work on the pharmacist’s part. The service is designed for easy navigation by the patients and their family caregivers, making it attractive to the patients and the pharmacists.

Connected Health Resources logo

The SafeIX Platform is designed using modern programming technologies to integrate data from multiple sources (including EHRs and HIEs) into a patient record for both patients and healthcare providers to use, based on their rights to access and share it. In the Gateway implementation, the pharmacist uses the SafeIX Platform to receive CDA documents from the HIE and to auto-assist medical data reconciliation between the various documents.

This information, along with the pharmacist recommendations, are organized into a daily medication calendar using an application from Polyglot Systems Incorporated, a company that offers medication regimen summaries in 18 languages. Low health literacy and the estimated 50 million people who do not speak English at home result in many patients not understanding their medication instructions. The plain language and multilingual, easy-to-use daily calendar can make the difference between understanding and total confusion.

Datuit’s SafeIX Platform uses interoperability standards (including, in test mode, the next-generation FHIR standard) to create a patient record that can show patients everything seen by multiple clinicians and allow a patient’s self-selected care team to view and add to a shared care plan. Datuit is encouraging app developers to build mobile apps for SafeIX that would prompt patients to take medications and record whether they did so, but that’s outside the scope of the pilot. There are plenty of challenges just fulfilling the tasks they have already taken on.

First, Connected Health Resources has to break down the clinical data silos that make it difficult for patients to collect their information. According to co-founder Shannah Koss, Maryland has a relatively advanced Health Information Exchange (HIE) called CRISP. However, it is defined as a provider-to-provider exchange, so it was only after a long-term relationship and negotiation that Connected Health Resources could collect medical data on behalf of the patients. This is the first time CRISP has allowed data to be retrieved for a patient-facing organization that is not a provider.

When enrolling, the patient gives the Gateway permission to get data through CRISP. Family and friends can be invited by patients to be part of their health community and enroll in the Gateway. The invitation includes a unique code that allows the Gateway to securely share records and help with health and social services navigation. If the patient wants help or is incapable of managing the medication list, a caregiver can do so.

CRISP transmits data primarily from hospitals. To round out a more comprehensive listing of medications from clinics and other healthcare providers, CRISP has enabled the ability to query Surescripts, which provides prescription fill data from chain pharmacies and pharmaceutical benefit management companies.

Pilot participants authorize the Gateway and the Alfa pharmacists to access their medication information and maintain, share, and augment the information in the secure SafeIX Platform. The CRISP data gives more complete medication records for the pilot participants. CRISP also provides an event notification system that let’s the pharmacist know whether a patient has been admitted to a hospital or visited the emergency department. These types of transition are precisely when medications get changed, but the clinicians at those crucial junctures often don’t know all of a patient’s current medications.

Finally, over-the-counter (OTC) medications can play an important role in a patient’s care. This has to be added to the daily calendar. The Alfa Pharmacist is helping round out the complete medication picture by working with the patient and family to identify OTC medications, supplements, and the medications that are actually being taken through the medication therapy management (MTM) program. The Gateway provides the means for everyone to better understand and manage the medicines for the best outcomes.

Further, the Gateway Community Resource Finder has enabled information about important resources such as transportation, meal delivery, social services, and home nursing. The MTM pharmacist knows that patients without food or transportation to their physicians cannot adequately manage their health or medications. The underlying SafeIX Platform also allows the Gateway to offer secure messaging that looks like email and lets the pharmacist, patient, friends, and family exchange messages about the patient’s care.

Traditional EHRs don’t accommodate treatment plans of the specificity designed by the pharmacy for patients in the pilot. This is where Datuit is pushing the EHR to new horizons: its SafeIX Platform helps multiple clinicians (including long term care providers), patients, and family caregivers contribute data. For example, patients can enter their own healthcare problems, such as fear of falling. The patients, families, and clinicians can then add interventions to address them.

Like other new organizations I’ve spoken too in health care, Connected Health Resources has grand plans beyond the current pilot. They are taking it slow, because Koss believes personal health records (PHRs) have tried to do too much at once and have overwhelmed their users with too many possibilities. But she would like Connected Health Resources to grow in response to what patients and families say they need. The Gateway tools already include the ability to generate multi-lingual discharge instruction from Polyglot. The initial pilot purposefully focuses on the more narrow scope of medications along with the health and social services support. The next step will be to engage hospitals to provide the plain language multi-lingual discharge instructions.

Chronic care ultimately goes beyond medications to things supported by a patient-centered medical home (PCMH), community health workers, and the many community-based service providers. The Gateway in partnership with the Datuit SafeIX Platform are poised to allow all participants identified by the patient and families to contribute to and be part of their health community.

Integrating Devices, Patients, and Doctors: HealthTap Releases an App for the Apple Watch

Posted on April 16, 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://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.

Doesn’t HealthTap want the same thing as all the other web sites and apps crowding into the health space? Immediate and intimate connections between doctors and patients. Accurate information at your fingertips, tailored to your particular condition. Software that supports your goals where automation makes sense and gets out of the way at other times.

HealthTap pursues this common vision in its own fashion. This week, its announcement of an app for Apple Watch pulls together the foundations HealthTap has been building and cleverly uses the visceral experience that the device on your wrist offers to meet more of the goals of modern, integrated health care.
Read more..

Annual Evaluation of Health IT: Are We Stuck in a Holding Pattern? (Part 1 of 3)

Posted on April 13, 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://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.

I don’t think anyone has complained of excessive long-term thinking among health care providers. But an urgent lack of planning has worsened in the past few months as key drivers of the health IT field search for new directions. Given today’s issues with Meaningful Use Stage 3, the FHIR data exchange standard, Accountable Care Organizations, medical device regulation, and health IT staffing, I expect the next several months to be a time of waiting.

This article will look over what has happened during the past year and try to summarize large-scale trends. I used to report annually from the HIMSS conference, the largest health IT gathering in the US, but stopped going because my articles were always cynical, cantankerous, and depressed. So I figure I just write up a cynical, cantankerous, and depressed summary of what’s happening in health IT from home.

Meaningful Use Stage 3: Shoot the Moon?

There are clear indications that the Meaningful Use program has gone off the tracks. I don’t consort with those who disparaged Meaningful Use from the start and claimed that it held back progress in the IT field. What little progress has occurred can be credited to Meaningful Use, because frankly, the health care industry was totally mired before. Choose your favorite metaphor: deer in the headlights (of oncoming disruptive competitors), ostrich in the sand, even possum in the road.

And no one can challenge that Stage 1 met its (very limited) goals. Centers for Medicare & Medicaid Services (CMS) just reported that the vast majority of hospitals have attested to Stage 1 (with rural and children’s hospitals lagging significantly). In fact, while defining Stage 3, CMS could remove some of its requirements because they have “topped out,” meaning that almost everybody already does them.

All the sharper is the contrast between Stage 1 and Stage 2, which was supposed to be incremental but apparently broke the camel’s back for many EHR vendors as well as providers, a lot of whom have thrown in the towel.

Interoperability was certainly a big stumbling block. Two different EHRs can claim to support a standard (such as the C-CDA) while not actually being able to exchange data in a useful manner, for reasons ranging from outright errors to differing interpretations of a fuzzy standard.

But the most whining from providers in Stage 2 arose over a requirement that patients view, transmit, or download (VDT) data from a patient portal. Even though providers needed only 5% of their patients to take a look at the site, they complained bitterly that they were being judged for something that relied on somebody else’s behavior (their patients).

The VDT measure is indeed a responsibility that depends on the behavior of outsiders (as are the interoperability requirements). But health providers seem slow to grasp the whole idea of “pay-for-value,” which means they won’t be rewarded in the future for doing stuff–they’ll be rewarded for results. Not that patients will get healthier just by viewing or transmitting data. But we need something measurable to mark progress, and since everybody issues paeons to patient engagement, the VDT measure is a natural one.

Calls have come from around the industry to water down or otherwise “simplify” Meaningful Use for Stage 3. A common request is to eliminate clinical quality measures (such as how many patients smoke) and focus on interoperability, which I oppose.

To muddy the Meaningful Use landscape further, Congress has started weighing in with complaints that the Office of the National Coordinator (ONC) hasn’t done enough to achieve its goals. One proposed bill overrides ONC and CMS to mandate changes in health care policy. There are rumors that Congress (who of course created the Meaningful Use provision in the first place) will take it back and do some serious micromanagement, perhaps as part of a bill on a totally different topic, the “doc fix” that is supposed to regularize Medicare payments.

In the midst of this turmoil, the ONC and CMS recently released Stage 3 recommendations, and it looks like they haven’t pulled their punches on a single thing. Interoperability is central, but the clinical quality measures still appear in full force. The requirement that patients engage with the technology has been softened, but still requires patients to take some action such as using a portal or uploading their own data.

Perhaps the boldest stake that CMS put in the ground was to force all providers onto a single schedule in Stage 3, a tremendous departure from the gentle steps offered by the first two stages. This has touched off a provider frenzy. They’ve been lobbying for years to slow Meaningful Use down, and notoriously ran to Congress to delay adoption of ICD-10 disease coding. But putting everyone on the same track makes eminent sense, particularly at this stage. If you’re really serious about data exchange and coordinated care, everybody has to equally capable. Otherwise we’re back to finger-pointing and claims that technology lapses have prevented compliance.

So what are ONC and CMS up to? Are they shooting the moon–hoping to make the big leap to their maximal goals in one bold play? Are they floating an audacious wish list that they know will be cut back in the course of negotiation? Are they even taunting resistant industries to go to Congress, knowing that Congress recently has been making even more radical noise than the Administration about the drawbacks of health IT? Something along these lines seems to be in the works.

To return to the theme of this article, I’m afraid that health care providers, insurers, EHR vendors, and all their business associates will freeze up while waiting for Congress and the various branches of Health and Human Services to determine which behaviors to prescribe and which to punish. So that’s my take on meaningful use–more on other developments in health IT in the next installments.

Fascinating Drawings from #DoMoreHIT Dell Healthcare Think Tank Event

Posted on March 20, 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 week I got the change to spend the day at SXSW at the Dell Healthcare Think Tank event. This is my third year in a row participating and it’s always an exciting event. In case you missed it, I’ve embedded the 3 Healthcare Think Tank sessions on EMR and HIPAA so you can watch the recorded video stream from the event.

Also, during each of the three sessions of the event, an artist was capturing what was being said. You can see each of the three drawings below (Click on the drawing to make it larger).

Session 1: Consumer Engagement & Social Media
Consumer Engagement and Social Media

Session 2: Bridging the Gap Between Providers, Payers and Patients
Bridging the Gap Between Payers Providers and Patients

Session 3: Entrepreneurship & Innovation
Healthcare Entrepreneurship and Innovation