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AMA Touts Physician Interest In Digital Health Tools

Posted on October 13, 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.

A few months ago, the group’s annual meeting, American Medical Association head Dr. James Madara ignited a firestorm of controversy when he suggested that many direct to consumer digital health products, apps and even EMRs were “the digital snake oil of the early 21st century.” Madara, who as far as I can tell never backed down completely from that statement, certainly raised a few hackles with his pronouncement.

Now, the AMA has come out with the results of physician survey whose results suggest that community doctors may be more excited about digital health’s potential than the AMA leader. The survey found that physicians are optimistic about digital health, though some issues must be addressed before they will be ready to adopt such technologies.

The study, which was backed by the AMA and conducted by research firm Kantar TNS, surveyed 1,300 physicians between July 7 and 18. Its content addressed a wide range of digital health technologies, including mobile apps, remote monitoring, wearables, mobile health and telemedicine.

Key findings of the study include the following:

  • While physicians across all age groups, practice settings and tenures were optimistic about the potential for digital health, their level of enthusiasm was greater than their current adoption rates.
  • The majority of physicians surveyed (85% of respondents) believe that digital health solutions can have a positive impact on patient care.
  • Physicians reported that they were optimistic a digital health can reduce burnout, while improving practice efficiency, patient safety and diagnostic capabilities.
  • Physicians said liability coverage, data privacy and integration of digital health tools with EMR workflows were critical to digital health adoption, as well as the availability of easy-to-use technologies which are proven to be effective and reimbursement for time spent conducting virtual visits.

All told, physicians seem willing to use digital health tools if they fit into their clinical practice. And now, it seems that the AMA wants to get out ahead of this wave, as long as the tools meet their demands. “The AMA is dedicated to shaping a future when digital health tools are evidence based, validated, interoperable, and actionable,” said AMA Immediate Past President Steven J. Stack, M.D

By the way, though it hasn’t publicized them highly, the AMA noted that it has already dipped its oar into several digital health-related ventures:

  • It serves as founding partner to Health2047, a San Francisco-based health care innovation company that combines strategy, design and venture disciplines.
  • It’s involved in a partnership with Chicago-based incubator MATTER, to allow entrepreneurs and physicians to collaborate on the development of new technologies, services and products in a simulated health care environment.
  • It’s collaborating with IDEA Labs, a student-run biotechnology incubator, that helps to support the next generation of young entrepreneurs to tackle unmet needs in healthcare delivery and clinical medicine.
  • It’s playing an advisory role to the SMART project, whose key mission is the development of a flexible information infrastructure that allows for free, open development of plug-and-play apps to increase interoperability among health care technologies, including EHRs, in a more cost-effective way.
  • It’s involved in a partnership with Omada Health and Intermountain Healthcare that has introduced evidence-based, technology-enabled care models addressing prediabetes.

Personally, I have little doubt that this survey is a direct response to the “snake oil” speech. But regardless of why the AMA is seeking a rapproachment with digital health players, it’s a good thing. I’m just happy to see the venerable physicians’ group come down on the side of progress.

 

What Do Med Students Need To Know About EMRs?

Posted on August 16, 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.

Recently, I was asked to write an introduction to EMRs, focusing on what medical students needed to know in preparation for their future careers. This actually turned out to be a very interesting exercise, as it called for balancing history with the future, challenges with benefits and predictable future developments with some very interesting possibilities. Put another way, the exercise reminded me that any attempt to “explain” EMR technology calls for some fancy dancing.

Here’s some of the questions I tackled:

  • Do future doctors need to know more about how EMRs function today, or how they should probably function to support increasingly important patient management approaches like population health?
  • Do med students need to understand major technical discussions – such as the benefits of FHIR or how to wrangle Big Data – to perform as doctors? If so, how much detail is helpful?
  • How important is it to prepare med students to understand the role of data generated outside of traditional patient care settings, such as wearables data, remote monitoring and telemedicine consults? What do they need to know to prepare for the gradual integration of such data?
  • What skills, attitudes and practices will help physician trainees make the best use of EMRs and ancillary systems? And how should they obtain that knowledge?

These questions are thornier than they may appear at first glance, in part because there no hard-and-fast standards in place as to how doctors who’ve never run a practice on paper charts should conduct themselves. While there have been endless discussions about how to help doctors adopt an EMR for the first time, or switch from one to the other, I’m not aware of a mature set of best practices available to med students on how next-gen, health IT-assisted practices should function.

Certainly, offering med school trainees a look at the history of EMRs makes sense, as understanding the reasons early innovators developed the first systems offers some interesting insights. And introducing soon-to-be physicians to the benefits of wearable or remote monitoring data makes sense. Physicians will almost certainly improve the care they deliver by understanding EMRs then, now and their near-term evolution as data sources.

On the other hand, I’m not sure it makes sense to indoctrinate med students in today’s take on evolving topics like population health management or interoperability via FHIR. These paradigms are evolving so rapidly that pinning down a set of teachable ideas may be a disservice to these students.

Morever, telling students how to think about EMRs, or articulating what skills are needed to manage them, might actually be a bad idea. I’m optimistic enough to think that now that the initial adoption frenzy funded by HITECH is over, EMRs will become far more usable and physician-shapeable over the next few years, allowing new docs to adapt the tool to them rather than adapt to the tool.

All that being said, educating med students on EMRs and health IT ancillary tools is a great idea. I just hope that such training encourages them to keep learning well after the training is over.

E-patient Update: Remote Monitoring Leaves Me Out of The Loop

Posted on May 24, 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.

As some readers may recall, I don’t just write about digital health deployment — I live it. To be specific, my occasional heart arrhythmia (Afib) is being tracked remotely by device implanted in my chest near my heart. My cardiac electrophysiologist implanted the Medtronic device – a “loop recorder” roughly the size of a cigarette lighter though flatter — during a cardiac ablation procedure.

The setup works like this:

  • The implanted device tracks my heart rhythm, recording any events that fit criteria programmed into it. (Side note: It’s made entirely of plastic, which means I need not fear MRIs. Neat, huh?)
  • The center also includes a bedside station which comes with a removable, mouse shaped object that I can place on my chest to record any incidents that concern me. I can also record events in real time, when I’m on the road, using a smaller device that fits on my key ring.
  • Whether I record any perceived episodes or not, the bedside station downloads whatever information is stored in the loop recorder at midnight each night, then transmits it to the cardiac electrophysiologist’s office.
  • The next day, a tech reviews the records. If any unusual events show up, the tech notifies the doctor, who reaches out to me if need be.

Now, don’t get me wrong, this is all very cool. And these devices have benefited me already, just a month into their use. For example, one evening last week I was experiencing some uncomfortable palpitations, and wondered whether I had reason for concern. So I called the cardiac electrophysiologist’s after-hours service and got a call back from the on-call physician.

When she and I spoke, her first response was to send me to my local hospital. But once I informed her that the device was tracking my heart rhythms, she accessed them and determined that I was only experiencing mild tachycardia. That was certainly a relief.

No access for patients

That being said, it bugs me that I have no direct access to this information myself. Don’t get me wrong, I understand that interacting with heart rhythm data is complicated. Certainly, I can’t do as much in response to that information as I could if the device were, say, tracking my blood glucose levels.

That being said, my feeling is that I would benefit from knowing more about how my heart is working, or failing to work appropriately in the grand scheme of things, even if I can’t interpret the raw data of the device produces. For example, it would be great if I could view a chart that showed, say, week by week when events occurred and what time they took place.

Of course, I don’t know whether having this data would have any concrete impact on my life. But that being said, it bothers me that such remote monitoring schemes don’t have their core an assumption that patients don’t need this information. I’d argue that Medtronic and its peers should be thinking of ways to loop patients in any time their data is being collected in an outpatient setting. Don’t we have an app for that, and if not, why?

Unfortunately, no matter how patients scream and yell about this, I doubt we’ll make much progress until doctors raise their voices too. So if you’re a physician reading this, I hope you’re willing to get involved since patients deserve to know what’s going on with their bodies. And if you have the means to help them know, make it happen!

More Details From Study: Health IT Could Cut Demand For Physicians

Posted on December 11, 2013 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.

Earlier, we wrote up the following study, which strongly suggests that health IT can boost physician productivity. But we didn’t include some of the details you’ll see below — and we thought they were important enough for a follow-up.

Much of the talk about health IT in physicians’ offices addresses the struggles doctors face when adopting new technologies, and the effort it takes to get productivity back to normal levels. But this study takes things a step further, asserting that if health IT was fully and widely implemented, it could reduce demand for physicians substantially.

The study, which originally appeared in Health Affairs, concluded that if health IT were fully implemented in 30 percent of community-based physicians’ offices, efficiency improvements would cut demand for physicians by 4 percent to 9 percent. What’s more, using health IT to delegate work to midlevel practitioners and from specialists to primary care docs could reduce demand for physicians by 6 percent to 12 percent, according to a story in Information Week.

Meanwhile, growing the amount of IT-enabled remote and asynchronous care could cut the volume of overall care that physicians provide could  have a big impact as well. Remote care could cut the percentage of care that physicians provide by 2 percent to 5 percent, and asynchronous care by 4 percent to  7 percent, Information Week reports.

And that isn’t all. If 70 percent of office-based docs adopted comprehensive IT support, including interoperable EMRs, clinical decision support, provider order entry and patient Web portals with secure messaging, the drop in demand for physician services would be twice as large, the Health Affairs study concluded.

That being said, the comprehensive use of health IT by even 30 percent of office-based doctors is at least five years and maybe as much as 15 years away, according to one of the study’s authors, Jonathan Weiner, professor of health policy and management at Johns Hopkins’ Bloomberg School of Public Health.

Is Remote Monitoring Data A Blessing, Or A Distraction?

Posted on August 1, 2013 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.

This week, Venture Beat reported on some growing remote monitoring efforts in which a handful of Massachusetts hospitals are working to pull the data into their EMR. The hospitals are hoping to get their arms around a growing body of data which increasingly lives not only in wireless medical devices (such as glucometers and pulse oximeters) but also smartphones, smart wristbands, FitBit devices and other health-tracking technology.

One of the players involved in the new effort is Partners HealthCare, whose Center for Connected Health is focused on collecting and making use of such data. Its latest initiative sweeps patient data collected at home — such as blood pressure, weight and blood glucose — into the Partners EMR, making it accessible as part of routine clinical workflow. (The data collected by patients is transmitted wirelessly and automatically subsumed into the EMR.)  Patients can also review the data through a patient portal known as Patient Gateway.

According to Partners, this process is designed to change care delivery by allowing doctors to keep a close watch on patients when they’re not in the hospital or doctor’s office.

This is all well and good, especially for monitoring the chronically ill, whose condition may fluctuate dangerously and require timely intervention. But the question is, is this new flood of data going to be manageable for doctors?  Can a physician managing thousands of patients really give appropriate attention to every data point a FitBit or smartphone produces?  Certainly not.

Perhaps that’s why Kaiser Permanente recently told a conference that it was going to be rather picky as to what data flows into its EMR. According to Lead Innovation Designer Christine Folck:

“Don’t come to us telling us you can upload [data] into our electronic medical record. We don’t necessarily want it there. We have too much information in our electronic medical record. Kaiser Permanente was one of the first to go nationwide with our electronic medical record, we are fully integrated, but the problem is now everybody wants to upload into it. Our physicians don’t want it all there. They really don’t need to know how much exercise each of their patients is getting on a daily basis; they just don’t have time to process all of that.”

So, while there’s clearly benefit to tracking chronic conditions via remote monitoring, it seems clear that there will be some pushback from doctors, who can’t possibly absorb all of the data the healthier “quantified self” types are producing.  It looks to me like we’re going to have to narrow down what categories of data are actually helpful in an EMR and which aren’t.

Partners Integrates Mobile Data With EMR

Posted on June 25, 2013 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.

In a move that could realize much of the promise of wireless remote monitoring, Partners HealthCare system has made it possible for providers to view remotely-collected patient health data in its EMR.  The program was launched by Partners division The Center for Connected Health, which focuses on delivering new forms of patient care outside of standard medical settings.

For years, Partners has been running programs which collect patient data through a combination of remote-monitoring technology, sensors and Web-based tools. Their focus has included management of chronic diseases such as diabetes and high blood pressure, medication adherence and improved pregnancy outcomes and cardiac care outcomes. The Center’s remote monitoring database now stores over 1.2 million  patient vital signs.

Now, Partners has linked The Center’s proprietary remote monitoring database to its EMR, a step which moves the system in the direction of offering continuous chronic disease management. If a patient is participating in a remote monitoring program, Partners physicians can can now see a patient’s day-to-day vital signs, blood glucose levels, weight and other key health indicators directly within their records in the EMR.

The ultimate notion, according to the press release at least, is to  “put the patient at the center of their care while maintaining a close watch on their condition when they are not in the hospital or doctor’s office.”

While Partners didn’t say how many patients are involved in The Center’s programs, it’s doubtless a small fraction of overall Partners patient population. So despite the general coolness of what they’re trying to do, this is still more on the order of an experiment than a population health management program via remote monitoring.

Still, what Partners is doing is a large step in the right direction, and will doubtless realize some of the long anticipated benefits of remote monitoring for patients who are involved. Good show, folks.