Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Driving Towards Quality Outcomes

Posted on September 9, 2013 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.

One of the most compelling talks at the Healthcare Forum was from Jennifer Brull, MD Physician Owner and CEO at Prairie Star Family Practice.  Dr. Brull practices in a small town of 1900 souls in Kansas and so she provided a unique perspective on quality outcomes in healthcare.  As Dr. Brull said, “Quality improvement for me is some about my ego and making sure that I’m a good doctor, but a lot about taking care of my friends who also happen to be my patients.”  However, the methods Dr. Brull used to improve outcomes can be applied to any size practice.

In fact, Dr. Brull uses the national Meaningful Use Outcome Priorities as a framework for her practice:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Engage patients and families in their healthcare
  • Improve care coordination
  • Ensure adequate privacy and security protections for personal health information
  • Improve population and public health

Dr. Brull noted that improving quality was first on her list because of its importance, but acknowledged how difficult it can be to measure.  We love to talk about big data and small data in healthcare, but sometimes there is no data.  As EHR use increases, the data captured provides valuable insight into opportunities to improve the care process.    If the data doesn’t match the provider’s perception of the care being provider, it can be scary.  Lots of times doctors get put on a pedestal, but Dr. Brull humbly shared how she fell off her pedestal and how awakening to the fact that she could benefit from the data in her EHRhelped save the lives of her patients.

One of the barriers to improving quality outcomes is convincing other members of the staff to participate.  Most people equate quality outcomes with more time per patient, which then translates to seeing fewer patients or more hours working.  Neither option is tenable long term.  Dr. Brull offered a much better alternative, “By making the right thing to do easy, you actually get more time to do quality improvement and you become more efficient in your processes.”

“If you measure it, you will improve it!” is Dr. Brull’s simple approach to quality improvement.  However, seeing the data before you will often illicit the reaction that “This data is not right!”  Dr. Brull has learned a simple lesson: “Trust your data, it’s probably right.”  Plus, measuring the data and graphing it will let you know if you are improving or not.  She shared, “Graphs help point out critical flaws.  They help motivate your staff.  They help direct your quality improvement cycles.  They show the effect of change over time.”

Dr. Brull offered a number of methods she used to improve the quality outcomes in her office.  The first is education.  She noted, “We don’t hide our poor performance results.  We talk about them.”  This education on the clinic’s performance can be a great motivator to improve.  Alerts in the EHR also proved effective.  Dr. Brull tried sending letters to patients, but found they were “A high dollar investment for a low dollar return.”

When trying to improve breast cancer screening, they found that sending a mammogram order directly to radiology proved effective at getting more patients screened.  The nurses prompted the doctor to screen for colon cancer by simply placing the Hemoccult kit on the counter.  Just by streamlining the referral process they often saw better results.  For example, Dr. Brull developed a patient information handout which the nurses gave patients before they were seen by the doctor.  This dramatically decreased the amount of time the doctor had to spend educating patients on why they should be screened.  These simple changes made doing the right thing easy.

One of Dr. Brull’s lessons learned was to “Never take your eyes off the data, because when you do you start to slip and sometimes you slip really big.”  The ultimate goal of EHR adoption is to improve the quality of care.  Most clinicians would be shocked to learn how they are performing on some of the standard quality measures.  Those who have the courage to use data to drive improvement will create the future of care.

Dr. Brull closed her remarks saying, “My enthusiasm around quality improvement has a lot to do with seeing those graphs.  My passion about quality improvement is because of Marilyn [a patient whose life was saved] and because of all the patients that I know every time I improve the care I take of them I make them live longer and healthier lives.”

I recommend watching the full Dr. Brull Healthcare Forum presentation (embedded below) to see and hear firsthand how she improved the quality outcomes in her clinic:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

The Patient Portal Conundrum

Posted on July 25, 2013 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.

Healthcare has two major challenges hanging over its head.  The first is how to handle newly empowered and engaged patients.  The second is how to lower the skyrocketing costs of healthcare.  At the Healthcare Forum, Ashwin Ram, PhD, looked at how both of these issues are impacted by the patient portal.

Dr. Ram pointed out that the internet is by far the leading source of health and wellness information.  However, patients aren’t looking to their doctors’ patient portal for this information.  Instead they’re looking to Facebook, Wikipedia, Twitter, and online patient communities.  Dr. Ram pointedly describes this shift:

The patient is the CEO of their health.  This stuff is happening.  It’s actually not a choice that we are going to make.  It’s already occurring and if we, the healthcare provider system and all the facets of it don’t drive this change, then some 20 year old kid in a Google garage will drive it for us and then we’ll wonder what happened.

Is healthcare going to drive this change?  Can patient portals be part of providers’ response to this change?

Dr. Ram suggested that “patient portals are great…if we can get people to use them.”  Therein lies the patient portal conundrum.  He offered a simple plan where EHR software gathers the information, patient portals garner patient engagement and then we see improved health as patients’ behaviors change.

Government regulations are pushing providers to engage with their patient through a patient portal.  Meaningful use requires organizations to not only make a patient’s health information available through a portal, but 5% of patients must view, download, or transmit their health information as well.   It is clear that providers need to not simply implement a patient portal, but also need to consider how they engage with healthcare consumers.  This will become even more important as we continue the shift away from fee–for-service to value based care.

Many people believe that most patients are passive consumers of healthcare, but a study by the CDC found that 68% of adults are actively trying to prevent at least one major chronic illness.   Dr. Ram described that we are “moving from this quick fix, reactive, I’ll see you when I’m sick mindset to a wellness oriented, proactive, let’s fix the problem before it occurs mindset. ”  Where are the patient portals that facilitate this kind of interaction?

People are not worried about sharing their health information online if they see value.  We know this because we see them using online patient communities every day.  However, we need to understand the user and their specific health needs so that we can provide information, coaching and resources highly tailored to that patient.  This highly tailored health experience is what could make regular patient portal use the norm and leads us down the road to behavior change.

To create engaged patient portals that drive behavior change, Dr. Ram asserted that, “It’s got to be mobile.  It’s got to be social.  You’re not going to change behavior without social pressure.”  Behavior change is social and that does not mean one person or a million people.  We need a small handful of people who care enough to be engaged in your life.  The technology that enables this is what will make the difference.

Furthermore, social pressures don’t all have to be human.  We can let the simple nudges happen automatically while we leave the higher value, more difficult things to humans.  This philosophy understands the value of automation while still embracing the value of human touch that doctors and friends provide.  Social rewards from both humans and computers matter more to the next generation of patients than money.

Healthcare is going through a fundamental software-based transformation.  Part of this has been driven through government regulation, but the more dramatic change will be driven by the empowered patient and the need to drive down healthcare costs.  The patient portal can play a key role in that transformation if healthcare providers use it to engage patients and leverage social pressures to effect behavior change.

Check out the full Healthcare Forum presentation by Ashwin Ram, PhD embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

Inspiring Multidisciplinary Collaboration to Achieve Innovation – TEDMED

Posted on April 22, 2013 I Written By

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


I was invited to attend TEDMED as a guest of Xerox and what an experience it was. If you missed my first post about the TEDMED experience, you’ll want to start with that post to provide some context to this one. The first day and a half that I describe in that post was a whirlwind experience and the second half of TEDMED was no different. However, the second day and a half had a bit of a different twist. It seemed to focus less on the technical side of medicine and more on its emotional and philosophical parts, but there were still a lot of lessons learned.

The reality of writing a TEDMED recap is that you could literally write about every speaker that participated and so you’re guaranteed to leave out some noteworthy talk. With that made clear, let me highlight some of the messages and people that struck me and would likely be useful to a healthcare IT crowd.

Close to the end of the TEDMED conference, Raghava KK took the stage with some really twisted perspectives on how to teach diversity and stretch your mind in new ways. This quote from his talk seemed to teach an important lesson for healthcare, “When you teach perspectives, you teach creativity.” In the insular healthcare environment, we could benefit from learning about outside perspectives. No doubt we see isolated examples of creativity in healthcare. Maybe the reason we don’t see more is because the healthcare industry needs more external perspectives.

Victor Wang from GeriJoy was a delightful person; I guess you’d need to be to start a virtual talking dog company. While his product is interesting in its own right, his approach is where we can all learn something valuable. Victor said, “We are leveraging the global supply of compassion and kindness.” I’m still trying to process the possibilities of that statement. Victor and GeriJoy are using people from around the world to share compassion and kindness with elderly people. I see an amazing untapped potential where technology has the power to deliver humanity. A talking dog is just the beginning.

Eli Beer‘s lifesaving flash mob, United Hatzalah, is something special. I loved his description of, “Not viral videos. Viral community building.” The power of community is often forgotten or left untapped.

There was an entire session of TEDMED on death. No doubt this applies to a large number of people in healthcare in a lot of different ways. Amanda Bennett offered a couple insights that seemed to capture some of the essence of the conversation including this gem, “Looking at death has taught me how to live.” Plus, if you’re interested in this topic, her discussion of patient denial is a great one. She even borrowed from software development to say, “Denial is not a bug, it’s a feature.”

Roni Zieger, Former Google chief health strategist, announced his new Smart Patients community at TEDMED. He called this and other similar communities a “network of micro experts.” Think of the power these micro experts have when put together in a network. He also pointed out a concept I’d never seen articulated before, “The biggest value isn’t in the data we can predict, it’s in the unexpected connections.” He even applied it to EHR software where he suggested that EHRs were pre-configured and therefore have a hard time seeing emergent trends. His solution, “We need systems that can reconfigure based on the context.”

Marleece Barber, chief medical officer at Lockheed Martin took us all to task when she asked, “If we can land a man on the moon, can we land your butt on a bike?”

Jessica Richman and her company uBiome are part of a growing concept around citizen science. She posed the inspiring question, “Can a citizen scientist win a noble prize?” She believes that if you can ask and answer questions, all you need are the right tools and anyone can be a scientist. I loved her idea of changing science from being a spectator sport on Discovery Channel to a sport that anyone can participate in.

Many of the concepts that Jessica described remind me of patients wanting to be more involved in their healthcare. The growing ePatient movement is a strong one and requires some really challenging shifts in culture. I’m sure I’ll be doing many posts on Jessica’s concepts in the future, but it seems that scientists have similar views to doctors. At the core of the issues to me is the belief that without years of schooling you’re not smart and can’t evaluate complex issues. I don’t want to understate the value of education, but we also shouldn’t understate the value of micro experts (to steal Roni Zieger’s term). They can both have a place in the process and working together they can be much more than the sum of their parts.

Two of the most heartwarming and inspiring presentations were Charity Tillemann-Dick and Sue Austin. Charity, the recipient of two double lung transplants, is a soprano opera singer who performed an aria for us. Her story of survival and drive to live is beautiful. Her message of organ donation is an important one, but her ability to inspire you to battle anything in life is priceless.

Sue is a scuba diver, but she does so in a wheel chair. Instead of trying to explain it, watch one of her other TED talks including a video of her scuba diving.

Martin Hoffman tweeted something that summed up TEDMED quite well, “Inspire multidisciplinary collaboration to achieve innovation.” I’d say that goal was accomplished for many.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox Blog and follow @XeroxHealthcare.

Survey Says Few Americans Want EMRs

Posted on August 31, 2012 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.

I don’t know what to make of the following survey, which suggests that EMRs have a very long way to go before they’re accepted by the public.  Let’s lay out the numbers and see what you think.

According to new research from Xerox, only 26 percent of Americans would like to see their medical records digitized, despite otherwise having a love affair with all things digital.

Xerox, which hired Harris Interactive to do the study, did an online survey of 2,147 U.S. adults in May, asking them several questions related to their perceptions of EMRs. Forty percent said that digital medical records could deliver better and more efficient care, true, but 85 percent said they were concerned about the use of EMRs, Xerox reported.

Whatever is generating their resistance — and I’ll speculate on that in a minute — it’s not because they’ve never seen digital medicine. When asked how their providers recorded digital information during their last visit, 60 percent said data was entered into a tablet, laptop or in-room computer.

So, if Americans love online banking, Internet gaming and ordering from restaurants via the Web, why would medical records concern them so?

My guess is that the results we see here may be a result of the approach the researchers took.  If someone asked me: “Do you want something delicious and cool to eat during hot weather?” I’m pretty sure I’d say yes. On the other hand, if I was asked “Would you like to try this brand new ‘ice cream’ thing you’ve seen your neighbors eat?” I’m not as sure I’d be high on the idea.

If we’re going to forward the dialogue on EMRs with consumers, we’re going to have to help them understand why EMRs matter, and how they get the job done. Sure, the more esoteric stuff we discuss here might fly over their heads, but if you explained, for example, that EMRs can protect them from medical errors and and coordinate care better, they’ll get it.