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Walgreen’s Perspectives on Patient Engagement at #DHIS18

Posted on August 15, 2018 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.

The past 2 days I’ve been attending the Digital Health Investor Summit that’s hosted by KLAS. It was a classy event and the people they had in attendance were phenomenal. I’ll be offering up a number of insights I got from the event across the Healthcare Scene network of blogs, but a couple slides from Chet Robson really stood out for me today. Chet is the Medical Director, Clinical Programs & Quality at Walgreens.

The slides that Chet Robson shared were around some views on patient engagement. Or as he framed it: patient engagement, patient activation, patient involvement, patient participation, patient adherence, patient compliance, patient empowerment, or patient experience. I love that we have so many terms for the same concept.

Here’s the first chart he shared for patient engagement:

The 3 dimensions in the chart listed above seemed like a good framework for patient engagement. So, I was glad when Chet then shared this slide:

I think that more things could be added to the above expectations. However, it’s a really good start. Imagine if all of healthcare implemented these principles.

As timing would have it, I’ve actually done 3 appointments at Walgreens in the last month. Without going into all the details of why, I’m happy to say that Walgreens delivered on these expectations. The visits were easy to schedule, quick and painless, and the experience was great. My only complaint was that the appointment process wasn’t clear. I wasn’t sure if you could only schedule certain appointments or if you could also do walk-ins. The answer is that it’s best to have an appointment. Otherwise, when you walk in, the computer will have you schedule an appointment and unless you’re lucky, you’ll likely be waiting for a bit. However, this is a minor learned thing that can easily be fixed.

What do you think of looking at patient experience from a behavioral, cognitive, and emotional dimension?

Let Vendors Lead The Way? Are You Nuts?

Posted on August 13, 2018 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.

Every now and then, a vendor pops up and explains how the next-gen EHR should work. It’s easy to ask yourself why anyone should listen, given that you’re the one dishing out the care. But bear with me. I’ve got a theory working here.

First of all, let’s start with a basic assumption, that EHRs aren’t going to stay in their current form much longer. We’re seeing them grow to encompass virtually every form of medical data and just about every transaction, and nobody’s sure where this crazy process is going to end.

Who’s going to be our guide to this world? Vendors. Yup, the people who want to sell you stuff. I will go out on a limb and suggest that at this point in the health data revolution, they’re in a better position to predict the future.

Sure, that probably sounds obnoxious. While vendors may employ reputable, well-intended physicians, the vast majority of those physicians don’t provide care themselves anymore. They’re rusty. And unless they’re in charge of the company they serve, their recommendations may be overruled by people who have never touched a patient.

On the flip side, though, vendor teams have the time and money to explore emerging technologies, not just the hip stuff but the ones that will almost certainly be part of medical practice in the future. The reality is that few practicing physicians have time to keep up with their progress. Heck, I spend all day researching these things, and I’m going nuts trying to figure out which tech has gone from a nifty idea to a practical one.

Given that vendors have the research in hand, it may actually make sense to let them drive the car for a while. Honestly, they’re doing a decent job of riding the waves.

In fact, it seems to me that the current generation of health data management systems are coming closer to where they should be.  For example, far more of what I’d call “enhanced EHR” systems include care management tools, integrating support for virtual visits and modules that help practices pull together MIPS data. As always, they aren’t perfect – for example, few ambulatory EHRs are flexible enough to add new functions easily — but they’re getting better.

I guess what I’m saying is that even if you have no intention of investing in a given product, you might want to see where developers’ ideas are headed. Health data platforms are at an especially fluid stage right now, tossing blockchain, big data analytics, AI and genomic data together and creating new things. Let’s give developers a bit of slack and see what they can do to tame these beasts.

eClinicalWorks Faces Additional Fine For Violating Terms Of Fraud Settlement

Posted on August 10, 2018 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 mid-2017, the news broke that EHR vendor eClinicalWorks had agreed to pay $155 million to settle a whistleblower lawsuit brought by a former employee. The government had accused the company of doctoring its code to cover the fact that its platform couldn’t pass certification testing,

Following the agreement with the government, eCW was hit with two class-action lawsuits related to the certification fraud, one filed by a group of clinicians over funds lost due to the certification and another by patients who say that data display errors may have affected their care.

Unfortunately for eCW, its legal troubles aren’t over. The vendor is now on the hook for a fine it incurred for failing to comply with the Corporate Integrity Agreement it signed as part of its settlement deal. The $132,500 fine probably won’t have a massive impact on the company, but it’s a reminder of how much trouble the certification problem continues to cause.

In signing the CIA, which will be in place for five years, eCW agreed to a number of things, including that it would adhere to software standards and practices, identify and address patient safety and certification issues and meet obligations to existing and future customers. eCW also promised to report patient safety issues in a timely manner.

Apparently, it didn’t do so, and that triggered the penalty stipulated in the CIA. Among the terms buried in the hefty CIA document is that the vendor would be fined $2,500 for each day eCW failed to establish and implement patient safety issues as reportable events. Somehow, the vendor let this go for almost two months. Bummer.

Of course, eCW leaders must be reeling. This has to have been the most painful year in the company’s history, without a doubt. Customers are understandably quite angry with eCW, and some of them are suing. Patients are suing. Its reputation has taken a major hit.

The financial implications of the settlement are staggering too. Very few companies could cover a $155 million payout without a struggle, and even if a business liability insurer is covering the loss, the settlement can’t be good for its relationships with financial institutions. It’s a mess I’d wish on no one.

On the other hand, am I being too harsh when I suggest that under the circumstances, letting a reporting problem go for 53 days doesn’t speak well of eCW’s recovery? Yes, I’m sure that keeping up with CIA requirements has been pretty burdensome, but we’re talking about survival here.

I’m not going to hazard a guess as to whether eCW is on the skids or just struggling to recover from a massive blow to its fundament. But geez, folks. Let’s hope you get on top of these issues soon. Violating the terms of the CIA within year two of the five-year agreement doesn’t exactly inspire confidence.

Nationwide Healthcare Interoperability Isn’t Happening

Posted on August 8, 2018 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’ve got interoperability on the mind today. I think it’s probably because of all the tweets that are coming out on the #InteropForum hashtag from the ONC Interoperability Forum in DC. I would have liked to attend, but I’m grateful that so many people are sharing what’s happening. That said, I must admit that I’m tired of a lot of the tweets that aren’t grounded in reality and that call for things that are never going to happen or tweets that propose goals that aren’t meaningful (yes, I had to use that word).

The first reality that’s become clear to me is that nationwide interoperability of healthcare data isn’t going to happen.

It’s just not going to happen and in most cases it shouldn’t happen when you consider the costs and benefits. Sure, we are all traveling a lot more, but there are 45 or so states in the US where no healthcare organization has need for my health information. If they do, then there are ways they can get it, but they are rare. Even if I have a crazy medical incident in an unusual state, those care providers know how to take care of me even without all my health records. Doctors are always treating patients with limited information. If I’m a chronic patient where certain information would be important for me if I’m treated out of state by a doctor that doesn’t know me, there are hundreds of options for me to carry that information on my phone.

My point here is that there aren’t any massive economic incentives for there to nationwide sharing of health data. Don’t be confused though. I’m not saying that sharing health data is not beneficial. What I’m saying is that we don’t need to build a national framework of health data sharing. When people suggest we should make that a reality, they’re essentially dooming interoperability. Talk about biting off more than you can chew. It’s become quite clear to me that Nationwide Interoperability of health data isn’t going to happen.

I love this excerpt from Brian Mack’s blog post on the Great Lakes Health Connect (an HIE) blog:

The Trusted Exchange Framework and Common Agreement (TEFCA) released by the Office of the National Coordinator last January, was (it was thought) intended to bring clarity and define a path forward for national interoperability, but has instead just added more uncertainty and the promise of additional layers of bureaucracy.

Discussions around national healthcare interoperability just bring more uncertainty and more layers of bureaucracy. It’s a failed approach.

With that said, it’s also very clear that smaller scale interoperability is not only possible but a valuable thing for most in healthcare. This was highlighted by interoperability expert, Greg Meyer, when he tweeted:

It’s really great that Greg is trying to figure out how we can generalize these point to point interoperability solutions. That’s a smart approach. However, buried in this tweet in a way that most will miss is the fact that there are a lot of unique scenarios and solutions where healthcare interoperability has been successful. Healthcare interoperability is possible and many organizations are doing it. Just not on a national scale.

To continue Greg’s analogy, we need more of these interoperability “snowflakes” and we need those creating the snowflakes to share their successes. A blizzard of snowflakes is a powerful thing even though the individual snowflakes are small. As it stands today, a national approach to interoperability is more like spending millions and billions of dollars on a snow making machine and then never turning it on. I’d rather have a million snowflakes than a billion dollar machine that doesn’t produce any snow. </ end snowflake analogy>

Another example of healthcare interoperability in action was shared at the Healthcare IT Expo this year. Don Lee offered a great summary of UPMC’s success with interoperability and the parts of interoperability they have solved. There’s always still more work to do, but if every hospital was able to accomplish what UPMC has accomplished in regards to healthcare interoperability, then we could have a very different discussion around healthcare data sharing.

The only solution I see to healthcare interoperability is for healthcare organizations to make it a priority. As I said back in 2013, Interoperability Needs Action, Not Talk. The more small interoperability connections we make, the more we’ll understand our data, how to connect, and build relationships between organizations. All of that will be key to even starting to thinking about nationwide healthcare interoperability. Until then, let’s table the nationwide healthcare interoperability discussions.

Three Ways You Might Be Unintentionally Violating HIPAA

Posted on August 6, 2018 I Written By

The following is a guest blog post by Tim Mullahy is the Executive Vice President and Managing Director at Liberty Center One.

For the most part, HIPAA is pretty straightforward – if a little extensive. It lays out some fairly clear-cut rules for protecting patient data, and an incredibly specific framework on what constitutes said data. But as with any set of regulatory guidelines, there are some gray areas.

And there are also some lesser-known aspects that a lot of organizations – both healthcare agencies and covered entities – tend to miss. The problem, obviously, is that ignorance in this case is no excuse. A HIPAA violation is a HIPAA violation, no matter how well-meaning the person responsible.

With that in mind, today we’re going to discuss a few of the most common ways both you and your staff might inadvertently run afoul if HIPAA (and more importantly, how to avoid doing so).

Through Employee Posts on Social Media

It’s a pretty common story these days. An employee says something they shouldn’t on social media. Their employer finds out, and next thing you know, they’re being let go.

That’s exactly what happened to Olivia O’Leary in 2017. An X-Ray technician at the Onslow Memorial Hospital in Jacksonville, North Carolina, O’Leary commented on a Facebook post that the victim of a car accident should have been wearing a seatbelt. Here’s the problem – the victim of the accident was brought to the hospital.

There’s some contention over whether or not O’Leary actually violated HIPAA (the news that the victim was not wearing a seatbelt had been made public by the time she commented). Even so, this story should still serve as a warning. It’s your responsibility to make your staff aware that even a seemingly harmless comment could be construed as a HIPAA violation.

By Not Keeping Proper Track of Employee Devices

Personally-owned smartphones and home computers are a huge no-no for HIPAA. Yet all too frequently, clinicians and other healthcare staff bring personal devices into the workplace, or else use them to work on patient data from the comfort of their own home. The problem isn’t that they’re using these devices, per-se.

It’s that they’re doing so without any sort of oversight.

Let’s say, for example, a physician looks at some patient data in her home office. She forgets to turn off her PC, and her husband wanders in to do a quick Google search. He sees the patient data – and suddenly a HIPAA violation falls right into their laps.

Or let’s say two doctors are communicating with one another via SMS, discussing a patient’s records. Instead of being careful about what they’re saying, they openly disseminate PHI between one another.

Again, no one here is necessarily acting maliciously. Even so, they’re still putting patient data at risk. Here’s what you need to do:

  • Incorporate some form of document management system that ensures PHI can only be accessed by authorized personnel – no matter if they’re at home or elsewhere. It should also include a timed expiration function so that if a file is left open for a certain amount of time without any activity, it becomes inaccessible.
  • Utilize endpoint management software that allows you to manage, monitor, and control the devices within your workplace.
  • Train and educate your staff on the importance of keeping PHI to approved, secure channels – and if need be, implement a secure messaging solution so they can still keep in touch.

Via Friends and Family

It seems harmless enough. Someone goes to a hospital for an MRI to check if they have a severe spinal cord injury. A few days later, someone else – a friend or family member – asks about the results.

And the physician tells them. No harm done, right? They’re just concerned about someone they care for.

Here’s the thing – that’s still a HIPAA violation, harmless though it may seem. Sure, it was an innocent inquiry. But unless the patient specifically consented for their information to be shared, it doesn’t matter who asks.

You’re still violating their privacy if you share it.

Caution is Key

There are a lot of little stumbling points in HIPAA that tend to catch many healthcare providers unaware. Things that may seem innocent or harmless can actually land you in a world of trouble with regulatory agencies, costing valuable staff their jobs and even bringing about a lawsuit. The best way to avoid such issues is to just be cautious – to treat PHI with the utmost care.

Do that, and you should be just fine.

About Tim Mullahy
Tim Mullahy is the Executive Vice President and Managing Director at Liberty Center One, a new breed of data center located in Royal Oak, MI. Tim has a demonstrated history of working in the information technology and services industry.

An EHR Twitter Roundup

Posted on August 3, 2018 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.

If you want to know how doctors feel about their EHR software, all you have to do is look at Twitter. There are doctors complaining all of the time about their EHR and the impact it’s having on their lives. I’m careful to not take their complaints too far. If Twitter was around 15 years ago, I’m 100% sure we’d have seen just as many doctors complaining about paper charts as we do about EHR software.

That said, it’s important to acknowledge the impact that EHR software and the policies and regulations it reflects has on doctors. Let me highlight some tweets that illustrate what I mean and add a little commentary and perspective.


The concept of cognitive bandwidth is an important one. We’ve all felt that burnt out feeling where some part of your job leaves you so burnt out that you can’t spend time on something else. I do find it interesting that this same doctor has still been able to tweet 6,660 times despite the cognitive burnout that Epic has offered him. Granted, tweeting doesn’t require the same cognitive load as other professional development tasks he could do. Twitter is much more bite-sized which makes us think that it doesn’t suck the life out of us as well. Maybe there’s a lesson here for us on how to better educate people. Regardless, I know this doctor is not alone in his feelings of an EHR making other things more difficult to accomplish.

Many replies to the tweet suggested that it would get better over time, but there was plenty of commiseration as well. There was also this reply:


To be honest, I hate this example. It usually leads to people saying that Apple could build a much better EHR than those out there today. Every day I’m more convinced that’s just not the case. Ok, maybe Apple’s EHR would be nominally better than what’s out there, but I’m quite confident that doctors would still hate it.

Here’s the problem. If your niece had to document 100 data points in an app with 10,000 possible variations, she’d hate it too. One day doctors will be able to walk into an exam room and microphones and video cameras will capture everything that happens with a patient, NLP will identify the various clinical elements, AI will know what it all means, and the visit will be documented automatically. Until that happens, many EHRs can improve what they’re doing, but it will all still feel “non-intuitive” compared to a simple app that your niece uses.


And EMR software wasn’t designed to improve care.


If you read through the full thread, you get more details about what’s really happening. Many of the complaints like this one are around poor configuration and implementation. There’s no doubt that every EMR can do what she’s asking. Someone in a reply acknowledges that they can do it. However, that doesn’t help the doctor when they’re frustrated in that moment. It’s amazing the impact poor configuration and implementation can have on morale.


A hopeful view, but a challenging one when you stack it up against even just the simple complaints above.

The reality is that EHRs aren’t going anywhere. So, Dr. Levi is right. Providers can’t be enslaved by the EHR. Easier blogged than done.

Looking Back: Facebook in Healthcare

Posted on August 1, 2018 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.

Today I decided that I’d start regularly doing a series of blog posts called Looking Back. In this blog post series I’ll look back at some of my popular (and maybe some not so popular) blog posts I’ve written and see how it holds up today. Have things changed? Were we totally wrong? Did we forget those lessons? I’ve done this on occasion, but with over 12,000 blog posts I think I want to make this a regular feature. There’s a lot of value in looking back at old posts and remembering where we came from and how things have changed.

Today’s “Looking Back” post was published in October 2014 and was titled Facebook in Healthcare. I’ll wait here while you go and read the post.

Now that you’ve read the post…

It’s fascinating for us to think about Facebook in healthcare. Especially with what we now know about people using Facebook to influence elections and other nefarious things. It’s sad, because those same people could have used Facebook to do some good things for healthcare, but they didn’t. That’s not to say that there aren’t some good Facebook healthcare groups that provide value for patients. There are, but they aren’t really stuff that Facebook has been working on as a specific product.

What’s crazy is that even back in 2014 when I wrote the previous post, I suggested that many people didn’t trust Facebook with our health info. Today that’s true times 10. That said there are still a lot of people that would have no problem sharing health info on Facebook as well. It’s amazing to think about the separation between the people who would still share pretty much anything on Facebook and those who don’t want to use Facebook for anything.

What’s surprising today is that the post didn’t even look at other big companies that are now becoming big players in healthcare. I mentioned Google which was just starting back into healthcare after the failure of Google Health. However, I don’t think even back then I would have been able to predict all of the healthcare things that Google is doing through Alphabet.

The other big company that wasn’t mentioned at all is Amazon. Back in 2014, I can’t even remember Amazon being mentioned in any healthcare conversations. That’s not true today where it seems like Amazon is mentioned in almost every healthcare conversation.

Looking at things as they are now, I think Amazon will be a big player in healthcare and will have a big impact on it. However, they’re going to do it in new ways. They’re going to create new opportunities and new gateways to healthcare and healthcare services. If we look back on this post 4 years from now I think we’ll have had no idea of the ways Amazon will impact healthcare. I think of all the big tech companies out there, Amazon will have a bigger impact on healthcare than others like Apple, Google, Samsung, etc.

What’s your take on these big companies impacting healthcare? Which ones do you think will be effective and in what ways? We’ll look back on this post in 4 years and see if we’re right.

Physicians Are (Justfiably) Ambivalent About Virtual Care

Posted on July 30, 2018 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.

It’s easy for pundits like myself to support virtual care. From my standpoint, it’s obvious that virtual care is the easiest and most effective way to handle many health conditions, from handling one-off issues like sore throats and sinusitis to managing long-term chronic conditions.

Not only that, emerging devices will allow patients to test their own blood, urine, heart rhythm and more. When these devices are perfected and put into common use, virtual care will become even more useful and appropriate.

Despite all of these signs of progress, though, physicians aren’t all in with virtual care just yet. According to a study by consulting firm Deloitte, doctors think virtual care might help with patient engagement and support. However, doctors said they would need to overcome several obstacles to virtual care use before they get involved.

Generally speaking, survey respondents seem to “get it” about telemedicine. In fact, according to the survey nine in 10 physicians understand the benefits of virtual care, particularly when it came to connecting with patients. They reported that these benefits include improved patient access to care (66%), increased patient satisfaction (52%) and staying connected with patients and their caregivers (45%).

They also said virtual care could improve patient care coordination (42%), boost the cost-effectiveness of care (42%), offer increased flexibility to clinician schedules (41%), streamline workflow (32%) and help them stay connected with peers and other clinicians (28%). Only 11% said they didn’t see any benefits to virtual care.

Given these advantages, you might think that physicians were gung-ho about virtual care adoption – but you’d be wrong. Just over a third (38%) have rolled out email/patient portal consultations, and 17% are conducting physician-to-physician electronic consultations. Only 14% are conducting virtual/video visits.

On a side note, I was interested to learn adoption of such technologies is higher among primary care physicians than specialists. The survey found that 48% of primary care physicians have implemented portals, compared with 34% of specialists, and that 17% of PCPs were offering video visits versus 13% of specialists.

Meanwhile, I was interested to learn that 43% of respondents who had electronic consultation tools at their disposal connected with colleagues at least once a week. In fact, I’m surprised to learn that this is even happening– electronic consults with between doctors and their peers was not on my radar.

But I wasn’t taken aback to learn that physicians employed or affiliated with hospitals and health systems (62%) made regular use of at least one virtual care technology. After all, hospitals are generally ahead of other providers when it comes to telemedicine. (For example, check out Intermountain’s virtual hospital program.)

Bottom line, physicians still face big obstacles to rolling out virtual care, including a need for training (51%), a lack of access to this technology (35%) and worries about security and privacy of patient data (33%).

All told, when I read about their reasonable objections, low physician adoption of virtual care makes a whole lot more sense. Until these concerns are addressed little is likely to change.

There Are No Simple Answers When You Try to Personalize Healthcare Communication

Posted on July 27, 2018 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.

Earlier this month, Brian Norris (@Geek_Nurse), a registered nurse and informaticist who also has an MBA (when has this mix ever occurred?) asked the question on Twitter “Which would you rather receive post having labs drawn as a patient?” His options were: A call, email, text, or Leave Me Alone. While not scientific in anyway, the poll did have a good response and the results below were quite interesting:

The results of this poll highlighted that everyone has different preferences. In fact, if you look over the comments in reply to the poll, you’ll realize that many hated the poll because they would want different modalities based on the specific situation. Personalizing healthcare communication gets really complex really quickly.

The good news is there are healthcare companies that are working towards this kind of personalization. My friends at CareCognitics (I’m an advisor to the company) are doing detailed tracking of each patient’s communication preferences so they can customize which communication platform is used, but also what time is best to communicate and much more.

Another great example of this is the ways Stericycle Communication Solutions allows patients to communicate across a wide variety of platforms from text to humans. That’s right, they have actual humans who talk to you. Eventually, our systems might get good enough that a human discussion isn’t needed, but as the poll above shows, there’s still a desire for phone discussions with patients. Depends on the situation of course since many would argue that a phone call is the worst experience when a text could have accomplished the same thing. Many long-time readers will remember a post by Jim Higgins from Solutionreach that highlights the gap between the communication patients want and what practices offer. A call when a text is sufficient is a bad patient experience. A text when a call is needed is a bad patient experience.

Of course, we also see outside of healthcare where we can experience communication overload. When I do a payment on Paypal, I get an email notification, a Paypal app notification, and a notification from my bank. Another example that might be more familiar to you is an Amazon shipment. They send me an email and a text and an app notice. That’s a bit of overkill no?

Over communication is generally better, but not always. When I’m receiving a package from Amazon, then a few extra messages might just get me more excited for the package to arrive. Even the extra notifications from Paypal are good since I’m afraid of some sort of identity theft. However, if it’s a bad lab result, do I want to be reminded of it 3 times? Definitely not.

What does all of this mean? Healthcare communication is hard work and it’s almost impossible to get perfect. However, we can do better than we do today. The key is to provide the patient multiple avenues of communication. Until the systems start learning about patient’s preferences, ask the patient and let them adjust their preferences over time as they learn what works for them and what doesn’t. Learn from communication mistakes that happen, but make sure you keep the mistakes in perspective. One bad communication doesn’t mean you should necessarily stop the thousands of good communications.

Stericycle Communication Solutions and Solutionreach are both Healthcare Scene sponsors.

Creating a “Clinancial” Model: Bridging the Gap Between Clinical and Financial

Posted on July 25, 2018 I Written By

The following is a guest blog post by David Dyke, VP Product Management at Ciox.

Healthcare at a broad level divides its business into two types of work: The clinical, and the financial. The groups that serve each effort are traditionally siloed. Doctors and nurses, for instance, focus on the clinical health of their patients.  Clinical pathways define the day: What is the plan of care? How do we improve the quality of care? How do we deliver the right course of treatment for this patient in the time we have, based on all of their individual variables?  And how do we apply that broadly to entire conditions and communities?

Separate from clinical practices are the equal and opposite financial forces within the business of healthcare. Healthcare CFOs, for example, are chartered with caring for the financial health of their organization.  Financial pathways rule the day: Ensuring administrative processes, patient experience and strategic plans align to the best operational outcomes.  How can we survive until tomorrow if reimbursement, risk, denials, cash, collections, debt and financing issues are not addressed today?

Yet, for all the division of labor and effort in the healthcare space, the reality is that the two sides of the business exist as the heads and tails of the same coin. When a patient walks into a healthcare provider’s office, clinical and financial pathways alike are opened up, and their relationship is far less siloed and far more symbiotic than the current model of care reflects. What if we approached these two traditionally separate parts of the healthcare system as two halves of the same? How do we break down the paradigm that these are two separate pathways? How do we connect the clinical and the financial?

Perhaps what we need is a new word; one that better reflects the concurrent pathways in healthcare. Maybe we are not laboring along two separate clinical and financial pathways, but a single “Clinancial” pathway.

cli·nan·cial (adjective)

Relating to both clinical and financial pathways in healthcare.

As the cost model in healthcare has shifted, the patient’s interest level in the financial side of the healthcare continuum has shifted dramatically. Health plans are increasingly prescriptive in their services.  Whether specifically defining limitations on choices, options, and access to specific providers, or implicitly influencing behavior through out-of-pocket cost motivators, the financial aspects of healthcare are increasingly top-of-mind.

Even for patients, the Clinancial pathway to care is here already. It’s not just simple decisions that intersect financial and clinical pathways. These meet again at the intersection of in-network, copays and out of pocket expenses, year to date costs, and whether a patient has a flex plan. All of these financial decisions have bearing on the patient’s end clinical pathway and could be better understood earlier in the process by those whose traditional focus is strictly clinical.

What clinical choices would be different if the outlook included financial realities and variables. What choices would be made in a Clinancial model? Similarly, what financial choices could be made with better clinical information?

From the way we code clinical services to the way we seek to manage reimbursement activities and claims, from denials to audits and at every point where Clinancial lines cross, we in healthcare have an opportunity to improve both our patient experiences and our bottom lines by better rolling together our clinical and financial information for all involved.

If case managers aren’t approaching patient care from the perspective of preventing denials, then they are missing a huge opportunity to improve not only the patient experience and clinical outcomes but also the organization’s ability to do the same thing systematically again tomorrow, and the day after that.

The landscape is continuously changing. Health Insurance Plan Designs vary widely today, and will have more variabity tomorrow. Medical guidelines are always evolving too. The barriers to adopting Clinical Guidelines are well documented, it’s most often a factor of information or population overload.  For example, in 2017 the guidelines for High Blood Pressure changed, effectively “giving” High Blood Pressure to 30 million more Americans.  It’s a business model where we need to know how to be continuously adaptive, how we are engaging with all parties involved, from the healthcare recipient to the insurers, and building a trust network around risk. Yet we traditionally do not evolve, or change, or update ourselves particularly efficiently.

Some organizations are doing this better than others – integrating even just their reporting structure. They ask themselves questions like “Are medical records part of the clinical or the financial operations of a hospital?”

Groups that see the shift have moved within their organizations to form teams with names like ‘Revenue Integrity’, and because of those new delineations they are more closely aligning the “how” and “why” of the clinical process with the “what” and “when” of the financial workflows. And as they have shifted into Revenue Integrity teams, they are looking at things more holistically to uncover key findings. Much like an integrated care team takes a holistic look at a patient, their direct conditions and their social situations. These integrated Clinancial teams can find connections between coding workflows and reimbursement speed, and can design and implement Clinancial Workflows to measure and improve their outcomes.

No matter the structure, integrated Clinancial Teams are doing three things well: They communicate regularly across the siloes, they collaborate across teams on opportunities that affect both the clinical and financial aspects of the business, and they share data, findings and ideas.

The victories are twofold: Organizations have a chance within a Clinancial model to improve patient satisfaction and outcomes, while at the same time better flowing clinical data through into reimbursement. We have entered a new financial reality where the patient’s experience has an increasingly material impact on a provider’s bottom line. By unifying around Clinancial Pathways, we can make strides to improve patient outcomes and experiences, while at the same time gaining operational efficiencies to drive margin improvement now, when we need it most.

And all we needed to do was invent a new word for it.  #easy

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com