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Patient Access to Health Information is a Right

Posted on April 14, 2017 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 browsing some old notes I’d taken to interesting resources and ideas. I came across some videos that ONC had created around the rights of patients when it comes to accessing health information.

Here’s a look at the first video:

The video is 3 minutes long and the information could have been shared in 30 seconds, but some of the points it shares are really good. For example, that it’s your right to be able to access your health information. Also, they make the point that you still have the right to get access to your health information even if you haven’t paid your bill.

It’s always amazing to me how many misconceptions there are out there when it comes to access to health information. We see HIPAA and other rules used as a reason to not provide patients their health information a lot and it’s often wrong.

The great thing is that over the 11 years I’ve been blogging, we’ve seen a real sea change in people’s perspectives on how and when you should have access to your patient record. That said, we still have a ways to go. Technology should make that record available to you whenever and wherever you want in near real time fashion. We see that in some organizations, but not enough.

These videos will never go viral, but they are a good information source for those patients who aren’t sure about their rights when it comes to access to their health information.

The Physician – Patient Disconnect

Posted on April 13, 2017 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’ve been in healthcare for a while, then you know that there’s often a disconnect between patients and healthcare professionals. However, this divide was illustrated pretty sharply in some research that Conduent (previously known as Xerox) put out about the relationship.

Plus, to add to this disconnect, there was an even bigger divide between patients from different ages. In fact, they’re a very heterogeneous group. However, so many healthcare organizations treat them the same.

For a good illustration of these differences, take a second to look at this infographic:

Provider-Backed Health Data Interoperability Organization Launches

Posted on April 12, 2017 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 1988, some members of the cable television industry got together to form CableLabs, a non-proft innovation center and R&D lab. Since then, the non-profit has been a driving force in bringing cable operators together, developing technologies and specifications for services as well as offering testing and certification facilities.

Among its accomplishments is the development of DOCSIS (Data-over-Cable Service Interface Specification), a standard used worldwide to provide Internet access via a cable modem. If your cable modem is DOCSIS compliant, it can be used on any modern cable network.

If you’re thinking this approach might work well in healthcare, you’re not the only one. In fact, a group of powerful healthcare providers as just launched a health data sharing-focused organization with a similar approach.

The Center for Medical Interoperability, which will be housed in a 16,000-square-foot location in Nashville, is a membership-based organization offering a testing and certification lab for devices and systems. The organization has been in the works since 2011, when the Gary and Mary West Health Institute began looking at standards-based approaches to medical device interoperability.

The Center brings together a group of top US healthcare systems – including HCA Healthcare, Vanderbilt University and Community Health Systems — to tackle interoperability issues collaboratively.  Taken together, the board of directors represent more than 50 percent of the healthcare industry’s purchasing power, said Kerry McDermott, vice president of public policy and communications for the Center.

According to Health Data Management, the group will initially focus on acute care setting within a hospital, such as the ICU. In the ICU, patients are “surrounded by dozens of medical devices – each of which knows something valuable about the patient  — but we don’t have a streamlined way to aggregate all that data and make it useful for clinicians,” said McDermott, who spoke with HDM.

Broadly speaking, the Center’s goal is to let providers share health information as seamlessly as ATMs pass banking data across their network. To achieve that goal, its leaders hope to serve as a force for collaboration and consensus between healthcare organizations.

The project’s initial $10M in funding, which came from the Gary and Mary West Foundation, will be used to develop, test and certify devices and software. The goal will be to develop vendor-neutral approaches that support health data sharing between and within health systems. Other goals include supporting real-time one-to-many communications, plug-and-play device and system integration and the use of standards, HDM reports.

It will also host a lab known as the Transformation Learning Center, which will help clinicians explore the impact of emerging technologies. Clinicians will develop use cases for new technologies there, as well as capturing clinical requirements for their projects. They’ll also participate in evaluating new technologies on their safety, usefulness, and ability to satisfy patients and care teams.

As part of its efforts, the Center is taking a close look at the FHIR API.  Still, while FHIR has great potential, it’s not mature yet, McDermott told the magazine.

A Tool For Evaluating E-Health Applications

Posted on April 11, 2017 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 recent years, developers have released a staggering number of mobile health applications, with nearly 150,000 available as of 2015. And the demand for such apps is rising, with the mHealth services market projected to reach $26 billion globally this year, according to analyst firm Research 2 Guidance.

Unfortunately, given the sheer volume of apps available, it’s tricky to separate the good from the bad. We haven’t even agreed on common standards by which to evaluate such apps, and neither regulatory agencies nor professional associations have taken a firm position on the subject.

For example, while we have seen groups like the American Medical Association endorse the use of mobile health applications, their acceptance came with several caveats. While the organization conceded that such apps might be OK, it noted that such approval applies only if the industry develops an evidence base demonstrating that the apps are accurate, effective, safe and secure. And other than broad practice guidelines, the trade group didn’t get into the details of how its members could evaluate app quality.

However, at least one researcher has made an attempt at developing standards which identify the best e-Health software apps and computer programs. Assistant professor Amit Baumel, PhD, of the Feinstein Institute for Medical Research, has recently led a team that created a tool to evaluate the quality and therapeutic potential of such applications.

To do his research, a write-up of which was published in the Journal of Medical Internet Research, Baumel developed an app-rating tool named Enlight. Rather than using automated analytics, Enlight was designed as a manual scale to be filled out by trained raters.

To create the foundation for Enlight, researchers reviewed existing literature to decide which criteria were relevant to determine app quality. The team identified a total of 476 criteria from 99 sources to build the tool. Later, the researchers tested Enlight on 42 mobile apps and 42 web-based programs targeting modifiable behaviors related to medical illness or mental health.

Once tested, researchers rolled out the tool. Enlight asked participants to score 11 different aspects of app quality, including usability, visual design, therapeutic persuasiveness and privacy. When they evaluated the responses, they found that Enlighten raters reached substantially similar results when rating a given app. They also found that all of the eHealth apps rated “fair” or above received the same range of scores for user engagement and content – which suggests that consumer app users have more consistent expectations than we might have expected.

That being said, Baumel’s team noted that even if raters like the content and found the design to be engaging, that didn’t necessarily mean that the app would change people’s behaviors. The researchers concluded that patients need not only a persuasive app design, but also qualities that support a therapeutic alliance.

In the future, the research team plans to research which aspects of app quality do a better job at predicting user behaviors. They’re also testing the feasibility of rolling out an Enlight-based recommendation system for clinicians and end users. If they do succeed, they’ll be addressing a real need. We can’t continue to integrate patient-generated app data until we can sort great apps from useless, inaccurate products.

A Quick Look at MACRA in the Twittersphere – MACRA Mondays

Posted on April 10, 2017 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

MACRA is still an extremely hot topic and so there’s a lot of discussion about it happening on Twitter and other social media platforms. For today’s MACRA Monday I thought I’d highlight a number of tweets about MACRA that might help you in your efforts.


This was one of the main reasons that doctors didn’t want to participate in meaningful use. Seems like it’s carrying over into MACRA. Is there reason to be concerned?


I thought this was an interesting way to breakdown the two parts of MACRA: APMs and MIPS. I’d just add that APMs require the new entities to report as well. You can’t get away from reporting in either of them.


Leavitt Partners has a deep perspective on what’s happening with healthcare. In the link they assert that MACRA may have a bigger direct impact on physicians and the delivery system than ACA (Obamacare). They could very well be right.


I wouldn’t have guessed this is a radiology society’s top priority. It matters to them, but it seems like they’d have bigger fish to fry.


Numbers like this are disturbing. Does it really take that much to be prepared for MACRA? Or do doctors just not understand MACRA and so they answered that they’re not ready? Maybe I was wrong about how many will just take the penalties. Although, it’s still early and I think most will be able to avoid penalties thanks to Pick Your Pace.

Any great tweets or insights you’ve seen about MACRA lately? If so, share them in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update: Doctors Need To Lead Tech Charge

Posted on April 7, 2017 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.

Doctors, like any other group of people, vary in how comfortable they are with technology. Despite the fact that their job is more technology-focused than ever before, many clinicians use tech tools because they must.

As a result, they aren’t great role models when it comes to encouraging patients to engage with portals, try mobile apps or even pay their healthcare bills online. I too am frustrated when doctors can’t answer basic tech questions, despite my high comfort level with technology. I like to think that we’re on the same page, and I feel sort of alienated when my doctors don’t seem to care about the digital health advantage.

This needs to change. Given the extent to which technology permeates care delivery, physicians must become better at explaining how basic tech tools work, why they’re used and how they benefit patients.

Below, I’ve listed three tools which I consider to be critical to current medical practices, based on both my patient experiences and my ongoing research on health IT tools. To me, knowing something about each of them is unavoidable if doctors want to keep up with trends and improve patient care.

The top three tools I see as central to serving patients effectively are:

  • Patient portals: This is arguably the most important technical option doctors can share with patients. To get the most value out of portals, every doctor – especially in primary care – should be able to explain to patients why accessing their data can improve their health and lives.
  • Connected health: For a while, connected health/remote monitoring solutions were a high-end, expensive way to track patient health. But today, these options are everywhere and accessible virtually anyone. (My husband bought a connected glucose monitor for $10 a few weeks ago!) If nothing else, clinicians should be able to explain to patients how such devices can help tame chronic diseases and prevent hospitalizations.
  • Mobile apps: While few apps, if any, are universally trusted by doctors, there’s still plenty of them which can help patients log, measure and monitor important data, such as medication compliance or blood pressure levels. While they don’t need to understand how mobile apps work, they should know something of why patients can benefit from using them.

Of course, this list is brief, but it’s a decent place to start. After all, I’m not suggesting that physicians need to get a master’s in health IT to serve patients adequately; I’m just recommending that they study up and prepare to guide their patients in using helpful tools.

Ultimately, it’s not as important that clinicians use or even have a deep understanding of digital health tools, health bands, smartwatches, sensor-laden clothing or virtual reality. They don’t have to understand cybersecurity or know how to reboot a server. They just have to know how to help patients navigate the healthcare world as it is.

By this point, in fact, I’d argue that it’s irresponsible to avoid learning about technologies that can help patients manage their health. Bear in mind that even if they don’t act like it, even confident, experienced patients like me truly admire our doctors and take what they say seriously. So if I am enthusiastic about using tech tools to manage my health, but my doctor’s eyes glaze over when I talk about them, even I feel a bit discouraged. So why not learn enough to encourage me on my journey?

Two Worth Reading

Posted on April 6, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

HIT is a relatively small world that generates no end of notices, promotions and commentaries. You can usually skim them, pick out what’s new or different and move on. Recently, I’ve run into two articles that deserve a slow, savored reading: Politico’s Arthur Allen’s History of VistA, the VA’s homegrown EHR and Julia Adler-Milstein’s take on interoperability’s hard times.

VistA: An Old Soldier That May Just Fade Away – Maybe

The VA’s EHR is not only older than just about any other EHR, it’s older than just about any app you’ve used in the last ten years. It started when Jimmy Carter was in his first presidential year. It was a world of mainframes running TSO and 3270 terminals. Punch cards still abounded and dialup modems were rare. Even then, there were doctors and programmers who wanted to move vet’s hard copy files into a more usable, shareable form.

Arthur Allen has recounted their efforts, often clandestine, in tracking VistA’s history. It’s not only a history of one EHR and how it has fallen in and out of favor, but it’s also a history of how personal computing has grown, evolved and changed. Still a user favorite, it looks like its accumulated problems, often political as much as technical, may mean it will finally meet its end – or maybe not. In any event, Allen has written an effective, well researched piece of technological history.

Adler-Milstein: Interoperability’s Not for the Faint of Heart

Adler-Milstein, a University of Michigan Associate Professor of Health Management and Policy has two things going for her. She knows her stuff and she writes in a clear, direct prose. It’s a powerful and sadly rare combination.

In this case, she probes the seemingly simple issue of HIE interoperability or the lack thereof. She first looks at the history of EHR adoption, noting that MU1 took a pass on I/O. This was a critical error, because it:

[A]llowed EHR systems to be designed and adopted in ways that did not take HIE into account, and there were no market forces to fill the void.

When stage two with HIE came along, it meant retrofitting thousands of systems. We’ve been playing catch up, if at all, ever since.

Her major point is simple. It’s in everyone’s interest to find ways of making I/O work and that means abandoning fault finding and figuring out what can work.

Insights from Alan Portela on Healthcare IT Barriers and Opportunities

Posted on April 5, 2017 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 interviewed hundreds and maybe even thousands of healthcare IT professionals. I learn a little bit from each of them. However, some people I interview offer me a view of healthcare IT that I haven’t thought about before. That’s what it was like for me when I first interviewed Alan Portela, CEO of AirStrip, 4-5 years ago.

Ever since then, I’ve never turned down a chance to interview Alan Portela. Plus, he’s so insightful that I usually ask him if it’s ok if we turn the cameras on so that everyone can learn from him. That’s what happened at HIMSS when I had a chance to interview Alan.

The focus of my interview with Alan was around the changing world of healthcare IT. I wanted to hear what challenges Alan and his team at AirStrip were facing and also what opportunities he saw for healthcare IT’s future. Like usual, Alan brought out some great insights that will benefit anyone working in healthcare IT.

Watch my full video interview with Alan Portela below:

Find more great Healthcare Scene interviews on YouTube.

Do Vendor Business Models Discourage EMR Innovation?

Posted on April 4, 2017 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.

Despite the ever-mounting levels of physician frustration, in some ways EMRs have changed little from their mass-market rollout. EMR interfaces are still counterintuitive, data sharing possibilities are limited, important information still lives in isolated silos and endless data entry is the rule rather than exception.

In theory, we could do better if we had a reasonable vision of what should come next. For example, I was intrigued by ideas proposed by Dr. Robert Rowley of Flow Health. He describes a model in which EMRs draw on a single, external data source which isn’t confined to any one organization. Providers would access, download and add data through a modern API.  Given such fluid access to data, providers would be able to create custom front-ends based on a collection of apps, rather than rely on a single vendor-created interface.

Unfortunately, EMR vendors are unlikely to take on a completely different approach like Rowley’s, for reasons inherent to their business model. After all, they have little reason to develop new, innovative EMRs which rely on a different data architecture. Not only that, the costs associated with developing and rolling out a completely new EMR model would probably be very high. And what company would take that chance when their existing “big iron” approach still sells?

Not only that, EMR vendors would risk alienating their customers if they stray too far off the ranch. While an innovative new platform might be attractive to some buyers, it might also be incompatible with their existing technology. And it would probably require both providers and vendors to reinvent workflows and transform their technical architecture.

Meanwhile, in addition to finding a way to pay for the technology, providers would have to figure out how to integrate their existing data into the new system, integrate the platform with its existing infrastructure, retrain the staff and clinicians and cope with reduced productivity for at least a year or two. And what would become of their big data analytics code? Their decision support modules? Even data entry could be a completely new game.

Smaller medical practices could be pushed into bankruptcy if they have to invest in yet another system. Large practices, hospitals and health systems might be able to afford the initial investment and systems integration, but the project would be long and painful. Unless they were extremely confident that it would pay off, they probably wouldn’t risk giving a revolutionary solution a try.

All that being said, there are forces in play which might push vendors to innovate more, and give providers a very strong incentive to try a new approach to patient data management. In particular, the need to improve care coordination and increase patient engagement – driven by the emergence of value-based care – is putting providers under intense pressure. If a new platform could measurably improve their odds of surviving this transition, they might be forced to adopt it.

Right now, providers who can afford to do so are buying freestanding care coordination and patient engagement tools, then integrating them into their existing EMRs. I can certainly see the benefit of doing so, as it brings important functions on board without throwing out the baby with the bathwater. And these organizations aren’t forced to rethink their fundamental technical strategy.

But the truth is, this model is unlikely to serve their needs over the long term. Because it relies on existing technology, welding new functions onto old, clinicians are still forced to grappled with kludgy technology. What’s more, these solutions add another layer to a very shaky pile of cards. And it’s hard to imagine that they’re going to support data interoperability, either.

Ultimately, the healthcare industry is going to be bogged down with short-term concerns until providers and vendors come together and develop a completely new approach to health data. To succeed at changing their health IT platform, they’ll have to rethink the very definition of key issues like ease of use and free data access, care coordination, patient engagement and improved documentation.

I believe that’s going to happen, at some point, perhaps when doctors storm the executive offices of their organization with torches and pitchforks. But I truly hope providers and vendors introduce more effective data management tools than today’s EMRs without getting to that point.

MACRA Success Calls For Team Effort – MACRA Mondays

Posted on April 3, 2017 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

A new study suggests that the common-sense approach to handling MACRA issues – getting everyone on your team engaged with issues that arise – is popular among medical practices.

According to Stoltenberg Consulting’s Fifth Annual Health IT Industry Outlook Survey, which polled a mix of IT professionals and executives at HIMSS17, the industry is still struggling to begin their MACRA process. In fact, 64 percent of respondents said that they were unprepared or very unprepared to handle MACRA.

On the other hand, many have a good idea of how they’ll proceed. The survey found that 68 percent of respondents said that practices should bring together clinical, financial and IT staffers when tackling MACRA challenges.

Even so, respondents had some significant concerns about their capabilities. Thirty-one percent of respondents said that revising data management and reporting processes to meet new reporting requirements was their biggest Quality Payment Program challenge. Almost tied was the need to motivate the entire organization to work together towards MACRA goals.

In its commentary, Stoltenberg expands on these themes. “Successful MACRA QPP reporting will take more than just passive submission of claim data,” the report states. “MACRA QPP success requires a defined, focused team which includes IT, clinical and operational departments all led by an executive representative. By combining their expertise, team members can better capture, maintain and analyze data that demonstrates program requirement achievement.”

But creating a team isn’t enough, the consulting firm notes. To move forward, the team must become thoroughly familiar with MACRA QPP and its subtleties. Then, the team will be equipped to evaluate the group’s existing reporting mechanism, decide which reporting gaps exist and figure out how to close them.

Then, the team should create a multi-year roadmap for meeting QPP requirements, including a look at alternative QPP paths they could take and what the impact on reimbursement might be, the report recommends. “A  roadmap will allow a healthcare organization to quickly adapt its MACRA program from year to year, preparing for more stringent requirements in future reporting years or transition from one reporting path to another.”

In addition to addressing MACRA issues, the researchers looked at issues in staffing healthcare IT departments. Fourty-four percent of respondents said that their department wasn’t fully staffed because they lacked the budget to do enough hiring.

Meanwhile, 43 percent said they hadn’t encountered enough qualified, experienced job candidates to fill their open positions. Also, 54 percent said that finding qualified health IT staff and support was difficult, and 28 percent said it was very difficult.

To close these hiring gaps, Stoltenberg recommended that healthcare organizations consider investing in training high-potential IT staffers with less experience, and pair them with advisors who can help them grow their skills.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.