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Connected Health Insights from Joseph Kvedar

Posted on October 22, 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.

While attending the Connected Health Conference in Boston last week, I had the pleasure to sit down and talk with Joseph Kvedar. Besides being one of the most knowledgeable people on connected health including two books, “The Internet of Healthy Things” and “The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan“, he also has to be one of the nicest people you’ll meet in the connected health space.

This was the first time I’d had a chance to sit down with Joseph Kvedar since the release of his latest book, so I was interested in the insights and experiences he’s had with that book. In the half hour we spent together, the connected health knowledge and experiences just flowed. Here are a few of the insights he shared which stood out to me.

First, Joseph Kvedar introduced the concept of Lifespan vs Healthspan. We all know that our expected lifespan has gotten longer over the past 50 years. While this is great, Joseph Kvedar wanted to ask the question of how many years of our lives we live in a healthy, productive state or what he calls Healthspan. His latest book addresses how technology can increase the number of healthy productive years we have in our lives. A noble goal indeed. What he discovered is there are three things that extend a person’s healthspan:

  • A Sense of Purpose
  • Physical Activity
  • Social Interactions

We could dive into each of these individually, but it’s better to go and read his book for all the details. However, he pointed out something really interesting about these three items. Technology can do pretty well at monitoring physical activity and even social interactions to a large degree. However, it’s much harder for technology to measure whether someone has a sense of purpose. It’s a clear reminder that technology can help us in healthcare, but it is certainly not the end all be all.

Joseph Kvedar went on to talk with me about how we’re going to need technology to facilitate what he calls one to many care. In many places, we don’t have enough healthcare providers or caregivers to take care of the silver tsunami as many have called our aging population. We’ll need technology to make up the difference and allow one person to be able to care for many people at once. It’s a powerful idea that we’re starting to see come to fruition in small ways already.

When talking with Joseph Kvedar, he compared it to us as all wishing we were like the US President who always has a doctor with him. When the doctor is needed for the US President, he’s there. Of course, that’s impossible to scale for everyone, but can technology help it to be as if you have a doctor with you all the time? Any technology solution will be less effective than having a real doctor there 24/7, but could technology help to fill the gaps? I think the answer is yes and we’re seeing that play out in the connected health world in really interesting ways.

Joseph Kvedar explained that “My generation was trained that you can’t rely on anyone to do anything, but we’ll never survive in this new world if we don’t rely on others and tech.” That’s a really powerful idea and message for our medical education institutions. Certainly, the trust but verify principle has been an important one for doctors, but the acceleration of technology and the data behind that technology is going to transform what a doctor needs to trust in order to care for patients effectively.

Lots to chew on coming out of a meeting with Joseph Kvedar. At one point he talked about how he was often too early on many of his connected health predictions. That might be true with some of the things he mentions above as well, but it’s hard to argue with any of them. It’s more a question of when these things are likely to happen versus if.

When Payor Innovation is Driven By Government

Posted on October 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.

This tweet from Jamey Edwards, CEO of Cloudbreak Health, inspired a really interesting discussion in a Twitter DM (direct message) group I’m in called Healthcare Disruptors. For those not familiar with private DM groups, in this case, there’s a group of 49 people on Twitter that are part of this group and members of the group regularly share information, events, insights, etc and the group comments on it.

Private Twitter DM groups aside, one of the comments in the group highlighted a concept I’ve heard for years. The government (largely Medicare and Medicaid) is the largest payor and the private sector has been taking its queues from Medicare and Medicaid for years. Is it any wonder that we haven’t seen much evolution in the payor space when we’re waiting on a massive government entity to drive the innovation?

Waiting for government to drive innovation largely explains why healthcare hasn’t evolved.

To solve this problem, there are two options First, the government could evolve more quickly and create new models for reimbursement that change the landscape. Is there anyone holding their breath on this one? Don’t get me wrong. I’m quite intrigued by Medicare’s attempts to push telehealth related reimbursement codes and their decision to try and reimburse based on the time spent with patients instead of how much you document in the record. These are big changes and I’m hopeful that they’ll be good changes. Not to mention ACOs which will hopefully help show us the path to a full value based reimbursement world and get us off the fee for service treadmill.

That said, I’ll never forget a CMS listening session that I went to. Someone asked about a specific policy and when we might hear the details of the final rule. The CMS representative said, “Pretty quickly.” Then, he corrected himself and said, “Government quickly which probably means months, not years.” The government moves slow. That’s just the reality. This is why innovation in healthcare shouldn’t depend solely on the government.

The other way for innovation to occur is for other payors to lead the innovation. When was the last time that payors did something really innovative? When did Medicare take something from the private payor space because it was an innovative solution? I’ll admit that I’m not a complete expert on the payor space, but I asked some friends and so far none of us have remembered a time where this happened.

What’s going to change this? The answer to that is not clear. Do you see something I’m not seeing? The better promise comes from something outside this traditional system disrupting healthcare as we know it. It feels like something like that needs to come, because Jamey is right that this is a big problem for many Americans, both republicans and democrats.

EHR Error Messages – Fun Friday

Posted on September 21, 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.

Sometimes these Fun Friday series of humorous blog posts hit a little too close to home. I’m pretty sure this week’s post will feel a little too personal for many readers. However, when I saw it, I couldn’t help but laugh and so I thought many of you might enjoy the humor as well. First, read the error message that Dr. Hayes share and then his question in the tweet below.

The nice thing is that most EHR are moving to the cloud. You don’t get this message in the cloud. Instead, you get 404 error messages and spinning wheels. Ok, you may never get away from these messages.

Have a great weekend and may you enjoy a weekend free of error messages like this.

Is Value Based Care Just Regulatory and Reimbursement Hoop Jumping?

Posted on September 17, 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.

In theory, we all love the move to value based care. Why aren’t we paying healthcare providers to improve care. It just makes sense. In fact, the fee for service model in many ways feels so unnatural. While the theoretical value based care sounds good, getting there is much easier said than done. Translating the simple idea of value based care into regulations and reimbursement is a really hard thing to do.

I’ve often asked the question, “Is value based care just a regulation and reimbursement hoop jumping activity?” Does he who can jump through the hoops the best win? Or is it really the person who improves the care the most win?

I found two Twitter threads discussing ACOs that may shed some insight into not only ACOs, but the shift to value based reimbursement. Plus, I think it might help to answer the question above.

The first ACO thread is in response to an NGACO report from CMS that was shared by David Muhlestein.

In response to David’s tweet, Adam Solomon offered his perspectives in this tweet storm:

Sorry to chime in late. Our NGACO experience was very interesting. Our benchmark was based on our historical utilization for a similarly attributed population. They then added a very low trend factor to come up with a final target.

In the end, our PBPM cost was actually lower than the benchmark, but we still owed over $5 million to CMS. What happened?

Because the baseline year risk was calculated in the 2014 model and year 1 was the 2016 model, they couldn’t directly compare the acuity of the two populations. Therefore, the utilized a ratio comparing our trend to that of others. Our RAF score didn’t jump as much as theirs.

So our RAF “decreased” suggesting our active population was healthier than our baseline. That accounted for over $2.5 million dollars of “loss.”

The other hit was the way they calculated stop loss. Sure, there was an elective level of aggregate stop loss, but they also assigned a PBPM cost for individual stop loss based on expectations for number of patients with claims over the 90th percentile.

Because California has historically high costs, they estimated that we would have an abnormally high number of patients that exceeded that threshold. That was something like a $20 PBPM hit or another $3.5 million of artificial cost to us.

In the end, although we saved CMS money, we still needed to pay them for our “loss.”

Separate from that, the NORC Report noted above uses a different methodology to estimate savings. Instead of using ourselves as a baseline, they used a regional reference population.

The saddest part for us was that our utilization was always at the top end with little room for improvement. As an example, here’s admits/k for year 2 NGACOs. We’re dark blue.

In a separate tweet storm, Farzad Mostashari, Former National Coordinator at ONC and now Founder of Aledade offered this look at the ACO results:

1/ 2017 #MSSP #ACO Results!
ACOs have scaled rapidly across the country!

In aggregate, the 472 ACOs were accountable for nearly 9 million Medicare beneficiaries and $95 Billion- that’s a quarter of all fee for service, and almost half of the entire Medicare Advantage market.

2/ If you add up all the actual costs versus benchmarks, these 472 ACOs were collectively $1.1B under their benchmarks (more on whether that’s the right counterfactual later).

Medicare shared $780 million in payments with the ACOs, netting the taxpayer $313M

But wait!

There’s lots of evidence that the benchmark under-estimates the savings produced. @JMichaelMcW et al have shown convincingly that a true “difference in difference” approach would show substantially higher net impact.

The green eyeshades folks at CMS OACT said add 60%

3/ So that means that the best guess for MSSP savings is actually $1.75B in 2017, with Medicare paying out $780M (45%)- not a bad deal for the taxpayer!!!

That does NOT count savings that come from lower costs to the taxpayer from Medicare Advantage rates that are keyed off FFS

4/ Here’s how the CMS actuaries put it:

And on quality- the average ACO earned 92% on their quality scores- and the scores improve the longer you are in the program according to the ACO Rule’s Regulatory Impact Assesment.

(The Aledade average quality score applied was over 95%, and as high as 99.8% #GoKANSAS)

6/ Lemme say that again….

ACOs saved Medicare over a Billion dollars in 2017.

Cheaper than FFS, cheaper than MA.

And they did it without cutting payments to doctors or narrow networks

And they did it with higher patient quality.

That’s called delivering what was promised

7/ the Track 1 ACOs more than held their own here

Best guess is that Track 2/3 generated 190M in savings (w 60% spillover) and received $95M (50%)

Track 1: $1.5B in savings, $685M in payments (44%)

(I’m still a believer in moving to 2-sided risk to help weed out ACO squatting)

8/ You know what was a great investment? Giving small and rural physician-led ACOs an advance payment to help them invest in infrastructure and setup costs.

It was critical to the success of several of our @AledadeACO

More commercial payors should do this!

9/ But what this initial release does not help us do is see which type of ACOs are creating the most value.

My guess is that it’s not much different from what the CMS actuaries found for PY 2016- ACOs that include hospitals and directly control more of the cost of care do worse

10/ The “low revenue” ACOs (in the OACT analysis – less than 10% of total cost of care came to them) were only a third of the lives in the program, but generated roughly 98% of the savings.

THAT is why in the ACO Rule CMS proposed letting them stay in low risk models longer

11/ That was the entire thesis behind “the paradox of primary care leadership” that informed the founding of @AledadeACO

That is also why @AledadeACO partners with independent physician practices, not hospitals like others do.

Health Reform and Physician-Led Accountable Care
Even though most adult primary care physicians may not realize it, they each can be seen as a chief executive officer (CEO) in charge of approximately $10 million of annual revenue. Consider that a t…
https://jamanetwork.com/journals/jama/fullarticle/1861359

12/ A quick analysis by the amazing @Travis_Broome divides these 2017 results by whether the ACOs included a “facility/CCN” (CAH, RHC, FQHC don’t count for this purpose) –

Same pattern- 95% of the savings are coming from the ACOs that don’t include hospitals.

13/ Only 3.5M of the 9M ACO-attributed benes were cared for by the smaller ACOs that didn’t include a hospital facility- and they generated 95% of the savings.

If you’re an independent practice seeing these results and the policy direction, why would you join a hospital ACO?
So how did @AledadeACO do?

We are always very transparent with our results- even when things didn’t go our way- to look for ways to be better, and to make policies better that are holding back broader success.

This article 2 years ago was full of pain.
The Opportunities and Challenges of the MSSP ACO Program: A Report From the Field
This article provides a detailed description of a Medicare Shared Savings Program accountable care organization (ACO)’s actions and results, to increase understanding of the challenges and opportunit…
https://www.ajmc.com/journals/issue/2016/2016-vol22-n9/the-opportunities-and-challenges-of-the-mssp-aco-program-a-report-from-the-field

15/ This was a good year for @AledadeACO

Only 1/7 freshmen ACOs made savings- but we have learned to set expectations- it’s a long game.

But 5/8 ACOs that were sophomores or older will get checks.

And 2/3 that didn’t get MSSP crushed it in commercial contracts.

16/ But I’m more proud that EVERY ONE of our @AledadeACO have measurably improved health for the patients we are accountable for.

We have increased wellness visits, transitional care, and chronic care management- and that’s translated into lower ED visits and readmissions

17/ So where do we go from here?

The #MSSP #ACO program has been a hugely successful motivator of nationwide transformation, but it can be reformed, and I believe @SeemaCMS is on the right track.

Here’s what I would expect might change between the NPRM and the final ACO rule:

18/ The GlidePath to risk reduces ACO squatting, and brings revenue-based downside risk to MSSP, but the lowered gainshare in 1st 2 years (25%) is not enough to get new entrants and ACO investments.

(as suggested) “low revenue” ACOs should get higher gain-share and lower MSR

19/ The refined benchmarking method gives greater predictability by allowing risk adjustment and regional trending-which is great!
But the cap on risk adj (3% over 5 years?!) don’t control for rising risk and introduces gaming on falling risk

Instead of a cap, do renormalization

20/ Concern about “windfall profits” led to an ill-advised proposal to cap regional efficiency at 5% – In Medicare Advantage if you are efficient, you get to keep the difference, which has spurred huge innovation in the space. why blunt improvement? 100% tax brackets are not good

21/ Credit to CMS for trying to fix the unintended “regional comparator” problem- where rural ACO savings are reduced in direct proportion to market share. But the “national trend blend” proposal makes NO SENSE.

Let’s just take ACO benes out of the regional comparison please!

22/ But the biggest impact of these results on the proposed rule should be on the idea that the way to benefit the Trust Fund is to protect it from ACO earnings.

These caps, etc reduce ACO earnings- and ACO motivation/participation- and therefore reduced benefit to Medicare

23/ The NPRM RIA estimates through 2024 these caps push $390M in lower ACO earnings, but lower ACO participation under these policies will INCREASE claims costs by $60M- and would prevent beneficiaries from receiving the benefits of the program. That’s not the right balance

24/ The magic of accountable care is when physicians & Medicare partner together to sustainably align financial incentives, help beneficiaries and the Trust Fund.

Medicare hasn’t behaved like some commercial payers who are still seeing zero sum. Let’s hold onto that partnership

I’ll let you be the judge after reading through these threads. Are ACOs going to really improve healthcare and lower costs? Will the best healthcare win? Or will the people who understand the government rule making process and healthcare accounting be the big winners?

As I read through these, it seems like you better get your accountants and healthcare policy experts ready. That brings joy to every doctor’s ears…I’m sure!

Patient Directed Health Data Exchange on The Blockchain

Posted on September 7, 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 long been friends with Dr. Tom Giannulli who most of you will probably have known as the CMO of Kareo. I first met Dr. Tom back when he created what I would call the first iPad optimized EHR interface back when Dr. Tom was at Epocrates and before they sold that EHR to Kareo. Needless to say, Dr. Tom is the kind of guy that likes to sit on the cutting edge of technology and how it applies to healthcare. So, it was no surprise to me when he came to me with his patient directed health data exchange called PatientDirected.io which is built on the blockchain.

While a lot of people talk about blockchain and theories about how blockchain could help healthcare, a lot of what people were doing was just talk. What I like about Dr. Tom and PatientDirected.io is that they just put out a video demo of a patient chart being requested from Kareo by the patient and then the patient sending that chart to Epic. Check it out to see what I mean:

Many of you that watch this demo might be asking. How is this on the blockchain? That’s one of the things that many people don’t understand about blockchain. If it’s done right, you won’t know anything about the blockchain. However, the blockchain can do things like creating smart contracts with providers which can create trusted connections. The blockchain is distributed, so your data isn’t stored on a central server that’s owned and controlled by PatientDirected.io. Basically, blockchain has a number of benefits, but it’s the “Intel Inside” and so it’s not something you should see as an end user, but it could provide some great benefits.

I also like that PatientDirected.io isn’t trying to reinvent the wheel. They’re using trusted third party applications like Verato to handle their master patient index and for verifying patients identity. There’s a lot more to explore when it comes to identity management, but it’s smart to work with companies that are doing this all across healthcare.

I was also impressed with the detailed sharing permissions that were available in PatientDirected.io. At first glance, a part of me wonders if it’s too complex for most patients. However, as long as the options are there, the interface can adapt to allow for specific patient preferences when it comes to data sharing. Of course, it’s nice that all of the sharing of this data will be tracked on the blockchain.

The key to all of this working for me is the integration with the EHR vendor. It looks like it’s using Direct to handle the messaging to the EHR vendor and back. This is good because I believe all certified EHR (which is pretty much all of them) have direct messaging built in. Some have integrated it better than others, but they all have this capability. My big concern with it though is whether what’s being shared by EHR vendors using Direct is enough data. And will that data that gets sent from one EHR to another appear in a format that’s useful to the receiving physician? If it’s not, then it doesn’t solve much of anything. Plus, I wonder what happens when a doctor gets a record request and doesn’t respond. This is especially true for EHR vendors who haven’t integrated Direct into the core EHR workflow. Will this take a culture change to not leave patients waiting for records that will never come?

As you could imagine, PatientDirected.io has an ICO offering on StartEngine.com. Looks like it just got started, but there’s an opportunity to buy their tokens if you’re interested and believe they’re on to something special.

I think there is a space for a patient directed health information exchange assuming we can make the exchange of information between disparate providers very simple. There are still some challenges for patients when it comes to getting access to their health information, but the law is clear that patients should have access to their health information. Now we just need the user interfaces to be as simple as clicking a button like is demonstrated in the video above and we’ll see much more patient directed health information exchange.

The Ambulatory EHR Market with Raul Villar, Jr. CEO of AdvancedMD

Posted on September 5, 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 ambulatory EHR market is near to my heart since that’s where I started when I entered this world of healthcare IT. My first job was implementing an EHR in a small ambulatory practice. As regular readers know, I’ve commented on how the independent small practice is in trouble. I’m not suggesting this is what I’d like to happen or what should happen, but there are certainly a lot of challenging pressures on small practices.

Along with these pressures, the ambulatory EHR market is extremely different today than it was 5-10 years ago. The $36 billion funded meaningful use era of EHR adoption was what I call the golden age of EHR. We could argue whether it was a golden calf or not, but from a market standpoint, the meaningful use money fueled adoption of the EHR.

Today’s ambulatory EHR market is very different. That’s why we were excited to sit down with Raul Villar, Jr. CEO of AdvancedMD to talk about his perspective on the ambulatory EHR market. We also talk with him about the evolution of AdvancedMD as it went from ownership by ADP to now being owned by Marlin Equity Partners and what those changes mean for their customers. Plus, we go over AdvancedMD’s acquisition of NueMD and what their strategy is behind the acquisition. Finally, we talk about EHR vendors as a platform and where he sees AdvancedMD taking their platform in the future.

If you’re interested in the ambulatory EHR market or in AdvancedMD, you’ll enjoy this interview with Raul Villar, Jr.

If you enjoyed this video interview, be sure to Subscribe to Healthcare Scene on YouTube and watch all of our healthcare IT interviews.

3 Types of Medical Billing Companies

Posted on August 31, 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 was recently talking with the CEO of an EHR vendor. As we talked about their EHR software and what they were working on in the future, the CEO made a really important comment. He said, “The EHR can be great, but if you don’t take care of the medical billing the right way then none of that matter.”

This was such an important point and one that I’d seen first hand. An OB/GYN friend of mine had an EHR that they loved. As the doctor, she loved it for her clinical work. The problem was that it wasn’t tied to a great practice management system. So, she was having issues with her billing. The problem was so bad that she ended up leaving the EHR she loved clinically to find something that would solve her billing problems. Don’t ever underestimate the importance of medical billing.

I recently came across an article on the Kareo blog which highlighted 3 levels of medical billing and RCM (revenue cycle management) services billing companies can offer a practice:

Light

Level of service offered by many billing software vendors.

Full-Service

Level of service offered by some software vendors and most traditional billing services.

Boutique

Level of service typically offered by smaller “mom and pop” billing companies who have expertise in a limited number of specialties and/or provide more oversight.

As you evaluate medical billing companies for your practice, this is a nice framework for evaluating the various medical billing companies that are out there. Each one provides a different set of expertises to help your practice. Understanding that difference is key to choosing one that will work best for you.

What’s been your experience with medical billing companies? Do these 3 types make sense to you or would you look at them from a different angle?

Physician Revolt Against EHRs – Unlikely to Happen

Posted on August 20, 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.

Physicians hate EHRs.

Yes, there are a few exceptions, but it’s pretty rare to find a physician that loves their EHR. There are a fair number of them that are apathetic towards their EHR, but there are a lot of doctors who hate them.

How much do they hate them? That’s hard to say, but it seems clear that they don’t hate them enough to really change things. Sure, they’ll leave some comments on message boards, send out some tweets or write some blogs, but they don’t seem ready to take it to the board (even when they’re the board). The most common path is doctors hate the EHR when it’s first implemented and then they learn the EHR software and become apathetic.

Clay Forsberg recently laid out the strategy for doctors who hate their EHR and want change:

Clay makes a great point. He then extends the discussion with these tweets:

The real problem here is that EHRs are the epitome of “meh.” They get in the way, but it’s hard to draw a specific line between EHR software and deaths or really poor quality care. They cause some time issues with multiple logins and lots of clicks, but they also save time in other ways. They have some bad workflows, but they make some workflows better.

EHRs are just good enough to avoid a revolt.

Plus, a doctor replying to Clay Forsberg’s tweet above identified another issue:

Doctors definitely don’t want to risk their livelihood, but I think even more than that they don’t think that complaints about the EHR are going to have any impact. This is particularly true in large health systems. As Clay Forsberg points out, one voice will likely fall on deaf ears. It would take a coordinated effort to really effect change.

I’d also add that the problem I’ve seen with those doctors that are complaining about EHR software aren’t doing it in a productive manner. It’s almost like these people are arguing that we should go back to paper. Let’s be honest. That’s not going to happen. Plus, they don’t acknowledge how much they hated paper either. Think about something as simple as a missing chart and that usually refreshes some of the memories. Let alone the stacks of paper charts on physician’s desks that still needed to be completed.

Don’t get me wrong. I’m not suggesting that EHRs couldn’t do a lot more to make physicians’ lives easier. There’s also a ton of poorly optimized EHR implementations that are driving doctors crazy. Those are fixable even if many doctors don’t realize that there are solutions out there. It’s important to realize that both are issues, but are addressed very differently.

At the end of the day, doctors can complain about EHR software until their blue in the face, but EHRs aren’t going anywhere. We’re not going back to paper and I don’t see an alternative to them coming soon. That said, a physician revolt against EHRs would make them better and that would be a great thing for everyone involved. I just don’t see enough doctors ready to revolt. Do you? If so, I’d love to hear what they’re doing.

The Independent Small Healthcare Provider is In Trouble

Posted on August 17, 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.

This week I attended the Digital Health Investment Summit hosted by KLAS. They brought together a great group of people from the healthcare provider, vendor, payer, and investor space. We had some really great conversations and I heard a lot of great perspectives. However, if there was one theme I had coming out of the event it was this:

I’d take this statement one step further. I don’t think I heard one thing said at this event that indicated that there’s something that was going to be beneficial to the small practice. Everything that was said was building towards the need for big data, comprehensive solutions, and tools, relationships, and technology that was largely only going to be available to large health systems.

As one person on Twitter pointed out, this is unfortunate because there have been a lot of studies that have shown how the small ambulatory practices are much more cost effective than the corporate ones. Plus, patients often love that personal relationship as well. However, patients also love the advanced services and personalization that future healthcare IT can provide when you have the right scale.

This reminds me of what we’ve seen in the banking industry. There used to be a lot of local banks. Now, they’re all but disappearing as the large corporate banks take over. Sure, there are some credit unions and a few local banks left, but it’s really hard for these to compete with the kind of services the large corporate banks can provide. The same is likely to happen in healthcare and it seems to be happening fast. One health system executive told me at the event, “Practices are coming to us saying they want to be part of us. We can’t keep them away.”

I’ve mentioned before that the one hope for small practices is that large health IT companies that provide some of these advanced services could make them available to small practices. Basically, a healthcare IT company could provide a service to enough small practices that all the small practices together share in the costs associated with the advanced services like genomics for example. To go back to the banking industry, that’s what we’ve seen. A small bank or credit union doesn’t create their own online banking tech with the scan technology for mobile deposits. However, they can use a third party to be able to provide those services.

The only problem with this view is that most entrepreneurs look at the small practices as the worst market. Talking to the investors this weekend and other startups, almost none of them are targeting the small practice as their market. There are a lot of reasons for this. It’s notoriously hard to get to the decision makers at a small practice. We can thank pharma sales reps for this. Plus, small practices are quite cheap when it comes to investing in technology. All of this makes for a really challenging sales process for companies that want to sell into the small practice. The large health systems have a long sales cycle, but at least the reward is big when you make the sale.

While there are so many things going against the small practice. I still hope they find a way to survive. I also think it will be interesting to see how super groups do in this environment. If you have all the gastroenterologists in your area in a group, that can give you a lot of power to resist the health system taking you over. A fair number of direct primary care practices seem to be doing well also and could very well survive as well.

Watching some of the past senate hearings for various legislation, you can see how the government wants to do things to keep the small practice alive. Will what they do be enough? I don’t think many of us want to put our faith in government in this regard, but they may surprise us. There are some interesting rules and regulations for rural that has allowed many of them to survive.

I’d love to hear opposing viewpoints. Do you see reasons why the small practice can survive? What does this mean for healthcare? Should we be doing more to support small practices? If so, what can we do? I think it’s clear that most would like to keep small healthcare providers around, but it’s hard to see how they’ll be able to compete as technology continues to evolve.

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?