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The Role of Practice Automation in Healthcare Communication

Posted on February 16, 2018 I Written By

The following is a guest blog post by Naveen Sarabu, Vice President of Product Management, AdvancedMD.

Practice automation was born out of the demand for quicker, more efficient manual processes. One of these manual processes is getting back to basics by using plain, old-fashioned communication – whether among members of a healthcare team, or between a physician and patient. Through automation we seek to deliver the right data to the right people exactly when they need it for the optimal provision of care. Likewise, we also seek to cut down on the manual processes that bog us down and add complexity. Many ambulatory practices struggle to find a solution that meets the complex demands of treating patients. Many admit that communication remains one of their greatest struggles – and miscommunication is one of the biggest frustrations for patients.

Doctors’ offices and hospital counterparts in the U.S. have shouldered $1.7 billion in malpractice costs due to poor communication—that’s 30 percent of all malpractice cases.

Automating manual processes of a physician practice enables the distribution of vital patient information in a fast, efficient, and accurate way. By leveraging an integrated physician-patient workflow system, physicians gain benefits of both accuracy and time in the sharing of clinical and billing information. This defines the next generation of the EHR: managing patient data among systems with authentic, automated data transfer and overall ease of use.

Task-based challenges

In a sense, many elements of communication, or information transfer points, are categorized as “tasks” by physicians. Obviously, every doctor in every office has his or her own way of organizing to-do’s. Rigid or cookie-cutter solutions can be more trouble than they’re worth for the busy ambulatory practice. The sheer volume of tasks and relentlessness of practice-specific workflow elements remain a huge burden to physicians and staff members. Without a straightforward means to categorize and execute frequently performed tasks such as prescriptions, refills, charge slips, notes, and orders, action items can fall through the cracks and leave room for errors.

Practices can address this by selecting flexible and customizable solutions that spell out all the moving parts of a practice and put them at the physician’s fingertips, much like an automated workflow analyst would. Visual tools like dashboards are helpful in presenting all tasks in a single snapshot, allowing physicians to manage to-do’s quickly and with ease to execute and communicate what must come next. Patient cards organized by specialty and workflow give physicians a snapshot of what’s really most important in a given moment. An integrated EHR dashboard not only helps physicians negotiate high-priority tasks of significant volume, it orients them to the vital patient information required for sound decision-making.

Impact of physician mobility on communication

A key asset of running a fully-automated ambulatory practice is the feasibility of team members accessing the same systems in real time, from any location. This has multiple benefits, including improved communication accuracy and workflow efficiencies.

“Many different user types [in my practice] from the nurse, to the office manager, to the biller, are all working with the same data on the same platform with real-time access. The seamless continuity is what I like about it,” said Larry J. Winikur, MD, pain management physician in Danville, Va.

Physician mobility is achieved through cloud-based technology and allows providers and staff members to communicate seamlessly from several practice locations: a home office, a patient’s home, the hospital or while traveling. It helps physicians respond to patient and staff messages quickly and stay on top of pressing work issues no matter where they are, preventing a backlog of tasks once they return onsite.

Surgical Specialists of Jackson (Miss.), treats more than 500 active patients, including those in rural areas. According to office manager Kristen Humphrey, having mobile capabilities as a result of complete practice automation has improved the quality of care the practice provides to patients. “When we have a physician seeing patients an hour away in a rural county, he takes the iPad and is able to log into the patients’ medical record and get any information he needs,” leveraging a seamless connectivity to the practice from our office in Jackson. “It makes life really easy,” Humphrey says.

Remote access also offers the feasibility of treating patients with video-based telemedicine, during hospital rounding, or home or hospice care. EHR mobile access is, without a doubt, a top priority for busy practices as they build out the future of their business.

The building blocks of patient engagement

As practices compete with other practices and larger health systems to secure and retain patients, these patients have developed a consumer-like healthcare mentality. Most patients want as much information about their condition as possible, so they can take a proactive role in their care. Patients want to engage with their physicians, by communicating openly and regularly about options and treatment decisions.

A fully-automated ambulatory practice utilizes patient engagement tools to secure satisfaction, retention, and referrals. Consider the ease with which patients can make appointments – online self-scheduling is a critical piece of functionality. Automated check-in tools such as an iPad kiosk are especially favorable to patients who can complete intake and consent forms electronically, eliminating the possibility of transcription errors that occur when data is transferred from paper to digital. A robust patient portal enables physicians to communicate with patients privately and efficiently; to share educational materials or share lab results.

Appointment reminders can also serve as simple communication tools that enhance not only the patient experience, but also the practice bottom line.

Dr. Winikur utilized a patient reminder system to help decrease costly no-show appointments in his busy schedule. The solution helped engage patients and reduced no-shows at his practice from about 12 percent to approximately two percent of appointments, which positively impacts his revenue.

The mobility benefits previously mentioned also allow physicians to demonstrate superior attention to patient needs. “I can pull up patient information no matter where I am in the world with internet access,” Winikur says. When patients receive a quick and effective response to inquiry, they perceive their doctor is in the office (even if he’s not!), which helps increase patient satisfaction.

Other important automated tools include post-visit surveys that enable patients to provide honest, timely feedback about the care they’ve received. These surveys can also trigger patients to post positive experiences to Google and social media outlets. In the event of a negative experience, patients can first communicate privately with the practice to resolve any potential problem or miscommunication.

The bottom line

In today’s competitive healthcare climate, patients have many options for their care. Practices that transition to cloud-based technology platforms with fully automated and customizable workflow elements show greater respect to the needs and time of their patients, increase revenues, and place greater value on their own needs and time. They also prove to be on the cutting edge of technology by streamlining processes and enhancing communication to deliver safer and more accurate care.

About Naveen Sarabu
Naveen Sarabu is Vice President of Product Management at AdvancedMD. Naveen has more than 15 years of experience developing innovative healthcare software solutions for the ambulatory, acute and accountable care organization (ACO) markets, including for Allscripts, Hill-Rom, and NTT DATA. Naveen received an MBA from University of North Carolina-Chapel Hill and an undergraduate degree from National Institute of Technology, Warangal, India.

Are EMR Clicks the Problem? – Deep Thought Thursday

Posted on February 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.

I agree with David Chou here when it comes to needing to make EMRs easier. However, I don’t believe reducing the number of clicks is the real issue. Clicks are just a symptom of the real problem. The real problem is regulations and reimbursement requirements that need revision and simplification.

If we simplified regulations and reimbursement requirements, EHRs would be significantly more usable and would require fewer clicks.

The next question you should ask yourself is whether this administrative simplification will happen first or whether the technology will evolve to the point where it can automatically document the patient visit to any level of complexity while not disrupting the physician workflow.

Where’s your bet? On government and payer changes? Or on technology?

My bets on technology even if Seema Verma, CMS Administrator, is calling for administrative simplification. However, we’re certainly not there yet on either front.

AAFP Proposes Tactics For Reducing EHR Administrative Burdens

Posted on February 12, 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.

The American Academy of Family Physicians has proposed a series of approaches it says will reduce the administrative burdens EHRs impose on primary care doctors.

The recommendations, which come in the form of a letter to CMS, address health IT simplification, prior authorization and standardization of quality measurement. However, the letter leads off with EHR concerns and much of the content is focused on making physician IT use easier.

Few would argue that the average physician spends too much time struggling with EHR-related administrative work. The AAFP backs this assertion up with a couple of studies, including one finding that primary care physicians spend almost 6 hours per day interacting with EHRs. It also cites research concluding that four types of specialist spent almost 2 hours using the EHR for every hour of direct patient care.

To address these concerns, the AAFP recommends taking the following steps:

  • Eliminating HIT utilization measures in MIPS: The group argues that such measures are not needed anymore now that MIPS includes quality, cost and practice improvement measures.
  • Updating documentation requirements: With the agency’s Evaluation and Management recommendation guidelines having been developed 20 years ago, prior to the widespread use of EHRs, it’s time to rethink their use, the letter asserts. Today, the group says, they have a negative impact on EHR usability and hinder interoperability. The group recommends eliminating documentation requirements for codes 99211-99215 and 99201-99205 entirely and allowing any care team member to enter medical information.
  • Rethinking data exchange policies: The AAFP is asking CMS and ONC to focus on how and when data is exchanged rather than demanding that specific data types be included. The group also urges CMS and ONC to penalize healthcare organizations not appropriately sharing information, using its authority granted by the 21st Century Cures Act.
  • Creating standardized clinical data models: To share data effectively across the healthcare ecosystem, the AAFP argues, it’s necessary to develop nationally-recognized, consistent data models that can be used to share data efficiently. It recommends that such principles be developed by physicians and other clinicians rather than policymakers, vendors or engineers.

I don’t know about you, but I find much of this to be a no-brainer. Of course, the decades-old E/M guidelines need to be reformed, consistent data models must emerge if we hope to improve interoperability and physicians need to lead the charge.

Unfortunately, it’s hard to tell whether CMS and ONC are willing and prepared to listen to these recommendations. In theory, leaders at ONC should be only too glad to help providers achieve these goals and CMS should support their efforts. But given how obvious some of this is, it should have happened already. The fact that it hasn’t points up how hard all of this could be to pull off.

E-Patient Update: Alexa Nowhere Near Ready For Healthcare Prime Time

Posted on February 9, 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.

Folks, I just purchased an Amazon Echo (Alexa) and I’ll tell you up front that I love it. I’m enjoying the heck out of summoning my favorite music with a simple voice command, ordering up a hypnotherapy session when my back hurts and tracking Amazon packages with a four-word request. I’m not sure all of these options are important but they sure are fun to use.

Being who I am, I’ve also checked out what, if anything, Alexa can do to address health issues. I tested it out with some simple but important comments related to my health. I had high hopes, but its performance turned out to be spotty. My statements included:

“Alexa, I’m hungry.”
“Alexa, I have a migraine.”
”Alexa, I’m lonely.”
”Alexa, I’m anxious.”
”Alexa, my chest hurts.”
“Alexa, I can’t breathe.”
“Alexa, I need help.”
“Alexa, I’m suicidal.”
“Alexa, my face is drooping.”

In running these informal tests, it became pretty clear what the Echo was and was not set up to do. In short, it offered brief but appropriate response to communications that involved conditions (such as experiencing suicidality) but drew a blank when confronted with some serious symptoms.

For example, when I told the Echo that I had a migraine, she (yes, it has a female voice and I’ve given it a gender) offered vague but helpful suggestions on how to deal with headaches, while warning me to call 911 if it got much worse suddenly. She also responded appropriately when I said I was lonely or that I needed help.

On the other hand, some of the symptoms I asked about drew the response “I don’t know about that.” I realize that Alexa isn’t a substitute for a clinician and it can’t triage me, but even a blanket suggestion that I call 911 would’ve been nice.

It’s clear that part of the problem is Echo’s reliance on “skills,” apps which seem to interact with its core systems. It can’t offer very much in the way of information or referral unless you invoke one of these skills with an “open” command. (The Echo can tell you a joke, though. A lame joke, but a joke nonetheless.)

Not only that, while I’m sure I missed some things, the selection of skills seems to be relatively minimal for such a prominent platform, particularly one backed by a giant like Amazon. That’s particularly true in the case of health-related skills. Visualize where chatbots and consumer-oriented AI were a couple of years ago and you’ll get the picture.

Ultimately, my guess is that physicians will prescribe Alexa alongside connected glucose meters, smart scales and the like, but not very soon. As my colleague John Lynn points out, information shared via the Echo isn’t confidential, as the Alexa isn’t HIPAA-compliant, and that’s just one of many difficulties that the healthcare industry will need to overcome before deploying this otherwise nifty device.

Still, like John, I have little doubt that the Echo and his siblings will eventually support medical practice in one form or another. It’s just a matter of how quickly it moves from an embryonic stage to a fully-fledged technology ecosystem linked with the excellent tools and apps that already exist.

Crypto Breach at Hospital, EHR Customization, and Some EHR Humor – Twitter Roundup

Posted on February 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.

It had been a while since we did a Twitter roundup. So many interesting, entertaining, and insightful things are shared. We decided to keep this one light but valuable. We hope you enjoy the Twitter roundup and some of our own added commentary.


Not sure this is the first, but certain it’s not the last. A lot of money to be made from cryptocurrency mining and hospitals have a lot of CPU that can be stolen to mine cryptocurrency. This is going to become a popular malware. It goes mostly hidden from site and so many organizations don’t even realize what’s happening.


If you’ve been part of an EHR implementation you know that Linda is right. However, there are some general lessons learned that are extremely valuable and help every implementation or now EHR optimization. The question I’d ask is, should EHR be standard?


I should have saved this for a Fun Frdiay post, but why not treat Wednesday like Friday. Some other replies to this tweet were just as hilarious (until you realize what they really mean):
If my patients went unresponsive as often as my EMR, I’d be a coroner. – @FredWuMD

Just spray a little epi into the USB port – @roto_tudor

Yes it would be like an episode of the resident. Multiple codes a day. @CaitlynMooneyMD

Three-Quarters Of Medical Practices Aren’t Getting Full Value From Their EHR

Posted on February 6, 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.

Given how many EHRs seem to feature position-hostile designs, it’s hardly surprising to learn that many medical practices aren’t getting the most from them. However, I was taken aback by how deep this underutilization seems to run.

A new study appearing in the American Journal of Managed Care has concluded that a whopping 73% of practices weren’t using their EHRs to the fullest extent and that another 40% make little or no use of health IT functions. Even given the obstacles to using EHRs, this seems like a big waste of money, time and potential, doesn’t it?

To conduct the study, researchers used data from a relevant HIMSS Analytics survey. The data included responses from 30,123 ambulatory practices with an operational EHR in place, most with fewer than seven affiliated doctors in place.  Researchers sifted the data to determine the extent to which these practices were using EHR-based health IT functionalities.

Of course, some medical groups were on top of their game. Researchers found that 26.6% of practices could be classified as health IT super-users that squeezed every benefit from their systems. As you might guess, the likelihood that a practice was a super-user grew as the number of affiliate doctors increased, as well as when the practice was located in a metropolitan area. But far more groups seem to have fallen well behind the leaders.

According to the data, among practices using CPOE tools, only 36% used them for more than 75% of orders. Also, while groups commonly used basic functions such as data storage, with 100% of practices storing transcribed reports electronically and 61% using the EHR for nursing documentation, most lagged in other areas. For example, only 29% used tools allowing them to find and modified orders for all patients on a specific medication.

To address this gap, researchers say, policymakers should consider how to address the barriers PCP and specialist practices face in using the health IT tools more fully. Understanding how this disparity has emerged and how to address it is critical, they suggest, as less sophisticated use of EHRs may have an impact on care quality and also on groups’ ability to participate in community efforts such as HIEs.

The truth is, if the under-utilizer practices don’t get some kind of help or support, it’s unlikely they’ll step up their use of EHR functions. Particularly if they’ve had the system in place for a while, the workflow is baked into the system and physician habits established. Maybe the pressure to provide value-based care will do the trick, but it remains to be seen. This is a problem that won’t go away quickly.

Medical Groups Adopting Telehealth, But Cautiously

Posted on February 5, 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.

Telehealth has gone from a neat idea to an accepted part of the spectrum of care. However, it’s largely been hospitals, not doctors, which have dived into telemedicine wholeheartedly

Recent data suggests that while doctors are gradually adopting telecare, they have many reservations about doing so. A study published last year by Reaction Data found that while 68% of physicians said they were in favor of telemedicine, most were using it only in special situations such as reaching patients in rural areas, visit follow-ups and managing specific patient populations.

A new survey by the Medical Group Management Association has reached a similar conclusion. In a poll conducted last month by the trade group, the MGMA found medical practices’ approaches to telemedicine have changed only marginally since January of last year.

In this year’s Stat poll, which had 1,292 respondents, 26% of respondents said their organization offered telehealth services, and another 15% said they planned to offer them in the future. That’s up only 3% from January 2017 research, which found that 23% of respondents provided such services and 18% planned to add them.

Meanwhile, two key statistics have stayed in place from last year. Thirty-nine percent of respondents to this year’s survey said they didn’t offer telehealth services and 20% weren’t sure if they would, the same percentages found in last year’s research.

When it announced the results, MGMA shared some specific suggestions for planning and implementing a telehealth program. They include:

  • Researching and understanding patient needs
  • Setting clear goals for telehealth and tying them to an existing strategic plan, which demands fewer organizational changes and speeds adoption
  • Understanding how telehealth supports value-based care
  • Researching telehealth vendors and platforms
  • Researching reimbursement and licensure requirements (if any) in the practice environment
  • Engaging and educating practice staff members on telehealth issues and strategies
  • Having doctors reach out to colleagues in their specialty to learn how their telehealth implementation experience has gone
  • Bearing in mind that telehealth implementations typically take an average of one year from plan to rollout

All that being said, it seems likely that some of the practices which are hanging back from telehealth have taken most or even all of the steps outlined above. The thing is, even if a practice has researched the telemedicine market, understands its patients’ needs and knows what issues it will face during a service rollout, these steps still can’t address some of the fundamental realities holding telehealth back today.

The truth is, from what I’ve seen medical practices still face two difficult issues when they consider telehealth seriously: how to make money at it and how to fit it into their workflow. These are major problems and won’t be resolved by advice alone (not that this is MGMA’s fault of course).

Despite medical groups’ concerns, there will doubtless be a tipping point where practices begin to see telehealth services as a routine part of what they provide. However, it seems clear that we’re far from getting there.

Two Medical Practices’ Reactions to MACRA Ruining Healthcare

Posted on January 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.

Last week I wrote a post that discussed whether MACRA was ruining Healthcare. It’s an important discussion to have as we look at where healthcare IT legislation should go in the future.

In response to the article I got some pretty heated responses from medical practices that I thought were worth sharing with the wider audience who doesn’t get a chance to read the comments (yeah, I know that’s most of you).

The first comment is from Billy who said the following:

I wouldn’t say MACRA is ruining healthcare, but it’s starting to drive the decision train, which may be the first step.

From my corner of healthcare in America, our practice is forcing adherence to MACRA to set the tone for an ever growing portion of the workflow. The benefit from such is viewed as non-existent aside from protecting revenues. We have compliant doctors (with plenty of grumblings), but no happy ones that are doing this in the belief it’s good for medicine.

Taking two parts of your post I think I can speak towards in view of that…

“All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice.”

They’re upset at the government because MACRA is seen as an intrusion with no benefit. At best, it’s a threat to their income (both to the business and their end of year salary), and at worst, they don’t trust the government entering the realm of “quality” which traditionally was limited to clinical relevancy. We’ve had plenty of internal discussions of how MACRA quality measures are worlds away from what the physicians view as truly important quality measures for their profession.

“Let’s imagine for a minute that Congress was functional enough to pass a law that would get rid of all of MACRA. Then what? Would doctor’s problems be solved?”

This doesn’t account for the primary reason MACRA was passed in the first place- controlling the costs of Medicare. They can talk about quality all they want, the government needed to eliminate the near automatic 2.5% (or thereabouts) increase in Medicare fee reimbursements. They do that with the freeze in rate increases, and making the physicians battle each other for what remains with the reward/penalty system.

Congress will never get rid of MACRA, it’s their plan to keep Medicare costs from blowing up until 2025 as the boomer generation keeps adding to the rolls.

So, MACRA is seen as having no benefit but a lot of downside in income and daily operations. About the only other thing that could have brought these emotions about would come from the IRS, but this is worse in some ways, as it’s forcing changes in clinical operations for the purpose of checking a box to protect income.

Welcome to the new normal.

It’s hard to think that Billy is right that this is the new normal. Should it be? Could we do something to make it so it’s not?

The next comment was from a long time reader who’s been commenting against MACRA and meaningful use before that (ie. a long time). Here’s meltoots’ take on the question of if MACRA is ruining healthcare:

Yep.
Count me as another mid career MD that sees the futility in any hope for the future of medicine. We are doomed. I do everything I can to talk everyone out of becoming an MD. Including my children.

We have 100% of the accountability and zero authority. Worse I am penalized by our government because I refuse to play stupid counting and clicking games. I was just discussing again (seems daily) my plans to exit this career. Too bad as I am one of only 4 orthopaedic surgeons left at our hospital. 20 years ago we had 35 on staff.

Every single person on earth seems to be saying all this data entry by MDs is silly, inefficient, useless, complex and frankly a huge costly waste of time. Everyone is speaking to burdens and the ridiculous nature of all this forced mindless data entry, super complex reporting, terrible auditing and penalizing for no good reason. When we look back a decade from now and wonder how we made medicine like the postal service, I know I can say I did try to point out better ways. But no one listened. At all.

If all these programs are so wonderful, tell me all the great things that have come out of MU, PQRS, VBM, QPP? So you got MDs to buy EHRs. Great. Everyone hates them. Great work.

HITECH set back real IT innovation in medicine at least a decade.

CMS touts patents over paperwork with absolutely no action, even worse, they made the MACRA program even more burdensome this year. AAPM, you want me to take even MORE risk, and hire more admins to run it? For 5%? Come on.

I have finally come to realization, that medicine has been destroyed by administrators, CMS /ONC, regulators, bean counters and the dozens of people I support just trying to stay ahead of the complexity. Its like the movie Office Space when I forget to click something in the 1000 clicks I have to do a day, I get 10 admins telling me about my TPS reports on what I did wrong.

What is really the worst part, is that I am pretty darned good at what I do, I am super busy and loaded with patients, too many. So I will be yet another MD, that has just had enough, that left the game in his prime. We should all be ashamed at what we did to our physicians.

E-Patient Update: Clinicians Who Email Patients Have Stronger Patient Relationships

Posted on January 26, 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.

I don’t know about you, but before I signed up with Kaiser Permanente – which relies heavily on doctor-to-patient messaging via a portal – it was almost unthinkable for a primary care clinician to share their email address with me. Maybe I was dealing with old-fashioned folks, but in every other respect, most of my PCPs have seemed modern enough.

Few physicians have been willing to talk with me on the phone, either, though nurses and clinical assistants typically passed along messages. Yes, I know that it’s almost impossible for doctors to chat with patients these days, but it doesn’t change that this set-up impedes communication somewhat. (I know – no solution is perfect.)

Given these experiences, I was quite interested to read about a new study looking at modes of communication between doctors and patients in the good old days before EHR implementation. The study, which appeared in the European Journal for Person Centered Healthcare, compared how PCPs used cellphones, email messages and texts, as well as how these communication styles affected patient satisfaction.

To conduct the study, researchers conducted a 16-question survey of 149 Mid-Atlantic primary care providers. The survey took place in the year before the practices rolled out EHRs offering the ability to send secure messages to patients.

In short, researchers found that PCPs who gave patients their email addresses were more likely to engage in ongoing email conversations. When providers did this, patients reported higher overall satisfaction than with providers who didn’t share their address. Cellphone use and text messaging didn’t have this effect.

According to the authors, the study suggests that when providers share their email addresses, it may point to a stronger relationship with the patient in question. OK, I get that. But I’d go further and say that when doctors give patients their email address it can create a stronger patient relationship than they had before.

Look, I’m aware that historically, physicians have been understandably reluctant to share contact information with patients. Many doctors are already being pushed to the edge by existing demands on their time. They had good reason to fear that they would be deluged with messages, spending time for which they wouldn’t be reimbursed and incurring potential medical malpractice liability in the process.

Over time, though, it’s become clear that PCPs haven’t gotten as many messages as they expected. Also, researchers have found that physician-patient email exchanges improve the quality of care they deliver. Not only that, in some cases email messaging between doctors and patients has helped chronically-ill patients manage their conditions more effectively.

Of course, no communication style is right for everyone, and obviously, that includes doctors. But it seems that in many cases, ongoing messaging between physicians and patients may well be worth the trouble.

Partners AI System Gives Clinicians Better Information

Posted on January 25, 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.

While HIT professionals typically understand AI technology, clinicians may not. After all, using AI usually isn’t part of their job, so they can be forgiven for ignoring all of the noise and hype around it.

Aware of this problem, Partners Connected Health and partner Hitachi have come together to create an AI-driven process which isolates data physicians can use. The new approach, dubbed ‘explainable AI,’ is designed to list the key factors the system has relied upon in making projections, making it easier for physicians to make relevant care decisions.

Explainable AI, a newer term used by the two organizations, refers not only to the work being done to develop the Partners system, but also a broader universe in which machines can explain their decisions and actions to human users. Ultimately, explainable AI should help users trust and use AI tools effectively, according to a Hitachi statement.

Initially, Partners will use the AI system to predict the risk of 30-day readmissions for patients with heart failure. Preventing such readmissions can potentially save $7,000 per patient per year.

The problem is, how can organizations like Partners make AI results useful to physicians? Most AI-driven results are something of a black box for clinicians, as they don’t know what data contributed to the score. After all, the algorithm analyses about 3,000 variables that might be a factor in readmissions, drawing from both structured and unstructured data. Without help, there’s little chance physicians can isolate ways to improve their own performance.

But in this case, the AI system offers much better information. Having calculated the predictive score, it isolates factors that physicians can address directly as part of the course of care. It also identifies which patients would be the best candidates for a post-discharge program focused on preventing readmissions.

All of this is well and good, but will it actually deliver the results that Partners hoped for? As it turns out, the initial results of a pilot program are promising.

To conduct the pilot, the Partners Connected Health Innovation team drew on real-life data from heart failure patients under its care. The patients were part of the Partners Connected Cardiac Care Program, a remote monitoring education program focused on managing their care effectively in reducing the risk of hospitalization.

The test compared the results calculated by the AI system with real-life results drawn from about 12,000 heart failure patients hospitalized and discharged from the Partners HealthCare network in 2014 in 2015. As it turned out, there was a high correlation between actual patient readmissions and the level predicted by the system. Next, Partners will share a list of variables that played the biggest role in the AI’s projects. It’s definitely a move in the right direction.