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AAFP Opposes Direction Of Federal Patient Data Access Efforts

Posted on April 4, 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.

Not long ago, a group of federal agencies announced the kickoff of the MyHealthEData initiative, an effort designed to give patients control of their data and the ability to take it with them from provider to provider. Participants in the initiative include virtually every agency with skin in the game, including HHS, ONC, NIH and the VA. CMS has also announced that it will be launching Medicare’s Blue Button 2.0, which will allow Medicare beneficiaries to access and share their health information.

Generally speaking, these programs sound okay, but the devil is always in the details. And according to the American Academy of Family Physicians, some of the assumptions behind these initiatives put too much responsibility on medical practices, according to a letter the group sent recently to CMS administrator Seema Verma.

The AAFP’s primary objection to these efforts is that they place responsibility for the adoption of interoperable health IT systems on physicians. The letter argues that instead, CMS should pressure EHR vendors to meet interoperability standards.

Not only that, it’s critical to prevent the vendors from charging high prices for relevant software upgrades and maintenance, the AAFP argues. “To realize meaningful patient access to their data, we strongly urge CMS to require EHR vendors to provide any new government-required updates such systems without additional cost to the medical practice,” the group writes.

Other requests from the AAFP include that CMS:

  • Drop all HIT utilization measures now that MIPS has offered more effective measures of quality, cost and practice improvement
  • Implement the core measure sets developed by the Core Quality Measures Collaborative
  • Penalize healthcare organizations that don’t share health information appropriately
  • Focus on improving HIT usability first, and then shift its attention to interoperability
  • Work to make sure that admission, discharge and transfer data are interoperable

Though the letter calls CMS to task to some degree, my sense is that the AAFP shares many of the agency’s goals. The physician group and CMS certainly have reason to agree that if patients share data, everybody wins.  The AAFP also suggests measures which foster administrative simplification, such as reducing duplicative lab tests, which CMS must appreciate.

Still, if the group of federal organizations thinks that doctors can be forced to make interoperability work, they’ve got another thing coming. It’s hard to argue the matter how willing they are to do so, most practices have nowhere near the resources needed to take a leading role in fostering health data interoperability.

Yes, CMS, ONC and other agencies involved with HIT must be very frustrated with vendors. There don’t seem to be enough sanctions available to prevent them from slow-walking through every step of the interoperability process. But that doesn’t mean you can simply throw up your hands and say “Let’s have the doctors do it!”

Comprehensive Health Record Vs. Connected Health Record

Posted on March 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.

The “comprehensive health record” model is quite in vogue these days. Epic, in particular, is championing this model, which supplants existing EHR verbiage and integrates social determinants of health. “Most health systems know they have to go beyond their walls,” Epic CEO Judy Faulkner told Healthcare IT News. A number of other EMR vendors have followed Epic’s lead.

To date, however, most clinicians have yet to embrace this model, perhaps because they’re out of patience with the requirements imposed by EHRs. What’s more, the broader healthcare industry hasn’t reached a consensus on the subject. For example, a team of experts from UCSF argues that healthcare needs a “connected health record,” a much different animal than vendors like Epic are proposing.

The authors see today’s EHR as an “electronic file cabinet” which is poorly equipped to handle health activities and use cases such as shared care planning, genomics and personalized medicine, population health and public health, remote monitoring and sensors.

They contend that to create an interoperable healthcare ecosystem, we will need to move far beyond point-to-point, EHR-to-EHR connections. Instead, they suggest adding connections with patients and family caregivers, non-clinical providers such as school clinics for youth and community health centers. (They do agree with Faulkner that incorporating data on social determinants of health is important.)

Their connected health record ties more professionals together and adapts to new models of care. It would foster connections between primary care physicians, multiple specialists, hospitals, clinics, pharmacies, laboratories, public health registries and new models of care such as ACOs. It would be adaptive rather than reactive.

For example, if the patient at home with cancer gets a fever, her temperature data would be transmitted to her primary care physician, her oncologist, her home care nurse and family caregiver. The care plan would evolve based on the recommendations of team members, and the revised vision would be accessible automatically to the entire care team. “A static, allegedly comprehensive health record misses the dynamics of an interactive, learning health system,” the authors say.

All that being said, this model still appears to be at the vision stage. Perhaps given its backing, the comprehensive health record seems to be getting far more attention. And arguably, attempting to integrate a good deal more data on patients into an EHR could be beneficial.

However, both models are largely untested, and both beg the question of whether building more content on an EHR skeleton can lead to transformation. On the other hand, while the concept of a connected health record is attractive, my sense is that the components needed to this happen have not matured yet.

Ultimately, it will be clinicians who decide which model actually works for them, not vendors or abstract thinkers. Let’s see which model makes the most sense to them.

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.

Big Gap Exists Between Wearables Hype And Physician Use

Posted on January 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.

Not long ago, I wrote an article describing some major advances in wearables and health tracking technologies. Standout technologies included Grail, a cancer detection startup, Beddit, which makes sleep tracking technology, and Senosis Health, which developed apps using smartphone sensors to monitor health signals.

In the article, I argued that we’re past the question of whether wearables are valuable and that it’s time to focus on what we want to do with next-generation of superpowered health tracking devices instead. I was driven by stats like the ones produced by the Consumer Technology Association, which asserted last year that by 2020, physician use of patient-generated data will reach critical mass. It noted that wearables are being used more often in clinical trials and that some health insurers offering free wearables to patients, trends which it predicts will cause the market to explode.

But at least to some extent, I think the CTA (and I) were both wrong. As impressive as the new patient trackers are, they won’t be that valuable if nobody on the frontlines of medicine uses them. And even if trackers are being used in clinical trials or given away by health insurers, that doesn’t mean physicians are on board. The issue is not just whether devices work well, but whether doctors can actually use them in their daily care routine.

Recent stats suggest that few physicians actually use patient-generated data in their practice. In fact, the Physicians Practice Technology Survey found that just 5% of respondents reported that they use such such devices as part of their care routine.

I’m not surprised by this research. My own informal discussions with physicians suggest that the number of practices that actively use patient-generated data may be even lower than 5%.

Why are so few medical practices leveraging patient-generated data? The reasons are fairly straightforward:

  • Few of devices offer measurements that are consistent, predictable and valid
  • Vanishingly few are FDA-approved, which does little to inspire clinicians’ confidence
  • In most cases, the data produced by wearables and related devices isn’t compatible with practice EMRs

For what it’s worth, I do believe that many physicians — especially those with an interest in health IT– know that patient-generated health data will eventually play a valuable role in their practice. After all, in principle, there must be ways that such data could inform patient care.

But right now, the simple devices patients own aren’t sophisticated enough to serve practice needs, and most of the advanced patient tracking devices are at the idea or testing phase. Until patient tracking devices become more practical, and offer reliable, valid, usable data, they’re likely to remain a dark horse.

Study Says Physicians Have Major Cybersecurity Problems

Posted on December 18, 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.

New research sponsored by the AMA and consulting firm Accenture has concluded that cyberattacks on medical practices are common – in fact, far more common than one might think.

Not only do these numbers suggest patient data is far more vulnerable than expected, it suggests that clinicians are often poorly educated about security and the implications of handling it badly. It’s fair to say that unless this trend is turned around, it could undermine industry efforts to build trusting relationships with patients and encourage them to engage in two-way data exchange.

The study found that most physicians (85%) think that sharing electronic protected health information is a good idea and that two-thirds believe that giving patients more access to their health data would improve care. One-third of respondents said that they share ePHI if they trust the vendors involved.

Thirty-seven percent get training content on security from their health IT vendor, and 50% said they trust these training providers are sure the content is adequate. However, this may be a mistake. While 87% of respondents said that their practice is HIPAA-compliant, the study also found that two-thirds of doctors still have basic questions about HIPAA. It’s clear, in other words, that trusted relationships aren’t doing the job here.

In fact, an eye-popping 83% of medical practices have experienced some form of cyberattack such as malware, phishing or viruses. Not surprisingly, 55% of physicians surveyed are very worried about future cyberattacks. Unfortunately, worrying is what many people do instead of taking action, and that may be what’s going on here.

What makes these lax attitudes all the more problematic is that when attacks occur, the effect can be very substantial. For example, 74% of respondents said that a cyberattack was likely to interrupt their clinical practice, and 29% of doctors working in medium-sized practices said that it could take up to a full day to recover from an attack, a crippling length of time for any small business.

So what are practices willing to do to avoid these problems? Among these respondents, 60% said they would pay someone to create a security framework to protect ePHI. Also, 49% of practices surveyed have in-house security staffers on board. However, it should be noted that three times more medium and large practices have such an officer in place compared to smaller medical groups, probably because security expertise is very pricey.

However, probably the most valuable thing they can do is the least expensive of the list. Every practice should require that physicians stay current at least on HIPAA and cybersecurity basics. If medical groups do this, at least they’ve established a baseline from which they can work on other security issues.

Patients Showing Positive Interest In NY-Based HIE

Posted on November 16, 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.

A few months ago, I shared the story of HEALTHeLINK, an HIE serving Western New York. At the time, HEALTHeLINK was announcing that it had managed to obtain 1 million patient consents to share PHI. The HIE network includes 4,600 physicians, in addition to hospitals, health plans and other providers.

This month, HEALTHeLINK has followed up with another announcement suggesting that it’s making significant progress in getting patients and physicians connected and perhaps more importantly, interested in what it can do for them. In particular, the study suggested that consumers were far more aware of the HIE’s existence, function and benefits than one might’ve assumed.

The study found that 90% of respondents said they knew their doctors use EHRs, a percentage which differed but remained high across all demographic groups study. Respondents also knew that their doctor could send and receive medical information back and forth with other healthcare providers involved in their care using EHRs.

Not only that, 51% of respondents felt that the use of EHRs by doctors and hospitals made healthcare “more safe,” though 24% said EHRs made no impact on their care and 18% said EHRs made care “less safe.” Fifty-eight percent of respondents said that electronic access is good for healthcare, and 24% answered “strongly yes” when asked whether electronic access was beneficial.

When asked whether electronic access is good for healthcare, 24% of respondents said “strongly yes” and 58% said “yes.” Things looked even more positive for the future of the HIE when patients were specifically aware of HEALTHeLINK, with 57% of this group of patients rating care as “more safe.”

Those who rated care as “more safe” using HEALTHeLINK also included respondents with a two-year degree, those who visited Dr. more than 15 times a year and those who fell into 35 to 44-year-old age bracket.(However, it is worth noting that 41% to respondents said they weren’t aware of the name HEALTHeLINK.)

The only significant downside mentioned by HEALTHeLINK users was a lack of face time, with 37% reporting that their doctor or healthcare professional was spending too much time on a laptop or computer, and another 11% saying that this was a significant problem. (Another 60% had no issue with this aspect of the electronic medical records use process.)

Despite those reservations, when asked if they were willing to cut their doctor to use the HIE to give the other providers instant access to medical records, 57 percent said “yes” and 24% said their answer was “strongly yes.”

Lest this begin to sound like a press release for HEALTHeLINK, let me stop you right there. I am in no way suggesting that these folks are doing a better overall job of running its business than those in other parts of the country. However, I do think it’s worth noting that HEALTHeLINK’s management is building awareness of its benefits more effectively than many others.

As obvious as the benefits of health information sharing may seem to folks like us, it never hurts to remind end users that they’re getting something good out of it — and if they’re not, to find out quickly and address the problem.

Digital Health Venture Snags $10M Investment After Buzzword Upgrade

Posted on November 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.

Melon Springs, FL – In a deal observers are calling “disruptive,” “groundbreaking” and “lemon-scented,” high-profile wellness startup ICanHazHealth has closed a $10 million investment round on the heels of its recent buzzword upgrade.

Investors participating in ICanHazHealth’s Series B round include Bracelet Capital, Two Right Thumbs LLC and Window Dressing Digital. Few details of the agreements were disclosed, though Bracelet’s Jared Spoon-Monicker told Wired that its investment contract included an agreement to provide buzzword platform to its other portfolio companies. “We’re calling it ‘BaaS’ — buzzwords-as-a service,” said Spoon-Monicker, an early backer of exaggeration engine JIVETalk. “It will be the Uber of monetizing incremental marketing hyperbole.”

Launched in 2010 to tap the emerging market for digital health investment catchwords, the vendor’s BLOviATE platform offers both employer-and consumer-compatible content libraries. “Today, it’s not enough for consumers to use digital health buzzwords,” said ICHH founder P. Foster Bellbottom. “If we want to improve outcomes, we need to increase their level of buzzword engagement.”

The latest iteration of ICHH’s enterprise jargon platform, BLOviATE nACTION, now offers modules supporting several functional areas, including bragging, wishful thinking, puffery, exaggeration, self-deception, embellishment, and hyperbole.

Hospitals and health systems can also opt for a 10-year buzzword maintenance contract which supports BLOviATE deployment over existing SLANG and LinGO databases. However, ICHH won’t be offering distortion upgrades for BLOviATE past 2020, so after that point facilities will need to do their own grandiloquence support.

When asked what they thought of the emerging doubletalk startup’s prospects, analysts noted that ICHH faces several competitors with well-established client bases. Many pointed to iNtercAP, iNc., a niche buzzword developer specializing in novel tech company names, whose customers include Hangzhou No Trouble Looking for Trouble Internet Technologies (usually referred to as HNTLFTIT for short) and connected health giant Slippers and Sonograms.

“The issue is not whether there’s enough demand to support a bunch of balderdash startups,” said Warren Wallaby, head of the braggadocio research consulting firm the Seesaw Group. “At the moment there’s definitely a market for a range of bravado solutions.” The thing is, there’s no guarantee that the buzzword market won’t go soft at some point. “Health IT buyers have to be ruthless,” Wallaby says. “The day CIOs can get the same results from a few white lies and a little dissembling, these startups will be out of business.”

Note: This is a parody for those so inundated by buzzwords that it’s hard to tell.

In What Seems Like An Effort To Make Nice, eClinicalWorks Joins OpenNotes Initiative

Posted on October 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.

eClinicalWorks has decided to try something new. The health IT vendor has announced that it will support the OpenNotes project, an initiative in which doctors share their notes with patients.

As most readers will know, it recently came to light that eClinicalWorks had gotten itself into some very hot water with the feds. eCW was forced to pay a $155 million settlement when the U.S. Department of Justice concluded that it had faked compliance with EMR certification standards.

Now, perhaps in an effort to make nice, eCW is making it possible for its customers to share visit notes using its patient portal. Actually, to be precise, the patient portal already had the ability to offer visit summaries to patients, but OpenNotes capabilities enhance these summaries with additional information.

OpenNotes, for its part, got its start in 2010, when Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center decided to study the effects of letting patients read their medical notes via a portal.

The study, the results of which were published in the Annals of Internal Medicine in 2012, concluded that patients approved of note-sharing wholeheartedly, felt more in control of their care and had an easier time with medication adherence. Also, while some doctors reported changing documentation during this process, the study also found that doctors saw no significant changes in workload.

Perhaps most telling, at the end of the process 99% of patients wanted OpenNotes to continue, and none of the participating doctors opted out. A movement had been launched.

Since then, a long list of organizations has come on board to drive implementation of open notes, including Kaiser Permanente Northwest, Providence Health System, Salem Health and Oregon Health and Science University. This year, OpenNotes announced that 16 million Americans now had access to their medical notes online.

Back in 2012, I asked readers whether OpenNotes would eventually influence EMR design. Today, I would suggest that the answer is both “yes” and “no.”

On the one hand, I have little doubt that the project helped to advance the notion that patients should have on-demand access to their healthcare information, and moreover, to use it in managing their care. While some doubted this approach would work, OpenNotes can now be said to have sold the idea that health data transparency is a good idea. While the initiative had its doubters at its outset, today patient record access is far better accepted.

On the other hand, eClinicalWorks is the first EMR vendor I’m aware of to explicitly announce its support for OpenNotes. While it’s hard to tell what this means, my guess is that its competitors don’t see a need to take a position on the matter. While vendors are certainly being forced to take patient-facing data access into account, we clearly have a long way to go.

MGMA17 Day 2 – The Future of Patient Engagement Looks Bright

Posted on October 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.

Day 2 at MGMA17 started very early for exhibitors when the doors to the exhibit hall opened sharply at 6:30am Pacific Time. It was clear that MGMA organizers were catering to the early-rising-east-coast contingent of attendees. Thankfully there was a warm breakfast with plenty of caffeine options available.

The early exhibit hours provided a unique opportunity to slowly browse the floor and read booth signage fully without being blocked by fellow attendees walking in the aisles…and in some cases without being blocked by company representatives in the booth itself.

As I walked around the exhibits I began to notice that the words “Patient Engagement” appeared frequently. EHR companies, revenue cycle management companies, call center providers and even HR consultants had this nebulous term emblazoned on their booth properties. I thought it would be interesting to ask a few of these companies how they interpreted patient engagement and how they saw it evolving over the next three years.

Josh Weiner, Chief Operating Officer at SolutionReach, was quick to say “Patient Engagement is more than having a portal on your EHR”. He believed that the key to engaging patients was communicating with them in an easy, convenient manner. “For SolutionReach, this means texting. Everyone knows how to text and it’s just so simple to use. A few years ago texting patients was just one-way. Doctors would send a text to a patient and that would be it. More recently companies like SolutionReach introduced the ability for healthcare providers to conduct one-to-one conversations with patients via text. We call it SR Conversations and we have over 4,000 clients using it.”

In the future, Weiner predicted that providers and patients would continue to use SMS texting as the primary means of patient engagement. The key difference is that instead of just sending text messages back and forth we would be sending mini-text-applications back and forth. He cited the example of the latest iOS upgrade which now featured the ability to send a map, a Starbucks gift card and other such applications within an SMS message. He foresaw a day when we will have the ability to send a prescription, a lab test, a referral and an appointment schedule to a patient via SMS.

At BinaryFountain, a company that makes a platform that consolidate patient feedback from multiple social media sources as well as from HCAHPS surveys and allows providers to publish positive comments made in those medium as online reviews, they define patient engagement through the lens of reputation management. Engaged patients mean they are more likely to provide a positive comment and if they provide a positive comment, they are more likely to rate the doctor/practice/hospital highly. That, in turn, leads to a better reputation which attracts patients who are more likely to be engaged in their care. In the future, the company believes that quantitative measures for patient engagement will be developed and that these measures will be used in a similar way that the 5-star rating system is used today.

West Communications is a provider of telephony solutions to a broad range of industries. In healthcare, West offers a number of patient communication tools that engage patients via phone, email, and text. They define patient engagement as the degree to which a patient is active in and adherent to their care plan. They saw a bright future for patient engagement – especially as technologies from other industries are adapted to healthcare. The West team, for example, has been working on adding AI-based intelligent IVR capabilities to their healthcare IVR solutions so that inbound calls from patients can be automatically triaged quickly based on needs.

At Stericycle Communication Solutions, Sarah Bennight, Healthcare Strategist, defined patient engagement as getting patients to be active throughout their care journey. “Patient engagement creates trust between patients and providers. It’s more than just pushing information out to patients, it’s true two-way conversations that are relevant to where the patients are in that moment. It means providing patients with useful calls to action – clicking on a button to book their next appointment, download information or connect with the right clinician.”

Bennight sees a patient engagement future that includes new forms of communication through platforms like Snapchat and iMessage. “The younger generation communicates in different ways. They’ve gone beyond voice, text, and email. Healthcare will need to adapt to these new forms of communication. We may even need to develop a healthcare nomenclature for communicating information via emoji’s and giphies.”

Finally, Varun Hippalgaonkar, Senior Vice President of Growth at HealthGrid suggested that patient engagement is the sum total of all the interactions that a patient has with their healthcare providers including face-to-face visits, phone calls, text messages, telemedicine, and emails. The key for Hippalgaonkar was not to try and engage patients across all channels, but rather to zero in on the communication modalities that each individual patient preferred.

“HealthGrid is striving to be the single communication platform for all pre-, day of and post- visit patient interactions. Our platform will provide a consistent patient experience in the communication channel or channels that patients prefer to use. We mine our own interaction data to determine the best way to interact with patients. For example, the analysis of past interactions may reveal that John Smith responds better during weekday mornings via text message and seems to prefer phone calls at night. When a hospital or a practice has the information they want to share with John, they simply put the content in our system and we handle how it will be delivered to him based on his known response patterns.”

Down the road, Hippalgaonkar saw patients interacting with AI-powered chat bots that were so sophisticated that patients would feel they were interacting with a person. These bots would work across the different communication channels providing a consistent experience no matter what modality the patient elected to use.

Hippalgaonkar summed up by saying: “In the end it’s all about motivating patients to make changes to their health or put another way, to engage in their health. We can only achieve this if we communicate with patients in a way that compels them to take action. As an industry, we need to build technologies and processes that takes things down to the individual patient level. We need to use AI, machine learning, personalization and deliver meaningful information to patients so that they are compelled to make a change.”

From these conversations, it was clear that patient engagement meant different things to different people. Yet everyone agreed healthcare needed more engagement and more involvement from patients in order to deliver on the promise of better health at lower cost. Motivating patients to become more involved is not going to be easy, but if the MGMA17 exhibit hall is representative of HealthIT overall, the future is certainly bright for patient engagement.

Full Disclosure: Solution Reach and Stericycle Communication Solutions are both sponsors of Healthcare Scene.

Say It One More Time: EHRs Are Hard To Use

Posted on September 19, 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.

I don’t know about you, but I was totes surprised to hear about another study pointing out that doctors have good reasons to hate their EHR. OK, not really surprised – just a bit sadder on their account – but I admit I’m awed that any single software system can be (often deservedly) hated this much and in this many ways.

This time around, the parties calling out EHR flaws were the American Medical Association and the University of Wisconsin, which just published a paper in the Annals of Family Medicine looking at how primary care physicians use their EHR.

To conduct their study, researchers focused on how 142 family physicians in southeastern Wisconsin used their Epic system. The team dug into Epic event logging records covering a three-year period, sorting out whether the activities in question involved direct patient care or administrative functions.

When they analyzed the data, the researchers found that clinicians spent 5.9 hours of an 11.4-hour workday interacting with the EHR. Clerical and administrative tasks such as documentation, order entry, billing and coding and system security accounted about 44% of EHR time and inbox management roughly another 24% percent.

As the U of W article authors see it, this analysis can help practices make better use of clinicians’ time. “EHR event logs can identify areas of EHR-related work that could be delegated,” they conclude, “thus reducing workload, improving professional satisfaction, and decreasing burnout.”

The AMA, for its part, was not as detached. In a related press release, the trade group argued that the long hours clinicians spend interacting with EHRs are due to poor system design. Honestly, I think it’s a bit of a stretch to connect the study results directly to this conclusion, but of course, the group isn’t wrong about the low levels of usability most EHRs foist on doctors.

To address EHR design flaws, the AMA says, there are eight priorities vendors should consider, including that the systems should:

  • Enhance physicians’ ability to provide high-quality care
  • Support team-based care
  • Promote care coordination
  • Offer modular, configurable products
  • Reduce cognitive workload
  • Promote data liquidity
  • Facilitate digital and mobile patient engagement
  • Integrate user input into EHR product design and post-implementation feedback

I’m not sure all of these points are as helpful as they could be. For example, there are approximately a zillion ways in which an EHR could enhance the ability to provide high-quality care, so without details, it’s a bit of a wash. I’d say the same thing about the digital/mobile patient engagement goal.

On the other hand, I like the idea of reducing cognitive workload (which, in cognitive psychology, refers to the total amount of mental effort being used in working memory). There’s certainly evidence, both within and outside medicine, which underscores the problems that can occur if professionals have too much to process. I’m confident vendors can afford design experts who can address this issue directly.

Ultimately, though, it’s not important that the AMA churns out a perfect list of usability testing criteria. In fact, they shouldn’t have to be telling vendors what they need at this point. It’s a shame EHR vendors still haven’t gotten the usability job done.