Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

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?

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

Posted on July 27, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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

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

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

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

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

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

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

Stericycle Communication Solutions and Solutionreach are both Healthcare Scene sponsors.

DrChrono App Store Illustrates Important Point

Posted on July 16, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In a recent post, my colleague John Lynn argued that EHRs won’t survive if they stick to a centralized model.  He contends — I think correctly — that ambulatory practices will need to plug best-of-class apps into their EHR system rather than accepting whatever their vendor has available. If they don’t create a flexible infrastructure, they’ll be forced to switch systems when they hit the wall with their current EHR, he writes.

Demonstrating that John, as usual, has read the writing on the wall correctly, I present you with the following. I think it illustrates John’s point exactly. I’m pointing to EHR vendor DrChrono, which just announced that billing and collections company Collectly would be available for use.

Like its peers, Collectly built on the DrChrono API, and will be available in the DrChrono App Directory on a subscription basis. (The billing company also offers custom pricing for large organizations.)

Other apps featured in the app directory include Calibrater Health, which offers text-based patient surveys; Staple Health, a machine learning platform that providers can use to manage at-risk patients and Genius Video, which sends personalized video via text message to educate patients. Payment services vendor Square is also a featured partner.

Collectly, for its part, digitizes paper bills and sends billing statements and collection notices to patients via text or email. The patient messages include a link to the patient portal which offers a billing FAQ, benefits and insurance info and a live chat feature where experts offer info on patient insurance features and payment policy. The live chat staffers can also help patients create an approved payment schedule on behalf of a practice.

While some of the DrChrono apps offer help with well-understood back-office issues – such as Health eFilings, which help practices submit accurate MIPS data –  those functions may be duplicated or at least partially available elsewhere. However, apps like Collectly offer options that EHRs and practice management platforms seldom do. The number of best of breed apps that an EHR won’t be able to replicate natively is going to continue to increase.

Integrating consumer-facing apps like this acknowledges that neither medical practice technology nor its staff is terribly well-equipped to bring in the cash from patients. It may take outside apps like Collectly, which functions like an RCM tool but talks like a patient, to bring in more patient payments in for DrChrono’s customers. In other words, it took a decentralized model to get this done. John called it.

The Role of Technology in Patient Satisfaction

Posted on July 11, 2018 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

Over the past six months, we have been discussing the importance of understanding patient needs in order to improve their satisfaction levels. But why does it really matter if patients are happy? Happy patients are the ones who refer their friends and family. They’re are the ones leaving you stellar reviews online. Happy patients stick with you.

One of the most effective (and easiest) ways to improve the patient experience is through the use of technology. According to one study, using technology to communicate with patients increases patient satisfaction scores by around 10 percent. Not only that, but technology saves practices a huge amount of time and hassle. Here are just a few of the ways you can use technology to personalize patient experience and simplify workflow for staff.

  1. Streamline (and personalize) scheduling and check-in

The Patient-Provider Relationship Study found that two of the biggest frustrations patient have around experience are feeling like a number and difficulty with scheduling and wait times. One great way to address these issues is to offer convenient 24/7 online scheduling and electronic forms.

Two-thirds of patients think it is important to be able to schedule appointments online. And practices can make that experience even easier with the right technology. When online scheduling in integrated with your practice management system, it can identify existing versus new patients and adapt the forms so existing patients don’t have to provide information that you already have.

Consider having patient forms on the scheduling page or somewhere on your website, or send them out in an email before the appointment. Then, instead of spending 15 minutes filling out forms, patients can relax. This also allows you to spend more time speaking with each patient individually and addressing any concerns they may have.

If you have patients who don’t fill out their forms online or bring them before arriving, consider using a tablet to expedite the process. Tablets make filling out those forms faster, easier, and more accurate. Waiting to see the doctor shouldn’t feel like homework time. Do whatever you can to make this a time, instead, where you connect with your patients.

  1. Implement two-way texting

Texting is the most popular method of communication today (even 80 percent of senior citizens own a cell phone). Just like people want to text their friends and families, they also want to text you. As the Patient-Provider Relationship study found, 73 percent of patients want to text back and forth with you. With two-way texting, you can:

  • Confirm appointments
  • Coordinate care
  • Discuss appointment follow-up instructions
  • Reschedule appointments

Of course, you want to make sure you stay HIPAA compliant whenever you may be sending PHI information via text message. Make sure to use technology that offers the tools to stay compliant.

  1. Upgrade your patient appointment reminders

If you want to stay competitive in today’s healthcare world, automated appointment reminders are a must. Not only does automating your patient reminders make life a lot easier for your staff, but it ensures that no patients fall through the cracks. Make sure to ask patients which way they prefer to be contacted and use that.

Using mobile messages like text message and email for reminders is especially important in this era when people just don’t like talking on the phone. Now your patients can be stuck in a boring work meeting and still get that text message appointment reminder. It saves you a lot of time, improves productivity, and gives you the time you need to focus on what is most important—the patients in your office.

Automated messages also provide another opportunity to personalize and customize communications to each patient. Just like a postcard or phone call, they have the patient’s name, appointment time, and provider listed, but they can also contain other appointment details. Based on the appointment type, they can have instructions like remember to fast or bring your medications. The patient will feel the personalization and your practice will be able to make sure patients show up prepared.

  1. Automate patient satisfaction surveys

As we’ve discussed at length in prior blog posts, surveys can tell you a whole lot about how you and your practice are measuring up to patient expectations. The more you focus on patient happiness, the more likely you are to make it a priority. So always send out patient surveys following patient visits.

In the past, you may have asked patients to fill out paper surveys in the office. That method of collecting surveys is difficult to track, less likely to be completed, and may have answers that are skewed. Using technology to email or text your patients a survey after their appointment increases the likelihood that they will give more honest responses. It also makes it a whole lot more likely that they will be filled out.

When it comes to making patient satisfaction a priority, it’s critical to gauge if your current technology is up to the challenge. Technology can greatly improve how your patients view you and your entire practice. It can also improve the productivity and efficiency of you and your staff.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff.

Payers Say Value-Based Care Is Lowering Medical Costs, But Tech Isn’t Contributing Much

Posted on June 22, 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.

A new survey of health insurers has concluded that while value-based care seems to be lowering healthcare costs significantly, they aren’t satisfied with the tools they have to analyze value-based performance.

The report, which draws on a survey sponsored by Change Healthcare, including answers from 120 payers across several types of insurance, including managed Medicare, managed Medicaid and commercial plans.

The topline finding from the report was that value-based care (VBC) has lowered healthcare costs by 5.6% on average, with one-quarter of respondents reporting savings of more than 7.5%.

Meanwhile, the volume of fee-for-service payments has dropped dramatically as a percent of overall payments, now accounting for just 37.2% of all reimbursement among respondents. That number is expected to fall below 26% by 2021.

Not only that, 64% of payers said that provider relationships improved, and 73% said patient engagement improved. This suggests that providers have made some strides in delivering value-based care, as many had a hard time restructuring their business in the past.

That said, some payers haven’t met their own VBC goals. In particular, 66% of payers are investing administrative staffers to support episode-of-care programs given what the study terms “exceptional” medical cost savings. Also, one third to one-half said that episode-of-care models were either very or extremely effective at improving care quality.

However, payers haven’t made much progress as they’d like in rolling out episode-of-care programs. While 21% of payers said they were capable of rolling out a new episode-of-care program in 3 to 6 months, more than a third said the needed a year to launch such a program, 21% said it would take 18 months, and 13% said it would take up to 24 months or more. In other words, many payers are so far behind the curve that the programs they’re designing might be obsolete by the time they roll them out.

What’s more, they’ve had a tough time getting providers interested in episode-of-care programs. Forty-three to 58% reported that it is either very or extremely difficult to get providers to participate in these efforts. Not only that, even when they find interested providers, payers are having a hard time finding common ground with them on episode definitions, budgets, the details of risk and reward sharing and performance metrics. These disagreements could prove a major hurdle to overcome.

In addition, more than half of payers said they were not very satisfied with the current value-based analytics, automation and reporting tools, even though most of the tools were developed in-house by the payers themselves. It could be that given provider resistance, the payers aren’t quite sure about what to look for. Regardless, it seems that payers have a longer-than-expected road to travel here.

AMA Says Med Students Don’t Get Enough EHR Training

Posted on June 20, 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.

Whether or not doctors like it, the U.S. healthcare industry has embraced EHR technology, and in most cases, medical groups depend on it for a number of reasons. Now, the industry may be taking the next step in this direction, with the AMA deciding that it’s time to enshrine EHR use as part of medical education.

At its recent annual meeting, the AMA released a new policy embracing two somewhat contradictory notions. On the one hand, it encouraged med schools to train students on using EHR technology, while on the other, underscored the need for future doctors to get their faces out of the computer screen and engage with patients.

According to the trade group, some medical schools actually limit student access to EHRs. The AMA contends that this is a bad idea. “Medical students and residents need to learn how to ensure quality clinical documentation within an electronic health record,” said AMA board member and medical student Karthik Sarma in a prepared statement. “There is a clear need for medical students to have access to – and learn how to properly use – EHRs well before they enter practice.”

That being said, the group’s report on this subject concedes that there’s a long way to go in making this happen. For example, it notes that many med school faculty members aren’t offering students and residents much of a role model for the appropriate use of and practices in working with EHRs.

To address this problem, the new policy urges medical schools and residency programs to design clinical documentation and EHR training. It also recommends that the training be evaluated to be sure that it’s useful for future medical practice.

The AMA also suggests that med schools and residency programs provide faculty members with EHR professional development options. These lessons will help faculty serve as better role models on EHR use during interactions between physicians and patients.

That being said, there is an inherent tension between these goals and the realities of EHR use. Yes, training students to create good clinical documentation makes sense. At the same time, there are good reasons to worry about the effects of EHRs on student and resident relationships with patients. Unfortunately, this problem seems to be unavoidable as things stand today. Either you train budding physicians to be clinical documentation experts or you encourage them to use EHRs as little as possible during patient encounters.

In short, we’ve already learned that we can’t have both at the same time. So what’s the point of telling medical students that they should try to do the impossible?

4 Tricks to Help Busy Practices Stay Organized

Posted on June 13, 2018 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

Over the past several months, we’ve been discussing how to use surveys to find out what your patients think of you—and then how to make the necessary changes. In addition, we’ve been looking at some of the most common complaints uncovered in patient surveys. These include:

* Excessive wait times (read more about that here)
* Inadequate communication (read more about that here)
* Disorganized operations

Today we are discussing the importance of keeping your practice moving smoothly and efficiently. No one likes going to a doctor’s visit only to find that they are running behind, have forgotten you were coming, or have lost your patient records. And yet that happens all too often.

Office managers and physicians are constantly balancing a huge number of tasks, including patient problems, staffing challenges, budget planning, payroll, and more. Unless you consciously strive to improve the organization and efficiency in your practice, you end up spending a whole lot of time putting out fires instead of preventing them from happening. This inevitably leads to more stress for you, lower productivity for staff, and poor satisfaction from patients.

With today’s consumer-focused patients, it’s imperative that you keep your office running like a well-oiled machine at all times. Otherwise, they are likely to simply move their business to the practice down the street instead. So here are a few tips to make juggling all the balls in your life a little easier.

  1. Schedule time for planning.
    One of the best ways to make sure you’re staying ahead of everything is to plan out your day in advance. Do you have a shipment of new supplies arriving? A new employee to train? Emails to be created? In this industry, every day brings something new. In order to make sure that nothing interferes with the patient experience, you’ve got to plan ahead. The best way to do this is to actually block off some time on your calendar where you decide what needs to be focused on—a simple 15-30 minutes each day is usually all you need. Many people find that the end of the day is a great time for this. That way you can be prepared for whatever the next day may bring.
     
  2. Batch your tasks.
    When doing your planning, give batching a try. Batching is when you select similar jobs and schedule them to be completed in one setting. Productivity experts have found that when we batch tasks, we are more focused, efficient, and, ultimately, more productive. We simply work better when we can focus on one thing at a time. Many large tasks can be batched by day. For example:

    • Mondays—Staff communication and training
    • Tuesdays—Payroll, billing, and other financial tasks
    • Wednesday– Marketing to get new patients (running ads, managing online presence, etc)
    • Thursday—Patient outreach to get returning patients (newsletters, social media, etc.)
    • Fridays—General administrative tasks and planning for the following week

     
    Of course, there will be times when things come up that need your attention. Be flexible in addressing those issues.

  3. Maximize efficiencies.
    Your practice should make life easier for patients. This means that you need to take a close look at everything from appointment scheduling to the check-in process to the way patients move within your facility to see if there can be improvements. Consider:

    1. Implementing an online scheduling tool, where patients can schedule their own appointments. This will help cut back on time on the phone.
    2. Using an automated wait list to fill last minute cancellations. Using a system to automatically send out an email or text message blast to everyone wanting to be seen sooner can free up time for staff and fill those exam rooms.
    3. Making your reception area easy to locate and clear of clutter so that patients can use it to sign forms. You may also try using a digital check-in process with a tablet or computer.
    4. Reviewing the flow of your practice. Patients should move from the waiting room to the exam room and back without much confusion. This is done best when they always move in a single direction—much like a highway.
       
  4. Take advantage of technology—but be wise.
    There are a lot of things still being done manually in an office that can be put on “auto” instead. Everything from recall to appointment reminders to birthday messaging and more can be done in a way that doesn’t require daily supervision from you. We have so many amazing technologies that can help us stay organized. Apps, calendars, to-do lists, and so on. It is important, however, to not let technology distract you. Did you know that every time you switch between tasks, you lose around 15 minutes? So every time you check email, for example, in the middle of another task, you lose precious amounts of productive time. Instead, set aside a time when you check your email (or complete other tech-related tasks) each day and stick to it. Perhaps you do it first thing in the morning, after lunch, and before leaving. That way you do not waste tons of time.

Ultimately, every practice wants to deliver exceptional patient care, and a big part of that is practice organization and efficiency. Ask yourself, “Is my office making a real effort to improve processes and make life easier for patients?” If not, implement procedures to do so. It will have a lasting, positive impact on both office staff efficiency and overall patient satisfaction.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff.

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.