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Physicians, Patients Intrigued By Digital Health Options

Posted on March 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.

While digital health technologies have been available for many years, it’s taken a long time to get both doctors and patients comfortable with using them. However, the time is fast approaching, as the following study suggests.

New research from Ernst & Young has concluded that both physicians and consumers want to collaborate using digital technologies. The study found that consumers are comfortable reaching out to the doctors via digital channels and that physicians agree that digital technologies and data sharing can improve patient well-being.

More than half (54%) of consumers responding to the survey said they were comfortable contacting their doctor digitally. Also, they were interested in using technologies found outside of the physician’s office, including at-home diagnostic testing (36%), using a smartphone or connected device to share information (33%) and video consultations (21%).

Meanwhile, 83% of physicians told researchers that harvesting consumer and patient-generated data would make more personalized care plans possible and improve care quality. In addition, 66% said they felt increased use of digital technologies would make the healthcare system more efficient and lower costs, while 64% said it would help lower the burden on doctors and nurses, reducing the potential for burnout.

To make such cooperation practical, however, providers need to create incentives for data sharing, the E&Y researchers concluded.

When asked whether they were prepared to share lifestyle information with their physician, only 26% said yes. On the other hand, if doing so would allow them to reduce waiting times, 61% said they would share such data, if it would lower costs, 55% were interested. Also of note, 26% said they would be willing to share dietary and exercise information if they got tailored diet and exercise plans.

That being said, the level of interest in digital cooperation varied by demographics. Specifically, the survey found much lower levels of engagement and interest from consumers age 45 years and older, regardless of the form of technology discussed.

Still, both consumers and physicians seem to have a fair amount of optimism about the future of health. Sixty-four percent of consumers reported that they saw the US health industry as innovative, and 70% of physicians saw currently used technology as effective, both of which are high-water marks.

As this research points out, the gap between physician users of medical data and consumer portal users is narrowing by the day, but it’s still far from closed. It may take some time to figure out what incentives consumers find the most motivating. At the moment, it’s still a shot in the dark.

#HIMSS18 First Day:  A Haze Of Uncertainty

Posted on March 7, 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.

Entering the HIMSS exhibit area always feels like walking straight into a hurricane. But if you know how to navigate the show, things usually start to come into focus.

There’s a bunch of young, scrappy and hungry startups clustered in a hive, a second tier of more-established but still emerging ventures and a scattering of non-healthcare contenders hoping to crack the market. And of course, there are the dream places put in place by usual suspects like Accenture, SAP and Citrix. (I also stumbled across a large data analytics company, the curiously-named splunk> — I kid you not – whose pillars of data-like moving color squares might have been the most spectacular display on the floor.)

The point I’m trying to make here is that as immense and overwhelming as a show like HIMSS can be, there’s a certain order amongst the chaos. And I usually leave with an idea of which technologies are on the ascendance, and which seem the closest to practical deployment. This time, not so much.

I may have missed something, but my sense on first glance that I was surrounded by solutions that were immature, off-target or backed by companies trying to be all things to all people. Also, surprisingly few even spoke the word “doctor” when describing their product.

For example, a smallish HIT company probably can’t address IoT, population health, social determinants data and care coordination in one swell foop, but I ran into more than one that was trying to do something like this.

All told, I came away with a feeling that many vendors are trapped in a haze of uncertainty right now. To be fair, I understand why. Most are trying to build solutions without knowing the answers to some important questions.

What are the best uses of blockchain, if any? What role should AI play in data analytics, care management and patient interaction? How do we best define population health management? How should much-needed care coordination technologies be architected, and how will they fit into physician workflow?

Yes, I know that vendors’ job is to sort these things like these out and solve the problems effectively. But this year, many seem to be struggling far more than usual.

Meanwhile, I should note that there seems to be a mismatch between what vendors showed up and what providers say that they want. Why so few vendors focused on RCM or cybersecurity, for example? I know that to some extent, HIMSS is about emerging tech rather than existing solutions, but the gap between practical and emerging solutions seemed larger than usual.

Don’t get me wrong – I’m learning a lot here. The wonderful buzz of excited conversations in the hall is as intense as always. And the show is epic and entertaining as always. Let’s hope that next year, the fog has cleared.

Most Health Organizations Now Integrating SDOH Into Pop Health Management Programs

Posted on February 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.

A new survey has found that healthcare organizations have begun to actively integrate social determinants of health into the population health management strategies.

The research, conducted by Change Healthcare and the HealthCare Executive Group, found that 80% of organizations had begun to track and use data on social determinants. This is a huge step up from just a few years ago, when discussions around SDOH and their use in population health management were more speculative than practical.

Perhaps the most interesting technique organizations are using is enlisting doctors in this effort. About 21% are training doctors to identify social determinants, a step which, in my opinion, is long overdue. Given how taxing this might be for physicians at first, it’s good to see that just a hair under 21% have also rolled out point-of-care checklists designed to help clinicians identify potential social determinants.

Other strategies respondents are using to leverage SDOH info include integrating community programs and resources into their population health management programs (42%), integrating medical data with financial, census and geographic data (34%), offering social assessment tools with health risk assessments (33%), incorporating social determinants into the clinical workflow (27 percent) and using third-party software, data and/or services (19%).

On a side note, the research data also suggests that another set of tools in PHM — mobile and digital health technologies — haven’t found their footing. When asked what’s limiting widespread consumer adoption of these tools, top reasons respondents cited included security and privacy concerns (49%), limited functionality (35%), a duplicative, redundant and confusing app environment (34%), problems with system interoperability (33%), a lack of healthcare literacy (33%) and poor user interface design (32%).

The latter data pointing to low mobile/digital health adoption came as a surprise to me. I like to think I can see through health IT industry hype, but maybe I’ve been fooled somehow. The data I’ve seen to date (some of it, admittedly, collected by vendors) has suggested for years that mobile healthcare adoption was climbing dramatically and that more recently, other digital health tools have begun to follow suit. I guess I missed something.

Given this lag, I’m glad to see that healthcare organizations are enlisting physicians, point-of-care checklists, clinical integration and other tactics to make use of SDOH data. We all know on a gut level that if the patient can’t get to the doctor, lacks social support or lives in a “food desert” where finding unprocessed foods and healthy produce may be quite difficult, preaching at them about their health concerns isn’t going to help. It’s high time we help physicians collect this information and find ways to close some of these gaps.

New Program Trains Physicians In Health Informatics Basics

Posted on January 18, 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 program has emerged to help physicians make better use of the massive flow of health information they encounter on a day-to-day basis. With any luck, it will not only improve the skills of individual doctors but also seed institutions with clinicians who understand health IT in the practice of medicine.

The Indiana Training Program in Public and Population Health Informatics, which is supported by a five-year, $2.5 million award from the National Library of Medicine, focuses on public and population health issues. Launched in July 2017, it will support up to eight fellows annually.

The program is sponsored by Indiana University School of Medicine Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis and the Regenstrief Institute. Regenstrief, which is dedicated to healthcare quality improvement, supports healthcare research and works to bring scientific discoveries to bear on real-world problems.

For example, Regenstrief participates in the Healthcare Services Platform Consortium, which is addressing interoperability issues. There’s also the Regenstrief EHR Clinical Learning Platform, an AMA-backed program training medical student to cope with misidentified patient data, learn how different EHRs work and determine how to use them to coordinate care.

The Public and Population Health training, for its part, focuses on improving population health using advanced analytics, addressing public health problems such as opioid addiction, obesity and diabetes epidemics using health IT and supporting the implementation of ACOs.

According to Regenstrief, fellows who are accepted into the program will learn how to manage and analyze large data sets in healthcare public health organizations; use analytical methods to address population health management; translate basic and clinical research findings for use in population-based settings; creating health IT programs and tools for managing PHI; and using social and behavioral science approaches to solve PHI management problems.

Of course, training eight fellows per year is just a tiny drop in the bucket. Virtually all healthcare institutions need senior physician leaders to have some grasp of healthcare informatics or at least be capable of understanding data issues. Without having top clinical leaders who understand informatics principles, health data projects could end up at a standstill.

In addition, health systems need to train front-line IT staffers to better understand clinical issues — or hire them if necessary. That being said, finding healthcare data specialists is tricky at best, especially if you’re hoping to hire clinicians with this skill set.

Ultimately, it’s likely that health systems will need to train their own internal experts to lead health IT projects, ideally clinicians who have an aptitude for the subject. To do that, perhaps they can use the Regenstrief approach as a model.

An Example Of ACO Deals Going Small And Local

Posted on January 2, 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.

Until recently, ACOs have largely focused on creating large, sprawling structures linking giant providers together across multiple states. However, a news item that popped up on my radar screen reminded me that providers are quietly striking smaller local deals with hospitals and insurance companies as well.

In this case, cardiologists in Tupelo have begun to collaborate with Blue Cross & Blue Shield of Mississippi. Specifically, Cardiology Associates of North Mississippi will with Blue plan associate Magellan Health to create Accountable Cardiac Care of Mississippi.

It’s easy to see why the two agreed to the deal. The cardiology group has outpatient clinics across a wide region, including centers in Tupelo, Starkville, Columbus, Oxford and Corinth, along with a hospital practice at North Mississippi Medical Center-Tupelo. That offers a nice range of coverage for the health plan by a much sought-after specialty.

Meanwhile, the cardiology group should get a great deal of help with using data mining to deliver more cost-effective care. Its new partner, Magellan Health, specializes in managing complex conditions using data analytics. “We think we have been practicing this way all along, [but] this will allow us to confirm it,” said Dr. Roger Williams, Cardiology Associates’ president.

Williams told the News Leader that the deal will help his group improve its performance and manage costs. So far it’s been difficult to dig into data which he can use to support these goals. “It’s hard for us as physicians to monitor data,” he told the paper.

The goals of the collaboration with Blue Cross include early diagnosis of conditions and management of patient risk factors. The new payment model the ACO partners are using will offer the cardiology practices bonuses for keeping people healthy and out of expensive ED and hospital settings. Blue Cross and the Accountable Cardiac Care entity will share savings generated by the program.

To address key patient health concerns, Cardiology Associates plans to use both case managers and a Chronic Care program to monitor less stable patients more closely between doctor visits. This tracking program includes protocols which will send out text messages asking questions that detect early warning signs.  The group’s EMR then flags patients who need a case management check-in.

What makes this neat is that the cardiologists won’t be in the dark about how these strategies have worked. Magellan will analyze group data which will measure how effective these interventions have been for the Blue Cross population. Seems like a good idea. I’d suggest that more should follow this ACO’s lead.

Should Doctors Offer Concierge IT Security Services?

Posted on December 20, 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.

Today, just for fun, I’m gonna start with a thesis and work my way back to see if you agree with its foundations. My conclusion: With the cost of IT security services climbing, the cost of care coordination rising and practice income in many cases remaining relatively level, group practices will have to change their business model substantially.

Specifically, though this may sound insane, I’m suggesting that they may have to begin charging patients for beyond-the-call-of-duty security efforts.

Of course, as we all know, practices are required to offer at least a minimal level of security protection as specified in rules like those in HIPAA. Necessary though it is, it’s a pricey exercise for many groups.

Even so, cold economics may push them to cut data protection further. Given that care coordination will be necessary to meet population health goals, and that quality monitoring and management are indispensable, they may see security as the most dispensable of these spending options.

As the need for care coordination staff, quality management and other necessities of value-based care rise, paying for IT security services will become almost impossible to pay for without borrowing from another source.

That source can come from an internal budgetary resource, such as money allocated for routine general expenses, or other overhead, such as salaries for existing staff members, neither of which is desirable. Of course, there’s also the possibility of obtaining a line of credit, but that’s arguably even worse for the future of the company.

But since no medical organization can go entirely without IT security protection, it will have to find the funds to pay for it somehow. Given that any of the possibilities discussed above will drain the practice and possibly cut its finances to the bone, but something will have to give.

At this point, many practices decide to sell their group to a hospital or health system. That’s certainly a legitimate way of taking on unmanageable levels of overhead and getting access to far more infrastructure options and financial resources.

But if that’s not the direction you want to take, here’s off-ball idea for recapturing some IT security revenue: concierge security services.

While every patient’s data needs to be protected, obviously, you could offer concierge security patients access to extra layers of security attentiveness, such as a private IT staff or to answer any data privacy and security questions they might have about the practice, hospital where they are seen or other entity.

Toss in a special “security report” (in all candor, probably info they could’ve read in any trade magazine), personalized to patient needs, and a free zip drive with secured copies of their data and you’ll have them hooked.

If this worked, and I’m not suggesting that it necessarily would, it could help carry the cost of mundane IT security services. What do you think? Would this model have a chance?

Telemedicine Becoming Popular, But Seldom Profitable

Posted on October 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 suggests that while most physicians are supportive of telemedicine, others have grave reservations about providing this type of care, and that more than half of organizations aren’t making money delivering telemedicine services.

In an effort to learn more about attitudes toward telemedicine, Reaction Data surveyed 386 physicians, physician leaders, IT leaders and nurse leaders as well as differences in adoption levels between different types of organizations.,

Some of the top benefits of telemedicine cited by respondents included that it helped providers to meet demand for simpler and more cost-effective care delivery (28%), allowed them to treat more patients (23%) and that it was easing demands on staff (19%). Interestingly, just 10% said that telemedicine was proving to be a viable source of revenue, and elsewhere in the survey, 14% reported that telemedicine was revenue-negative.

The majority of physicians (68%) reported that they were in favor of telemedicine, while another 15% took a neutral position. Only 17% didn’t support widespread telemedicine use.

Their responses varied more, however, when it came to how much of care could be effectively delivered via telemedicine.

Thirty-two percent felt that 0 to 20% of care could be delivered this way; 33% of physician respondents felt that 30 to 40% care could be delivered digitally; 19% of respondents said 50 to 60% of care could be provided via telemedicine; 14% felt that 70 to 80% of care could be provided digitally. Just 2% felt that 90 to 100% of care could be delivered via this channel.

When it came to actually delivering the care themselves — rather than a hypothetical situation — respondents seemed less flexible. For example, 33% said that they would never contract with an outsourced telemedicine company to provide patient consults.

On the other hand, 50% said they’d considered moonlighting as a telemedicine consultant, 7% said they’d already done so frequently, 8% said they delivered such consults occasionally 2% said that was all they did for a living.

Regardless, many healthcare organizations are adopting this approach on a corporate level. Sixty-one percent of hospitals in a health system said they adopted telemedicine: 40% of standalone hospitals had done so; 58% practices owned by a health system has that this technology. Only 17% of physician-owned practices had done so, which could reflect cultural issues, costs or technology adoption concerns.

Physicians that were delivering telemedicine services most often used them to reach patients in rural areas (24%), provide follow-up care (24%) and manage specific patient populations (23%).

Among organizations that haven’t adopted telemedicine, many are scarcely getting their feet wet. While one in three providers are evaluating telemedicine options currently, 20% are two years or more away from adoption and 26% said they would never move in this direction.

Meanwhile, roughly one-third of physician-owned practices reported that they would never adopt telemedicine. One responding physician called it “inherent malpractice,” and another called it a “blatant attempt to circumvent the physical examination.” It seems unlikely that these clinicians will change their views on this topic.

Getting Buy-in For Your Second (Or More) EMR Purchase

Posted on August 15, 2017 I Written By

The following is a guest blog post by Michael Shearer is VP of Marketing for SelectHub.

Remember when you rolled out your first EMR?  Many of your doctors were uncertain, frustrated or angry, insurers were rejecting claims left and right and revenue fell as providers struggled to use the new system. Ah, those were lovely days.

Thankfully, in time everyone finally adapted. Through a combination of one-on-one coaching, group training, peer-to-peer mentoring and daily practice, clinicians got used to the system. Your patient volumes returned to normal. Some, though probably not all, of them got comfortable with the EMR, and a few even developed an interest in the technology itself.

Unfortunately, over time you’ve realized that your existing EMR isn’t cutting it. Maybe you want a system with an integrated practice management system. Perhaps your vendor isn’t giving you enough support or plans to jack up prices for future upgrades.  It could be that after working with it for a year or two, your EMR still doesn’t do what you wanted it to do. Whatever your reasons, it’s time to move on and find a system that fits better.

Given how painful the previous rollout was, buying a new EMR could be pretty disruptive and could easily stir up resentments and fears that had previously been laid to rest. But if you handle the process well, you might find that getting EMR buy-in is easier the second (or more) time around. Below are some strategies for getting clinicians on board.

Learn from your mistakes

Before you begin searching for an EMR, make sure that you’ve learned from your past mistakes. Consider taking the following steps:

  • Conduct thorough research on how clinicians (and staff if relevant) see your existing system. This could include a survey posing questions such as:
    • How usable is the EMR?
    • What impact does the EMR have on patient care, and why?
    • Does the EMR meet the needs of their specialty?
    • What features does the existing EMR lack?
    • Are EMR templates helping with documentation?
    • What are the great features of your existing EHR?
  • Compile a list of technical problems you’ve experienced with the system
  • Evaluate your relationship with the EMR vendor, and make note of any problems you’ve experienced
  • Consider whether your purchasing model (perpetual license vs. online subscription) is a good fit

Put clinicians in charge

When you bought your first EMR, you may have been on uncharted ground. You weren’t sure what you wanted to buy or how much to spend, and clinicians were at a loss as well.  Perhaps in the absence of detailed clinical feedback, you moved ahead on your own in an effort to keep the buying process moving.

This time around, though, clinicians will have plenty to say, and you should take their input very seriously. If they’re like their peers, their critiques of the existing EMR may include that:

  • It made documentation harder and/or more time-consuming
  • It wasn’t intuitive to use
  • It got in the way of their relationship with patients
  • It forced them to change their workflow
  • It didn’t present information effectively

These are just a few examples of the problems clinicians have had with their first EMR – you’ll probably hear a lot more. Ignoring these concerns could doom your next EMR rollout.

To avoid such problems, put clinicians in charge of the EMR purchasing process. By this point, they probably know what features they want, how documentation should work, what breaks their workflow, what supports their process and how the system should present patient data.

This will only work if you take your hands off of the wheel and let them drive the EMR selection process. Giving them a chance for token input but buying whatever administrators choose can only breed hostility and distrust.

Look to the future

When EMRs first showed up in medical practice, no one was sure what impact they’d have on patient care. Administrators knew that digitizing medical records would help them produce cleaner claims and shoot down denials, but few if any could explain why that would help their providers offer better care. In some cases, these first-line systems did nothing whatsoever for clinicians while weighing them down with extra work.

Over time, however, providers have begun using pooled EMR data to make good things happen, such as improving the health of entire populations, identifying how genetics can dictate responses to medication and predicting whether a patient is likely to develop a specific health condition. These are goals that will inspire most clinicians. While they may not care what happens in the business office, they care what happens to patients.

These days, in fact, using EMR data to improve care has become almost mandatory. Even if they didn’t bother before, practices are now buying systems better designed to help providers deliver care and improve outcomes. If your clinicians are still unhappy about their first experience, they may have trouble believing this. But make sure that they do.

The truth is, there will always be someone who doesn’t like technology, or refuses to take part in the buying process, and it’s unlikely you’ll win them over. But if your EMR actually enhances their ability to provide care, most will be happy to use it, and even evangelize the system to their colleagues. That’s the kind of buy-in you can expect if you deliver a system that meets their needs.

Michael Shearer is VP of Marketing for SelectHub, which offers selection tools for EMRs and practice management systems.

 

Should EMR Vendors Care If Patients Get Their Records?

Posted on August 11, 2017 I Written By

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

Not long ago, Epic CEO Judy Faulkner and former Vice President Joe Biden reportedly butted heads over whether patients need and can understand their full medical records. The alleged conversation took place at a private meeting for Cancer Moonshot, a program with which Biden has been associated since his son died of cancer.

According to a piece in Becker’s Health IT & CIO Review, Faulkner asked Biden why patients actually needed their full medical records. “Why do you want your medical records? They’re a thousand pages of which you understand 10,” she is said to have told Biden.

Epic responded to the widely-reported conversation with a statement arguing that Faulkner had been quoted out of context, and that the vendor supported patients’ rights to having their entire record. Given that Becker’s had the story third-hand (it drew on a Politico column which itself was based on the remarks of someone who had been present at the meeting) I have little difficulty believing that something was lost in translation.

Still, I am left wondering whether this piece had touched on something important nonetheless. It raises the question of whether EMR vendor CEOs have the attitude towards patient medical record access Faulkner is portrayed as having.

Yes, I suspect virtually every EMR vendor CEO agrees in principle that patients are entitled to access their complete records. Of course, the law recognizes this right as well. However, do they, personally, feel strongly about providing such access? Is making patient access to records easy a priority for them? My guess is “no” and “no.”

The truth is, EMR vendors — like every other business — deliver what their customers want. Their customers, providers, may talk a good game when it comes to patient record access, but only a few seem to have made improving access a central part of their culture. In my experience, at least, most do what medical records laws require and little else. It’s hard to imagine that vendors spend any energy trying to change customers’ records practices for the better.

Besides, both vendors and providers are used to thinking about medical record data as a proprietary asset. Even if they see the necessity of sharing this information, it probably rubs at least some the wrong way to ladle it out at minimal cost to patients.

Given all this background, it’s easy to understand why health IT editors jumped on the story. While she may have been misrepresented this time, it’s not hard to imagine the famously blunt Faulkner confronting Biden, especially if she thought he didn’t have a leg to stand on.

Even if she never spoke the words in question, or her comments were taken out of context, I have the feeling that at least some of her peers would’ve spoken them unashamedly, and if so, people need to call them out. If we’re going to achieve the ambitious goals we’ve set for value-based care, every player needs to be on board with empowering patients.

Bringing Zen To Healthcare:  Transformation Through The N of 1

Posted on July 21, 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.

The following essay wasn’t easy to understand. I had trouble taking it in at first. But the beauty of these ideas began to shine through for me when I took time to absorb them. Maybe you will struggle with them a bit yourself.

In his essay, the author argues that if providers focus on “N of 1” it could change healthcare permanently. I think he might be right, or at least makes a good case.  It’s a complex argument but worth following to the end. Trust me, the journey is worth taking.

The mysterious @CancerGeek

Before I share his ideas, I’ll start with an introduction to @CancerGeek, the essay’s author. Other than providing a photo as part of his Twitter home page, he’s chosen to be invisible. Despite doing a bunch of skillful GoogleFu, I couldn’t track him down.

@CancerGeek posted a cloud of interests on the Twitter page, including a reference to being global product manager PET-CT; says he develops hospital and cancer centers in the US and China; and describes himself as an associate editor with DesignPatient-MD.

In the essay, he says that he did clinical rotations from 1998 to 1999 while at the University of Wisconsin-Madison Carbone Comprehensive Cancer Center, working with Dr. Minesh Mehta.

He wears a bow tie.

And that’s all I’ve got. He could be anybody or nobody. All we have is his voice. John assures me he’s a real person that works at a company that everyone knows. He’s just chosen to remain relatively anonymous in his social profiles to separate his social profiles from his day job.

The N of 1 concept

Though we don’t know who @CancerGeek is, or why he is hiding, his ideas matter. Let’s take a closer look at the mysterious author’s N of 1, and decide for ourselves what it means. (To play along, you might want to search Twitter for the #Nof1 hashtag.)

To set the stage, @CancerGeek describes a conversation with Dr. Mehta, a radiation oncologist who served as chair of the department where @CancerGeek got his training. During this encounter, he had an insight which helped to make him who he would be — perhaps a moment of satori.

As the story goes, someone called Dr. Mehta to help set up a patient in radiation oncology, needing help but worried about disturbing the important doctor.

Apparently, when Dr. Mehta arrived, he calmly helped the patient, cheerfully introducing himself to their family and addressing all of their questions despite the fact that others were waiting.

When Dr. Mehta asked @CancerGeek why everyone around him was tense, our author told him that they were worried because patients were waiting, they were behind schedule and they knew that he was busy. In response, Dr. Mehta shared the following words:

No matter what else is going on, the world stops once you enter a room and are face to face with a patient and their family. You can only care for one patient at a time. That patient, in that room, at that moment is the only patient that matters. That is the secret to healthcare.

Apparently, this advice changed @CancerGeek on the spot. From that moment on, he would work to focus exclusively on the patient and tune out all distractions.

His ideas crystallized further when he read an article in the New England Journal of Medicine that gave a name to his approach to medicine. The article introduced him to the concept of N of 1.  All of the pieces began to began to fit together.

The NEJM article was singing his song. It said that no matter what physicians do, nothing else counts when they’re with the patient. Without the patient, it said, little else matters.

Yes, the author conceded, big projects and big processes matter still matter. Creating care models, developing clinical pathways and clinical service lines, building cancer centers, running hospitals, and offering outpatient imaging, radiology and pathology services are still worthwhile. But to practice well, the author said, dedicate yourself to caring for patients at the N of 1. Our author’s fate was sealed.

Why is N of 1 important to healthcare?

Having told his story, @CancerGeek shifts to the present. He begins by noting that at present, the healthcare industry is focused on delivering care at the “we” level. He describes this concept this way:

“The “We” level means that when you go to see a physician today, that the medical care they recommend to you is based on people similar to you…care based on research of populations on the 100,000+ (foot) level.”

But this approach is going to be scrapped over the next 8 to 10 years, @CancerGeek argues. (Actually, he predicts that the process will take exactly eight years.)

Over time, he sees care moving gradually from the managing groups to delivering personalized care through one-to-one interactions. He believes the process will proceed as follows:

  • First, sciences like genomics, proteomics, radionomics, functional imaging and immunotherapies will push the industry into delivering care at a 10,000-foot population level.
  • Next, as ecosystems are built out that support seamless sharing of digital footprints, care will move down to the 1,000-foot level.
  • Eventually, the system will alight at patient level. On that day, the transition will be complete. Healthcare will no longer be driven by hospitals, healthcare systems or insurance companies. Its sole focus will be on people and communities — and what the patient will become over time.

When this era arrives, doctors will know patients far more deeply, he says.

He predicts that by leveraging all of the data available in the digital world, physicians will know the truth of their experiences, including the food they eat, the air they breathe, how much sleep they get, where they work, how they commute to and from work and whether they care for a family member or friend, doctors will finally be able to offer truly personalized care. They’ll focus on the N of 1, the single patient they’re encountering at that moment.

The death of what we know

But we’re still left with questions about the heart of this idea. What, truly, is the N of 1? Perhaps it is the sound of one hand clapping. Or maybe it springs from an often-cited Zen proverb: “When walking, walk. When eating, eat.” Do what you’re doing right now – focus and stay in the present moment. This is treating patients at the N of 1 level, it seems to me.

Like Zen, the N of 1 concept may sound mystical, but it’s entirely practical. As he points out, patients truly want to be treated at the N of 1 – they don’t care about the paint on the walls or Press Ganey scores, they care about being treated as individuals. And providers need to make this happen.

But to meet this challenge, healthcare as we know it must die, he says. I’ll leave you with his conclusion:

“Within the next eight years, healthcare as we know it will end. The new healthcare will begin. Healthcare delivered at the N of 1.”  And those who seek will find.