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The Role of Practice Automation in Healthcare Communication

Posted on February 16, 2018 I Written By

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

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

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

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

Task-based challenges

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

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

Impact of physician mobility on communication

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

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

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

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

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

The building blocks of patient engagement

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

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

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

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

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

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

The bottom line

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

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

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.

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.

The Secure Texting Scam

Posted on September 6, 2012 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

I fondly remember going deer hunting with my father and grandfather in Pennsylvania where I grew up.  We hardly ever actually killed anything.  One deer hunting technique we never used was called “putting on a drive.”   You start with a group of hunters at each end of the woods.  The first group does the “driving” by walking through the woods making lots of noise.  The other group lies hidden at the other end.  The first group scares the deer towards the second group for an easy blindside kill.  Even if you like hunting it’s not very sportsmanlike.  The deer don’t stand a chance.

Recent developments in health information technology convince me that Washington politicians and health IT vendors are putting a drive on physicians. Together they coerce physicians into technology purchases that may be redundant and unnecessary.  One such example is all the noise health IT vendors make about secure texting.

In November 2011 JCAHO posted a notice deeming the use of texting to communicate physician orders as unacceptable.   This very short statement offered two supporting arguments:  1.  The sender’s identity could not be verified, and 2.  There is no way to preserve the text message for the medical record.  The statement did NOT mention any potential for hacking, eavesdropping or any other privacy / security issue.

The following April a small (5 physician) cardiology practice was fined $100,000 for a number of HIPAA violations.  The worst of these was putting appointment and surgical schedules on a publicly accessible online calendar.  Other violations included failure to appoint a privacy officer and failure to conduct a risk analysis.  The HHS press release for this settlement does not list texting protected health information (PHI) as one of the violations.  Nonetheless many secure texting vendors have cited this settlement as evidence that the Feds are prosecuting providers for texting PHI.  My inbox has been inundated with ads: “Don’t get caught texting PHI!  Buy our secure texting product today!”

Many providers have drunk the Kool-Aid, succumbing also to strong intuitive – but unverified – arguments regarding SMS texting.  It is widely accepted that every text has at least 3 copies:  the sender phone, the receiver phone, and one or more copies on the telecom servers involved in the transmission.  The first 2 clearly exist.  But has anyone verified current practices among telecom providers regarding server storage of text messages?  There is no credible source that clearly documents what those practices are.  Many providers and IT folks also intuitively believe that text messages can be easily monitored / intercepted remotely.

One secure text vendor I reviewed offers secure texting for the “bargain” price of $10 per user per month.  For our practice that totals $12,000 per year.   The app requires installation on both sending and receiving ends, so even after all that money is spent I can text “securely” only to employees inside my practice.  Too bad I don’t need secure communication inside my practice.  My EMR already does that.  So the product is both expensive and useless.  Most secure text products are structured similarly.

The argument for secure texting products fails in several ways:

  1. The November 2011 JCAHO directive regarding texting of physician orders does not mention privacy as an issue.  The two issues it does raise, identity verification and documentation in the medical record, are not solved by secure text products.  Furthermore, the JCAHO arguments should apply to voice conversations as well.  The voice of a caller cannot be objectively identified, and voice conversations are not preserved for the record either.   Telephone orders have been the standard of care for decades.  We have tolerated those “shortcomings” without difficulty.
  2. No federal agency has investigated anyone for texting PHI – although the secure texting vendors would like you to believe otherwise.
  3. There have been no documented PHI security breaches related to texting.
  4. The biggest security issue for texting is the smart phones themselves, where stored text messages are just waiting to be lost or stolen with the phone.  Secure text products don’t solve that problem either.  This is more appropriately handled by password protecting phones and remote-erasing technology for lost or stolen phones.  There are lots of other ways to address the problem, such as storing text messages in the cloud rather than on the phone.
  5. Physicians have been using text communications for almost 20 years, since the advent of text-enabled pagers.  This far predates SMS technology.  We contacted our answering service regarding the security of the text-pages that they send to our smart phones.  We were assured that their secure server adequately addresses the issue.  Really?  Don’t their messages pass through the same telecom servers as other texts to reach our smart phones?  Am I missing something?
  6. Smart phones can be eavesdropped for both voice conversations and text using the same methods.  If the eavesdropping argument is used to outlaw unsecured text, then voice communications should be treated similarly.
  7. How exactly do the wireless carriers handle text messages?   Why isn’t anyone grilling them about securing their servers?  Current practice across the IT community is that the owner of a database is responsible for its security.  Verizon Wireless, starting last April, has expressed great interest in health care and has declared its intention to establish a role in the management of chronic diseases.  How about something simpler and much more useful…like secure texting for health care providers?

The “logical” conclusion – ignoring common sense – is that PHI would be prohibited in all wireless communications.  Doctors would have to return to 1980’s era pagers that only emit a tone.  You call the answering service – on a landline – to get the message.  The privacy policies made necessary by the Information Age would force us back to the Stone Age.

Instead consider the following plan that would serve PHI privacy needs without all the hysteria and expense of add-on products:

–       Establish a set of practices for texting medical information that avoids or minimizes the creation of PHI.  This would include referring to patients by initials and avoiding the use of identity-establishing information.  I have done this for the past few months and it works well.  You can include all the medical information you want in a text, but if the patient is identified only by initials then it is not PHI.

–       Engage telecom providers to establish adequate security measures for its servers.  They should be doing this anyway.  There would be many users willing to pay a reasonable amount to cover the expense.  This would be much better than add-on products since it would be compatible across all users.

–       Aggressively implement protection for smart phones, starting with mandatory password protection and remote erasing, and implementing more sophisticated technologies as they become practical and widely available.

How do you get a marginal product to sell?  Either have the government make people buy it (Meaningful Use) or use marketing sleight of hand to create the illusion of a legal imperative.  Secure text marketing strategy works just like the deer drive.  The “drivers” are the secure texting vendors.  They leverage poorly written and randomly enforced government regulations to make lots of noise in an attempt to scare physicians.  At the other end of the forest lurks Secure Texting Snake Oil – products that only pretend to rescue doctors from prosecution and patients from identity theft.  Their only true effect is to raise health care costs without any improvement in quality of care or data security.