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Patient Generated Data, Workflow and Usability Coming Into Focus for EHR Vendors

Posted on October 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

At the recent Medical Group Management Association annual conference (MGMA17), I made a point of visiting as many of the EHR vendors in the exhibit hall as I could so that I could ask them two questions:

  1. What are you working on right now, given that there is a bit of a lull between ONC requirements?
  2. How do EHRs and EHR vendors need to evolve over the next 5 years?

Below are some of the best responses I received.

Steve Dart, Senior Director of Product Management at AdvancedMD believes that both EHRs and EHR companies need to fundamentally change their paradigms in order to thrive over the next five years. “EHRs should facilitate the job that needs to get done rather than serve as a documentation repository,” says Dart. “What is that job? Helping patients live healthier lives while at the same helping physicians be happier at work. We really missed the boat during the Meaningful Use (MU) gold rush. We neither helped patients be healthier nor did we make physician lives easier. In fact, as an industry we generally made things more difficult for doctors.”

AdvancedMD is charting a new path forward, instead of just fixing their user interface (UI), they are rethinking their entire approach to their EHR. The company is taking full advantage of the lull in MU requirements by using the time to bring together designers, UI experts, physicians and office managers to design a brand new EHR. Dubbed the “connect the dots” strategy, AdvancedMD is centering their next generation on clinical and administrative workflows.

“When you think about it, healthcare is really just a journey of sequential workflows,” Dart explains. “A patient starts by experiencing symptoms, then moves to research physicians online, schedules an appointment, comes in for their visit, goes to get lab tests done, comes back to discuss the results and fills a prescription. What EHR companies have done is create whole bunch of point solutions for each one of these situations. What we haven’t done well is connect these all together with technology. We siloed everything. Instead what we need to realize is that each situation is actually a complex workflow and we journey from one workflow to another as patients. What we need now, and what AdvancedMD believes, is that we should build technology that enables these workflows – make them easier and more seamless for patients and physicians. Data collection, for example, should happen on devices that both doctors and patients already use and in a way that doesn’t detract from the visit.”

To illustrate that AdvancedMD is doing more than just giving their theory lip-service, Dart showed an early design prototype of an EHR interface that provides a longitudinal view of a practice. Instead of clicking down into one patient to order labs or renew prescriptions and then clicking down into the next patient to do the same, the new interface groups all lab orders together and all the prescriptions together. One click and the physician can see all that they need to do and clicks once to push the orders ahead. The new interface is highly intuitive and functional.

Juan Molina, VP of Strategy and Business Development at CareCloud also believes that EHRs need to radically change. “EHRs need to allow doctors and their staff to do their jobs better,” says Molina. “We have to stop asking doctors to be data entry clerks and documentation specialists. They need to go back to being 100% focused on the patient and providing care. As an industry we have focused too much on checking the box. We need to move beyond that through better use of technology – especially modern cloud-based architectures.”

Mollna is most excited about the potential of real-time analytics and Artificial Intelligence (AI) at the point of care. He feels that the promise of precision medicine and true personalized care will only be possible if “massive amounts of health data is crunched and context from that data delivered to the doctor at the time when they are seeing a patient.” CareCloud is using the freedom from compliance requirements to work on new partnerships for deep analytics, AI and patient experience (read about their partnership with First Data here).

It is refreshing to hear EHR companies talk about collaboration. Over the past several years it was frustrating to see vendors attempt to build everything themselves only to end up with inferior solutions to what was readily available in other industries from other vendors. Partnership and collaboration are a welcome shift in EHR strategy.

athenahealth is actively pursuing partnerships as part of their More Disruption Please (MDP) program. “We are constantly expanding and improving our cloud-based platform to align with our vision,” says Stephanie Zaremba, Director of Government and Regulatory Affairs at athenahealth. “We want to see a healthcare industry free from administrative burden, enabled to care for diverse and disparate populations, and one that ultimately lets doctors be doctors. We believe that the current paradigm of federal regulations hinders, rather than helps, our industry from making this vision a reality. The innovation we so desperately need can’t flourish in the confines of check-the-box requirements that do not grow and evolve with technological advances. But even if we’re stuck with the regulatory status quo, in the next five years, we hope that vendors will continue to embrace their collective potential, shifting from competitors to collaborators in an effort to create a more provider-friendly, patient-facing, and connective tech landscape that captures the full continuum of care.”

The announcement of the partnership between Pulse Systems and InteliChart at MGMA17 is a prime example of this newfound collaborative spirit. For years Pulse offered a perfectly serviceable patient portal, yet they recognized that they would never pour as much time and effort into that area of their solution versus a company like InteliChart.

“We are pursuing an open-EHR strategy,” explains Chris Walls, President & CEO of Pulse Systems. “Although we provide a comprehensive solution, we recognize that clients may not want every component from our stack. They may want to keep a best-of-breed solution that they already have in place. Rather than force our clients to change, we are working to ensure we can integrate and play nice with others.”

Pulse arrived at this open approach by listening closely to clients and prospects. What they found was an under-current of a best-of-breed approach. Physician offices wanted to use different tools and applications from different vendors but the lack of integration and internal IT resources forced them to go with a single monolithic solution instead.

Through this listening exercise, Pulse also realized that it was more than an EHR vendor to its clients. Many of their clients are smaller practices which do not have ready access to technical support. Rather than deflect their client’s calls for help with mundane things like anti-virus updates, internet connection issues and printer failures, they leaned into it. They created a dedicated IT Field Support team that handles calls for routine IT issues and will even fly out to help a client if needed.

By proactively helping their clients in this manner, Pulse has found that they reduce EHR issues down the road and they engender tremendous loyalty. When you think about it Pulse is essentially applying a Population Health approach to their own clients – offering preventative maintenance to avoid more costly support calls in the future.

Most impressive is how Greenway Health is using this lull in compliance requirements. “Now that we are freed from working on ONC compliance work, we are putting focus on customer requested enhancements” says Mark Janiszewski, EVP of Product Managmeent & Corporate Development at Greenway. “Much to the delight of our customers, we can now apply resources to the enhancements that they have asked for, but that were lower in priority compared to what was needed to comply with regulations and the Meaningful Use program.”

Greenway is also using their “found time” to take a serious look at EHR usability. They recognize that there is tension between physicians and EHR makers caused by the endless clicking and confusing user interfaces. Greenway is hoping to relieve that tension by collaborating with clients to improve their system. According to Janiszewski, the company has planned a series of customer visits where a team of designers and engineers can observe how people interact with their system over a 2-3 day period.

The team has already identified several areas of improvement after observing how admin staff were copying down ID numbers from one screen onto post-it notes in order to key it in on a different screen to bypass a lengthy click-path. The team is hard at work to ensure data is transferred across the system more seamlessly.

Over the next five years, Janiszewski believes that EHR companies will have to embrace the concept of multiple care settings and multiple data sources: “EHRs will need to have a higher degree of interoperability as patients move between care settings – from acute care to rehab to home care or from acute care to elder care. EHRs will also need to solve for Patient Generated Data. We are all wearing fitness trackers and using apps to track our health. This data needs to be incorporated in a meaningful way into the EHR. “

The responses from MGMA17 demonstrates that companies are well aware of the negative feelings healthcare providers have towards EHRs. What is very encouraging is that fixing the user interface is only one of many different solutions being pursued by EHR companies. Rather than myopically focusing on the shiny object in front of them, companies like Greenway, Pulse, athenahealth, CareCloud and AdvancedMD are taking a step back and looking at healthcare with a broader perspective in order to identify opportunities for improvement. It will be interesting to circle back with them a year from now to see what progress has been made.

CareCloud + First Data Partnership a Hopeful Sign of Things to Come

Posted on October 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Earlier today, CareCloud and First Data (NYSE: FDC) announced they have partnered to create Breeze, a new patient experience management platform. Built on First Data’s Clover infrastructure, Breeze’s mobile, web and kiosk based applications provide consumer-style convenience to patients while helping practices streamline workflows. Through Breeze, CareCloud customers will be able to offer patients the ability to book appointments, fill out medical forms, check-in remotely and manage payments from their phones.

“We looked outside of healthcare for inspiration on what patients want” says Juan Molina, VP of Strategy and Business Development at CareCloud. “What we found was that consumer interactions have changed from in-person transactions to online experiences. We wanted to give patients the same experience in healthcare that they are used to from the rest of the world through apps like Uber, OpenTable and Amazon.”

At a Breeze-enabled CareCloud practice, the “happy path” patient interaction would be as follows:

  • Patient is invited to Breeze by their doctor’s office through a text with a specific link
  • Patient downloads the Breeze app to their phone through that link
  • Patient books an appointment through the app
  • Prior to the appointment date, patient is reminded by the app to fill in paperwork which could include: demographic information, consent forms and insurance data (photo of insurance cards can be uploaded)
  • On the day of the appointment, patient can check in remotely
  • After the appointment, patient can manage payments through the app (credit card on file, Apple Pay, Android Pay or other options made available by the practice)

By automating parts of the appointment booking, patient intake and payment workflows, Breeze reduces the workload on front-line staff.

“From the moment that the patient walks in, they are happier, and my staff no longer has to spend time dealing with packets of registration papers. Our front office can now focus on patient care and delivering the excellent level of service that they deserve,” says Barbara Arbide, a practice manager who is using Breeze in her allergy practice in Coral Gables, FL.

The CareCloud and First Data partnership is encouraging. For many years now, EHR vendors have tried to build their own walled gardens where customers and partner companies could play nicely together. Unfortunately, a lack of useful application interfaces (APIs) and a high cost of entry for potential partners, resulted in a barren courtyard with high walls (aka a prison) for customers rather than a thriving garden.

By partnering with First Data, CareCloud is showing that it is a company willing to break from traditional EHR vendor thinking. They have opted to play in someone else’s ecosystem in order to bring more functionality to their customers at a faster pace.

First Data’s Clover platform already has hundreds of useful business apps built for it including employee scheduling tools, customer loyalty apps, inventory management systems and survey programs. By basing Breeze on Clover, CareCloud’s customers have access to this rich library of apps.

“After just two days of using Breeze,” Molina told EMRandEHR.com, “A practice in southern Georgia went and downloaded a time-and-attendance app for their system from the Clover library. This replaced a cumbersome Excel spreadsheet that they had been using. This helped the practice become more efficient and sophisticated.”

Could CareCloud have developed a time-and-attendance app on their own? I’m sure they could have. Would it have been a wise investment of their time? Probably not. Would it have been delivered in two days? Absolutely not. Although in theory CareCloud is forgoing potential revenue, their partnership with First Data allows them to focus on what truly matters – improving the clinical and practice operations side of their own platform.

What’s next for Breeze? According to Molina: “Patient expectations are only going to climb higher and higher as more and more consumer apps bring more sophistication into their lives. We have to pay attention to what’s happening outside of healthcare – how people are booking tickets online, speaking to Alexa, tracking their fitness with wearables and getting food from uberEats. Patients don’t want to be transported back to the 1980s when they come to a physician office where you have to fill out forms on a clipboard. With Breeze we have a flexible platform that can continue to grow and expand. We will be able to build new patient-centric applications faster, that help our clients with more and more of their workflows.”

Hopefully this new partnership is a sign of things to come.

Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

Integrating With EMR Vendors Remains Difficult, But This Must Change

Posted on October 4, 2016 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.

Eventually, big EMR vendors will be forced to provide a robust API that makes it easy to attach services on to their core platform. While they may see it as a dilution of their value right now, in time it will become clear that they can’t provide everything to everyone.

For example, is pretty unlikely that companies like Epic and Cerner will build genomics applications, so they’re going to need to connect using an API to add that functionality for their users. (Check out this video with John Lynn, Chris Bradley of Mana Health and Josh Siegel of CareCloud for more background on building a usable healthcare API.)

But as recent research points out, some of the vendors may be dragged kicking and screaming in that direction before they make it easy to connect to their systems. In fact, a new study by Health 2.0 concludes that smaller health IT vendors still face significant difficulties integrating with EMRs created by larger vendors.

“The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors,” wrote Health 2.0’s Matthew Holt on The Health Care Blog. “Most EMR vendors don’t make it easy.”

The study, which was supported by the California Health Care Foundation, surveyed more than 100 small health technology firms. The researchers found that only two EMR vendors (athenahealth and Allscripts) were viewed by smaller vendors as having a well-advertised, easy to access partner program. When it came to other large vendors, about half were happy with Epic, Cerner and GE’s efforts, while NextGen and eClinicalWorks got low marks for ease of integration, Holt reported.

To get the big vendors on board, it seems as though customer pressure is still critical at present, Holt says. Vendors reported that it helped a great deal if they had a customer who was seeking the integration. The degree to which this mattered varied, but it seemed to be most important in the case of Epic, with 70% of small vendors saying that they needed to have a client recommend them before Epic would get involved in integration project.

But that doesn’t mean it’s smooth sailing from there on out.  Even in the case where the big EMR vendors got involved with the integration project, smaller tech vendors weren’t fond of many of their APIs .

More than a quarter of those using Epic and Cerner APIs rated them poorly, followed by 30% for NextGen, GE and MEDITECH and a whopping 50% for eClinicalWorks. The smaller vendors’ favorite APIs seemed to be the ones offered by athenahealth, Allscripts and McKesson. According to Holt, athenahealth’s API got the best ratings overall.

All that being said, some of the smaller vendors weren’t that enthusiastic about pushing for integration with big EMR vendors at present. Of the roughly 30% who haven’t integrated with such vendors, half said it wasn’t worth the effort to try and integrate, for reasons that included the technical or financial cost would be too great. Also, some of the vendors surveyed by Health 2.0 reported they were more focused on other data-gathering efforts, such as accessing wearables data.

Still, EMR vendors large and small need to change their attitude about opening up the platform, and smaller vendors need to support them when they do so. Otherwise, the industry will remain trapped by a self-fulfilling prophecy that true integration can never happen.

Building a Usable Healthcare API

Posted on August 31, 2016 I Written By

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

I’ve long believed that a rock solid API is going to be required by healthcare IT software companies and EHR vendors in particular. If we want hospitals and doctors to be able to accomplish everything they need to accomplish, we need APIs to connect providers to services that will better serve the patients. EHR vendors aren’t going to do everything. With this in mind, we thought that it was time to start a discussion on how to build a usable healthcare API.

On Thursday, September 8th at 3:30 PM ET (12:30 PM PT), join us LIVE in our latest Healthcare Scene interview, as we discuss healthcare APIs with the following experts:

2016 September - Building a Usable Healthcare API-Headshots
There are a lot of people who talk generally about an API, but very few that have executed it well in healthcare. CareCloud and ManaHealth are two healthcare companies that are trying to implement a health care API in the right way, so we’re excited to sit down with them to talk about their experience building healthcare APIs.

If you’ve never watched one of our live video interviews, you can watch it live on this YouTube page (includes Live Chat room as well) or just visit this post on the day of the event and watch the video embedded below:

We look forward to shedding more light on what it takes to build a high quality, usable healthcare API.

Be sure to Subscribe to Healthcare Scene on YouTube to be updated on our future interviews or watch our archive of past Healthcare Scene Interviews.

$5 million for a PMS and Revenue Cycle Management

Posted on October 13, 2010 I Written By

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

I’d been meaning to post this for a while. It’s the news that the company CareCloud got a $5 million round of financing after their initial $2.3 million round of financing. Here’s the description of Care Cloud from the Techcrunch post:

A cloud-based app suite, CareCloud attempts to modernize the process of being a healthcare provider; physicians can use CareCloud’s web-based apps to streamline the managing of their businesses as well as collaborate with other doctors in the CareCloud’s healthcare provider social network.

The interesting part of this to me is that when I visited the CareCloud website it seems that they are basically a PMS and Revenue Cycle Management company. That seems like a lot of funding for such a niche.

The website does mention the healthcare provider social network which kind of sounds like a health information exchange, but really doesn’t give any details of how CareCloud plans to connect all these doctors together. Plus, without an EHR software or connections to other EHR software, what information are they planning to share?

I guess I’m still trying to get the vision of what $2.3 million was spent on initially and where they plan on spending the next $5 million. That’s a lot of cash if they’re just going to be a PMS and Revenue Cycle Management company. Of course, maybe they just need to spend some of that $5 million and update their website to portray what they’re really trying to do.