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Patient Directed Health Data Exchange on The Blockchain

Posted on September 7, 2018 I Written By

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

I’ve long been friends with Dr. Tom Giannulli who most of you will probably have known as the CMO of Kareo. I first met Dr. Tom back when he created what I would call the first iPad optimized EHR interface back when Dr. Tom was at Epocrates and before they sold that EHR to Kareo. Needless to say, Dr. Tom is the kind of guy that likes to sit on the cutting edge of technology and how it applies to healthcare. So, it was no surprise to me when he came to me with his patient directed health data exchange called PatientDirected.io which is built on the blockchain.

While a lot of people talk about blockchain and theories about how blockchain could help healthcare, a lot of what people were doing was just talk. What I like about Dr. Tom and PatientDirected.io is that they just put out a video demo of a patient chart being requested from Kareo by the patient and then the patient sending that chart to Epic. Check it out to see what I mean:

Many of you that watch this demo might be asking. How is this on the blockchain? That’s one of the things that many people don’t understand about blockchain. If it’s done right, you won’t know anything about the blockchain. However, the blockchain can do things like creating smart contracts with providers which can create trusted connections. The blockchain is distributed, so your data isn’t stored on a central server that’s owned and controlled by PatientDirected.io. Basically, blockchain has a number of benefits, but it’s the “Intel Inside” and so it’s not something you should see as an end user, but it could provide some great benefits.

I also like that PatientDirected.io isn’t trying to reinvent the wheel. They’re using trusted third party applications like Verato to handle their master patient index and for verifying patients identity. There’s a lot more to explore when it comes to identity management, but it’s smart to work with companies that are doing this all across healthcare.

I was also impressed with the detailed sharing permissions that were available in PatientDirected.io. At first glance, a part of me wonders if it’s too complex for most patients. However, as long as the options are there, the interface can adapt to allow for specific patient preferences when it comes to data sharing. Of course, it’s nice that all of the sharing of this data will be tracked on the blockchain.

The key to all of this working for me is the integration with the EHR vendor. It looks like it’s using Direct to handle the messaging to the EHR vendor and back. This is good because I believe all certified EHR (which is pretty much all of them) have direct messaging built in. Some have integrated it better than others, but they all have this capability. My big concern with it though is whether what’s being shared by EHR vendors using Direct is enough data. And will that data that gets sent from one EHR to another appear in a format that’s useful to the receiving physician? If it’s not, then it doesn’t solve much of anything. Plus, I wonder what happens when a doctor gets a record request and doesn’t respond. This is especially true for EHR vendors who haven’t integrated Direct into the core EHR workflow. Will this take a culture change to not leave patients waiting for records that will never come?

As you could imagine, PatientDirected.io has an ICO offering on StartEngine.com. Looks like it just got started, but there’s an opportunity to buy their tokens if you’re interested and believe they’re on to something special.

I think there is a space for a patient directed health information exchange assuming we can make the exchange of information between disparate providers very simple. There are still some challenges for patients when it comes to getting access to their health information, but the law is clear that patients should have access to their health information. Now we just need the user interfaces to be as simple as clicking a button like is demonstrated in the video above and we’ll see much more patient directed health information exchange.

Real-world Health AI Applications in 2018 and Further

Posted on August 29, 2018 I Written By

The following is a guest blog post by Inga Shugalo, Healthcare Industry Analyst at Itransition.

In contrast to legacy systems that are just algorithms performing strict tasks, artificial intelligence can extend the task itself, creating new insights from the information fed to it. Current healthcare AI is powerful enough to undertake such complex challenges as automated diagnosis, medical image analysis, virtual patient assistance, and risk analysis, supporting health specialists in making more swift and informed decisions.

In 2016, Frost & Sullivan predicted the healthcare AI market to reach $6.6 billion by 2021. Meanwhile, 2017’s Accenture report estimates AI saving $150 billion annually for the U.S. healthcare economy by 2026. “At hyper-speed, AI is re-wiring our modern conception of healthcare delivery,” researchers from Accenture say.

Standing in the middle of 2018, the industry already hints on its course regarding further AI expansion. Spoiler alert: as well as with blockchain AR, VR, and any other kind of innovative custom medical software, the adoption challenges persist.

Current and prospective AI directions in healthcare

Diagnosis support

One of the most fascinating and valuable directions for AI to evolve is its ability to help providers diagnose patients more accurately and at a higher pace. We are thrilled to see how 2018 erupts with many healthcare organizations adopting artificial intelligence and creating unprecedented cases of assisted diagnostics with it.

Geisinger specialists applied AI to analyze CT scans of patients’ heads and detect intracranial hemorrhage early. Intracranial hemorrhage is a life-threatening form of internal bleeding, affecting about 50,000 patients per year, with 47% dying within 30 days.

Geisinger was able to automatically pinpoint and prioritize the cases of intracranial hemorrhage, focusing the attention of radiologists on them and thus allowing for timely interventions. This approach reduced the time to diagnosis by 96%.

Mayo Clinic currently uses IBM Watson’s superpowers to match patients with fitting clinical trials. The clinic’s officials stated that only 5% of patients enrolled in trials in the U.S., which significantly hinders clinical research and innovation in cancer therapies. On the other side, manual patient-trial matching is a time-exhausting process.

Watson runs this process on the background, comparing the patients’ conditions with available trials and suggesting the appropriate trials for providers and patients to consider including in a treatment plan. Since its implementation in 2016, Watson was able to deliver about an 80% increase in enrollment to Mayo’s trials for breast cancer.

Patient risk analysis

“…Healthcare is one of the most important fields AI is going to transform,” Google CEO Sundar Pichai noted during the Google I/O 2018 keynote. Last year, the event presented Google AI, a “collection of our teams and efforts to bring the benefits of AI to everyone.”

In 2018, Google uses their AI to tap into critical patient risks, such as mortality, readmission, and prolonged LOS. Cooperating with UC San Francisco, The University of Chicago Medicine, and Stanford Medicine, they analyzed over 46 billion anonymized retrospective EHR data points collected from over 216 thousand adult patients hospitalized for at least 24 hours at two US academic medical centers.

The deep learning model built by researchers reviewed each patient’s chart as a timeline, from its creation to the point of hospitalization. This data allowed clinicians to make various predictions on patient health outcomes, including prolonged length of stay, 30-day unplanned readmission, upcoming in-hospital mortality, and even a patient’s final discharge diagnosis. Remarkably, the model achieved an accuracy level that significantly outperformed traditional predictive models.

According to Pichai, “If you go and analyze over 100,000 data points per patient, more than any single doctor could analyze, we can actually quantitatively predict the chance of readmission 24 to 48 hours earlier than traditional methods. It gives doctors time to act.”

Of course, researchers don’t claim that their approach is ready for implementation in clinical settings, but they are looking forward to collaborating with providers to test this model further. Hopefully, we will see field trials and, who knows, even early adoption in 2019.

EHRs “on steroids”

HIMSS18 was all about artificial intelligence and machine learning. Surprisingly, all major EHR vendors – Allscripts, Cerner, athenahealth, Epic, and eClinicalWorks – came up with a promise to include AI into upcoming iterations of their platforms.

At the event, Epic announced a new partnership with Nuance to integrate their AI-powered conversational virtual assistant into the Epic EHR workflow. Particularly, the assistant will enable health specialists to access patient information and lab results, record patient vitals as well as check schedules and manage patient appointments using voice.

Similarly, eClinicalWorks puts AI into work on voice control but also prioritizes telemedicine, pop health, and clinical decision support. According to the company’s CEO Girish Navani, “We spent the last decade putting data in EHRs. The next decade is about intelligence and creating inferences that improve care outcomes. We can have the computer do things for the clinician to make them aware of actions they can take.” The new EHR’s launch is expected in late 2018 or early 2019.

Athenahealth also added a virtual assistant into their EHRs to improve mobile connectivity and welcomes NoteSwift’s AI-based Samantha technology to enhance clinical workflows by introducing robust automation. Samantha can grasp free-text and natural language, process information, structure it, assign ICD-10, SNOMED or CPT codes, prepare e-prescriptions and orders.

Pre-existing challenges for healthcare AI adoption

Gartner predicted that 50% of organizations will miss AI and data literacy skills to gain business value by 2020. Certainly, a lot of healthcare organizations will get in this 50%, and there are two reasons for that.

Regulations and security concerns are the main pre-existing challenges that delay practically any technology adoption in healthcare and entail an array of new challenges along with them.

First, an AI application or device has to be approved by the FDA. The catch is that the existing process focuses on the hardware or the way that algorithms work, but not the data it should or would interact with.

Speaking of data, another challenge is security breaches. Safeguarding sensitive information is a must for healthcare because patient data is a constant target for identity theft and reimbursement fraud. In Accenture’s new report, nearly 25% of healthcare execs admitted experiencing “adversarial AI behaviors, like falsified location data or bot fraud.” While this doesn’t mean AI threatens patient data, such claims do increase the concerns related to its adoption.

Still, artificial intelligence is growing in healthcare and will continue to do so. Maybe not at rocket speed, but the most recent cases show consistent improvements in major care delivery gaps. Healthcare AI’s future appears bright.

About Inga Shugalo
Inga Shugalo is a Healthcare Industry Analyst at Itransition. She focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Inga’s articles explore diagnostic potential of healthcare IoT, opportunities of precision medicine, robotics and VR in healthcare and more.

Comprehensive Health Record Vs. Connected Health Record

Posted on March 26, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

Top 10 Blog Posts on EMR and EHR from 2017

Posted on January 4, 2018 I Written By

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

As we kick off 2018, I thought it would be fun to look back at the top 10 blog posts (based on views) in 2017 for EMR and EHR. It’s always great to see what people found interesting and which topics were of interest to readers. Plus, I’m always fascinated to see what old articles are still of interest to people. Not to mention, to look at what has changed since the article was written.

Facebook in Healthcare – What’s amazing about this blog post is that it’s from 2014. Looking back 3+ years later, I haven’t really seen Facebook become a big player in healthcare. Sure, there are plenty of patient groups on Facebook, but it’s not really a Facebook product. Facebook has done a number of things in healthcare over the years to get the word out about organ donation and things like that, but I currently don’t see them as a big player in healthcare the same way Amazon, Google, and Apple are looking at healthcare.

What the EMR Industry Can Learn From Facebook – Amazing that another article about Facebook was in the Top 10 and this one from 2012 was written by Priya Ramchandran. Her vision of a world where a patients health record was just automatically pushed down to a server every time we have a health encounter has been far from realized. The challenge of the comparison for me is that Facebook has a reason to push all that data together. In healthcare, there are reasons why organizations don’t want to push the data out to the patient. Until we change those reasons, we won’t see this vision despite hundreds of companies efforts to try and accomplish it. Yes, even Apple is working on solving this problem now and I think they’ll fail.

Epic Launches FHIR-Based App Platform – Epic’s launch of the Epic App Orchard platform was big news in 2017. I’ll admit that I’m still a bit skeptical about Epic App Orchard. Many herald it as Epic opening up their EHR to developers. I personally am skeptical and fear that it’s really just making public the connections they were already creating and is more PR than anything. Epic App Orchard isn’t a truly open API that would allow innovators and entrepreneurs to build on top of the Epic EHR. Plus, I fear that Epic App Orchard is just a new revenue stream for Epic. Those are my fears that I’ll be exploring as I talk to people in 2018 about it.

Publicly Traded Health IT Companies – I wouldn’t have thought of this blog post as one that would have garnered a lot of attention. Maybe that means we should do more work covering the publicly traded healthcare IT companies on this blog. They seem to be increasingly dominating the landscape.

Artificial Intelligence in Healthcare: Medical Ethics and the Machine Revolution – One of the great additions to EMR and EHR this year was Janae Sharp and this blog post was an excellent example of her work. Understanding the impact of AI in healthcare is going to be an extremely important topic over the next decade. I’m glad she kicked off the conversation since it’s a challenging one. I still keep thinking about the question she asked, “Can a machine learn empathy?” Chew on that one for a while.

EHR Innovation & Regulation: Friends or Foes? – I’m really glad that this post by Stephen Dart from AdvancedMD did so well. I think most doctors don’t appreciate the challenging situation EHR vendors are in when it comes to balancing compliance and innovation. I believe it’s the core of what’s wrong with most EHR software out there and contributes to a lot of physician burnout.

Is Cerner Edging Up On Epic? – This post was from 2016, but the question is still a good one. The reality is that both Cerner and Epic are doing amazingly well. I don’t see anything on the horizon that’s going to change it. Both of them are behemoths that are doing incredibly well. I don’t really see either of them cutting into the progress of the other either. What do you think?

Is Your Health Data Unstructured? – Enabling an AI Powered Healthcare Future – I still love the insight shared in this article. Technology doesn’t solve your problems. Technology amplifies your current state. If you’re doing a good job, technology will accelerate the good. If you’re doing poorly on something, technology will accelerate and amplify the bad.

#HIMSS17 Mix Tape – This is just a fun post leading into HIMSS that Colin has done every year with us for a lot of years. The exciting part is that when Colin posted this he was still working at a Healthcare IT vendor. We’re lucky to now have him formally as part of the Healthcare Scene team. I’m quite sure Colin will be doing a #HIMSS18 Mix Tape shortly. So, if you have suggestions, reach out to him on Twitter.

12 Reasons Why EMRs Improve Patient Care – How amazing that this post from 2011 is still doing so well. I imagine it’s because so many people are trying to understand the value of the EHR. Especially as it related to improving patient care. This post really deserves a future dedicated blog post to look at the 12 ways EMR improve patient care and how many of them have been realized. I’ll put it on my to-do list for 2018.

There you have it. The top 10 blog posts on EMR and EHR for 2017. It’s always fun to look back and see what’s changed and what’s stayed the same. Thanks to each of you for reading and supporting the work we do here. Now on to an awesome 2018!

A Look At Share Everywhere, Epic’s Patient Data Sharing Tool

Posted on September 28, 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.

Lately, it looks like Epic has begun to try and demonstrate that it’s not selling a walled garden. Honestly, I doubt it will manage to convince me, but I’m trying to keep an open mind on the matter. I do have to admit that it’s made some steps forward.

One example of this trend is the launch of App Orchard, a program allowing medical practices and hospitals to build customized apps on its platform. App Orchard also supports independent mobile app developers that target providers and patients.

Marking a break from Epic’s past practices, the new program lets developers use a FHIR-based API to access and Epic development sandbox. (Previously, Epic wouldn’t give mobile app developers permission to connect to its EMR unless a customer requested permission on its behalf.) We’ll have to keep an eye on the contracts they require developers to sign to see if they’re really opening up Epic or not.

But enough about App Orchard. The latest news from Epic is its launch of Share Everywhere, a new tool which will give patients the ability to grant access to their health data to any provider with Internet access. The provider in question doesn’t even have to have an EHR in place. Share Everywhere will be distributed to Epic customers at no cost in the November update of its MyChart portal.

Share Everywhere builds on its Care Everywhere tool, which gives providers the ability to share data with other healthcare organizations. Epic, which launched Care Everywhere ten years ago, says 100% of its health system customers can exchange health data using the C-CDA format.

To use Share Everywhere, patients must log into MyChart and generate a one-time access code. Patients then give the code to any provider with whom they wish to share information, according to a report in Medscape. Once they receive the code, the clinician visits the Share Everywhere website, then uses the code once they verify it against the patient’s date of birth.

As usual, the biggest flaw in all this is that Epic’s still at the center of everything. While patients whose providers use Epic gain options, patients whose health information resides in a non-Epic system gain nothing.

Also, while it’s good that Epic is empowering patients, Direct record sharing seems to offer more. After all, patients using Direct don’t have to use a portal, need not have any particular vendor in the mix, and can attach a wide range of file formats to Direct messages, including PDFs, Word documents and C-CDA files. (This may be why CHIME has partnered with DirectTrust to launch its broad-based HIE.)

Participating does require a modest amount of work — patients have to get a Direct Address from one of its partners — and their provider has to be connected to the DirectTrust network. But given the size of its network, Direct record sharing compares favorably with Share Everywhere, without involving a specific vendor.

Despite my skepticism, I did find Share Everywhere’s patient consent mechanism interesting. Without a doubt, seeing to it that patients have consented to a specific use or transmission of their health data is a valuable service. Someday, blockchain may make this approach obsolete, but for now, it’s something.

Nonetheless, overall I see Share Everywhere as evolutionary, not revolutionary. If this is the best Epic can do when it comes to patient data exchange, I’m not too impressed.

Say It One More Time: EHRs Are Hard To Use

Posted on September 19, 2017 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

Healthcare Execs Have Varied Opinions On Patient Access To Medical Data

Posted on September 8, 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, I wrote an item about an alleged exchange between Epic CEO Judy Faulkner and former Vice President Joe Biden. Reportedly, Faulkner questioned whether patients actually need their full medical records or are capable of understanding them.

Even if that particular exchange didn’t take place as written (Epic challenges the account) it still leaves me wondering whether her supposed views are widespread in the industry.

Now, I may have at least one answer. A recent write-up in Becker’s Hospital Review suggests that healthcare leaders are conflicted as to what part of medical records patients need, the circumstances under which they should have access to their records and if patients should own them. The article, which includes comments from five different healthcare execs, includes a wider range of view than I had expected.

For example, Daryl Kallevig, CIO of Aitkin, MN-based Riverwood Healthcare Center, argues that there are times when it might not be beneficial to let the patient see their entire record:

“Physicians and clinicians document in notes things they would hope patients may never see – [like] mental health patients or drug-seeking patients that come into our emergency room…[Also], if they’ve had an ongoing relationship for a number of years, would that patient or that physician want to see that compromised by a statement in a medical note? There has to be discretion in what is released to the patient.”

Keith Safian, former president and CEO of Sleepy Hollow, N.Y.-based Phelps Hospital, has a problem with the idea of patients owning their data:

“Patients should have unlimited access to the data, but since they did not create it and are not responsible for maintaining it, they do not own it…If the patient owned it, he or she could demand a hospital or practice destroy ‘his’ or ‘her’ medical record, which a hospital cannot do for many reasons.”

Another interviewee, CEO Grant Geiger of New York City-based EIR Healthcare, suggests that as clinical and technical models change, the whole notion of patient data stewardship will evolve:

“As we [look] beyond the EHR and we think about the adoption of [Internet of things] functionality… we need new guidelines and regulations in place for the future of healthcare. We are going to collect more data from patients in the next five years than we have in the past 10.”

In the interest of simplicity, I’ve edited out some of the nuances from these comments. Regardless, I think you will agree with me that they offer some food for thought.

I do have a couple of things I’d like to challenge:

  • Having written about the success of the Open Notes project, I’m not sure I agree with Kallevig that patient should be protected from the content of their records. My feeling is that in most cases, the patient would rather know what they say and deal with any comments they don’t like than miss important notes because of the care.
  • I take issue with Safian’s notion that patients shouldn’t own their records because it might be inconvenient for providers. Even if patients don’t own the records, or want to do something with them that’s impermissible by law, providers should at least think of patient is having moral ownership of the information. Any records request they make should be honored if possible, evaluated in light of their needs rather than it affects the healthcare organization.

That being said, I largely found the comments to be worth reading and considering. We can’t spend too much time thinking about patient access to records, not only for ethical reasons but also because we need to figure out how to use records to build engagement.

How about you, readers? To what extent would you like to see patients have access to and/or on their medical records? And why?

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.

Did Meaningful Use Really Turn EMRs Into A Commodity?

Posted on July 12, 2017 I Written By

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

Not long ago, I had a nice email exchange with a sales manager with one of the top ambulatory EMR vendors.  He had written to comment on “The EMR Vendor’s Dilemma,” a piece I wrote about the difficult choices such vendors face in staying just slightly ahead of the market.

In our correspondence, he argued that Meaningful Use (MU) had led customers to see EMRs as commodities. I think he meant that MU sucked the innovation out of EMR development.

After reflecting on his comments, I realized that I didn’t quite agree that EMRs had become a commodity item. Though the MU program obviously relied on the use of commoditized, certified EMR technology, I’d argue that the industry has simply grown around that obstacle.

If anything, I’d argue that MU has actually sparked greater innovation in EMR development. Follow me for a minute here.

Consider the early stages of the EMR market. At the outset, say, in the 50s, there were a few innovators who figured out that medical processes could be automated, and built out versions of their ideas. However, there was essentially no market for such systems, so those who developed them had no incentive to keep reinventing them.

Over time, a few select healthcare providers developed platforms which had the general outline EMRs would later have, and vendors like Epic began selling packaged EMR systems. These emerging systems began to leverage powerful databases and connect with increasingly powerful front-end systems available to clinicians. The design for overall EMR architecture was still up for grabs, but some consensus was building on what its core was.

Eventually, the feds decided that it was time for mass EMR adoption, the Meaningful Use program came along. MU certification set some baselines standards for EMR vendors, leaving little practical debate as to what an EMR’s working parts were. Sure, at least at first, these requirements bled a lot of experimentation out of the market, and certainly discouraged wide-ranging innovation to a degree. But it also set the stage for an explosion of ideas.

Because the truth is, having a dull, standardized baseline that defines a product can be liberating. Having a basic outline to work with frees up energy and resources for use in innovating at the edges. Who wants to keep figuring out what the product is? There’s far more upside in, say, creating modules that help providers tackle their unique problems.

In other words, while commoditization solves one (less interesting) set of problems, it also lets vendors focus on the high-level solutions that arguably have the most potential to help providers.

That’s certainly been the case when an industry agrees on a technology specification set such as, say, the 802.11 and 802.11x standards for wireless LANs. I doubt Wi-Fi tech would be ubiquitous today if the IEEE hadn’t codified these standards. Yes, working from technical specs is different than building complex systems to meet multi-layered requirements, but I’d argue that the principle still stands.

All told, I think the feds did EMR vendors a favor when they created Meaningful Use EMR certification standards. I doubt the vendors could have found common ground any other way.

E-Patient Update: The Kaiser Permanente Approach To Consumer Health IT, Second Stanza

Posted on July 7, 2017 I Written By

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

As some of you may recall, I recently wrote a positive review of Kaiser Permanente’s use of consumer-facing health IT. (Kaiser Permanente is both my health insurer and provider.) Their offerings have a number of strengths including:

  • Interfaces: The kp.org site is decent, and the KP app highly usable
  • Access to care: Booking medical appointments is easy, as is cancelling them
  • Responsiveness: Physicians are quick to replay to email via the Kaiser portal
  • Connectedness: Thanks to being on a shared Epic platform, every provider knows my history (at least for the time I’ve spent within the KP system, which is pretty useful)

At the time, I also noted that I had a few minor concerns about the portal features and whatnot, but I was still a fan of KP’s setup.

By and large, my perceptions of Kaiser’s consumer health IT strengths haven’t changed. However, after a couple of months in the system, I’ve gotten a good look at its weaknesses as well. And I thought you might be interested in the problems Kaiser faces in connecting consumers, particularly given its use of best practices in many cases.

All told, these weaknesses suggest that over more than ten years after its Epic rollout, KP leaders still haven’t put their entire consumer health IT strategy in place. Here are a couple of my concerns.

Specialist appointments aren’t integrated

The biggest gripe I have with Kaiser’s interactive tools is that while I can schedule PCP appointments myself, I haven’t been able to set specialist appointments without speaking to a real live person. (My primary care doctor seems to be able to access specialist schedules and set appointments with them on my behalf.)

This may work for someone with no significant health problems, but creates a significant burden for me. After all, as someone with multiple chronic illnesses, I schedule a lot of specialist consults. You don’t realize how much time it takes to set each appointment with a clerical person until you’ve done it for five times in a week.  Try it sometime.

You might assume that this is a rationing measure, as organizations like KP are pretty strict about limiting access to specialist care. The truth is, that doesn’t seem to be the case. At least when it comes to my primary care physician (a big shout out to my PCP, Dr. Jason Singh) it doesn’t seem to be unduly hard to get access to specialists when needed.

No, I have concluded that the reason I can’t schedule specialist appointments online is that KP still hasn’t gotten their act together on this front. My guess is that the specialist systems live in some kind of silo, one that KP hasn’t managed to break down yet.

Mobile and web tools clash

As noted above, I’m largely satisfied with both KP’s consumer portal and its mobile app. True, the website sprawls a bit when it comes to presenting static content — such as physician bios — but the portal itself works fine. The mobile app, meanwhile, is great to use, as it presents my choices clearly and uses screen real estate effectively.

That being said, it annoys the heck out of me that there are minor but seemingly pointless, differences between how the portal and the mobile app function. It would be one thing the app was a shrunken down version of the website, offering a parallel but more limited version of available functions, but that isn’t how it works.

Instead, the services accessible through the portal and via the mobile app vary in small but irritating ways. For example, when emailing providers, you must choose a prewritten subject line from a drop-down menu. And I don’t know why, but the list of subjects available on the web portal version varies significantly from the list of subjects you can access via the mobile app.

There may be a rational reason for this. And mine may sound like a petty objection. But when you’re trying to address something as important as your healthcare, you want to know what’s going on with every detail.

I’d identify other ways in which the app and website portal vary, but I don’t have any other examples I can recall. And that’s the whole point. You don’t remember how the site and/or portal function until you stumble into another incompatibility. You roll your eyes and move on, but you see them again and waste one more spark of energy being annoyed.

It’s all about tradeoffs

So, you might ask if there’s any broad lesson to be taken from this. Honestly, probably not. I don’t like that KP’s tools pose these problems, but they don’t strike me as unusual.

And do my criticisms have any meaning for other healthcare organizations? Nothing more than a reminder that patients will take note of even small problems in your health IT execution, particularly when it comes to tools they rely upon to get things done.

In the end, of course, it’s all about trade-offs, as with any other industry. I don’t know whether KP chose to prioritize a potentially dangerous problem in provider-facing technologies over consumer quibbles, or just don’t know what’s going on. Perhaps they know and have added the fix to a long list of pending projects, or perhaps they don’t have their act together.

Still, lest it is lost in the discussion, remember I’m the customer, and I really don’t care about your IT problems. I just want to have tools that work every time and simplify my life.

So this is my official challenges to Kaiser leadership. For Pete’s sake, KP, would you please help me cut down on the specialist phone calls? Perhaps you could create a centralized specialist appointment call center, or use carrier pigeons, or let me suss out their schedules using my vast psychic powers — hey, they’re all options. Or maybe, just maybe, you can let me schedule the appointments online. Your call.