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Patients Expect Retail-Style Digital Health Experiences

Posted on March 30, 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 retail industry has been pretty successful in integrating digital tools into their business. All major retailers have customized apps of their own, many if not all retail sites offer chatbots to answer questions and virtually all have spent countless millions on their e-commerce websites.

Healthcare organizations, on the other hand, are far behind when judged by these standards. That’s particularly true in the case of medical practices, few of which offer much in the way of digital sophistication. In fact, in most cases the most patients can hope for is a basic portal offering data, scheduling and bill payment options. (Ok, at times, bigger offices may toss in a kiosk or two, but that’s not a huge service upgrade.)

According to one study, however, consumers are losing patience with this gap. New research by NTT DATA Services has concluded that 59% of US consumers expect their healthcare digital experience to be comparable to their retail digital experience. This is part of a larger trend in which patients are looking for seamless care bringing together diagnosis, treatment, rehab and health promotion, according to Alan Hughes of NTT in a prepared statement.

Some of consumers’ frustrations around mobile options include not being able to accomplish what they wanted to do (62%), feeling that the options offered are not relevant to them (42%) and that entering data into forms took too long to complete (40%). This is not exactly a good report card.

Meanwhile, patients have a long list of services they feel could be improved, including searching for a doctor or specialist (81%), accessing their family health records (80%), making or changing an appointment (79%), accessing test results (76%), paying their bills (75%) and filling a prescription (74%). In other words, consumers see most of the digital services provided by medical practices as subpar. Again, this is not encouraging news.

What’s more, within the general population of consumers, there is one subsection of patients who are particularly demanding, a group NTT has dubbed “explorers.” ITT research found that 78% of explorers say that the digital healthcare experience must improve. Perhaps even more importantly, 50% of these explorers would leave their current doctor if another offered a better digital experience.

If healthcare providers can barely meet the needs of the general population, they’re likely to lose these explorers pretty quickly if they don’t get their act together. Medical practices, in particular, need to step up their digital health game.

Does HIMSS Serve Practicing Doctors Well?

Posted on March 5, 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.

Take a look around you at HIMSS18 and you will see a lot of different types. Of course, the biggest and flashiest presence will be the hordes of vendor marketing and salespeople. You’ll also run into C-suite and mid-level executives with health systems in hospitals or managing partners of large medical practices, along with a grab bag of consultants, researchers, attorneys and bloggers like myself.

What you seldom see, however — and this has been true for decades — are physicians active in day-to-day medical practice. I’m sure the reasons for this vary, including a reluctance to spend the time and money to attend and questions about the show’s immediate value, but regardless, practicing doctors are sorely underrepresented at the annual HIT blast.

In the past, I might’ve suggested that the reason they aren’t showing up was lack of interest. After all, in the past, most physicians had very little contact with their IT infrastructure. Sure, they interacted with billing and coding systems, and to a lesser extent practice management platforms, but that was about it.

That’s hardly the case today, though. For most doctors, it’s smartphones in the morning, tablets in the afternoon and EMRs all day. What’s more, some practices are integrating connected health monitoring and wearables data to the mix and some are rolling out telemedicine services.  While few doctors have to dig into the guts of these tools, they’re increasingly dependent upon them and in some cases, and hardly function without daily access.

Given the extent to which these tools are ultimately designed to serve clinicians at the point of care, it’s disconcerting how seldom HIMSS attendees seem to put clinicians’ IT challenges front and center.

Perhaps I’m being unfair, but my sense is that most of the show is designed to serve health systems CIOs, practice leaders with complex IT needs and to a lesser extent, the influencers that guide sales decisions (such as analyst firms). I’m not saying small-practice doctors get ignored, but from what I’ve seen they don’t get catered to either. In fact, many companies focused on small practices have stopped exhibiting at HIMSS because of this and instead focus on the various medical society conferences.

Sadly, this reflects the larger dynamic in which vendors work to strike deals with senior executives first, putting physician needs largely aside. Rather than seeing to it that the actual end users find the products to be workable, they accept the reality that most cases, non-physicians are calling the shots.

For the benefit of the entire health IT community, I hope that in successive years, HIMSS does far more to attract the 10-doctor and below practices that make up the backbone of the medical community. Letting the deepest pockets in health IT systems dictate everything is simply toxic.

Three-Quarters Of Medical Practices Aren’t Getting Full Value From Their EHR

Posted on February 6, 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.

Given how many EHRs seem to feature position-hostile designs, it’s hardly surprising to learn that many medical practices aren’t getting the most from them. However, I was taken aback by how deep this underutilization seems to run.

A new study appearing in the American Journal of Managed Care has concluded that a whopping 73% of practices weren’t using their EHRs to the fullest extent and that another 40% make little or no use of health IT functions. Even given the obstacles to using EHRs, this seems like a big waste of money, time and potential, doesn’t it?

To conduct the study, researchers used data from a relevant HIMSS Analytics survey. The data included responses from 30,123 ambulatory practices with an operational EHR in place, most with fewer than seven affiliated doctors in place.  Researchers sifted the data to determine the extent to which these practices were using EHR-based health IT functionalities.

Of course, some medical groups were on top of their game. Researchers found that 26.6% of practices could be classified as health IT super-users that squeezed every benefit from their systems. As you might guess, the likelihood that a practice was a super-user grew as the number of affiliate doctors increased, as well as when the practice was located in a metropolitan area. But far more groups seem to have fallen well behind the leaders.

According to the data, among practices using CPOE tools, only 36% used them for more than 75% of orders. Also, while groups commonly used basic functions such as data storage, with 100% of practices storing transcribed reports electronically and 61% using the EHR for nursing documentation, most lagged in other areas. For example, only 29% used tools allowing them to find and modified orders for all patients on a specific medication.

To address this gap, researchers say, policymakers should consider how to address the barriers PCP and specialist practices face in using the health IT tools more fully. Understanding how this disparity has emerged and how to address it is critical, they suggest, as less sophisticated use of EHRs may have an impact on care quality and also on groups’ ability to participate in community efforts such as HIEs.

The truth is, if the under-utilizer practices don’t get some kind of help or support, it’s unlikely they’ll step up their use of EHR functions. Particularly if they’ve had the system in place for a while, the workflow is baked into the system and physician habits established. Maybe the pressure to provide value-based care will do the trick, but it remains to be seen. This is a problem that won’t go away quickly.

E-Patient Update: Doctors Need To Lead Tech Charge

Posted on April 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.

Doctors, like any other group of people, vary in how comfortable they are with technology. Despite the fact that their job is more technology-focused than ever before, many clinicians use tech tools because they must.

As a result, they aren’t great role models when it comes to encouraging patients to engage with portals, try mobile apps or even pay their healthcare bills online. I too am frustrated when doctors can’t answer basic tech questions, despite my high comfort level with technology. I like to think that we’re on the same page, and I feel sort of alienated when my doctors don’t seem to care about the digital health advantage.

This needs to change. Given the extent to which technology permeates care delivery, physicians must become better at explaining how basic tech tools work, why they’re used and how they benefit patients.

Below, I’ve listed three tools which I consider to be critical to current medical practices, based on both my patient experiences and my ongoing research on health IT tools. To me, knowing something about each of them is unavoidable if doctors want to keep up with trends and improve patient care.

The top three tools I see as central to serving patients effectively are:

  • Patient portals: This is arguably the most important technical option doctors can share with patients. To get the most value out of portals, every doctor – especially in primary care – should be able to explain to patients why accessing their data can improve their health and lives.
  • Connected health: For a while, connected health/remote monitoring solutions were a high-end, expensive way to track patient health. But today, these options are everywhere and accessible virtually anyone. (My husband bought a connected glucose monitor for $10 a few weeks ago!) If nothing else, clinicians should be able to explain to patients how such devices can help tame chronic diseases and prevent hospitalizations.
  • Mobile apps: While few apps, if any, are universally trusted by doctors, there’s still plenty of them which can help patients log, measure and monitor important data, such as medication compliance or blood pressure levels. While they don’t need to understand how mobile apps work, they should know something of why patients can benefit from using them.

Of course, this list is brief, but it’s a decent place to start. After all, I’m not suggesting that physicians need to get a master’s in health IT to serve patients adequately; I’m just recommending that they study up and prepare to guide their patients in using helpful tools.

Ultimately, it’s not as important that clinicians use or even have a deep understanding of digital health tools, health bands, smartwatches, sensor-laden clothing or virtual reality. They don’t have to understand cybersecurity or know how to reboot a server. They just have to know how to help patients navigate the healthcare world as it is.

By this point, in fact, I’d argue that it’s irresponsible to avoid learning about technologies that can help patients manage their health. Bear in mind that even if they don’t act like it, even confident, experienced patients like me truly admire our doctors and take what they say seriously. So if I am enthusiastic about using tech tools to manage my health, but my doctor’s eyes glaze over when I talk about them, even I feel a bit discouraged. So why not learn enough to encourage me on my journey?

External Incentives Key Factor In HIT Adoption By Small PCPs

Posted on January 25, 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.

A new study appearing in The American Journal of Managed Care concludes that one of the key factors influencing health IT adoption by small primary care practices is the availability of external incentives.

To conduct the study, researchers surveyed 566 primary care groups with eight or fewer physicians on board. Their key assumption, based on previous studies, was that PCPs were more likely to adopt HIT if they had both external incentives to change and sufficient internal capabilities to move ahead with such plans.

Researchers did several years’ worth of research, including one survey period between 2007 and 2010 and a second from 2012 to 2013. The proportion of practices reporting that they used only paper records fell by half from one time period to the other, from 66.8% to 32.3%. Meanwhile, the practices adopted higher levels of non-EMR health technology.

The mean health IT summary index – which tracks the number of positive responses to 18 questions on usage of health IT components – grew from 4.7 to 7.3. In other words, practices implemented an average of 2.6 additional health IT functions between the two periods.

Utilization rates for specific health IT technologies grew across 16 of the 18 specific technologies listed. For example, while just 25% of practices reported using e-prescribing tech during the first period of the study, 70% reported doing so during the study’s second wave. Another tech category showing dramatic growth was the proportion of practices letting patients view their medical record, which climbed from one percent to 19% by the second wave of research.

Researchers also took a look at the impact factors like practice size, ownership and external incentives had on the likelihood of health IT use. As expected, practices owned by hospitals instead of doctors had higher mean health IT scores across both waves of the survey. Also, practices with 3 to 8 physicians onboard had higher scores than those were one or two doctors.

In addition, external incentives were another significant factor predicting PCP technology use. Researchers found that greater health IT adoption was associated with pay-for-performance programs, participation in public reporting of clinical quality data and a greater proportion of revenue from Medicare. (Researchers assumed that the latter meant they had greater exposure to CMS’s EHR Incentive Program.)

Along the way, the researchers found areas in which PCPs could improve their use of health IT, such as the use of email of online medical records to connect with patients. Only one-fifth of practices were doing so at the time of the second wave of surveys.

I would have liked to learn more about the “internal capabilies” primary care practices would need, other than having access to hospital dollars, to get the most of health IT tools. I’d assume that elements such as having a decent budget, some internal IT expertise and management support or important, but I’m just speculating. This does give us some interesting lessons on what future adoption on new technology in healthcare will look like and require.

Call to Halt ICD-10 Puts New Angle on Demand for Physicians

Posted on January 12, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

The American Medical Association’s most recent call to halt implementation of ICD-10 codes brings to light an interesting angle to the coding story – one that I hadn’t recognized until I read up on just why the AMA has consistently made it known that the switch is a bad idea.

The association believes transitioning to the new, 68,000 codes will place too much of a financial and administrative burden on physicians (especially small practices), and will ultimately force many of them to shut their doors.

Attending education sessions at AHIMA last fall left me with the impression that though learning the new codes and suffering through dual coding wouldn’t be fun, they would ultimately help physicians and hospitals receive proper reimbursement for their services. Yes, there were vendor cheerleaders on many panels, but the logic made sense even to a novice like me.

I realize that physician practices are quite a different kind of beast when it comes to handling administrative tasks, and I can certainly understand how a small practice would feel completely overwhelmed when, as the AMA stated in a letter to CMS, overlapping federal regulations combined with predicted Medicare pay cuts will make switching to ICD-10 a huge difficulty for them.

But I feel as if there’s a catch 22 here. If physicians don’t make the switch, they won’t see the potential financial benefits of more accurate coding. If they do make the switch, they’ll likely face such huge financial strains that they’ll opt to go out of business. Are there any physician readers out there who are cheerleading the ICD-10 switch?

It occurred to me, reading recently about the predicted banner year for physicians seeking hospital employment, that physicians that do decide to close their doors as a result of ICD-10 may contribute to this glut of MDs looking for work.

Perhaps there’s a domino effect waiting to happen – CMS stands firm on the ICD-10 deadline / Physicians work incredibly hard to try and make it happen. / Physicians fail and go out of business, or decide early on that it’s just not worth the trouble and close up shop. / Said physicians seek hospital employment. / There aren’t enough hospital jobs to go around and many MDs are left in the unemployment line.

That’s just one scenario I’ve been mulling over, and of course doesn’t take into consideration the large amount of other challenges facing physicians right now. What’s your take on the ICD-10 and physician staffing situation?

Cutting EMR Training Budget Can Create Serious Problems

Posted on April 17, 2012 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, American Medical News ran an article on training up medical practice staffers for EMR use. The piece concluded that while practices may save some bucks on the front end, they generally end up regretting it later.  An anecdote from the piece:

Nine months after All Island Gastroenterology and Liver Associates in Malverne, N.Y., went live with its electronic medical record system, practice administrator Michaela Faella realized things had not gone as smoothly as planned.

Even though the staff had used other health information technology systems for many years and considered itself tech-savvy, it had taken everyone six months to learn how to use the new EMR system. Several months later, the staff still had not become proficient at it.

The problem was not with the staff, but that the practice cut training short to save time and money. “Training was not placed high on the priority list, and we paid the price for it,” Faella said.

As the piece notes, many practices assume that the training bundled into the cost of their new EMR will meet their needs, and find out to their regret that this isn’t the case.  (In fact, I’d argue that this is more the rule than the exception, based on anecdotes I hear in the field and in conversations with physicians.)

A consultant quoted in the piece suggests that practices should consider three main issues when planning for training:

1) How much data they’ll be dealing with, which can vary greatly depending on whether all data is imported in advance or done patient by patient

2) Whether the practice will be integrating new systems into the EMR, such as e-prescribing, or conversely, adding an EMR to existing systems

3) Whether using the EMR will call for using new hardware such as tablet computers

Personally, I’m not satisfied by that list at all.

What about, first and foremost, assessing the staff’s existing skills more precisely, walking staffers through the various layers of the EMR on a daily basis, forming teams of superusers within the organization to help the less skilled and taking steps to be sure EMR problems don’t interrupt critical functions (a backup/workaround plan for the short term)?

What do you think?  Does the list above cover the critical EMR practice integration issues?  Am I just being testy?

Is This Failure Really Necessary? Another HIE Closes Its Doors

Posted on July 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For several years, I’ve been watching health information exchanges struggle to birth themselves. Despite ongoing support from state and local governments, HIEs continue to fade away, few having found a business model that works. And no workable business model seems to be on the horizon yet, either, despite efforts by thousands of providers to keep their HIE afloat.

This week, I was sorry to read about the death of yet another HIE.  CareSpark, a Kingsport, TN-based network which has been in existence for six years, announced on July 11th that it would be ceasing operations.  CareSpark, whose age makes it almost a young adult in HIE years, holds records for 1.28 million patients.

According to a piece in FierceHealthIT, CareSpark was forced to close because it couldn’t come up with a viable plan to sustain itself.  The group’s leaders had hoped to move from a grant-supported non-profit to one-funded by payments from subscribers, but apparently, they just couldn’t attract enough cash to survive.

The group began its final descent in March, when Health Information Partnership of Tennessee pulled federal funding from CareSpark.  The closing leaves 38 participating healthcare organizations in the lurch.

Given you don’t have a mature EMR if you can share health information freely — at least according to HIMSS Analytics — you’d think that providers would finally be ready to dish out enough money to support their local HIE.  But apparently, they aren’t.

The question is, why?  Do hospitals and medical practices think of HIEs as “nice to have” rather than “need to have”?  Do providers only kick in money when they can control the whole exchange (such as linking up hospitals within a single chain)? Have any of them done a cost/benefit analysis which suggests HIEs *aren’t* a good investment?

All I know is that if 38 providers spend six years building up trust, it doesn’t make much sense to cheap out now, especially if it shuts down critical linkages between their EMRs. I’d really like to know why they don’t want to pay for this. Don’t you? After all, it’s about time we figure out what kind of HIE model does work.

Is There An Alternative To The RECs?

Posted on July 10, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A few days ago, I wrote a column for sister blog EMRandHIPAA dishing out scathing criticism of the Regional Extension Center (REC) program.

Not one to mince words, I confess I was a bit merciless in my critique, slamming the RECs as virtually useless. (Yes, I’m sure they’ve had the occasional success, but far too few to justify their existence  — or so it seems from my vantage point.)  The column smoked out a few REC defenders, but most  people who commented seemed to share my frustration.

All that being said, it’s hard to argue that there’s a place for organizations that intelligently, efficiently offer EMR adoption help to smaller medical practices.  It’s all well and good to push hospitals and other institutions to go digital, but doctors are where the rubber hits the road.

So after heaping abuse on the RECs — your call as to whether I’ve been fair — I thought it might be worthwhile to offer a few alternative approaches (which could be offered singly or as a package):

* Small practices usually can’t afford top-drawer IT consultants to guide them in EMR adoption. What if the REC program existed entirely to help practices assess their workflow and clinical needs? The consultants, which could be made available for free or for a small fee, would come on site and teach practices how to think about these problems.

* The RECs could offer a very rich Web resource, including checklists and forms, helping practices create lists of automatically-generated criteria and matching those results to EMR products. Once the matching process was complete, RECs could offer phone-based or live sessions helping doctors understand how to effectively research those vendors.

* What if RECs offered intense EMR education classes, as some professional societies are beginning to do, which physician leaders could attend to gain a broader view of both business problems and technology issues.  Ideally, the classes would come with CME credits, which would definitely encourage more doctors to attend.

So, these are just a few ideas that popped into my head as I composed this article. I’d love to hear your thoughts. What services should a REC or similar organization offer to advance EMR adoption?

Who Are You Leaving Out Of Your EMR Plans?

Posted on April 11, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As any reader of this blog knows, it takes a lot of consensus building to successfully implement an EMR, whether you’re rolling it out across a large health system or within a small medical practice.

The thing is, I get the sense that many of the day-to-day staffers who will have to live with the EMR system aren’t consulted during the acquisition process, or only at best, only get to participate late in the game.

I’ll remind readers up front that I’m a journalist, not an EMR consultant, but from what I’ve seen, the following healthcare professionals seldom get much input into EMR decision-making:

– Front-line nurses

– Nurse managers

– Billing managers

– Coding professionals

– Medical practice managers

– Day-to-day IT support staff

– Medical assistants

While admittedly, some of these players play a more central role in patient care than others, they all have a window into what the EMR should deliver.  And if you asked them to review the vendor demo, examine the features and pose some questions, they might find issues that you hadn’t anticipated.

They might also note process problems that you weren’t aware of which, even if they can’t be solved by the EMR itself, may never come up for discussion during the normal course of business.

All told, my sense is that if a hospital or medical practice circulated questionnaires asking a broad range of staffers what the EMR should do, and what’s not working in the current environment, they’d make better decisions and learn a lot about their organizations along the way.

Unfortunately, I doubt this will happen much, as healthcare is still lamentably hierarchical and riddled with inefficient top-down decision making. But hey, the idea’s worth a mention…