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Marketing Predicted the Failure of Meaningful Use Stage II Patient Engagement

Posted on June 17, 2015 I Written By

The following is a guest post by John Sung Kim, General Manager of DoctorBase, a Kareo Company.
John Sung Kim
Marketers knew far ahead of CMS and the ONC that certain components of Meaningful Use Stage 2 (MU2) were simply not attainable. Thankfully, one of the original components of MU2, whereby 5% of a provider’s patients have to exchange secure messages, is now being relaxed to the simple ability to have secure messaging as an available option for patients.

When MU2 was first drafted, the original threshold was 10%, which was met with a wave of criticism from vendors, analysts, and providers who pointed out that forcing patients to adopt a new technology was outside of a provider’s control.

Yet, even the subsequently reduced 5% goal was difficult to achieve for most organizations, especially smaller independent practices that were dealing with a confluence of changing competitive markets, new billing codes, and mandated technological updates. Any digital marketer with two years of experience running ad campaigns could have told us this would become the case.

There were several marketing related reasons why 5% (or 1 in 20 patients) was simply not achievable for many practices, even with many modern EHR systems:

  • Activation Energy: Most patient portals are too difficult to register for. It’s a well known marketing rule that the number of fields a user has to fill in to register for a service is inversely proportional to the completion rate. Marketers call the amount of effort that users are required to obtain a desired action on a computer or mobile device the “activation energy.” Quite simply, the activation energy required to register for most patient portals is too high.
  • The Funnel: The most common way that patients look for the address or phone number of a provider is to enter permutations of the doctor’s name in search engines. This is what marketers call the “top of the funnel.” If a patient portal is not optimized for search engines (very few are) patients won’t enter the funnel, in other words—what can’t be seen at the top of a Google search result simply doesn’t exist to the patient.
  • Call to Action: Any modern digital marketing campaign has a “Call to Action,” commonly referred to as a CTA. In healthcare, it’s rare that any brochure, office sign, or practice website has a CTA asking patients to engage or interact, and that’s a shame since colorful, visible (and often large) buttons directing the user to click have interaction rates that are often on an order of magnitude greater than collateral without a clear CTA.
  • Email Marketing: Having worked in both digital health and digital marketing, I know how important collecting email addresses of users is, and how poorly most practices actually do this in a routine fashion. A “typical” small or group practice will have no more than 20% to 25% of their patients’ email addresses. So when a marketer does the math of registering 5% of their users through emails, the true number becomes much larger. For example, a practice with 20% of their panel with an email address would need a 25% engagement rate—not 5%! That’s an incredibly aggressive target, even for the biggest brands and best marketers.

Is it time for the Office of the National Coordinator and CMS to start hiring more marketers?

About John Sung Kim
John Sung Kim is the founder and founding CEO of Five9 (NASDAQ: FIVN) widely recognized as the leading company in the contact center industry. He’s acted as a consultant to numerous startups including LGC Wireless (acquired by ADC), Qualys (NASDAQ: QLYS), RingCentral (NYSE: RNG), Odesk (merger w/ Elance), 6connect (funded by Hummer Winblad) and M5 Networks (acquired by ShoreTel). Follow him @JohnSungKim.

Kareo, the leading provider of cloud-based software and services for independent medical practices, is a sponsor of EMR and EHR. Find out more about Kareo’s award-winning solutions at

The Patient Portal Conundrum

Posted on July 25, 2013 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare has two major challenges hanging over its head.  The first is how to handle newly empowered and engaged patients.  The second is how to lower the skyrocketing costs of healthcare.  At the Healthcare Forum, Ashwin Ram, PhD, looked at how both of these issues are impacted by the patient portal.

Dr. Ram pointed out that the internet is by far the leading source of health and wellness information.  However, patients aren’t looking to their doctors’ patient portal for this information.  Instead they’re looking to Facebook, Wikipedia, Twitter, and online patient communities.  Dr. Ram pointedly describes this shift:

The patient is the CEO of their health.  This stuff is happening.  It’s actually not a choice that we are going to make.  It’s already occurring and if we, the healthcare provider system and all the facets of it don’t drive this change, then some 20 year old kid in a Google garage will drive it for us and then we’ll wonder what happened.

Is healthcare going to drive this change?  Can patient portals be part of providers’ response to this change?

Dr. Ram suggested that “patient portals are great…if we can get people to use them.”  Therein lies the patient portal conundrum.  He offered a simple plan where EHR software gathers the information, patient portals garner patient engagement and then we see improved health as patients’ behaviors change.

Government regulations are pushing providers to engage with their patient through a patient portal.  Meaningful use requires organizations to not only make a patient’s health information available through a portal, but 5% of patients must view, download, or transmit their health information as well.   It is clear that providers need to not simply implement a patient portal, but also need to consider how they engage with healthcare consumers.  This will become even more important as we continue the shift away from fee–for-service to value based care.

Many people believe that most patients are passive consumers of healthcare, but a study by the CDC found that 68% of adults are actively trying to prevent at least one major chronic illness.   Dr. Ram described that we are “moving from this quick fix, reactive, I’ll see you when I’m sick mindset to a wellness oriented, proactive, let’s fix the problem before it occurs mindset. ”  Where are the patient portals that facilitate this kind of interaction?

People are not worried about sharing their health information online if they see value.  We know this because we see them using online patient communities every day.  However, we need to understand the user and their specific health needs so that we can provide information, coaching and resources highly tailored to that patient.  This highly tailored health experience is what could make regular patient portal use the norm and leads us down the road to behavior change.

To create engaged patient portals that drive behavior change, Dr. Ram asserted that, “It’s got to be mobile.  It’s got to be social.  You’re not going to change behavior without social pressure.”  Behavior change is social and that does not mean one person or a million people.  We need a small handful of people who care enough to be engaged in your life.  The technology that enables this is what will make the difference.

Furthermore, social pressures don’t all have to be human.  We can let the simple nudges happen automatically while we leave the higher value, more difficult things to humans.  This philosophy understands the value of automation while still embracing the value of human touch that doctors and friends provide.  Social rewards from both humans and computers matter more to the next generation of patients than money.

Healthcare is going through a fundamental software-based transformation.  Part of this has been driven through government regulation, but the more dramatic change will be driven by the empowered patient and the need to drive down healthcare costs.  The patient portal can play a key role in that transformation if healthcare providers use it to engage patients and leverage social pressures to effect behavior change.

Check out the full Healthcare Forum presentation by Ashwin Ram, PhD embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

Social Media and Doctor Satisfaction

Posted on June 14, 2011 I Written By

John Lynn is the Founder of the 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 and 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 found this recent post by Howard J. Luks, MD very intellectually stimulating. It’s a great read. Particularly if you’re a doctor or someone who tries to understand some of the various physician perspectives.

Here’s one section that sounded all too familiar to me:

Discussions about physician dissatisfaction occur at every water cooler, in every operating room lounge, and that every dinner many of us attend. But I often wonder if any of my colleagues are actively pursuing workflow changes, office efficiencies, or changes to their daily habits which may improve their level of job satisfaction. Interestingly, when I pose that question to my colleagues… the answer always seems to focus on finding another job… hmmm.

I can’t tell you how many doctors I’ve had come up to me with some hair brained website/internet idea and they want to build it. The story is so often the same. They make good money as a doctor, but they have to do it forever to make that money. They see the internet as this font of wealth. I try to let them down easy when I describe what it really takes to do what they’ve described. Ok, maybe I’m not that gentle in my description. I don’t want to crush dreams, but I do want them to understand what it really takes to do what they want to do. I digress…

Here’s another powerful part of Dr. Luk’s post:

Last week in my office, I received 5 emails germane to this topic. Three simply mentioned how satisfied they were with their encounter in the office in terms of the time they were given, the time I took to listen to their complaints, and the time I took to explain the natural history of their disease. Two of the e-mails came from long-term patients who are many years out from surgery — yet ventured onto my website and decided that they would touch base.

That simply makes my day.
From a work perspective, there’s no greater level of satisfaction that I could ask for.

The whole post is great since he covers the challenges of medicine as well and has a great golf analogy about how the perfect shot makes up for all the bad shots kind of like the grateful patient makes up for the bad ones.

Of course, all this discussion of patient and doctor satisfaction makes me wonder what role things like social media, PHR and patient portals can play in a doctor’s satisfaction. Many doctors fear the idea of being connected to their patients in some sort of social media. I’m not saying there aren’t reasonable precautions that need to be taken in our litigious society. However, I wonder if many doctors are missing out on some of the satisfaction they could get by using social media.

I have first hand knowledge of the job satisfaction you get when someone sends you a kind email in response to your blog post, tweet, or other communication. I know I can recount many such experiences because they were so satisfying that I’ll never forget them. I’m sure many doctors are missing out on similar experiences, because their afraid to open a channel up for that communication.