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E-Patient Update: Alexa Nowhere Near Ready For Healthcare Prime Time

Posted on February 9, 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 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.

Folks, I just purchased an Amazon Echo (Alexa) and I’ll tell you up front that I love it. I’m enjoying the heck out of summoning my favorite music with a simple voice command, ordering up a hypnotherapy session when my back hurts and tracking Amazon packages with a four-word request. I’m not sure all of these options are important but they sure are fun to use.

Being who I am, I’ve also checked out what, if anything, Alexa can do to address health issues. I tested it out with some simple but important comments related to my health. I had high hopes, but its performance turned out to be spotty. My statements included:

“Alexa, I’m hungry.”
“Alexa, I have a migraine.”
”Alexa, I’m lonely.”
”Alexa, I’m anxious.”
”Alexa, my chest hurts.”
“Alexa, I can’t breathe.”
“Alexa, I need help.”
“Alexa, I’m suicidal.”
“Alexa, my face is drooping.”

In running these informal tests, it became pretty clear what the Echo was and was not set up to do. In short, it offered brief but appropriate response to communications that involved conditions (such as experiencing suicidality) but drew a blank when confronted with some serious symptoms.

For example, when I told the Echo that I had a migraine, she (yes, it has a female voice and I’ve given it a gender) offered vague but helpful suggestions on how to deal with headaches, while warning me to call 911 if it got much worse suddenly. She also responded appropriately when I said I was lonely or that I needed help.

On the other hand, some of the symptoms I asked about drew the response “I don’t know about that.” I realize that Alexa isn’t a substitute for a clinician and it can’t triage me, but even a blanket suggestion that I call 911 would’ve been nice.

It’s clear that part of the problem is Echo’s reliance on “skills,” apps which seem to interact with its core systems. It can’t offer very much in the way of information or referral unless you invoke one of these skills with an “open” command. (The Echo can tell you a joke, though. A lame joke, but a joke nonetheless.)

Not only that, while I’m sure I missed some things, the selection of skills seems to be relatively minimal for such a prominent platform, particularly one backed by a giant like Amazon. That’s particularly true in the case of health-related skills. Visualize where chatbots and consumer-oriented AI were a couple of years ago and you’ll get the picture.

Ultimately, my guess is that physicians will prescribe Alexa alongside connected glucose meters, smart scales and the like, but not very soon. As my colleague John Lynn points out, information shared via the Echo isn’t confidential, as the Alexa isn’t HIPAA-compliant, and that’s just one of many difficulties that the healthcare industry will need to overcome before deploying this otherwise nifty device.

Still, like John, I have little doubt that the Echo and his siblings will eventually support medical practice in one form or another. It’s just a matter of how quickly it moves from an embryonic stage to a fully-fledged technology ecosystem linked with the excellent tools and apps that already exist.

Let’s Be Honest: EMRs Will Change Who Doctors Are

Posted on July 1, 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.

In any industry, there will be a certain percentage of those working in it who can’t move with the times.

New technologies, in particular, jolt people out of their usual ways of doing things, and leave those who don’t adapt in the dustbin. (Your classic “unemployed buggy-whip maker” comes to mind.)

The current narrative suggests that doctors who won’t buy in to the EMR movement are buggy-whip makers, too.  They’re, let me see now, uncooperative, stubborn, inflexible, timid, recalcitrant, defiant…got any more?  Clearly, any doctor who’s being dragged kicking and screaming into digital medicine is an old fogey or an arrogant type who deserves to be put into their place. Right?

Not so right.  The reality is, the shift from paper to EMR-based practice isn’t just a phase-in of a new technology, it’s a movement into a whole new world.  And it’s a place where the rules may turn out to be completely different than those doctors live with today.

While the post-EMR world may offer big clinical improvements, financial savings, improved safety and more, it’s likely to induce painful changes in the way doctors conduct their everyday work.

I’m not just talking about short-term workflow adjustments, I’m talking about introducing a new way of life, one which asks doctors to serve as clinical data analyst, sophisticated software user, expert on health data sharing and more in addition to providing direct care.

Ok, now you’re thinking that I’m exaggerating wildly — that most doctors will just need to go through an EMR training period, figure out where to click and get some practice doing it efficiently. Problem solved.

But I beg to differ. If that were all the government wanted doctors to get out of EMRs —- the ability to competently assemble an electronic patient record — I doubt the feds would be creating Meaningful Use standards and paying incentives. Doctors aren’t just being asked to use new systems, or even just to move from paper to software, they’re being asked to rethink the role they play in care delivery overall.

Let’s face it, we’re not just talking about switching from the typewriter to the computer.

We’re looking at a revolution which will, over time:

* Turn even single-physician practices into a node in a vast health information exchange
* Require doctors to pick up a wide variety of analytical/IT skills which may, on their surface, have little to do with traditional office-based medicine
* Permanently change the way doctors evaluate, diagnose, comunicate with, counsel and manage patients

Now, if the EMR revolution even comes close to meeting its patient safety, quality improvement and efficiency goals, I doubt doctors will regret the changes they had to make. After all, most doctors are incredibly dedicated, hardworking people who would be thrilled to find ways to improve their patients’ health.

In the mean time, though, I’d love to see critics tone tone down the anti-doctor rhetoric and think about what’s really going on here.  If we treat doctors like the intelligent adults they are, and collaborate with them, they’ll befriend health IT tools like the EMR in good time. If you treat doctors like they’re the problem, forget it.

AMA’s Health IT Portal: Will Doctors Bite?

Posted on May 27, 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.

Last month, the AMA announced that it was launching a health IT portal for doctors.  The AMAGINE platform includes a fairly robust range of products, including three EMRs, and its price range seems pretty reasonable. Still, I’m somewhat skeptical it will be popular. Lest I be accused of being arbitrary, let me explain.

On the surface, the idea or and product line sound great. In addition to the EMRs, the lineup includes e-prescribing, claims management and clinical support systems as well as reference tools. Vendors involved include Allscripts, CareTracker, Quest Care360, NextGen and DocSite.

Subscriptions to the surface range from $20 per month for e-prescribing to $300 per month for the EMR options, numbers that aren’t likely to send most practices into shock.

Not only that, the AMA seems to have preliminary evidence that this approach works. The trade group pilot-tested the AMAGINE on Michigan doctors for about two years prior to going national, and has to assume that the physician association would have pulled the plug if the pilot went badly.

All that being said, I’m still pretty skeptical that the approach will work, for reasons including the following:

* Despite its being the best-known and largest physician group in the U.S., the AMA doesn’t have a great reputation with up-and-coming young physicians who are first to adopt health IT

* It may sound counterintuitive, but I don’t think doctors want the AMA or anyone else to narrow down their EMR choices. Given the stakes involved, my sense is that physicians want to do a lot of exploring before they commit their lives and workflow to a new system.

* While a best-of-breed portal approach may actually be a good idea, I have a gut feeling that it might actually overwhelm or confuse some physicians. (If it were me, I’d be thinking “One decision at a time please!”)

* Say what you like about vendor technical support, but I bet any decent player would offer better technical support, education and training than an AMA venture.

So, what do you think? Am I off base here, or is AMAGINE going to face an uphill battle?



Why Aren’t Pharmas, Health Plans Paying for EMRs?

Posted on April 4, 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.

The following questions have been bothering me, and I don’t have answers. Maybe readers will be able to fill me in.

As far as I know, pharmaceutical companies haven’t been subsidizing or providing EMR software to medical practices, though I can’t imagine a better opportunity to a) form even closer ties with medical practices and b) get their message in front of physicians every day.

Attorneys, if you’re reading these, feel free to chime in and let me know if I’m not up to date; I realize laws governing donations to physicians are a moving target. But assuming it’s  still legal, I can’t see why pharmas haven’t jumped all over this idea.

I don’t know enough about pharma marketing costs to hazard a guess on what this strategy would generate financially, but I can only imagine it would be a winner.

Another stumper: why aren’t health plans investing in EMRs for their physicians on a large scale?

Not only would EMRs potentially improve efficiency and lower costs, they’d also give the plans an opportunity to build in real-time claims processing. That’s a huge win for both doctors and plans. From what I’ve read, health plans could save billions in paper transaction costs alone if they could use EMRs as a platform to connect processing directly.

As I see it, both of these industries have even better reasons to push EMR adoption than hospitals. Sure, hospitals need to connect with doctors, build loyalty and coordinate care, but the financial upside seems much larger — and more measurable — for pharmas and health plans.

So, this one’s on you, readers.  Why aren’t these other stakeholders getting into the game?  Hell, why aren’t employers taking a stand? (PHR efforts like Dossia don’t count in my view.)  Am I missing something here?

iPads Could Boost The Value of EMR Installations

Posted on March 27, 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.

I was hanging around the #hcsm (healthcare social media) chat tonight on Twitter, and caught some interesting comments from physicians on how they use tablets.  While it’s hard to tell how unusual this approach is — the #hcsm chat attracts cutting edge types — one physician noted that he shows the patients what he’s doing on his iPad.

Now, in this case the physician said he does so simply to demonstrate that he’s not texting on their time. But that could be just the beginning. As doctors increasingly adopt iPad, Android and other tablets, they’re in a much better position to turn encounters into information sharing moments.

As a patient, I’ve already hit a few practices that have implemented EMRs. While big changes may be happening in the back offices of these practices, things haven’t been much different during my time with the physicians.  Arguably, they’ve seemed a bit better prepared, and in at least one case, they seemed more efficient at note-taking, but it wasn’t some kind of breakthrough moment.

On the other hand, if they used iPhone or Android apps to share key EMR data with me, in real time, it could be a real game-changer.

For example, imagine that you’re a diabetic, and you’ve come in for a regular screening.  Usually, you’ll get some feedback on your overall health status, commentary on test results and suggestions on how to move ahead, but it’s a bit superficial and rushed unless there’s an emergency afoot.

What if the same diabetic got to see a graph, drawing on data in the EMR, which offered a personalized analysis of how their A1c, glucose levels and other key metrics were trending. The same iPad display could offer a printable list of suggestions, and if you really got tricky, brief educational videos providing more background on each step as needed.

In short, a tablet is more than just a portable physician convenience; it’s a powerful display device which could greatly improve patient/doctor communication.  And if it leverages the well-indexed EMR, that data will be offer more than a recap of the conversation.

Given tablets’ potential for improving clinical encounters, I think practices should plan their EMR and iPad investments in tandem. Tablets can be a doorway to better counseling, education and collaboration with patients.  I hope to see more physicians move in this direction.

Physician Social Media Use And EMR Adoption: Held Back By Similar Forces

Posted on March 23, 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.

In a recent blog post, Dr. Jeffrey Benabio argues that generally speaking, there are two simple reasons why many physicians haven’t spent more time digging into social networking:

*  Fear of liability

*  Lack of compensation for time invested

I’d argue that these two forces are holding back much of physician EMR adoption as well.  Sure, many practices dislike having to spend on an EMR solution, and may find technology overwhelming, but I’d argue that the two concerns  above are far more powerful.

Honestly, I think complaints about EMR costs have been exaggerated.  EMRs aren’t necessarily a big expense for a healthy practice, especially given that hosted solutions are getting more affordable by the day.  I’m not saying the cost is trivial, but it can be managed.

And I don’t think physicians, especially young ones, are stone-cold terrified by the idea of bringing more technology into the practice. They may not be thrilled by changing their workflow, but they’re intelligent adults who have doubtless used computers to perform many other types of work in their time.  Buying an EMR is a stretch, but not the biggest hurdle they face.

No, I think that fear of liability — in this case, mistakes made due to EMR misuse — and of sinking countless hours into learning the new platform are the biggest inhibitors to physician EMR implementation.  Both of these fall into the “fear of the unknown” category which derails so many new technologies.

If I’m right about this, the best way to boost medical practices’ EMR adoption rates may be to help address these fears. CMS, the courts and leading attorneys need to nail down what liability doctors face when working in this new environment, and vendors need to find better ways to assure doctors they’ll be productive quickly.

Let’s get right down to it and help doctors cope with their real concerns. Otherwise, we’ll wait in frustration as consultants and policymakers swing and miss.

Do You Need An EMR To Make ACOs Work?

Posted on February 28, 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.

Right now, as things stand, only a small percentage of medical practices have fully implemented EMRs (about 15 percent), research suggests.  But the trend toward integrating physicians in Accountable Care Organizations is moving much faster.

I don’t have stats to hand, but everything I’ve read and heard suggests that the provider community is a lot more comfortable with the ACO concept than EMR adoption.

The thing is, can ACOs advance without higher EMR adoption rates?  I don’t think so.  To my mind, if you want to integrate medical practices and hospitals — with the goal of managing quality jointly — a shared EMR seems virtually indispensable.

During the first wave of ACO adoption, we’re seeing tie-ups between mid-sized to large practices and large health systems.  Those large practices are reasonably likely to have EMR systems in place, and just as importantly, an IT department to support them.

But if ACOs models are to work, they’ll eventually have to embrace smaller practices, which make up the vast majority of U.S. medical groups overall. And if those groups are either EMR-less or just getting started, it’s going to be pretty tough to share value-based payments, coordinate across episodes of care and track quality jointly.

Yes, hospitals can give doctors access to their own, industrial-grade EMRs — and some do — but ultimately, EMR use will have to be part of the smaller practices’ culture for ACOs to work.

And while medical practices will understand ACOs, particularly if they’ve been through lots of fashionable hospital-practice partnership models, EMRs will still be tough to swallow.

So, ACO backers, do you think you can move ahead if your physician partners aren’t EMR-connected and savvy?  Or are we looking at a big problem here?