EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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drchrono preps EHR, PHR for Apple Watch

drchrono preps EHR, PHR for Apple Watch | EHR and Health IT Consulting | Scoop.it

The first developer to make an EHR exclusively for the iPad is now aiming to be the first choice for physicians and patients looking to make the most of their new Apple Watches.


When the Apple Watch first becomes available from select retailers April 24,  Mountain View, Calif.-based ambulatory EHR developer drchrono will be ready – just as is it was five years ago, when a newfangled contraption called the iPad first hit stores.


At HIMSS15 in Chicago this past week, Daniel Kivatinos, drchrono's co-founder and chief operating officer, demonstrated new software for the Apple Watch that had been in the works for months – since Apple first put out the software development kit for the device.


"The moment they release the SDK, we can build a simulator app, even though we don't actually have the physical hardware," said Kivatinos. "We did the same thing with the iPad: When we heard about the iPad in 2010, we downloaded the SDK prior to the actual hardware being released.


"The moment the physical hardware came out for the iPad, we released the app in the app store," he added. "Same situation here: The moment the physical hardware comes out, our app will be available."

Kivatinos says drchono plans to be among the first to offer an integrated EHR as soon as Apple Watch becomes available. He's excited about the device's potential to transform the office experience for doc early adopters, offering a new twist on real-time communication between physicians and their patients.


"We've thought about this a lot: What is our company, what do we do?" said Kivatinos. "Over the past several years we've realized we're creating wearable health records for doctors and patients."

With close to 70,000 physicians and more than 4 million patients registered on the drchrono platform, he said, both groups are poised to enjoy the benefits of this unique way of interaction.


"This is a completely new experience," he said. "For the first time, doctors are going to have information given to them with their hands free: A doctor could be administering a shot, picking up a child, moving an elderly person – looking at the information while doing whatever it is they need to do."


Likewise, said Kivatinos, patients should be drawn to experiencing their personal health records through a device on their wrists, using drchrono's app to schedule appointments, get medication reminders and manage their chronic diseases: "Apple creates a very nice experience for patients. It's not just about usability, it's about enjoyment."


The app will enable docs to view a patient information at a glance, respond to messages via quick text and see eRx refill requests – offering a wearable extension of the drchrono iPhone and iPad apps, according to drchrono.


"Doctors are incredibly busy; drchrono on Apple Watch gives them insights about their practice and patients just by checking their wrist," said CEO Michael Nusimow in a press statement. "Its simply amazing to have a hands-free way to gather quick insights about a patient."

Plenty of other vendors have already readied software for the Apple Watch's release, of course, and many of them were showcasing it at HIMSS15. Epic, Cerner, athenahealth, Vocera, Mayo Clinic and more all announced apps – or plans for apps – at the show.


Kivatinos said he's confident drchrono's early leadership among curious early adopters of Apple technology will keep them well-positioned among physician practices.


"If you look at the early days in 2010, we put our (iPad) app out the first week and had thousands and thousands of docs download it," he said. "It took some of our competitors years to get to that point."


Physicians "want innovation, but they want it to work," said Kivatinos. "We had one doctor who bought a $100,000 EHR, and came to us a week later and said, 'This doesn't work. What do you guys have?' He literally just junked it. If it doesn't work, they're just going to walk away."

The critical questions? "Is it usable, is it designed well, can I just put information into it and walk away quickly? Can I just do my rounds? I don't want this thing in my way."


The company touts different "modes" for the Apple Watch app, depending who's using it and how. "Glance" offers a quick view, giving docs a snapshot of their patient schedule for the day. "Short Look Notifications" can display brief messages generated from the EHR app. "Long Look Notifications" offer a doctor a view of the app itself.


Kivatinos says he's "100 percent" certain the Apple Watch is going to catch on in a big way among consumers – and his customers.

I wonder aloud whether the embrace might be more tepid – something akin to a new form factor such as Google Glass, which found limited acceptance among the general public, but is still enjoying innovative clinical use cases.


Kivatinos says he's convinced it's an Apple to oranges comparison. Glass, with its temple tapping and head nodding, necessitated a new and sometimes questionable type of social etiquette, he said. The "experience was a little different: harder to set things up and install," he said – to say nothing of the cost.


"I bought a Google Glass. It cost $2,000 with prescription lenses," he said. "$2,000 and $350 is a drastic difference. Price point is so critical."

Whether it's docs looking for easy access to vital signs, staff messaging, e-prescriptions and labs; or patients looking for an attractive and convenient interaction to manage their meds or schedule appointments, he's convinced the Apple Watch will find favor among folks and physicians alike.



"The interest is amazingly high," he said.


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Why So Many New Tech Companies Are Getting into Health Care - HBR

Why So Many New Tech Companies Are Getting into Health Care - HBR | EHR and Health IT Consulting | Scoop.it

A flood of new health care IT companies has been pouring into the U.S. health care market. The cause of this torrent: the recognition that as market and regulatory forces alter incentives in health care, IT companies will play a powerful role in combating the overemployment and declining productivity that has plagued this industry and in helping providers improve the quality of care.

The dam broke in September 2007, when Athenahealth went public, the price of its shares jumping by 97% on the first day. Since then, the company’s value has risen to $5 billion. Athenahealth proved to entrepreneurs, software engineers, and investors that the health care sector is fertile ground for creating large technology-services companies that use a subscription-based business model to offer software as a service (SaaS).

Despite its size and growth rate, the health care sector was long considered an impenetrable, or at least an unattractive, target for IT innovation — the entrepreneurial equivalent of Siberia. Athenahealth broke the ice by proving that it could sell SaaS efficiently to small physician businesses, get doctors to accept off-premises software, and achieve the ratios of customer-acquisition costs to long-term value that other sectors already enjoy.

As Athenahealth accomplished its goals, several larger forces have dramatically widened the scope of opportunity in the sector:

  • The Great Recession led to a loss of 8.8 million U.S. jobs and big declines in demand throughout the economy (including health care services) — yet health care employment grew by 7.2%. That reality increased awareness that a decline in labor productivity was driving much of the excessive spending in health care.
  • The American Recovery and Reinvestment Act of 2009 included the Health Information Technology for Economic and Clinical Health (HITECH) Act, a $25.9 billion program to give doctors and hospitals incentives to adopt electronic health records. EHR adoption has now grown to nearly 80% of office-based physicians and 60% of hospitals, fueling many successful software start-ups, such as ZocDoc, Health Catalyst, and Practice Fusion.
  • The Affordable Care Act (ACA) requires that an enormous amount of data on cost and quality be made freely available. In addition, digital health applications, mobile phones, and wearable sensors, as well as breakthroughs in genomics, are creating truly big data sets in health care. These data contribute to greater market efficiency, more consumer-oriented products and services, and clinical care that is evidence-based and personalized.
  • The ACA has led to a proliferation of risk-based (rather than fee-for-service) payment models. For example, providers in accountable care organizations are rewarded for generating annual savings, and providers who use bundled payments get a fixed budget for an end-to-end course of treatment. Effectively responding to these changing economic incentives will increase reliance on software that helps providers manage population risk, understand costs and trends, and engage patients.

These macro-level developments set the stage for other SaaS companies to follow Athenahealth’s lead in enormously improving labor productivity and quality of care.


Within the next decade, software tools will eliminate thousands, perhaps millions, of jobs in hospitals, insurance companies, insurance brokerages, and human resources departments. Not the jobs of people who actually provide care — but those of administrative middlemen, whose dead weight contributes to economic loss. Here are five examples:

  1. Digital insurance markets, combined with ACA-enacted regulatory changes such as guaranteed issue and community rating, make it possible to price and sell health plans to anyone immediately. These developments will decimate the armies of brokers who act as intermediaries between customers and insurance services.
  1. Price transparency, digital insurance products, and tools such as reference pricing make it possible to generate an exact price and instantly collect payment for a health care service. As a result, revenue cycle managers in hospitals and claims adjudicators in insurance companies will be displaced.
  1. The inevitable shift to the cloud will render obsolete the costly, insecure data centers that most doctors and hospitals are now building, staffing, and running.
  1. Adopting self-serve mobile applications will eliminate the forms, faxes, and excess staffing at many call centers, thereby improving satisfaction for everyone in the process.
  1. Centralized clearinghouses that share information across organizations and state lines will eventually replace the byzantine, paper-based process of credentialing doctors, tracking continuing medical education, and keeping licenses up-to-date. That means smaller staffs in hospitals’ medical affairs divisions, health plans, medical boards, and state and local health departments.

Given that wages account for 56% of all health care spending, improvements in labor productivity could generate enormous value. Simply reducing administrative costs could yield an estimated $250 billion in savings per year.

As compelling as the prospective labor efficiencies are, the benefits of SaaS extend beyond direct labor costs. Easier access to data on physician quality, specialization, and adherence to evidence-based care will better match patients with doctors who provide high-quality, efficient services, thereby averting health complications for their patients. Moreover, software can help bring relevant clinical guidelines and personalized risk scores to patients and clinicians as they improve care plans, engage in shared decision making, and avoid duplicative services. Such efficiencies will, in turn, enhance how patients perceive and experience the care they receive. SaaS companies can trumpet all of these advantages, not just the employment savings they yield.

To seize on the new opportunities in the health care sector, SaaS companies can take these steps:

  • Attack economic inefficiencies in order to generate immediate, tangible customer return on investment. Witness how Castlight Health’s transparency tools are generating annual savings for employers and employees. And be clear about the source of the ROI, given that in most cases the revenue comes from another health care stakeholder who may be able to undermine the business.
  • Focus on building in network effects so that improvements made by one user enhance the product’s value for current and future users, just as Athenahealth does when it rapidly disseminates changes in payment rules at one provider to all other providers. Most SaaS businesses in health care IT cannot protect their intellectual property; so it is important to continually augment the value of the product to achieve scale.
  • Use software-enabled service models, rather than pure SaaS. For example, Grand Rounds’ software not only recommends an expert doctor for a patient but also collects, organizes, digitizes, and summarizes the patient’s records — and then books the appointment for the patient. In effect, the software makes it easier for patients to adhere to high-quality, cost-effective care, thereby enhancing the overall ROI for the product.

It took Athenahealth a decade, from 1997 to 2007, to go public on the strength of its SaaS model. It took Castlight Health only six years, from 2008 to 2014, to do the same. Now an array of highly valued healthcare SaaS companies, each worth more than $100 million, is emerging. They include Zenefits, Grand Rounds, Doctor on Demand, Omada Health, Health Catalyst, Doximity, and Evolent Health. Indeed, Zenefits is one of the fastest-growing SaaS companies ever, regardless of industry, surpassing $500 million in enterprise value in its first year.

The success of SaaS companies in health care is thanks, in part, to an influx of leaders from other sectors. They bring with them teams of technical talent that deliver consumer and enterprise software faster, better, and more cheaply than many legacy health care IT companies can do. Witness ZocDoc, founded by first-time entrepreneurs from McKinsey; Grand Rounds, founded by Owen Tripp, who cofounded Reputation.com; Zenefits, founded by Parker Conrad, who cofounded SigFig; and Doctor on Demand, founded by Adam Jackson, who cofounded Driverside (just to name a few). This type of cross-pollination is an essential ingredient of innovative change.

The barriers between health care IT companies and IT in other industries are clearly coming down, and we expect the number of sector disruptions and billion-dollar companies to swell. As each innovation wave generates more data, disruption-cycle times will shorten, thereby forcing all players in the health care ecosystem to address inefficiency as they compete on quality and value creation. Those who fail to act will be washed away by the tide that lifts all other boats to greater productivity.


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How Primary Care Health IT Use Spurs Quality Improvements

How Primary Care Health IT Use Spurs Quality Improvements | EHR and Health IT Consulting | Scoop.it

Strengthening workflow, treatment, and billing processes in primary care is critical to healthcare reform initiatives taking place around the nation. EHR technologies and other health IT systems play significant roles in supporting quality improvements in primary care practices.

The Agency for Healthcare Research and Quality (AHRQ) released a white paperUsing Health Information Technology to Support Quality Improvement in Primary Care –that discusses some key best practices for supporting enhanced quality of care.


The report outlines various health IT tools that can lead to quality improvements in the primary care setting as well as ways to stimulate greater use of health IT among primary care physicians. The key health IT tools primary care physicians will need in their practice include EHR systems, registries, decision support systems, and health information exchange (HIE). Several case studies are also presented to illustrate ways that providers can incorporate health IT in quality improvements.


Over the last six years, the Health Information Technology for Economic and Clinical Health (HITECH) Act has pushed forward the adoption of EHRs, e-prescribing systems, and other health IT tools.

Through the Medicare and Medicaid EHR Incentive Programs, the majority of healthcare providers have adopted health IT systems and are working toward quality improvement within their practice. The Patient Protection and Affordable Care Act also spurred healthcare reforms such as the integration of Accountable Care Organizations (ACOs).


AHRQ spoke with a panel of eight health IT experts to establish ways of incorporating health IT tools and advancing the development of quality improvements in the primary care setting. The organization also spoke with clinicians from an independent primary care practice, a large academic primary care facility, and a health information exchange that supports primary care establishments.


The researchers from AHRQ uncovered four factors that lead to the effective use of health IT tools in pursuit of improving the quality of primary care. These four factors are:

  1. A practice culture committed to health IT
  2. High-functioning health IT tools capable of tracking
  3. Knowledgeable staff with experience in health IT and quality improvement
  4. Workflows and practice processes that incorporate health IT

Both financial incentives and training assistance from health IT experts are key to garnering these four factors for a primary care practice. The Centers for Medicare & Medicaid Services (CMS) has already been utilizing this finding by offering meaningful use incentives and ICD-10 testing to ensure providers are on track with federal health initiatives.

One example of how health IT can be used for quality improvements in the primary care setting comes from Foresight Family Physicians, which has been operating for 25 years in western Colorado. The facility began transitioning to electronic records starting in 2004 and adopted a full-scale EHR system in 2007.


“Foresight currently uses health IT for quality improvement in several interrelated ways. First, the practice has a standing QI team, which includes four people who meet every two weeks for 1.5 hours,” the AHRQ report states. “To identify gaps in care and needed preventive health screening, the front office staff runs approximately 15 daily registry reports for all patients with appointments that day. This process generates reminders for patients who require screenings for depression, are due for a colonoscopy or mammography, have a body mass index over 30, and other concerns.”



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