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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A prescription for EHRs and patient engagement 

A prescription for EHRs and patient engagement  | EHR and Health IT Consulting |

Most physician practices and hospitals in the U.S. have installed electronic health records. In a classic Field of Dreams scenario, we have made patients’ medical records digital, but people aren’t asking for them or accessing them en masse.


“How do we make it easier for patients to request and manage their own data?” asks a report from the Office of the National Coordinator for Healthcare IT-Improving the Health Records Request Process for Patients – Highlights from User Experience Research.


The ONC has been responsible for implementing the HITECH Act’s provisions, ensuring that healthcare providers have met meaningful use criteria for implementing EHRs, and then receiving the financial incentives embedded in the Act for meeting those provisions.


Now that the majority of healthcare providers in the U.S. have indeed purchased and implemented EHRs, it remains for patients, health consumers, and caregivers to take advantage of them. In my post on the EHR Field of Dreams effect, I highlighted research from the U.S. General Accountability Office that explored the question of how the Department of Health and Human Services should assess the effectiveness of efforts to enhance patient access to EHRs.


The ONC team conducted in-depth interviews with 17 patients to understand their health IT personae and personal workflows for accessing their personal medical records. The research also considered medical record release forms and information for 50 large U.S. health systems and hospitals, and interviewed “insiders” – healthcare stakeholders inside and outside of ONC – to assess how patients request access to medical records data and look for solutions to improve that process.


Why is it so important for people to access their medical records? By doing so, patients and caregivers can better manage and control their health and well-being, ONC notes, by preventing repeat tests, managing clinical numbers (like blood pressure for heart or glucose for diabetes), and sharing decision-making with doctors and other clinicians – together, the process of patient and health engagement, which boosts health outcomes for individuals and populations.


The general process of a patient requesting their health data works like this, illustrated by the patient journey of Melissa and Ava Crawford, a mother and toddler daughter portrayed in the ONC report:

  • A patient/consumer makes an initial inquiry
  • The consumer requests the records, which can be done via a paper authorization form (that is then completed and either mailed or faxed to a provider) or sent online via the portal. Sometimes a consumer must write a letter to request the provider.
  • The consumer waits for a response, which ONC calls “a bit of a black hole for consumers.” This can be as long as 30 days under the HIPAA law.
  • The health system receives and verifies the request, then verifies the patient identify and address.
  • Health systems then fulfill the records request, often a printed copy of the medical record that can be faxed or mailed, PDF files, or a computer disk – CD.


ONC conducted research into the consumer journey through this process to identify opportunities to improve the patient experience of requesting and receiving personal health information.


Health Populi’s Hot Points: Most Americans see their doctors entering medical information electronically, and most people say accessing all kinds of medical information is important, the Kaiser Family Foundation learned in a health tracking poll conducted in August 2016. However, there are big gaps in the information available to U.S. patients online, such as prescription drug histories and lab results – two very popularly demanded information categories. And through the consumer-patient demand lens, 1 in 2 U.S. adults said they had no need to access their health information online, as the chart from the KFF poll attests.


How to bridge the chasm between self-health IT, providers, and patients? The most effective patient engagement technologies are biometric measurement devices like WiFi scales and glucometers, apps, texting, and wearables – with portals ranking last – according to physicians and clinical leaders polled in a New England Journal of Medicine (NEJM) survey published earlier this month.


The top benefit of engaging patients with these technologies is to support people in their efforts to be healthy and to provide input to providers on how patients are doing when not in the clinic, this research found.


My friend and collaborator Michael Millenson wrote in the BMJ in July about patient-centered care no longer being “enough.” In this era of technology-enabled healthcare, and rising consumerism among patients, three core principles must underpin the relationship between patient and provider:

  • Shared information
  • Shared engagement
  • Shared accountability.


Michael quotes Jay Katz from his book, The Silent World of Doctor and Patient, who talked 35 years ago about the concept of “caring custody.” Jay explained this as, “the idea of physicians’ Aesculapian authority over patients'” being replaced with “mutual trust.”


It is not enough to build and offer a technology “meant” for patients and people to use for their health and healthcare. Trust underpins all health engagement and must be designed and “baked” into the offering. Today, that trust is built as much on consumer retail experience (the last-best experience someone has had in their daily life, exemplified at this moment by Amazon) as in a new social health contract between providers and patients.

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How EHR Portals Can Increase and Optimize Patient Engagement

How EHR Portals Can Increase and Optimize Patient Engagement | EHR and Health IT Consulting |

In order for patient engagement to be effective, providers need to learn how to integrate patients as partners in care, the Senior Director of Clinical Applications at Inland Northwest Health Services (INHS) added.

However, efforts to do so are impeded by struggles to provide patients with adequate methods of accessing information. Patient portals, which are often included on a hospital’s EHR, seem to be the most prevalent method by which patients may engage with their health information, but as Cheadle pointed out, patient portals present considerable hurdles in increasing patient engagement.

“Consumers said that a provider’s website needs improvement,” Cheadle said. “That we could not find the portal easily on the website, and if we did find the portal, they’re not easy to use, and they did not have an ability to find the information -- either it wasn’t there or wasn’t the relevant information that the patient was looking for.”

Throughout the webcast, Cheadle provided strategies on how providers can increase patient engagement via the patient portal, as well as on where the healthcare industry is today in implementing that patient engagement.


A huge economic industry expected to reach $9 million by 2017, patient portals on EHRs are major drivers of measuring patient engagement. Cheadle explained how patient portals have been used by the federal government to measure meaningful use success, and to subsequently reward outstanding providers or providers who are not up to par.

However, as Cheadle pointed out, most patients don’t visit with their physicians often, making the current model for EHRs and patient portals ineffective. Although patient behavioral and social data have an underscored importance, much provider technology doesn’t align itself with these goals, making it hard to implement truly meaningful patient engagement.

Data sharing

A critical aspect of patient engagement is patient access to medical information. That patient data sharing is the primary job of the patient portal, but as Cheadle explained, these portals don’t seem to be performing that job adequately.

She stated that portals have been fairly well implemented amongst many providers, but there are still no widespread positive results.

“Despite the success of the implementation of portals across the United States, our readmission rates into our hospitals is remaining relatively consistent,” she said. “We have not reduced the high cost of readmissions into the healthcare setting.”

Cheadle continued the rest of the webcast by explaining different strategies providers can implement to make best use of their patient portals to increase patient engagement.

What can we do?

Cheadle explained that it is important to use the overall structure of patient portals and change the way in which providers use them to engage with the patient. The means using a patient-by-patient, individualistic approach to patient engagement.

By using pre-existing parameters for the healthcare provider’s business model, physicians can alter their engagement strategies to integrate the needs of the patient and to incorporate the patient as a part of his or her own care team.

Creating patient partnerships

Cheadle suggested creating a balance and a feasibility in improving patient engagement by selecting top priorities and implementing them with excellence. Incorporating the patient as a part of the care team should be among those priorities.

“By having more patient involvement, that activation of the patients in their care journey, their longitudinal healthcare journey, we’re really looking to leave behind that unilateral decision-making, that white coat paralysis that happens to all of us when go in to see the doctor,” Cheadle said.

An important aspect of integrating patient portals into patient lives is to do so at a basic level. Cheadle suggested using this kind of technology for patients to do simple tasks such as update insurance information or medication and allergy information in the waiting room.

Determine consumer preference

Ultimately, Cheadle asserted, making patient portals more consumer-centric will make patients more likely to utilize them. This means establishing what a specific patient may want out of their portal.

Cheadle suggested engaging with patients’ health histories-- gathering information about what they already know about their health conditions and feedback regarding the kinds of care they have received in the past. This will help providers to shape what kinds of information patients would like to receive from their portals.

Two components of patient portals, convenient reminders and photos, are really helping patients to engage. Convenient reminders can offer scheduling assistance or allow patients to remember to get a routine screening. Photos allow patients to see what is going on in their bodies-- the progressing growth of a baby, or the healing of a broken bone, for example.

Education strategies

It is simply not enough to emphasize portal use, Cheadle said. Providers need to explain to consumers what to do with them as well. This means explaining how often they should use it, when to use it, and for what purposes.

This process may replace printouts used to outline patient self-care which often get discarded upon leaving the physician’s office.

“What if instead I said to the patient as they leave the emergency room in my discharge process, ‘hey, let me show you where your information is on your portal.’ What would that look like?” Cheadle said.

Taking a moment like the one Cheadle described is an opportunity not only to show patients the structure of the portal and how to access it, but to explain to them for what purposes they should be utilizing it.

Optimization of care

How do we use these strategies to optimize patient care? Cheadle said by providing patients with the skills and the resources to provide more health information during their next visit. By helping patients engage with their health information on the portal, as well as with any data collected via wearable technologies, patients can increase their own health knowledge and help their physicians increase the quality of their treatment.

Cheadle also emphasized the importance of opening dialogue over all points of care in order to foster an environment in which patients feel comfortable expressing health concerns.

“From an overall perspective just as a healthcare provider, really encouraging me as a healthcare provider to talk differently, to engage differently, maybe to take off my coat when I meet with the patient,” Cheadle said.

Keys to success

These patient engagement strategies are just a piece of the puzzle in terms of healthcare industry shifts, Cheadle said.

“In the big picture, we are in a huge healthcare shift, a huge change,” she said. “What we have not identified is that we are at a point where we have patient reform where we can engage and activate that curiosity by patients about their health and wellness, where we can begin to leverage that to improve overall their desired clinical outcomes.”

Through integrating these strategies to increase and optimize patient engagement, Cheadle said overall quality of care can flourish.

“I truly believe it is through these engagement strategies, these key strategies, that we can ultimately impact overall care.”

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Patient Engagement, Usability, and Meaningful Use Stage 3

Patient Engagement, Usability, and Meaningful Use Stage 3 | EHR and Health IT Consulting |

Patient Engagement

Patient engagement was a very hot topic at the recent HIMSS conference in Chicago. There was no shortage of exhibitors promoting their patient engagement tools and there were also several presentations that contained suggestions for better engaging patients. Some exhibitors that we spoke to were not aware of the proposed patient engagement rules (described below) and were very excited at the prospect of greater use of their tools.

Healthcare Usability and the Joint Commission

Usability was again a hot topic at HIMSS. Well, actually the lack of usability in healthcare software was again a hot topic at HIMSS. For many years, we have been a strong advocate for promoting Usability in healthcare. The Joint Commission provides detailed evidence for the need to create #SafeHealthIT.

The most salient catalyst to the many usability conversations that we had in Chicago was the Joint Commission’s Sentinel Event Alert number 54. The “Safe use of health information technology,” in which the Joint Commission presents the case for improving the usability of healthcare software by explaining, amongst other, things how “Incorrect or miscommunicated information entered into health IT systems may result in adverse events.”

ONC and Meaningful Use Stage 3

The Office of the National Coordinator (ONC) released their proposed rules for Meaningful Use Stage 3 just in time to be top on the minds of majority of HIMSS attendees. ONC proposed an increase from five to 25 percent for getting patients to view, download, and transmit personal health data. They propose requiring that more than 35 percent of all patients seen by a provider or discharged from a hospital receive some type of a secure message using the electronic health record’s (EHR) electronic messaging function. They also call for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.

The proposed ONC requirements are a very tall order for many providers to satisfy, particularly when many of the EHR systems they are using provide a less than satisfactory user experience for the medical staff that use them. Adding an entire new user population, namely patients and patient caregivers, to the mix make patient engagement even more difficult.

How should EHR vendors create tools for Patient Engagement?
The answer, of course, is usability and user-centered design. Patient portals cannot merely output information from the patient chart (that is normally viewed by trained medical staff) in a fancy new view. Patient Portals need to be designed with the patient in mind.

In order to achieve the improved engagement, Patient Portals need to present information, and workflow, to the patient, and/or caregivers, that are easily understood and are useful to the patients or the caregivers.

Who are your users? What types of experiences and expectations do they have? What are their goals? Are there any industry standards that should be followed? In the software development cycles the thoughts and expectations of your users can be predicted by creating user persona(s). This is one of the first steps in doing User-Centered-Design.

The first step to creating an engaging, usable and useful patient portal would be to try to gain an understanding of it’s potential users. Go to their home or place of work. Go talk to as many as you can afford in the environment that they are most likely to use your portal. We call this conducting a “contextual inquiry”.

While you are there, look at some of the other common tools that they use every day. Ask them what they believe will be the most common tasks that they will access your portal to complete. Ask what they would like the portal to do for them.

Talk a number people and seem if any patterns emerge. You may notice that some users are interested in using the product one way, while another group is interested in using it in a completely different way. Use these patterns to create a number of “Persona’s” that you can use to drive your development efforts.

Design for the users–not the requirements

Use the persona’s to create realistic use cases based upon the real patient and caregiver needs that you understand based upon your research. Usability people often call these use cases “user journey maps.”

Now, when you design your portal to engage the patient around their tasks (and not merely to satisfy regulatory requirements) the end users/patients will find the information presented to be easy to understand, useful to them, and they will freely engage with your system.

Embracing Usability and user-centered design is the key to creating a patient portal that encourages patient engagement and ultimately a healthier, more informed, and satisfied patient.

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Patient Portal Adoption Diverges Among Older Generation

Patient Portal Adoption Diverges Among Older Generation | EHR and Health IT Consulting |
Under the Stage 3 Meaningful Use proposed rule, providers would need to ensure that at least 25 percent of their patients accessed, downloaded, and transmitted their medical information. While this exact percentage may change after the comment period, providers know that the Centers for Medicare & Medicaid Services (CMS) will continue pushing patient engagement and patient portal adoption throughout the healthcare sector.

However, one of the reasons that providers are struggling in ensuring patients access and download their health data through the patient portal is due to the aging population of their typical consumers. Since the baby boomer generation is aging and older adults are more likely to suffer from chronic conditions, this sect of the population dominates the healthcare field.Patient Portal Adoption

Researchers from Northwestern University published a study in the Journal of the American Medical Informatics Association about the common discrepancies of patient portal adoption among elderly patients.

Out of 534 adults, the youngest subjects studied were 55 years of age and others were more than 65 years old. The Northwestern Medicine Electronic Data Warehouse was used to study the behavior of patients when registering for the portal and using it to monitor their health. While the majority of patients in the study had their patient portal access code created for them, only of 57.5 percent of those individuals registered their accounts.

Health literacy and a college graduation background actually boosted the likelihood of patient portal adoption and registration. As a background, patient portals often include the ability to view protected health data like lab results and medical history and offer drug prescription refill options, appointment scheduling, and secure messaging capabilities.

Out of all who registered their portal, 90 percent of those subjects messaged their physician and 96 percent examined a test result. Additionally, 55 percent of subjects ordered a reauthorization while only 11 percent monitored their vital health statistics. Higher education was linked with prescription reauthorization requests.

The researchers from Northwestern University found some significant differences among the older generation regarding their patient portal adoption. Some key differences include health literacy, education, and racial disparities.

“There were fewer disparities in the use of the patient portal’s functions, but some observations have important clinical consequences. Highly educated patients were consistently more likely to use the patient portal for prescription refill requests. Alternative methods are available, but they can be more time consuming for the patient and cannot be used when the clinic is closed,” the researchers wrote in the published paper. “Patients with an adequate level of health literacy were nearly 8 times more likely than those with limited health literacy to use the secure patient–physician messaging function.”

Patient portal implementation is expanding throughout the country and providers are gearing up to meet patient engagement objectives under the meaningful use requirements. However, there are clear disparities with regard to patient portal adoption that providers need to be aware of. Essentially, the researchers concluded that providers who implement patient portals in their medical practice should also create strategies for monitoring and decreasing discrepancies in the use of these tools.
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Lessons All Practices Can Learn from the Concierge Model

Lessons All Practices Can Learn from the Concierge Model | EHR and Health IT Consulting |

Starting a private practice requires a heavy dose of entrepreneurial spirit. Keeping one afloat requires a keen mind for business operations.

Rather than shrugging his shoulders at an overly complex healthcare system, internal medicine physician Tom Lee founded a practice that focused on fixing some of the glaring flaws in healthcare delivery at the practice level.

One Medical, a large concierge practice, epitomizes what’s required to succeed in private practice: ambition, innovation, and efficiency. Even if you’re not pursuing a concierge model for your practice, this practice's success still has several lessons to offer healthcare providers looking to maintain some autonomy through a private practice. It may also offer a window into the future of the physician-patient relationship.

Here are three things private practice providers can take from Lee’s success.

 Build Your Foundation on Technology

Despite seeing an average of 35 percent fewer patients per day than the average practice, One Medical already boasts patient numbers in the thousands as well as a reported growth rate of 50 percent.

Can seeing fewer patients while growing at a meteoric rate be anything other than a paradox?

The answer seems to be yes. This coupling of rapid growth without tortuous physician hours and work flows is best explained by the practice’s effective use of technology to increase the operational efficiency.

It’s no secret that One Medical receives significant backing from venture capital firms — much of which is likely due to Lee’s success with Epocrates, which he cofounded. But instead of exclusively spending those assets on new office buildings and advertising, Lee invested heavily in technology, specifically iOS and Android apps.

As part of the annual $199 membership fee, One Medical patients receive access to the practice’s app from which they can book online appointments, renew prescriptions, and even get a review of their medical information and have subscriptions sent to a pharmacy or tests scheduled.

This same functionality can be found in many patient portals, though these features are less common on mobile devices at the moment.

Instead of worrying about how the patient portal-esque app would fulfill meaningful use requirements, Lee seized the opportunity to automate all the clerical processes he could. As a result, One Medical employs half as many office staffers per provider as the normal practice.

Center the Experience Around the Patient

One Medical’s emphasis on technology streamlines the way the practice functions, and improves the patient experience. Creating a useful mobile application wasn’t done for reimbursement purposes, but rather to create a more intuitive experience for patients.

Many practices lack this focus on the patient experience. Instead of taking the time to make sure the patient is comfortable with a diagnosis, providers must rush the examination in order to move on to the next patient.

This directly contradicts the mindset of the modern consumer, and it only feeds healthcare’s reputation for anachronistic operating models. Consumers now use their experience with a service provider as validation for continuing to choose that provider. Failing to focus on experience is a surefire way to lose patients — perhaps driving them to competitors who do seem to have the time to talk longer in the exam room.

Remember that One Medical physicians see less patients? That’s so they can dedicate more time with each individual.

To be sure, technology powers the customer experience by making the healthcare provider more efficient and enabling him to prioritize the patient. But using the lack of technology as an excuse for the poor engagement is self-defeating.

Patients now expect a holistic experience from providers, beginning with digital access to health information and ending with follow-up after the appointment.

Look Past the Status Quo

Physicians have a reputation for being resistant to change. However, the current reimbursement system mire and the myriad of new regulations aren’t asking physicians to change; these forces are demanding it.

Doing things the same old way simply won’t suffice. A concierge model may not be the answer for every practice, but it does serve as an example of what’s possible with technology and the right priorities. Luckily for independent practices, there’s an expansive market of medical software that supplies the raw materials for building a more effective, patient-centered practice.

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As CMS Becomes Lenient, Providers Tackle Patient Engagement

As CMS Becomes Lenient, Providers Tackle Patient Engagement | EHR and Health IT Consulting |

While patient engagement remains a top priority for many medical organizations across the country, the Centers for Medicare & Medicaid Services (CMS) released a proposed ruling modifying meaningful use requirements and specifically relenting on a major patient engagement objective.

Previously, Stage 2 Meaningful Use requirements called for 5 percent of a provider’s patient base to access, download, and/or transmit their electronic health information, but now this objective has been changed for the years 2015 to 2017 in the proposed ruling. If the proposed rule becomes initiated as part of the meaningful use requirements for the next several years, eligible hospitals and physicians will need to ensure that just one patient views, downloads, or transmits their electronic medical data.

Even though CMS may be changing some patient engagement requirements, healthcare providers are still geared toward improving patient satisfaction as well as medication adherence. At the 2015 HIMSS Annual Conference and Exhibition in Chicago, the company TowerView Health was announced the winner of the 9th annual Venture+ Forum pitch competition meant for startups, according to the company’s press release.

Last week, 15 startup companies were chosen to take part in pitching live presentations to a panel of investors and healthcare experts. TowerView Health pitched to the investors a solution that assists patients with chronic diseases manage their complicated medication schedules.

TowerView’s pillbox allows patients to receive a pre-filled medication tray directly from their pharmacist. This pillbox is capable of sending reminders to patients if they miss a dose or don’t take a prescribed drug on time. The company works with health plans and at-risk providers to offer this particular service to patients for free.

“HIMSS and the mHealth Summit are focused on creating opportunities, providing business-building content, fostering partnerships and supporting entrepreneurs and early-stage companies developing innovative new health technologies.  The Venture+ Forum is an excellent resource for companies to network and connect with healthcare providers, payers, channels, institutions and strategic dealmakers,” Richard Scarfo, Vice President of Personal Connected Health Alliance at HIMSS, said in the press release.

TowerView Health isn’t the only organization looking to increase patient engagement. For example, HealthPrize Technologies, LLC and MeadWestvaco are collaborating on a new patient engagement and medication adherence platform, according to a news release.

Another organization called IntegraMed Fertility has adopted web-based patient engagement applications that are likely to revolutionize care and patient satisfaction through this network. The Patient PLUS portal from Anthelio Healthcare Solutions provides a much-desired self-service aspect that’s missing from much of the medical industry. These self-service capabilities include automating appointment scheduling and pre-registration. It also allows for viewing and accessing medical histories, electronic records, laboratory results, and radiology reports while at home or in a healthcare setting. Secure messaging tools for strengthening the patient-physician relationship are also available through this portal.

“Patient PULSE is a perfect fit for these patient-centered clinics, as it provides a multitude of ways to personalize the patient portal experience, providing additional support and communication opportunities for patients while empowering them to take a more active role in their care,” Asif Ahmad, CEO of Anthelio Healthcare Solutions, said in a public statement.

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Tech Tools to Boost Patient Collections

Tech Tools to Boost Patient Collections | EHR and Health IT Consulting |

With the proliferation of high-deductible health plans under the Affordable Care Act, patient payments have become a bigger chunk of many practices' revenue. As a result, experts say physicians should be developing more sophisticated collection strategies that take advantage of technology to help get money in the door.

Used effectively, technology can help smaller practices stay on top of patients' coverage and financial responsibilities under the new high-deductible plans, as they may be new to both practice and patient. Many newly insured patients are unaware of the service-level details of their policies. So it's important to give your staff readily available information about coverage, balances, and answers to frequently asked questions.

Technology can help you streamline processes at the front desk to facilitate collection at time of service, provided that you invest in staff training, said Colleen Fusetti, a director at FluidEdge Consulting in Malvern, Pa.

"You need to put a lot of emphasis on training staff to use the technology and understand patient balances and payment options so that they, in turn, can educate the patient," she said. "The ability to collect drops considerably after the patient walks away from the front desk."

Fusetti and other revenue cycle management experts also offered these tips for getting the most out of your technology tools to improve patient collections:

• Set up a patient portal. The portal allows patients to check their eligibility and claims data and view or pay their balances online.

• Integrate an insurance eligibility service into your practice management and EHR systems. Some services allow you to run a verification check on every patient scheduled for a visit over the next few days so that you can reach out to patients in advance to get new insurance information, if needed.

• Use an automated appointment reminder service. The services not only remind patients about upcoming appointments but also link patients to the portal where they can see any pending balances, make payments, and review their coverage before arriving.

• Consider online credit card processing. You can accept credit or debit card payments from any Internet-enabled device linked to a mobile card swiper.

• Set up automatic payments. Many merchant service companies offer an option to keep patients' credit card information on file securely. After discussing financial responsibility for a future procedure or service, patients can decide whether to authorize a one-time payment pending final calculation of their bill or set up a payment plan with recurring payments.

• Take advantage of online resources. The AMA offers a Point-of-Care Pricing Toolkit free to its members. The resource provides tools to help practices collect what patients owe at the time of service.

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Baystate Health's CIO on the Key to Solving Healthcare's Challenges

Baystate Health's CIO on the Key to Solving Healthcare's Challenges | EHR and Health IT Consulting |

At the Healthcare Information and Management Systems Society (HIMSS) conference this year, the buzz throughout the halls of McCormick Place Convention Center in Chicago has been largely around population health, analytics, health information exchange (HIE), and patient engagement. But according to Joel Vengco, vice president and CIO at the Springfield, Mass.-based Baystate Health, many healthcare leaders are forgetting a core piece to the puzzle—access to data.

Vengco has provided the vision, plan, and execution behind the December 2014 launch of the Springfield-based TechSpring Innovation Center, a collaborative initiative that will match private enterprises with partners from Baystate to take on some of healthcare’s most difficult challenges. Vengco says that TechSpring offers partners flexible space to work and the ability to collaborate directly with care providers from Baystate Health on their projects, assessing providers' needs and creating solutions to address those needs. On April 13 at HIMSS15, Vengco sat down with HCI Associate Editor Rajiv Leventhal to talk about this project, as well as what's further needed for the healthcare industry to meet its growing challenges. Below are excerpts of that interview.
HCI: Tell me more about the idea behind and goals of TechSpring. 
Vengco: We want to crowdsource innovation. There are so many problems in healthcare as a result of this new focus on value-based care. Don't get me wrong, these are good problems, but with them comes lots of challenges, and you need a lot solutions to address those issues. The vendor market today does not have all the answers, so TechSpring is an invitation for the globe to partner with health systems like Baystate Health to utilize assets including data, experts, the environment and clinical organizations, and bring solutions that we absolutely need in healthcare today. In today's environment, failing fast is a good thing. Inventing quickly and winning big is a capability that our systems have provided to us. So TechSpring is focused on bringing those solutions to market. 
What kind of solutions? 
Solutions beyond the electronic health record (EHR)—features and functions that are needed for caregivers that can take their  work and engagement to another level. Take a look at other industries that focus on consumer services, and think about how we can deliver solutions to our patients to enable us to engage with them. Consumer-based products such as Uber and OpenTable are examples of what we can address and achieve today in healthcare.  
The other part of this is around patient engagement and mobile apps. It's about turning hospitals and care delivery into the experience of the future; no longer are the four walls of buildings the way you should deliver care. How do we invite other industries to help us develop capabilities that consumers use to engage with us frequently? And of course, analytics is a big deal too. I don't believe that we have solved the big data issues, so let's bring in vendors and start-ups from this industry and others to utilize the data for these kinds of models. People from other industries can say, "Hey I've done this in the financial sector and it's worked." 
Can this kind of idea be the gateway to an open healthcare ecosystem?
Absolutely. It's a way to liberate the data, and a platform for innovators to develop solutions to create an ecosystem of capabilities and solutions for providers and patients to access. One of the things that's the focus is to fail fast and win big. Part of what we want for innovators to understand is when you come in to TechSpring, it's up to you to solve some of these challenges, in the way we believe we can solve them. It's okay to fail. Healthcare software in the past has been plagued with the idea that everything is part of a larger system, and that's an issue when you want to make everything so perfect. The life cycle becomes a multi-year journey. You can get to solutions in sprints as well. 
There's a huge issue to getting access to data from sourced systems, such as legacy EHR systems. Having access to data is paramount to getting to population health, analytics, and new care delivery models. We often forget about that core piece of the puzzle. TechSpring is pushing different ways to get there, via FHIR (fast healthcare interoperability resources) standards, and asking our vendors to move with application program interfaces (APIs). All of these pieces are critical for us. 
The feds have certainly put great pressure on vendors, though. Is that why they try to be so "perfect?"
You're right. Innovation has been stifled because of mandates that have have forced people to put resources into addressing problems such as EHR certifications and meaningful use, and not other challenges in healthcare. Even more relevant is to have the ability to crowdsource innovation. These larger vendors should feel compelled to grow inorganically to partner with these other innovators that are coming up with solutions.
Vendors are reluctant to open up their databases, as they want to be the solution provider for everything, though that's not possible. So many commercial vendors and start-ups are out there that can deliver solutions. There was a study a few years ago on the impact that holding onto data has on healthcare. They found that if data was open for innovators to get access to, it would be a $40 billion industry. There is lots of innovation still to be done. 
You presented yesterday during HIMSS' HIE Symposium. How is this lack of data liberation affecting data exchange?
We started a regional HIE, Pioneer Valley Information Exchange (PVIX), in western Massachusetts, and the single biggest issue right now by far is the cost of creating the connection from the EHR to the HIE. EHR vendor costs are inhibiting members to joining—smaller practices are finding the costs outrageous. The problem isn't the technology, it's that the up-front costs and transaction fees from EHR vendors makes interoperability expensive. I would say interoperability should be free.
Legislation won't change it. The feds won't develop legislation to force vendors to open their data, nor should they. But they can do different things to put pressure on vendors such as pushing open APIs, and pushing ways to access this data, perhaps through certification measures and through meaningful use. 
So you would say the biggest challenge in healthcare is...?
Access to that data is the single biggest challenge. There are cultural challenges as well, as sharing data with competitive organizations is still something that providers don't like. It comes back to the idea that we shouldn't be competing with the data, but instead what we should do with the data. Vendors should start to create larger alliances, and by that I don't mean just CommonWell with 60 percent of the patient population. It should be CommonWell plus Epic plus everyone else, so you have 100 percent of the population. But Epic may not ever agree to that, they may believe that their 40 percent share will continue to grow and be interoperable. But having data available will create more opportunities for patients and providers. 
So the "buzz" at HIMSS will focus a lot on patient engagement, and vehicles to engage patients like mobility. There will also be analytics buzz. Those two pieces bring you to population health management. However, what I'm really focused on is how these vendors and how these innovators are going to help us get access to the data. I'll be speaking with many of our vendors and partners to move the needle on data liberation. That is most important thing in healthcare today. We aren't there yet with the data, and that's the biggest issue for us.

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Do Patient Engagement Measures Address Privacy Concerns?

Do Patient Engagement Measures Address Privacy Concerns? | EHR and Health IT Consulting |

With patient engagement measures playing a significant role in the recently released Stage 3 Meaningful Use proposed ruling, it becomes more imperative than in prior years to better understand how to effectively engage patients in their own healthcare. More companies are conducting market research surveys and other polls to find out how health IT and healthcare reform is perceived from the patient perspective.

Nuance Communications is one such company that has polled approximately 3,000 patients from the US, the United Kingdom, and Germany to learn more about patients’ views on healthcare technology. The survey, called Healthcare from the Patient Perspective, found that patients in Germany value privacy during a physical exam while those in the UK and the US care more about the physician being fully engaged and showing eye contact during a visit. Important findings like these may need to be further addressed within patient engagement measures.

Dr. Nick van Terheyden, Chief Medical Information Officer of Nuance Communications, spoke with about the findings from this survey. Since van Terheyden is passionate about both clinical and patient advocacy, he was pleased with the survey results.

“One of the biggest surprises came from the differences between the countries. The UK and the US were similar in people’s perspective around technology and the physician interaction as well as what troubled them about it,” said Dr. van Terheyden. “In many instances, patients feel this technology is reducing their quality time with the clinician. From the German side of the survey, their primary concern with the introduction of technology was the security and confidentiality issue.”

“There was a concern about having additional people like scribes in the office,” he continued. “For me as a clinician, I think we take for granted the interaction that we have with our patients. They walk in with an incredible level of trust with their clinician. Patients lay their heart out to their physician to help him or her understand your problems and to share deep, personal details about one’s clinical condition. The fundamental basis of clinical medicine is honesty between the patient and the clinician.”

The Chief Medical Information Officer explained that adding an extra individual such as a scribe, nurse, or other healthcare professional into the exam room has made some patients, specifically those in Germany, less likely to open up and share all of their health issues with the physician.

“[This finding] needs to be taken account of as we try and support clinicians and patients in the office setting,” stated Dr. van Terheyden.

While there may be some concerns with the use of scribes among patients from Germany, there are also some benefits to having another professional document the patient-doctor interaction, especially with regard to reaching patient engagement measures. For example, the use of scribes could allow physicians to focus on the patients instead of data entry and essentially give both patients and doctors more time to interact.

The use of scribes is “one of the emerging trends under a great deal of discussion. From a clinician standpoint, one of the things they see is supporting infrastructure around them that allows them to focus on the patient,” said Dr. van Terheyden. “What came out clearly from the survey is the feeling of being rushed. Forty percent of patients feel rushed during their visit. If asked to classify the quality of the interaction, it was about the focus of the physician, eye contact, and attention to the patient. All of this technology has detracted from that.”

The use of a scribe or possibly recording tools could solve some of the issues surrounding the patient-doctor relationship. However, both privacy and documentation quality concerns of a scribe may need to be addressed before healthcare providers adopt this service, the Nuance Communications CMIO explained.

The survey showed that a significant number of patients spend less than 10 minutes with their physician during an average visit. Dr. Nick van Terheyden went on to offer solutions on ways to increase the amount of time and quality of time doctors spend with patients.

The healthcare industry would benefit from doctors “using other clinical resources to take on activities, using technology to become more efficient, [and] using telemedicine.”

“Sometimes the interaction that occurs in a patient’s home using a video exchange can be perceived as high quality because they didn’t have to spend 40 minutes waiting or driving. Technology can apply some potential solutions that might improve the amount or quality of time physicians spend with patients,” stated Dr. Nick van Terheyden.

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Making Health IT Lead Patient Engagement Improvements

Making Health IT Lead Patient Engagement Improvements | EHR and Health IT Consulting |

Enhancing the quality of patient care and expanding patient engagement improvements are key areas that healthcare providers are focused on today. Through the utilization of new health IT tools, many medical professionals are seeing improvements in patient care processes throughout their practices.

Physicians’ Alliance, Ltd. (PAL) is one organization that has put their efforts into advancing patient care by adopting a leading analytics platform from Geneia, a vendor of software solutions for the healthcare industry.  PAL runs 22 practices throughout Pennsylvania and this analytics platform may lead to lowering medical costs and improving the quality of care for more than 500,000 patients, according to a company press release.

Victoria Martell, Quality Initiatives Coordinator at PAL, spoke with about some of their efforts toward improving patient care and the benefits of the new analytics platform. The organization has only implemented the technology within the last week and it may take more time to garner the exact advantages the analytics system will bring.

“I can tell from what little exposure I’ve had to it is that it’s definitely a powerful tool,” Martell said. “I’m very hopeful that it will provide us with a deeper dive into the information we’ll need to offer better care or identify areas of costs and utilization that can help us create better care management programs for our patients.”

The analytics platform may even “save the community and the patient [costs] in the long run.” Another Geneia client found that the platform offers information that can assist in lowering prescription costs and targeting patients that have high medical spending but have not seen their primary care provider in the last year.

According to Martell, analytics software and other health IT tools can help in “identifying patients that have gaps in their care such as quality measures, cancer screenings, adult immunizations, and patients with chronic diseases who haven’t had tests that monitor the diseases.”

“It will help us identify patients who might not have had those tests completed,” Martell explained. “In turn, we can reach out to them to ensure they are able to obtain the care that they need so we can better manage their conditions. This will also help prevent and identify diseases early on, so it will be more treatable.”

When it comes to using these tools for clinical analysis, Martell believes that they will improve patient health outcomes at PAL. The way this will be achieved is by identifying patients with gaps in their care and working on managing disease to prevent more serious or fatal outcomes.

“[These tools can help us by] identifying patients who have gaps in care especially with disease management,” Martell said. “If we’re able to identify patients who might not be seeing primary care providers or specialists regularly enough to help manage their chronic diseases, we can come up with a care plan strategy and a care team that leads to ultimately better care in the long run.”

Quality care and patient engagement improvements are also significant goals at PAL and Martell spoke about the processes and health IT tools needed to enhance the patient experience.

“Patient engagement is new and previously the patient would only sit and listen to the provider. Now technology allows for more availability of patients to reach out to providers rather than just a phone call. It is slowly coming around,” Martell mentioned. “We had a struggle early on with our patient portal. We struggled with having patients wanting to utilize the patient portal. Over time, they’ve seen the benefits of it and use it a lot now.”

“The Physicians Alliance is also a Level 3 Patient-Centered Medical Home. Obtaining this recognition, we had to demonstrate the ability to encourage patient engagement,” Martell explained. “Through our care teams and patient education that we have available, patients seem to be more apt to converse with us and ask questions. The providers have more time to spend with patients because we were able to shift things that the providers didn’t necessarily need to do [and transfer it over to] qualified nurses. This allowed the providers to have the time to sit and work with the patient.”

Victoria Martell also spoke on the benefits of EHR systems for impacting patient engagement improvements and patient care. When looking at the provider side of things, EHR technology can help enhance tracking of patient needs and helps improve efficiencies across a hospital or physician practice. The EHR system at PAL is able to flag reminders for clinical staff on any upcoming tests or immunizations patients may need.

When it comes to the new analytics platform, Martell said: “The system can integrate with our scheduling system and can compare what is needed for a patient and provide a ‘report card’ for that patient so that information can be used for an upcoming visit. It will help the nurse and provider team work with the patients to ensure that needed screenings are completed.”

Martell also discussed how Stage 2 Meaningful Use requirements have affected patient engagement improvements. PAL has reported Stage 2 Meaningful Use at their practices and Martell believes these requirements have increased patient engagement.

“One of the core elements of reporting [Stage 2 Meaningful Use] is patient engagement through the use of the patient portal. Prior to us striving to achieve Stage 2, our portal usage was not meeting the thresholds needed. We had to evaluate our workflows and how we presented portals to patients,” Martell stated. “Informing patients that they don’t need to sit on hold on the phone [by using the portal instead] really had increased patient awareness and we now see portal usage has substantially increased since July of 2014.”

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ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption

ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption | EHR and Health IT Consulting |
The healthcare industry is on track for spending billions of dollars on health IT products throughout 2015. With the ICD-10 compliance deadline looming in October, most providers are looking to adopt advanced IT systems that incorporate the new ICD-10 coding set.

Almost 60 percent of polled hospitals leaders stated they will be focusing on transitioning to ICD-10 compliance throughout 2015, according to a report from peer60. Some typical IT products many may be purchasing include revenue cycle management, population health management, patient engagement, EHR, and ICD-10 migration systems.147504495

The researchers also broke down the surveyed hospitals by size and found that the bigger organizations are more likely to invest in health IT technology over the next year due to having more resources to spend. However, the report also discovered that very small hospitals are more likely to purchase an EHR system when compared to larger medical facilities.

It is likely that larger hospitals already have EHR systems set up and are looking toward health IT than can better coordinate care, engage patients, and provide analytics. Additionally, every hospital with over 1,000 patient beds was planning on purchasing a major IT solution in 2015.

EHR vendors are likely to remain busy throughout this year, as 27 percent of surveyed hospitals are looking to either replace a current EHR system or install a new one in the ambulatory care setting. Additionally, 31 percent of those looking to replace a system are undecided on whether to purchase from their previous vendor. This means that around one in ten hospitals will be changing their EHR vendor.

The data analytics market is also emerging among health IT systems. Despite it being a new avenue, 26 percent of hospital leaders said they are planning to buy an enterprise analytics suite in 2015, with 30 percent of these tools being first time purchases. Chief Information Officers (CIOs) were the key positions that were looking to incorporate analytics systems in their healthcare facilities. Additionally, 25 percent of those who already have analytics products are looking to update and replace their systems with more enhanced features. Nonetheless, 40 percent of the survey takers are unsure whether they will be renewing their data analytics software.

With Stage 2 Meaningful Use requirements calling for greater patient engagement and the creation of patient portals among medical facilities, the healthcare sector is poised to incorporate more patient-centric solutions. However, the report found that 40 percent of hospital leaders have not picked a patient engagement strategy as of yet. Regardless, 48 percent of hospitals will be addressing patient engagement in 2015.

Others in the industry are already choosing replacement products to increase patient engagement at their facilities. With many looking to leave their current health IT vendor, there is definitely a market for product replacement aimed toward improving the patient-doctor relationship. Smaller hospitals are still considering their options.

Along with data analytics and patient engagement, more providers are looking for health IT products that improve population health management. All of these resources should move the healthcare sector toward enhancing the quality of care and patient safety over the coming years.
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4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch

4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch | EHR and Health IT Consulting |

One of the biggest misnomers about an EHR implementation is that it will replace many of the human elements of your practice. While the EHR can replace some of the tasks and processes that were done by humans, the reality is that EHR software is most powerful when paired with human touch. This concept is infused into our Ideal Medical Practice Workflowwhitepaper and should be infused into every clinical practice.

As we enter 2015, here’s a look at 4 more ways your practice can benefit from a mix of technology and human touch:

1. Rescheduling Patients
One of the biggest forms of lost revenue for a practice comes in not rescheduling patients who missed their appointment. While some of these missed appointments represent low quality patients, many missed appointments happen for a good reason and are an opportunity for more revenue for your practice. Unfortunately, most practices don’t consistently reach out to patients and reschedule their appointment. Along with providing additional revenue for your practice, this extra patient outreach is a great form of customer service that will be appreciated by many of your patients and shared with their friends. While some of the rescheduling can be done using technology like emails and text messages, nothing shows a patient you care about them more than a telephone call about a missed appointment.

2. Complete Eligibility Verification
I’ve written previously about the importance of complete eligibility verification and a quality eligibility verification team. While having the correct eligibility information is always important, I can’t stress how much more important eligibility verification is at the start of a new year. At the start of a new year, patients once again are working to meet their deductible and therefore have a higher patient pay amount. Plus, the new ACA insurance plans means many patients will start the new year off with a new insurance plan. If you don’t have a 100% consistent process for verifying a patient’s eligibility, then you’re office is likely working off of old information which will hamper your ability to collect the correct payment from the patient.

3. Referral Tracking
Not appropriately tracking referrals is a big issue in many practices that can easily be handled with a mix of technology and human follow up. Not tracking these referrals is a big clinical compliance issue for your practice that has the potential to lead to a lawsuit. Along with the potential legal liability, I believe having a dedicated team following up on these orders will become extremely important in the new world of value based reimbursement and ACOs. In this next generation of reimbursement, your payment will depend on your ability to ensure patient compliance with outside referrals.

4. Annual Well Visit Reminders
Annual Well visit reminders are another great way to increase high quality visits to your practice. Many practices convert a regular visit into an Annual Well visit. While this may seem convenient for the patient, it usually means you’re cutting the patient short in the care you could provide them. You just don’t have the time in a sick visit to do a thorough well visit exam as well. Even more important is reaching out to those patients you haven’t seen for a while. It’s incredibly valuable to have a dedicated person or team who identifies all of these patients and sends them a reminder or calls them about their annual well visit. Plus, these annual well visits are a great way to add to your bottom line.

As you look at each of these 4 ways to improve your practice, they all require the right mix of technology and human touch to be done properly. In a busy practice, that can often mean hiring more staff or outsourcing some of these processes to an outside company. Either way, the value created for your practice by implementing these small but important changes will easily offset any additional costs. Plus, you’ll have happier and healthier patients in the process.

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Why Don’t 35% of Patients Know that Patient Portals Exist? |

Why Don’t 35% of Patients Know that Patient Portals Exist? | | EHR and Health IT Consulting |
Patient portals are becoming important tools for engagement and population health, but patients are largely unaware of the technology.

While patients are generally enthusiastic about viewing their EHR data and engaging with their providers online, a concerning number of patients are unaware of the possibilities of using a patient portal, finds a new survey from Xerox.  Among the 64 percent of patients who are not portal users, 35 percent did not know a portal was available to them, and 31 percent stated that their providers had never mentioned the technology to them.  Despite the widespread lack of knowledge, 57 percent of non-users said they would be more engaged and more proactive in their own healthcare if they had access to their data online.

“With providers facing regulatory changes, mounting costs, and patients who increasingly seek access to more information, our survey points to an opportunity to address issues by simply opening dialogue with patients about patient portals,” said Tamara St. Claire, Chief Innovation Officer of Commercial Healthcare for Xerox. “Educating patients will empower them to participate more fully in their own care while helping providers demonstrate that electronic health records are being used in a meaningful way.”

The survey indicates a generation gap when it comes to how patients use online tools.  While baby boomers are more likely to view patient portals as a utilitarian feature by making appointments online (70 percent), refilling prescriptions (58 percent), and communicating through emails with their physicians (60 percent), millennials view portals as an informational hub.  Younger patients want to see personalized information (44 percent), tailored care plans, details about related services from their providers (44 percent), and industry news that might relate to their issues and concerns (23 percent).

Perhaps surprisingly, baby boomers, aged 55 to 64, were among the most frequent users of patient portals.  Eighty-three percent of this age group indicated that they already do or would be very interested in communicating with their healthcare providers through a portal.  Millennials were more likely to want mobile access to online tools, with 43 percent stating their preference for smartphone and tablet interfaces.

Providers can help to shape patient engagement – and help themselves to meet the 5 percent patient engagement threshold included in Stage 2 meaningful use – by taking the time to educate patients about their options and opportunities.  Reinforcing the idea of signing up for a patient portal account at multiple points along the patients’ journey through the office, from check-in to follow-up, can help to secure a patient’s interest.  And physicians themselves should take the lead, St. Claire asserts.

“Physicians just aren’t having that dialogue,” she said to HealthITAnalytics.  “When we look at some of the best practices out there, we see that having that conversation multiple times along the patient’s path through the office is most effective.  And we think having that conversation directly with their physician is going to be most important.  People really want to hear it from their physician, because they’re that trusted source.  Even as medicine is changing, having that talk with the physician is probably going to have the most impact.”

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Methods for Improving Patient Access to Health Information

Methods for Improving Patient Access to Health Information | EHR and Health IT Consulting |

The latest hearing held by the Senate Committee on Health, Education, Labor & Pensions (HELP) resulted in more than the call to delay Stage 3 Meaningful Use. It also provided numerous methods that federal legislators and healthcare organizations can take to improve patient access to health information.

Each of the three witnesses offered insight into the barriers preventing patients from having timely access to their health information in a highly useable electronic form.

First up was Raj Ratwani, PhD, who serves as Scientific Director at National Center for Human Factors in Healthcare at MedStar Health and Assistant Professor of Emergency Medicine at Georgetown University School of Medicine.

For Ratwani, the major issue surrounding patient access to health information is usability.

"Patients must have easy access to their health information to improve health outcomes, facilitate patient and family engagement in care, and to reduce safety risks. Critically, this information must be presented in a manner that is both understandable and useful," he stated in his opening remarks.

In comments specific to the critical nature of patient use of health IT, Ratwani identified three critical factors: access, functionality, and information quality.

Of the first, he noted that patients "should be able to easily access all of their health information, securely, and in one place" and that "interoperability is crucial to patient access."

Of the second, he emphasized the need for user-centered design when presenting health information to patients and making patient engagement a part of the clinician's workflow.

"The information and capabilities of the system must be useful for the patient," he stated. "The design of system capabilities, such as patient-provider communication, should be intelligently integrated with the workflow processes of the clinician so that the clinicians are able to support the patient in a timely manner."

Lastly, Ratwani tied to quality of information to its usefulness to patients. "Information must be accurate and meaningful to the patient, presented in a manner that can be easily understood, and that will help them gain insights," he added.

According to a second witness, Kathy Giusti, MBA, Founder and Executive Chairman of the Multiple Myeloma Research Foundation, the potential of patient health IT to improve health outcomes hinges of EHR integration, aggregation, and sharing of data.

For Giusti, patient engagement begins with education to ensure that patients are aware of the tools available to them to help manage their own care. "Physicians, hospitals, advocacy organizations, and the government must ensure that patients are educated on how best to use the technology," shenoted.

EHR integration plays an important picture in enabling providers to have a complete picture of a patient's health at the point of care rather than having to access disparate sources of clinical data.

"The greatest efficiency will come from our ability to integrate EHRs across the vast number of specialized doctors and centers that patients now see," she maintained. "That data must be integrated into a centralized portal that we as patients feel like we own, share, update, and provide."

Giusti's final observation on patient access to health information centered on the importance of analyzing large stores of health information for research purposes, such as in her organization's work on cancer.

"The ability to understand, integrate, aggregate and analyze EHRs is on the critical path to improving outcomes and accelerating cures. We have shown the impact of data sharing in one uncommon, fatal disease," she closed.

The hearing's third witness shifted the focus of patient access to information to Congressional intervention. In his opening remarks, Intel Felllow and General Manager for Health and Life Sciences at Intel Corporation Eric Dishman called on Congress to do four things:

  • Advance health IT standards and current interoperability initiatives
  • Remove legal and financial obstacles to health data sharing and access
  • Continue shift to value-based care models
  • Eliminate social and economic barriers to health data access

Altogether, the testimony of three witnesses highlight the many moving pieces involved in ensuring patient access to health information.

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Patient Engagement: Much Bigger Than Patient Portals

Patient Engagement: Much Bigger Than Patient Portals | EHR and Health IT Consulting |

There is no doubt that the topic of patient engagement has taken center stage in healthcare. It was the hot topic at HIMSS 2015 where a major national study was unveiled, Three Perspectives of Patient Engagement. And that was just one of the many sessions, events, and booths focused on patient engagement at the event.

Thanks to Meaningful Use, a lot of the focus on patient engagement has been around patient portals. It makes sense since practices have to meet specific thresholds in both MU2 and MU3 for portal use. They certainly play a key role in providing patients with access to medical records, test results, and even tools like online scheduling and billpay. The benefits have not gone unnoticed by providers. Over 80% of doctors believe a patient portal helps with patient satisfaction and 71% believe it helps with patient/physicians communication. The benefits haven’t gone unnoticed by patients either. Two-thirds of patients say they would be more loyal to physicians who provides a portal through an EHR.

Despite the undeniable value of portals, they are just one component of true patient engagement. This was clear in the presentation about the new national study released at HIMSS. According to the presentation, the biggest problem in creating patient engagement isn’t providing access to health information. The problem is shifting the attitudes and expectations of both clinicians and patients.

Resolving this problem requires a major culture change in healthcare. Despite the fact that patients and providers say they want improved access, communication, and outcomes and that patient engagement may hold the key, change is slow.

The reason is actually pretty simple. A shift in the culture towards a truly patient-centric model requires changes at every interaction and that involves every person across the spectrum. In many cases this means not only shifting attitudes but also the way things are done. That can require adding, changes, or maximizing technology. While technology plays this critical role, it is much bigger than portals alone.

It starts with finding the appropriate provider and goes all the way until the final bill is paid. The new patient-centric model looks something like this:

Patients can search for providers online, see patient reviews, and book an appointment from home.

Patients can easily find answers to questions about the practice on their website.

When the patient does call the office, the phone is answered quickly and so is the inquiry.

The patient receives a reminder through the means of their choice—text, email, or phone, and can complete pre-registration information to speed up check in and the encounter.

The patient doesn’t have a long wait time after check in, and if there is a delay, someone alerts the patient and gives them the option to reschedule.

In the exam room, the patient encounter runs smoothly as all the relevant patient information is at hand and the provider can refer to their mobile HER, which allows the physician to maintain eye contact and share information and images with the patient.

The patient receives education and a visit summary before leaving the practice.

The patient receives a follow text or email with directions to leave a review of the practice.

The patient can follow up on the patient portal to see lab results or review medical record information.

The patient receives an email or text with a link to their bill to pay online.

The patient has an ongoing connection to the practice through regular emails, social media, practice blog, and/or newsletter.

There are lots of other little things a practice can do to provide a positive experience that makes them want to come back and helps them feel more engaged in their own wellness and can even improve outcomes.

This consumer-like experience is really what patients want not just a portal. They want a strong relationship with their provider and to be in control of medical decisions or participate in shared decision-making with their doctors.

There is a huge opportunity here for all healthcare providers to begin shifting the way they relate to patients and provide care. It’s a chance to go beyond Meaningful Use and portals and look at the entire patient experience, including a new element to patient care—convenience.

As smaller practices are more nimble, they may find it easier to make these changes than large practices. This can be a unique competitive advantage that smaller practices can take advantage of.

Today, there are also a lot of affordable, easy-to-use solutions for patient engagement and practice marketing that can help. A practice can now easily create an engaging website, provide an online scheduling widget, share positive reviews, and send mass emails and texts with news and information. When combined with an electronic health record and best practices in billing, any practice can become a truly patient-centric practice. Then, the ability to meet those portal use thresholds becomes an easy to achieve by-product of a larger patient engagement strategy.

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IBM’s Watson Extracts EHR Patient Data to Improve Care

IBM’s Watson Extracts EHR Patient Data to Improve Care | EHR and Health IT Consulting |

Anyone who enjoys watching the quiz show Jeopardy! has heard about the computer system Watson, which was initially developed to compete on the show but has since garnered the attention of leaders across a variety of industries. Watson can even be used to better analyze EHR patient data and lead to improved quality of care.

The company division IBM Watson Health has announced today that it is working with Epic and the Mayo Clinic to apply some of the computing capabilities of Watson to analyzing EHR patient data and systems in order to boost patient health outcomes. Providers will also gain advantages when applying Watson’s power to EHRs and gaining faster analysis of the many issues that affect a patient’s health and wellness.EHR Patient Data

Using secure, cloud-based Watson services will help physicians with clinical decision making and understanding of patients’ medical conditions. Over the last year, Epic has exchanged more than 80 million patient health records within its community and outside of it.

“Building on our recent announcement of IBM Watson Health, we are collaborating with Epic and Mayo Clinic in another important validation of the potential of Watson to be used broadly across the healthcare industry,” Mike Rhodin, Senior Vice President of IBM Watson, remarked in a public statement. “This is just the first step in our vision to bring more personalized care to individual patients by connecting traditional sources of patient information with the growing pools of dynamic and constantly growing healthcare information.”

The hope is to have Watson and Epic software be utilized to effectively create patient treatment protocols and more customized health management solutions for patients with chronic conditions. Watson would be used to bring forth relevant case studies and medical knowledge that is applicable to treating a patient when doctors and other healthcare professionals share EHR patient data with Watson in real-time.

Epic will be incorporating Watson’s computing features into its clinical decision support tools including Health Level -7 (HL7) Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs). Through this combined system, clinicians will be able to more quickly access the knowledge necessary to more effectively treat patients and improve health outcomes.

IBM and Mayo Clinic is collaborating on ways to revolutionize cognitive computing by applying it to clinical trials matching among cancer patients. With the streamlined and accurate processes available through Watson’s computing capabilities, physicians are able to register patients much faster in relevant clinical trials that are customized to each individual’s needs. With more than 1 million patients seen at the Mayo Clinic every year and more than 1,000 clinical trials available year-round, integrating Watson should lead to significant progress in quickly assigning patients to innovative studies.

“Patients need answers, and Watson helps provide them quickly and more thoroughly. We are excited by Watson’s potential to efficiently provide clinical trials information at the point of care,” Dr. Steven Alberts, an oncologist at Mayo Clinic, said in a public statement.

IBM’s Watson offers significant opportunity for healthcare providers to bring about high-quality care through the use of cognitive computing capabilities tailored to each individual patient.

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Three Vendors are Driving Patient Engagement and Portal Use

Three Vendors are Driving Patient Engagement and Portal Use | EHR and Health IT Consulting |

Driving patient engagement is still vital for the healthcare sector despite certain inconsistencies from the Centers for Medicare & Medicaid Services (CMS). Even though CMS has proposed new Stage 2 Meaningful Use regulations that drop the 5 percent requirement of patients viewing, downloading, and transmitting their health information to just one patient per provider, the organization still expects eligible professionals and hospitals to meet a much larger percentage – currently proposed to be 25 percent – of patients viewing their medical data through patient portals under the Stage 3 Meaningful Use requirements. As such, providers would be wise to continue integrating patient engagement strategies at their facility.

Vendors play a vital part in developing effective patient portals to assist providers in driving patient engagement among their community of consumers. A report from the research firm KLAS examined which vendors in particular have been most useful in moving forward patient portal adoption amidst healthcare providers.Driving Patient Engagement

Athenahealth, Epic, and Medfusion were reported to be at the top of their game when it comes to increasing portal adoption throughout the patient population. More than half of the customers under all three vendors report that at least 20 percent of their patients have accessed the patient portal. This is well above the previous 5 percent threshold that CMS initially unrolled under Stage 2 Meaningful Use regulations.

KLAS discovered these findings after interviewing 186 medical provider organizations on which vendors have really made a difference in meeting their needs and advancing health IT and patient engagement for a brighter tomorrow.

The KLAS report focused on three main areas regarding patient portal strategies: enterprise, ambulatory, and EMR agnostic. A variety of factors associated with increasing patient portal adoption were addressed in the report including product performance and vendor guidance.

“Value-based care is forcing patient portals to evolve from being merely tools for reactive regulatory compliance to becoming valuable instruments that allow patients to proactively engage in their own care,” said report author Coray Tate. “Providers report that vendor guidance and functionality that patients find useful, such as billing and self-scheduling, are the most effective ways to encourage portal adoption among patients.”

A study published by the American Health Information Management Association (AHIMA) further outlines the use of the patient portal particularly among teenagers and parents. The researchers studied the attitudes of these two groups through one teen digital bulletin board, one parent digital bulletin board, and two focus groups for each faction. Videos and transcripts from the sessions were then analyzed.

The results showed that both teenagers and parents found that patient portals are beneficial and should be used to help teens better manage their own healthcare. Some teenagers were concerned that physicians would not be keeping certain information private and will let their parents see data that is meant to be protected. One parent said: “This kind of access will help my teen become much more interested in her healthcare and also motivate her to take control. And that will be great.”

With greater teamwork between vendors, providers, and the patients themselves, there should be a rise in the use of portals and patient engagement.

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Three Ways Front-Office Staff Can Improve Collections

Three Ways Front-Office Staff Can Improve Collections | EHR and Health IT Consulting |

Cash flow at medical practices can be especially slow in the first and second quarters of the year as many patients with consumer-directed health plans (CDHPs) have not yet met their deductibles.

The cash flow problem is worsening as CDHPs become more popular. According to a National Business Group on Health survey, more than half (57 percent) of employers are implementing or expanding CDHPs. This leaves many patients 100 percent responsible for their healthcare costs until they meet that deductible.

If you’re one of the independent practices — especially one with fewer than 10 staff members — dealing with this issue, here are three ways your front-office staff can help you navigate this growing problem:

1. They can focus on detailed eligibility verification. Train your staff to always confirm if a patient has coverage and if he has a copay or deductible. At a minimum, understand if the deductible has been met, but try to obtain a real-time deductible balance. Your staff should also understand benefit details tied to the services you offer and confirm if you are considered in-network for the patient. The more information on hand, the more you can prepare the patient for what his responsibility may be.

 2. They can be prepared to collect at time of service. Your front-office staff is the most important resource in the process of collecting payments up front and collecting on outstanding bills. With benefits and deductible information in hand before a patient walks in the door, your staff is already in a better position for the conversation. And it’s extremely important to establish the systems to manage and collect money because once a patient walks out the door, collection rates drop to 50 percent to 70 percent for small-dollar payments from insured patients, and to only 10 percent from self-pay patients. Make the money conversation part of your practice’s DNA and you will change your business.

3. They can offer a variety of payment options. When McKinsey surveyed consumers to ask why they would opt not to pay a medical bill, respondents cited a lack of options for payment plans, poor timing of bills, and difficulties coping with confusing statements or policies as barriers. The shift to a retail-centric approach in healthcare is here. Smartphones have built-in one-touch payment capabilities and major retail chains are working healthcare into their daily store offerings. Patients want to know what they owe up front and have multiple options to pay, especially when their responsibility is increasing. Make it easy for your patients. Accept credit or debit cards. Allow payments through mobile devices, cards on file, patient portals, monthly billing plans, or payment by check. Think of your front desk as a point of sale terminal and help your staff shift their mindset to work with patients to collect those funds any way a patient will pay.

Bonus Tip: All of these tips can be leveraged without investing in much more than staff time. Your cash flow should go up and your bad debt should decrease to help reduce your revenue cycle.

I encourage you to investigate tools and software solutions that can help your staff be even more efficient and effective with these steps. There are tools that focus on streamlining the eligibility verification process and that can provide additional insurance details in one place.

Check your EHR system for possible add-ons or leverage other Web-based solutions that focus on not only eligibility but also provide additional features for your front desk such as payment or scheduling. Look for a tool that streamlines work flow and gives you a point-of-sale system that meets your patients’ retail expectations. This can greatly reduce the expenditure on staff time and ultimately create a seamless front-desk experience.

With this continued growth in patient responsibility, practices have to adapt their systems and expect that a larger portion of their income is coming directly from the patient.

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Essential Tools for Building a Direct-Pay Practice

Essential Tools for Building a Direct-Pay Practice | EHR and Health IT Consulting |

I have been operating my direct-pay practice (I accept no insurance; patients pay me a low monthly fee for care) now for over two years. Two years means several things. First, it means that I am out of the "start-up phase" of the business; it is no longer an experiment, or a concept I am trying to prove. I am successfully making a living using an entirely different business model than most doctors in this country.

Two years also means that people see me differently. I have experienced a recent surge in patients joining my practice; many of whom were initially nervous about joining, but now see that my practice is stable.

The last thing that two years means is that I've had a chance to figure out what really works in this type of practice and what is window dressing. Here are the tools I have found most useful in building a successful direct-pay practice.

Essential #1: A good office space

I am not in a typical medical office area, but instead intentionally found a homey-looking space in a commercial office complex. I designed it to feel different from most doctors' offices: comfortable and welcoming. From the outside it looks like a house, not a medical office, and I've filled it with comfortable furniture, pleasing decorations, and coffee for patients on request. Patients will make a point to come in just to chat; and we can because our schedule allows us the extra time to connect with our patients.

This was my biggest start-up expense, but I believe it was absolutely essential in building a new mindset in my patients.

Essential #2: A staff that believes

I now have two nurses (to handle 600 patients), both of whom came from my previous practice. Both of my nurses are zealous in their belief in the direct-care model. Part of their zeal comes from the fact that their lives are so much better in this new office setting, but also, much of it is because they truly like to help patients. My practice model is all about customer service and exceeding expectations. I am really fortunate to have staff to whom that focus comes naturally.

Essential #3: The right communication tools

The one thing my patients value the most in my practice is access to me and my staff. If they have questions, they can call the office or reach me via secure messaging. While it's technically OK to use e-mail for communications (as long as patients sign a HIPAA waiver), I found that most of my patients value security in communication over ease of use. Here are three ways I communicate with my patients:

1. A good phone system. I use Ring Central which is a VOIP Internet phone system, which allows me to cheaply have a complex phone system. Voicemails are e-mailed to me; faxes are also received and turned into e-mails. I can text with patients as well as hold a conference call. It has its flaws, but overall we get a lot for a low price.

2. Messaging system. I use Twistle, which is a HIPAA-compliant "chat" system. This might be the tool my patients value the most. It works like a secure chat, with apps available for Apple and Android phones. It also notifies me via e-mail when patients have tried to contact me, and my nurses can be copied on the messages as well. I can securely send lab reports (as PDF files) or handouts regarding conditions as attachments, and patients can send images (rashes, wounds, etc.) to me from their mobile app.

3. E-mail system. While I don't encourage e-mail communication, some patients prefer it. We use our own domain hosted on Google's Gmail website. It's very easy to use and extremely affordable.

Essential #4: Billing systems

I experimented with several billing systems. I initially used Intuit Quickbooks and their integrated billing features. For a while I used ADP's automatic billing system, which worked fairly well, but didn't integrate well. Most recently, a new start-up, Hint Health has built a very elegant and easy-to-use billing system specifically designed for direct-care practices. They are very easy to work with, and solve issues quickly and easily. They also integrate with several EHR systems, and are always open to further integrations.

Essential #5: Facebook

Hands-down, the best marketing tool I have is my Facebook page. Not only does it provide an easy communication tool for patients and those interested in my practice, but I can promote posts to the exact demographic I am interested in. I promote any specials I am running for new patients, but I also promote posts or articles that highlight how my practice is different. The money I've invested here has paid itself over manyfold.

There are other tools I use regularly, but these are what I consider essential, and without which I could not have created a successful direct-pay practice.

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Future of EHRs: Interoperability, Population Health, and the Cloud

Future of EHRs: Interoperability, Population Health, and the Cloud | EHR and Health IT Consulting |

Ever since the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 and the Medicare and Medicaid EHR Incentive Programs were established, healthcare providers have been quickly implementing EHR systems and adopting health IT tools. The overall movement toward improved quality of care and greater access to healthcare information will likely stimulate the future of EHRs.

Before predictions regarding the future of EHRs and their designs can be considered, it is critical to examine the history and evolution of EHR technology over the last five decades. The American Medical Association Journal of Ethics discussed how the earliest developments in EHR design took place in the 1960s and 1970s.  Healthcare leaders began forming organizations as early as the 1980s to develop standards for the increased use of EHR systems across the sector.

The very first health IT platforms, developed by Lockheed in the mid-1960s, were called clinical information systems. This particular system has been modified over the years and is now part of Allscripts’ platforms.  The clinical information system was capable of having multiple users on at once due to its high processing speed. During the same period, the University of Utah developed the Health Evaluation through Logical Processing (HELP) system and later Massachusetts General Hospital created the Computer Stored Ambulatory Record (COSTAR).

The COSTAR platform was able to separate key healthcare processes into separate entities such as accounting or billing versus clinical information. The federal government adopted an EHR system in the 1970s through the Department of Veteran Affairs’ Computerized Patient Record System.

Over the last several decades, there have been even more developments in EHR design and implementation, especially since the federal government constructed meaningful use objectives under the EHR Incentive Programs. In 1991, the Institute of Medicine (IOM) published a report analyzing the effects of paper health records and making a case for the use of EHR systems. The report also covered challenges to EHR adoption such as costs, privacy and security concerns, and a lack of national standards.

In 2000, the IOM also published its infamous report To Err is Human in which the high rates of medical errors were discussed and health IT systems were addressed as a potential solution. The history surrounding health IT will likely impact the future of EHRs, as the same principles toward better quality of care, lower costs, and improving patient health outcomes are at the forefront of EHR adoption. spoke with three leaders in the healthcare IT industry to discuss the future of EHRs and the trends to expect over the coming years. Bob Robke, Vice President of Interoperability at Cerner Corporation, mentioned the importance of healthcare data sharing across multiple platforms.

“We’re moving out of the era of EHR implementation and adoption and into the era of interoperability,” Robke said. “Now that we’ve automated the health record, the next phase is connecting all of the information in the EHR. We need interoperability and open platforms to accomplish this.”

The functionalities possible in future EHR systems will also focus greatly on interoperability and Big Data. As telehealth functions spread across the country, patient health outside of the medical facility will be greatly considered.

“Interoperability has the potential to unlock a richer set of data that clinicians can use to help improve the care they provide to patients,” Robke explained. “More than ever, clinicians will need access to information about the patient’s care that happens outside of their four walls as healthcare moves from fee-for-service to value-based models.”

When asked what healthcare trends are affecting the design of EHR systems, Robke replied, “There is a lot of exciting work being done to advance open standards that enable information stored in one EHR to be accessed by other systems. A good example of this is the work being driven by the Argonaut Project to advance the development and adoption of the FHIR standard. We’re big supporters of the SMART on FHIR approach that allows information to be accessed from directly within the EHR workflow, and are enabling that within the Cerner EHR.”

Health information exchange and EHR interoperability will continue to impact the future of EHRs over the coming decades, as the healthcare industry continues to strive toward meaningful use of health IT systems. Robke spoke on the benefits of health information exchange and the strategic actions of the Commonwell Health Alliance, which is geared toward nationwide healthcare data exchange.

“Interoperability is a critical next step in the EHR world. Interoperability can provide clinicians with the data they need to manage the health of their populations and truly put the patient at the center of care,” Robke explained. “For interoperability to succeed, it will require all of the different information system suppliers coming together to find ways to connect their platforms, like those vendors who have joined together in the CommonWell Health Alliance. The great thing about CommonWell is vendors representing 70 percent of the acute market share in the U.S. have joined together to make interoperability a reality.”

When discussing how telemedicine and population health measures will affect the future of EHRs and the development of health IT platforms, Robke stated: “Connecting different information sources are key to successful telehealth and population health management strategies. Health care organizations need to access a patient’s full health history regardless of where that care was provided or what information system houses that information.”

“And yet, when it comes to results, there is an alarming failure in the healthcare industry.  Despite huge investments in enterprise systems, venerable healthcare organizations failing even at the basics like exchanging information electronically, communicating amongst care teams, and engaging patients,” Bush elaborated on the topic. “Some are even going bankrupt!  The shortcomings of software – the cost, the inability to share information at scale, the demands for onsite management and maintenance, and the sluggish pace of innovation—are chiefly responsible for this.”

The revenue cycle in the healthcare industry will also have a great impact on the future design of EHR systems and trends within this sector, Bush explained. The costs of investing in complex technologies will affect the future adoption rates while the financial incentives of the Medicare and Medicaid EHR Incentive Programs will also stimulate hospitals and physician practices.

“That’s why I believe that health care leaders are going to start thinking in terms of the total cost of driving results, not the total cost of ownership, when they contemplate the HIT of the future,” Jonathan Bush explained. “It’s crucial in the current landscape to adopt a cost calculation that accounts for labor and operational costs across several departments, as well as the opportunity costs of an underperforming system. As CIOs and health system boards are increasingly held to account for their investment decisions, I think we’ll start to see a new model for total cost of ownership emerge—and a fleet of next-generation services emerge to keep up.”

When asked what functionalities he thinks health IT systems will be able to obtain in the future, Bush replied: “Malleable IT strategies available from the cloud will reinvent what we ever thought HIT was capable of.  I agree with a recent IDC report and its vision for a future filled with ‘3rd Platform EHRs’ capable of functions we just don’t see in software today.”

“Those functionalities would include easy access to data; population-wide analytics; and network intelligence that crowd sources the wisdom of many to improve overall performance,” he continued. “These functionalities are already being built in to service value-based care organizations.  The promise is better healthcare in an accountable care environment.”

Next, the Athenahealth CEO discussed the importance of connectedness and interoperability when it comes to the design of EHR technology and future trends in health IT.

“Connectedness is a huge barrier to humanity in health care, as well as to the design of intelligent IT systems,” Bush said. “Achieving connectedness, or the meaningful use of health IT, isn’t reliant on getting all providers onto one system.”

“I believe that the one-size-fits all mantra is finally waning and that healthcare will continue to demand what I like to think of as the ultimate ‘backbone’ solution: lightweight technology that can unite data across multiple platforms and support advanced levels of care coordination and connectedness. That sort of infrastructure is not only more cost effective, nimble, and future-proof; it’s also best for patient choice and access and — ultimately — quality care.”

Some of the typical trends that are affecting the future of EHR technology include telehealth, population health management, accountable care, and health information exchange. Population health management in particular will affect the development of analytics software and statistical measurements vital for demonstrating healthcare quality improvements.

“The arrival of population health is, and will continue to be, huge. It’s trending in M&A, has wound its ways into vendors’ capability descriptions, and is on the required ‘must support’ list for healthcare organizations of all sizes,” Jonathan Bush explained.

“To do population health correctly, EHRs will need to gain insight into patient populations, translate that insight into meaningful knowledge for care teams, and enable a new standard of connectedness to manage and deliver care. To do such complex, hairy, and crucial processes, EHRs will have to leverage a combination of software, knowledge, and work.  Software alone simply isn’t cut out to do the job.” also spoke with Practice Fusion Founder and Chief Executive Officer Ryan Howard about future trends in EHR design. Howard spoke about the importance of data sharing among health IT systems.

“The single biggest trend will be cloud-based EHRs. The biggest single problem in the space is not deployment of EHRs. It is sending data back and forth whether it’s for quality and accountable care or sharing data with a payer or a lab or other doctors,” said Howard. “In every spirit of this, data from EHR needs to be shared with another EHR system.”

“The challenges of that is to install software offsite. Most of the major competitors have enterprise solutions. The data is incredibly difficult to get out. A cloud-based model inherently has an exponential cognitive scale that allows it to do this easily,” Howard explained. “In our case, when we connected to Quest, every doctor on our platform has a connection to Quest now because they’re all the same multi-tenant cloud-based systems. I think the biggest problems in health IT will be solved by simple integration into the cloud.”

Howard was of the same opinion as the other CEOs when it comes to the functionalities EHRs will need in the coming years. Interconnectedness, interoperability, or the efficient sharing of health data between disparate systems will become a necessity in the quest to improve patient care and health outcomes.

“The biggest single thing [that will affect the future of EHRs] is that systems need to seamlessly connect to each other,” the Practice Fusion CEO stated. “Most of the systems are pretty robust, but I think the major cloud-based systems will need to interoperate. I think the major cloud-based vendors in the marketplace will connect and all their doctors will be able to interoperate. I think all the doctors will migrate to cloud-based systems.”

“This is only possible in a web-based or cloud-based model where the population data is in one place,” Howard said. “There’s very little value in doing this in a solution that’s installed in the doctor’s office. In that situation, all the data isn’t in one place and, in a population health management program, you’re constantly rolling out new rules and tackling new chronic conditions.”

When asked what healthcare trends will affect the design of EHR systems, Howard replied: “Population health management in addition to the electronic health records role in enabling telemedicine will all be key in the marketplace. Unless you have the patient’s record which only exists in the EHR, then there will be very little value on the telemedicine platform.”

“However, if I’m using a telemedicine platform that’s connected to the EHR, I have all that data in real-time. Most EHRs that are certified do drug-drug and drug-allergy checking dynamically in the system. That’s a good example of the value that comes from the platform.”

In predicting the coming impacts in EHR developments, Howard said, “cloud-based systems, population health management, private care management, and big data” are the major catalysts in health IT design.

“I think most vendors don’t have a population health management solution. The challenges of that is that population health does not work unless all the data is in one place,” Howard stated. “For population health management to work, take a look at diabetes. What the system is doing in a population health management model is that it is constantly monitoring your patient on a day-to-day basis.”

If a patient hasn’t had a required test done, “the system should automatically be reaching out to that patient to drive awareness – get them to book an appointment – and the system should also be prompting the physician with the standard of care during the visit.”

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How Patient Access to Doctor Notes Affects Physicians

How Patient Access to Doctor Notes Affects Physicians | EHR and Health IT Consulting |

Releasing physician notes to patients is scary for many doctors. Common concerns include patient misunderstandings regarding the health information included in the note, damaged physician-patient relationships due to the content included, and a flood of questions from patients who are confused about clinical terminology.

But presenters at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago said it's time to put those concerns to rest.

The presenters, Jan Walker, assistant professor at Beth Israel Deaconess Medical Center and codirector of the OpenNotes initiative; Amy Gleason, chief operating officer at CareSync; and internist Susan Woods, director of patient experience and connected health at the Veterans Health Administration, agreed that providing patients secure online access to physician notes is a win-win for all parties.

Here are three key findings they shared during their presentation:

1. More patients want — and expect — access to physician notes.
During the presentation, Walker shared results from a one-year Open Notes demonstration project funded by the Robert Wood Johnson Foundation. About 100 physicians from Beth Israel Deaconess Medical Center, Geisinger Health System, and Harborview Medical Center participated in the project, affecting more than 13,000 patients in multiple locations.

Jan Walker In the demonstration project, patients received an alert that their note was ready to view as soon as the physician signed the note (and they received another alert prior to patient visits).

Walker acknowledged that one big question prior to starting the project was whether patients would be interested. Ultimately, over the course of the 12-months, 82 percent of patients at Geisinger who had a visit to their provider opened at least one note.

Notably, that included older patients, sicker patients, and less educated patients. In fact, patients with no more than a high school education looked at notes at same rate as everyone else, said Walker.

Ninety nine percent of patients said they wanted to continue having access to physician notes, and 85 percent said availability of physician notes would influence their future choice of providers.

2. Patients report positive results when they can view physician notes.
So what effect did that increased access to physician notes have on patients? The study suggests a positive one. About three-quarters of the survey respondents said they take better care of themselves, understand their health better, feel more in control, take their meds as prescribed at greater rates, and feel better prepared for patient visits, said Walker.

Other positive results Walker said patients reported included:

• Improved recall of the patient visit and improved ability to adhere to follow-up recommendations, because looking at the note helped patients refresh their memory.

• Improved trust between patients and their physicians because it removed the "mystery" of what the physician was writing in the record.

• Improved ability of patients to be prepared for their next visit and to engage in shared decision making.

3. Physicians report positive results when patients can view their notes.
While many of the physicians reported concerns regarding how patient access to notes would affect their work flow, very few actually saw these concerns come to fruition, according to Walker.

Only 2 percent reported longer visits, 3 percent reported spending more time on patient questions, and 11 percent reported spending more time on documentation. In fact, Walker commented that a common question received from physicians who were participating in the demonstration was whether the access to physician notes feature was on, because they weren't getting questions from patients about the notes. 

And, contrary to the fear that patients might be confused, unnecessarily worried, or offended by the notes, only one percent to eight percent of physicians reported these problems, said Walker.

Perhaps most telling is that, at the end of the 12-month demonstration, none of the participating primary-care physicians stopped participation, even though that was an option. "We really believe this is the right thing to do," said Walker.

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How Meaningful Use Stage 3 Got Patient Engagement Wrong

How Meaningful Use Stage 3 Got Patient Engagement Wrong | EHR and Health IT Consulting |

Criteria for Stage 3 of meaningful use of EHRs were released recently and there is lots of controversy, as would have been predicted. One set of recommendations that is raising eyebrows is around patient engagement.

The recommendations include three measures of engagement, and providers would have to report on all three of them, but successfully meet thresholds on two.

Following on the Stage 2 measure of getting patients to view, download, and transmit their personal health data, the Office of the National Coordinator (ONC) has proposed an increase from five to 25 percent.

The second measure requires that more than 35 percent of all patients seen by the provider or discharged from the hospital receive a secure message using the electronic health record’s (EHR) electronic messaging function or in response to a secure message sent by the patient (or the patient’s authorized representative).

The third measure calls for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.

This is all a mouthful, and it’s striking and a bit misguided from two perspectives. First, this requires health care providers to present material to or interact with patients electronically in the name of patient engagement. But it is really mostly about shoveling uninspiring material at our patients that is redolent of highly technical jargon with minimal context, with the belief that it is somehow good for patients to be engaged in this way. The intent is admirable, but the execution flawed. In addition, it is not surprising that many providers have had challenges meeting the Stage 2 requirement that five percent of patients download their medical records. It seems akin to saying that this week’s book club selection is the text for advanced graduate study of quantum mechanics — and then wondering why no one shows up for the meeting.

Some define engagement in terms of how many times consumers or patients interact with informational websites or portals. Both insurers and providers do this. Once again, there is puzzlement over why consumers would choose to spend more time on sites such as BuzzFeed, Facebook and Yahoo, rather than intently study their health benefits or review their lab tests.

At Partners HealthCare Connected Health, our first generation interest in engagement came when we saw, reproducibly, that people who interact with connected health programs have consistently better health outcomes.

This brings up two salient points: The first is how finely we can measure engagement using connected health. If it’s a glucose monitoring program, the system knows how often you measure your glucose, how often you upload your data, how often you interact with the website and how long you are there each time. If it’s one of our mobile apps, we know whether you respond to messages, open the app, which screens you visit, etc. Each time we’ve studied it, we have shown that the more people engage, the better their health outcomes. This is a pretty good argument for the power of engagement.

The second point is how we can segment people according to their level of engagement and then offer them different solutions. Not everyone likes a stern coaching voice. Some people respond to a monetary incentive, some a competition, etc. If you are not engaging with what we offer you, we can sense it and should offer you something else.

Which leads me to some recent, exciting news. I’ve written before about our site Wellocracy, which is designed to educate consumers about the value of self tracking.

Based on our research related to engagement noted above, we know that if we can hook you on self tracking, your health will improve. Wellocracy was our entry to helping consumers understand and embrace self tracking, and it has been successful. We even have a quiz that helps identify personality types and then offers consumers advice on matching trackers and apps to their individual goals and motivational characteristics.

But what if we could get to know you more and more each time you came to the Wellocracy website. Our vision is that when you come back you’ll feel like you’re visiting with an old friend that can anticipate your wishes, mood and preferences.

This is what we proposed to our friends at the Robert Wood Johnson Foundation and I’m pleased to say they saw eye to eye with us, funding our vision to build an “engagement engine” to support the sustained use of health and activity trackers to help improve health outcomes. This engagement engine will leverage machine learning and other big data analytic tools to convert insights from users into targeted feedback. We’ll develop and test an algorithm, and then test it in a clinical study.

Of course, there are models out there for this. Netflix recommends TV shows and movies for you. Amazon recommends books. Google populates the side panels of your browser with ads it feels are relevant to your interests based on your search habits.

Our engagement engine will work something like that, but it will have to be much more sophisticated. If Google presents an ad I don’t like, I can ignore it. Likewise, when Netflix recommends the Kardashians because that’s what my daughter watches on my account, I can laugh it off. But if we’re going to get to know you well enough to recommend health behaviors or health-related strategies, we can’t get it wrong. If we’re off one time, that could be offensive and you’d never come back.

We’re optimistic that we can employ the latest techniques in “deep learning” to learn enough about you so that we’ll be able to message you in such a personal, relevant way you’ll feel excited to engage with us.

And we know that improved health outcomes correlate with engagement.

How does this all benefit Partners HealthCare? We are a provider organization that is taking on more and more insurance risk. The way we will win in today’s performance-based reimbursement environment is to more efficiently deploy our human resources over larger and larger populations of patients while maintaining the highest levels of patient care. That can’t be accomplished by one-on-one, face-to-face interactions. We have to employ technology to create effective, meaningful, one-to-many relationships. That is our mission at Partners Connected Health.

As an industry, we have to do better than measuring successful engagement based on whether a patient downloads a copy of their medical record. Our engagement engine represents a fundamental building block to get us there.

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Can Human-Centered HIT Design Improve Patient Engagement?

Can Human-Centered HIT Design Improve Patient Engagement? | EHR and Health IT Consulting |

Patient engagement is a hot topic in the healthcare industry today and the federal government is pushing forward patient-centered care through meaningful use regulations. However, the question remains: how do providers engage their patients more in their physical health? Are basic patient portals enough? spoke with Shaun Gummere, Chief Design Officer at Story+Structure, to learn more about human-centered health IT design for the healthcare sector. Gummere explains that his company focuses on finding new ways for organizations to create human relationships.

During the interview, the design of human-centered patient portals was discussed and Gummere mentioned the importance of developing a “natural and intuitive” method for increasing health literacy. Currently, the design of patient portals is not effective enough to truly engage the patient, the Chief Design Officer explains.

“When I think about a patient portal as it’s currently conceived, it’s an afterthought that arises from checklist requirements,” Gummere said. “When I think of an electronic engagement with your provider, it is much more about the question of ‘why?’”

“When you look at why people don’t take the medication they’re prescribed, they feel disconnected from their provider. They listen when they’re in an acute care setting, but when they go home, they don’t have that voice and that guide with them.”

He goes on to explain that patient portals provide bi-directional communication and the inclusion of mobile health technology can help patch the gaps found when patients leave the doctor’s office.

Additionally, Gummere spoke about restructuring the tools used today to improve medication and treatment adherence among patients. Most EHR systems, he explains, are more technology-based and include too many data dashboards and codes, which puts a significant administrative burden on healthcare professionals.

Patient engagement is low because doctors don’t have time to make eye-contact as they’re entering data into EHRs. Gummere said it is vital to discover the engagement process between providers, tools, and patients before installing a new system.

“EHRs to date have been a technology-first initiative. The goal was get an EHR and we’ll find out later where the cost savings arise,” Gummere explained. “Today I think it needs a complete rethink. We need to do some deep research and observation of what people really need.”

“How can you make the relationship between the healthcare provider and the patient more present?” Gummere asked. “I would look beyond what a portal is currently conceived of. The human-centered design process is really one that takes a very divergent view and… gets very deep into human contact, human behavior and human motivation.”

When asked about some of the most important features to include in a patient portal or other patient engagement tools, Gummere spoke about how these technologies need to be intuitive and easy to use among patient populations. He also went on to explain the benefits of mobile and wearable technology in the healthcare setting.

“It needs to be attractive, intuitive and as simple as possible. There’s some phenomenal opportunities as we start to look at mobile and also wearable. I think that’s going to be a huge trend for the next five years and there’s going to be a tremendous amount of innovation there.”

“Healthcare practitioners need accurate data. Asking the patient to be an administrator is often extremely difficult,” Gummere said. “If you look at wearables to be your supplement and supporter to deliver that data. It’s almost like you have your own assistant.”

When asked about some of the ways human-centered EHR systems lead to better patient engagement, Gummere spoke about the importance of observation and research aspects of designing these type of technologies.

“One thing to know about our design process is that it begins with observation and then we hypothesize. We essentially frame an opportunity,” Gummere stated. “If an EHR provider were to hire us, we would do a great deal of research. We would think about the people who need to use it and try to understand their context.”

“Once we have the hypothesis, we do prototypes. Prototypes are a test of what we think may lead to greater engagement. That test goes through a number of reiterations,” he continued. “We like to go through a design process using co-design. That could be bringing doctors and nurses for an afternoon session … [and] bring patients into the room to get everyone talking.”

When asked whether Gummere believed Stage 2 Meaningful Use requirements are leading to better patient engagement and human-centered design, he answered: “Absolutely not.”

“What I see there is well-intentioned bureaucracy trying to ensure that the investment being made is used. It’s a fine sentiment but it reminds me of implementations that lead with technologies or lead with a checklist idea. It’s a top down approach. I think the people-first approach we’re advocating would be ideal.”

“How can patients own their own wellness or care?” Gummere asked. “That’s not going to be addressed by a checklist approach. It’s too minute and too specific and it’s missing the ‘forest from the trees.’”

The Chief Design Officer also spoke about the capabilities that telemedicine and current trends in the healthcare sector have for improving patient engagement, the doctor-patient relationship, and the overall practice of medicine.

“It holds great promise,” Gummere stated. “A lot of the moving parts need to be refined but I think telemedicine is incredibly promising because it would help people attain well-being, attain health, and co-own their own care.”

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Ideal Medical Practice Workflow | Physicians Practice

Ideal Medical Practice Workflow | Physicians Practice | EHR and Health IT Consulting |
We recently put together a whitepaper focused on what we consider the “Ideal Medical Practice Workflow.” After having worked with hundreds of medical practices we wanted a way to share our tried and true process for improving the efficiency and profitability of a medical practice. The whitepaper looks at 8 Key Steps to Maximize Reimbursement:

1. The Effective Appointment Phone Call
2. Thorough Eligibility Verification
3. Patient Check-In/Out Process
4. Pre-Physician Patient Engagement
5. Do What You Do Best: See Patients!
6. Consistent Claim Generation and Monthly Audit
7. Monthly Cost Reduction Meeting
8. Generate Clinical Reminders
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Do We Need Patient Relationship Management (PRM) Systems? | The Health Care Blog

Do We Need Patient Relationship Management (PRM) Systems? | The Health Care Blog | EHR and Health IT Consulting |
As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital, home or smartphone.

Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.

Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people (patients) are not paramount to the equation.

If you haven’t been paying close attention, ‘patient engagement’ is a white-hot topic in healthcare these days. It wasn’t sexy 5 years ago. In fact, at the keynote speech at HIMSS 13 (the national Health IT conference), it was announced that the “The blockbuster drug of the 21st century is Patient Engagement”.

While the mantra is strong, the industry seems to conflate “patient engagement” with “consumer engagement”, which in my view are two distinctly different propositions. Consumer engagement is predicated on the fact that there is choice, a free market and low barriers. As consumers, we can swing by the Apple Store and pick-up a Jawbone bracelet to monitor our exercise activity and sleep patterns, perform an in-home ECG screening with AliveCor’s iPhone Heart Monitor, or self-assess symptoms and find an appropriate doctor using the BetterDoctor service..

These products represent the innovative eye-candy that dominates the headlines, but I’m here to tell you that none of them are the killer app for patient engagement. They are all important pieces of the puzzle but the kernel of transformation lies in tapping into one of the most under-valued assets in health care, the doctor-patient relationship. Consumers, who strap on monitoring devices and crawl the web for solutions without the guidance of a doctor, are heading down a path towards anxiety – and likely more questionable consumption of healthcare resources. The always available Dr. Google enables anyone to self-diagnose, but what consumers don’t realize is that Dr. Google is an oncologist that often lists cancer as one of the possibilities….more anxiety.

Patients engaging with themselves are a noble aim, for sure, however coupling a patient to their doctor throughout their healthcare journey is simple, elegant, and necessary: essentially we need a Clinical CRM (or PRM – Patient Relationship Management). On the surface this may seem like an improbable proposition, as many doctors are already suffering from Chronic EMR Fatigue Syndrome, overloaded schedules and diminishing payments. They don’t want yet another solution.

Taking human physiology as a metaphor for complex systems (in the spirit of biomimicry), excess sugar in our food supply causes metabolic syndrome and ultimately diabetes – which extracts a huge drag on the body in terms of aging and pathologic opportunities. Our healthcare system is no different; excess technology and proprietary solutions have caused a digital opacity syndrome and ultimately a health care system of balkanized cash vacuums, people suffering unnecessarily and finger pointing. Healthcare is the diabetes of our GDP.

When technology understands what people want from healthcare, our system has a chance. This is not about what the system wants for itself and it’s not about what ‘consumers’ want for themselves; it’s what makes the most sense to achieve the ultimate outcome: a healthy population at the most efficient cost.

We need a new angle, a new dimension, something simple and human that provides demonstrable value; both in the short term and the long run. The good news is that we’re at a once-in-a-generation moment in time where great change is upon us….and where there is great change, there is great opportunity.

We need a new Healthcare Operating System; one that enables shared ownership between all parties and where innovative ideas fit together like Legos.

The four walls of medicine and the millions of telephones that occupy the space between doctors and patients must evolve.

It has failed to scale. Grab the eraser and let’s start all over. Please.

I have a few ideas…perhaps the next blockbuster drug of the 21st century is Physician Engagement…(wait, what?). Yep, if we do not get physicians involved and engaged in a new model and we try to commoditize them, we will have failed to appreciate the important role they play. There is plenty of talk about “the algorithm will see you now”. Meh.

People have always lived in tribes and relied on other people for help; physicians are people, too. While we (and I believe I speak for many physician) are as frustrated as patients about the oligopolistic and opaque healthcare system, we really just want to help people…and we need technology to work with us, not around us.

Jordan Shlain is a physician in San Francisco and a founder of HealthLoop.
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