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E-Patient Update: Clinicians May Be Developing Strong EMR Preferences

Posted on December 8, 2017 I Written By

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

Not long ago, I wrote about a story from another publication, one which engaged in a bunch of happy talk about how EMR companies were improving their user interfaces. At the time, I expressed a great deal of skepticism about this claim, suggesting that the vendors had misled the reporter into believing that user aspects of EMRs were changing for the better across the industry.

While I stand by my original skepticism to some degree, I have to say that I got a surprise recently when I heard some nurses discussing two major EMR platforms. The one they were using, they said, was awful and awkward to use. Apparently, they missed the other terribly.

Now, at the time I was a patient in the emergency department, so I didn’t have a chance to ask them any questions about their preferences, but I was struck by the conversation because I knew which vendors they were discussing. However, they could have been talking about any enterprise EMR.

Clinicians developing preferences

I don’t mention this exchange to praise one EHR over another. I bring this up merely because this is the first time, having spent a lot of time in medical environments due to chronic illness, that I’d heard any front-line clinician express a preference for one enterprise EMR over the other.

In the early days of widespread EMR adoption, I could scarcely find a clinician who didn’t hate the system they were working with, much less one who truly liked it and wanted to use it. Eventually, I began to find that many clinicians thought the system they worked with was more or less okay, though I rarely found any screaming fans for any system in particular.

Now, I’m arguing that we may be at a new stage in clinician adoption of EMRs. The point I am making is that now, some of the clinicians with whom I’ve had contact showing some enthusiasm about one EMR or another.

No big surprise: Experience breeds preference

The truth is, when you think about it, it’s not surprising that clinicians have finally developed preferences (rather than the lists of EMRs which they truly hate). After all, it’s been going on 10 years since the HITECH Act was passed and the money started to flow into EMR subsidies.

Since then, clinicians have had the opportunity to work with multiple EMR platforms at various facilities, and informally at least, develop a catalog of the strengths and weaknesses. Nurses and doctors know which interfaces they like, whether tech support tends to respond when they have a problem with the particular system, whether any analytics tools they provide are worth using and so on.

Given this fact it’s hardly surprising that they’ve figured out what they like and what they don’t, and which vendors seem to suit those needs. After this much time, why wouldn’t they?

As I see it, this is something of a turning point in the industry, a new moment in which clinical professionals have learned enough to know what they want from an EMR. I don’t know about you, but speaking as an e-patient, I think this is a very good thing. The more empowered clinicians feel, the better the work they will do.

The Benefits Of Creating Data Stewards

Posted on December 7, 2017 I Written By

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

Maybe I’m behind the times, but until today I’ve never heard of the notion of a “data steward” for healthcare organizations. An article I read today from the Journal of AHIMA IGIQ blog has given me some ideas on the subject to ponder, however.

The blog author lays out a role which combines responsibility for data structure and consistent data type definitions — in other words, which sees that datatypes are compared on an apples-to-apples basis and that data categories make sense and relate to each other appropriately.

In the article, “Data Stewards Play an Important Role in the Future of Healthcare,” writer Neysa Noreen, MS, RHIA, notes that providers are already struggling to categorize and describe types of medical data, much less leverage and benefit from them. But while we need to impose such a level of discipline, it isn’t easy, she notes.

“[Creating a workable data structure] it is a complex process with many challenges,” Noreen writes. “There are many data terms and concepts, roles and structures to decipher from information governance and data governance to data integrity,” which is why we need to put data stewards and place in many organizations, she suggests.

Though the idea of the data steward isn’t new, “emphasis on data comparison and quality has increased their necessity,” Noreen argues. “Data stewards are essential to ensure that standard data sets and definitions are implemented and used for data integrity and quality.”

The question then becomes what qualifications and skills a data steward should have. According to Noreen, data stewards aren’t necessarily IT experts. What they will need is to have a thorough understanding of the data itself and how to extract value from that data on the broadest level.

Data stewards will often turn out to be people who are already working with data in some other manner, which will allow them to know what organization needs to do to resolve discrepancies between data definitions, according to Noreen. Such a past also gives them a head start in figuring out how data can be organized and leveraged effectively into classes.

Given their knowledge of data standards and definitions, as well as a history of working with the data sets the organization has, data stewards will be in a good position to make data use more efficient. For example, they will be able to review and compare data requests on an institutional level, identifying data redundancy in finding opportunities for cost-efficiencies.

Having given this some thought, I find it hard to argue that most healthcare organizations could benefit from having a data steward in place. Providers may begin by starting with a committee that handles this function, rather than creating one or more dedicated positions, but eventually, the scope of such efforts will call for specialized expertise. Expect to see these positions pop up often in the future.

The Future Of Telemedicine Doesn’t Depend On Health Plans Anymore

Posted on December 6, 2017 I Written By

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

For as long as I can remember, the growth of telemedicine depended largely on overcoming two obstacles: bandwidth and reimbursement. Now, both are on the verge of melting away.

One, the availability of broadband, has largely been addressed, though there are certainly areas of the US where broadband is harder to get than it should be. Having lived through a time when the very idea of widely available consumer broadband blew our minds, it’s amazing to say this, but we’ve largely solved the problem in the United States.

The other, the willingness of insurers to pay for telemedicine services, is still something of an issue and will be for a while. However, it won’t stay that way for too much longer in my opinion.

Yes, over the short term it still matters whether a telemedicine visit is going to be funded by a payer –after all, if a clinician is going to deliver services somebody has to pay for their time. But there are good reasons why this will not continue to be an issue.

For one thing, as the direct-to-consumer models have demonstrated, patients are increasingly willing to pay for telemedical care out-of-pocket. Customers of sites like HealthTap and Teladoc won’t pay top dollar for such services, but it seems apparent that they’re willing to engage with and stay interested in solving certain problems this way (such as, for example, getting a personal illness triaged and treated without having to skip work the next day).

Another way telemedicine services have changed, from what I can see, is that health systems and hospitals are beginning to integrate it with their other service lines as a routine part of delivering care. Virtual consults are no longer this “weird” thing they do on the side, but a standard approach to addressing common health problems, especially chronic illness.

Then, of course, there’s the most important factor taking control of telemedicine away from health plans: the need to use it to achieve population health management goals. While its use is still a little bit lopsided at present, as healthcare organizations aren’t sure how to optimize telehealth initiatives, eventually they’ll get the formula right, and that will include using it as a way of tying together a seamless value-based delivery network.

In fact, I’d go so far as to say that without the reach, flexibility and low cost of telehealth delivery, building out population health management schemes might be almost impossible in the future. Having specialists available to address urgent matters and say, for example, rural areas will be critical on the one hand, while making specialists need for chronic care (such as endocrinologists) accessible to unwell urban patients with travel concerns.

Despite the growing adoption of telemedicine by providers, it may be 5 to 10 years or so before it has its fullest impact, a period during which health plans gradually accept that the growth of this technology isn’t up to them anymore. But the day will without a doubt arise soon enough that “telemedicine” is just known as medicine.

Vanderbilt Disputes Suggestion That Larger Hospitals’ Data Is Less Secure

Posted on November 27, 2017 I Written By

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

Ordinarily, disputes over whose data security is better are a bit of a snoozer for me. After all, if you’re not a security expert, much of it will fly right over your head, and that “non-expert” group definitely includes me. But in this case, I think the story is worth a closer look, as the study in question seems to include some questionable assumptions.

In this case, the flap began in June, when a group of researchers published a study in JAMA Internal Medicine which laid out analysis of HHS statistics on data breaches reported between late 2009 to 2016. In short, the analysis concluded that teaching hospitals and facilities with high bed counts were most at risk for breaches.

Not surprisingly, the study’s conclusions didn’t please everyone, particularly the teaching-and high-bed-count hospitals falling into its most risky category. In fact, one teaching hospitals’ researchers decided to strike back with a letter questioning the study’s methods.

In a letter to the journal editor, a group from Nashville-based Vanderbilt University suggested that the study methods might hold “inherent biases” against larger institutions. Since HHS only requires healthcare facilities to notify the agency after detecting a PHI breach affecting 500 or more patients, smaller, targeted attacks might fall under its radar, they argued.

In response, the authors behind the original study admitted that the with the reporting level for PHI intrusions starting at 500 patients, larger hospitals were likely to show up in the analysis more often. That being said, the researchers suggested, large hospitals could easily be a more appealing target for cybercriminals because they possess “a significant amount of protected health information.”

Now, I want to repeat that I’m an analyst, not a cybersecurity expert. Still, even given my limited knowledge of data security research, the JAMA study raises some questions for me, and the researchers’ response to Vanderbilt’s challenge even more so.

Okay, sure, the researchers behind the original JAMA piece admitted that the HHS 500-patient threshold for reporting PHI intrusions skewed the data. Fair enough. But then they started to, in my view at least, wander off the reservation.

Simply saying that teaching hospitals and hospitals with more beds were more susceptible to data breaches simply because they offer big targets strikes me as irresponsible. You can’t always predict who is going get robbed by how valuable the property is, and that includes when data is the property. (On a related note, did you know that older Toyotas are far more likely to get stolen than BMWs because it’s easier to resell the parts?  When I read about that trend in Consumer Reports it blew my mind.)

Actually, the anecdotes I’ve heard suggests that the car analogy holds true for data assets — that your average, everyday cyber thief would rather steal data from a smaller, poorly-guarded healthcare organization then go up against the big guns that might be part of large hospitals’ security armament.

If nothing else, this little dispute strongly suggests that HHS should collect more detailed data breach information. (Yes, smaller health organizations aren’t going to like this, but let’s deal with those concerns in a different article.) Bottom line, if we’re going to look for data breach trends, we need to know a lot more than we do right now.

AMA Connects Doctors With Health IT Ventures

Posted on November 22, 2017 I Written By

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

Maybe I’m wrong, but the following strikes me as coming straight from the Redundancy Department of Redundancy…but let’s see. Maybe I’m just being mean. Or maybe it’s because I just couldn’t taste The Rainbow in my last package of Skittles.

Anyway, recently AMA announced the launch of an online platform, the Physician Innovation Network (PIN), designed to connect physicians together with health tech firms.

The PIN will give HIT companies will have a straightforward channel for collecting physician input on the products and services they’re developing. The health IT ventures will also be able to search for physicians who have the expertise they need and are willing to exchange information with them. Meanwhile, the platform will help physicians to find paid and volunteer opportunities to work with health tech companies to work with the health take ventures that suit them.

In recent years, the AMA has taken several steps to bring the world of health IT and physicians closer together. Most recently, the trade group announced that it had created a data standardization organization known as the Integrated Health Model Initiative. The physician group and its partners say the new data model will include clinically-validated data elements designed to speed up the development of improved data organization, management, and analytics.

Its other HIT initiatives include:

  • Co-founding Health2047, a company designed (like PIN) to bring together physicians with established healthcare companies and help them launch useful services and products
  • Serving as one of four founding organizations behind Xcertia, an organization intended to foster knowledge about clinical content, usability, privacy, security and evidence of efficacy for mHealth apps
  • Managing a student-run biotechnology incubator in collaboration with Sling Health,

But what is there to say about PIN that distinguishes it from all of these efforts? It resembles Health2047, mais non? And what benefit does it add over LinkedIn? Specialty interest groups within the MGMA and HIMSS? AngelList? A giant digital corkboard and some virtual Post-It notes?

Don’t get me wrong, I know I’ve come down hard on the AMA’s product launch announcements rather often, perhaps too often. Depending on how it actually works, PIN may actually offer some incremental value over all of these other options. And hey, if the trade group wants to throw its money around, whom am I to say that they shouldn’t have at it.

The thing is, though, the AMA doesn’t work in a vacuum.

Look, as we all know, we’re absolutely drowning in initiatives and proposals and great new ideas for interoperability and the collection of consumer-generated health data. And don’t forget scoping out the best architecture for deploying two tin cans with a piece of string between them, getting budget approval from a Magic 8 Ball (signs point to no), and repurposing some BASIC code from a  Commodore 64 to develop your next mobile health app. (Yes, it tired me out to write that sentence but it was worth it.)

Silliness aside, when you have the kind of resources the AMA does, you want to the profession to say something meaningful when you open your mouth, professionally speaking. Other than that, you’re just sucking air out of the room that could be used for people with a differentiated idea in real value to deliver.  Hey, but other than that, the PIN announcement is just fine.

Health Data Tracking Is Creeping Into Professional Sports

Posted on October 27, 2017 I Written By

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

Pro athletes are used to having their performance tracked minutely, not only by team owners but also by legions of fans for whom data on their favorite players is a favored currency. However, athletic data tracking has taken on a shape with the emergence of wearable devices.

For example, in spring of last year, Major League Baseball approved two devices for use during games, the Motus Baseball Sleeve, which tracks stress on elbows, and the Zephyr Bioharness, which monitors heart and breathing rates, skin temperature and sleep cycle.

In what must be a disappointment to fans, data from the devices isn’t available in real time and only can be downloaded after games. Also, clubs use the data for internal purposes only, which includes sharing it with the player but no one else. Broadcasters and other commercial entities can’t access it.

More recently, in April of this year, the National Football League Players Association struck a deal with wearables vendor WHOOP under which its band will track athletes’ performance data. The WHOOP Strap 2.0 measures data 100 times per second then transmits the data automatically to its mobile and web apps for analysis and performance recommendations.

Unlike with the MLB agreement, NFL players own and control the individual data collected by the device, and retain the rights to sell their WHOOP data through the Players Association group licensing program.

Not all athletes are comfortable with the idea of having their performance data collected. For example, as an article in The Atlantic notes, players in the National Basketball Association included the right to opt out of using biometric trackers in their latest collective-bargaining agreement, which specifies that teams requesting a player wear one explain in writing what’s being tracked and how the team will use the information.  The agreement also includes a clause stating that the data can’t be used or referenced as part of player contract negotiations.

Now, it’s worth taking a moment to note that concerns over the management of professional athlete performance data file into a different bucket than the resale of de-identified patient data. The athletic data is generated only during the game, while consumer wearables collect data the entire time a patient is awake and sometimes when they sleep. The devices targeting athletes are designed to capture massive amounts of data, while consumer wearables collect data sporadically and perhaps not so accurately at times.

Nonetheless, the two forms of data collection are part of a larger pattern in which detailed health data tracking is becoming the norm. Athletic clubs may put it to a different purpose, but both consumer and professional data use are part of an emerging trend in which health monitoring is a 24/7 thing. Right now, consumers themselves generally can’t earn money by selling their individual data, but maybe there should be an app for that.

Is It Time To Redefine Interoperability?

Posted on October 26, 2017 I Written By

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

Recently, an article appearing in healthcare journal HealthAffairs argued that hospitals’ progress toward interoperability has been modest to date. The article, which looked at the extent to which hospitals found, sent, received and integrated information from outside providers in 2015, found that they’d made few gains across all four categories.

Researchers found that the percent of hospitals engaging in all four activities rose to 29.7% that year, up from 24.5% in 2014. The two activities that grew the most in frequency were sending (growing 8.1%) and receiving (8.4%). Despite this expansion, only 18.7% of hospitals reported that they used this data often. The extent to which hospitals integrated the information they received didn’t change from 2014 to 2015.

Interesting, isn’t it, how these stats fail to align with what we know of hospitals’ priorities?  Not only did the rate hospitals sent and received data increase slowly between those two years, hospitals don’t seem to be making any advances in integrating (and presumably, using) shared data. This doesn’t make sense given hospitals’ intense efforts to make interoperability happen.

The question is, are hospitals still limping along in their efforts, or are we failing to measure their progress effectively? For years now, looking at the extent to which they sent/received/found/integrated data has been the accepted yardstick most quarters. To my knowledge, though, those metrics haven’t been validated by formal research as being the best way to define and capture levels of interoperability.

Yes, hospital health data interoperability may be moving as slowly as the HealthAffairs article suggests. After all, I hardly have to tell readers like you how difficult it has been to foster interoperability in any form, and how challenging it has been to achieve any kind of consensus on data staring standards. If someone tells progress toward health data exchange between hospitals hasn’t reached robust levels yet, it probably won’t surprise you in the least.

Still, before we draw the sweeping conclusions about something as important as interoperability, it probably wouldn’t hurt to double-check that we’re asking the right questions.

For example, is the extent to which providers send data to outside organizations as important as the extent to which they receive such data?  I know, in theory, that health data exchanges would be just that, a back and forth between parties on both sides. Certainly, such arrangements are probably better for the industry as a whole long term. But does that mean we should discount the importance of one side or the other of the process?

Perhaps more importantly, at least in my book, is the degree to which hospitals integrate the data into their own systems a good proxy for measuring who’s making interoperability progress? And should be assumed that if they integrate the data, they’re likely to use it to improve outcomes or streamline care?

Don’t misunderstand me, I’m not suggesting that the existing metrics are useless. However, it would be nice to know whether they actually measure what we want them to measure. We need to validate our tools if we want use them to make important judgments about care delivery. Otherwise, why bother with measurements in the first place?

Patient Portal Use Rising Rapidly

Posted on October 25, 2017 I Written By

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

A new study has concluded that patient portal use has shot up over the past few years, with a substantial majority of patients reporting that they use provider portals if possible.

The purpose of the study, results of which was published in Perspectives in Health Information Management, was to examine how healthcare consumers saw their interactions with provider portals, their use of personal health records and their take on the process of releasing health data.

According to a 2015 study cited by the article’s authors, 53% of HIM professionals reported charging consumers for both electronic and paper copies of their health information. Thirty-eight percent said they had a patient portal, but less than 5% of patients were using it.

Over the last two years, however, the picture has changed a great deal. Researchers conducting the current study found that only 10% of consumers were charged for their health information. In addition, 49% reported that they maintained a personal health record. Eighty-three percent of respondents said that their providers had portals, and 82% said that they were taking advantage of their provider’s portal where available.

Patient uses for portals included viewing lab results (35%), requesting medication refills (19%), requesting appointments (22%), secure messaging (19%) and other (5%). Among portal users, 53% were very satisfied and 38% were satisfied with their experiences.

Meanwhile, 49% of respondents said they maintained PHRs, with top record format being combined paper and electronic (46%), followed by paper only (35%), electronic only (18%) and other (1%).

It’s important to note that the study population was especially healthcare-savvy. Participants chosen were campus-based and online students enrolled in a College of Health Professions course, alumni of BA programs in HIM at the researchers’ university, local AHIMA members and the researchers’ family and friends.

The article argues that because the participants were all current healthcare consumers, they were qualified participants. That may be so, but the high concentration of HIM-friendly respondents probably stacked the deck somewhat. (To be fair, the authors admit this.)

That being said, even these relatively sophisticated respondents weren’t completely comfortable with the health data access they had. Complaints cited by consumers included a lack of interoperability between physicians’ offices and electronic PHI, as well as the difficulty of getting data into the portal or updated when already present. Others reported having concerns about health data security.

All told, it looks like the hoped-for growth in patient health data use is taking place over time. I suspect that a direct comparison between less-informed consumers from 2015 and today would show less pronounced changes, though.

 

Health IT Continues To Drive Healthcare Leaders’ Agenda

Posted on October 23, 2017 I Written By

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

A new study laying out opportunities, challenges and issues in healthcare likely to emerge in 2018 demonstrates that health IT is very much top of mind for healthcare leaders.

The 2018 HCEG Top 10 list, which is published by the Healthcare Executive Group, was created based on feedback from executives at its 2017 Annual Forum in Nashville, TN. Participants included health plans, health systems and provider organizations.

The top item on the list was “Clinical and Data Analytics,” which the list describes as leveraging big data with clinical evidence to segment populations, manage health and drive decisions. The second-place slot was occupied by “Population Health Services Organizations,” which, it says, operationalize population health strategy and chronic care management, drive clinical innovation and integrate social determinants of health.

The list also included “Harnessing Mobile Health Technology,” which included improving disease management and member engagement in data collection/distribution; “The Engaged Digital Consumer,” which by its definition includes HSAs, member/patient portals and health and wellness education materials; and cybersecurity.

Other hot issues named by the group include value-based payments, cost transparency, total consumer health, healthcare reform and addressing pharmacy costs.

So, readers, do you agree with HCEG’s priorities? Has the list left off any important topics?

In my case, I’d probably add a few items to list. For example, I may be getting ahead of the industry, but I’d argue that healthcare AI-related technologies might belong there. While there’s a whole separate article to be written here, in short, I believe that both AI-driven data analytics and consumer-facing technologies like medical chatbots have tremendous potential.

Also, I was surprised to see that care coordination improvements didn’t top respondents’ list of concerns. Admittedly, some of the list items might involve taking coordination to the next level, but the executives apparently didn’t identify it as a top priority.

Finally, as unsexy as the topic is for most, I would have thought that some form of health IT infrastructure spending or broader IT investment concerns might rise to the top of this list. Even if these executives didn’t discuss it, my sense from looking at multiple information sources is that providers are, and will continue to be, hard-pressed to allocate enough funds for IT.

Of course, if the executives involved can address even a few of their existing top 10 items next year, they’ll be doing pretty well. For example, we all know that providers‘ ability to manage value-based contracting is minimal in many cases, so making progress would be worthwhile. Participants like hospitals and clinics still need time to get their act together on value-based care, and many are unlikely to be on top of things by 2018.

There are also problems, like population health management, which involve processes rather than a destination. Providers will be struggling to address it well beyond 2018. That being said, it’d be great if healthcare execs could improve their results next year.

Nit-picking aside, HCEG’s Top 10 list is largely dead-on. The question is whether will be able to step up and address all of these things. Fingers crossed!