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Counter Intuitive Findings from Patient Portal Use

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The patient portal is becoming a really hot topic in healthcare. I think we can attribute much of the discussion to the EMR meaningful use requirements to engage with patients in a patient portal. I recently started a thread on LinkedIn based on a post by Jennifer Dennard called Opening up the Pandora’s Box of Patient Portals. The conversation in the thread was great, but David Voran, MD provided some incredibly valuable insight that I wanted to share with all of my readers. The following are Dr. Voran’s comments based on his experience using a patient portal.

Long have exploited the portal in our organization and we’ve now progressed to where the entire chart is available to patients. Can begin to list the results but here are my counter intuitive findings:
1) The more barriers a clinician erects between them and the patient the MORE work they wind up doing.
- Those of us physicians who have configured the portal to have most message types routed directly to the physician wind up answering less messages at the end of the day.
- Typically physicians will have all medication refill requests, questions about the last visit, requests for visits, etc. routed to a nurse or a pool to attempt to answer first. The majority of the time the person receiving this message can answer only part of the question and will then send a message to a physician for direction; the physician responds and then the nurse will interact with the patient; then the physician has to approve any orders or actions taken. This usually involves having the physician receive or respond in some way to 2 messages in their inbox. Those of us who receive the patient’s message directly answer one.
- Many other examples but typically those physicians who have barriers are answering or responding to 35-50% more messages than those who have no barriers.

2) The more the patient has access to the more engaged they will be and the more accurate the record will be. The patient is the best auditor of the record and will point out inconsistencies that can be corrected.

3) If the physician is the one to enroll or engage the patient. Those physicians who promote the portal will get 60-75% utilization of the portal. Those that are passive will see about 30% response rate.

4) Aggressive use of the portal will eliminate up to 8 hours of patient related phone conversations per nurse per week.

May 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

What’s Ahead After TEDMED 2013

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Last week, a number of TEDMED attendees and myself participated in a Google+ Hangout sponsored by Xerox to take a look back at our unique experiences at TEDMED 2013. The discussion included the following people:

  • Markus Fromherz, chief innovation officer of Xerox Healthcare
  • Benjamin Miller, assistant professor at the University of Colorado Denver School of Medicine
  • Nick Dawson, chief experience officer at Frontier Health Consulting
  • John Lynn, editor and founder of the Healthcare Scene blog network

We made it a really focused 15 minute discussion of the key takeaways from TEDMED. Some of the topics we discussed included: healthcare big data, multidisciplinary collaboration, citizen science, patient centered care, and a look at TEDMED topics 5-10 years from now. It was a really great discussion, and I encourage you to watch the TEDMED recap video embedded below.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox Blog and follow @XeroxHealthcare.

May 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EMR Workforce Shortage

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One of the longest running conversations we’ve had on this site is the shortage of qualified EMR workers. It’s a discussion that quite frankly is difficult on many levels. On the one hand you have the hospitals and clinics who are suffering because they can’t find the right people to work on their EMR. On the other hand, you have the unemployed but experienced IT worker that’s trying to crack into the healthcare IT and EMR world.

This later group breaks my heart about once a week. There stories and efforts trying to find a job in healthcare IT are hard for me to take. Sadly, I haven’t figured out a way to help them beyond pointing them to our EMR and EHR Job board which appears in the sidebar of each of our sites. Otherwise, I’m not sure how to bridge the gap between the EHR workforce shortage that many people describe and those looking for jobs in the EHR world.

Although, I was reading something recently that opened my eyes a little bit to why I hear two sides of the same story. This is what I read:

There’s always a shortage of the perfect worker.

This is a challenging idea to consider, but an important one. There are only a handful of perfect workers out there for each situation, so of course there’s a shortage of that talent. Plus, it’s amazing how the perfect workers always seem to have work. Yes, there are a few exceptions and much of job hunting is about timing and location. However, I wonder if the EHR shortage that many describe is the lack of the perfect worker and not an actual EHR worker shortage.

I thought it would be interesting to have a poll to see what people think about the EMR workforce shortage. Is there one or isn’t there? Select your answer below.

Feel free to elaborate on your poll response in the comments.

May 14, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

5 Tips for Improving Provider Productivity with an EMR

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The most recent EMR adoption numbers I’ve seen are putting EMR adoption at about 60% of doctors. When I think about the other 40% of doctors that have yet to adopt an EMR, my guess is that the biggest reason they haven’t adopted an EMR is based on their fear that an EMR will negatively impact their practice and their productivity. They fear that a change to EMR is going to be negative rather than a positive that it could be.

A whitepaper called Getting Lean with Your Practice: Five Tips for Improving Provider Productivity with an EHR does a good job looking at the issues of productivity in a practice and how to improve that productivity. One thing it points out is that if you can’t measure it, then you don’t really know how you’re doing. Turns out, an EMR is a great way to measure productivity.

Think about all the data an EMR can produce that would have never been possible in an EMR. Patient wait times and documentation times are the most obvious when we’re talking about productivity. In the paper world, you really didn’t have a good idea if a doctor had 20 charts outstanding or none other than looking at the stack of charts on the desk and checking them. In the EMR world, you can easily report on who’s staying up with their charting and who is not.

In the productivity whitepaper mentioned above, after studying 25 providers at 12 diverse practices they found that same-day encounter close rates (ie. finishing the charting the day of the visit) was the single most revealing metric about the success of patient workflow processes. They suggest that this doesn’t mean you document every patient as you seem them. Instead, they suggest documenting as much as you can with the patient when you’re with them and then you wrap up any complex patients as the end of the day. This is usually the right balance for most doctors I’ve worked with as well.

Here are the full 5 tips from the whitepaper:

  1. Start on time.
  2. Work with cross-trained staff that can handle intake and documentation.
  3. Document encounters as much as possible during and immediately after visits, but don’t document more than necessary or spend too much clinical time on complex documentation.
  4. Close all patient encounters by the end of the day – This should involve just wrapping up documentation for complex encounters.
  5. Route documents appropriately and delegate responsibility for document handling effectively.

One of the other great takeaways from the whitepaper is the idea that doctors can and should be delegating more of the documentation to their staff. A Dr. Lizabeth Riley pointed out that “the data the system provided immediately opened my eyes to the fact that I was only giving my staff 1% of charting duties! Once I saw that, I knew thing had to change. My staff now does 40%-60% of my charting for me.”

There was a lot more interesting data in the whitepaper including the 5 different physician work styles from Truly Lean to Falling Behind and Frustrated. This last group is behind the EMR backlash. Hopefully some of the tips above can help a doctor become more productive with their EMR.

May 13, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

The Rise Of mHealth And EHR Use, And The World Of Telehealth – Around Healthcare Scene

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mHealth is on the rise, and it looks like usage of smart phones among physicians is following that same trend. A recent study shows that usage rose about nine percent in 2012, which shows that it is becoming more accepted in the medical world. It will be interesting to see if it increases even more this year (I have a feeling it might.)

Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

Even though 90 percent of doctors are using an EMR at one point or another, only about 55 percent have actually adopted an EHR into their practice. It can be nerve-racking trying to find the perfect EHR. If you are finding yourself at that crossroad, be sure to read these five tips from ADP AdvancedMD on how to have a successful EHR implementation.

Still, some of you may be hesitant to implement an EHR. You may ask, is it worth it? Does it takeaway from healthcare? There is debate from both sides, each with compelling arguments. John believes that technology is overall positive in any industry, and discusses his thoughts, and some of the challenges that faces the industry.

Telehealth and medicine is so huge, it can be hard to digest. Neil Versel recently attended the American Telemedicine Association’s annual conference in Austin, Texas, and saw just how huge this market was. Be sure to check out this video he created from his experience, and to perhaps get a better idea about the many types of telehealth. Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

With summer quickly approaching, it’s more important than ever to stay hydrated. But if you need a little reminder, be sure to look into the Jomi Band.  It gives you warnings when you might be on the brink of dehydration, and makes it easy to keep track of how much water you’ve consumed in a day’s time.

May 12, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EHR Backlash, ACO, and Center of Care – #HITsm Chat Highlights

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Topic One: What’s your take on the emerging #EHRBacklash? A post-Meaningful Use fad, or a movement with actual potential?

 

Topic Two: Will patients ever take their place at the center of the care team? Do they know that they should care about it?

 

Topic Three: What does #ACO mean to you? Does anyone understand what will make them sustainable? Does human behavior even permit such things?

 

Topic Four: Open Forum. What topics are you tuned into right now? #healthIT

 

May 11, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Healthcare IT From the Mouth of Babes

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A little Fun Friday post to get you started for the weekend. This past week was Take Your Child to Work Day. This is always an interesting thing for me since I work from home. However, I usually try and head out to one of the local Las Vegas tech startup hangouts so my kids can see some other people I work with.

This time I decided to put my son to work a little bit. I had him on the iPad following some people on Twitter. It was fun to see him working.

As we started to work my son asked me, “What DO you do for work dad?” I knew that sooner or later this question would be coming since I mostly work from home. I responded, “I’m a blogger.” My son replied, “Oh, I told my class you were a typist.” I guess my son’s teacher had asked those planning to go to work with their parents what their parents did. He was right about me typing. It’s a pretty fundamental part of my job and really the only visible part of my work from his perspective.

I then went on to explain to my son a little bit more about what I did for my job. I told him that I wrote about how doctors can keep track of their patients on the computer. My son then responded, “That’s kind of weird that a doctor would write on paper…and then give it to a bird to deliver it, but you’d have to train the birds. That’s how they use to do it.” Sadly, he’s not that far from the truth.

From the mouth of babes indeed. Looks like I need to spend a little more time teaching them what I do for work. Although, I was grateful for the good laugh. I hope you enjoyed it as well.

Now I’m going back to work as a “typist” so I can write about doctors switching from pigeon chart delivery to electronic exchange of charts.

May 10, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EHR Benefit – Eligibility for Pay-for-Performance

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It’s time for the next installment in my series of posts looking at the long list of EHR benefits.

Eligibility for Pay-for-Performance
I think that this is a really scary topic for most doctors. It’s not that a doctor is afraid of being reimbursed for the way they perform. The problem with pay for performance (ACO if you prefer) is that we have no idea what that’s really going to look like. The unknown is scary and a real problem. A change as dramatic from fee for service to pay for performance is an enormous shift and we still have very little idea how that shift is going to happen.

However, as one person told me, “That train (the shift to pay for performance) has already left the station.” In fact, I was talking with the former CEO of a major EMR vendor and he suggested that the shift is going to happen a lot faster than most of us realize. If we assume that this shift is going to happen, then doctors and healthcare better be prepared.

I believe having an EMR will be the only way a clinic can participate in pay for performance.

I make this assertion, because how else are payers going to measure your performance if they don’t have the data on how you’re performing? I’ve never thought of this before, but the EMR could become the performance measurement tool for doctors. Trying to flintstone your performance in a paper world is just not going to happen. The data collected in an EMR (and possibly other software) is going to drive the performance metrics which will drive the payments.

Think about what that means to a clinic. If you don’t have an EMR, you will miss out on the pay for performance payments.

I imagine many that read this will discount the shift that’s going to happen. That’s a fair position to take, but one that I think will come back to bite you. If the shift in payments doesn’t happen, then you won’t have to worry. However, if the shift to pay for performance has left the station, then you’re going to be at a tremendous disadvantage.

Healthcare data is going to drive a lot of things in the future of healthcare. Pay for performance is one of those things. Physicians who don’t have that data available in an EMR or other electronic format are going to face stiff challenges.

May 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

How Do You Improve the Quality of EHR Data for Healthcare Analytics?

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A month or so ago I wrote a post comparing healthcare big data with skinny data. I was introduced to the concept of skinny data by Encore Health Resources at HIMSS. I absolutely love the idea of skinny data that provides meaningful results. I wish we could see more of it in healthcare.

However, I was also intrigued by something else that James Kouba, HIT Strategist at Encore Health Resources, told me during our discussion at HIMSS. James has a long background in doing big data in healthcare. He told me about a number of projects he’d worked on including full enterprise data warehouses for hospitals. Then, he described the challenge he’d faced on his previous healthcare data warehouse projects: quality data.

Anyone that’s participated in a healthcare data project won’t find the concept of quality data that intriguing. However, James then proceeded to tell me that he loved doing healthcare data projects with Encore Health Resources (largely a consulting company) because they could help improve the quality of the data.

When you think about the consulting services that Encore Health Resources and other consulting companies provide, they are well positioned to improve data quality. First, they know the data because they usually helped implement the EHR or other system that’s collecting the data. Second, they know how to change the systems that are collecting the data so that they’re collecting the right data. Third, these consultants are often much better at working with the end users to ensure they’re entering the data accurately. Most of the consultants have been end users before and so they know and often have a relationship with the end users. An EHR consultant’s discussion with an end user about data is very different than a big data analyst trying to convince the end user why data matters.

I found this to be a really unique opportunity for companies like Encore Health Resources. They can bridge the gap between medical workflows and data. Plus, if you’re focused on skinny data versus big data, then you know that all of the data you’re collecting is for a meaningful purpose.

I’d love to hear other methods you use to improve the quality of the EHR data. What have you seen work? Is the garbage in leads to garbage out the key to quality data? Many of the future healthcare IT innovations are going to come from the use of healthcare data. What can we do to make sure the healthcare data is worth using?

May 8, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

URMC Faces Third HIPAA Breach

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The University of Rochester Medical Center has seen a third HIPAA breach, this one caused by the loss of an unencrypted USB drive by a physician, reports Healthcare IT News.  The drive, which belonged to a resident, contained protected health information on 537 patients.

Officials with URMC say they have notified the 537 former orthopedic patients whose information was lost on the drive.  Lost information included patients’ names, genders, ages, dates of birth, telephone numbers, medical record numbers, and more, though it didn’t include addresses, Social Security numbers or insurance information.

According to Healthcare IT News, the resident’s unencrypted, unprotected drive runs counter to URMC’s campus-wide policy. URMC requires physicians and staff to use only encrypted drives — the only kind which are stored in its on-campus computer center.  The latest URMC security policy also requires all mobile devices to be password protected, encrypted, and to have a time-out if unattended.

In an effort to make sure further security breaches don’t occur, the health organization is re-educating its faculty and staff on its security policy, and plans an annual education series to reinforce this training, a hospital spokesperson told Healthcare IT News.

This is URMC’s third data breach involving more than 500 patients reported to HHS, the magazine reports. The previous two breaches, which involved PHI for nearly 3,500 patients, both took place in 2010.  One of the two involved the loss of an encrypted portable electronic device.

May 7, 2013 I Written By

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