Patient Portal | EMR and HIPAA

Practice Fusion EMR Brings Patients Into The Picture

Practice Fusion was one of the first free, advertising supported, cloud-based EMR to enter the market and has likely been the loudest proponent of free EMR software. Although, they have some interesting Free EMR competitors like Mitochon and Kareo. Since 2007, Practice Fusion has focused on offering unfettered access to its product in exchange for physicians being willing to accept advertisements relevant to the health records they’re using and the aggregate use of the EHR data.

The company, which has raked in venture capital in buckets since its founding, now says it has 150,000 healthcare providers using its EMR and records on 60 million patients, according to a piece in The New York Times.

Now, the company has taken another step in its free-for-all model with a new service it calls Patient Fusion. Patient Fusion is a new service which allows patients using the system to schedule appointments with any participating doctor who uses the EMR. It also allows patients to rate the doctors in question and to access their records with permission. So far, 27,000 of Practice Fusion’s EMR users have signed up for the service, the Times reports.

The Times columnist covering this announcement speculates that Practice Fusion has launched its new product as a means of building up patient traffic, but I don’t see how that would work. Patients may see more of their records, but this won’t necessarily do anything to increase the number of doctor-based views the network can sell to lab companies and pharmas.

On the other hand, Patient Fusion could prove to be a powerful way of attracting and keeping doctors who want to offer easy-to-administer appointment scheduling to patients. Also, getting patients engaged with their medical records is very much in the spirit of Meaningful Use and the ONC’s priorities generally, so this new patient feature could be a beacon for doctors going through MU-motivated EMR switching this year.

Bottom line, this seems like a nifty idea. I predict that most of Practice Fusion’s EMR customers will sign up over the next year or so.

British Doctors Fear Repercussions Of Sharing EMR Data With Patients

Written by: Katherine Rourke

Like their American counterparts, British doctors fear giving patients too much access to their electronic health records, according to a new survey.

The survey was conducted by a non-profit group called the Medical Protection Society, which provides professional indemnity coverage to doctors, dentists and health professionals globally.

Researchers there found that 75 percent of patients responding to the survey want medical records to be written in “simple language” that patients can read without help, according to the British Journal of Healthcare Computing.

Doctors, on the other hand, aren’t so keen on the idea, with only 21 percent agreeing that medical records should be written in this manner. Moreover, 84 percent of physician respondents were afraid that sharing data would complicate their relationship with patients and potentially turn out to be a time sink.

It’s not so much that doctors fear sharing information with patients. Physicians seemed to agree that it’s good when patients understand their records and can make better decisions about their own care.

But it seems that doctors and patients have different expectations as to how to manage that sharing. While patients want readable records, physicians worry that it’ll be difficult to write records accurately if they have to avoid clinical terms, jargon, acronyms and shorthand that might confuse patients.

In fact, they believe that writing a record in non-professional English might cause those records to grow considerably longer while offering less value to other professionals, the BJHC reports.

To avoid such problems, it will be important to introduce comprehensive educational support for both doctors and patients, the researchers concluded.

Does Patient Interaction Lock a Doctor In to an EHR?

Written by: John Lynn

I’ve been thinking a lot lately about EHR vendor lock in. I think this was prompted by some stories I’ve heard of EHR vendors holding clinics EHR data “hostage” when the clinic chooses to switch EHR software. I heard one case recently that was going to cost the clinic a few hundred thousand dollars to get their EHR data out of their old EHR software. It’s a travesty and an issue that I want to help work to solve this year (more on that in the future).

I think it’s such a failed model for an EHR vendor to try to keep you as their EHR customer by holding your EHR data hostage. There are so many other ways for an EHR vendor to keep you as a customer that it’s such a huge mistake to use EHR data liquidity to keep customers. EHR vendors that choose to do this will likely pay the price long term since doctors love to talk about their EHR with other doctors. If a doctor is locked into an EHR they dislike, then you can be sure that their physician colleagues won’t be selecting that EHR.

There are a whole series of better ways to lock an EHR customer in long term. The best way being providing an amazing EHR product.

I recently considered another way that I think most EHR vendors aren’t using to create a strong relationship with their physician customers. Think about the strength of a company’s relationship with a doctor if a doctor’s patients are all familiar with their connection to the EHR. If a physician-patient interaction occurs regularly through the EHR, then it’s very unlikely that a doctor is going to switch EHR software.

The most obvious patient interaction that occurs is through a patient portal that’s connected to a provider’s EHR. Once a clinic has gotten a large portion of their patients connected to an EHR patient portal, then it makes it really hard for a doctor to consider switching from that EHR. It’s one thing for a doctor to change their workflow because they dislike their EHR. Add in the cost of getting patients to switch from a portal they have been using and I can see many doctors sticking with an EHR because of their patients.

Of course, from a doctor perspective, there’s some value in selecting an EHR that uses a 3rd party patient portal. That way if you choose to switch EHR software, then you can still consider keeping your interaction with patients the same through the same third party patient portal. Although, there’s some advantage to using the patient portal from the EHR vendor as well. It’s not an easy decision.

Can the Benefits of Hospitals Acquiring Practices Be Achieved By Other Means?

Written by: John Lynn

I’ve regularly talked about the current healthcare environment of hospitals acquiring physician practices. This trend is occurring at a really rapid rate, but in an email exchange I had recently with Dave Chase from Avado I started asking myself if the benefits of a consolidated group of providers could be achieved by other means.

At the core of the current trend is a little reimbursement loophole that many hospitals have been exploiting. I wrote about this loophole in a post on Hospital EMR and EHR called Reasons Hospitals Acquire Medical Practices. Considering this reimbursement loophole, I think there is a little that can be done to discourage hospitals that want to try and increase revenue through this loophole.

At some point Medicare is going to catch up with this and close the loophole. Once that happens, it’s worth considering the other benefits of being part of a large organization as opposed to being a solo practice. Plus, can those benefits be achieved through other means than fully acquiring a practice? This is particularly important as doctors that are currently working for hospitals choose to go back out on their own and for those organizations who haven’t already gotten on the practice acquiring bandwagon.

I think the most pressing reason that practices are interested in relationships with hospitals is based on the changing reimbursement models. It will be impossible to access the ACO money that’s coming without tight ties to a large number of organizations. One way to achieve this is for a healthcare organization to acquire all of the various healthcare organizations that will make up an ACO. I think that’s part of what we’re seeing now and I’ve discussed before how this might be the way hospitals avoid the cycle of doctors leaving. Although, we’re already seeing signs of doctors leaving for new medical models.

This seems like a pretty expensive proposition for hospitals to acquire practices just for the doctors to go back to private practice. Which makes me wonder if the benefits of an acquired practice can be achieved through software and relationships? As we’ve discussed before, interfaces in healthcare are quite hard to do. So, once you’ve been able to create that interface with a clinic or hospital, then you have some pretty solid lock in with that organization.

Although, I’m pretty sure that Dave Chase (which inspired this idea) would take this idea one step further. Imagine that most of the patients used one portal to interact with your local healthcare community. Could that portal facilitate your ACO efforts? Once the majority of patients are in that portal, will anyone in the community want to be somewhere else? There’s real lock in that can occur once patients are engaged with healthcare institutions. This occurs with the patients and with the healthcare organizations that are engaging with those patients.

I think it will be interesting to see if software can facilitate some of the same benefits to hospitals that they get from acquiring physician practices.

EMR & Patient Safety, Meaningful EHR Measures, and the Patient Portal “Switch”

Written by: John Lynn

Patient Safety and the Ethics of #EMR Implementation | @doctorwes goo.gl/fb/MZ74V #DigitalHealth #HealthIT #EHR #Health20

— Paul Sonnier (@Paul_Sonnier) January 21, 2013

What an important topic of discussion. In fact, it makes me want to look at writing a whole series of articles on the patient safety issues using an EMR and also the patient safety issues of not using an EMR. Much of it I’ll be covering in my EHR benefits series, but quite a different angle. Although, the ethics side of it could be really interested. I’m glad Dr. Wes is starting this discussion.

ACP on Stage 3: Let’s measure improvements, not just create more measures ow.ly/1RkFvd #HealthIT #EHR

— Michael Crosnick (@MichaelCrosnick) January 20, 2013

I keep wishing it was interoperability, but I do think we could go way too far when it comes to adding more measures and end up with measures that provide little to no value if we’re not careful.

@devincfoster @jeanmoorjani @chriscarrollmd @peds_id_doc Love patient portals. Docs need to remember to flip EMR switch so info goes to pt.

— Gail Zahtz (@GailZahtz) January 16, 2013

I love that people think that implementing a patient portal is as easy as flipping a switch. I can have a full EMR at my fingertips in 2 minutes by signing up at one of the Free EHR, but that misses so many important parts of implementing an EMR. The same goes for a portal. It takes a little more thought to implement a patient portal than just flipping a switch.

Health IT Hazards, Selecting the Right EHR, and Withings Wireless Scale – Around Healthcare Scene

Written by: Katie

Hospital EMR and EHR

Health IT Stands Out In Health Technology Hazards List

The Top 10 Health Technology Hazards list was recently released by ECRI. And this year, two of the hazards that made the list are health IT related – patient/data mismatches in EHRs and other HIT systems, and, interoperability failures with medical devices and health IT systems. Anne Zeiger predicts that more HIT issues will top this list in the future.

Patients Accessing Online Medical Records Use More Services

A new study revealed something interesting — patients who use online access to medical records are likely to use more clinical services than those who do not. The Journal of the American Medical Association drew this conclusion after studying members of Kaiser. Kaiser has had a patient portal in place since 2006, which made it an ideal candidate for this study.

EMR and EHR

10 Tips for Selecting the Right EHR

In the market for a new EHR? Or perhaps just implementing one? This post highlights 10 tips on selecting the right EHR for your practice, as presented by Insight Data Group. Some of the suggestions include making sure the EHR is easy to use and customized, and use the government’s money to pay for your EHR.

Meaningful Healthcare IT News

Social and Mobile Continue to Converge in Healthcare

An interesting infographic is shown and discussed in this post. It is called “How Health Consumers Engage Online,” and reveals some interesting facts about the digital and health world. According to it, more people in the United States own a smart phone than a tooth brush, and 23 percent of people use social media to follow the health experiences of a friend. This definitely presents some fascinating data that is worth reading.

Smart Phone Health Care

New Withings Wireless Internet Scale Hits the Market

A new scale was recently released, and it does more than just tell a person how much they weigh. It tracks numerous variables, including BMI, and can be synced to various mHealth apps. There is also an app that goes along with the scale as well. It is a bit pricey at over $100, but it definitely “tips the scales” when it comes to scales.

Smart Phone Enabled Thermometer Approved By FDA

The “Raiing” is the newest in smart phone technology. It’s a high-tech, yet easy-to-use, thermometer, designed for iOS devices. It is placed under the armpit, and can actually track a person’s temperature over time. If a temperature reaches a certain number, an alarm will go off on the connected smart phone. This can help give parent’s peace of mind, as a sick child sleeps.

Patients and EMRs, EMR Value, and Healthy Food Guide: Around Healthcare Scene

Written by: Katie

Hospital EMR and EHR

What do Patients Need From EMRs?

Meaningful Use Stage 3 requires that EMRs be accessible by both patients and providers for comments. This post contains several suggestions for what patient data must include. Some points discussed include links to medical information (to help identify unfamiliar terms), the ability to view information in different views, and mobile access to health information.

Adolescent Data Needs Stronger EMR Protections, Group Says

The AAP recently came out with a statement concerning the protection of adolescents in EMR. They believe that adolescents don’t enjoy the same protection as adults do, and this needs to change. To help with this, the AAP has presented a list of principals that should “govern” EMRs, PHRs, and HIEs. Some of the ideas include creating criteria for EMRs that meed standards for adolescent privacy, and flexibility within standards for protection of privacy for diagnoses, lab tests, etc. These new suggestions will place an added burden on EMR vendors.

EMR and EHR

EMR Value Diminished If Patients Can’t Access Care

A recent study was released that analyzed primary care practices in 10 countries around the world. While it indicated that more US physicians are using EMRs than in the past, a large percentage patients in the US are still struggling to pay for health treatments. This is well-below the numbers from other countries surveyed. This may suggest that even if EMR is in use, it doesn’t really matter if patients can’t afford getting help.

New Healthcare Facility Experiences IT Growing Pains

Jennifer Dennard recently has to visit a new facility in the area in order to treat an illness. She was pleasantly surprised with the facility, and recounts her experience here. However, she discusses some of the IT “growing pains” the facility is experiencing, such as still using paper prescriptions.

Smart Phone Health Care

Healthy Food Guide Uses MyPlate.Gov Standards to Track Calories

There are many mobile food diaries available, and a new one just hit the market. Healthy Food Guide puts a twist on the typical calorie counting idea, and helps its users make sure they are getting enough of each food group. There’s a few glitches here and there that need to be worked out, but it’s a neat little alternative to some of the other diaries out there, because of how simple and to the point it is.

CMS May Revisit Patient Engagement Rules – Meaningful Use Monday

Written by: John Lynn

Health Data Management has a fascinating quote from Travis Broome, specialist at CMS, during a presentation on meaningful use Stage 2 at MGMA 2012.

Stage 2 electronic health record meaningful use requirements that at least five percent of patients conduct secure messaging with physicians, and view, download, or transmit their ambulatory and inpatient data came at the insistence of HHS Secretary Kathleen Sebelius. And those requirements might not be set in stone.

The patient engagement requirement has long been one of the most talked about challenges with meaningful use stage 2. The problem is easily seen. Doctors EHR incentive is being held hostage by something they don’t control. If patients don’t want to access their health information, are doctors suppose to coerce them into doing so?

An article in Fierce Health IT also has a money quote on what’s wrong with this MU stage 2 provision:

As Jeremy Tucker, medical director of MedStar St. Mary’s Hospital in Leonardtown, Md., told FieceHealthcare, better patient experience comes from cultural change across all levels of the organization. “If the reason for doing patient experience is simply to get a better score on a test, you will fail,” he said. “It only takes one cold meal tray or a roll of the eyes by a staff member to derail the patient experience.”

While I love the intent of patient engagement, I don’t love it as a requirement for EHR incentive money.

Another great comment from Broome from the Health Data Management article above is in regards to meaningful use audits:

Answering a question about meaningful use payment audits, Broome acknowledged that the audits have begun. He declined to give many specifics other than saying that providers falling into certain “risk profiles” might be asked to justify their attestations. One practice, for example, attested to meaningful use and supplied identical statistics across multiple criteria, all but inviting suspicion. When challenged, that practice returned the money, Broome said.

UPDATE: Travis Broome sent me this clarifying tweet:

“@techguy:dlvr.it/2PKQMV” Of course I actually said Sec approved and revisit only if everyone was actually failing the measure

— Travis Broome (@Travis_Broome) October 30, 2012

Of course we know he can’t do anything without the secretary approval. Hopefully the bar is a little more than everyone failing. How about almost everyone failing or most people failing?

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

Written by: Lynn

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Without delving into all the specifics detailed in the 672-page Final Rule for Stage 2, what is important to comprehend—for now—is how Stage 2 raises the bar set by Stage 1 and how it intensifies the focus on health information exchange and patient engagement.

The following are some highlights of Stage 2:

The Final Rule not only confirms 2014 as the earliest effective date for Stage 2 (as expected), but it provides additional leeway for providers and for vendors by limiting the Stage 2 reporting period to 90 days in 2014, instead of a full year.
EPs must meet or exclude all 17 core measures and must meet—not “meet or exclude”—3 of the 6 menu measures. (Unlike Stage 1, exclusions of menu measures do not count unless the EP cannot find 3 relevant menu measures.)
All Stage 1 menu measures except syndromic surveillance become core measures.
5 new menu measures have been added: access to imaging results, family history, progress notes, reporting to cancer registries, and reporting to specialized registries.
Stage 2 increases most Stage 1 thresholds.
CPOE is expanded to include lab and radiology orders, in addition to prescriptions.
Patient portals play an important role as a means of providing patients with access to their medical records. Physicians will have to ensure that at least 5% of the patients they see actually view, download or transmit their health information and that over 5% of the patients seen send them a secure e-mail message containing clinical information, (i.e., not just a request for an appointment.)
Clinical summaries of office visits must be available to patients within 1 day, instead of the 3-day timeframe in Stage 1.
The Stage 1 measure requiring a test of the ability to exchange clinical data with another provider has been dropped effective 2013, in favor of a more robust 2014 Stage 2 requirement for ongoing exchange of a significantly more extensive data set.
EPs will report on 9 of 64 clinical quality measures, and after the provider’s first incentive year, the CQM data must be submitted electronically, rather than by attestation.
In an effort to streamline the reporting process, Stage 2 offers opportunities for batch reporting by group practices and for consolidated CQM reporting for PQRS and meaningful use.
Penalties and hardship exemptions are defined, establishing October 1, 2014 as the latest date by which an EP can attest for the first time and avoid a 1% payment adjustment in 2015.

More information about Stage 2 will follow in future Meaningful Use Monday posts.

EHR Mouseclicks, #HIT100 Interview, EMR and Doctor-Patient Relationships, and Sleep Rate: Around Healthcare Scene

Written by: Katie

I apologize for not having a weekly round-up last week — my family and I were in Southern Colorado, and while the owner of the lodge we were staying at said there was Internet available, that didn’t prove to be completely true. So for the next two weeks, these posts will have a combination of two weeks’ of posts. There were some great posts recently, and I’d hate for anyone to miss them!

EMR and EHR

Too Many EHR Mouseclicks and Keystrokes – A Solution for EHR Vendors

Critics of EHRs claim that there are too many mouseclicks/keystrokes involved to consider it efficient. However, there are ways to overcome this complaint. If vendors would focus on making their product respond consistently, and physicians get the training they need, this hurdle can be overcome. It may take awhile for this point to be reached, but it is possible.

EMR Advocate Tops the #HIT100

The #HIT100 list aims to recognize great #HITsm and #HealthIT communities on Twitter. This week, the #1 person on the list, Linda Stotsky (@EMRAnswers), was interviewed by Jennifer Dennard. She gives her thoughts on social media and health IT, and how it’s affected her career. Stotsky also reflects on the the value that the #HIT100 list brings to the health care community.

The Intersection of EMRs and Health Information Management

While researching for a discussion she was going to moderate on the exchange of personal health information with an ACO at Healthport’s first HIM Educational Summit, Jennifer Dennard stumbled upon some interesting information. This post contains some of her thoughts, and includes a list of the top 10 trends impacting HIM in 2016. At the conclusion of her article, she asks questions concerning Meaningful Use and the relationship HIM professionals have with EMR counterparts.

Happy EMR Doctor

How an EMR Gets in the Way of Doctor-Patient Relationships

While happy with his current EMR, Dr. Michael West talks about the “darkside” of EMRs. He says that he has to pay more attention to his computer than maintaining eye contact with his patients, but this is a problem that will be difficult to resolve. Although he could just jot notes down and update the EMR later, he feels this would be more time consuming and less accurate. Is there are a solution to the barrier created between doctors and patients when an EMR is used?

Smart Phone Health Care

SleepRate: Improves Your Sleep by Monitoring Your Heart

Everyone has trouble sleeping every now and then. Unfortunately, it’s not always easy to figure out why. SleepRate, a cloud based mobile service, may be the solution. This service tracks and analyzes the users sleep patterns, and, from that information, gives suggestions on how to improve sleep. It does this by monitoring your heart using a ECG.

App Helps Potential Skin Care Victims Track Moles

1 in 5 Americans will be diagnosed with skin cancer in their life. With a chance this high of getting this terrible disease, it’s more important than ever to monitor moles and other skin lesions. An app created by the University of Michigan Health System, UMSkinCheck, makes that monitoring easier. The app sends reminders about skin checks, and allows the user

EMR Thoughts
Digital Health Takes Off in 2012

Digital Health is growing more and more. Rock Health Weekly reported that there is 73 percent more funding for it this year than at this time last year. The yearly funding report by Rock Health Weekly was recently released, and there were several interesting findings in it. Digital Health isn’t going anywhere.

Hospital EMR and EHR

The Meaningful Use Song (To The Tune of “Modern Major General”)

If you need a little pick-me up, or a smile to end your week, don’t miss this video. The “Meaningful Use Song” includes commentary on MU, written by Peggy Polaneczky, MD, to a catch tune.

From The Horse’s Mouth: What Scribes Are For

Ever wonder what a scribe does, and if they are really even needed? This post includes quotes from Scott Hagood, the director of business development for PhysAssist Scribes. This is a great position for pre-med students, and with the growth of EMR, the field for scribes continues to develop and expand as well.

Practice Fusion EMR Brings Patients Into The Picture

British Doctors Fear Repercussions Of Sharing EMR Data With Patients

Does Patient Interaction Lock a Doctor In to an EHR?

Can the Benefits of Hospitals Acquiring Practices Be Achieved By Other Means?

EMR & Patient Safety, Meaningful EHR Measures, and the Patient Portal “Switch”

Patients and EMRs, EMR Value, and Healthy Food Guide: Around Healthcare Scene

CMS May Revisit Patient Engagement Rules – Meaningful Use Monday

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

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