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This Geek Girl’s Singing: HIMSS 14 Social Media Finale

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As one of the inaugural crop of HIMSS Social Media Ambassadors, a second-generation native Floridian, and a former Orlando resident, it is my sworn duty to summarize, recap, and perhaps satirize the last group of Blog Carnival posts, to metaphorically sing the HIMSS opera finale. And you folks submitted some doozies! I’m very grateful to the HIMSS (@HIMSS) and SHIFT Communications (@SHIFTComm) team for providing me with links to all entries. Y’all have been BUSY!

A man after my own heart, and a frequent #HITsm participant who weathers harsh criticism with witty aplomb: Dan Haley’s (from athenahealth, @DanHaley5) piece on 3 Takeaways From HIMSS – Policy And Otherwise caught my attention with the line, “Regulators are from Mars…” He stole my favorite blog entry prize with the line: “Orlando is magical when you are a kid. Kids don’t attend HIMSS.”

First-time attendee Jeffrey Ting (from Systems Made Simple) outlined his experiences with some of my favorite topics in his piece, HIMSS Reflections By A First-Time Attendee: HIEs and interoperability. I agree with him: the Interoperability Showcase’s “Health Story” exhibit was one of the best presentations of the whole conference.

Dr. Geeta Nayyar’s perspective as a board member of HIMSS and CMIO for PatientPoint gave her a unique vantage point for her post, HIMSS 14: A Truly Inspiring Event. Take note, HIMSS conference planners – your monumental efforts were recognized, as was the monumental spirit of the closing keynote speaker, Erik Weihenmayer.

HIMSS Twitter recaps permeated the blogosphere, with my favorite being the inimitable Chuck Webster’s (@wareflo) HIMSS14 Turned It Up To 11 On And Off-Line!. Chuck also periodically provided trend analysis results of year-over-year #HIMSS hashtag traffic for each period of the conference, complete with memes for particular shapes: Loch Ness monster humped-back, familiar faces of frequent tweeters.

Health IT guru Brian Ahier’s (@ahier) wrapped up the “Best In Show” of HIMSS Blog Carnival , complete with Slideshare visuals awarding Ed Parks of Athenahealth “Best Presentation” and providing an excellent summation of must-read posts.

Interoperability was one of the most prevalent themes of HIMSS, and a plethora of posts discussing the healthcare industry’s progress on the path to Dr. Doug Fridsma’s (@Fridsma) High Jump Of Interoperability (Semantic-Level) were submitted to the Blog Carnival. Notable standouts included: Shifting to a Culture of Interoperability by Rick Swanson from Deloitte, and Dr. Summarlan Kahlon’s (of Relay Health), Diagnosis: A Productive HIMSS 2014, which posited that, “this year’s conference was the first one which convinced me that real, seamless patient-level interoperability is beginning to happen at scale.”

And who could forget about patient engagement, the belle of the HIMSS ball? Telehealth encounters, mobile health apps and implications, patient portals, and the Connected Patient Gallery dominated the social media conversation. Carolyn Fishman from DICOM Grid called it, HIMSS 2014: The Year of the Patient, and discussed trepidation patients feel about portal technologies infringing on face-time.

Quantified-self wearable-tech offered engagement opportunities, as well. Having won one such gadget herself, Jennifer Dennard (@SmyrnaGirl) gave props to organizations like Patientco and Nuance for their use (and planned use) of wearable tech in support of employee wellness programs, and posited on the applications of such tech in the monitoring and treatment of chronic disease in her piece, Watching for Wearables at HIMSS14.

Finally, if you’re able to read Lisa Reichard’s (from Billians Health Data) @billians) highlights piece,Top 10 Tales and Takeaways, without busting out into Beatles tunes, you probably wouldn’t have had nearly as much fun as she and I did at HISTalkapalooza, dancing to Ross Martin’s smooth parodies. You also probably don’t have your co-workers frantically purchasing noise-canceling headphones.

I did say I’d be singing to bring HIMSS to a virtual close.

Can’t wait to get back to the metaphorical microphone for HIMSS 2015 in Chicago!

March 14, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

In 2014, Health IT Priorities are Changing

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The following is a guest blog post by Cliff McClintick, chief operating officer of Doc Halo. Cincinnati-based Doc Halo sets the professional standard for health care communication offering secure messaging for physicians, medical practices, hospitals and healthcare organizations. The Doc Halo secure texting solution is designed to streamline HIPAA-compliant physician and medical clinician sharing of critical patient information within a secure environment.

2014 is a major year for health care, and for more reasons than one.

Of course, some of the most significant reforms of the Affordable Care Act take effect this year, affecting the lives of both patients and providers.

But it’s also a year in which health care institutions will come to grips with IT issues they might have been putting off. Now that many organizations have completed the electronic health record implementations that were consuming their attention and resources, they’re ready to tackle other priorities.

Expect to see issues related to communications, security and the flow of patient information play big in coming months. At Doc Halo, we’re already seeing high interest in these areas.

Here are my predictions for the top health IT trends of 2014:

  • Patient portal adoption. Web-based portals let patients access their health data, such as discharge summaries and lab results, and often allow for communication with the care team. Federal requirements around Meaningful Use Stage 2 are behind this trend, but the opportunity to empower patients is the exciting part. The market for portals will likely approach $900 million by 2017, up from $280 million in 2012, research firm Frost & Sullivan has predicted.
  • Secure text messaging. Doctors often tell us that they send patient information to their colleagues by text message. Unfortunately, this type of data transmission is not HIPAA-compliant, and it can bring large fines. Demand for secure texting solutions will be high in 2014 as health care providers seek communication methods that are quick, convenient and HIPAA-compliant. Doc Halo provides encrypted, HIPAA-compliant secure text messaging that works on iPhone, Android and your desktop computer.
  • Telehealth growth. The use of technology to support long-distance care will increasingly help to compensate for physician shortages in rural and remote areas. The world telehealth market, estimated at just more than $14 billion in 2012, is likely to see 18.5 percent annual growth through 2018, according to research and consultancy firm RNCOS. Technological advances, growing prevalence of chronic diseases and the need to control health care costs are the main drivers.
  • A move to the cloud. The need to share large amounts of data quickly across numerous locations will push more organizations to the cloud. Frost & Sullivan listed growth of cloud computing, used as an enabler of enterprise-wide health care informatics, as one of its top predictions for health care in 2014. The trend could result in more efficient operations and lower costs.
  • Data breaches. Health care is the industry most apt to suffer costly and embarrassing data breaches in 2014. The sector is at risk because of its size — and it’s growing even larger with the influx of patients under the Affordable Care Act — and the introduction of new federal data breach and privacy requirements, according to Experian. This is one prediction that we can all hope doesn’t come true.

To succeed in 2014, health care providers and administrators will need to skillfully evaluate changing conditions, spot opportunities and manage risks. Effective health IT frameworks will include secure communication solutions that suit the way physicians and other clinicians interact today.

Doc Halo, a leading secure physician communication application, is a proud sponsor of the Healthcare Scene Blog Network.

January 30, 2014 I Written By

Unlocking The Power of Data Science In Healthcare

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Vinod Khosla, Founder of Sun Microsystems and Khosla Ventures, recently stated that “in the next 10 years, data science and software will do more for medicine than all of the biological sciences together.”

The rise of population health and healthcare analytics companies aligns with Khosla’s claim. There are hordes of companies implementing healthcare analytics and helping providers identify at-risk populations to engage in proactive care. Despite their efforts, most of the analytics companies have been struggling to help providers actually improve outcomes.

Why?

Because data science in and of itself is meaningless. Effective data science can only provide insights. The challenge is in acting on insights provided by data. This is a widely acknowledged problem that every data science / analytics company faces; this problem has been particularly difficult in healthcare where a backwards culture and incentive structure have skewed the system towards complacency and volume rather than proactive care and value.

In healthcare, the actionability and effectiveness of data science hinge on communication between providers and patients, and on patients’ ability to act on those insights. There are a few methods of provider-to-patient communication and actionability:

At the point of care (in person or virtual visit) – providers have been educating patients at the point of care since the dawn of the profession. With advanced data analytics, providers can give more accurate, more customized education during the encounter. But the problem is that patients must act on that information at home when the doctor isn’t looking over the patient’s shoulder. Patients consistently fail to do what providers have asked them to do. The problem here is that the patient education and actionability based on education are intermediated by time and (lack of) context. Patients simply forget or are unwilling to do what their providers ask them to do in order to better care for themselves. Patients aren’t being educated in the right context. Point of care education won’t encourage patients from smoking the next cigarette, taking their meds on time, or skipping cheesecake at the office party.

Patient portals – the federal government has mandated that providers enable patients to engage with providers via patient portals. The basic premise of this mandate is that with access to their own health information, patients will take better care of themselves. Patient portals have some potential to empower patients to learn about their conditions at home and investigate conditions in more depth, but they don’t solve the context problem. Patient portals won’t do anything to help patients order a salad instead of a hamburger.

Messaging and notifications – this is the least explored, least understood, and in my opinion, the most potent communication channel to impact patient behavior. Automated notifications on iOS and Android can be presented contextually provided the device has contextual data to present notifications. Context is king. We live in the age of context. As devices learn more about their owners, devices can present contextual information to help change behavior. If your smartphone (or Google Glass, Jawbone, iWatch, etc) knows that you’re about to smoke a cigarette, it can automatically connect you with your husband/wife so that they can yell at you. If your device knows that you’re out at a steakhouse for dinner with business guests, it can remind you to order grilled chicken instead of a fried steak. The number of opportunities are endless.

To provide a better sense of the power of context, let’s examine Google and Facebook ads. Facebook ads are anything but contextual. When I’m scrolling through my news feed, I don’t care about the latest Hobbit movie, some new workout shake, or Dell’s newest laptop. I logged into Facebook to check out what my friends are up to, not to learn about the Hobbit or a laptop.

But when I Google “flight from Austin to New York January 18th” there’s a huge probability that I’m already committed to spending several hundred dollars to fly to New York, get a hotel, and spend money in NYC. With that search, only relevant advertisers – airlines, taxis, hotels, and local NYC attractions – will bid for my attention; I’m not going to see an ad for The Hobbit when searching for for a trip to NY.

This sense of context is reflected in Facebook and Google’s click through rates (CTR). 1-3% of all Google searches result in the user clicking on an ad. Between .01-.3% of FaceBook ads are clicked on. Google is measurably 10-100x more effective than Facebook. That’s the power of context.

There’s nothing wrong with emailing patients PDFs and interactive digital education tools after an encounter; there’s nothing wrong with patient portals and BlueButton. All of these communication channels fall short in that they don’t take advantage of real-time two way contextual communications. All of these channels are intrinsically one-way and lack context.

Books were the the first few-to-many communication channel. Then newspapers and magazines. Then radios. Then movies and TV. The defining characteristic of the Internet is that it is the first to enable two-way, many-to-many communications. The federal government’s healthcare communication model is fundamentally based on 20th century communication strategies. The power of data science will drive meaningful changes in patient behavior only when communication strategies leverage 21st century communication models.

January 29, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

The Good News About Patient Portals …

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I recently wrote that it’s not clear whether patient portals do much to improve health care.

Now a new study suggests they help in at least one area: medication adherence.

The research involved diabetic patients who were using cholesterol-lowering statin drugs and had registered for online portal access. Among those who started using the system’s online refill function as their only method of getting the medication, “nonadherence” dropped 6 percent.

LDL or “bad” cholesterol also decreased.

The researchers concluded that “wider adoption of online refills may improve adherence.” No decline in nonadherence was seen in patients who didn’t use the online refill function.

The Kaiser Permanente study was published in the journal Medical Care.

The study included plenty of subjects — 8,705 people who used online refills and 9,055 who didn’t. But if there’s a cause-effect relationship at work in this study, you have to wonder in which direction it might run. Might the people who tend to take their medicine as prescribed be more likely to sign up for online refills in the first place?

Still, the study is an intriguing hint that patient portals might be worth at least some of the attention they’re getting. Nonadherence to medication regimens is a huge issue for health care because of both the human toll it takes and the inefficiency it fosters in the system.

Typical nonadherence rates are in the 30-60 percent range, depending on the condition, the medication and other factors, according to Medscape. It’s especially easy to slack off when symptoms disappear.

The study builds on another piece of good news for health IT. Researchers recently found that EMRs can make diabetes care better by rendering care coordination more efficient, as Katherine Rourke wrote here at EMR and HIPAA.

Portals are, of course, experiencing tremendous popularity because they help health care providers to meet Meaningful Use Stage 2 patient-engagement requirements. But, as I wrote earlier, in a review of 46 studies related to portals, researchers didn’t find evidence for much in the way of patient benefits.

Physicians have a major job ahead of them if they’re to make full use of patient portals and receive the available federal incentives. Perhaps this study, modest as its results are, suggests that their efforts will have some benefit for the patients they serve.

 

January 14, 2014 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

EMR Can Improve Diabetes Care

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EMRs can help improve diabetes care by making care coordination of such patients more efficient, according to a study reported in iHealthBeat.

The federally-funded study, which was done by the Western New York Beacon Community, went to one of 17 Beacon Communities funded by ONCHIT, which has handed out $250.3 million in total grants.

In this case, the Beacon Community is a partnership between HealtheLink, Catholic Medical Partners and P2 Collaborative of Western New York. The partnership’s $16.1 million is the largest grant received by any of the 17 Beacon Communities.

To study the impact of EMRs on diabetes care, the partners looked at about 40,000 patients, and 344 primary care physicians working in 98 practices.

To implement the study, participants created diabetes registries that tracked lab tests and results, created personalized reminders and guidance for patients, and generated quarterly reports for physicians underscoring areas where they could cut costs and improve diabetic care, iHealthBeat said.

But the diabetic registry was just the beginning. The Beacon project also implemented preventive telemonitoring to avoid excess emergency department visits and hospital readmissions; medication therapy tools to alert doctors — in real time — of changes ED doctors make medication regiments, and patient portals giving patients access to prescription refills, appointment requests and lab results.

At the end of the study, researchers polled the 57 practices that consistently used the registries, and found that the number of diabetics with uncontrolled sugars levels fell 4 percent, with some practices seeing as much as a 10 percent improvement. Researchers calculated that if project guidelines were followed by 20 percent of patients with diabetes and their doctors in Western New York, savings could be $18 million.

This result echoes results of other studies. For example, last year researchers at Weill Cornell Medical College concluded that when a group of community-based doctors moved to EMRs , they provided better care, particularly in managing chlamydia, diabetes, colorectal cancer and breast cancer.

December 16, 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.

Are Patient Portals Really Helping Patients?

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One thing’s for sure about patient portals: They’re a hot commodity.

What’s less clear is how much good they’re doing for health care.

The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.

Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.

But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.

In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”

Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.

Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.

Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.

The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.

When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.

The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.

December 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

What Value Does a Healthy Patient Get from a PHR?

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In my previous post about a Patient Controlled Medical Record, I asserted that such a thing would be a challenge to get to work in the US, but that there was a lot of potential internationally. I did provide one caveat when it came to chronic patients where I think there is potential in the US as well. Although, some argued against even that group being interested in the comments.

Let me further expound on why I think the patient controlled medical record fails for a healthy patient (and this includes people who think they’re healthy, or at least relatively healthy…ie. they don’t go to a doctor for any chronic condition). In many respects this is my talking from my own personal perspective as a young, healthy adult (although I guess all of those descriptors could be argued).

The problem for someone that’s healthy is that their medical record basically has no data. The reason you want a patient controlled medical record is so that you can extract value from the data. I don’t need to look at my online medical record to see that I don’t have any drug allergies, that I had a cold or flu 3 years ago, that I got my flu shot 4 years ago, and that when I was 15 I had a hernia operation.

The point being that my medical record is so short that there’s so little value in me trying to aggregate that record in once place. What value do I get from doing so?

I think there could be value in doing so, but not today. For example, if by keeping a patient controlled medical record I could avoid filling out the crazy stack of paperwork that’s given you at every new doctor you visit, I and every other patient would want to keep an online patient record. This should be a solvable problem, but I won’t go into the hundreds of systemic reasons why it’s not going to happen anytime soon. Although, we’ll start with the doctor preferring your allergies to be in the upper right corner in red. Now scale that request up to 700,000 doctors.

Similar to the above item, there are other ancillary functions (ie. appointment scheduling, prescription refills, message your doctor, etc.) that could be tied to your medical record that would make people want to use a PHR or other similar system. However, most people would use it for the ancillary functions and not to be able to control their medical record in one place. For many of the ancillary services this portal will need to be tethered to a PHR.

One trend that I hope will change my description above is the wave of new health sensors that are hitting the market. As those health sensors get better I believe we’ll see a new type of portal that is attractive for even a “healthy” person to visit. This concept coincides with what I call Treating a Healthy Patient. All of this new sensor data could make it worth my time as someone who thinks I’m healthy to check and aggregate my data in one location. The volume of data available would be much more than what I have stored in my memory and so it will make sense for me to visit somewhere that stores and processes my whole medical record.

How these portals full of health sensor data will work with doctors is a topic for another blog post. Until then, I’ll be surprised how many healthy patients really get on board collecting their patient data in a patient controlled medical record.

November 11, 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 and Google Plus. Healthcare Scene can be found on Google+ as well.

Mobile PHRs On The Way — Slowly

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On-demand mobile PHRs are likely to emerge over time, but not until the healthcare industry does something to mend its interoperability problems, according to a new report from research firm Frost & Sullivan.

As the paper notes, mobile application development is moving at a brisk clip, driven by consumer and governmental demands for better quality care, lower healthcare costs and improved access to information.

The problem is, it’s hard to create mobile products — especially a mobile PHR — when the various sectors of the healthcare industry don’t share data effectively.  According to Frost  & Sullivan, it will be necessary to connect up providers, hospitals, physician specialty groups, imaging centers, laboratories, payers and government entities, each of which have operated within their own informational silos and deployed their own unique infrastructures.

The healthcare industry will also need to resolve still-undecided questions as to who owns patient information, Frost & Sullivan suggests.  As things stand, “the patient does not own his or her health information, as this data is stored within the IT  protocols of the EHR system,  proprietary to providers, hospitals and health systems,” said Frost & Sullivan Connected Health Senior Industry Analyst Patrick Riley in a press statement.

While patient ownership of medical data sounds like a problem worth addressing, the industry hasn’t shown the will to address it.  To date, efforts to address the issue of who owns digital files has been met with a “tepid” response, the release notes.

However, it’s clear that outside vendors can solve the problem if they see a need. For example, consider the recent deal in which Allscripts agreed to supply clinical data to health plans.  Allscripts plans to funnel data from participating users of its ambulatory EMR to vendor Inovalon, which aggregates claims, lab, pharmacy, durable medical equipment, functional status and patient demographics for payers. Providers are getting patient-level analyses of the data in return for their participation.

Deals like this one suggest that rather than wait for interoperability, bringing together the data for a robust mobile PHR should be done by a third  party. Which party, what it will it cost to work with them and how the data collection would work are the least of the big problems that would have to be solved — but might be that or nothing for the foreseeable future.

October 24, 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.

Parents Using PHRs More Likely To Get In All Well-Child Visits

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Parents using an integrated PHR were more likely to take their young children to all recommended well-child visits, according to a Kaiser Permanente study reported in iHealthBeat.

More than 4.3 million members are registered to use Kaiser’s PHR, My Health Manager, on kp.org. During the first half of this year, patients have viewed 17.5 million lab test results, sent 7.4 million secure e-mails to their care providers, refilled 7.1 million prescriptions and scheduled 1.8 million appointments, reports News-Medical.

The study, which was published in The Journal of Pediatrics, analyzed data on more than 7,000 children ages zero to two living in the Northwest U.S. and Hawaii.  The children were enrolled in KP health plans between January 2007 and July 2011.  To determine the appropriate number of well-child visits, researchers  used performance measures listed in the 2010 Healthcare Effectiveness Data and Information Set that state that children aged 0 to 15 months should attend at least six well-care visits, News-Medical says.

The study found that in the Northwest region, children whose parents used the Kaiser PHR during the study period were 2.5 times more likely to bring their child to the recommended number of well-child visits. These children were also 1.2 times more likely to get all of their immunizations.

In Hawaii, meanwhile, children in this group were two times more likely to get all well-child visits, but results related to immunizations were statistically insignficant, iHealthBeat notes.

While it may be too soon to call it a trend, this is one of a growing number of projects which use the PHR concept to help patients engage and take responsibility for their health behaviors.

For example, this summer Howard University Hospital rolled out a mobile PHR for pre-diabetic young adults designed to help them take control of their health.  Howard has given the young adults in the program — aged 18 to 24 and diagnosed with pre-diabetes — access to a mobile version of the NoMoreClipboard PHR for their smartphones.

The program sends a variety of text messages to the young adults targeted by this intervention, which include reminders to interact with the PHR. The program participants are also given a FitBit Zip wireless activity tracker which keeps track of steps taken, distance covered and calories burned per user.

Projects like these, which help patients make the PHR the fulcrum point for better health, are a smart way of using the technology. I expect to see a great deal more of this “PHR=patient engagement=better health” model going forward.

October 18, 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.

Eyes Wide Shut – Managing Multi-EMR Meaningful Use Stage 2 Is Hard

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Most discussions on Meaningful Use (MU) seem to focus on a single healthcare provider organization (acute or ambulatory), with a single EMR, and a single Medical Record Number (MRN) pool generating unique patient identifiers. Even in that context, the complaints of the difficulties of successfully implementing the technology and obtaining the objectives are deafening. How daunting might those challenges seem, multiplied across a large integrated delivery network (IDN), attempting to make enterprise-wide technology and operational process decisions, in alignment with MU incentive objectives?

Imagine you are an IDN with 9 hospital facilities, sharing a single EMR. You also have 67 ambulatory practices, with 7 additional EMRs. You’ve made the progressive choice to implement a private health information exchange (HIE) to make clinical summary data available throughout the IDN, creating a patient-centric environment conducive to improved care coordination. To properly engage patients across the IDN and give them the best user experience possible, you’ve purchased an enterprise portal product that is not tethered to an EMR, and instead sources from the HIE. And because you’ve factored the MU incentive dollars into the budget which enabled these purchasing decisions, there is no choice but to achieve the core and select menu measures for 2014.

It is now October 2013. The first quarter you’ve chosen to gather Stage 2 attestation data starts on April 1, 2014. All your technology and process changes must be ready by the data capture start date, in order to have the best opportunity to achieve the objectives. Once data capture begins, you have 90 days to “check the box” for each MU measure.

Tech check: are all the EMRs in your IDN considered Certified Electronic Health Records Technology (CEHRT) for the 2014 measures?

Your acute EMR is currently 2 versions behind the newly-released MU 2014-certified version; it is scheduled to complete the upgrade in November 2013. Your highest-volume ambulatory EMR is also 2 versions behind the 2014-certified version, and it cannot be upgraded until March 2014 due to vendor resource constraints. Your cardiology EMR cannot be upgraded until June due to significant workflow differences between versions, impacting those providers still completing Stage 1 attestation. One of your EMRs cannot give you a certification date for its 2014 edition, and cannot provide an implementation date for the certified version. The enterprise portal product has been 2014-certified as a modular EMR, but the upgrade to the certified version is not available until February 2014.

Clearly, your timeline to successfully test and implement the multitude of EMR upgrades required prior to your attestation date is at risk.

Each EMR might be certified, but will it be able to meet the measures out of the box?

Once upgraded to the 2014 version, your acute EMR must generate Summary of Care C-CDA documents and transmit them to an external provider, via the Direct transfer protocol. Your ambulatory EMRs must generate Transition of Care C-CDA documents and use the same Direct protocol to transmit. But did you purchase the Direct module when you signed your EMR contract, or maintenance agreement?

Did you check to see whether the Direct module that has been certified with the EMR is also an accredited member of DirectTrust?

Did you know that some EMRs have Direct modules that can ONLY transmit data to DirectTrust-accredited modules?

You determine your acute EMR will only send to EMRs with DirectTrust-accredited modules, and that you only have a single ambulatory EMR meeting this criteria. That ambulatory EMR is not the primary target for post-acute care referral.

You have no control over the EMRs of providers outside the IDN, who represent more than 20% of your specialist referrals.

Your 10% electronic submission of Summary of Care C-CDA documents via Direct protocol measure is at risk.

Is your organization prepared to manage the changes required to support the 2014 measures?

This is a triple-legged stool consideration: people, process, and technology must all align for change to be effective. To identify the process changes required, and the people needed to support those processes, you must understand the technology that will be driving this change. Of all the EMRs in your organization, only 2 have provided product specifications, release notes, and user guides for their 2014-certified editions.

Requests for documentation about UI, data, or workflow changes in the 2014 versions are met with vague responses, “We will ask product management and get back to you on that.” Without information on the workflow changes, you cannot identify process changes. Without process change recognition, you cannot properly identify people required to execute the processes. You are left completely in the dark until such time as the vendors see fit to release not only the product, but the documentation supporting the product.

Clearly, your enterprise program for Meaningful Use Stage 2 health IT implementation and adoption is at risk.

What is the likelihood that your Meaningful Use Stage 2 attestation will be a successful endeavor for the enterprise?

As a program manager, I would put this effort in flaming red status, due to the multitude of risks and external dependencies over which the IDN organization has zero control. I’d apply that same stoplight scorecard rating to the MU Stage 2 initiative. There is simply too much risk and too many variables outside the provider’s control to execute this plan effectively, without incurring negative impacts to patient care.

The ONC never said Meaningful Use would be easy, but does it have to be this hard?

October 2, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.