Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Patient Portal Security Is A Tricky Issue

Posted on April 25, 2016 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.

Much of the discussion around securing health data on computers revolves around enterprise networks, particularly internal devices. But it doesn’t hurt to look elsewhere in assessing your overall vulnerabilities. And unfortunately, that includes gaps that can be exposed by patients, whose security practices you can’t control.

One vulnerability that gets too little attention is the potential for a cyber attack accessing the provider’s patient portal, according to security consultant Keith Fricke of tw-Security in Overland Park, Kan. Fricke, who spoke with Information Management, noted that cyber criminals can access portal data relatively easily.

For example, they can insert malicious code into frequently visited websites, which the patient may inadvertently download. Then, if your patient’s device or computer isn’t secure, you may have big problems. When the patient accesses a hospital or clinic’s patient portal, the attacker can conceivably get access to the health data available there.

Not only does such an attack give the criminal access to the portal, it may also offer the them access to many other patients’ computers, and the opportunity to send malware to those computers. So one patient’s security breach can become a victim of infection for countless patients.

When patients access the portal via mobile device, it raises another set of security issues, as the threat to such devices is growing over time. In a recent survey by Ponemon Institute and CounterTack, 80% of respondents reported that their mobile endpoints have been the target of malware the past year. And there’s little doubt that the attacks via mobile device will more sophisticated over time.

Given how predictable such vulnerabilities are, you’d think that it would be fairly easy to lock the portals down. But the truth is, patient portals have to strike a particularly delicate balance between usability and security. While you can demand almost anything from employees, you don’t want to frustrate patients, who may become discouraged if too much is expected from them when they log in. And if they aren’t going to use it, why build a patient portal at all?

For example, requiring a patient to change your password or login data frequently may simply be too taxing for users to handle. Other barriers include demanding that a patient use only one specific browser to access the portal, or requiring them to use digits rather than an alphanumeric name that they can remember. And insisting that a patient use a long, computer-generated password can be a hassle that patients won’t tolerate.

At this point, it would be great if I could say “here’s the perfect solution to this problem.” But the truth is, as you already know, that there’s no one solution that will work for every provider and every IT department. That being said, in looking at this issue, I do get the sense that providers and IT execs spend too little time on user-testing their portals. There’s lots of room for improvement there.

It seems to me that to strike the right balance between portal security and usability, it makes more sense to bring user feedback into the equation as early in the game as possible. That way, at least, you’ll be making informed choices when you establish your security protocols. Otherwise, you may end up with a white elephant, and nobody wants to see that happen.

Medical Website Design: Jedi Credibility via Technology

Posted on March 17, 2016 I Written By

Medical Website Design
In the case of a medical emergency, a successful clinical portal has to meet the following two conditions at once: it should pop up in the back of the person’s mind and at the front of search results. To achieve this level of influence, your medical website’s design needs that wicked Jedi mind power to attract visitors, engage them and make them come back again and again.

A resource’s ultimate goal is to become a patient’s Master Yoda guide to the twists and turns of their health. A great medical website is able to meet patients halfway, educate and comfort them, and leave them more confident about their well-being.

Supported by cutting-edge technologies and breakthroughs, healthcare is one of the most important industries for human lives. Unfortunately, only examination and treatment are subject to first-priority innovation (for example, in vitro diagnostic medical equipment developments). So, persuading a caregiver to revamp or optimize their medical website can be challenging, as this effort is far outside their focal point.

So, the first question is – why should health providers pay extra attention to their websites?

An integral part of the Meaningful Use criteria, patient engagement, encourages individuals to contribute to their own well-being, thus reducing readmissions and improving care outcomes.

And the first tool to provide effective patient engagement – hug your patients at the doorstep, shake their hands and lead them into a physician’s office  –  is your website.

We’ve gone through a number of top clinical websites and noticed that they have several common characteristics. These are only some key features, but they will help your medical website stand out from other health resources.

1. Designed to Persuade and Help

Master Yoda sas, at the head of every clinical portal user interface should be, patients are most in need of humane and friendly words empowered with:

  • Responsive design
  • Straightforward navigation
  • Credible messages that speak directly to patients
  • Comprehensive and illustrated service descriptions
  • Moderate use of medical jargon

We put responsive design at the top as Healthcare IT News states that mobile healthcare technology makes NIH’s (National Institutes of Health) list of 14 goals for the next 5 years.  Moreover, mHealth technologies correlate with ACA’s plan to reduce excessive preventable readmissions. And, finally, Medicare spends more than $17 billion on avoidable readmissions annually.

Should any acute situation occur, a person might find themselves under an extreme pressure, panicky and irrational. What’s in their hands right now, a mouse or a phone? You can guess it. So, either the website is flawless across devices or you are blamed for falling short of the person’s expectations at the moment of utmost need.

2. Content Personalization. Jedi or Sith?

Content personalization is the light saber of a medical website. Without this influential tool, the resource is standing at the crossroads while needing to choose a side. If you decide to go on with the light side, get ready to accept the robe, the saber and the following consequences.

The Jedi side is the right personalization. You don’t overuse it, you’re careful, respectful and – what is most important – precisely targeted. Personalization is about picking and using the right details to bring patients what they need. So, you improve your revenue while nurturing and caring about your patients through:

  • Relevant services shown according to the patient’s previous visits. For example, if an individual has checked some information about implant dentistry or plastic surgery on your website, during the next visit they can continue where they left off via the recently visited section.
  • Clinic locations search offering the closest facilities first
  • Pages providing personalized promotions
  • Loyalty systems with cumulative discounts, bonus points and other incentives

To efficiently personalize content, medical websites can use patients’ personal information, such as:

  • EHR/EMR system health data (we make sure they are compliant with HIPAA rules)
  • Browsing history from previous visits
  • Current browsing behavior
  • And the trickiest part: information about family members

On the other hand, the wrong personalization makes your website a Sith, undermining the promising relations with patients and making them apprehensive about the service quality of the whole medical practice. If a barren woman opens a website and sees a page offering a personalized discount on fetal ultrasound, she might feel insulted and even mocked. She may even consider abandoning this medical provider.

3. Protected Functionality Starships

We consider the patient portal as a very important, next-to-mandatory element of a medical website. Patients want to have health data at their fingertips, and secure. Privacy must be at the core of patient portals. From resource to resource, secure features typically include:

  • Appointment scheduling options
  • Examination results
  • Diagnoses
  • Prescriptions and medication refill request form
  • Online billing

Again, this is just the basic scope serving most patients’ needs. We are sure that only through further customization with careful research and testing a medical provider can highlight the more peculiar details that enable an open dialogue with patients.

Jedi Website: Credibility via Technology

What do your patients need? Usability that won’t let them down in acute situations, access to health data, and personalized offers embedded into a protected system. Being able to communicate with physicians and track down their current treatment progress and lab results, patients feel more confident and empowered.

By shedding the light on the health problem, showing care and attention and giving the patient the needed information, you are creating a forceful halo of engagement. So let’s create a useful patient portal, include personalization and ensure responsive design with a friendly UI. That’s what transforms a medical website into a Master Yoda.

By Vadzim Belski, PHP Department Coordinator at a software development company ScienceSoft. With over 10 years of experience, he has taken part in large-scale web projects with a primary focus on the healthcare industry.

Patient Engagement Panel – Inaugural Online Medical Conference

Posted on September 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John Bennett, MD reached out to me recently about a unique opportunity to be part of the 1st International Online BioMedical Conference. The conference was unique because it was being organized completely online using Google Hangouts as the platform for speakers. Having done a number of Google Hangouts on Healthcare IT myself, I thought it would be a unique opportunity to test out the online conference waters.

As part of the conference, I brought together a panel of social media and healthcare IT rockstars to talk about Patient Engagement (in all its facets) and the challenges of patient engagement. Plus, I wanted to be sure we talked about how it could help and hinder care. On the panel were Colin Hung (@Colin_Hung), Dr. Nick Van Terheyden (@DrNic1), Dr. Charles Webster(@wareflo), and myself (@ehrandhit). With such a wide set of experiences, it made for a really great discussion. You can watch it below:

Thanks to each of my fellow panelists for participating with me and to Manuel and Dr. Bennett who organized the conference.

Is HIPAA Misuse Blocking Patient Use Of Their Data?

Posted on August 18, 2015 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, a story in the New York Times told some troubling stories about how HIPAA misunderstandings have crept into both professional and personal settings. These included:

  • A woman getting scolded at a hospital in Boston for “very improper” speech after discussing her husband’s medical situation with a dear friend.
  • Refusal by a Pennsylvania hospital to take a daughter’s information on her mother’s medical history, citing HIPAA, despite the fact that the daughter wasn’t *requesting* any data. The woman’s mother was infirm and couldn’t share medical history — such as her drug allergy — on her own.
  • The announcement, by a minister in California, that he could no longer read the names of sick congregants due to HIPAA.

All of this is bad enough, particularly the case of the Pennsylvania refusing to take information that could have protected a helpless elderly patient, but the effects of this ignorance create even greater ripples, I’d argue.

Let’s face it: our efforts to convince patients to engage with their own medical data haven’t been terribly successful as of yet. According to a study released late last year by Xerox, 64% of patients were not using patient portals, and 31% said that their doctor had never discussed portals with them.

Some of the reasons patients aren’t taking advantage of the medical data available to them include ignorance and fear, I’d argue. Technophobia and a history of just “trusting the doctor” play a role as well. What’s more, pouring through lab results and imaging studies might seem overwhelming to patients who have never done it before.

But that’s not all that’s holding people back. In my opinion, the climate of medical data fear HIPAA misunderstandings have created is playing a major part too.

While I understand why patients have to sign acknowledgements of privacy practices and be taught what HIPAA is intended to do, this doesn’t exactly foster a climate in which patients feel like they own their data. While doctor’s offices and hospitals may not have done this deliberately, the way they administer HIPAA compliance can make medical data seem portentous, scary and dangerous, more like a bomb set to go off than a tool patients can use to manage their care.

I guess what I’m suggesting is that if providers want to see patients engaged and managing their care, they should make sure patients feel comfortable asking for access to and using that data. While some may never feel at ease digging into their test results or correcting their medical history, I believe that there’s a sizable group of patients who would respond well to a reminder that there’s power in doing so.

The truth is that while most providers now give patients the option of logging on to a portal, they typically don’t make it easy. And heaven knows even the best-trained physician office staff rarely take the time to urge patients to log on and learn.

But if providers make the effort to balance stern HIPAA paperwork with encouraging words, patients are more likely to get inspired. Sometimes, all it takes is a little nudge to get people on board with new behavior. And there’s no excuse for letting foolish misinterpretations of HIPAA prevent that from happening.

Transferring Custody of a Chart to the Patient – Could That Drive Patient Engagement?

Posted on August 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently wrote about the concept of health information disposal and how we’re going to have to reevaluate how we approach disposing of patients charts in this new digital world. Plus, EHR vendors are going to have to build the functionality to make it a reality. However, some replied to that article that in this new world we shouldn’t ever dispose of charts.

We’ll leave that argument for that article (or in the comments) and instead discuss another concept that Deborah Green from AHIMA told me about. Deborah suggested that one possible solution for digital chart disposal would be to transfer custody of the chart to the patient. I think that terminology might not sit right with some people since the patient should have access to the chart regardless. However I think the word custody has a slightly different meaning.

When a healthcare organization is ready to dispose of an electronic chart based on their record retention laws (which usually vary by state), then it’s the perfect time to give patients the opportunity to download and retain a copy of their paper chart before it’s destroyed. In that way, the healthcare organization could worry less about deleting the electronic chart since they’ve transferred “custody” of the chart to the patient.

This removes the responsibility of storing the patient chart from the healthcare organization and puts it on the patients that want to have their entire medical chart. The perfect custodian of the patient chart is the patient. At least it should be.

I wonder if a healthcare organization informing patients that their old charts will be deleted would be enough to actually drive patient engagement and download of their electronic record. While meaningful use has required the view, download and transmit of records by patients, most people have been gaming that requirement without patients really getting the benefit. I have a feeling that patients hearing the words “deleted chart” would wake a lot of them up from their slumber. They wouldn’t know why they’d want the paper chart, but I imagine many would take action and preserve their medical record. Once they download the chart, it would be the first step towards actually engaging with their health data.

What do you think? Is transferring custody of the electronic record the right approach to health information disposal? Would this drive a new form of patient engagement? Would it wake up the sleeping giant which is involved patients?

HIM Departments Need More Support

Posted on July 16, 2015 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.

As both a contributor to this blog, and an assertive, activist patient managing chronic conditions, I get to see both sides of professional health information management.  And I have to say that while health data management pros obviously do great things against great odds, support for their work doesn’t seem to have trickled down to the front lines.  I’m speaking most specifically about Medical Records (oops, I mean Health Information Management) departments in hospitals.

As I noted in a related blog post, I recently had a small run-in with the HIM department of a local hospital which seems emblematic of this problem. The snag occurred when I reached out to DC-based Sibley Memorial Hospital and tried to get a new log-in code for their implementation of Epic PHR MyChart. The clerk answering the phone for that department told me, quite inaccurately, that if I didn’t use the activation code provided on my discharge summary papers within two days, my chance to log in to the Johns Hopkins MyChart site was forever lost. (Sibley is part of the Johns Hopkins system.)

Being the pushy type that I am, I complained to management, who put me in touch with the MyChart tech support office. The very smart and help tech support staffer who reached out to me expressed surprise at what I’d been told as a) the code wasn’t yet expired and b) given that I supplied the right security information she’d have been able to supply me with a new one.  The thing is, I never would have gotten to her if I hadn’t known not to take the HIM clerk’s word at face value.

Note: After writing the linked article, I was able to speak to the HIM department leader at Sibley, and she told me that she planned to address the issue of supporting MyChart questions with her entire staff. She seemed to agree completely that they had a vital role in the success of the PHR and patient empowerment generally, and I commend her for that.

Now, I realize that HIM departments are facing what may be the biggest changes in their history, and that Madame Clerk may have been an anomaly or even a temp. But assuming she was a regular hire, how much training would it have taken for the department managers to require her to simply give out the MyChart tech support number? Ten minutes?  Five? A priority e-mail demanding that PHR/digital medical record calls be routed this way would probably have done the trick.

My take on all of this is that HIM departments seem to have a lot of growing up to do. Responsible largely for pushing paper — very important paper but paper nonetheless — they’re now in the thick of the health data revolution without having a central role in it. They aren’t attached to the IT department, really, nor are they directly supporting physicians — they’re sort of a legacy department that hasn’t got as clearly defined a role as it did.

I’m not suggesting that HIM departments be wiped off the map, but it seems to me that some aggressive measures are in order to loop them in to today’s world.

Obviously, training on patient health data access is an issue. If HIM staffers know more about patient portals generally — and ideally, have hands-on experience with them, they’ll be in a better position to support such initiatives without needing to parrot facts blindly. In other words, they’ll do better if they have context.

HIM departments should also be well informed as to EMR and other health data system developments. Sure, the senior people in the department may already be looped in, but they should share that knowledge at brown bag lunches and staff update sessions freely and often. As I see it, this provides the team with much-needed sense of participation in the broader HIT enterprise.

Also, HIM staff members should encourage patients who call to log in and leverage patient portals. Patients who call the hospital with only a vague sense that they can access their health data online will get routed to that department by the switchboard. HIM needs to be well prepared to support them.

These concerns should only become more important as Meaningful Use Stage 3 comes on deck. MU Stage 3 should provide the acid test as to whether whether hospital HIM departments are really ready to embrace change.

Patient Safety and EHR’s: Q&A with Two Companies Striving to Make a Difference – Breakaway Thinking

Posted on July 15, 2015 I Written By

The following is a guest blog post by Lori Balstad, Learning and Development Specialist at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Lori Balstad
While electronic health records (EHRs) have been in existence since the late 1960s, it wasn’t until almost 30 years later that the Institute of Medicine (IOM) concluded that healthcare would be safer with computerized physician order entry, estimating that 100,000 Americans die each year from preventable adverse events. Now in 2015, most have heard the frightening number of deaths per year due to medical errors—400,000—or more than 1,000 lost lives in the U.S. every day. Preventable medical errors cause the third most deaths in the U.S., right after heart disease and cancer. With many organizations either upgrading old systems or making the decision on their first EHR, it is critical that patient safety is the ultimate goal.

Enter two companies striving towards this goal on both sides of the process:  The Breakaway Group and Sociotechnologix.

The Breakaway Group, A Xerox Company, is committed to ensuring healthcare organizations gain value from technology.   Our innovative approach using “flight simulators” allows users to practice new workflows and reinforce the handoffs required to achieve the quality and safety outcomes they expect. Our research-based solution expedites end-user adoption of new technologies and using the EHR system to its full potential.  This results in fewer errors, and a higher level of care.  Healthcare professionals adopt new applications faster, giving back critical time for providers to do what they do best – care for patients.

Sociotechnologix works to help healthcare organizations understand the influence of culture and leadership on safety and quality of care.  The implementation of technology can create significant patient risk when not used correctly or when system issues are ignored post go-live.  Sociotechnologix uses a validated assessment to measure HIT safety.  This focus on organizational culture drives organizations to integrate quality initiatives into every aspect of care.  They recently launched a tool that allows providers to quickly and easily identify patient safety risks in their EHR.  The application called SafeHIT, provides detailed analytics on the safety, usability, and workflow, from the perspective of clinicians to prioritize safety issues. As sighted by Westat in a report for The Office of the National Coordinator for Health IT (ONC), “Examining health IT incidents within the context of the socio-technical model enables organizations to look beyond the incident to understand it in the context of the people who use the system and the other technologies and processes affected by health IT. Understanding these interactions enables high-reliability organizations to make improvements to their health IT systems when flaws in the systems are identified that can lead to patient harm.”


In the following Q&A, we discuss how EHRs impact patient safety and how each company hopes to improve it. The individuals interviewed from each company are Dr. Heather Haugen, CEO and Managing Director of The Breakaway Group, and Dr. Michael Woods, a Principal of Sociotechnologix, LLC.

Question #1: How must healthcare change to ensure proper use of EHRs for improved safety?

Heather: We must move beyond an implementation mindset.  The hard work begins when the technology is installed.  An EHR is simply one tool we can use to improve care processes.  It requires clinical leadership and a long term commitment to achieve the promise of the EHR- improved quality and safety.

Michael: No one would give their child a medication the FDA had not approved as safe and effective, yet we don’t think twice about having our child cared for in a hospital that has implemented an EHR whose safety and efficacy for patients (and users) hasn’t been systematically demonstrated. Clinical leaders and their organizations will not be able to optimize quality and patient safety without committing to a structured methodology to capture, track, and fix the EHR safety, usability, and workflow issues encountered daily on the frontline of care.

Question #2: Can you share examples of how your company helps improve patient safety?

Heather: We are witnessing a unique time in healthcare.  Healthcare leaders face an increasing number of competing priorities with fewer resources every year.  If we continue to quickly push more technology into clinical care processes without ensuring users are proficient, we will experience an increase in errors and negative impact on quality and safety.  By mimicking the clinical environment, we can easily assess end user proficiency in their actual workflow before they use the live system.  These clinicians are less likely to make an error and learn the system faster.  Giving clinicians time back to focus on the patient and properly use the tools results in safer care.

Michael: We use a sociotechnical approach to assess an organization’s overall patient safety. HIT is one of three components in our model, but it has profound impact on the other two, culture and process. In consulting to a number of organizations, we consistently found EHRs leave frontline caregivers frustrated, cognitively burdened (culture), and forcing workarounds (processes) to the EHR to ensure their patients aren’t harmed. We’ve never heard a frontline caregiver say, “Gosh, our HIT system is just so awesome — it’s so intuitive, easy to use, and safe for our patients.” On the other side of the fence, our data tells us our information technology (IT) colleagues are paralyzed by the sheer volume of (legitimate) frontline complaints (“tickets”), often with no way to categorize, prioritize, and track what issues are creating real safety risks, or which HIT usability issue is costing 10’s or even 100’s of thousands of dollars per year in lost efficiency. It’s for these reasons we created SafeHIT™, a mobile, SaaS-based application for real-time, frontline reporting and advanced analytics of HIT safety, usability, & workflow issues. SafeHIT brings the clinical and IT folks together collaboratively to solve HIT problems, leveraging in-App, bi-directional, highly secure communication.

Question #3: How can companies like The Breakaway Group and Sociotechnologix work together to improve patient safety?

Heather: Both organizations are passionate about improving patient safety through research-based solutions.  We understand patient safety is a complex issue that must be addressed from multiple touch points in the organization.  By pairing our solutions, an organization can address safety across the care continuum – from the leadership culture of safety to how providers use technology to deliver the highest quality of care.

Michael: Heather is spot-on. Sociotechnologix talks about EHR ROS – return on safety – an EHR system that actually helps the entire sociotechnical environment (culture, processes, and technology) be safer. Combining the methodologies and data streams from The Breakaway Group and Sociotechnologix creates a truly unique — and frankly, for the first time — complete approach to not just the initial EHR implementation, but ongoing and sustained EHR proficiency, safety, usability, and workflow optimization, while stopping the pandemic, ongoing lost efficiency costs associated with sub-optimal adoption and usability.


Many government organizations and institutions have also recognized the need to evaluate health IT’s role in patient safety over the last few years. The ONC has funded numerous reports and projects for this very reason and holds meetings with the Agency for Healthcare Research and Quality (AHRQ) to coordinate health IT and patient safety.  AHRQ has recently awarded $4 million in new research grants to improve the safety of health IT. More information can be found at healthit.ahrq.gov.

Focusing on processes to ensure better use of health IT, from the true adoption of applications to how they are being used in real time and what issues arise, will make us all safer and provide a better patient experience. The right intentions have been there for 50 years.  We’ve had successes and growth, and are getting better at defining the needs of patients, providers, and organizations to reach the ultimate goal of safety.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Interoperability of Electronic Health Records– Benefits and Opportunities – Breakaway Thinking

Posted on June 17, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron
Electronic health records (EHR) aim to improve healthcare and processes for providers and patients on a number of fronts. In an ideal situation according to HealthIT.gov, the clinician benefits by having quick access to patient records and alerts, the ability to quickly and accurately report, and a path to safer prescribing. Patients should be able to spend less time filling out duplicative forms at clinics, have prescriptions sent automatically to pharmacies, and gain easier access to specialist referrals.

The International Journal of Innovation and Applied Studies points out that interoperability can work toward a resolution to several current problems including patient record accessibility and consolidation, and healthcare costs. As far as getting patient information and all available information when it’s needed, the report “estimated that 18% of medical errors that result in an adverse drug event were due to inadequate availability of patients’ information.” Healthcare costs are reduced when different entities can share and communicate common data and could save up to $77.8 billion annually.

Given the potential benefits, there are still opportunities to achieve interoperability. For example, not all healthcare organizations are using EHRs so data isn’t being collected consistently across the board. In 2014 there was an increase in the percentage of hospitals with EHRs. However, only 39% of physicians reported that they share data with other providers. Even though the data is available to share, some EHR users may still be living in a silo and haven’t reached full adoption. In addition, existing specification standards have not promoted interoperability. Even though there is data is available to share, few providers are tapping into that information.

To help increase data sharing, more attention is being paid to FHIR, or Fast Healthcare Interoperability Resources. FHIR stems from HL7 (Health Level Seven) data exchange and information modeling standards. HL7 has been around since 1987 to develop families of standards used to automate healthcare data sharing with the goal to improve patient care. FHIR builds upon the interoperability uses of HL7 and takes into consideration the changes in technology and requirements. According to the Office of the National Coordinator for Health Information Technology (ONC), FHIR is used to enable data access, is used as the container to return query results, and will be used to build necessary security and privacy controls.

FHIR combines what are called “resources” — also known as an instance of data – that define data and are used for specific content. Within a resource are characteristics including “a common way to define and represent them, building them from data types that define common reusable patterns of elements, a common set of metadata, and a human readable part.” Collected data can be used and exchanged, searched for individually or in groupings, analyzed and examined.

Interoperability and the role of FHIR is not yet clearly defined. Going forward, the roadmap for interoperability built by the ONC will be watched closely. Guidelines are broad at this point to allow appropriate decision-making as paths are forged. A group of organizations called the Argonaut Project has committed to working with FHIR. HI7.org defines the Argonaut Project as having the purpose of developing “a first-generation API (application programming interface) and Core Data Services specification to enable expanded information sharing for electronic health records, documents, and other health information based on the FHIR specification.”

APIs are at work behind the scenes when we’re accessing information online. Although healthcare is beginning to harness the power of APIs these interfaces are present everywhere in our day-to-day lives. For example, say you are listening to Spotify and want to connect that application with Facebook. An API helps make that translation of information from Spotify to Facebook happen.  Imagine the possibilities in the realm of data and healthcare. The development of APIs by the Argonaut Project is just the beginning stages of data sharing and interoperability.

In order to reach true interoperability and efficient use of FHIR, the first step is EHR adoption. Once data is captured into an EHR system, organizations can focus on data standards and clear data management, and have the ability to measure impacts to healthcare patients, providers, costs, and communication. Without the right, accurate data input, interpretation at the end of the process is not accurate or actionable. If clinicians are aware of how their engagement with data and proper input at the beginning of this process affects their practice, their patient’s experience and health, and healthcare on a broad spectrum, they can make a difference well into the future.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Healthcare Applies Innovation from Other Industries for Big Impact – Breakaway Thinking

Posted on March 18, 2015 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron

Healthcare is applying innovations from other industries to make advancements in the study of disease, surgery, and research. If you’re fascinated by new ways to use everyday tools and at the same time make life easier, also known as lifehacks, you can appreciate the same concept in healthcare.

3D imaging, cellphone camera technology, and sonograms like those used in underwater navigation are all being used in healthcare. Let’s begin with a look at cellphone technology and one way it is being applied to healthcare.

UCLA researchers developed a lens-free microscope that, through a series of steps, allows tissue samples to be formed into a 3D image using a microchip that is the same type found in your cellphone camera. The image shows contrast so the researcher can see tissue depth. This lens-free microscope also offers a broader, clearer view than conventional microscopes. The result is that “the pathologist’s diagnosis using the lens-free microscopic images proved accurate 99% of the time”, according to a recent study.   In order to apply this same concept to disease, imagine that a researcher could isolate a section of diseased tissue, remove it from its environment, color code the tissue to easily spot abnormalities, and have the ability to study it from all angles.

Techradar.com reminds us that lasers, used in missile defense, in the world’s fastest camera (which takes 6.1 million pictures per second), in entertainment devices such as Blu-ray players, and in grocery check-out lines, are also used in surgery and diagnoses. Lasers can decrease the diagnosis time and cause less disruption to a patient’s comfort. Zero-dilation Scanning Laser Opthmalogy (cSLO), a new imaging technique, can diagnose a patient with diabetic retinopathy, which causes progressive damage to the retina, in as little as 3 minutes.

Technology is not only impacting the patient experience, but how caregivers are brought up to speed on new technologies. In fact, the founder of The Breakaway Group based the company’s electronic health record (EHR) learning concept on flight simulation. Flight simulators train pilots how to maneuver in extreme circumstances, situations that would be difficult to create in real life. At The Breakaway Group, we use simulation technology to increase adoption of EHRs by training providers, nurses, and healthcare professionals.

Speed to proficiency, one of four key adoption elements of The Breakaway Method, provides learners with real-life situations in a safe environment.  Learners can quickly experience many different circumstances, fail, and learn to complete tasks correctly, all without affecting patient outcomes. In addition, The Breakaway Group can cut classroom time in half on average by using simulations.

Healthcare is reaching into other industries to become more efficient and effective. Whenever information is shared and innovations are repurposed to make a process better, we all benefit.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Measuring Steps to Patient Empowerment – Breakaway Thinking

Posted on November 19, 2014 I Written By

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer Bergeron

Trends and fads come and go. When they stick, it’s clear they address a consumer need, whether it’s a service, promise, or hope. Here at The Breakaway Group, A Xerox Company (TBG), we operate within a proven methodology that includes metrics, and it’s exciting to those of us who can’t get enough of good data. Most people find metrics interesting, especially when they understand how it relates to them, and the results are something they can control. Metrics are powerful.

To understand the power of data in shaping behaviors, consider the popularity of the self-monitoring fitness tracker or wearable technology. Even as their accuracy is scrutinized, sales in 2014 are predicted to land somewhere in the $14 billion range.1 Do mobile fitness trackers actually help people change their activity habits? Could doctors actually use the data to help their patients? Can companies be built on the concept of improving health with a wearable device? Not conclusively.2 Does a dedicated athlete need this kind of information? Some think not.3

So what is driving the growth of the fitness tracker market and what are these devices offering that creates millions of dedicated users? The answer is real-time data, personalized goals and feedback, and a sense of control; in other words, empowerment.

In the 70s and 80s, my grandparents spoke about their doctor as though he were infallible. They didn’t doubt, question, or even note what he prescribed, but took his advice and dealt with the outcomes. If healing didn’t progress as planned, my grandmother blamed herself, as though she’d failed him.

Jump ahead a few decades when more emphasis is being placed on collaboration. We expect our physicians to work with us, rather than dictate our treatment decisions.4 Section 3506 of the Affordable Care Act, the Program to Facilitate Shared Decision Making, states that the U.S. Department of Health and Human Services is “required to establish a program that develops, tests and disseminates certificated patient decision aids.”5 The intent is to provide patients and caregivers educational materials that will help improve communication about treatment options and decisions.6

Patient portals are important tools in helping to build this foundation of shared information. The portals house and track patient health data on web-based platforms, enabling patients and physicians to easily collaborate on the patient’s health management.7  Use of patient portals is a Meaningful Use Stage 2 objective.

The first measure of meeting this objective states that more than half the patients seen during a specified Electronic Health Record reporting period must have online access to their records. The second measure puts the spotlight on the patient and their use of that web-based information. MU Stage 2 requires that more than 5% of a provider’s patients must have viewed, downloaded, or transmitted their information to another provider in order for the provider to qualify for financial incentives from the Federal government.8

Empowered consumers want information immediately, whether it’s a restaurant review, number of steps taken in the last hour, how many calories they’ve burned, or their most recent checkup results. We like to weigh the input, make a decision, and then take action. Learning and information intake, no matter the topic, is expected to happen fast.

Metrics show us where we stand and how far we’ve come, which empowers us to keep going or make a change, and then measure again. We’re in an age of wanting to know but also wanting to know what to do next. The wearable device market has met a very real need of consumers. Whether or not fitness trackers make us healthier, whether or not our doctors know what to do with the information, or if this is information an athlete would really use, these devices can serve the purpose of putting many people in control of their own health, one measurable step at a time.

Sources:
1 Harrop, D., Das, R., & Chansin G. (2014) . Wearable technology 2014-2024: Technologies, markets, forecasts. Retrieved from http://www.idtechex.com/research/reports/wearable-technology-2014-2024-technologies-markets-forecasts-000379.asp

2 Hixon, T. (2014) . Are health and fitness wearables running out of gas? Retrieved from  http://www.forbes.com/sites/toddhixon/2014/04/24/are-health-and-fitness-wearables-running-out-of-gas/

3 Real athletes don’t need wearable tech. (2014) . Retrieved from http://www.outsideonline.com/outdoor-gear/gear-shed/tech-talk/Real-Athletes-Dont-Need-Wearable-Tech.html

4 Chen, P. (2012) . Afraid to speak up at the doctor’s office. Retrieved from  http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_r=0

5 Informed Medical Decisions Foundation. (2011-2014) .  Affordable care act. Retrieved from http://www.informedmedicaldecisions.org/shared-decision-making-policy/federal-legislation/affordable-care-act/

6 HealthcareITNews. (2014) . Patient pjortals. Retrieved from http://www.healthcareitnews.com/directory/patient-portals

7 Bajarin, T. (2014) . Where wearable health gadgets are headed. Retrieved from http://time.com/2938202/health-fitness-gadgets/

8 HealthIT.gov. (2014) . Patient ability to electronically view, download & transmit (VDT) health information. Retrieved from http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures-2/patient-ability-electronically-view-download-transmit-vdt-health-information

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.