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!!

E-Patient Update: Naughty, Naughty Telehealth Users

Posted on March 17, 2017 I Written By

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

Wow. I mean, wow. I can’t believe the article I just read, in otherwise-savvy Wired magazine yet, arguing that patients who access telemedicine services are self-indulgent and, well, sorta stupid.

Calling it the “Uber-ization” of healthcare, writer Megan Molteni (@MeganMolteni on Twitter) argues that telemedicine will only survive if people use it “responsibly” – apparently because people are currently accessing care via direct-to-consumer services because their favorite online gambling site was offline for system maintenance.

In making this claim, Molteni cites new research from RAND, published in the journal Health Affairs, which looked at the impact direct-to-consumer telemedicine services had on overall healthcare costs. But the piece goes from acknowledging that this model might not reduce costs in all cases to attacking e-patients like myself – and that’s where I got a bit steamed.

In structuring the piece, the writer seems to suggest that if consumer behavior doesn’t save the health insurance industry money, we need to stop being so gosh-darned assertive about getting help with our health. Then it goes further, arguing that we should just for-Pete’s-sake control ourselves (apparently we’re either hypochondriacs, attention-seekers or terminally bored) and just step away from the computer.  Why can’t we just say no?

First, the facts

Before we take this on, let’s take a look at the journal article which the writer drew upon as a primary source and see what assertions it makes. Facts first.

In the abstract, the authors note that demand for direct-to-consumer telehealth services is growing rapidly, and has the potential to save money by replacing physician office and emergency department trips with virtual visits.

To see whether this might be the case, the authors gathered commercial claims data over 300,000 patients covered by CalPERS Blue Shield, which began covering telehealth services in April 2012. During the next 18 months, 2,943 of those 300,000 enrollees came down with a respiratory infection, one third of which sought services from direct-to-consumer telehealth company Teladoc.

Once they had their data in hand, the research looked at patterns of care utilization and spending levels for treatment of acute respiratory illnesses.

After completing the analysis, the authors found that 12% of direct-to-consumer telehealth visits replaced visits to other providers, while the remaining 88% represented new care utilization. Net annual spending on acute respiratory illness grew $45 per telehealth users, researchers found.

The researchers concluded that because it offers more convenient access, direct-to-consumer telehealth may increase utilization and healthcare spending.

It should be noted that Molteri’s article doesn’t look at whether increased utilization was excessive or ineffective. It doesn’t ask whether patients who accessed telemedical care had different outcomes than those who didn’t and if those new patients saved the health system money because of the interventions that wouldn’t have happened without telehealth. It doesn’t address whether patients who used telehealth in addition to face-to-face care were actually sicker than those who didn’t, or had other co-existing conditions which affected overall costs. It just notes a pattern for a single group of patients diagnosed with a single condition.

Also, it’s worth pointing out that we don’t know whether Teladoc’s performance is better or worse than that of rivals like HealthTap, MDLive and Doctor on Demand. And if there are meaningful differences, that would be important.  But the piece doesn’t take this on either.

So in summary, all we know is that using one provider for one condition, a health plan paid a little bit more for some patients’ care when they had a telemedicine consult.

Consumer indictment

But in Molteri’s analysis, the study offers nothing less than an indictment of consumers who use these services. “For telehealth to fully deliver on its promise, people have to start treating their health care less like an Uber you summon in a thunderstorm,” she asserts, while citing no evidence that people do in fact access such services too casually.

All told, the piece suggests that the people are accessing telehealth for trivial reasons such as, I don’t know, kicks, or as an easy way to find an online buddy. Really? Give me a break. Even when it’s delivered online, people seek care out because they need it, not because they’re lazy or, as I noted above, stupid.

To be as fair as I can be, the article does note that direct-to-consumer healthcare models have unique flaws, particularly a lack of integration with patients’ ongoing care. It also concedes that some providers (such as the VA, which has slashed costs with its telehealth program) are using the technology effectively.

It also notes that telemedicine can do more to meet its potential if it’s used to manage chronic disease and engage people in preventive care. “Telehealth has to be integrated fully into a total care system,” said Mario Gutierrez, executive director of the Center for Connected Health Policy, who spoke with Molteri. As a patient with multiple chronic conditions, I couldn’t agree more. Anything that makes care access easier on one of my bad days is a winner in my book.

Ultimately, though, the author unfortunately bases her article on the assumption that the real problem here is patients accessing care. Not the gaps in the system that prompt such usage. Not the unavailability of primary care in some settings. Not the 15-minute fly-by medical visits that perforce leave issues unaddressed. Not even the larger issues in controlling healthcare costs. No, it’s e-patients like me who use telehealth to meet unmet needs.

Please. I can’t even.

E-Patient Update:  Can Telemedicine Fill Gap For Uninsured Patients?

Posted on February 24, 2017 I Written By

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

As someone who will soon will need to buy insurance through an ACA exchange – but doesn’t know whether that will still be possible – I’ve been thinking about my healthcare needs a lot, and how to meet them effectively if I’m ever uninsured.

Being an e-patient, the first thing that crossed my mind was to explore what Internet connectivity could do for me. And it occurred to me that if I had access to a wider range of comparatively-affordable telemedical services, I just might be able to access enough doctors and advanced practice clinicians to survive. (Of course, hospital and prescription drug costs won’t be tamed that easily, but that’s a subject for a different column.)

I admit that video visits aren’t an ideal solution for me and my husband, as we both have complex, chronic health conditions to address. But if I end up without insurance, I hold out hope that cheaper telemedicine options will get me through until we find a better solution.

Right now, unfortunately, telemedical services largely seem to be delivered on a hit-or-miss basis – with some specialties being easy to find and others almost inaccessible via digital connectivity – but if enough people like me are forced to rely on these channels perhaps this will change.

What’s available and what isn’t

This week, I did some unscientific research online to see what kind of care consumers can currently access online without too much fuss. What I found was a decidedly mixed bag. According to one telehealth research site, a long list of specialties offer e-visits, but some of them are much harder to access than others.

As you might have guessed, primary care – or more accurately, urgent care — is readily available. In fact one such provider, HealthTap, offers consumers unlimited access to its doctors for $99 a month. Such unfettered access could be a big help to patients without insurance.

And some specialties seem to be well-represented online. For example, if you want to get a dermatology consult, you can see a dermatologist online at DermatologistOnCall, which is partnered with megapharmacy Walgreens.

Telepsychiatry seems to be reasonably established, though it doesn’t seem to be backed yet by a major consumer branding effort. On the other hand, video visits with talk therapists seem to be fairly commonplace these days, including an option provided by HealthTap.

I had no trouble finding opportunities to connect with neurologists via the Web, either via email or live video. This included both multispecialty sites and at least one (Virtual Neurology) dedicated to offering teleneurology consults.

On the other hand, at least in searching Google, I didn’t find any well-developed options for tele-endocrinology consults (a bummer considering that hubby’s a Type 2 diabetic). It was the same for tele-pulmonology services.

In both of the former cases, I imagine that such consults wouldn’t work over time unless you had connected testing devices that, for example allow you to do a peak flow test, spirometry, blood or urine test at home. But while such devices are emerging, I’m not aware of any that are fully mature.

Time to standardize

All told, I’m not surprised that it’s hit or miss out there if you want to consult your specialists via an e-visit. There are already trends in place, which have evolved over the last few years, which favor some specialties and fail to address others.

Nonetheless, particularly given my perilous situation, I’m hoping that providers and trade groups will develop some standardized approaches to telemedicine. My feeling is that if a specialty-specific organization makes well-developed clinical, technical, operational and legal guidelines available, we’ll see a secondary explosion of new tele-specialties emerge.

In fact, even if I retain my health insurance benefits, I still hope that telemedical services become more prevalent. They’re generally more cost-efficient than traditional care and certainly more convenient. And I’m pretty confident that I’m not the only one champing at the bit here. Let’s roll ‘em out, people!

Consumers Want Their Doctors To Offer Video Visits

Posted on February 6, 2017 I Written By

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

A new survey by telemedicine provider American Well has concluded that many consumers are becoming interested in video visits, and that some of consumers would be willing to switch doctors to get video visits as part of their care. Of course, given that American Well provides video visits this is a self-interested conclusion, but my gut feeling is that it’s on target nonetheless.

According to the research, 72% of parents with children under 18 were willing to see a doctor via video, as well as 72% of consumers aged 45-54 and 53% of those over age 65. Americal Well’s study also suggests that the respondents see video visits as more effective than in-person consults, with 85% reporting that a video visit resolved their issues, as compared with 64% of those seeing a doctor in a brick-and-mortar setting.

In addition, respondents said they want their existing doctors to get on board. Of those with a PCP, 65% were very or somewhat interested in conducting video visits with their PCP.  Meanwhile, 20% of consumers said they would switch doctors to get access to video visits, a number which rises to 26% among those aged 18 to 34, 30% for those aged 35 to 44 and and 34% for parents of children under age 18.

In addition to getting acute consults via video visit, 60% of respondents said that they would be willing to use them to manage a chronic condition, and 52% of adults reported that they were willing to participate in post-surgical or post-hospital-discharge visits through video.

Consumers also seemed to see video visits as a useful way to help them care for ill or aging family members. American Well found that 79% of such caregivers would find this approach helpful.

Meanwhile, large numbers of respondents seemed interested in using video visits to handle routine chronic care. The survey found that 78% of those willing to have a video visit with a doctor would be happy to manage chronic conditions via video consults with their PCP.

What the researchers draw from all of this is that it’s time for providers to start marketing video visit capabilities. Americal Well argues that by promoting these capabilities, providers can bring new patients into their systems, divert patients away from the ED and into higher-satisfaction options and improve their management of chronic conditions by making it easier for patients to stay in touch.

Ultimately, of course, providers will need to integrate video into the rest of their workflow if this channel is to mature fully. And providers will need to make sure their video visits meet the same standards as other patient interactions, including HIPAA-compliant security for the content, notes Dr. Sherry Benton of TAO Connect. Providers will also need to figure out whether the video is part of the official medical record, and if so, how they will share copies if the patient request them. But there are ways to address these issues, so they shouldn’t prevent providers from jumping in with both feet.

Time To Treat Telemedicine as Just “Medicine”

Posted on October 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.

Over the last year or two, hospitals and clinics have shown a steadily growing interest in offering telemedicine services. Certainly, this is in part due to the fact that health plans are beginning to pay for telehealth consults, offering a new revenue stream that providers want to capture, but there’s more to consider here.

Until recently, much of the discussion around telehealth centered on how to get health insurance companies to pay for it. But now, as value-based purchasing becomes more the norm, providers will need to look at telemedicine as a key tool for managing patient health more effectively.

Evidence increasingly suggests that making providers available via telemedicine channels can help better manage chronic conditions and avert needless hospitalizations, both of which, under value-based payments, are more important than getting a few extra dollars for a consult.

Looked at another way, the days of telehealth being a boutique service for more-sophisticated consumers are ending. “It’s time to treat telemedicine as just ‘medicine,’” one physician consultant told me. “It’s no different than any other form of medicine.”

As reasons for treating telehealth as a core clinical service increase, barriers to sharing video and other telemedical records are falling, the consultant says. Telemedicine providers can already push the content of a video visit or other telehealth consult into an EMR using HL7, and soon information sharing should go both ways, he notes.

What’s more, breaking down another wall, major EMR vendors are offering providers the ability to conduct a telehealth visit using their platform. For example, Epic is offering telemedicine services to providers via its MyChart portal and Hyperspace platform, in collaboration with telehealth video provider Vidyo. Cerner, which operates some tele-ICUs, has gone even further, with senior exec John Glaser recently arguing that telehealth needs to be a central part of its population health strategy.

Admittedly, even if providers develop a high level of comfort delivering care through telehealth platforms, it’s probably too soon to rely on this medium as an agent of change. If nothing else, the industry must face up to the fact that telemedicine demand isn’t huge among their patients at present, though consumer plays like AmWell and DoctoronDemand are building awareness.

Also, while scheduling and conducting telemedicine consults need not be profoundly different than holding a face-to-face visit — other than offering both patient and doctor more flexibility — working in time to manage and document these cases can still pose a workflow challenge. Practical issues such as how, physically, a doctor documents a telehealth visit while staring at the screen must be resolved, issues of scheduling addressed and even questions of how to store and retrieve such visit records must be thought through.

However, I think it’s fair to say that we’re past wondering whether telemedicine should be part of the healthcare process, and whether it makes financial sense for hospitals and clinics to offer it. Now we just have to figure out where and when.

What Do You Think Of Data Lakes?

Posted on October 4, 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.

Being that I am not a high-end technologist, I’m not always up on the latest trends in database management – so the following may not be news to everyone who reads this. As for me, though, the notion of a “data lake” is a new one, and I think it a valuable idea which could hold a lot of promise for managing unruly healthcare data.

The following is a definition of the term appearing on a site called KDnuggets which focuses on data mining, analytics, big data and data science:

A data lake is a storage repository that holds a vast amount of raw data in its native format, including structured, semi-structured and unstructured data. The data structure and requirements are not defined until the data is needed.

According to article author Tamara Dull, while a data warehouse contains data which is structured and processed, expensive to store, relies on a fixed configuration and used by business professionals, a data link contains everything from raw to structured data, is designed for low-cost storage (made possible largely because it relies on open source software Hadoop which can be installed on cheaper commodity hardware), can be configured and reconfigured as needed and is typically used by data scientists. It’s no secret where she comes down as to which model is more exciting.

Perhaps the only downside she identifies as an issue with data lakes is that security may still be a concern, at least when compared to data warehouses. “Data warehouse technologies have been around for decades,” Dull notes. “Thus, the ability to secure data in a data warehouse is much more mature than securing data in a data lake.” But this issue is likely to receive in the near future, as the big data industry is focused tightly on security of late, and to her it’s not a question of if security will mature but when.

It doesn’t take much to envision how the data lake model might benefit healthcare organizations. After all, it may make sense to collect data for which we don’t yet have a well-developed idea of its use. Wearables data comes to mind, as does video from telemedicine consults, but there are probably many other examples you could supply.

On the other hand, one could always counter that there’s not much value in storing data for which you don’t have an immediate use, and which isn’t structured for handy analysis by business analysts on the fly. So even if data lake technology is less costly than data warehousing, it may or may not be worth the investment.

For what it’s worth, I’d come down on the side of the data-lake boosters. Given the growing volume of heterogenous data being generated by healthcare organizations, it’s worth asking whether deploying a healthcare data lake makes sense. With a data lake in place, healthcare leaders can at least catalog and store large volumes of un-normalized data, and that’s probably a good thing. After all, it seems inevitable that we will have to wring value out of such data at some point.

One Example Of Improving Telehealth Documentation 

Posted on August 16, 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.

Over the past year or two, the pressure has risen for providers to better document telehealth encounters, a pressure which has only mounted as the volume of such consults has grown. But until recently, telemedicine notes have been of little value, as they’ve met few of the key criteria that standard notes must meet.

The fact that such consults aren’t integrated with EMRs has made such an evolution even trickier. I guess doctors might be able to squeeze the patient’s video screen into one corner, allowing the clinician to work within the existing EMR display, but that would make both the consult and the note-taking rather inefficient, wouldn’t it?  The bottom line is that if telemedicine is to take its place alongside of other modes of care, this state of affairs is unsustainable.

For one thing, health plans that reimburse for telehealth services won’t be satisfied with vague assurances that such care made a difference – they’ll want some basis for analyzing its impact, which can’t be done without at least some basic diagnostic and care-related information. Also, providers will need similar records, for reasons which include the need to integrate the information into the patient’s larger record and to track the progress of this approach.

All of which is to note that I was happy to stumble across an example of a telemedicine provider that’s making efforts to improve its consult notes. While the provider, Doctor on Demand, hasn’t exactly reinvented the telehealth record, it’s improving those records, and to my way of thinking that deserves a shout-out.

As some readers may know, Doctor on Demand is a consumer-facing telemedicine provider which offers video visits with primary care doctors, counselors and psychiatrists. Its competitors include HealthTap and American Well. Because the company works with my health plan, United Healthcare, I’ve used its services to deal with off-hours issues as they arise.

Just today I had a video visit with a Doctor on Demand doctor to address a mild asthma care issue, after which I reviewed the physician’s notes. When I did so, I was happy to see that those notes included a ICD-10 diagnosis code. The notes also incorporated a consumer-level summary of what the diagnosed condition was, what to do about it, what its prognosis was and how to follow up. Essentially, Doctor on Demand’s notes have evolved from a sentence of two of informal suggestions to a more-structured document not unlike a set of hospital discharge instructions.

Don’t get me wrong, I’m certainly well aware that these are just baby steps. Doctor on Demand will have to move a lot further in this direction before consult documentation offers much to other providers. That being said, adding a formal diagnosis code gives the company a better means for analyzing key patterns of utilization internally by presenting condition, which can help its leaders look at whom they serve. Doctor on Demand can also use this information to pitch deals with potential partners, by sharing data on its population and underscoring its capabilities. In other words, these changes should make an impact.

Ultimately, telehealth documentation will have to meet the same expectations that other healthcare documentation does. And it’s not clear to me how freestanding telemedicine firms like Doctor on Demand will bridge that gap. After all, generating complete documentation takes far more than a few useful gestures. Even if the company threw a high-end EMR at the problem, merging it with the existing workflow is likely to be a huge undertaking. But still, making a bit of progress is worthwhile. I hope Doctor on Demand’s competitors are taking similar steps.

E-Patient Update: Using Digital Health For Collaborative Medication Management

Posted on June 1, 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.

Recently, I had a medical visit which brought home the gap between how doctors and patients approach to medications. While the physician and his staff seemed focused on updating a checklist of meds, I wanted med education and a chance to ask in-depth self-management questions. And though digital health tools and services could help me achieve these goals, they didn’t seem to be on the medical group’s radar.

At this visit, as I waited to see the doctor, a nurse entered with a laptop on a cart. Consulting her screen, she read off my medication list and item by item, asked me to confirm whether I took the given medication. Then, she asked me to supply the name and dosage of any drugs that weren’t included on the list. Given that I have a few chronic conditions, and take as many as a dozen meds a day, this was an awkward exercise. But I complied as best I could. When a physician saw me later, we discussed only the medication he planned to add to the mix.

While I felt quite comfortable with both the nurse and doctor, I wasn’t satisfied with the way the medication list update was handled. At best, the process was clumsy, and at worst, it might have passed over important information on drug history, interactions and compliance. Also, at least for me, discussing medications was difficult without being able to see the list.

But at least in theory, digital health technology could go a long way toward addressing these issues. For example:

  • If one is available, the practice could use a medication management app which syncs with the EMR it uses. That way, clinicians could see my updates and ask questions as appropriate.
  • Alternatively, the patient should have the opportunity to review their medication list while waiting to be seen, perhaps by using a specialized patient login for an EMR portal. This could be done using a laptop or tablet on a cart similar to what clinicians use.
  • When reviewing their medication list, patients could select medications about which they have questions, delete medications they no longer take and enter meds they’ve started since their last visit.
  • At least for complex cases, patients should have an opportunity to do a telehealth consult with a pharmacist if requested. This would be especially helpful prior to adding new drugs to a patient’s regimen. (I don’t know if such services exist but my interest in them stands.)

To me, using digital health options to help patients manage their meds makes tremendous sense. Now that such tools are available, physicians can loop patients into the med management discussion without having to spend a lot of extra time or money. What’s more, collaboration helps patients manage their own care more effectively over the long term, which will be critical under value-based care. But it may not be easy to convince them that this is a good idea.

Unfortunately, many physicians see sharing any form of patient data as a loss of control. After all, in the past a chart was for doctors, not patients, and in my experience, that dynamic has carried over into the digital world. I have struggled against this — in part by simply asking to look at the EMR screen — but my sense is that many clinicians are afraid I’ll see something untoward, misinterpret a data point or engage in some other form of mischief.

Still, I have vowed to take better control of my medications, and I’m going to ask every physician that treats me to consider digital med management tools. I need them to know that this is what I need. Let’s see if I get anywhere!

Telemedicine Parody of Daughtry’s “Home” #LetERsBeERs

Posted on May 30, 2016 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.

It’s a Holiday and so we thought we’d do something a little fun. It comes from Frank Fortner, President of Iatric Systems, in this great parody song. However, there’s little doubt that this was something that Frank created on the side as opposed to some marketing campaign for Iatric Systems. It’s great to have someone that’s so passionate about healthcare that they’re willing to use their creativity in their off time to create these healthcare parody songs.

Here’s Frank’s description of the video:

An acoustical, telehealthical parody of Daughtry’s hit song “Home” inspired by true stories, most recently, a great experience with an online telehealth provider. ERs are incredible places that save lives every day, but for primary or less urgent care, there are now a lot of great options out there. #LetERsBeERs!

Now enjoy his parody of “Home” that he calls “Staying Home”

Galaxy Will See You Now

Posted on May 27, 2016 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.

This post is sponsored by Samsung Business. All thoughts and opinions are my own.

We all know how dramatic our lives have changed thanks to technology. Many of us remember the impact a computer in every home had on our lives. Now we’re seeing that same transformation happening as we all start carrying a smartphone in our pocket. Each of these technologies has opened up new worlds of possibilities in our personal lives and also for healthcare. I think we’ll see a similar transformation with the introduction of voice recognition and AI (Artificial Intelligence).

When we start talking about AI, most of us probably think about the movies they’ve seen where AI was on display. Hollywood’s use of AI in movies often makes it so it doesn’t feel very real. However, if you have a smartphone, then you’ve probably used AI. I know my first real experience with AI was on my Samsung Galaxy S3. I remember my wife and I going on a date and we spent the majority of our date asking “Galaxy” various questions. We got surprisingly good answers including easy access to the show times for the movie we ended up seeing.

Most of us have had this type of experience with AI on our smartphone. It’s pretty magical, but I must admit that I didn’t use it that often when it was just on my phone. There were a few cases it was really useful like when I was driving and needed directions to a gas station. The hands-free access to information was extremely powerful, but it wasn’t part of my daily experience. However, that changed for me when I introduced an always on AI solution in my home. Now it’s become a daily part of me and my family’s life.

How does this apply to healthcare? It’s becoming very clear that the home is the healthcare hub of the future. Think about having always on tablets, smart TVs, and other devices positioned throughout your home where you can easily access your health information, medical knowledge, and healthcare providers. That’s powerful. Plus, those devices and attached sensors are starting to easily monitor you, your environment, and your health. This two way connection creates an extremely powerful combination that will change the way we view healthcare.

Certainly there are practical examples of home health services that exist today including monitoring recently discharged patients, monitoring seniors, connecting patients with doctors, and much more. We’re seeing all of these connected home health services happen more and more every day. Just what we’ve already begun to implement will improve the healthcare we provide dramatically. However, we’re just starting to explore what AI and new technologies can do for healthcare. The best is still to come.

How long will it be before we can sit at home and we can ask our tablet or smart TV “Galaxy, how’s my blood pressure doing today?” Or “Galaxy, can you schedule me a telemedicine visit with my doctor to discuss my prescription refill?” Not to mention Galaxy proactively reaching out to you to motivate healthy decision making.

What’s so incredible is that executing these ideas and many more aren’t that farfetched given the powerful technology that exists today. We still need to connect a few dots, but it’s all extremely doable from a technical perspective.

What’s going to be harder is the cultural shift and change of mindset. However, that’s happening already and it will accelerate over time. I’m sure my kids wouldn’t think twice about asking our TV or tablet for a doctor’s appointment and then having the doctor streamed right to the TV or their tablet. They probably wonder why it’s not already possible.

Even while we wait for this more automated AI future, there are still big home health things happening on smartphones and tablets. Each of those things is a building block to this exalted future. I’m ready for Galaxy to see me now. In fact, in some ways he already does. Are you ready?

For more content like this, follow Samsung on Insights, Twitter, LinkedIn , YouTube and SlideShare.

The Perfect EHR Workflow – Video EHR

Posted on May 12, 2016 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’ve been floating this idea out there for years (2006 to be exact), but I’d never put it together in one consolidated post that I could point to when talking about the concept. I call it the Video EHR and I think it could be the solution to many of our current EHR woes. I know that many of you will think it’s a bit far fetched and in some ways it is. However, I think we’re culturally and technically almost to the point where the video EHR is a feasible opportunity.

The concept is very simple. Put video cameras in each exam room and have those videos replace your EHR.

Technical Feasibility
Of course there are some massive technical challenges to make this a reality. However, the cost of everything related to this idea has come down in price significantly. The cost of HD video cameras negligible. The cost of video storage, extremely cheap and getting cheaper every day. The cost of bandwidth, cheaper and higher quality and so much potential to grow as more cities get fiber connectivity. If this was built on the internal network instead of the cloud, bandwidth is an easily solved issue.

When talking costs, it’s important to note that there would be increased costs over the current documentation solutions. No one is putting in high quality video cameras and audio equipment to record their visits today. Not to mention wiring the exam room so that it all works. So, this would be an added cost.

Otherwise, the technology is all available today. We can easily record, capture and process HD video and even synchronize it across multiple cameras, etc. None of this is technically a challenge. Voice recognition and NLP have progressed significantly so you could process the audio file and convert it into granular data elements that would be needed for billing, clinical decision support, advanced care, population health, etc. These would be compiled into a high quality presentation layer that would be useful for providers to consume data from past visits.

Facial recognition technology has also progressed to the point that we could use these videos to help address the patient identification and patient matching problems that plague healthcare today. We’d have to find the right balance between trusting the technology and human verification, but it would be much better and likely more convenient than what we have today.

Imagine the doctor walking into the exam room where the video cameras in the exam room have already identified the patient and it would identify the doctor as she walked in. Then, the patient’s medical record could be automatically pulled up on the doctor’s tablet and available to them as they’re ready to see the patient.

Plus, does the doctor even need a tablet at all? Could they instead use big digital signs on the walls which are voice controlled by a Siri or Alexa like AI solution. I can already hear, “Alexa, pull up John Lynn’s cholesterol lab results for the past year.” Next thing you know, a nice chart of my cholesterol appears on the big screen for both doctor and patient to see.

Feels pretty far fetched, but all of the technology I describe is already here. It just hasn’t been packaged in a way that makes sense for this application.

Pros
Ideal Workflow for Providers – I can think of no better workflow for a doctor or nurse. Assuming the tech works properly (and that’s a big assumption will discuss in the cons), the provider walks into the exam room and engages with the patient. Everything is documented automatically. Since it’s video, I mean literally everything would be documented automatically. The providers would just focus on engaging with the patient, learning about their health challenges, and addressing their issues.

Patient Experience – I’m pretty sure patients wouldn’t know what to do if their doctor or nurse was solely focused on them and wasn’t stuck with their head in a chart or in their screen. It would totally change patients’ relationship with their doctors.

Reduced Liability – Since you literally would have a multi angle video and audio recording of the visit, you’d have the proof you’d need to show that you had offered specific instructions or that you’d warned of certain side effects or any number of medical malpractice issues could be resolved by a quick look at the video from the visit. The truth will set you free, and you’d literally have the truth about what happened during the visit on video.

No Click Visit – This really is part of the “Ideal Workflow” section, but it’s worth pointing out all the things that providers do today to document in their EHR. The biggest complaint is the number of clicks a doctor has to do. In the video EHR world where everything is recorded and processed to document the visit you wouldn’t have any clicks.

Ergonomics – I’ve been meaning to write a series of posts on the health consequences doctors are experiencing thanks to EHR software. I know many who have reported major back trouble due to time spent hunched over their computer documenting in the EHR. You can imagine the risk of carpal tunnel and other hand and wrist issues that are bound to come up. All of this gets resolved if the doctor literally walks into the exam room and just sees the patient. Depending on how the Video EHR is implemented, the doctor might have to still spend time verifying the documentation or viewing past documentation. However, that could most likely be done on a simple tablet or even using a “Siri”-like voice implementation which is much better ergonomically.

Learning – In mental health this happens all the time. Practicum students are recording giving therapy and then a seasoned counselor advises them on how they did. No doubt we could see some of the same learning benefits in a medical practice. Sometimes that would be through peer review, but also just the mere fact of a doctor watching themselves on camera.

Cons
Privacy – The biggest fear with this idea is that most people think this is or could be a major privacy issue. They usually ask the question, “Will patients feel comfortable doing this?” On the privacy front, I agree that video is more personal than granular data elements. So, the video EHR would have to take extreme precautions to ensure the privacy and security of these videos. However, from an impact standpoint, it wouldn’t be that much different than granular health information being breached. Plus, it’s much harder to breach a massive video file being sent across the wire than a few granular text data elements. No doubt, privacy and security would be a challenge, but it’s a challenge today as well. I don’t think video would be that much more significant.

As to the point of whether patients would be comfortable with a video in the exam room, no doubt there would need to be a massive culture shift. Some may never reach the point that they’re comfortable with it. However, think about telemedicine. What are patients doing in telemedicine? They’re essentially having their patient visit on video, streamed across the internet and a lot of society is very comfortable with it. In fact, many (myself included) wish that telemedicine were more widely available. No doubt telemedicine would break down the barriers when it comes to the concept of a video EHR. I do acknowledge that a video EHR takes it to another level and they’re not equal. However, they are related and illustrate that people’s comfort in having their medical visits on video might not be as far fetched as it might seem on the surface.

Turns out that doctors will face the same culture shift challenge as patients and they might even be more reluctant than patients.

Trust – I believe this is currently the biggest challenge with the concept of a video EHR. Can providers trust that the video and audio will be captured? What happens if it fails to capture? What happens if the quality of the video or audio isn’t very good? What is the voice recognition or NLP isn’t accurate and something bad happens? How do we ensure that everything that happens in the visit is captured accurately?

Obviously there are a lot of challenges associated with ensuring the video EHR’s ability to capture and document the visit properly. If it doesn’t it will lose providers and patients’ trust and it will fail. However, it’s worth remembering that we don’t necessarily need it to be perfect. We just need it to be better than our current imperfect status quo. We also just need to design the video EHR to avoid making mistakes and warn about possible missing information so that it can be addressed properly. No doubt this would be a monumental challenge.

Requires New Techniques – A video EHR would definitely require modifications in how a provider sees a patient. For example, there may be times where a patient or the doctor need to be positioned a certain way to ensure the visit gets documented properly. You can already see one of the cameras being a portable camera that can be used for close up shots of rashes or other medical issues so that they’re documented properly.

No doubt providers would have to learn new techniques on what they say in the exam room to make sure that things are documented properly. Instead of just thinking something, they’ll have to ensure that they speak clinical orders, findings, diagnosis, etc. We could have a long discussion on the impact for good and bad of this type of transparency.

Double Edged Sword of Liability – While reduced liability is a pro, liability could also be a con for a video EHR. Having the video of a medical visit can set you free, but it can also be damning as well. If you practice improper medicine, you won’t have anywhere to hide. Plus, given our current legal environment, even well intentioned doctors could get caught in challenging situations if the technology doesn’t work quite right or the video is taken out of context.

Reality Check
I realize this is a massive vision with a lot of technical and cultural challenges that would need to be overcome. Although, when I first came up with the idea of a video EHR ~10 years ago, it was even more far fetched. Since then, so many things have come into place that make this idea seem much more reasonable.

That said, I’m realistic that a solution like this would likely start with some sort of half and half solution. The video would be captured, but the provider would need to verify and complete the documentation to ensure its accuracy. We couldn’t just trust the AI engine to capture everything and be 100% accurate.

I’m also interested in watching the evolution of remote scribes. In many ways, a remote scribe is a human doing the work of the video EHR AI engine. It’s an interesting middle ground which could illustrate the possibilities and also be a small way to make patients and providers more comfortable with cameras in the exam room.

I do think our current billing system and things like meaningful use (or now MACRA) are still a challenge for a video EHR. The documentation requirements for these programs are brutal and could make the video EHR workflow lose its luster. Could it be done to accommodate the current documentation requirements? Certainly, but it might take some of the polish off the solution.

There you have it. My concept for a video EHR. What do you think of the idea? I hope you tear it up in the comments.