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E-Patient Update: Patients Need Better Care Management Workflows

Posted on March 10, 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.

Now and then, I get a little discouraged by the state of my health data. Like providers, I’m frustrated as heck by the number of independent data sources I must access to get a full picture of my medications, care and health status. These include:

* The medication tracker on my retail pharmacy’s site
* My primary care group’s portal
* My hospital’s Epic MyChart portal
* A medication management app to track my compliance with my regimen
* A health tracker app in which I track my blood pressure
* My Google calendar, to keep up with my health appointments
* Email clients to exchange messages with some providers

That’s not all – I’m sure I could think of other tools, interfaces and apps – but it offers a good idea of what I face. And I’m pretty sure I’m not unusual in this regard, so we’re talking about a big issue here.

By the way, bear in mind I’m not just talking about hyperportalotus – a fun term for the state of having too many portals to manage – but rather, a larger problem of data coordination. Even if all of my providers came together and worked through a shared single portal, I’d still have to juggle many tools for tracking and documenting my care.

The bottom line is that given the obstacles I face, my self-care process is very inefficient. And while we spend a lot of time talking about clinician workflow (which, of course, is quite important) we seldom talk about patient/consumer health workflow. But it’s time that we did.

Building a patient workflow

A good initial step in addressing this problem might be to create a patient self-care workflow builder and make it accessible website. Using such a tool, I could list all of the steps I need to take to manage my conditions, and the tool would help me develop a process for doing so effectively.

For example, I could “tell” the software that I need to check the status of my prescriptions once a week, visit certain doctors once a month, check in about future clinical visits on specific days and enter my data in my medication management app twice a day. As I did this, I would enter links to related sites, which would display in turn as needed.

This tool could also display critical web data, such as the site compiling the blood sugar readings from my husband’s connected blood glucose monitor, giving patients like me the ability to review trends at a glance.

I haven’t invented the wheel here, of course. We’re just talking about an alternate approach to a patient portal. Still, even this relatively crude approach – displaying various web-based sources under one “roof” along with an integrated process – could be quite helpful.

Eventually, health IT wizards could build much more sophisticated tools, complete with APIs to major data sources, which would integrate pretty much everything patients need first-hand. This next-gen data wrangler would be able to create charts and graphs and even issue recommendations if the engine behind it was sophisticated enough.

Just get started

All that being said, I may be overstating how easy it would be to make such a solution work. In particular, I’m aware that integrating a tool with such disparate data sources is far, far easier said than done. But why not get started?

After all, it’s hard to overestimate how much such an approach would help patients, at least those who are comfortable working with digital health solutions. Having a coordinated, integrated tool in place to help me manage my care needs would certainly save me a great deal of time, and probably improve my health as well.

I urge providers to consider this approach, which seems like a crying need to me. The truth is, most of the development money is going towards enabling the professionals to coordinate and manage care. And while that’s not a bad thing, don’t forget us!

Can Interoperability Drive Value-Based Care?

Posted on December 14, 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.

As the drive to interoperability has evolved over the last few decades — and those of you who are HIT veterans know that these concerns go at least that far back — open data sharing has gone from being a “nice to have” to a presumed necessity for providing appropriate care.

And along the way, backers of interoperability efforts have expanded their goals. While the need to support coordinated care has always been a basis for the discussion, today the assumption is that value-based care simply isn’t possible without data interoperability between providers.

I don’t disagree with the premise. However, I believe that many providers, health systems and ACOs have significant work to do before they can truly benefit from interoperability. In fact, we may be putting the cart before the horse in this case.

A fragmented system

At present, our health system is straining to meet the demand for care coordination among the populations it serves. That may be in part because the level of chronic illness in the US is particularly high. According to one Health Affairs study, two out of three Americans will have a chronic condition by the year 2030. Add that to the need to care for patients with episodic care needs and the problem becomes staggering.

While some health organizations, particularly integrated systems like the Cleveland Clinic and staff-model managed care plans like Kaiser Permanente, plan for and execute well on care coordination, most others have too many siloes in place to do the job correctly. Though many health systems have installed enterprise EMRs like Epic and Cerner, and share data effectively while the patient remains down in their system, they may do very little to integrate information from community providers, pharmacies, laboratories or diagnostic imaging centers.

I have no doubt that when needed, individual providers collect records from these community organizations. But collecting records on the fly is no substitute for following patients in a comprehensive way.

New models required

Given this history, I’d argue that many health systems simply aren’t ready to take full advantage of freely shared health data today, much less under value-based care payment models of the future.

Before they can use interoperable data effectively, provider organizations will need to integrate outside data into their workflow. They’ll need to put procedures in place on how care coordination works in their environment. This will include not only deciding who integrates of outside data and how, but also how organizations will respond as a whole.

For example, hospitals and clinics will need to figure out who handles care coordination tasks, how many resources to pour into this effort, how this care coordination effort fits into the larger population health strategy and how to measure whether they are succeeding or failing in their care coordination efforts. None of these are trivial tasks, and the questions they raise won’t be answered overnight.

In other words, even if we achieved full interoperability across our health system tomorrow, providers wouldn’t necessarily be able to leverage it right away. In other words, unfettered health data sharing won’t necessarily help providers win at value-based care, at least not right away. In fact, I’d argue that it’s dangerous to act as though interoperability can magically make this happen. Even if full interoperability is necessary, it’s not sufficient. (And of course, even getting there seems like a quixotic goal to some, including myself.)

Planning ahead

That being said, health organizations probably do have time to get their act together on this front. The move to value-based care is happening quickly, but not at light speed, so they do have time to make plans to leverage interoperable health data.

But unless they acknowledge the weaknesses of their current system, which in many cases is myopic, siloed and rigid, interoperability may do little to advance their long-term goals. They’ll have to admit that their current systems are far too inward-looking, and that the problem will only go away if they take responsibility for fixing it.

Otherwise, even full interoperability may do little to advance value-based care. After all, all the data in the world won’t change anything on its own.

Early Attestation Results: Some Observations – Meaningful Use Monday

Posted on August 8, 2011 I Written By

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

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

At last week’s HIT Policy Committee meeting, Robert Tagalicod, (the new director of the Office of E-Health Standards & Services), presented an analysis of the attestation experience to-date [See John’s previous Meaningful Use Details post for the slides and report]. The results lend themselves to some interesting observations—admittedly preliminary findings, but revealing nonetheless: 

  • The average performance levels were quite high—on those measures that have thresholds to be met, providers attested to results considerably above the level required for successful accomplishment. This is a positive sign that once providers commit to an EHR and to meaningful use, they try to use the EHR on a routine basis, not just to satisfy the minimum requirements. True, these initial attesters represent early EHR adopters who have had time to become successful EHR users, but hopefully this trend will be sustained.
  • Care coordination measures seem to present a challenge for many providers—the most commonly deferred (i.e., not selected) menu measures were medication reconciliation and summary of care at transitions.
  • Very few providers were actually able to conduct a test of their ability to electronically submit syndromic surveillance information to public health agencies or submit immunization data to registries (5% and 28% of attesters, respectively). Not surprisingly, most EPs either excluded or deferred these public health measures

Of the 2,383 EPs that attested, 137 were unsuccessful. I’d be interested to know where they stumbled and if they will succeed in another reporting period.