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The Future Of…Patient Engagement

Posted on March 19, 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.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Healthcare has a major challenge when it comes to the term “Patient Engagement.” $36 billion of government money and something called meaningful use has corrupted the word Patient Engagement. While meaningful use requires “5% patient engagement”, that’s a far cry from actually engaging with patients. Anyone that’s attested to meaningful use knows what I mean.

As we move past meaningful use, what then will patient engagement actually look like?

When I start to think about the future of patient engagement, I’m taken back to my experience with a new primary care provider that’s trying to Restore Humanity to Healthcare (see Restore Humanity to Healthcare part 2 as well). In this case, I’m exploring the idea of unlimited primary care along with a primary care team that includes a doctor, but also includes a wellness coordinator that’s interested in my wellness and not just my presenting problem.

Once you take the payment portion out of primary care, it dramatically changes the equation for me. Gone are the fears of going to the doctor because you don’t want to pay the co-pay. Gone are the days where a doctor needs to see you in the office in order to be able to make money from the visit. With unlimited primary care, an email, phone call or text message that solves the problem is a great solution for the doctor and the patient.

Of course, this model of primary care is only one example of the shift that’s going to drive us to patient engagement. ACOs and value based care models are going to require a much deeper relationship between doctors and patients. Trust me that 5% patient engagement through an online portal isn’t going to be enough in these new models.

Plus, these new models are going to really convert our current sick care system into a true healthcare system. I like to call this new model “Treating Healthy Patients.” Quite frankly we’re not ready for this change right now, but in the future we’ll have to adapt. The biggest change is going to be in how we define “patient” and “healthy.”

The wave of connected medical devices and innovation are going to completely reframe how we look at health. Instead of describing ourselves as healthy, the data will tell us that we’re all sick. We’re just at different points in the continuum of sickness.

In the future, patient engagement will be the key to treating each of us individually. The symptoms will change from coughing and vomiting to 85% risk for diabetes and 76% risk for a heart attack. We thought we had patient compliance issues when someone is coughing and vomiting (ie. something they want to fix). Now imagine patient compliance challenges when the patient isn’t feeling any pain, but they need to change something in order to avoid some major health problem.

I think this describes perfectly why we’re entering one of the most challenging times in healthcare. It’s a dramatic shift in how we think about healthcare and has a new set of more challenging problems that we’ve never solved. One of the keys to solving these new challenges is patient engagement.

The Future Of…Healthcare Innovation

Posted on March 17, 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.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Innovation is a fascinating concept. Historians and philosophers have been thinking and investigating the key to innovation forever. I’m not sure anyone has ever found the true secret sauce to innovation. Every innovation I’ve ever seen has been a mix of timing, luck, and hard work.

Some times the timing is not right for a product and therefore it fails. The product might have been great, but the timing wasn’t right for it to be rolled out. Innovation always requires a little luck. Maybe it was the chance meeting with an investor that helps take and idea to the next level. Maybe it’s the luck of getting the right exposure that catapults your idea into a business. Maybe it’s the luck of the right initial end users which shape the direction of the product. Every innovation has also required hard work. In fact, the key to ensuring you’re ready for luck to be heaped upon you or to test if your timing is right is to put in the work.

The great thing is that it’s a brilliant time to be working on innovations in healthcare. We’re currently at the beginning of a confluence of healthcare innovations. Each one on its own might seem like a rather small innovation, but taken together they’re going to provide amazing healthcare innovations that shape the future of healthcare as we know it.

Let me give a few examples of the wave of innovations that are happening. Health sensors are exploding. Are ability to know in real time how well our body is performing is off the charts. There are sensors out there for just about every measurable aspect of the human body. The next innovation will be to take all this sensor data and collapse it down into appropriate communication and actions.

Another example, is the innovations in genomic medicine. The cost and speed required to map your genome is collapsing faster than Moore’s law. All of that genomic data is going to be available to innovators who want to build something on top of it.

3D printing is progressing at light speed. Don’t think this applies to healthcare? Check out this 3D printed prosthetic hand or this 3D printed heart. If you really want your mind blown, check out people’s work to provide blood to 3D printed organs.

If you think we’ve gotten value out of healthcare data, you’re kidding yourself. There are so many innovations in healthcare data that are sitting there waiting in healthcare data hoards. We just need to tap into that data and start sharing those findings with a connected healthcare system.

The mobile device is an incredible innovation just waiting for healthcare. We are all essentially walking around with a computer in our pocket now. We’ve already started to see the innovations this will provide healthcare, but it’s only just the beginning. This computer in our pocket will become the brain and communication hub for our healthcare needs.

I’m sure you can think of other innovations that I haven’t mentioned including robotics, health literacy, healthcare gaming, etc. What’s most exciting to me about the future of healthcare innovation is that each of these innovations will combine into a unforeseen innovation. The most powerful innovations in healthcare will not be a single innovative idea. Instead, it will come from someone who combines multiple innovations into one beautiful package.

The most exciting part of innovation is that it’s usually unexpected and surprising. I love surprises. What do you see as the future building blocks of innovation in healthcare?

The Future Of…Healthcare Security

Posted on March 13, 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.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Security is on the top of mind of most healthcare boards. I think the instruction from these boards to CIOs is simple: Keep Us Out of the News!

That’s an order that’s much easier said than done. If Google and Anthem can’t stay out of the news because of a breach, then a hospital or doctor’s office is fighting an uphill battle. Still don’t believe me, check out this visualization of internet attacks. It’s pretty scary stuff.

The reality is that you don’t really win a security battle. You can just defend against attacks as well as possible with the limited resources you have available. What is clear is that while still limited, healthcare will be investing more resources in security and privacy than they’ve ever done before.

The future of effective security in healthcare is going to be organizations who bake security into everything they do. Instead of hiring a chief security officer that worries about and advocates for security, we need a culture of security in healthcare organizations. This starts at the top where the leader is always asking about how we’re addressing security. That leadership will then trickle down into the culture of a company.

Let’s also be clear that security doesn’t have to be at odds with innovation and technology. In fact, technology can take our approach to security and privacy to the next level. Tell me how you knew who read the chart in a paper chart world? Oh yes, that sign out sheet that people always forgot to sign. Oh wait, the fingerprints on the chart were checked. It’s almost ludicrous to think about. Let’s be real. In the paper chart world we put in processes to try to avoid the wrong people getting their hands on the chart, but we really had no idea who saw it. The opposite is true in an EHR world. We know exactly who saw what and who changed what and when and where (Note: Some EHR are better than others at this, but a few lawsuits will get them all up to par on it).

The reality is that technology can take security and privacy to another level that we could have never dreamed. We can implement granular access controls that are hard and fast and monitored and audited. That’s a powerful part of the future of security and privacy in healthcare. Remember that many of the healthcare breaches come from people who have a username and password and not from some outside hacker.

A culture of security and privacy embraces the ability to track when and what happens to every piece of PHI in their organization. Plus, this culture has to be built into the procurement process, the implementation process, the training process, etc. Gone are the days of the chief security officer scapegoat. Technology is going to show very clearly who is responsible.

While I’ve described a rosy future built around a culture of privacy and security, I’m not naive. The future of healthcare security also includes a large number of organizations who continue to live a security life of “ignorance is bliss.” These people will pay lip service to privacy and security, but won’t actually address the culture change that’s needed to address privacy and security. They’ll continue the “Just Enough Culture of HIPAA Compliance.”

In the future we’ll have to be careful to not include one organization’s ignorance in a broad description of healthcare in general. A great example of this can be learned from the Sutter Health breach. In this incident, Sutter Health CPMC found the breach during a proactive audit of their EHR. Here’s the lesson learned from that breach:

The other lesson we need to take from this HIPAA breach notification is that we shouldn’t be so quick to judge an organization that proactively discovers a breach. If we’re too punitive with healthcare organizations that find and effectively address a breach like this, then organizations will stop finding and reporting these issues. We should want healthcare organizations that have a culture and privacy and security. Part of that culture is that they’re going to sometimes catch bad actors which they need to correct.

Healthcare IT software like EHRs have a great ability to track everything that’s done and they’re only going to get better at doing it. That’s a good thing and healthcare information security and privacy will benefit from it. We should encourage rather than ridicule organizations like CPMC for their proactive efforts to take care of the privacy of their patients’ information. I hope we see more organizations like Sutter Health who take a proactive approach to the security and privacy of healthcare information.

In fact the title of the blog post linked above is a warning for the future of healthcare IT: “Will Hospitals Be At Risk for HIPAA Audits If They Don’t Have HIPAA Violations?”

Security and privacy will be part of the fabric of everything we do in healthcare IT. We can’t ignore them. In order for patients to trust these healthcare apps, security will have to be a feature. Those in healthcare IT that don’t include security as a feature will be on shaky ground.

The Future Of…Healthcare Big Data

Posted on March 12, 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.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

In yesterday’s post about The Future of…The Connected Healthcare System, I talked a lot about healthcare data and the importance of that data. So, I won’t rehash those topics in this post. However, that post will serve as background for why I believe healthcare has no clue about what big data really is and what it will mean for patients.

Healthcare Big Data History
If we take a quick look back in the history of big data in healthcare, most people will think about the massive enterprise data warehouses that hospitals invested in over the years. Sadly, I say they were massive because the cost of the project was massive and not because the amount of data was massive. In most cases it was a significant amount of data, but it wasn’t overwhelming. The other massive part was the massive amount of work that was required to acquire and store the data in a usable format.

This is what most people think about when they think of big data in healthcare. A massive store of a healthcare system’s data that’s been taken from a variety of disparate systems and normalized into one enterprise data warehouse. The next question we should be asking is, “what were the results of this effort?”

The results of this effort is a massive data store of health information. You might say, “Fantastic! Now we can leverage this massive data store to improve patient health, lower costs, improve revenue, and make our healthcare organization great.” That’s a lovely idea, but unfortunately it’s far from the reality of most enterprise data warehouses in healthcare.

The reality is that the only outcome was the enterprise data warehouse. Most project plans didn’t include any sort of guiding framework on how the enterprise data warehouse would be used once it was in place. Most didn’t include budget for someone (let alone a team of people) to mine the data for key organization and patient insights. Nope. Their funding was just to roll out the data warehouse. Organizations therefore got what they paid for.

So many organizations (and there might be a few exceptions out there) thought that by having this new resource at their fingertips, their staff would somehow magically do the work required to find meaning in all that data. It’s a wonderful thought, but we all know that it doesn’t work that way. If you don’t plan and pay for something, it rarely happens.

Focused Data Efforts
Back in 2013, I wrote about a new trend towards what one company called Skinny Data. No doubt that was a reaction to many people’s poor experiences spending massive amounts of money on an enterprise data warehouse without any significant results. Healthcare executives had no doubt grown weary of the “big data” pitch and were shifting to only want to know what results the data could produce.

I believe this was a really healthy shift in the use of data in a healthcare organization. By focusing on the end result, you can do a focused analysis and aggregation of the right data to be able to produce high quality results for an organization. Plus, if done right, that focused analysis and aggregation of data can serve as the basis for other future projects that will use some of the same data.

We’re still deep in the heart of this smart, focused healthcare data experience. The reality is that healthcare can still benefit so much from small slices of data that we don’t need to go after the big data analysis. Talk about low hanging fruit. It’s everywhere in healthcare data.

The Future of Big Data
In the future, big data will matter in healthcare. However, we’re still laying the foundation for that work. Many healthcare organizations are laying a great foundation for using their data. Brick by brick (data slice by data slice if you will), the data is being brought together and will build something amazingly beautiful.

This house analogy is a great one. There are very few people in the world that can build an entire house by themselves. Instead, you need some architects, framers, plumbers, electricians, carpenters, roofers, painters, designers, gardeners, etc. Each one contributes their expertise to build something that’s amazing. If any one of them is missing, the end result isn’t as great. Imagine a house without a plumber.

The same is true for big data. In most healthcare organizations they’ve only employed the architect and possibly bought some raw materials. However, the real value of leveraging big data in healthcare is going to require dozens of people across an organization to share their expertise and build something that’s amazing. That will require a serious commitment and visionary leadership to achieve.

Plus, we can’t be afraid to share our expertise with other healthcare organizations. Imagine if you had to invent cement every time you built a house. That’s what we’re still doing with big data in healthcare. Every organization that starts digging into their data is having to reinvent things that have already been solved in other organizations.

I believe we’ll solve this problem. Healthcare organizations I know are happy to share their findings. However, we need to make it easy for them to share, easy for other organizations to consume, and provide appropriate compensation (financial and non-financial). This is not an easy problem to solve, but most things worth doing aren’t easy.

The future of big data in healthcare is extraordinary. As of today, we’ve barely scraped the surface. While many may consider this a disappointment, I consider it an amazing opportunity.

The Future Of…The Connected Healthcare System

Posted on March 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.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

As I think about the future of a connected healthcare system, I get very excited. Although, that excitement is partially tamed by the realization that many of these connections could have been happening for a long time. A connected healthcare system is not a technological challenge, but is a major cultural challenge for healthcare.

The Data Connected Healthcare System
Implementation challenges aside, the future of healthcare absolutely revolves around a connected healthcare system. In the short term these connections will focus on sharing the right data with the right person at the right time. Most of that data will be limited to data inside the EHR. What’s shocking is that we’re not doing this already. I guess we are doing this already, but in a really disconnected fashion (see Fax machine). That’s what’s so shocking. We already have the policies in place that allow us to share healthcare data with other providers. We’re sharing that data across fax machines all day every day. Over the next 3-5 years we’ll see a continuous flow of this data across other electronic channels (Direct Project, FHIR, HIEs, etc).

More exciting to consider is the future integration of consumer health device data into the healthcare system. I’m certain I’ll see a number of stories talking about this integration at HIMSS already. These “pilot” integrations will set the groundwork for much wider adoption of external consumer health data. The key tipping point to watch for in this is when EHR vendors start accepting this data and presenting the data to doctors in a really intuitive way. This integration will absolutely change the game when it comes to connecting patient collected data with the healthcare system.

What seems even more clear to me is that we all still have a very myopic view of how much data we’re going to have available to us about a person’s health. In my above two examples I talk about the EHR patient record (basically physician’s charts) and consumer health devices. In the later example I’m pretty sure you’re translating that to the simple examples of health tracking we have today: steps, heart rate, weight, blood pressure, etc. While all of this data is important, I think it’s a short sighted view of the explosion of patient data we’ll have at our fingertips.

I still remember when I first heard the concept of an IP Address on Every Organ in your body reporting back health data that we would have never dreamed imaginable. The creativity in sensors that are detecting anything and everything that’s happening in your blood, sweat and tears is absolutely remarkable. All of that data will need to be connected, processed, and addressed. How amazing will it be for the healthcare system to automatically schedule you for heart surgery that will prevent a heart attack before you even experience any symptoms?

Of course, we haven’t even talked about genomic data which will be infiltrating the healthcare system as well. Genomic data use to take years to process. Now it’s being done in weeks at a price point that’s doable for many. Genomic medicine is going to become a standard for healthcare and in some areas it is already.

The connected healthcare system will have to process more data than we can even imagine today. Good luck processing genomic data, sensor data, device data, and medical chart data using paper.

It’s All About Communication
While I’ve focused on connecting the data in the healthcare system of the future, that doesn’t downplay the need for better communication tools in the future connected healthcare system. Healthcare data can discover engagement points, but communication with patients will cause the change in our healthcare system.

Do you feel connected to your doctor today? My guess is that most of you would be like me and say no (Although, I’m working to change that culture for me and my family). The future connected healthcare system is going to have to change that culture if we want to improve healthcare and lower healthcare costs. Plus, every healthcare reimbursement model of the future focuses on this type of engagement.

The future connected healthcare system actually connects the doctor’s office and the patient to treat even the healthy patient. In fact, I won’t be surprised if we stop talking about going for a doctor’s visit and start talking about a health check up or some health maintenance. Plus, who says the health check up or maintenance has to be in the doctors office. It might very well be over a video chat, email, instant message, social media, or even text.

This might concern many. However, I’d describe this as healthcare integration into your life. We’ll have some stumbles along the way. We’ll have some integrations that dig too deeply into your life. We’ll have some times when we rely too heavily on the system and it fails us. Sometimes we’ll fail to show the right amount of empathy in the communication. Sometimes we’ll fail to give you the needed kick in the pants. Sometimes, we’ll make mistakes. However, over time we’ll calibrate the system to integrate seamlessly into your life and improve your health based on your personalized needs.

The future Connected Healthcare System is a data driven system which facilitates the right communication when and where it’s needed in a seamless fashion.

Interoperability Needs Action, Not Talk – #HIMSS13 Blog Carnival

Posted on February 8, 2013 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.

When you talk to people outside of healthcare about the value of healthcare IT, you will often get a response that healthcare IT is fantastic because it makes it so easy for medical data to be shared with who needs the data when they need it. Those of us in healthcare IT know that this is far from the reality of what’s possible with healthcare data today. This is really unfortunate, because the promise of technology in healthcare is to make the movement of data possible. We’re currently missing out on the benefits of this promise.

I don’t know about the rest of you, but I’m sick and tired of hearing the excuses for why healthcare data can’t be shared. We’ve heard them all: privacy, security, data governance, payment model, etc etc etc. Yet we go to the HIMSS Interoperability Showcase and see that the technology to start sharing data is there, but what seems to be missing is the willpower to push the data sharing through despite the challenges and naysayers.

Maybe Farzad is on to something when he called for EHR vendors to do what’s “Moral and Right.” There’s no more moral or right thing someone can do in healthcare than to make healthcare data interoperable. It’s not only EHR vendors that need to do this, but hospital institutions and doctors offices as well.

We need some brave leaders in healthcare IT to step up and start sharing data. No, I don’t want an announcement at HIMSS that a healthcare organization has partnered with a vendor to start sharing data. I don’t want a new organization formed to assist with healthcare data sharing initiatives. I don’t need another book on the challenges of HIE. We don’t need a session on HIEs and data sharing standards. No, we need brave organizations that say that sharing healthcare data is the right thing to do and we’re making it happen.

I’m not suggesting an organization should do anything ruthless or reckless. I’m suggesting that healthcare organization start DOing something as opposed to talking about it. The time for talking is over and the time for DOing is here. Healthcare data interoperability won’t happen until we make this choice to DO instead of TALK.

I’m not even asking for a healthcare organization to start sharing all their healthcare data everywhere. In fact, I think that’s another failed interoperability strategy that we seem to keep trying over and over. If you try to solve all of our healthcare interoperability problems in one major project, you’ll end up doing nothing and solve none of the problems.

Instead a successful interoperability strategy will focus on sharing one meaningful piece of healthcare data while still keeping in mind that this is just the start. Connect the healthcare data end points with that one meaningful piece of data. Once you make that connection, others will start to wonder why that same process can’t be used for other important and valuable pieces of healthcare data. This is exactly the push that healthcare interoperability needs. We need departments and providers jealous of other departments and providers that are sharing their data. The same principle of jealousy can apply across institutions as well.

Yes, this will take a forward looking leader that’s willing to take what many in healthcare would consider a risk. Imagine a hospital CIO whose stuck trying to explain why their hospital is sharing data that will help doctors provide better care to their patients. Imagine a hospital CIO explaining why they’re driving healthcare costs down by lowering the number of duplicate tests that are done because they already have the data they need thanks to interoperable healthcare data. I’d hate for a hospital CEO to have to explain why they’ve reduced hospital readmissions because they shared the hospital data with a patient’s primary care doctor.

Maybe implementing interoperability in healthcare isn’t such a brave thing after all. In fact, it’s a brave thing for us not to be sharing data. Why aren’t we holding our healthcare institutions accountable for not sharing data that could save lives, lower costs, and improve healthcare? Why are we ok with non-profit institutions worrying more about profit than the real stakeholders their suppose to be serving? Are we really so far gone that healthcare organizations can’t do something so obvious: sharing healthcare data?

Think of all the other major healthcare initiatives that would benefit from being able to share healthcare data where it’s needed. Meaningful Use, Obamacare (Affordable Care Act if you prefer), Clinical and Business Intelligence, Mobile Health, ACO’s, population health, etc could all benefit from healthcare institutions that embraced interoperable healthcare data.

Who’s going to take the lead and start doing what we all know should be happening? It won’t happen by #HIMSS13, but over cocktails at HIMSS I hope some hospital CIOs, doctor groups, EHR vendors, and other medical providers come together to do what they know is the right thing to do as opposed to just talking about it.

The above blog post is my submission to the #HIMSS13 Blog Carnival.