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The Good News About Patient Portals …

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

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

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

LDL or “bad” cholesterol also decreased.

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

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

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

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

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

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

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

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

 

January 14, 2014 I Written By

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

Kaiser Permanente Accused Of Using EMR As Smokescreen

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Kaiser Permanente, California’s largest healthcare provider, has been cited by state officials for using its EMR to work its way around requirements to see mental health patients promptly, reports EHR Intelligence.

Potentially risking their own jobs, Kaiser’s own mental health team brought the discrepancies to the attention of the state.  Their complaint not only slams Kaiser’s practices regarding wait times, but also its overall clinical approach to treating mental health patients, going so far as to accuse the giant HMO of defrauding Medicare by upcoding cursory visits as complete.

According to the California Department of Managed Healthcare, Kaiser has been keeping two sets of records, one in its official EMR and another on paper that hid violations of the state’s law mandating short wait times for mental healthcare. The EMR also fails to retain a record of booking dates, so if an appointment date is changed, the wait time is being calculated from the most recent booking date, not the original date, the state charges.

The dual record keeping procedure allowed Kaiser to hide the fact that mental health patients may have waited weeks longer than the state’s “timely access” law requires, for illnesses such as schizophrenia, depression and suicidal ideation, as well as other serious conditions.

In defiance of the state-required two days between contacting an enrollee and booking an appointment, Kaiser had been recording initial contacts on paper, then asking patients to call back during the next window for appointments, up to four weeks later.  The EMR would then record the initial contact as taking place during the later booking windows, leaving out completely the weeks of waiting mentally-ill patients endured.

Kaiser has said that it addressed the discrepancies noted by the government, which were first brought to its attention last August, but the Department of Managed Healthcare has concluded that the changes needed have not yet been made.

March 27, 2013 I Written By

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

88 New ACO Organizations – What Does That Mean?

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It has been a really interesting couple months for those interested in ACO’s (Accountable Care Organizations) and healthcare. I love how Gregg Masters of ACO Watch called the ACO the “Child of the ACA (Accountable Care Act).” He even declares the SCOTUS supreme court ruling as a big battle won for the ACO. I certainly can’t disagree with him when it comes to the government ACO initiatives. The loss of ACA would definitely hamper much of the government’s work on ACOs. Although, he also acknowledges that ACA is still up in the air pending the Presidential election. ACA is directly in the republican cross hairs.

Politics aside, the ACO program is going forward. CMS recently named 88 new Accountable Care Organizations (ACOs) that will take part in the Medicare Shared Saving Program (Originally it was 89 ACOs, but one organization dropped out).

You can see the full list of ACOs on the press release linked above, but I really like this image that The Advisory Board Company put together that shows the location of the various ACOs across the US (click image twice for full size):

I think this represents a pretty good distribution across the country. However, there are a few things that I find a bit disturbing about the organizations participating in the government ACO programs. The first is that many healthcare organizations that you think would be perfect fit for an ACO aren’t participating. Kaiser and IHC come to mind. I’ve heard that both organizations are very interested in ACOs, but not the government ACO programs. I think this is a bad sign for the government sponsored ACO programs.

The second is that only five of the ACOs applied for the version of the Medicare Shared Savings Program where they have a chance to earn a higher share of any savings, but they’ll also be accountable for any losses if the cost o the care increases. You might take a look back at my ACO Risks and Reward post. These five organizations have gone all in with the ACO program. With that said, I wonder why only five of them chose to participate in it? Shouldn’t we want more organizations to have some accountability and responsibility if they don’t improve care and lower costs?

As I have pointed out before, the ACO movement is happening and is not likely to slow down. Even if ACA or other government legislation is repealed, the move to ACOs is going to happen. With that knowledge and some of the comments above, it makes me wonder if the government should be the one funding an ACO initiative. Will their involvement help or hurt the overall ACO movement?

I’ll be interested to see how it goes for these new ACOs. As we’ve seen with EHR and meaningful use, we’ll have to be careful to filter through the messages coming out of CMS about the success or failure of the ACOs. As they progress we’re going to have to reach out to the ACOs and hear the first hand stories. If you’re an organization that’s participating, we’d love to hear your thoughts in the comments.

July 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Kaiser’s Mobile Health Approach

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As I mentioned in my previous post about laptops and iPads in healthcare, I had the chance to meet with Kaiser at the Health 2.0 conference in Boston. I had a chat with Brian Gardner, head of the Mobile Center of Excellence at Kaiser Permanente and learned a bunch of interesting things about how Kaiser looks at mobile healthcare.

The first most interesting thing to note was that Kaiser currently does not support any sort of BYOD (Bring Your Own Device) at this time. Although, they said that they’ve certainly heard the requests from their doctors to find a way for the doctor to use their own mobile device. Since this means that all the mobile devices in use at Kaiser are issued by them, I was also a little surprised to find that the majority of their users are currently still using Blackberry devices.

Brian did say that the iPhone is now an approved Kaiser device. It will be interesting to check in with Brian and Kaiser a year from now to see how many Blackberry devices have been replaced with iPhones. I’m pretty sure we know exactly what’s going to happen, but I’ll have to follow up to find out. What is worth noting though is the time delay for an enterprise organization like Kaiser to be able to replace their initial investment in Blackberry devices with something like an iPhone or Android device. While I’m sure that many of those doctors have their own personal iPhones, that doesn’t mean they can use it for work.

I also asked Brian about the various ways that he sees the Kaiser physicians using their mobile devices. His first response was that a large part of them were using it as an email device. This would make some sense in the context of most of their devices being Blackberry phones which were designed for email.

He did say that Kaiser had done some video pilots on their mobile devices. I’ll be interested to hear the results of these pilot tests. It’s only a matter of time before we can do a video chat session with a doctor from our mobile device and what better place to start this than at Kaiser?

Of course, the other most popular type of mobile apps used at Kaiser were related to education apps. I wonder how many Epocrates downloads are used by Kaiser doctors every day. I imagine it gets a whole lot of use.

What I found even more intriguing was the way that Kaiser used to discover and implement apps. Brian described that many of their best apps have come from students or doctors who had an idea for an app. They then take that idea and make it a reality with that student or doctor working on the app. It sounded like many of these students or doctors saw a need and created an app. Then, after seeing its success Kaiser would spread it through the rest of the organization.

This final point illustrates so well how powerful mobile health can be now that the costs to developing a mobile health innovation is so low. Once you lower the cost of innovation the way mobile health has done, you open up the doors to a whole group of entrepreneurs to create amazing value.

July 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Laptops End Up With Kids, iPads Don’t

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As I mentioned previously, I had the great opportunity to talk with Kaiser recently about their mobile initiatives at Health 2.0 Boston. It was a great chat with Brian Gardner, head of the Mobile Center of Excellence at Kaiser Permanente.

At one point in the conversation I asked Brian about Kaiser’s approach to devices. Did they allow physicians to bring their own device? Were they deploying their own devices and which devices did they use. Brian made a couple of comments that I found really intriguing.

First, he stated clearly that Kaiser issued all of their devices. They were looking at the BYOD (Bring Your Own Device) idea, but currently they didn’t support any BYOD options. Based on his response to this question I could tell that there were a lot of conversations about this topic happening at Kaiser. I got the feeling that they were likely getting quite a bit of pressure from their doctors to do something along these lines.

Brian then also provided what I find to be a really compelling observation. He commented that from their experience the laptops they issued to doctors always seemed to end up with their physician’s kids using them. I assume they could see this based upon the software the physician’s children installed on the laptop. Then, Brian observed that they hadn’t seen the same thing happening with the iPads they’d given out. He surmised that this was possibly because many of the doctors that got iPads saw it as a privilege and those doctors didn’t want to lose that privilege?

How intriguing no? Why is it that a laptop feels like a commodity and an iPad feels like a luxury item? One you don’t mind your children touching and the other is a luxury that your child shouldn’t touch.

I’d also extend this observation to say that working on a laptop feels like work. Using an iPad feels more like play. At least that’s the feeling I get. I imagine many doctors feel the same way. I wonder if that will change as the iPad starts to get more applications that really help you do work on it.

June 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Mobile Health App Ratings by Kaiser

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I recently had the chance to sit down with Kaiser’s mobile group at the Health 2.0 conference in Boston. We had a really interesting discussion where I was able to learn a number of interesting things about Kaiser’s approach to mobile healthcare. As everyone knows they have a really unique environment with a number of incredible opportunities, but also with their own unique challenges. I’ll be discussing a number of these items in future posts.

Although one opportunity came to my mind in my discussion with Kaiser: A Mobile Health App Rating service by Kaiser.

Many people might remember my previous post about the atrocious idea of an mHealth App Certification. I think this is a really terrible idea and will do nothing to help physicians and patients be able to weed through the overwhelming number of mobile health apps.

With that side comment, I love the idea of Kaiser using its vast network of doctors and patients to rate various mobile health apps. Sure, there are some issues with this model as well, but the benefits of having so many valid doctors rate mobile health apps could be tremendous.

The challenge with most rating services is that you have no way of knowing if the person rating the service is actually who they say they are. For example, Sermo is supposedly a physician only forum. However, I know a lot of non-physicians that are on the forum. One advantage Kaiser has is that they could know if the person in their network is a Kaiser physician or not.

One key question is whether Kaiser would be open to making their physician mobile health app ratings available to the public. I’m sure this will be a tricky question for them to answer. No doubt they already kind of do some of this already in their internal network. Maybe it’s not totally codified into a website with a formal process, but it could be. Plus, the benefits to healthcare in general could be great.

What do you think of Kaiser physicians rating mobile health apps? Are there other better ways to filter through the volume of mobile health apps that exist out there?

May 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Kaiser’s Mobile App, EHR Anxiety Coding, EHR Accessibility Challenge and EHR Design

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We’re back with our weekend round up of interesting tweets from the Twittersphere. We’ve got some really interesting ones to consider this week. So, much is happening in healthcare IT. Hopefully I can provide a good insight to some of the trends that are most interesting. No doubt this will be a challenge as we head into what is one of the most busy healthcare IT news cycles of the year around HIMSS.

Now, on to the various EHR and Healthcare IT tweets:


Kaiser Permanente just made 9 Million EHR records available on line to the patients. That’s definitely worth talking about. Go read about it in Jennifer’s post.

This tweet just made me laugh (although, if you’re experiencing it, it’s not that funny):


I think they probably need a DSM-IV code.


I know there are a number of companies working on this. The problem isn’t the technology to get the Qcode to access your patient record. It’s aggregating your patient record in some place so that it’s accessible. That’s going to take a long time (if ever) to get it all connected.


I’m fascinated by this idea as well. I hope some companies will take it really seriously. The interesting thing is that often by making software accessible, you also learn a lot about how you can simplify the software.


Dr. Rick does a great job starting the conversation around EHR usability. I can’t imagine the effort he put in just to create the first post. Of course, it is a first offering, but I’m really glad that he’s started a deeper discussion around EHR usability. My only disappointment is that he isn’t posting them on one of my sites instead of HIStalk. Regardless, by the looks of the discussion in that post it’s going to drive some really interesting conversation that will hopefully result in improved EHR design.

January 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Benefits from EMR Come from Interoperability

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“Looking for savings in hospitals that use EMRs is short-sighted. The real payday for use of EMRs will come with interoperability. Measurable savings will be realized as middleware is installed that will allow for the electronic transmission and translation of patient records across different proprietary systems between delivery networks.” – Jim Lott, Executive Vice President, Hospital Council of Southern California, Los Angeles source

“EMRs don’t save money in standalone situations. However, EMRs will absolutely save significant money (and improve care and safety) when connected and sharing clinical information.” Johnny Walker, MBA, CPA, Founder and past CEO of Patient Safety Institute, Plano, Texas source

These two quote remind me a lot of my previous post about the real long term benefits of EMR. Interoperability is one of those benefits that we won’t see right away. In fact, we’ll see little benefit from them until we hit a critical mass of EMR implementations that it’s almost futile to share information between EMR software. Kaiser and the VA are always held up as examples of successful EMR implementations and one of the main reasons for that is that they have such broad EMR adoption that they can share the clinical information across all of their clinics.

So, YES! there is a real benefit to EMR adoption long term and it comes dressed in the name “EMR data sharing.” However, it’s worth pointing out that this doesn’t diminish the very important more quickly seen EMR benefits.

December 10, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EMR Interoperability and Working Together

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I recently got the following email which highlights my point that the EHR stimulus money should have been focused on things like interoperability standards and not funding EMR adoption the way it is doing it. He also makes some interesting comparisons worth considering:

I see an uncoordinated money pot out there, attracting uncoordinated work on EMR. — about as effective technically as HDTV (since mid-80′s), W3C, the space station. Non-profit efforts seem to generally fail, or to work so slowly as to be irrelevant.

EMR standardization would likely benefit from an authoritative organization (similar to IEEE) that would work with existing systems as provided by Kaiser, Walmart, GE, etc. and grind out a solution acceptable to these and other major (and minor) players. Then a de facto standard would exist in a well-defined form, and other players would join the effort.

I may be wrong, but I don’t see this happening. Everyone seems to be drawing out the money and just going on their separate ways. People like me that try to help doctors into the electronic age thus have to develop their own protocols, as anything resembling a portable data standard simply doesn’t seem to exist.

Of course, whenever I think about and post something like this, I feel like it’s too late too change anything. The legislation is what it is and we have to make the most of it. It’s just really sad to consider what it could be.

I guess maybe the message to consider is that we can still start having EMR working together even if it’s not government funded.

August 30, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.