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Restoring Humanity to Health Care – My Experience Part 2

Posted on February 27, 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.

It seemed appropriate for me to follow up with part 2 of my experience with a new wellness focused medical practice called Turntable Health, an operating partner of Iora Health. In case you missed part 1 of the journey, you can find it here.

Walking into the clinic, there was a different feel. It felt more like walking into a local coffee shop than going for a doctors appointment. The lobby was so inviting that I wondered if some in the community used it as a place to go and work on occasion. I spend a fair amount of time in the Downtown Las Vegas tech community, so it wasn’t a surprise that I actually knew a few of the people in the lobby. So, I was able to connect with some friends while I waited for my appointment.

The check in process was simple and I was invited back by my health coach. In this case the health coach acted very much like an MA or nurse in a regular medical office, but the feel was more friendly an casual. We both knew we had an hour together so there wasn’t the usual frenetic pace the accompanied a doctors office.

I had a couple paper forms to sign (yes, the signature is still often easier on paper), but no major health history to fill out or anything like that. They had a one question survey that I think was about my current state of wellness. Over the hour the health coach did ask many of the questions that would be on a normal health history form and key them into the Iora EHR system. It was a unique approach since it gave me the opportunity to talk about the things as we went through them and many of the things we talked about (ie. my family health history) came up later in my conversation with the doctor.

The exam room looked quite a bit like any other exam room you might visit. The colors and lighting were nice and they had little touches like this local art work display in the exam room (see picture below). It’s kind of interesting to think about a doctor’s office as a kind of local art gallery.

At one point in the conversation with my health coach, we talked a bit about fitness tracking and she quickly emailed me some fitness apps that she liked. Little did she know that I write about such apps and that industry for a living on Smart Phone Healthcare. It also illustrated how much of a need there is for someone to be a trusted content curator of the 30k+ mobile health apps out there. Especially if we want healthcare providers to make a dent in actual usage of these to improve our wellness.

After completing her assessment, my health coach left the room and came back with the doctor. When he came in he told me that my health coach had talked with him about me and my health (in a normal practice this amounts to “Fever in room 3″) and he wanted to talk to me about a few of the issues I was dealing with. When he did this, the doctor and my health coach came into the room and we all sat around a small table. It was almost as if I’d just sat down for hot chocolate (I don’t drink coffee) with my doctor and my health coach.

There were a few differences though. When my doctor sat down he plugged in a chord to display his computer screen (my record) on a big plasma monitor that we could all see. I’m not sure why my health coach didn’t do that too. I almost moved over next to her to watch her enter the data, but I felt like that was just my inner EHR nerd coming out. Plus, I didn’t want her to necessarily know my background in that regard and that I’d be writing about the experience later. I wanted to see what they usually did for patients.

Because we were all sitting around the proverbial exam room “coffee table” I didn’t feel rushed at all. We talked about a couple sports issues I’ve been dealing with and ways that I could make sure they don’t continue to get worse (since I’m definitely not stopping my sports playing). We also spent some time talking about how to work on some long term wellness tracking around high cholesterol and diabetes.

After the visit, I realize that in many ways it wasn’t any different than a regular doctor visit. I could have gone into any doctor’s office and discussed all of these things and likely gotten similar answers. I think part of this is Turntable Health still working on the evolution of how to really treat a patient from a Wellness perspective. However, while many aspects of the treatment were the same, the experience felt different.

The long appointment time. The health coach. The doctor that wasn’t rushed all contributed to a much different visit than you’d get in most doctors’ offices. You can be certain that had I gone to a doctor for my sports issues, we wouldn’t have talked about things like cholesterol and diabetes. There wouldn’t have been time. Was the care any better or worse? It’s the same care that would have been provided by other professionals, but the care was given room to breathe.

As I left the visit, a part of me did feel a little disappointed. You might wonder why after this glowing review of the unique experience. I think the disappointment came from some improperly placed expectations. I’m not sure I really thought deeply about it, but I wish I’d realized that they’re not going to solve your wellness in one visit.

When I think about my psyche as it relates to doctors, I’ve always approached a doctor as someone you go into and they fix you and then you go home. When applying that same psyche to a wellness based approach to medicine, it leads to inappropriate expectations. Wellness is a process that takes time to understand and address. In fact, it’s a process that’s likely never done. So I think that led to my gut reflex expectation of what I’d experience.

I think one way Turntable Health could help to solve these expectations is to do a better job on the first visit to describe the full model and plan for what they want to accomplish with a patient. Otherwise, you really just feel like you’re going in for another doctor’s appointment. I’m not sure if that’s a cool chart of all their services and how they help me improve my wellness or if it’s a list of ways that they’re working to help improve my wellness.

Basically, I wish they’d over communicated with me how Turntable Health was different and how they were going to deploy a suite of professionals and services to better help my overall wellness. It’s easy for those working at Turntable Health to forget that new patients haven’t seen their evolution and don’t know everything they’ve done to improve the primary care experience.

A few other things I’d have loved to seen. First, I filled out their 20 minute (I think it took me 10-15) survey before the appointment. I didn’t get any feeling that the health coach or the doctor had actually seen the results. In fact, the health coach asked me some of the same questions. Redundancy can be appropriate on occasion, but it could have made the visit more efficient if they already knew the answer to those questions and instead of getting the info they could have spent the time talking about the answers as opposed to getting the answers. Plus, I’m sure my answers would have triggered some other discussions. It all made me partially wonder why I filled out the survey in the first place. Were those just part of some research experiment or were they to help me improve my health?

I was quite interested in their portal and what it offered (obviously, since I’m a techguy). It seemed like the framework as opposed to a fully fleshed out solution. I could see where it could grow to something more powerful, but was disappointing on first login. In one area called measurements it had graphs of my Blood Pressure, Fasting Glucose, and Weight. Unfortunately, after one visit they only had one data point and now way for me to easily upload all my weight measurements from my iHealth scale. Hopefully integrations like that are coming since that data could definitely inform my wellness visits. I guess they need to work on the first time user experience for the portal. At least I can schedule appointments through it.

I imagine some of you are probably looking at this as a pretty major investment in my health. Some might even think an hour long appointment would be more time than they want to spend with the doctor. I get that and I don’t always want my appointment to be that long. In fact, now that I have my baseline, I hope that many visits become an email exchange or other electronic method that saves me going into the doctor at all. However, as I’m getting older, I see this as an important investment in my long term health. Hopefully this investment has a good ROI.

With that in mind, I’ll do what I can to keep you updated on my experience. Since I’m on a journey of wellness, I imagine this is Part 2 of Many. I hope you enjoyed the look into my experience.

Giving Email Addresses to Patients Who Don’t Have Them

Posted on August 21, 2014 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.

In my post, 4 Things Your Patient Portal Should Include, I talked about the thing patients want most in a patient portal is the ability to communicate with someone in the physician office. I still think that’s the most powerful part of a patient portal.

In response to that post, the people at Engaged Care sent me an interesting way that they’re approaching engaging the patient. Their efforts are focused on those patients who don’t have an email address. Check out this video which demonstrates the workflow they offer.

I’m not sure how many patients don’t have an email address, but this is a pretty slick solution to get them signed up for an email address. The other challenge is getting those patients who don’t have an email address motivated and skilled enough to check the newly created email as well. However, maybe access to a well done patient portal might be motivation enough for them to get involved.

The other benefit to these physician provided email addresses is that they are secure. You might remember that native email is not HIPAA secure. The email addresses that Engaged Care provides are HIPAA secure.

I’ll be interested to see how this company does. How many patients actually use the new email addresses and where they take it next. Although, I found the idea of giving patients a secure email address quite interesting.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

In 2014, Health IT Priorities are Changing

Posted on January 30, 2014 I Written By

The following is a guest blog post by Cliff McClintick, chief operating officer of Doc Halo. Cincinnati-based Doc Halo sets the professional standard for health care communication offering secure messaging for physicians, medical practices, hospitals and healthcare organizations. The Doc Halo secure texting solution is designed to streamline HIPAA-compliant physician and medical clinician sharing of critical patient information within a secure environment.

2014 is a major year for health care, and for more reasons than one.

Of course, some of the most significant reforms of the Affordable Care Act take effect this year, affecting the lives of both patients and providers.

But it’s also a year in which health care institutions will come to grips with IT issues they might have been putting off. Now that many organizations have completed the electronic health record implementations that were consuming their attention and resources, they’re ready to tackle other priorities.

Expect to see issues related to communications, security and the flow of patient information play big in coming months. At Doc Halo, we’re already seeing high interest in these areas.

Here are my predictions for the top health IT trends of 2014:

  • Patient portal adoption. Web-based portals let patients access their health data, such as discharge summaries and lab results, and often allow for communication with the care team. Federal requirements around Meaningful Use Stage 2 are behind this trend, but the opportunity to empower patients is the exciting part. The market for portals will likely approach $900 million by 2017, up from $280 million in 2012, research firm Frost & Sullivan has predicted.
  • Secure text messaging. Doctors often tell us that they send patient information to their colleagues by text message. Unfortunately, this type of data transmission is not HIPAA-compliant, and it can bring large fines. Demand for secure texting solutions will be high in 2014 as health care providers seek communication methods that are quick, convenient and HIPAA-compliant. Doc Halo provides encrypted, HIPAA-compliant secure text messaging that works on iPhone, Android and your desktop computer.
  • Telehealth growth. The use of technology to support long-distance care will increasingly help to compensate for physician shortages in rural and remote areas. The world telehealth market, estimated at just more than $14 billion in 2012, is likely to see 18.5 percent annual growth through 2018, according to research and consultancy firm RNCOS. Technological advances, growing prevalence of chronic diseases and the need to control health care costs are the main drivers.
  • A move to the cloud. The need to share large amounts of data quickly across numerous locations will push more organizations to the cloud. Frost & Sullivan listed growth of cloud computing, used as an enabler of enterprise-wide health care informatics, as one of its top predictions for health care in 2014. The trend could result in more efficient operations and lower costs.
  • Data breaches. Health care is the industry most apt to suffer costly and embarrassing data breaches in 2014. The sector is at risk because of its size — and it’s growing even larger with the influx of patients under the Affordable Care Act — and the introduction of new federal data breach and privacy requirements, according to Experian. This is one prediction that we can all hope doesn’t come true.

To succeed in 2014, health care providers and administrators will need to skillfully evaluate changing conditions, spot opportunities and manage risks. Effective health IT frameworks will include secure communication solutions that suit the way physicians and other clinicians interact today.

Doc Halo, a leading secure physician communication application, is a proud sponsor of the Healthcare Scene Blog Network.

What Value Does a Healthy Patient Get from a PHR?

Posted on November 11, 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.

In my previous post about a Patient Controlled Medical Record, I asserted that such a thing would be a challenge to get to work in the US, but that there was a lot of potential internationally. I did provide one caveat when it came to chronic patients where I think there is potential in the US as well. Although, some argued against even that group being interested in the comments.

Let me further expound on why I think the patient controlled medical record fails for a healthy patient (and this includes people who think they’re healthy, or at least relatively healthy…ie. they don’t go to a doctor for any chronic condition). In many respects this is my talking from my own personal perspective as a young, healthy adult (although I guess all of those descriptors could be argued).

The problem for someone that’s healthy is that their medical record basically has no data. The reason you want a patient controlled medical record is so that you can extract value from the data. I don’t need to look at my online medical record to see that I don’t have any drug allergies, that I had a cold or flu 3 years ago, that I got my flu shot 4 years ago, and that when I was 15 I had a hernia operation.

The point being that my medical record is so short that there’s so little value in me trying to aggregate that record in once place. What value do I get from doing so?

I think there could be value in doing so, but not today. For example, if by keeping a patient controlled medical record I could avoid filling out the crazy stack of paperwork that’s given you at every new doctor you visit, I and every other patient would want to keep an online patient record. This should be a solvable problem, but I won’t go into the hundreds of systemic reasons why it’s not going to happen anytime soon. Although, we’ll start with the doctor preferring your allergies to be in the upper right corner in red. Now scale that request up to 700,000 doctors.

Similar to the above item, there are other ancillary functions (ie. appointment scheduling, prescription refills, message your doctor, etc.) that could be tied to your medical record that would make people want to use a PHR or other similar system. However, most people would use it for the ancillary functions and not to be able to control their medical record in one place. For many of the ancillary services this portal will need to be tethered to a PHR.

One trend that I hope will change my description above is the wave of new health sensors that are hitting the market. As those health sensors get better I believe we’ll see a new type of portal that is attractive for even a “healthy” person to visit. This concept coincides with what I call Treating a Healthy Patient. All of this new sensor data could make it worth my time as someone who thinks I’m healthy to check and aggregate my data in one location. The volume of data available would be much more than what I have stored in my memory and so it will make sense for me to visit somewhere that stores and processes my whole medical record.

How these portals full of health sensor data will work with doctors is a topic for another blog post. Until then, I’ll be surprised how many healthy patients really get on board collecting their patient data in a patient controlled medical record.

Does Patient Interaction Lock a Doctor In to an EHR?

Posted on March 28, 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.

I’ve been thinking a lot lately about EHR vendor lock in. I think this was prompted by some stories I’ve heard of EHR vendors holding clinics EHR data “hostage” when the clinic chooses to switch EHR software. I heard one case recently that was going to cost the clinic a few hundred thousand dollars to get their EHR data out of their old EHR software. It’s a travesty and an issue that I want to help work to solve this year (more on that in the future).

I think it’s such a failed model for an EHR vendor to try to keep you as their EHR customer by holding your EHR data hostage. There are so many other ways for an EHR vendor to keep you as a customer that it’s such a huge mistake to use EHR data liquidity to keep customers. EHR vendors that choose to do this will likely pay the price long term since doctors love to talk about their EHR with other doctors. If a doctor is locked into an EHR they dislike, then you can be sure that their physician colleagues won’t be selecting that EHR.

There are a whole series of better ways to lock an EHR customer in long term. The best way being providing an amazing EHR product.

I recently considered another way that I think most EHR vendors aren’t using to create a strong relationship with their physician customers. Think about the strength of a company’s relationship with a doctor if a doctor’s patients are all familiar with their connection to the EHR. If a physician-patient interaction occurs regularly through the EHR, then it’s very unlikely that a doctor is going to switch EHR software.

The most obvious patient interaction that occurs is through a patient portal that’s connected to a provider’s EHR. Once a clinic has gotten a large portion of their patients connected to an EHR patient portal, then it makes it really hard for a doctor to consider switching from that EHR. It’s one thing for a doctor to change their workflow because they dislike their EHR. Add in the cost of getting patients to switch from a portal they have been using and I can see many doctors sticking with an EHR because of their patients.

Of course, from a doctor perspective, there’s some value in selecting an EHR that uses a 3rd party patient portal. That way if you choose to switch EHR software, then you can still consider keeping your interaction with patients the same through the same third party patient portal. Although, there’s some advantage to using the patient portal from the EHR vendor as well. It’s not an easy decision.

Can the Benefits of Hospitals Acquiring Practices Be Achieved By Other Means?

Posted on February 13, 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.

I’ve regularly talked about the current healthcare environment of hospitals acquiring physician practices. This trend is occurring at a really rapid rate, but in an email exchange I had recently with Dave Chase from Avado I started asking myself if the benefits of a consolidated group of providers could be achieved by other means.

At the core of the current trend is a little reimbursement loophole that many hospitals have been exploiting. I wrote about this loophole in a post on Hospital EMR and EHR called Reasons Hospitals Acquire Medical Practices. Considering this reimbursement loophole, I think there is a little that can be done to discourage hospitals that want to try and increase revenue through this loophole.

At some point Medicare is going to catch up with this and close the loophole. Once that happens, it’s worth considering the other benefits of being part of a large organization as opposed to being a solo practice. Plus, can those benefits be achieved through other means than fully acquiring a practice? This is particularly important as doctors that are currently working for hospitals choose to go back out on their own and for those organizations who haven’t already gotten on the practice acquiring bandwagon.

I think the most pressing reason that practices are interested in relationships with hospitals is based on the changing reimbursement models. It will be impossible to access the ACO money that’s coming without tight ties to a large number of organizations. One way to achieve this is for a healthcare organization to acquire all of the various healthcare organizations that will make up an ACO. I think that’s part of what we’re seeing now and I’ve discussed before how this might be the way hospitals avoid the cycle of doctors leaving. Although, we’re already seeing signs of doctors leaving for new medical models.

This seems like a pretty expensive proposition for hospitals to acquire practices just for the doctors to go back to private practice. Which makes me wonder if the benefits of an acquired practice can be achieved through software and relationships? As we’ve discussed before, interfaces in healthcare are quite hard to do. So, once you’ve been able to create that interface with a clinic or hospital, then you have some pretty solid lock in with that organization.

Although, I’m pretty sure that Dave Chase (which inspired this idea) would take this idea one step further. Imagine that most of the patients used one portal to interact with your local healthcare community. Could that portal facilitate your ACO efforts? Once the majority of patients are in that portal, will anyone in the community want to be somewhere else? There’s real lock in that can occur once patients are engaged with healthcare institutions. This occurs with the patients and with the healthcare organizations that are engaging with those patients.

I think it will be interesting to see if software can facilitate some of the same benefits to hospitals that they get from acquiring physician practices.

What Can We Do Today That We Couldn’t Do Five Years Ago in Health IT?

Posted on January 11, 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.

As I’ve been seeing the flood of creativity and innovation that can be seen at the CES (Consumer Electronics Show) in Las Vegas, I’ve often been witness to the amazing things that are possible today that wouldn’t have been possible five years ago.

There are so many examples of this happening throughout the IT world. A simple example is how many things are now possible with a mobile device that has always on mobile internet access (3G and 4G), an accelerometer, GPS, video camera, and voice recognition. 5 years ago we had little pieces of each, but now we have all of those items easily packed into one device. Think of the innovation that is happening that would have never happened if we didn’t have those technologies available.

I started thinking about how this applies to healthcare. What things can we do now that we couldn’t do five years ago?

Some of the technologies above are perfect examples of technology we have now that wasn’t available five years ago. A company like AirStrip Technologies wouldn’t even exist without the technologies mentioned above. Yet, because of those technologies, they’re now taking healthcare data mobile.

Five years ago we were at a pitiful EHR adoption level (10-20% depending on who you talked to). Now we’re at a much higher EHR adoption level. What is healthcare doing to capitalize on this increased adoption of EHR? What amazing things can we do now with EHRs in place that we couldn’t even consider before?

One example might be patient portals to access your clinical information. Before an EHR, the patient portal didn’t make sense because it didn’t have the EHR data to back up the portal. Once you have an EHR, it’s much easier to put up a portal that’s integrated with a patient’s record. That’s a simple example, but hopefully we’re going to see a lot more dramatic options. If we don’t then something’s wrong.

I guess the key message is that incremental progress in multiple areas combined together can lead to extraordinary breakthroughs. We need more of those in healthcare.

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

Posted on August 27, 2012 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.

Without delving into all the specifics detailed in the 672-page Final Rule for Stage 2, what is important to comprehend—for now—is how Stage 2 raises the bar set by Stage 1 and how it intensifies the focus on health information exchange and patient engagement.

The following are some highlights of Stage 2:

  • The Final Rule not only confirms 2014 as the earliest effective date for Stage 2 (as expected), but it provides additional leeway for providers and for vendors by limiting the Stage 2 reporting period to 90 days in 2014, instead of a full year.
  • EPs must meet or exclude all 17 core measures and must meet—not “meet or exclude”—3 of the 6 menu measures. (Unlike Stage 1, exclusions of menu measures do not count unless the EP cannot find 3 relevant menu measures.)
  • All Stage 1 menu measures except syndromic surveillance become core measures.
  • 5 new menu measures have been added: access to imaging results, family history, progress notes, reporting to cancer registries, and reporting to specialized registries.
  • Stage 2 increases most Stage 1 thresholds.
  • CPOE is expanded to include lab and radiology orders, in addition to prescriptions.
  • Patient portals play an important role as a means of providing patients with access to their medical records. Physicians will have to ensure that at least 5% of the patients they see actually view, download or transmit their health information and that over 5% of the patients seen send them a secure e-mail message containing clinical information, (i.e., not just a request for an appointment.)
  • Clinical summaries of office visits must be available to patients within 1 day, instead of the 3-day timeframe in Stage 1.
  • The Stage 1 measure requiring a test of the ability to exchange clinical data with another provider has been dropped effective 2013, in favor of a more robust 2014 Stage 2 requirement for ongoing exchange of a significantly more extensive data set.
  • EPs will report on 9 of 64 clinical quality measures, and after the provider’s first incentive year, the CQM data must be submitted electronically, rather than by attestation.
  • In an effort to streamline the reporting process, Stage 2 offers opportunities for batch reporting by group practices and for consolidated CQM reporting for PQRS and meaningful use.
  • Penalties and hardship exemptions are defined, establishing October 1, 2014 as the latest date by which an EP can attest for the first time and avoid a 1% payment adjustment in 2015.

More information about Stage 2 will follow in future Meaningful Use Monday posts.

Patient Relationship Management Taking on the Patient Portal and PHR

Posted on May 8, 2012 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.

The other day I had the chance to get a demo of Avado‘s PRM (Patient Relationship Management) system from Dave Chase. I’d seen a lot of the writings of Dave Chase throughout the internet. He’s been really smart to go after a number of really high profile tech blogs to get some good exposure for Avado. This isn’t a good strategy for a lot of healthcare IT companies, but it can work really well for the right ones. Either way, I was fascinated by many of Dave Chase’s writings and so I knew it would be an interesting experience.

Needless to say, Dave Chase and Avado are looking at the physician patient relationship quite different from many others. At some point, I may do a full write up of the Avado service, but I think this slide that Dave Chase showed me summed up the comprehensive way that Avado looks at the physician patient relationship. Take a look at the comparison of Avado with a patient portal (I wish PHR was included in the chart as well):

I love companies that look at situations in a really comprehensive manner. Avado seems to be a company that does that. I think it’s still early to know if Avado will be able to execute on this comprehensive approach, but I think it’s a good starting point. Many who have looked at patient portals and PHR software in the past probably wondered why many of the things listed in the chart above weren’t features of the portal or PHR.

I must admit, my next idea for this list is to take it and see how the various PHR and portals handle each of the items on the list. Considering the new emphasis on the patient portal thanks to meaningful use stage 2, physicians might want to give a little extra thought into what the patient portal they adopt is able to do.