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In 2014, Health IT Priorities are Changing

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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.

January 30, 2014 I Written By

What Value Does a Healthy Patient Get from a PHR?

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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.

November 11, 2013 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.

Does Patient Interaction Lock a Doctor In to an EHR?

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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.

March 28, 2013 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.

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

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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.

February 13, 2013 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.

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

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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.

January 11, 2013 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.

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

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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.

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.

Patient Relationship Management Taking on the Patient Portal and PHR

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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.

May 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.

Interview with Dr. David Lischner Founder of Valant Medical Solutions Behavioral Health EHR

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I’ve had a somewhat unique interest in the behavioral health world ever since I started working with EHR software because the first EHR I implemented had to merge a health center together with a counseling center. As such, I was really excited to get a chance to interview Dr. David Lischner, CEO and Founder of Valant Medical Solutions. Those interested in Behavioral Health EHR software will enjoy this interview.

Can you tell us a little bit about how Valant Medical Solutions came about?
I founded Vālant with the purpose of helping behavioral healthcare providers manage their practices more efficiently. After graduating from residency in 2002 I started a group practice and became disappointed with the solutions available to psychiatrists for managing their practices. I knew that in order to successfully run and grow my practice, I was going to have to be as efficient as possible and utilize technology to my advantage. After unsuccessfully searching for software that fit my needs, I partnered with my brother who is a software developer to create the Vālant EHR.

Being a newer EHR company, what assurance can you provide psychologists and psychiatrists that your EHR is on solid footing?
First off we are the fastest growing behavioral health specific EHR on the market – and don’t plan to change that any time soon! We have been in business since 2005 and have over 1,100 providers and close to 2,000 users across the country using our product. Our product is fully certified and HIPAA compliant.

Secondly, we are 90% through a very successful round of financing, and it is clear that we have become the market leading solution for behavioral healthcare practices. We are on very solid footing.

Why do behavioral health professionals need a specialized EMR? What does Valant provide that other traditional EHR software don’t include?
It all comes down to the understanding and knowledge we have of the market. That “domain expertise” is expressed in every interaction and every feature of our product. Psychiatrists again and again tell me that we just get it, and that the product “understands how I work”, in a way that other vendors and products do not.

As an example, our new module release: Mobile NotesTM, is designed for capturing outcomes data relevant to a behavioral health clinician and using that data to not only improve care, but also auto generate narrative for the provider. That functionality is simply not present in other EHR’s and couldn’t be provided within large multidisciplinary EHR’s.

Behavioral healthcare providers want speed boats that are fast and have a very specific purpose rather than big cruise ships that have a little bit of something for everyone.

How many psychiatrists and other mental healthcare professionals do you have using your EMR?
We have over 500 psychiatrists and over 1,100 providers using our product. Including solo practices, public community health centers, mobile practices, and large group practices.

What’s Valant’s approach and thoughts on the HITECH Act and meaningful use? Do you see many mental health professionals getting EHR incentive money?
We have had over 20 providers successfully attest for meaningful use and a number of them have already received their checks. Our approach is unique in that we support “ease of meaningful use” in both our product and our support processes.

We have practice success managers that monitor the progress of our doctors and coach them along to help them achieve success. It’s not enough to simply buy a certified product. It’s important to assess the vendor and product’s ability to help you achieve success. We view the attestation process as a partnership with our doctors, treating their success as our own.

What advantages do you see for mental health professionals that have an EMR versus those that still chart on paper?
I think 3 of our biggest advantages are: greater efficiency, better patient outcomes and more revenue capture. Our newest module: Mobile Notes, delivers rapid note creation at the point of care that is faster than paper documentation. It includes automatic narrative generation from patient outcomes questionnaires and leverages an IPad’s voice recognition capability for the narrative sections of the note. It’s the perfect note creation tool for a behavioral healthcare provider and even before its release, has pried many doctors away from paper and pen.

Mobile Notes also allows practitioners to track outcomes data for their patients, providing the ability to monitor patient progress over time. This ability is not only helpful when assessing treatment plans and communicating progress to a patient, but may also become required in the future. As an example, United recently announced that over 70% of their codes would be pay for performance.

Who are Valant’s biggest competitors and what differentiates Valant from other behavioral health EMR?
I’d say that for the private practice psychiatry market, it is now mostly a race between ICANotes, Valant, and Practice Fusion.

ICANotes has been around for a number of years. I remember being impressed by a demonstration even before Valant was founded. They have had a nice system for converting check boxes into narrative. Some users are very happy with the way they can create intake notes and progress notes with just clicks. They’ve clearly developed a nice system for doing this that has generated a loyal following. It is still fundamentally a client-server product rather than a web based system. Also, when I last looked, they had not added a practice management module. [Update: Sandy Crowley commented that ICANotes does have a practice management capability.] We’ve addressed the narrative generation issue in our v5.0 release and have tied it to outcomes measures pushed from a patient portal. So we’ve combined 3 processes into one, which we think creates something much, much bigger and more powerful than check box to narrative generation alone.

The most common reason that Psychiatrists go with Practice Fusion is the price. The basic EHR without practice management is free, however the user will have to suffer through ad pop-ups and accept that your anonymized patient data is now owned by Practice Fusion. [John's Editorial Comment: Practice Fusion does have advertising, but does not use pop up ads as part of that advertising. Practice Fusion does have research rights to the data, but the doctors own the data. I'm sure many see research rights to the data as Practice Fusion owning the data, but it's worth highlighting that physicians own the data on Practice Fusion as well.] It’s an option for practices that are not bothered by this and are OK with a system that is largely text based and not optimized for behavioral healthcare.

Our big differentiator now, is our newest module release. I know that I am repeating myself. (Can you tell that I am excited about our newest release?) I really do think it is going to change the way we (clinician) practice. It will allow us (behavioral health practitioners) to get our notes done more rapidly and easily, engage better with patients, and allow us to incorporate outcomes tracking into our clinical practices.

You’ve recently launched a number of mobile initiatives, can you tell me what mobile solutions you offer mental health providers?
We were the first in our market to release a pure mobile version, which we now call Mobile Calendar. It includes a calendar with syncing to smart phones or any other calendar and key clinical information and demographic information necessary to support care when you are away from your office.

We also now have Mobile Notes, which is a more robust version of Mobile Calendar. It takes outcomes measures completed by patients on their PC or mobile devices and converts the data into narrative and then takes advantage of the iPad’s native voice recognition capabilities to support rapid note creation at the point of care.

And what mobile health options do you provide their patients and clients?
We now have Vālant Patient PortalTM. Allowing clinicians to send intake forms before the first appointment. Patients will receive push reminders to fill out intake forms before initial appointments and outcome measures before follow-up appointments. All of this is done via a secure patient platform that is branded to the practice. Patients are also able to confirm upcoming appointments, update demographic information as well as view CCDs.

5 years from now, what will differentiate Valant’s EMR?
Well it’s worth taking a step back and asking what the EHR landscape will look like in 5 years. Nearly all providers will be using EHR’s. EHR’s will be connected. Patients, hopefully, will have some control over how their data is utilized and who gets to see their data. Providers will think of EHR’s as tools that support them and work for them at the point of care. An EHR will that keep providers connected, educated and prepared. Patients will have their own set of tools that work seamlessly with EHR’s that help keep them healthy and connected to their providers. All this should be in the service of improving patient outcomes, keeping patients healthy, and improving the quality of work for healthcare providers. I believe in that vision.

By staying within the behavioral healthcare segment and not trying to be all things to all providers, Vālant will have a better chance of fulfilling this vision for our providers and their patients. It’s a big enough challenge as behavioral healthcare is 7% of the entire $2.6 Trillion healthcare market.

So in summary, we’ll be very deeply imbedded within the vertical market of behavioral healthcare and will ultimately be a platform that connects providers, patients and other areas of medicine, as they adapt to the changing healthcare landscape. We’ll continue to offer a set of tools to our providers and patients that improve provider life and work quality, the value of healthcare, and patient health.

May 4, 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.

PHR Options for Meeting Meaningful Use Stage 2

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An EHR vendor recently asked me for some suggestions of PHR or portal options that they could use with their EHR software. Turns out that this is going to be particularly important given the changes in meaningful use stage 2 that require you to not only share medical information with the patient, but the patients have to actually access that information as well (unless that gets taken out in the MU stage 2 rule making process). Regardless, the question of which PHR and/or patient portal solutions was an interesting question. Here’s my answer to him (with a little bit added):

I only know of a few and you’ve probably heard of the ones I know about. I’m also not sure of the price of the various options really [He wanted to know of an inexpensive option]. Here’s what I know:

I like what NoMoreClipboard has done and that they’ve been doing it a really long time. They have a good understanding of how to work with many different vendors and also sizes of practices or healthcare institutions. Plus, you can be sure they’re going to be on top of all the meaningful use stage 2 requirements you’ll need to meet.

I also know that Medical Web Experts was working hard on a patient portal. I’m not sure how far it’s come since I first talked to them though. It might be one worth checking out. Just be sure that they can meet the meaningful use stage 2 requirements.

Then, of course you have Microsoft HealthVault. Everyone seems to know about them. I’ve heard that they’re a bit of a challenge to integrate with. Hopefully they also don’t have the same fate as Google Health. Although, Microsoft has a much better position in healthcare than Google ever did.

Coincidentally, I also was just emailed about a brand new book just released by O’Reilly Media about HealthVault and how to integrate with it. It’s called Enabling Programmable Self with HealthVault: An Accessible Personal Health Record. I’ve heard it’s a pretty technical book that would be quite useful if you decided to go with Healthvault for your PHR.

What other PHR and/or patient portal options are out there? I’m sure there are more that I’m missing and have probably just forgotten about them.

I’ll be interested to see if meaningful use stage 2 will drive the return of the PHR.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

March 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.

Expanding the Healthy Patient – Doctor Relationship

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Patient Doctor Relationship
It seems like this topic keeps coming up in my online and social media reading. Basically, the discussion usually centers around the role the patient plays in healthcare. Many people like to discuss what has been called the ePatient. I instead want to talk about the motivations of patients and their ability to influence the healthcare system.

Patients in healthcare are unlike “customers” in many other industries. I can’t think of a single patient that wants to go and see a doctor. Ok, maybe they like the doctor and they want to get whatever’s ailing them fixed, but to a person I’m sure we’d say that going to the doctor is the last place we want to be. It’s not like going shopping for a new pair of shoes. There’s nothing you get to take home from the doctor. Well, at least nothing that you really want to take home.

Plus, healthcare is an interesting thing, because often it’s not clear if you should go to the doctor or not. If my A/C is broken, then it’s quite clear that I need to call an A/C repairman. Seeing a doctor is quite different since it’s a fine line between when you need to go and see the doctor versus when your body will heal on its own. I think we’ve all hated the doctor visit where they check you out and basically say there’s nothing they can do for you. Well, other than send you the bill for your visit. I guess that’s the cost of the peace of mind that you get from the visit (I know I’ve done that with my kids a few times).

Please don’t take this as me knocking doctors or the healthcare profession. They provide an absolutely essential and critical role in our lives. Without great doctors many of us wouldn’t be here today. My point in this post is that the patient doctor relationship is quite different than the customer business relationship that we’re use to seeing.

Online Patient Portals
Take for example the online patient portal. Many people love to go on Amazon.com (or insert your preferred shopping site) and browse through all the various things they could buy. We all know people who spend hours shopping. I don’t think I’ve ever heard someone say that they wanted to spend hours browsing through their patient portal. You know, someone who just couldn’t wait to see what great healthcare services their doctor could provide them.

The only partial exception to the above reasoning is possibly the chronic patient. If I’m a diabetic patient, then I am going to have an ongoing dialogue with my care provider and the services they provide. I’m going to be interested in monitoring and tracking my care in collaboration with the treatments that my doctor provides.

Is there a reason why we don’t want this kind of interaction for our general healthcare?

Regular Online Interaction with Doctors
Why shouldn’t I go online on a regular basis so that my doctor can assist me in total wellness even when I’m a healthy patient? The difference here of course lies in doctors treating symptoms and illness as opposed to a very different form of care: wellness. To be honest, I’m not sure I’ve seen any doctors who treat healthy patients. Sure, some doctors do provide some pro-active wellness information during a sick visit to the doctor. Regular physicals are the closest we come to doctors treating healthy patients, but how many health people get those? It feels counter intuitive that we would go and see a doctor when we’re healthy or appear to be healthy. However, maybe that’s the shift our healthcare system needs.

Reimbursement Model Challenge
One real challenge with what I just described is the reimbursement model we have in healthcare. We’ve incentivized treatment of sickness and illness. We haven’t (yet?) incentivized treatment of healthy patients and promotion of wellness. This sounds a bit like the ACO discussion that’s become so popular these days. I’ll be interested to see how these incentives play out. Word on the street is the train has left the building and reimbursement is going to be tied to healthcare outcomes in the future.

Healthy Patient Motivation
Unfortunately, another major challenge I see is that healthy patients aren’t really motivated by wellness initiatives. I’m sure that there are people that understand this phenomenon a lot better than I. Although, I think it’s abundantly illustrated when you talk to someone who’s getting older and starting to lose their health.

It seems particularly poignant for highly successful people that start to get older. How many times have we heard during Oprah or a Barbara Walters interview someone talk about being willing to give up all their riches and fame to just have their health (and they often throw family in there too)? All the time! The problem is that it takes old age or some other health incident for people to make healthy living and wellness an important part of their life. Which begs the question of whether even a change in the reimbursement model for healthcare will get unmotivated people to visit their doctors and be “treated” even when they’re a healthy patient.

Gamification of Healthcare
One idea that I find incredibly intriguing is the idea of gamification of healthcare and wellness. The basic concept behind gamification is to create incentives for people to do the behaviors you want them to do. I believe Foursquare was one of the first applications to do this. They would give you electronic badges and crown you as mayor as you did certain things on their mobile app. It was (and still is) amazing to see what people will do for a little electronic badge and the electronic title of mayor (Turns out this works in the offline world as well. There’s a reason boy scouts give out badges, beads and pins.). The question is how can we apply rewards systems to incentivize healthy behavior and wellness?

To be completely honest, I don’t think I’ve seen anyone crack the gamification code in healthcare. Although, I think the concept is just beginning. I predict in the next couple years that we’re going to see some amazing mobile and web applications that really drastically impact our motivation to healthy living.

The closest I’ve seen so far has been something like the Nike+ device and website. It’s a simple device that tracks your running habits either in a watch, iPod or even in your shoe. Then, that device uploads your running data to a website where you can create and track your running progress. It also provides a social experience, but that’s a topic for another day.

I actually find these tracking device/website combinations (see the FitBit and DigiFit as other examples) to be some of the most interesting things happening when it comes to pro active treating of healthy patients. A while back I predicted a whole plethora of medical tracking devices are going to hit the market. This is happening and will continue for many years to come. I heard one guy interviewed who talked about one day (many years from now) having little mini processors attached to every nerve or blood cell in our body. Ok, that’s kind of creepy to think about, but personal monitoring of our body is a burgeoning field in healthcare.

Crunching All the Personal Healthcare Device Data
The question once we’re monitoring all of these various vital signs and health information is what are we going to do with that information. Is it reasonable to think that we’ll be able to use computers to crunch through all the data and provide a self service analysis of all the data collected? Yes, Watson did some amazing things on Jeopardy, but I think we’re far away from the day when this type of self service crunching of all the medical data we collect will be possible.

Yes, that means we’re still going to need doctors and other healthcare professionals who help us analyze the data that we’re collecting and dealing with the health issues that are related to that data. In fact, I predict a whole new breed of doctor will come together that will be specialized at analyzing this data and treating even the healthy patients.

Future Healthy Patient Doctor Relationship
This all comes full circle when you go back to the start of this discussion: the doctor patient relationship. How are doctors going to see all this health information we’re collecting? Where are we going to have these healthy patient interactions with doctors? I predict that it will be through patient portals that are connected to a physician’s EHR.

I and every blogger I’ve ever known has been a stats junkie. We’re addicted to checking our stats. There’s no reason we wouldn’t be just as addicted to checking our health stats on a patient portal. The problem is that the patient portals I’ve seen aren’t there yet. Plus, most doctors aren’t yet ready for this type of healthy patient interaction around such a large set of data. Although, I predict we’ll get there and it will change the doctor patient relationship forever.

August 9, 2011 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.