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The Future of Healthcare Rests on the Backs of Our Ability to Influence Behavior

Posted on May 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This morning I was pondering the future of our healthcare system and the constantly changing and shifting world of healthcare reimbursement. Some observations are undeniable. Our current system is flawed and not sustainable. Something has to change.

As I look at all the changes happening in healthcare, I came to one major realization. Every program to reduce the cost of healthcare rests on the back of our ability to influence patients’ choices.

The future of health insurance companies hinges on their ability to change patients’ behavior. Looking at ACOs and MACRA, doctors reimbursement is going to be tied directly to the choices their patients make (or don’t make). Employers that are looking to lower their healthcare costs are going to invest in programs and technologies that ensure their patients are making healthy choices.

While many healthcare IT companies fall short of this goal, we do see some that are going to play a major role in influencing patient behavior. Take something as simple as a patient portal. Can access to your medical records influence your behaviors? Can access to your doctor or a nurse through a patient portal help influence the decisions you make? Absolutely. Do they go far enough? Absolutely not, but they’re a start.

Take a look at telemedicine. Will easy access to a doctor change our behavior? Could telemedicine mean that we choose to be seen by a doctor earlier as opposed to delaying a visit to the doctor because it’s too painful to schedule an appointment and go into the doctor? Absolutely. Plus, telemedicine is just one simple example of how we’re making a visit easier. Online self scheduling could influence this as well. A whole new wave of messaging apps and provider communities are forming which allow us to get “health care” remotely.

As I’ve written before, my fear is that most healthcare IT companies don’t go deep enough into the behavior change and instead focus mostly on process optimization. Behavior change is a surprising byproduct for some, but is certainly not their intention. In fact, that’s true for most of the examples I describe above.

It becomes more and more clear to me every day that the real breakout companies in healthcare are going to be those who figure out how to influence patients’ behavior. That includes influencing them the 98% (or whatever the correct stat is) of time that patients spend outside of the exam room. Every reimbursement effort is going to be focused around it.

The real challenge for these companies is going to be tracking and quantifying the value they created. It’s hard to track attribution when it comes to a patient’s health. It’s so complex that it’s easy to incorrectly assess who or what is responsible for a patient’s improved health. Plus, it’s extremely hard to quantify the benefit of these behavior changes. A company focuses on influencing patients’ behaviors is also going to have to get really good at tracking the benefit of that influence and attribution of what influenced the patient.

These are extremely challenging opportunities. Healthcare is full of them. I already see some companies heading down this path. I’m excited to see which ones really break through.

Can Patients Be Trusted?

Posted on August 14, 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.

“Pay no attention to that man behind the curtain!”  This was how Dr. CT Lin, CMIO at University of Colorado Hospital & Health Sciences Center, opened his talk at the Healthcare Forum.  Dr. Lin’s premise was that we have kept healthcare information hidden from patients for far too long.  Giving patients access to their medical record does not create confusion and extra work for providers, but instead there is strong evidence in Dr. Lin’s research that patients are highly engaged and satisfied with access to their record and it does not create added burden on providers.

While the mystique of the all knowing, all powerful doctor is a strong one, healthcare is changing.  We’re quickly moving from the all knowing, no mistake doctors, to a more realistic paternal collaboration between doctors and patients.  No doubt this change is a hard shift in medical culture.  Take a simple look at the 5th century BC Hippocratic Oath [emphasis added]:

“I will impart a knowledge of this art…to pupils who have signed the covenant, and have taken an oath according to the medical law, but no one else.”

In the 70’s we started to see the very first shift away from closed records and medical knowledge when patients were allowed to access their paper records.  In the 80’s and 90’s we started to see the first patient portals.

Dr. Lin described the old healthcare mentality as follows:

  • Knowledge is power.  Respect my studies.
  • I am too important for clerical tasks.
  • Patients do best when they do what I say.
  • There is nothing wrong with the way I work.

Then, he suggested where we are headed in healthcare:

  • Collaboration is powerful.
  • Communication improves safety.
  • Connection fosters participation.
  • Change requires a burning platform.

This shift requires us to move from a physician centered healthcare system to a patient centered healthcare system.  Is it any wonder why physicians feel threatened?  However, Dr. Lin has studied how this shift impacts both doctors and patients and the results are profound.

Dr. Lin discussed these results during his presentation at the Healthcare Forum (embedded below):

His presentation focused on studies he conducted on: online messaging, online release of test results, and online release of doctor notes.  In each case, Dr. Lin presents the fears many doctors have of connecting with patients in this manner and also the many doctors who see potential benefits of pulling back the curtain.  Some of those fears include: “This is a crazy idea; the phone will ring off the hook” and “Patients will be more anxious.”  One doctor only agreed to participate in his study because he thought that Dr. Lin was doing a “rigorous study” and he was certain that the study would validate his fears.

The results from his research consistently showed that the “floodgates” of patient requests didn’t open and where studied there was a dramatic improvement in patient satisfaction.   The irony of people’s reaction to the study was that it varied based on the clinic’s perspective.  For example, a busy clinic that has more patients than it can handle was happy to reduce the number of patient calls while a slower clinic was not happy with that result.  An even more surprising result was doctors who found they were better doctors after the change.

Plus, there were plenty of anecdotal examples of patient benefit that were not captured in the qualitative portion of the study.  For example, one patient who had been given access to their physician’s notes reported this experience: “I lost my luggage while traveling.  I went to a local doc and said: ‘If you have Internet Explorer, I can show you my chart.  Could I have a few days of my meds?”  Access to the physician notes changed the entire experience.

Dr. Lin’s research has also been confirmed by a 250 doctor initiative called OpenNotes which came to similar conclusions.  When you involve the patient, the world does not come to an end.  Patients are happier, more satisfied, more connected, and more empowered.  Dr. Lin concluded, “Patient centered information technology is fast moving, often out of focus, but always exciting.”

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

Missed Patient Portal Changes to MU Stage 1

Posted on July 8, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s fun to have this post on Monday since we did a few years of Meaningful Use Monday posts. This actually comes from a regular reader of EMR and HIPAA who works at an EHR vendor. He wanted to point out a change to meaningful use stage 1 that they’d missed. I expect there are likely others that might have missed this change as well.

Practices attesting stage 1 in 2014 for their year one or two must have the Patient Portal. ONC made a change and made the menu item Core for this in Stage 1. We thought it was stage 2 only. I reached out to a dozen or so REC consultants we work with and more than half of them had missed this point also.

CMS replaced the Stage 1 objectives for providing electronic copies of (CORE) and electronic access to health information (MENU) with the objective to provide patients the ability to view, download, or transmit their health information.

This means that any provider attesting to Stage 1 MU in 2014 (either Year 1 or Year 2) must attest to the objective: “Provide patients ability to view download and transmit their health information.” This will be a CORE measure and will require the portal.

More information is available on page 3 of this
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

Looks like we’re going to have more patient portals in place really soon. Is your organization ready with a patient portal to meet this meaningful use measure?

2013 Health IT Predictions – 3-D Printing in Healthcare

Posted on January 6, 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 never can resist clicking on a tweet that looks at the future landscape of healthcare IT. I love to see what other people are saying about it. Although, as is the case above, I usually find that people are pretty cautious in their predictions. The challenge is that a year is probably not a big enough time frame to really make bold predictions.

For example, the above article suggests the following as major healthcare IT trends: patient portals, mobile devices, and telemedicine. They are absolutely right. Does anyone doubt that all of these things won’t be major happenings in 2013? We know they will because they’ve already started happening today. Next year will just be an extension of this year.

On the other hand, I was intrigued by this tweet about 3-D Printing in healthcare:

If you don’t know about 3-D printing, then check it out on Wikipedia. It is an absolutely incredible technology that’s going to absolutely revolutionize manufacturing products as we know it. That includes many of the products we use in healthcare. Is it going to happen next year? I don’t think so. Certainly much progress will be made in 2013, but 5 years from now 3D printing is going to be able to do insane things when it comes to creating your own products with a simple 3D printer.

I’d love to hear your thoughts. What drastic things do you think will happen in healthcare 5 years from now? Feel free to look even farther out if you prefer.

Does EHR Choice Matter for ACO’s?

Posted on November 22, 2011 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.

There’s a really interesting article on Nextgov that talks about a CSC report that looks at the role of health IT and EHR software in Accountable Care Organizations (ACOs). The most valuable part of the article is this list of items that an EHR must enable or allow to support an ACO:

  • Clinical information and point-of-care automation, with integrated ambulatory and inpatient records and a central repository for clinical data.
  • Enterprise master data management and integration, with a population management repository, a master person index and a master provider index.
  • Tools to enable participation in a health information exchange.
  • Patient engagement tools, including secure messaging, e-visits and tele-visits, social media, patient portals and mobile health applications.
  • Care management and coordination tools, including referral and request tracking, provider-to-provider communication, medication reconciliation and case- and disease-management applications.
  • Performance management tools, including integrated business and clinical intelligence and analytics.

To be honest, as I look through this list of EHR items, I can’t say that any of them really stick out to me as impossible for any EHR to achieve. In fact, I’d say that they’re quite achievable by almost all EHR software vendors.

The only partial fear I have reading through the list is that some of the points depend on an EHR vendor working with other EHR software vendors. In most of the cases, these are large hospital EHR vendors that have often worked in very closed environments.

The reason this is a cause for concern is that even the best EHR software in the world won’t be an effective ACO and won’t meet the above requirements if the large EHR software vendors don’t work with them to connect their system.

Maybe this isn’t something we should be too concerned about since the hospital client will be motivated to get their EHR vendor to work with the other even small EHR vendors in order to make the ACO happen and get access to the extra reimbursement. However, my gut tells me that this won’t be the case and there will be stories where EHR software is basically shut out of the ACO based on the large EHR vendors decision to not work with them.