I’m always on the lookout for new online communities around Healthcare IT. I test drive them for a little while and then decide how I’m going to incorporate them into my daily routine. I evaluate what benefits I get from participating. Sometimes the benefits of participating are just helping someone out. There’s something really satisfying about doing something for someone else.

My latest test drive has been the Healthcare IT Question and Answer site on Stack Exchange. I’ve used Stack Exchange a bunch before when I needed some programming help. However, I’m guessing that most people in healthcare IT (unless you’re a programmer) probably aren’t that familiar with Stack Exchange. Well, they created such an interesting community around question and answers that they got a whole bunch of VC funding and they’ve been growing their network into all sorts of new niches. Thus, the launch of the Healthcare IT Stack Exchange community.

You can go and check out my techguy profile on the HIT Stack Exchange site if you want to see what I’ve done. I’ve already got a reputation of 46 (whatever that means). I’ve already answered 9 questions on the site and a few people have been nice enough to vote up my answers.

For example, if you are a MUMPS lover, you can see my answers on this MUMPS replacement question and this NoSQL in Healthcare IT one. I couldn’t resist answering a question about CCHIT. I also took a swing at the PHR question, but I’m sure I could have dug a little more on that one to mention some other PHR software. Instead, I opted for the two most popular ones. I even hopped in the chat room, but it wasn’t that exciting since I was the only one there. You can check out the chat room, but you won’t be able to chat until you have enough reputation. Keeps out spammers, but makes for a boring chat room until you get some critical mass.

Of course, the real challenge with any site like this is the standard chicken and egg problem. You need a large number of people to ask and answer questions. However, in order to get a large number of people asking and answering questions, you need a lot of good questions and answers. I guess we’ll see how it evolves over time. The sidebar of the site says they’ve had 113 questions, 241 answers, 319 users and 147 visitors/day. A pretty small community, but a pretty good response rate considering the number of users. I just wish there was more discussion of EMR & EHR on the site since that’s what interests me most.

Let me know what you think and if you see any good questions or answers on the site that you think I should see. I’ll be keeping an eye on it to see how the community develops. I’d hate to have my 46 reputation points go to waste.

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.

Meaningful Use Menu Measure: At least 10% of all unique patients seen by the eligible professional (EP) are provided timely (available to the patient within 4 business days) electronic access to their health information.

This is a third meaningful use measure related to providing patients with access to their health information. Meaningful Use Mondays has already addressed the two core measures—clinical summary and electronic copy of health information—“timely access” is a menu measure.

 The requirements are as follows:

• The measure includes a provision for EPs to claim an exclusion, but I don’t believe that many will qualify for this exclusion. They would have to attest that they “neither order nor create lab tests or information that would be contained in the problem list, medication list, medication allergy list, etc.”—a fact that would make meeting the core meaningful use measures quite unlikely.
• Access to patient information must be provided online, via a portal or a personal health record (PHR)—in contrast to the other two patient-related, access-to-information measures, which allow the use of various types of electronic media and/or paper.
• The denominator is “all unique patients seen during the reporting period.” Therefore, in order for that patient to be counted in the numerator, every time any piece of clinical information that can reside in the EHR is added to the patient’s chart, the portal must be updated within 4 days of the EP’s receipt of that information.
• This measure assesses the availability of timely access. It does not matter—for meaningful use purposes—whether patients request, or ever access, the information.

A challenge associated with this measure is securing patient consent to have clinical information posted on an online portal and then getting a sufficient number of patients to register. Because it is a menu measure, EPs can choose to omit this measure in Stage 1, and it appears—from my conversations with providers and with CMS—that many are planning to do just that!

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.

Katherine Rourke, on my sister site EMR and EHR, wrote an interesting piece on Adding Genomic Info to the EMR. Here’s a short excerpt from the post. You should go and read the rest of the post as well.

As the author notes, some specialties have already begun to tailor drug treatments to individual patients based on their genomic profile. For example, DNA sequencing of tumors in non-Hodgkin’s and Mantle Cell lymphoma can lead to personalized cancer vaccines that can produce great results, notes writer Gerry Higgins of the NIH.

Such data can also be used for a growing number of clinical situations, such as tailoring Coumadin doses to specific patients and providing psychiatric patients with the appropriate drug.

I’d been meaning to write about genomics and EMR for a while and so I’m glad that Katherine did. In one of my more interesting discussions at HIMSS with CMO of Nuance, Dr Nick (sorry, his last name is too hard to spell), we talked about the future of EMR and the possible benefits it could provide to patient care, diagnosing, etc. Nuance had partnered with IBM’s Watson project (the famous Jeopardy Watson) to apply the Watson technology to healthcare. At its core is using technology to crunch a lot of data and provide some meaningful (sorry I had to use the word) results or information.

As this discussion progressed, I casually suggested that one day we’ll need the same sort of processing across things like a person’s genome. The genome project isn’t quite a consumer commodity, but it’s getting there. One day, it won’t be at all surprising for us to bring our PHR info along with our personal genome to the doctor’s office. The lady at the front desk will ask you for a copy of your genome. Pretty crazy to consider, but probably much closer to happening than we realize.

Imagine trying to somehow process the information found in a genome in a paper based world. Exactly! The thought is so unreasonable you have to just laugh. I don’t follow the science of using the genome in healthcare that closely, but the examples in the above article by Katherine are quite interesting.

Plus, I think we’re still in an old world mentality where the world is still flat when it comes to understanding the data that’s available in the human genome. One day some remarkable humane genome Christopher Columbus is going to discover a new world that nobody knew about before. EMR software will be the tool used by most doctors to tap into that new world of healthcare based on the human genome.

This is why I’ve argued for so long about the possible long term benefits of having an EMR. The integration of a patient’s genome into their healthcare is just one of those potential long term benefits of having an EMR in your office.

Last week I posted a poll asking how many readers of EMR and HIPAA used a PHR. Here’s the results of the PHR poll:

Pretty interesting to see that about 77% of those voting have not started a PHR or started one, but didn’t add much to their PHR. I guess I’m not all that surprised since I fall into that category as well. The scary thing is that this is coming from people who are in the healthcare and healthcare IT industry. If we’re not using a PHR, then I’d imagine that the number of PHR users outside of the industry is even smaller.

I’m still considering the compelling PHR use case since the results from this PHR poll says that one hasn’t shown its face yet. However, I must admit that the more I research and read about PHR and some of the possibilities, the more potential I can see in the PHR. Although, I also believe it won’t likely look like what most people call a PHR today.

Now for this week’s poll about reader’s approach to the EHR stimulus money. This should have some interesting results since I’ve added the time frame people plan to apply for the EHR incentive money as well.

I recently read an article (which I can’t find now) that said, We don’t log in to check our health data as much as we do our financial data. This was a pretty interesting statement considering a few days back I posted this tweet about PHR and being an active patient:

I want to spend some time thinking about the motivation for a healthy individual to become an active patient. #PHR #ePatient

February 25, 2011 10:15 pm via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

Figuring out the right motivation for someone to use a PHR has been something that’s been on my mind for quite a while. You may remember my post about requesting an appointment and sending your medical record using a PHR where I was asking some similar questions.

There’s certainly a place for software that connects patients with their doctors for things like scheduling an appointment, paying their bills, requesting prescription refills, and even doing e-visits. In fact, one of my advertisers recently launched an enterprise patient portal that has these types of features (check out this video which describes their feature set).

There’s no arguing that these types of connections to doctors are valued and something that patients would love to have. Many doctors are still on the fence about them, but I’m sure we’ll be seeing more and more of these types of services over time. However, while being really great features they still don’t solve the problem of a healthy patient wanting to log in to this portal regularly.

I think one game changer when it comes to PHR will likely be around an emerging set of devices which track our health. For example, over on Smart Phone Healthcare I recently wrote about Tracking Fitness and Activity Levels on Your Smartphone. These devices will track your steps, calories, heart rate, and sleep data and upload it to a centralized location where you can see all that data and watch your fitness and activity levels change over time. Plus, I believe we’re just getting started with collecting this type of data. You can easily see this moving to blood sugar levels, cholesterol, blood pressure, etc.

Now imagine that all of this data was available in your PHR. This type of data would be constantly updated and seeing the graphs of this health data over time is something that I’d login to check as much as I do my financial data.

Previously, I’d always been a bit down on these types of tracking devices. I’ve argued that we’re missing that link for doctors to be able to do something with the data that patients are collecting. I still think this is the case, but just because your doctor might not use the data a patient collects doesn’t mean it can’t be valuable to the patient to collect and see that data regularly. Plus, once EHR software and doctors are ready to digest the data, you’ll be ready as well.

As is often my Sunday tradition, I love to post some healthcare IT related polls. Today’s poll is prompted by this tweet I sent out earlier this weekend:

I want to spend some time thinking about the motivation for a healthy individual to become an active patient. #PHR #ePatient

February 25, 2011 10:15 pm via HootSuiteReplyRetweetFavorite

@techguy

John Lynn

On that note, I’d love to see how many of my readers use a Personal Health Record (PHR) and more specifically if you update your PHR or not. Of course, this poll will be completely bias since it’s industry people right. Which is why if the results say that few people in the healthcare IT industry are updating their PHR info, then maybe PHR has some issues to be dealt with.

I was looking through the HIMSS session titles and saw one about the Usability of PHR, which prompted me sending out the following tweet:

Usability of PHR? First, shouldn’t we address the reason to use PHR?

January 14, 2011 12:53 pm via webReplyRetweetFavorite

@techguy

John Lynn

Then, a smart HIT journalist named Neil Versel sent his comment on my tweet:

Amen! #healthit #PHR RT @techguy: Usability of PHR? First, shouldn’t we address the reason to use PHR?

January 14, 2011 1:55 pm via ÜberSocialOrigReplyRetweetFavorite

@nversel

Neil Versel

Something to think about this weekend.

I recently got a message from Jerry Theis of MyCrisisRecords. He sent me a story that I thought was a great way to start off the new year. It talks about the value of health care data interoperability and in this case a device and PHR with a person’s health information. Enjoy the story!

Yesterday, one of my members called me to tell me she was taken to the emergency room suffering combinations of complications caused by a rare condition, Polymorphous along with a flare up of fibromyalgia which caused to her go into cardiac arrest. The ER doctors were able to effectively treat her because she had her digital device which provided them all of her medications, conditions, allergies (she is allergic to latex). Because of this rare condition and her acute distress she was told by the doctors had she not had this device there would have been adverse events, medical errors and it would have been fatal.

The ER doctors read the article I had downloaded in the device about Polymorphous. She, the patient educated the doctors who said they had never treated or seen this rare condition. The ER doctors consulted with Mayo Clinic and an expert on Polymorphous consulted with them and spoke to the patient while reviewing the transmittal of her PHR sent to him. She consented to be injected with a drug that had to be sent from Mayo (2hrs). It relieved her of the severe pain and swelling in her throat.

I share this with you because it meant so much to me to hear her testimonial and how thankful she was and how grateful she said the doctors were about what I created. I am a psychotherapist and she is a patient of mine who has a Bi Polar condition. The doctors said they may have had discarded her presentation because of her psychiatric condition had they not had the complete PHR. Another primary reason why I relentlessly developed this technology, for the special needs populations.

While I admit that I’m much more suited to comment on other people’s prognostications and predictions for EMR and health care IT in 2011, I decided to throw caution to the wind and try and make some predictions for the EMR world in 2011.

Few EMR Vendor Acquisitions – I predict that acquisitions of EMR vendors will actually slow down in 2011. Certainly there needs to be some EMR company consolidation with 300+ EMR companies out there right now (and it seems more coming every day). However, I think 2011 will be a wait and see period where companies want to see how the various EMR companies perform for their clients interested in getting the EMR incentive money. The only thing that might ruin this prediction is that if many of the 300+ EMR companies have issues selling product and then have to basically sell off their assets in a fire sale. We might see some of those, but I believe even those will wait until 2012.

EHR Incentive Numbers Down – We’ve all heard the $36 billion in EHR incentive money. Of course, this is just the projection of how much EHR incentive money they’ll have to give out. I expect that when we get the total amount of EHR incentive money paid out in 2011 that it will be much lower than the projected targeted. Especially if many of them sit out 2011 and wait for 2012.

Health Information Exchange Success Stories – There are so many people working on the health information exchange issue that in 2011 we’re finally going to start seeing some breakthrough stories about the exchange of health information. Although, it won’t likely come from where we expect it. Watch for some unique approaches by companies and communities to finally make the exchange of health information a reality. It won’t be across the US in 2011, but we’ll see the signs of what could be in 2011.

Reimbursement for Online Visits – I’m far from an expert on reimbursement and trends in health insurance so this might be a stretch, but I think we’re going to see the first insurance reimbursement for some sort of online visit. The first draft will be a bit cumbersome and restricted, but it will be the start of the online doctor visit in earnest.

Portable Doctor’s Offices – A few years back I started hearing about some doctors who were going back to the old days. Not the old days of medical care, but the old days of the doctor visiting the patients in their homes. When I think about this, I always think of Little House on the Prairie and them calling for someone to go and get Doc Baker. In 2011, I bet we see a lot more doctors eschewing the traditional doctor’s office and visiting patients in their homes. With a hosted EMR and the portable laptops and iPad like technologies that we have today, it makes running an office out of your car pretty reasonable. Certainly it won’t work for all specialties, but it is a service that I think many patients would pay to have from their doctor.

PHR Adoption Will Continue to Lag – I just see no signs that PHR adoption is going to take off this year.

First EMR Lawsuit – I predict 2011 will bring the first HIPAA lawsuit where EMR is at the center of the lawsuit. It will be an important one to watch since it will likely set precedent for future EMR related lawsuits.

There you go. A few little 2011 predictions. I’d love to hear any predictions you’d like to make and which predictions I’ve made that you think are wrong and why.