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Creating Provider Loyalty – And Why Communication Matters

Posted on June 14, 2018 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Chelsea Kimbrough

A few months ago, I was on the hunt for the perfect healthcare provider – and my list of expectations was high. Thankfully, my extensive search paid off. I am happy to report I found an amazing physician who I fully plan on remaining loyal to for years to come! The main reason for this loyalty boils down to one common characteristic: communication. Across every step of my patient journey, I was engaged in a clear, convenient way.

Scheduling my appointment was easy. Like many patients, I enjoy the convenience of online scheduling. But as a first time patient, I opted to pick up the phone to make my appointment. The person who answered my call was friendly, focused, and efficient. I was not asked to repeat information and ended the call more quickly than I anticipated – and with more confidence that I’d made the right choice.

Before my appointment, I received a number of reminders. The first was sent via email a few days before my appointment. When I failed (read: forgot) to reply to it, I received another friendly reminder via text message. This time, I promptly confirmed my appointment. A few days before the appointment, I was invited to pre-check in online. I did this from the comfort of my home computer in just a few minutes. As a digital-minded patient, I was stoked that this was an available perk of my new doctor’s office.

When I arrived, I was thanked for already checking in. Unlike other locations where I needed to fill out additional paperwork upon arrival, I didn’t need to do this often repetitive task. This pleasant surprise allowed me to simply wait to be called back.

During my appointment, the doctor looked me in the eye, asked me genuine questions, and clearly explained anything I wanted to know more about. This level of dedicated attention made me feel genuinely cared for. What’s more, she ensured I understood what to expect after my appointment.

After my appointment, I received the communications I was advised to expect in a timely and unobtrusive manner. What’s more, I was invited to provide candid, anonymous feedback about my appointment. The survey was quick and unobtrusive, and left me feeling as if my opinion was valid and valued.

Each point of my patient journey was met with timely, convenient, and reliable engagement. As a patient, I felt confident and at ease. And as someone who works closely with healthcare communication services and solutions – both human and technology based – I was impressed. Few healthcare organizations provide patient experiences that meet patients’ traditional and digital expectations and reliably deliver on the expectations they set. Those that do, however, are sure to acquire patients like me who will stay loyal for the foreseeable future.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

How Technology Helped My Family Receive a Better Healthcare Experience

Posted on May 10, 2018 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Brittany Quemby - Stericycle

When was the last time you had a truly outstanding patient experience? For my family, two healthcare facilities located hours apart recently teamed up to make our lives significantly more convenient. Without modern technology, however, our new reality may never have been possible. Let’s start from the beginning.

A few years ago, my family member suffered a heart attack that caused a traumatic brain injury. He was treated at a major facility about two hours away from his home for speech therapy, occupational therapy, neurological care, cardiologist support, and more. After a year of hard work, he was discharged from the hospital and was able to move back to his home town.

Unfortunately, his community hospital was not equipped to provide the specific care he required. So for the next two years, he and his wife, who is now his primary care giver, commuted to the city multiple times a week to ensure he received the care he needed.

Eventually, we all wondered the same thing: Isn’t there a better way?

After many meetings with the facility that treated my relative and our local hospital, we started discussing how digital health experiences and virtual care could augment my family’s patient and caregiver experience. We were determined to find a solution that provided care options and choice, and allowed them to continue receiving the necessary care without the exhaustion of “living on the road.”

A recent study by Accenture said it best: “Finding the best combination of traditional in-person services and making those same services available virtually can offer consumers the choice they want in deciding when and how they receive care and support.”

Fortunately, we learned that our local hospital was equipped to provide virtual care. However, many patients had not yet taken advantage of these technologies. After some coordinating between facilities, we were able to set up ongoing virtual appointments. These appointments enabled my family member to receive care in a much more convenient setting.

With virtual appointments, they can even:

  • Easily schedule virtual appointments
  • Participate in the appointments from the comfort of a boardroom at the hospital
  • Consult with the first hospital’s specialist and also an in-person care facilitator
  • Receive follow-up health reminders and education directly after the appointment

Now, almost half of his appointments have transitioned to virtual appointments. And my family is not the only one taking advantage of this care capability. Recent research explores the many reasons why healthcare consumers are making this virtual shift:

  • One of the top three reasons why consumers tried virtual health was convenience. 37% said it was more convenient than traditional, in-person health services
  • 76% of people would have a follow-up appointment (after seeing a doctor or healthcare professional)
  • 74% would get virtual follow-up care services in their home after being hospitalized
  • 73% would discuss a specific health concern virtually with a doctor or other healthcare people and
  • 72% would be open to getting virtual daily support to manage an ongoing health issue

Consumer willingness to demand choice and becoming more involved in their health is rising. Like my family, more patients are ready to collaborate with clinicians, embrace new technologies, and explore digital health experiences that can help manage our health and create more convenient and engaging patient experiences.

Learn more about how Stericycle Communication Solutions is helping create the optimal patient experience through a combination of human and tech-enabled communication services. Check out our service overview here!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality live agent services, scheduling solutions, and automated messaging solutions.  Stericycle Communication Solutions provides unified human & tech-enabled communication solutions for optimized patient experiences.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Why I Didn’t Choose Your Healthcare Organization

Posted on April 12, 2018 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Chelsea Kimbrough

I recently had a bad healthcare experience. I received functional care, but I wasn’t cared for. As in, I’m fairly certain my doctor didn’t know my name when she walked into the room or when she left it. To her, I was another patient in a crowded schedule. To me, it was a rushed, impersonal experience that left me with absolutely no desire to trust my wellbeing in her hands.

As someone who is familiar with the healthcare space, I’m the first to admit that finding a new provider is hard work – and finding one that meets each of your communication expectations is even harder. But after that appointment, I was more than up for the challenge.

It’s important to note that I’m a proud millennial who is accustomed to the service and support provided in other industries. When I wanted to make a dinner reservation last night, I did it via a mobile app. When I needed a great blazer to wear to a conference, I requested one in my clothes subscription box. I am an all-access-at-all-hours type of person. So when it came time to schedule an appointment, I turned to the place where I, the consumer, felt I had the most power: the internet.

But first, I needed to find a new doctor. I leveraged a process that went something like this:

  1. I opened multiple review-focused sites.
  2. I searched for what I needed (i.e. ‘family practitioner within 10 miles of my zip code’).
  3. I filtered results to ensure my search only displayed doctors with the rating and characteristics I prefer.
  4. I began the tedious process of cross referencing their profiles on different sites.
  5. When I thought I found a keeper, I scoured their organization’s website for more information.
  6. And then, I dug into any information I could find online to learn more about the doctor.

This process eliminated doctors who had poor reviews, who lacked information available online, and who had questionable posts on social media. (Seriously, everything is available online these days – and digitally-savvy patients like me will find it.)

In the end, I narrowed my search to a handful of local, highly-rated doctors and organizations. But what I was searching for wasn’t just someone with a great online rating and an office close to my front door, I was looking for someone who:

  • Communicates information quickly via text message
  • Calls patients to communicate more important messages
  • Offers online scheduling that doesn’t require a formal login
  • Keeps average wait times down
  • Creates genuine connections with their patients

In short, I wanted to find an organization that provides exceptional in-person care, prompt telephone support, and convenient technology-based tools. Anyone who seemed lacking was unceremoniously crossed off my ‘potential new doctor’ list.  And I’m not the only one who goes to these lengths: in today’s digitally-empowered world, there are more healthcare consumers than ever flexing their online search superpowers before entrusting their care to any healthcare professional.

Unfortunately, the process isn’t perfect. Bad experiences happen, and when they do, patients like me may choose to look elsewhere for care. On the other hand, when we find a healthcare organization that does provide all of the above, we receive a more seamless, enjoyable experience. And when met with a better experience, we are less likely to choose a different provider, facility, or organization to provide future care.

Want to learn more about consumer-minded patients’ healthcare journeys? Check out our patient journey infographic here!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

The Human Side of Healthcare Interactions

Posted on March 19, 2018 I Written By

The following is a guest blog post by Sarah Bennight, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

The week after HIMSS is certainly a rest and reflect (and catch up) time period. So much information is crammed into five short days that hopefully fuel innovation and change in our industry for the next year. We hear a lot of buzzwords during HIMSS, and as marketers in general. This year my biggest area of post-HIMSS reflection is on the human side of healthcare. Often, as health IT professionals, we can be so enamored with the techie side of things that we lose sight of what adding more automation does to our daily interactions.

The digital revolution has certainly made life easier. We can connect online, schedule an appointment, Uber to our destination, order groceries online, and pick them up on our way home with limited interactions with any real human. While the convenience for many far outweighs any downside, the digital world is causing its own health concern: loneliness.

Research by Holt-Lunstad found that “weak social connections carry a health risk that is more harmful than not exercising, twice as harmful as obesity, and is comparable to smoking 15 cigarettes a day or being an alcoholic.” But the digitization of our lives is reducing the amount of human interaction and our reasons to connect in real life. I keep hearing the phrase “we are more connected than ever, but we are feeling more alone”.  How do we avoid feeding another health issue, such as depression, while making healthcare more accessible, cost-effective, and convenient?

In healthcare communications, I want both technological convenience and warm, caring human interaction depending on what my need is at a given moment. If I need to schedule an appointment, I’d better have the option to schedule online. But in the middle of the night, when my child has a 104F fever and I call my doctor, I want a real person to talk and ask questions to, who will listen to the state my child is in and make the best recommendation for their health.

I had the privilege of discussing this balance of human and tech in a meet up at HIMSS last week. We learned that my colleague and friend learned the gender of her baby via a portal while waiting patiently for the doctor’s office to call. This is pushing the line of being ok in my opinion. But what if it was something worse, such as a cancer diagnosis or something equally scary? Is that ok for you? Wouldn’t you prefer and need someone to guide you through the result and talk about next steps?

As we add even more channels to communicate between health facility and patient, we need to take a look at the patient interaction lifecycle and personalize it to their needs. We should address the areas where automation might move faster than the human connections we initiate to ensure we are always in step with our tools and technology. Healthcare relationships rely on confidence and loyalty, and these things aren’t so easily built into an app. Online interactions will never replace the human, day-to-day banter and touch we all need. But I believe that technology can create efficiency that allows my doctor to spend more quality time with me during my visits and better engage me in my health.

So the question stands: how do you think the healthcare industry can find the right tech and human balance?

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Patient Access to Health Data: The AHA Doesn’t Really Want to Know

Posted on March 8, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

As Spring holds off a bit longer this March in New England, it’s certainly pleasant to read a sunny assessment of patient access to records, based on a survey by the American Hospital Association. Clearly, a lot of progress has been made toward the requirement that doctors have been on the hook for during the past decade: giving patients access to their own health data. We can also go online to accomplish many of the same tasks with our doctors as we’re used to doing with restaurants, banks, or auto repair shops. But the researchers did not dig very deep. This report may stand as a model for how to cover up problems by asking superficial questions.

I don’t want to denigrate a leap from 27% to 93%, over a four to five year period, in the hospitals who provide patients with their health data through portals. Even more impressive is the leap in the number of hospitals who provide data to patient caregivers (from zero to 83%). In this case, a “caregiver” appears to be a family member or other non-professional advocate, not a member of a health team–a crucial distinction I’ll return to later.

I’m disappointed that only 50% of health systems allow patients to reorder prescriptions online, but that’s still a big improvement over 22% in 2012. A smaller increase (from 55% to 68%) is seen in the number of providers who allow patients to send secure online messages, a recalcitrance that we might guess is related to the lack of reimbursement for time spent reading messages.

That gives you a flavor of the types of questions answered by the survey–you can easily read all four pages for yourself. The report ends with four questions about promoting more patient engagement through IT. The questions stay at the same superficial level as the rest of the report, however. My questions would probe a little more uncomfortably. These questions are:

  • How much of the record is available to the patient?
  • How speedily is it provided?
  • Is it in standard formats and units?
  • Does it facilitate a team approach?

The rest of this article looks at why I’d like to ask providers these questions.

How much of the record is available to the patient?

I base this question on personal interactions with my primary care physician. A few years ago he installed a patient portal based on the eClinicalWorks electronic health record system used at the hospital with which he is affiliated. When I pointed out that it contained hardly any information, he admitted that the practice had contracted with a consultant who charges a significant fee for every field of the record exposed to patients. The portal didn’t even show my diagnoses.

Recently the affiliated hospital (and therefore my PCP) joined the industry rush to Epic, and I ended up with Epic’s hugely ballyhooed MyChart portal. It is much richer than the old one. For a while, it had a bug in the prescription ordering process that would take too long to describe here–an interesting case study in computer-driven disambiguation. My online chart shows a lot of key facts, such as diagnoses, allergies, and medications. But it lacks much more than it has. For instance:

  • There are none of the crucial lab notes my doctors have diligently typed into my record over multiple visits.
  • It doesn’t indicate my surgical history, because the surgeries I’ve had took place before I joined the current practice.
  • Its immunization record doesn’t show childhood immunizations, or long-lasting shots I got in order to travel to Brazil many years ago.

Clearly, this record would be useless for serious medical interventions. A doctor treating me in an emergency room wouldn’t know a childhood injury I got, or might think I was suffering from a tropical disease against which I got an inoculation. She wouldn’t know about questions I asked over the years, or whether and why the doctor told me not to worry about those things. My doctor and his Epic-embracing hospital are still hoarding the data needed for my treatment.

How speedily is it provided?

Timeliness matters. My lab results are shown quickly in MyChart, and it seems like other updates take place expeditiously. But I want to hear whether other practices can provide information fast enough for patients and caregivers to take useful steps, and show relevant facts to specialists they visit.

Is it in standard formats and units?

Although high-level exchange is getting better with the adoption of the FHIR specification, many EHRs still refuse to conform to existing standards. A 2016 survey from Minnesota says, “Most clinics do not incorporate electronic information from other providers into their EHRs as standardized data. Only 31 percent of clinics integrated data in standardized format for immunization, 25 percent for medication history, 19 percent for lab results, and just 12 percent for summary-of-care records.”

The paragraph goes on to say, “The vast majority said they fax/scan/PDF the data to and from outside sources.” So FHIR may lead to a quick improvement in those shockingly low percentages.

Labs also fail to cooperate in using standards.

Does it facilitate a team approach?

This is really the bottom line, isn’t it–what we’re all aiming at? We want the PCP, the specialist, the visiting nurse, the physical therapist and occupational therapist, the rehab facility staff, and every random caregiver who comes along to work hand-in-latex-glove as a team. The previous sections of this article indicate that the patient portal doesn’t foster such collaboration. Will the American Hospital Association be able to tell me it does? And if not, when will they get to the position where they can care collaboratively for our needy populations?

Taking Healthcare Communication to the Next Level

Posted on February 16, 2018 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 was looking through the Healthcare Scene YouTube channel and I realized that I did this video interview a few years back and never actually shared it here on EMR and HIPAA (I think I did share it a few other places).

The topic for the video discussion was healthcare communication and it included an all star lineup of people in the industry:

  • Jessica Johnson, Director of Operations, Health Transformation at Dartmouth-Hitchcock Population Health Management
  • Ethan Bechtel, CEO at OhMD
  • Nathan Larson, Chief Experience Officer at ImagineCare
  • Mandi Bishop, Healthcare Analyst
  • John Lynn, Founder of HealthcareScene.com

Healthcare Communication and engaging patients effectively has become a huge topic and these people were way ahead of the curve. Check out this video from a couple years ago to see what I mean:

What’s amazing is that a number of people in this video have moved on to new jobs, but they’re still part of the main healthcare IT community. Would be fun to get “the band” back together again and see what’s changed since this video and what’s still the same. Unfortunately, I think that much of it is still the same.

Predicting the Top Patient Engagement Themes of #HIMSS18

Posted on February 12, 2018 I Written By

The following is a guest blog post by Brittany Quemby, Marketing Strategist for Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Brittany Quemby - StericycleWe all have different motivations in life – and when it comes to your health, it is no different. Motivation strikes us all differently, especially regarding eating well, exercising, maintaining good health, and engaging in our healthcare.  Have you ever thought about what motivates you when it comes to your healthcare?

For instance, I love carbs. So, my motivation for exercising is the reward of being able to eat pizza and pasta without feeling guilty. When it comes to my relationship with my provider, I want to be able to conveniently schedule an appointment without waiting on hold for over an hour. With this in mind, I’ve been thinking about some of the ways the industry is starting to close communication gaps in an effort to improve patient experiences, and how these trends will influence focus at the HIMSS18 conference in Las Vegas.

Below are some of the themes to keep a look for at HIMSS18 that are driving more strategic engagement amongst patients and providers.

Convenience

As consumers, we drive trends and change in the market. As patients, we do something similar in the healthcare market: drive our healthcare experiences.  Consumers and patients alike want convenience and quality and will choose care providers accordingly.

Take those aged 18 to 34, or millennials, as an example. They are now the largest generation in the U.S. labor force right, surpassing Gen Xers according to U.S. Census Bureau data by Pew Research.  Convenience for this generation is a top motivator. Millennials, for example, find it inconvenient to see their physician and find scheduling preventative visits and booking appointments to be a chore. A survey from Salesforce and Harris Poll showed that 71 percent of millennials want to be able to book appointments through mobile apps.

And I think I can speak for the rest of us by saying that convenience is at the top of list for everyone else. According to Accenture, 64 percent of all patients will book appointments digitally by 2019. Tapping into the convenience card is essential for establishing lasting engagement with patients while delivering an optimal user experience.

Access

It’s time to say goodbye to 9 a.m. to 5 p.m. support. Unfortunately for Dolly, these days it is no way to make a livin’. Consumers have grown accustomed to instant gratification and are looking for constant accessibility. In fact, a recent EMC report found that patients want faster access to services. The report found that a whopping 45 percent wanted 24/7 access and connectivity and 42 percent wanted access on more devices.

For most, patients’ craving more access shouldn’t be a surprise. Whether it’s through portals, apps, phone, email, chat, or text – we want it! Patients have become much more comfortable with new technology and are constantly seeking new tools that make accessing and engaging with our providers easy.

Personalization

You know that feeling when the barista calls out your name when your coffee is ready? You strut up to the counter, grab the cup with your name on it, and enjoy the hot brew that was made especially for you. The same sentiment can be created in the healthcare space, and can lead to enticing results. Personalized patient engagement correlates with better care outcomes. The more involved and invested a patient is and feels with his or her healthcare, the greater the likelihood for successful outcomes.

An EMC report showed that 47 percent of patients want “personalized” experiences. The key for healthcare providers is the same as the barista: know your customer. Not all patients are the same, and treating them as such deters them from taking part in their health. Utilizing data and preferences, healthcare organizations can tailor interactions with patients, including what doctor a patient prefers, their health history, how they like to communicate, and potential other health issues, allowing treatment options to become easy, delightful, and accessible.

Conclusion

As the industry goes forward to improve upon strategic patient experience improvement, research from PwC suggests that the solution is systemic: 73 percent of provider executives say balancing patient satisfaction and employee job satisfaction is a barrier to efforts to improve the patient experience. But with the right technology-based tools and human support, this barrier can be lifted, helping eliminate employee hardships and improve the patient experience by delivering on each of the above trends.

If you’re going to be at HIMSS18, come and stop by the Stericycle Communications Solutions booth #859 to share your ideas and perspectives on patient engagement.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality live agent services, scheduling solutions, and automated messaging solutions.  Stericycle Communication Solutions provides unified human & tech-enabled communication solutions for optimized patient experiences.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Key Articles in Health IT from 2017 (Part 1 of 2)

Posted on January 2, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This article provides a retrospective of 2017 in Health It–but a retrospective from an unusual perspective. I will highlight interesting articles I’ve read from the year as pointers to trends we should follow up on in the upcoming years.

Indubitably, 2017 is a unique year due to political events that threw the field of health care into wild uncertainty and speculation, exemplified most recently by the attempts to censor the use of precise and accurate language at the Centers for Disease Control (an act of political interference that could not be disguised even by those who tried to explain it away). Threats to replace the Affordable Care Act (another banned phrase) drove many institutions, which had formerly focused on improving communications or implementing risk sharing health care costs, to fall back into a lower level of Maslow’s hierarchy of needs, obsessing over whether insurance payments would cease and patients would stop coming. News about health IT was also drowned out by more general health topics such as drug pricing, the opiate crisis, and revenue pressures that close hospitals.

Key issues

But let’s start our retrospective on an upbeat note. A brief study summary from January 4 reported lower costs for some surgeries when hospitals participated in a modest bundled payment program sponsored by CMS. This suggests that fee-for-value could be required more widely by payers, even in the absence of sophisticated analytics and care coordination. Because only a small percentage of clinicians choose bold risk-sharing reimbursement models, this news is important.

Next, a note on security. Maybe we should reprioritize clinicians’ defenses against the electronic record breaches we’ve been hearing so much about. An analysis found that the most common reason for an unauthorized release of data was an attack by an insiders (43 percent). This contrasts with 26.8 percent from outside intruders. (The article doesn’t say how many records were compromised by each breach, though–if they had, the importance of outside intruders might have skyrocketed.) In any case, watch your audit logs and don’t trust your employees.

In a bracing and rare moment of candor, President Obama and Vice President Biden (remember them?) sharply criticized current EHRs for lack of interoperability. Other articles during the year showed that the political leaders were on target, as interoperability–an odd health care term for what other industries call “data exchange”–continues to be just as elusive as ever. Only 30% of hospitals were able to exchange data (although the situation has probably improved since the 2015 data used in the study). Advances in interoperability were called “theoretical” and the problem was placed into larger issues of poor communication. The Harvard Business Review weighed in too, chiding doctors for spending so much money on systems that don’t communicate.

The controversy sharpened as fraud charges were brought against a major EHR vendor for gaming the certification for Meaningful Use. A couple months later, strangely, the ONC weakened its certification process and announced it would rely more on the vendors to police themselves.

A long article provided some historical background on the reasons for incompatibility among EHRS.

Patients, as always, are left out of the loop: an ONC report finds improvements but many remaining barriers to attempts by patients to obtain the medical records that are theirs by law. And should the manufacturers of medical devices share the data they collect with patients? One would think it an elementary right of patients, but guidance released this year by the FDA was remarkably timid, pointing out the benefits of sharing but leaving it as merely a recommendation and offering big loopholes.

The continued failure to exchange data–which frustrates all attempts to improve treatments and cut costs–has led to the question: do EHR vendors and clinicians deliberately introduce technical measures for “information blocking”? Many leading health IT experts say no. But a study found that explicit information blocking measures are real.

Failures in interoperability and patient engagement were cited in another paper.

And we can’t leave interoperability without acknowledging the hope provided by FHIR. A paper on the use of FHIR with the older Direct-based interoperability protocols was released.

We’ll make our way through the rest of year and look at some specific technologies in the next part of the article.

Make The Busy Patient’s Living Room Their Waiting Room

Posted on December 14, 2017 I Written By

The following is a guest blog post by Chelsea Kimbrough from Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms

Chelsea Kimbrough

Patients are busier than ever before. Between the hours of eight to five, a majority have only limited availability to reach out to their healthcare providers. And after the day’s work is done, other responsibilities – such as their children’s after-school activities or errands – reign supreme. Providing easy-access avenues to securing care is the key to acquiring these patients’ loyalty.

In many ways, I’m the busy patient described above. And when I recently came down with a stubborn cough and began looking for an urgent care that could quickly see me, I experienced what I already knew: many healthcare organizations are unequipped to provide care that caters to digitally-minded patients. There were three key problems with my experience.

Problem: Limited Information Available Online
When initially searching for a local urgent care, I struggled to learn more about what a typical experience looked like at various locations. As a first time, admittedly nervous urgent care patient, I wanted to make an informed decision about where to receive care. However, I found that many websites did not offer the insight I sought. Without more information to go off of, I made my decision based on the health system’s good reputation.

Solution: Beef Up Your Web Presence
Ensuring your website has information for all patient types – especially those who may be less familiar with what your unique experience may include – will provide greater peace of mind, set accurate expectations, and enhance patient satisfaction.

Problem: Inability to Reserve Estimated Treatment Time Online
For many, leaving work to sit in a waiting room isn’t a viable option. And without an easy way to reserve an estimated treatment time or insight regarding how long the wait time may be, making time to seek valuable care can be a challenging task. While I was able to leave work early and spend the afternoon at my chosen urgent care, many others don’t have the same flexibility in their positions.

Solution: Introduce Urgent Care Digital Check-In
Enabling patients to reserve their place in line from wherever they may be creates a more seamless patient experience, enhances their sense of access, and creates greater operational efficiency within your facility.

Problem: Forced to Wait in Waiting Room
Though I was lucky be able to leave work early and wait for care at the facility, I would have much rather waited at home. Unfortunately, the urgent care only allowed patients to wait to be seen from within the waiting room with little way of entertainment; leaving would forfeit the patient’s place in the queue. As someone who has been spoiled with this capability across numerous restaurant, veterinary, and mechanic experiences, I was disappointed to find this feature wasn’t readily provided by the healthcare facility.

Solution: Automatically Notify Patients When It’s Time to Be Seen
More patients than ever have access to convenient communication tools. By digitizing your check-in process, you can enable patients to wait from the comfort of their home and notify them when it’s nearly time to be seen via an automated text message or voice call.

In all, my urgent care experience took over two hours. Had the facility provided access to more information regarding what my experience could include, the ability to reserve an estimated treatment time online, and a convenient reminder when my time to be seen neared, I could have saved over an hour spent sitting in the waiting room. If I had access to these capabilities, I could have spent this time completing important work tasks while relaxing (and keeping my germs) at home.

To learn more about how busy, consumer-minded patients are driving the need for omnichannel experiences in the healthcare industry, check out our recent e-book, OmniWhat?!

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

Evolving Message Systems Learn To Filter And Route Alerts For Health Care Providers

Posted on December 11, 2017 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Because health care is a collaborative endeavor, patients can suffer if caretakers don’t get timely notifications. At the same time, the caretakers suffer when they are overloaded with alerts. Threading one’s way through this minefield (“Communications are complicated,” Vocera CMIO, Dr. Benjamin Kanter told me) was the theme of November’s Healthcare Messaging Conference and Exhibition at the Harvard Medical School. Like HIMSS, the major conference in health IT, something of a disconnect existed here between the conference and the exhibition. The speakers in the sessions implicitly criticized what the vendors were offering, information overload being the basic accusation.

Conference speakers told story after story of well-meaning installations of messaging systems that almost literally assaulted the staff with dozens of messages an hour. Kenny Schiff of CareSight reported seeing boxes full of expensive devices stuffed into closets in many hospitals. Dr. Trey Dobson reported research suggesting that 85% of standard hospital alarms require no intervention at all. He speculated that messaging has similar wasteful effects. In his facility, the Southwestern Vermont Medical Center at Dartmouth, they determined which lab results need to be delivered to the physician immediately and which could wait. They greatly reduced the number of messages sent about labs, which in turn decreased delivery time for important messages from an average of 50 minutes to only 7 minutes. These stories show both the benefits and drawbacks of current messaging systems.

State of the science
We all remember the first generations of pagers. Modern messaging systems, as represented by the vendors at the Healthcare Messaging Exhibition, offer a much sleeker experience, including:

  • Knowledge about who is responsible for a patient. No longer should messages be delivered to the nurse who left his shift an hour ago. The technical mechanism for tracking the role played by each clinician is group membership, familiar from the world of security. All clinicians who share a responsibility–such as working on a particular ward or caring for a particular patient–are assigned to a group. The status of each clinician is updated as he or she logs into the system, so that the message is delivered to the doctor or nurse currently on duty. A clinician dealing with one urgent situation should also not be interrupted by messages about another situation.

  • Full tracking of a message throughout its lifetime. The system records not only when a message was sent, but whether and when it was read. A message that goes ignored after a certain period of time can be escalated to the next level, and be sent to more and more people until someone addresses it.

  • Flexibility in delivery medium: mobile device, pager, computer, WiFi link, cellular network.

  • Sophisticated auditing. If a hospital needs to prove that a message was read (or that it was never read), the logs have to support that. This is important for both quality control and responses to legal or regulatory actions.

  • Integration with electronic health record systems, which allows systems to include information about the patient in messages.

  • HIPAA compliance. This essentially requires just garden-variety modern encryption, but it’s disturbing to learn how many physicians are breaking the law and risking their patients’ confidentiality by resorting casually to non-compliant messaging services instead of the ones offered at this exhibtion, which are designed specifically for health care use.

  • Cloud services. Instead of keeping information on devices, which can lead to it becoming lost or unavailable, it is stored on the vendor’s servers. This allows more flexible delivery options.

Although some of these advances generate more informative and useful messages, none of them reduce the number of messages. In fact, they encourage a vast expansion of the number of messsages sent. But some companies do offer enhancements over the common traits just cited.

  • Vocera has been connecting health care staff for many years. The company formed the subject of my first article on health IT in 2003, and of course its technology has evolved tremendously since then. Their services extend beyond the hospital to the primary care physician, skilled nursing facilities, and patients themselves. Dr. Kanter told me that they conceive of their service not simply as messaging, but as a form of clinical decision support. Their acquisition of Extension Healthcare in 2016 allowed them to add a new dimension of intelligence to the generation of messages. For instance, the patient’s health record can be consulted to determine the degree of risk presented by an event such as getting out of bed: if the patient has a low risk of falling, only the patient’s nurse may be alerted. Location information can also be incorporated into the logic, so that for instance a nurse who is already in the patient’s room will not receive an alert for that patient. Vocera has a rules engine and works with hospitals to develop customized rules.

  • HipLink has a particularly broad range of both input and delivery devices. In addition to all the common devices used by clinicians, HipLink can convert text to voice to call a plain telephone with a message. CEO Pamela LaPine told me it also accepts input not only from medical sensors, but from sensors embedded in fire alarms, doors, and other common props of medical environments.

  • OnPage helps coordinate secure communications through the use of schedules, individual and group messaging, and message tracking. For instance, the end of an operation may generate a message to the nursing staff to prepare for the arrival of a post-op patient. A message to the cleaning staff might be generated in order to prepare a room. All the necessary messages are presented to a dispatcher on a console.

  • 1Call, which provides a suite of innovative and integrated scheduling and communication applications, includes prompts to call center staff, a service they call Intuitive Call Flow Navigation. For a given situation, the service can help the staff give the information needed at the right point in each call. The same logic applies to the automated processes carried out with 1Call’s integration engine and automated notification software, which can also consolidate messaging based on rules, be customized to each organization’s needs, and improve efficiency throughout the organization.

Michael Detjen, Chief Strategy Officer of Mobile Heartbeat, laid out the pressures on messaging companies to evolve and become more like other cutting-edge high-tech companies. As messaging become universal through a health care institution, workflows come to depend on it, and thus, patient lives depend on it too. Taking the system down for an upgrade–or even worse, having it fail–is not acceptable, even at 2:00 in the morning. Both delivery and successful logging must be guaranteed, both for quality purposes and for compliance. To achieve this kind of reliability, developers must adopt the advanced development techniques popular among the most savvy software companies, such as DevOps and continuous testing and integration.

Looking toward the future
In his presentation, Schiff described some of the physical and logistical requirements for messaging devices. Clinicians should be able to switch devices quickly in case one is lost. They should be able simply to run their ID card through a reader, pick up a new device, and have it recognize them along with their message history (which means storing the messages securely in the cloud). Login requirements should be minimized, and one-hand operation should be possible. Schiff also looks forware to biometric identification of users.

Shahid Shah pointed out that the burden current messaging places on caregivers amounts to a form of uncompensated care. If messages are sent just to reassure patients, doctors and nurses will treat them as annoyances to be avoided. However, if the messages improve productivity, staff will accept them. And if they improve patient outcomes, so much the better–as long as fee-for-value reimbursements allow the health care provider to profit from improved outcomes.

To introduce the intelligence that would make messaging beneficial, Shah suggests more workflow analysis and the automation of common responses. A number of questions regarding patients could be answered automatically by bots, leaving only the more difficult ones for human clinicians.

The message regarding messaging was fairly consistent at the Healthcare Messaging Conference. Messaging has only begun to reap the benefits it can provide, and requires more analytics, more workflow analysis, and more integration with health care sites to become a boon to health care staff. The topic was a rather narrow one for a two-day conference, perhaps the reason it did not attract a large audience in its first iteration. But perhaps the conference will help drive messaging to new levels of sophistication, and become true life-savers while reducing burdens on clinicians.

Healthcare messaging and communication is also one of the focuses of our conference Health IT Expo happening May 30-June 1, 2018 in New Orleans. If you’re in charge of your hospital messaging systems, join us in New Orleans for an in depth look at best practices, hacks, and strategies for hospital messaging and communication.

This article is also available in a Portuguese translation by homeyou.