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MGMA 2018 Keynotes Hit Back-to-Back Home Runs

Posted on October 2, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Not far from legendary Fenway Park, MGMA hit back-to-back home runs with their opening keynotes: Simon Sinek and Mel Robbins. Both had us completely enthralled and hanging on their every word. It was an incredible way to start a conference.

I have never been more excited for a set of keynotes than I have for the 2018 MGMA Annual Conference #MGMA18Annual. When the agenda for the conference was officially released I was pleasantly surprised to see not one, but TWO well-known keynote speakers.

Simon Sinek is best known for his TEDTalk – “How great leaders inspire action” which became one of the most popular ever produced. In it Sinek talks about getting past WHAT you offer and HOW you offer it in order to reach the crucial WHY you do what you do. It is one of my favorite videos to watch.

Sinek’s #MGMA18Annual keynote was based on his latest work on Finite vs Infinite Games of Leadership. For a preview you can watch this video of his presentation at Google.

According to Sinek a finite game is one where there known players, fixed rules and an agreed upon objective. Baseball, football and hockey are classic examples of finite games. Infinite games, have known and unknown players, changeable rules and the objective is to keep the game going. With infinite games there are no winners or losers. The only way the game ends is when the second-to-last player loses the will or the resources to continue playing the game.

Sinek used the Cold War as an example of an infinite game. The Soviet Union was the second-to-last player and they dropped out when they lost the will and the resources to keep playing. Sinek warns that when you pit a finite player vs an infinite player you are in fact playing an infinite game and inevitably the finite player loses. That is because the finite player is playing to WIN whereas the infinite player is playing to keep playing. Sooner or later the finite player will drop out – not prepared to dedicate as much resources to the game as the infinite player.

Sinek applied this finite vs infinite game analogy to business and found that too many companies are finite players in an infinite game. “We talk about being number 1.” said Sinek. “We boast about beating the competition, but in fact that isn’t the case at all in business. There is no winner. You are either ahead or behind, but you can’t actually win in the game of business. You just have to keep playing.”

According to Sinek, one of the keys to succeeding in an infinite game is to have a Just Cause. Such a cause will help you rally the necessary resources and will to keep playing the game. Ending child poverty, and making the sum total of human knowledge searchable are examples of Just Causes.

Healthcare clearly has a Just Cause – to help people live longer, healthier lives. So why is healthcare in such a quagmire? (something Sinek claims is typical of finite players in an infinite game). This was one of the questions posed by a member of the audience at #MGMA18Annual. Sinek’s answer was brilliant.

“I believe that the problem in healthcare is that many organizational leaders have mistakenly taken the industry’s Just Cause and made it their own. Healthcare as industry is supposed to keep people healthy. However, the job of the leaders of healthcare organizations isn’t to make people healthy. No! Their job is to take care of the people who deliver care to patients.”

Imagine how different healthcare would be if administrators, healthcare leaders and government officials all had the same goal: taking care of the physicians, nurses and support staff under their influence. Think about the level of care a patient would receive if the doctor and the nurse felt that the organization they worked for had their back? How different would the patient experience be?

Home Run #1.

Mel Robbins, #MGMA18Annual’s second keynote speaker, kicked off Day 2 of the conference with a rousing session centered on her transformative 5 second rule. Her simple rule has helped people stay sober, save their marriages and turn-around failing careers. The rule is so simple that she felt obligated to call it out in her opening: “After I tell you the secret of the 5 second rule, most of you will likely say to yourself – that can’t possibly work, but trust me it does. And that’s the beauty of it, it’s simple.”

In a nutshell, Robbins method involved counting down from 5 whenever you find yourself starting to have a negative thought or when you feel yourself making an excuse NOT to do something you know you should.

Roll out of bed and see your running shoes, but then look outside and see that a few dark clouds. Don’t let the excuse fully form in your mind. Instead, change your mental soundtrack by counting down 5 – 4 – 3 – 2 – 1 and then do it. See a task that you’ve been putting off all day, 5 – 4 – 3 – 2 – 1 and dive in. Sounds too simple right?

Robbins spent much of her time on stage giving scientific evidence and examples of how this 5 second rule actually works. She talked about being on “autopilot” – a mental state where your brain falls back on learned behaviour to guide the actions you take. Procrastination and self-doubt are the autopilot settings for most of us. According to Robbins, in order to break free of autopilot, you need to engage your frontal cortex – which is what happens when you count down from 5.

This simple brain hack puts you back in control of your actions and suddenly the excuses melt away and you get on with the necessary task. That essay suddenly gets written, the house gets painted, the phone call gets made and the important email gets sent.

Robbins was quick to point out that her 5 second rule did not apply to life-or-death medical decisions, nor should it be used to make important financial or life-altering decisions. It was meant to be used when we start hearing the voice of our inner doubts.

I must admit that when I first watched Robbin’s TEDTalk I did not internalize her message. I fell into the trap and thought it was too simple to be effective. Hearing her deliver her message live at #MGMA18Annual changed my mind. It’s only been a day but already I’ve used Robbin’s 5 second rule to climb the stairs instead of using the escalators at the convention center, opt for water instead of soda,  and write this blog before going to bed.

Home Run #2

Thank you MGMA organizers.

Patient Billing And Collections Process Needs A Tune-Up

Posted on October 1, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study from a patient payments vendor suggests that many healthcare organizations haven’t optimized their patient billing and collections process, a vulnerability which has persisted despite their efforts to crack the problem.

The survey found that while the entire billing collections process was flawed, respondents said that collecting patient payments was the toughest problem, followed by the need to deploy better tools and technologies.

Another issue was the nature of their collections efforts. Sixty percent of responding organizations use collections agencies, an approach which can establish an adversarial relationship between patient and provider and perhaps drive consumers elsewhere.

Yet another concern was long delays in issuing bills to patients. The survey found that 65% of organizations average more than 60 days to collect patient payments, and 40% waited on payments for more than 90 days.

These results align other studies that look at patient payments, all of which echo the notion that the patient collection process is far from what it should be.

For example, a study by payment services vendor InstaMed found that more than 90% of consumers would like to know what the payment responsibility is prior to a provider visit. Worse, very few consumers even know what the deductible, co-insurance and out-of-pocket maximums are, making it more likely that the will be hit with a bill they can’t afford.

As with the Cedar study, InstaMed’s research found that providers are waiting a long time to collect patient payments, three-quarters of organizations waiting a month to close out patient balances.

Not only that, investments in revenue cycle management technology aren’t necessarily enough to kickstart patient payment volumes. A survey done last year by the Healthcare Financial Management Association and vendor Navigant found that while three-quarters of hospitals said that their RCM technology budget was increasing, they weren’t necessarily getting the ROI they’d hoped to see.

According to the survey, 77% of hospitals less than 100 beds and 78% of hospitals with 100 to 500 beds planned to increase their RCM spending. Their areas of investment included business intelligence analytics, EHR-enabled workflow or reporting, revenue integrity, coding and physician/clinician documentation options.

Still, process improvements seem to have had a bigger payoff. These hospitals are placing a lot of faith in revenue integrity programs, with 22% saying that revenue integrity was a top RCM focus area for this year. Those who would already put such a program in place said that it offered significant benefits, including increased net collections (68%), greater charge capture (61%) and reduced compliance risks (61%).

As I see it, the key takeaways here are that making sure patients know what to expect financially and putting programs in place to improve internal processes can have a big impact on patient payments. Still, with consumers financing a lot of their care these days, getting their dollars in the door should continue to be an issue. After all, you can’t get blood from a stone.

A Justin Bieber Opioid Ballad from ZDoggMD

Posted on September 28, 2018 I Written By

John Lynn is the Founder of the 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 and 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 a casual work Friday here at Healthcare Scene, so we like to take off from our regularly scheduled programming for something a little more casual. The latest parody video from ZDoggMD is about the Opioid Crisis and might be his best work yet. The messages he shares in the video are really spot on. I can imagine many of the legitimate chronic pain suffers might not like some of the ways it characterizes those who use opioids, but I thought ZDoggMD covers that in his comments about the impact the opioid crisis has had on chronic pain patients.

Check out the video below:

Have a great weekend and let’s all do what we can to help those around us impacted by opioids.

Healthcare AI Could Generate $150B In Savings By 2025

Posted on September 27, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Is the buzz around healthcare AI solutions largely hype, or can they deliver measurable benefits? Lest you think it’s too soon to tell, check out the following.

According to a new report from market analyst firm Frost & Sullivan, AI and cognitive computing will generate $150 billion in savings for the healthcare business by 2025.  Frost researchers expect the total AI market to grow to $6.16 billion between 2018 and 2022.

The analyst firm estimates that at present, only 15% to 20% of payers, providers and pharmaceutical companies have been using AI actively to change healthcare delivery. However, its researchers seem to think that this will change rapidly over the next few years.

One of the most interesting applications for healthcare AI that Frost cites is the use of AI in precision medicine, an area which clearly has a tremendous upside potential for both patients and institutions.

In this scenario, the AI integrates a patient’s genomic, clinical, financial and behavioral data, then cross-references the data with the latest academic research evidence and regulatory guidelines. Ultimately, the AI would create personalized treatment pathways for high-risk, high-cost patient populations, according to Koustav Chatterjee, an industry analyst focused on transformational health.

In addition, researchers could use AI to expedite the process of clinical trial eligibility assessment and generate prophylaxis plans that suggest evidence-based drugs, Chatterjee suggests.

The report also lists several other AI-enabled solutions that might be worth implementing, including automated disease prediction, intuitive claims management and real-time supply chain management.

Frost predicts that the following will be particularly hot AI markets:

  • Using AI in imaging to drive differential diagnosis
  • Combining patient-generated data with academic research to generate personalized treatment possibilities
  • Performing clinical documentation improvement to reduce clinician and coder stress and reduce claims denials
  • Using AI-powered revenue cycle management platforms that auto-adjust claims content based on payer’s coding and reimbursement criteria

Now, it’s worth noting that it may be a while before any of these potential applications become practical.

As we’ve noted elsewhere, getting rolling with an AI solution is likely to be tougher than it sounds for a number of reasons.

For example, integrating AI-based functions with providers’ clinical processes could be tricky, and what’s more, clinicians certainly won’t be happy if such integration disrupts the EHR workflow already in existence.

Another problem is that you can’t deploy an AI-based solution without ”training” it on a cache of existing data. While this shouldn’t be an issue, in theory, the reality is that much of the data providers generate is still difficult to filter and mine.

Not only that, while AI might generate interesting and effective solutions to clinical problems, it may not be clear how it arrived at the solution. Physicians are unlikely to trust clinical ideas that come from a black box, e.g. an opaque system that doesn’t explain itself.

Don’t get me wrong, I’m a huge fan of healthcare AI and excited by its power. One can argue over which solutions are the most practical, and whether AI is the best possible tool to solve a given problem, but most health IT pros seem to believe that there’s a lot of potential here.

However, it’s still far from clear how healthcare AI applications will evolve. Let’s see where they turn up next and how that works out.

2018 Thrival Festival. Are We Asking the Right Questions?

Posted on September 26, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Presentations in a botanical garden. Workshops in an actual work shop. Disco in a museum. The 2018 Thrival Festival eschewed tradition and challenged attendees to ponder: Are we asking the right questions when it comes to humanity + technology + art?

The annual Thrival Festival held in Pittsburgh PA is truly unique. It combines art, technology, philosophy, music, and yes, even healthcare, into an event that is part science fair and part theatre. Instead of holding the event in a traditional auditorium or hotel, the organizers chose the beautiful Phipps Conservatory and Botanical Gardens as the setting for this year’s event.

Rising like a glass armadillo out of lush grass splashed here and there with colorful flowers, the Conservatory welcomed attendees with a warm scent of green leaves and rich earth. It was immediately apparent we were in for something different as we passed through the mammoth glass entryway and wound our way through the maze of monarchs and waterfalls to reach the main session room.

With sunshine and mother nature as a backdrop, Thrival kicked off with a keynote from John Battelle @johnbattelle, CEO and Editor-in-Chief of WIRED. Battelle wasted no time in setting the tone for the day. Early in his presentation he put up the following picture from National Geographic with the caption: What makes us human?

© Martin Schoeller/National Geographic

The image was from National Geographic’s October 125th anniversary issue (2013) where they photographed the new faces of America – a reflection of the blurring of traditional racial and ethnic lines. Battelle used the slide to highlight that society will soon be challenged to define humanity more broadly than before – as we manipulate our genes, embed technology into our bodies and program human-like qualities into robots.

Later in the morning, the issue of do-it-yourself implantable devices and pseudo-scientific injectable cocktails was discussed by a panel of experts. Dr. Rasu Shrestha @RasuShrestha was asked: Is biohacking the future of medicine? With a smile and wink, he deftly answered the question by putting forward the notion that the original healers and physicians were themselves the biohackers of their day. Instead of nanobots they used herbs and crude instruments to try and cure our pre-industrial ancestors.

*Yes, Rasu did use “OG” in his answer, to the delight of the audience.

The panel also featured Rich Lee @lovetron9000 the controversial sex technologist who not only installed a vibrating implant in himself but also recently self-injected a gene therapy that he hopes will cure him of his color blindness. Vilified by authorities, Lee was decidedly normal both on and off the stage answering questions about his motivations.

Over lunch I had the opportunity to chat with Laura Montoya, Founder of Accel:AI and Director of Women Who Code. Montoya teaches development teams to consider the ethical issues relating to AI algorithms. She posed the most interesting question of the day: Would you get into a self-driving car if you knew the algorithm governing it would choose to save the life of a pedestrian over you the passenger?

“Think of it this way,” explained Montoya. “When you sign up for a ride-sharing service, you have to agree to the company’s terms of use. Buried in that agreement is a waiver of liability. Essentially you as an individual are opting into the fact that you are okay with being driven around by a computer rather than an actual driver. The liability of the company for you is therefore limited. Now think about the pedestrian. They have not opted into the company’s self-driving car. They have not agreed that a self-driving car should be in their neighborhood. Therefore, the pedestrian represents a potentially high financial liability – being an innocent bystander. So if the car is faced with the choice of crashing into the pedestrian vs crashing into a tree, would the difference in the degree of liability influence it’s decision. And if it did, would you have knowingly gotten into the vehicle in the first place.”

*Note to self, uncheck the self-driving option from my Uber app.

My Thrival afternoon began with a short viewing of GAPPED – a documentary from Molten Media Group. The excerpt contained powerful and moving interviews of Pittsburgh residents who were in danger of being left behind by the innovation boom that the city is currently enjoying. After the screening, the producers of the film shared that they were seeking to answer a single question: Will Pittsburgh and its people have the chance to rise together or will those unwilling to adapt be left behind?

To me the film asks a much broader question: What happens when innovation wealth is unequally distributed within an ecosystem? And I don’t mean the spoils of innovation like money, equity stakes and fancy offices. What happens when public and private programs inadvertently leave out a portion of the local population? Is it fair that 95% of the innovation seed funding goes to middle-class college graduates while innovators living under the poverty line struggle to keep afloat? I can’t wait to see the entire film when it is released later this year.

I decided to end my Thrival day by attending the Moonshot Workshop led by the XPRIZE Foundation – the people behind the space competition that spawned Virgin Galactic and SpaceX. The workshop started with a short presentation by Amir Banifatemi, AI Lead at XPRIZE. Banifatemi explained the process they go through to curate, refine and define the incentive competitions that “entice the world to take action”. It turns out that it takes the team at XPRIZE over nine months to clearly define one of their challenges.

“If we define the challenge too broadly, teams become overwhelmed with where to start.” Said Banifatemi. “Problems need to be specific enough to spark the imagination but not so blue-sky that people get lost in the possibilities. If we make our challenges too difficult, we may discourage people from entering. It turns out that coming up with the right question, the right challenge is almost as hard as solving it. But if you get the question right, magic happens.

Banifatemi’s statement was the perfect bow on my day at Thrival Festival. Before innovation can happen, a problem or challenge must first exist. Once we understand that problem, our collective imaginations can be unleashed. Better definition of the problem leads to better innovation. The question of: “How can we look inside the human body?” begat X-ray machines. The more refined question of: “How can we look inside the human body without causing harm to the person and with sufficient detail to see tissue?” begat MRI machines (okay maybe a bit of a stretch, but you get the idea).

As the high-energy techno anthems from Veserium washed over me at the Thrival evening event, I found myself thinking about all the questions we are asking in healthcare. Perhaps we need to take a moment and ask ourselves if we are really asking the right ones.

How Does Interoperability Affect Technology Adoption in Healthcare? – #HITsm Chat Topic

Posted on September 25, 2018 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/28 at Noon ET (9 AM PT). This week’s chat will be hosted by Niko Skievaski @niko_ski from @redox.

In her opening remarks at the 2nd ONC Interoperability Forum, Centers for Medicaid and Medicare (CMS) Administrator Seema Verma set the goal of eliminating the use of fax machines in healthcare by 2020. It’s true – fax is still the most common form of communication among providers for transmission of medical records, test results, instructions, and treatment regimens all thanks to its insusceptibility to hacking. While the rest of the world is embracing digitalization and the benefits it has brought us, healthcare seemed a bit reluctant about moving on. Fax or other paper-based records are largely inconvenient and created barriers to information exchange.

In the era of artificial intelligence and machine learning, we’re generating data in an unbelievable speed – more information to process, exchange and analyze, posing bigger challenges for snail-paced interoperability progress. Tech giants see this lack of interoperability as a perfect opportunity to enter healthcare and disrupt the “broken” industry. Apple Health is promoting open API for iOS users to own their health data; Amazon’s working with multiple healthcare organizations to build its own system; and the recent interoperability pledge by the six big companies is set to transform healthcare data infrastructure.

Coming from an outsider perspective, these companies are familiar with the user authorization approach. When you sign in to an app with your Google account, you’ll be asked to grant the app access to your information through an authentication protocol called OAuth 2.0. Ideally, this is the vision for healthcare data use in the future.

But the existing healthcare data infrastructure, in the meantime, is drastically different from the one these tech giants are familiar with. Perhaps a more realistic, pragmatic approach is to work with the established stakeholders in healthcare, particularly the big EHR vendors, instead of bringing in a whole new system to solve interoperability.

Join us for this week’s #HITsm chat to discuss interoperability’s impact on technology adoption in healthcare and share your opinions on what stakeholders need to do to improve interoperability and accelerate technology adoption.

Topics for this week’s #HITsm Chat:
T1: What are the biggest barriers to technology adoption in healthcare? #HITsm

T2: Is interoperability more challenging now with more data generated by technologies such as AI? #HITsm

T3: Will patient-authorized API access bring fundamental changes to interoperability? #HITsm

T4: How will tech giants’ move into healthcare impact interoperability? #HITsm

T5: What needs to be done by the established stakeholders in healthcare, e.g. EHR vendors, to solve interoperability? #HITsm

Bonus: What do you want as a patient when it comes to interoperability? #HITsm

Upcoming #HITsm Chat Schedule
10/5 – Medication Compliance & Drug Monitoring
Hosted by Joy Rios (@askjoyrios) and Robin Roberts (@rrobertsehealth)

10/12 – TBD
Hosted by Janet Kennedy (@getsocialhealth) and Carol Bush (@TheSocialNurse) from the Healthcare Marketing Network

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Going from Paper-Based Consents to eConsents in Healthcare

Posted on September 24, 2018 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For years we’d talk about the “paperless office” that would be created by the adoption of EHR software. Years later, that paperless office still doesn’t exist. One of the big reasons this hasn’t come to fruition is because EHRs can print massive reams of paper with the click of the button. Another reason the paperless office still alludes us is paper-based consents.

For years, there wasn’t a good way to replace paper-based consents with eConsents. However, that’s not the case today. To help us move towards the paperless office and to learn about adoption of eConsents in healthcare, I interviewed Robin McKee, MS, RN, Director of Clinical Informatics Solutions at FormFast. In this interview, Robin offers a lot of great insights into consents in healthcare and the value of healthcare organizations moving towards eConsents.

What are the main reasons people are still doing paper-based consents?

I see two big reasons for this. First, it’s a case of “it’s what we’ve always done.” When EHRs were first implemented, mobile was not a part of the strategy. This meant that getting a consent in front of a patient still meant paper and a clipboard. Today, the informed consent workflow is difficult if you don’t have a mobile solution.

Another reason is the sheer magnitude of the project. Over the years, each department, even each surgeon, may have their own version of a paper form, adding up to hundreds of variations of paper consent forms stuck in drawers of offices and nurse’s stations. It is a daunting task to try and tackle the conversion, standardization, and consolidation of the plethora of paper consents without a concrete path forward.

FormFast addressed both of those issues with our mobile eConsent solution.  We digitize all of the organization’s consent forms and make them available in an online eForms library.  The forms are delivered at the point-of-care on a mobile tablet for the patient to review and sign.  Once completed, they’re automatically archived in the EHR.  It’s a much more streamlined process.

Are electronic consent forms as legally binding and effective as paper-based consents?

Yes. When you take the stylus and sign your name and submit it, an eConsent electronically dates and time stamps your signature. It also locks the content on the form to prevent it from being modified post signature.

Are there ways that electronic consents are more effective than paper-based consents?

Definitely. In addition to the benefits I mentioned in the previous question, there are several more to add.

From a maintenance standpoint, you have one form to modify and it is instantly available to all staff. Templates can be created to ensure standardized statements on all consents and provide the means to add procedure specific content. Clinicians cannot submit consent forms that have required fields left incomplete. This helps guide the process and ensure consents are completed.

Our eConsent forms also allow for links to your organization’s educational content, right on the form, so it’s easy to link out to approved content for further education while having the informed consent discussion.

What are the biggest misconceptions around electronic consents?

What I have seen most often with our customers has been the idea that the consent is not modifiable, that it is a fixed document. We provide dynamic content based on procedure selection, or editable fields, as well as areas to add content via free text or speech recognition.

Our customers appreciate having a combination of standardized, dynamic, and free text content. Every patient is unique; providers must be able to account for the specific risks, benefits, and alternatives of any procedure for each patient.

What are the costs and savings associated with implementing eConsent?

We see both direct and indirect impact on B organization’s financial landscape. The direct impact is, of course, the savings from eliminating paper. We’ve seen estimates from $3 – 6 per page due to the following factors:

  • Supplies – paper, ink, etc.
  • Materials – copiers, scanners, faxes as well as maintenance on the hardware
  • Staff – to perform printing scanning and indexing functions
  • Storage of paper records
  • Secure shredding of scanned documents

More indirect costs include the loss of productivity of procedures or operating rooms, due to the delays caused by missing or incomplete paper consent forms. A JAMA Surgery article estimated over $500K per year is lost simply on this factor. Also, while less common, malpractice claims that site a lack of informed consent comprise 2/3 of total claims, opening organizations to costly legal proceedings.

One also needs to consider the value of better forms, workflow and communication via eConsent which improves both patient and clinician satisfaction.

Many of the consents are needed in the EHR.  What’s the process for integrating eConsent into the EHR?

Electronic consent forms are superior to paper in this regard. While paper consents get lost or have to be carried around in a paper chart until they are scanned into the EHR, eConsent forms are instantly archived into the EHR. This ensures the document is archived correctly every time.  Plus it is easy to access the form in pre-op, as well as confirm in the OR during timeout. We utilize a variety of methods, including HL7 and FHIR, to integrate with any EHR or document management system.

Are eConsent forms secure and trusted?  Could a digital signature be inappropriately replicated?

There are a couple of ways we prevent signatures from being inappropriately or inaccurately added.

When a clinician chooses to digitally sign a consent form, the login user’s name is applied. Additionally, our solution provides audit logs to track who has been in the system.

We also require that the patient sign each signature field.  This helps ensure that their informed consent is accurately documented.

What are you looking at next when it comes to eConsent?

FormFast recently introduced a great feature that launches and pre-populates the right consent form for the patient by scanning the patient’s wristband.  It’s another way that we’ve tried to make the consent process more streamlined.

We continue to refine our eConsent solution based on customer feedback. No one knows better than the end users what a successful solution should look like, what it should contain, and what makes for an optimal workflow.

We look toward updates, such as enhanced notification processes, more OS compatibility, and further improving the user interface, that will continue to improve clinician and patient satisfaction.

About FormFast
With over 25 years exclusively focused on healthcare needs and 1100+ hospital clients, FormFast is recognized as the industry leader in electronic forms, eSignature, and document workflow technology. FormFast’s enterprise software platform integrates with EHRs and other core systems to automate required documents, capturing data and accelerating workflows associated with them. By using FormFast, healthcare organizations achieve new levels of standardization and operational efficiency, allowing them to focus on their core mission – delivering quality care. Learn more at

FormFast is a proud sponsor of Healthcare Scene.

Will The Fitbit Care Program Break New Ground?

Posted on September 21, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.

As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.

Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to gather activity, sleep and heart rate data. However, unlike with individual use, users have the option to let the program harvest their health data and share it with care teams, which permits them to make personalized care recommendations.

Another option Fitbit Care offers is health coaching, in which the program offers participants personalized care plans and walks them through health challenges. Coaches communicate with them via in-communications, phone calls, and in-person meetings, targeting concerns like weight management, tobacco cessation, and management of chronic conditions like hypertension, diabetes, and depression. It also supports care for complex conditions such as COPD or congestive heart failure.

In addition, the program uses social tools such as private social groups and guided workouts. The idea here is to help participants make behavioral changes that support their health goals.

All this is supported by the new Fitbit Plus app, which improves patients’ communication capabilities and beefs up the device’s measurement capabilities. The Fitbit app allows users to integrate advanced health metrics such as blood glucose, blood pressure or medication adherence alongside data from Fitbit and other connected health devices.

The first customer to sign up for the program, Fitbit Care, is Humana, which will offer it as a coaching option to its employer group. This puts Fitbit Care at the fingertips of more than 5 million Humana members.

I have no doubt that employers and health systems would join Humana experimenting with wearables-enhanced programs like the one Fitbit is pitching. At least, in theory, the array of services sounds good.

On the other hand, to me, it’s notable that the description of Fitbit Care is light on the details when it comes to leveraging the patient-generated health data it captures. Yes, it’s definitely possible to get something out of continuous health data collection, but at least from the initial program description, the wearables maker isn’t doing anything terribly new.

Oh well. I guess Fitbit doesn’t have to do anything radical to offer something valuable to payers, employers and health plans. They continue to search for behavioral interventions that actually have an impact on disease management and wellness, but to my knowledge, they haven’t found any magic bullet. And while some of this sounds interesting, I see nothing to suggest that the Fitbit Care program can offer dramatic results either.


Open Source Software and the Path to EHR Heaven (Part 2 of 2)

Posted on September 20, 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 ( 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.

The previous segment of this article explained the challenges faced by health care organizations and suggested two ways they could be solved through free and open source software. We’ll finish the exploration in this segment of the article.

Situational awareness would reduce alert fatigue and catch errors

Difficult EHR interfaces are probably the second most frustrating aspect of being a doctor today: the first prize goes to the EHR’s inability to understand and adapt to the clinician’s workflow and environment. This is why the workplace redounds with beeps and belches from EHRs all day, causing alert fatigue and drowning out truly serious notifications. Stupid EHRs have an even subtler and often overlooked effect: when regulators or administrators require data for quality or public health purposes, the EHR is often “upgraded” with an extra field that the doctor has to fill in manually, instead of doing what computers do best and automatically replicating data that is already in the record. When doctors complain about the time they waste in the EHR, they often blame the regulators or the interface instead of placing their finger on the true culprit, which is the lack of awareness in the EHR.

Open source can ease these problems in several ways. First, the customizability outlined in the first section of this article allows savvy users to adapt it to their situations. Second, the interoperability from the previous section makes it easier to feed in information from other parts of the hospital or patient environment, and to hook in analytics that make sense of that information.

Enhancements from outside sources could be plugged in

The modularity of open source makes it easier to offer open platforms. This could lead to marketplaces for EHR enhancements, a long-time goal of the open SMART standard. Certainly, there would have to be controls for the sake of safety: an administrator, for instance, could limit downloads to carefully vetted software packages.

At best, storage and interface in an EHR would be decoupled in separate modules. Experts at storage could optimize it to improve access time and develop new options, such as new types of filtering. At the same time, developers could suggest new interfaces so that users can have any type of dashboard, alerting system, data entry forms, or other access they want.

Bugs could be fixed expeditiously

Customers of proprietary software remain at the mercy of the vendors. I worked in one computer company that depended on a very subtle feature from our supplier that turned out not to work as advertised. Our niche market, real-time computing, needed that feature to achieve the performance we promised customers, but it turned out that no other company needed it. The supplier admitted the feature was broken but told us point-blank that they had no plans to fix it. Our product failed in the marketplace, for that reason along with others.

Other software users suffer because proprietary vendors shift their market focus or for other reasons–even going out of business.

Free and open source software never ossifies, so long as users want it. Anyone can hire a developer to fix a bug. Furthermore, the company fixing it usually feeds the fix back into the core project because they want it to be propagated to future versions of the software. Thus, the fixes are tested, hardened, and offered to all users.

What free and open source tools are available?

Numerous free and open source EHRs have been developed, and some are in widespread use. Most famously is VistA, the software created at the Department of Veterans Affairs, and used also by the Indian Health Service and other government agencies, has a community chaperone and has been adopted by the country of Jordan. VistA was considered by the Department of Defense as well, but ultimately rejected because the department didn’t want to invest in adding some missing features.

Another free software EHR, OpenMRS, supports health care in Kenya, Haiti, and elsewhere. OpenEMR is also deployed internationally.

What free and open source software has accomplished in these settings is just a hint of what it can do for health care across the board. The problem holding back open source is simple neglect: as VistA’s experience with the DoD showed, institutions are unwilling to support open source, even through they will pay 10 or 100 times as much on substandard proprietary software. Open Health Tools, covered in the article I just linked to, is one of several organizations that shriveled up and disappeared for lack of support. Some organizations gladly hop on for a free ride, using the software without contributing either funds or code. Others just ignore open source software, even though that means their own death: three hospitals have recently declared bankruptcy after installing proprietary EHRs. Although the article focuses on the up-front costs of installing the EHRs, I believe the real fatal blow was the inability of the EHRs to support efficient, streamlined health care services.

We need open source EHRs not just to reduce health care costs, but to transform health. But first, we need a vision of EHR heaven. I hope this article has taken us at least into the clouds.

Open Source Software and the Path to EHR Heaven (Part 1 of 2)

Posted on September 19, 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 ( 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.

Do you feel your electronic health record (EHR) is heaven or hell? The vast majority of clinicians–and many patients, too, who interact with the EHR through a web portal–see it as the latter. In this article, I’ll describe an EHR heaven and how free and open source software can contribute to it. But first an old joke (which I have adapted slightly).

A salesman for an EHR vendor dies and goes before the Pearly Gates. Saint Peter asks him, “Would you like to go to heaven or hell?”

Surprised, the salesman says, “I didn’t know I had a choice.”

Saint Peter suggests, “How about this. We’ll show you heaven and hell, and then you can decide.”

“Sounds fair,” says the EHR salesman.

First they take him to heaven. People wearing white robes are strumming harps and singing hymns, and it goes on for a long time, till they take him away.

Next they take him to hell. And it’s really cool! People are clinking wine glasses together and chatting about amusing topics around the pool.

When the EHR salesman gets back to the Pearly Gates, he says to Saint Peter, “You know, this sounds really strange, but I choose hell.”

Immediately comes a clap of thunder. The salesman is in a fiery pit being prodded with pitchforks by dreadful demons.

“Wait!” he cries out. “This is not the hell I saw!”

One of the demons answers, “They must have shown you the demo.”

Most hospitals and clinicians are currently in EHR hell–one they have freely chosen, and one paid for partly by government Meaningful Use reimbursements. So we all know what EHR hell look like. What would EHR heaven be? And how does free and open source software enable it? The following sections of this article list the traits I think clinicians would like to see.

Interfaces could be easily replaced and customized

The greatest achievement of the open source movement, in my opinion, has been to strike an ideal balance between “let a hundred flowers bloom” experimentation and choosing the best option to advance the field. A healthy open source project encourages branching, which lets any individual or team with the required expertise change a product to their heart’s content. Users can then try out different versions, and a central committee vets the changes to decide which version is most robust.

Furthermore, modularization on various levels (programming modules, hooks, compile-time options, configuration tools) allows multiple versions to co-exist, each user choosing the options right for their environment. Open source software tends to be modular for several reasons, notably because it is developed by many different individuals and teams who want control over their small parts of the system.

With easy customization, a hospital or clinic can mandate that certain items be highlighted and that safe workflow rules be followed when entering or retrieving data. But the institution can also offer leeway for individual clinicians and patients to arrange a dashboard, color scheme, or other aspect of the environment to their liking.

Many of the enablers for this kind of agile, user-friendly programming are technical. Modularity is built into programming languages, while branching is standard in version control systems. So why can’t proprietary vendors do what open source communities routinely do? A few actually do, but most are constrained in ways that prevent such flexibility, especially in electronic health records:

  • Most vendors are dragging out the lifetime of nearly 40-year old technology, with brittle languages and tools that put insurmountable barriers in the way of agile work styles. They are also stuck with monolithic systems instead of modular ones.
  • The vendors’ business model depends on this monolithic control. To unbundle components, allow mix-and-match installations, and allow third parties to plug in new features would challenge the prices they charge.
  • The vendors are fundamentally unprepared for empowered users. They may vet features with clinically trained consultants and do market research, but handling power over the system to users is not in their DNA.

Data could be exchanged in a standard format without complex transformations

Data sharing is the lifeblood of modern computing; you can’t get much done on a single computer anymore. Data sharing lies behind new technologies ranging from the Internet of Things to real-time ad generation (the reason you’ll see a link to an article about “Fourteen celebrities who passed out drunk in public” when you’re trying to read a serious article about health IT). But it’s so rare in health care–where it’s uniquely known as “interoperability”–that every year, reformers call it the most critical goal for health IT, and the Office of the National Coordinator has repeatedly narrowed its Meaningful Use and related criteria to emphasize interoperability.

Open source software can share data with other systems as a matter of course. Data formats are simple, often text-based, and defined in the code in easy-to-find ways. Open source programmers, freed from the pressures on proprietary developers to reinvent wheels and set themselves apart from competitors, like to copy existing data formats. As a stark example of open source’s advantages, consider the most recent version of the Open Document Format, used by LibreOffice and other office suites. It defines an entire office suite in 104 pages. How big is the standards document for the Microsoft OOXML format, offering roughly equivalent functionality? Currently, 6,755 pages–and many observers say even that is incomplete. In short, open source is consistently the right choice for data exchange.

What would the adoption of open source do to improve health care, given that it would solve the interoperability problem? Records could be stored in the cloud–hopefully under patient control–and released to any facility treating the patient. Research would blossom, and researchers could share data as allowed by patients. Analytical services could be plugged in to produce new insights about disease and treatment from the records of millions of people. Perhaps interoperability could also contribute to solving the notorious patient matching problem–but that’s a complicated issue that I have discussed elsewhere, touching on privacy issues and user control outside the scope of this article.

The next segment of this article will list three more benefits of free and open source software, along with an assessment of its current and future prospects.