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Face-to-Face in Medicine

Posted on July 29, 2013 I Written By

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


What a great tweet and insight into healthcare. Indeed, most people really underestimate what can be done face-to-face in healthcare. I first realized the value of this when a doctor visited my blog and described to me all of the things a doctor was observing in a face to face office visit. Everything from the way someone breathes, to the way someone sits, to the way someone coughs. It’s amazing how much data is available from just visually seeing the patient.

I agree that face-to-face is the best way to treat a patient. However, can an online video visit accomplish almost all of the upside of face-to-face interactions while minimizing any downsides? I think this is the challenge of telemedicine and something we’re making great strides in accomplishing. Of course it will never be as good as face-to-face, but I think it can get very close.

The other reason I’m a huge fan of the e-visit is that there’s a large percentage of visits where there’s no need for the visual part of the visit. Doctors know that much of the physical part of a patient visit is often just theatrics for the patient. The only reason we’re not doing more e-visits today is that doctors don’t get paid if they do e-visits. If they got paid they’d do many more with the same quality of care.

As we get more and more health sensors constantly tracking our health, we’ll need even less physical interaction to be seen by a doctor. For example, if I’ve been tracking my blood pressure twice a day at home, then is there a need for a patient to go into the doctor to get another blood pressure reading?

We’re just at the very beginning of these health sensors. The next generation doctor will be as good at understanding vast amounts of self generated health data as they are at understanding physical queues. The physical will never leave us completely, but what a doctor will be able to treat virtually will grow exponentially. The face-to-face interaction will just likely be by video instead of in an exam room.

Telemedicine Panel at CES Hosted by HealthSpot

Posted on January 9, 2013 I Written By

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

I had the chance to attend a Telemedicine panel today at CES that was put together by HealthSpot (see my previous post about HealthSpot at CES). They put together a good panel that included:
Peter Tippett, MD, PHD – Vice President, Connected Healthcare Solutions, Verizon
John F. Jesser – Vice President, Health Care Management, WellPoint
William Wulf, M.D. — Central Ohio Primary Care
Leslie Kelly Hall — Healthwise

The panel was an interesting discussion, but I think the underlying discussion really centered around how screwed up many parts of healthcare are right now. This showed itself in two different ways. One was that telemedicine could possibly fix some of those screwed up parts of healthcare. Second, telemedicine is actually hard to execute because of some of the screwed up parts of healthcare. It’s kind of odd to look at it that way.

I tweeted a number of the comments that struck me and so I thought I’d share them here for those who weren’t following along on Twitter.


This was a fitting comment at a “consumer” electronics show.


I think there are still some wackos;-), but I think the message they send is clear.


This would be a monumental achievement if we can embrace HIPAA and make the technology happen. I think the key message is: HIPAA should not be used as an excuse.


Such a no brainer question with an easy answer. Why is it so hard to do?


Will telemedicine become the “standard of care” so that this becomes a big issue? I hope we don’t reach the point that this is the reason we implement telemedicine, but it might take something like it to get people off the proverbial couch.

Get Peace of Mind and Avoid The ER With Snap.MD

Posted on November 23, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

As I was perusing HisTalkMobile.com today, the first article on the page caught my eye. A new start-up from LA aims to decrease ER visits from “worried” moms with telemedicine visits.

According to the article about Snap.md, on average, a new baby visits the doctor’s office about eight times in the first year, and when those visits are to the ER, they definitely could have been avoided. Snap.md plans to connect parents with someone in the Emergency Room for a consultation, within 10 minutes.

We’ve taken my son to the doctor many times in the past eight and half months. While many of those times were actually warranted (our son really is sick, all the time), I think this could be come in handy. Our average wait time at the doctor’s office is about 30-45 minutes, and the ER is even longer (we went a few months ago, and we were three for three hours…before we even saw someone.) This may not be the typical wait (or maybe it is!) but something like this really could cut down on the amount of time wasted going to the ER for things that may not be an emergency. Sometimes, just getting the reassurance from a health professional is all a new mother needs, and I think that is one of the goals behind this.

The article said the company is targeting three different “categories” of parents:

  1. Those without insurance
  2. Those with private insurance
  3. Medicaid families

So, it sounds like, just about anyone! The fee for those without any insurance will be around $60, which is a whole lot less than the going to the Emergency Room. From what I can tell, it looks like medicaid and private insurance companies may cover that cost, or at least, that is the hope I’m guessing. Dave Skibinski, the man behind the company, said the company isn’t trying to replace seeing a physician.

Our goal is not to direct the care. If the patient wants to see their own physician or go to a different ER, that’s fine. The point is to avoid an unnecessary visit to the ER.

In my opinion, that’s a great goal. Perhaps that would clear up the wait time at Emergency Rooms, so those that truly do have an emergency don’t have to wait quite as long.

I do think telemedicine is definitely going to play a prominent role in healthcare in the very near future, and be a significant part of mHealth. Snap.md doesn’t have a lot if information available yet, or even when it’s going to be released, but it looks like contracts have already been negotiated with a few different children’s hospitals in California, with plans to expand. I sure hope this comes to my town.

9 Ways IT is Transforming Healthcare – “Top 10” Health IT List Series

Posted on December 27, 2011 I Written By

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

As is often common at the end of the year, a lot of companies have started putting together their “Top 10” (or some similar number) lists for 2011. In fact, some of them have posted these lists a little bit earlier than usual. This week as people are often off work or on vacation, I thought it might be fun to take one list each day and comment on the various items people have on their lists.

The first list comes from Booz Allen Hamilton and is Booz Allen’s Top 9 ways IT is Transforming healthcare. Here’s their list of 9 items with my own commentary after each item.

Reduces medical errors. I prefer to say that Health IT has the potential to reduce medical errors. I also think long term that health IT and EMR will reduce medical errors. However, in the interim it will depend on how people actually use these systems. Used improperly, it can actually cause more medical errors. There have been studies out that show both an improvement in medical errors and an increase in medical errors.

My take on this is that EMR and health IT improves certain areas and hurts other areas. However, as we improve these systems and use of these systems, then over all medical errors will go down. However, remember that even once these systems are perfect they’re still going to be run be imperfect humans that are just trying to do their best (at least most of them). Even so, long term health IT and EMR software will be something that will benefit healthcare as far as reducing medical errors.

Improves collaboration throughout the health care system. I’m a little torn as we consider whether health IT improves collaboration. The biggest argument you can make for this is that it’s really hard to be truly interoperable in really meaningful and quick ways without technology. Sure, we’ve been able to fax over medical records which no one would doubt has improved health care. However, those faxes often get their too late since they take time to process. Technology will be the solution to solving this problem.

The real conundrum here is the value that could be achieved by sending specific data. A fax is basically a mass of data which can’t be processed by a computer in any meaningful way. How much nicer would it be to have an allergy passed from one system to another. No request for information was made. No waiting for a response from a medical records department. Just a notification on the new doctor’s screen that the patient is allergic to something or is taking a drug that might have contraindications with the one the new doctor is trying to prescribe. This sort of seamless exchange of data is where we should and could be if it weren’t for data silos and economics.

Ensures better patient-care transition. This year there was a whole conference dedicated to this idea. No doubt there is merit in what’s possible. The problems here are similar to those mentioned above in the care collaboration section. Sadly, the technology is there and ready to be deployed. It’s connecting the bureaucratic and financial dots to make it a reality.

Enables faster, better emergency care. I’m not sure why, but the emergency room gets lots of interesting technology that no one else in healthcare gets. I imagine it’s because emergency rooms can easily argue that they’re a little bit “different” from the rest of the hospital and so they are able to often embark on neat technology projects without the weight of the whole hospital around their neck.

One of the technologies I love in emergency care is connecting the emergency rooms with the ambulances. There are so many cool options out there and with 3G finally coming into its own, connectivity isn’t nearly the problem that it use to be. Plus, there are even consumer apps like MyCrisisRecords that are trying to make an in road in emergency care. I’d like to see broader adoption of these apps in emergency rooms, but you can see the promise.

Empowers patients and their families to participate in care decisions. Many might argue that with Google Health Failing and Microsoft HealthVault not making much noise, that the idea of empowering patients might not be as strong. Turns out that the reality is quite the opposite.

Patients and families are participating more and more in care decisions. There just isn’t one dominant market leader that facilitates this interaction. Patients and families are using an amalgamation of technologies and the all powerful Google to participate in their care. This trend will continue to become more popular. We’ll see if any company can really capture the energy of this movement in a way that they become the dominant market leader or whether it will remain a really fluid environment.

Makes care more convenient for patients. I believe we’re starting to see the inklings of this happening. At the core of this for me is patient online scheduling and patient online visits. Maybe it could more simply be identified as: patient communication with providers.

I don’t think 2011 has been the watershed year for convenient access to doctors by patients. However, we’re starting to see inroads made which will open up the doors for the flood of patients that want to have these types of interactions.

Helps care for the warfighter. This is an area where I also don’t have a lot of experience. Although, I do remember one visit with someone from the Army at a conference. In that short chat we had, he talked about all the issues the Army had been dealing with for decades: patient record standards, patient identifiers, multiple locations (see Iraq and Afghanistan), multiple systems, etc. The problem he identified was that much of it was classified and so it couldn’t be shared. I hope health IT does help our warriors. It should!

Enhances ability to respond to public health emergencies and disasters. I’ve been to quite a few presentations where people have talked about the benefits and challenges associated with electronic medical records and natural disasters. They’ve always been really insightful since they almost always have 5-6 “I hadn’t thought of that” moments that make you realize that we’re not as secure and prepared for disasters as we think we are.

It is worth noting that moving 100,000 patient records electronically to an off site location is much easier in the electronic world than it is in paper. With paper charts we can’t even really discuss the idea of remote access to the record in the case of a natural disaster.

Possibly even more interesting is the idea of EMR and health IT supporting public health emergencies. We’re just beginning to aggregate health data from EMR software that could help us identify and mitigate the impact of a public health emergency. Certainly none of these systems are going to be perfect. Many of these systems are going to miss things we wish they’d seen. However, there’s real potential benefit in them helping is identify public health emergencies before they become catastrophes.

Enables discovery in new medical breakthroughs and provides a platform for innovation. Most of the medical breakthroughs we’ve experienced in the last 20 years would likely have been impossible without technology. Plus, I don’t think we’ve even started to tap the power that could be available from the mounds of healthcare data that we have available to us. This is why I’m so excited about the Health.Data.Gov health data sharing program that Priya wrote about on EMR and EHR. There’s so many more medical discoveries that will be facilitated by healthcare data.

There you have it. What do you think of these 9 items? Are there other things that you see happening that will impact the above items? Are there trends that we should be watching in health IT in 2012?

Be sure to read the rest of my Health IT Top 10 as they’re posted.

Does EHR Choice Matter for ACO’s?

Posted on November 22, 2011 I Written By

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

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

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

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

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

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

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