Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

HIEs and Patient Engagement – Why and Why Now?

Posted on June 20, 2013 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.

The following is a guest post by Jeff Donnell, President of NoMoreClipboard.
Jeff Donnell - NoMoreClipboard PHR
Health information exchanges have become quite adept at moving medical data from provider to provider on behalf of patients, but making that data available to those same patients has rarely been attempted – until recently.

Not including patients at the HIE exchange table is understandable, but ironic. Understandable for reasons ranging from policy challenges to a lack of standards to technical limitations. Ironic because HIEs are ideally positioned to aggregate data from multiple providers – leveraging the interfaces already in place with provider applications – and deliver that data to consumers, overcoming several of the major barriers to patient adoption and use of tools like PHRs and patient portals.

HIEs have recently grown interested in supporting electronic patient engagement, in large part based on provider inquiries regarding meaningful use stage two requirements. Many providers are looking for affordable alternatives to the tethered patient portals being offered by their EHR vendors, and they want to provide their patients with a solution that can be used across the care continuum. Increasingly, providers recognize that a patient who visits five different clinicians is not about to create five different patient portal accounts. Savvy providers realize that the HIE is well equipped to provide portable, interoperable solutions.

For HIEs interested in long-term sustainability, patient engagement makes perfect sense. The HIE can leverage its existing interfaces and aggregated data – making existing medical information available to patients from a single pipe, in a standardized format. The HIE can act as a conduit between consumers and clinicians – adding value for all parties. Providers can transmit data to patients, and recent CMS guidance indicates that all providers who contribute data to a shared portal (like that provided by an HIE) can count patients who use that portal toward their 5% patient participation requirement. Patients avoid having to collect data from every provider they see, and can populate a PHR or HIE portal account with existing electronic data. Everybody wins.

The value is evident, but what about those challenges? In the state of Indiana, we received an ONC Challenge Grant to figure out how to get HIE data in the hands of consumers with a PHR. We are fortunate to reside in a state with five well-established HIEs and a provider community eager to innovate, and we have spent the last two years working on those challenges (giving us a real appreciation for why the ONC affixed the challenge label to this grant program). We have addressed issues ranging from patient ID/Auth/Match to minor consent to provider skepticism to amended data use agreements. We have overcome any number of obstacles to get data flowing, and we are seeing increased levels of engagement and enhanced clinical outcomes.

We have learned any number of lessons to help other HIEs, state agencies and healthcare providers avoid pitfalls and make accelerated progress. We are eager to share what we have learned. Perhaps the most important lesson is to get started now – as crafting and implementing a patient engagement strategy takes time. As nobody appears to be manufacturing more time these days, HIEs and other organizations that envision sharing data with patients even a year or two down the road would be well advised to begin working in earnest, with an eye on making incremental progress.

Jeff Donnell is president of NoMoreClipboard, a web-based, Personal Health Record (PHR) management system designed to consolidate medical information in one convenient and secure location for easy retrieval and updates. NMC enables consumers to share personal or family member medical information with medical professionals electronically, reducing the need for repetitive medical paperwork.  Jeff and the company are committed to developing PHR applications that are consumer-friendly, interactive, secure, mobile and interoperable.  For more information, follow us on Twitter @NoMoreClipboard or visit

Jubilee Health Community and NoMoreClipboard Combine Forces To Help Diabetes Patients

Posted on December 20, 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.

According to the U.S. Department of Health and Human Services, 20.8 million people in the United States are affected by diabetes. This amounts to around seven percent of the population, which is a fairly large percentage. Many of those with diabetes likely have no health insurance

Jubilee  Health Community and NoMoreClipboard PHR are working together to help uninsured manage diabetes, according to a recent press release. The objectives of this include:

  • Explore the use of a PHR by rural, uninsured patients with diabetes
  • Improve patient health outcomes by providing patients with a PHR to share and track daily glucose readings
  • Improve diabetes care management by sharing health information between a clinician and patients using a PHR.

28 diabetes patients of Jubilee Health Community were given a smartphone-enabled version of the NoMoreClipboard PHR about a year ago to assist them in managing their diabetes. Immediate feedback was given when glucose values were entered, and lab results were input within about 72 hours.

These patients and their use of the PHR were monitored over the course of a year, and that findings were interesting. Here are some of the stats that were listed in the press release:

  • 37.5 percent of the patients remained actively engaged and regularly entered blood glucose readings via NoMoreClipboard
  • Of those 37.5 percent of patients, 28.6 had improved A1C levels and reported feeling better
  • Those that did not actively use the PHR, 21.4 percent had no improvement or increased A1C levels
  • Of those that did not stay engaged, one of the patients whose A1C level increased suffered an MI.

Diabetes is linked to a host of other health problems, which include adult blindness, kidney failure, non-traumatic amputations, and heart disease and strokes. Obviously, there is a great need for some additional help for these patients, and this PHR seems like it could really do a lot of good. The sample size might not be the greatest to glean the most accurate results on the effectiveness of the PHR, but it does give some insight to indicate it would be worth trying. I think it’s great that some of those who used the PHR regularly did see improvement.

Jeff Donnell, president of NoMoreClipboard, offered some commentary concerning the value of electronic patient engagement:

This project reinforces the value of electronic patient engagement in helping underserved patients manage chronic conditions. Providers are often skeptical that populations including seniors and safety net patients will be able to cross the digital divide and use a PHR. Our experience with rural and urban underinsured patients make it clear that these individuals are looking for tools to help them take a more active role, and they will use those tools when they provide benefit.

In general, I feel like when people are accountable and regularly track information concerning their health (whether it be for diabetes, trying to lose weight, etc.) there will be an increase in their health and well-being. The problem is, it can be very hard to stay on track with systems like this –which is evidenced by the fact that over 60 percent of the people didn’t remain active at the end of the trial period. It raises the question, what can be done to convince people to keep track of their health on things like the NoMoreClipboard PHR?

NoMoreClipboard and iMPak Join Forces as PHR Meets ACO and Patient Centered Medical Home

Posted on February 14, 2012 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.

I’ve long been fascinated by NoMoreClipboard ever since I learned at HIMSS a few years back that Jeff Donnell, President of NoMoreClipboard, was the creative genius behind the always entertaining Extormity EHR parody. So, I guess I should have expected Jeff to continue the trend of creativity in where he’d take PHR vendor NoMoreClipboard in the future.

While many are writing off the PHR after Google Health was shut down, NoMoreClipboard seems to be doubling down (a great reference before HIMSS Las Vegas) on PHR and extending it to capture two healthcare mega trends: patient centered medical homes (PCMH) and accountable care organizations (ACOs).

In an effort to learn more about this move I did the following interview with Jeff Donnell, President of NoMoreClipboard, and Sandra Elliott, Director of Consumer Technology and Service Development at Meridian Health, a not-for-profit health system in New Jersey that helped to create iMPak.

Tell me about what seems to be a shift of NoMoreClipboard from PHR to focus more on the patient centered medical home (PCMH) and facilitating ACOs.

Jeff: Our focus at NoMoreClipboard has always been on providing value to consumers and clinicians – looking for ways to connect patients with providers to facilitate meaningful information exchange, dialog and care coordination. This is not a shift away from PHR. Rather, we are elated that the concept of patient engagement is not only gaining traction, but taking off like a rocket. One of the reasons is the shift toward concepts like PCMH and ACO – where provider organizations have incentives to manage patient populations more carefully. Doing so at scale requires the use of technology to streamline communication, gather and analyze electronic data, and identify those patients who require more aggressive intervention. The PHR can be very valuable as the electronic management and communication tool for patients and their family members. We are adding provider-facing tools to help clinicians manage the patient populations who can benefit most from technology. And the collaboration with iMPak provides patients with easy-to-use, affordable and very powerful medical devices.

ACOs are quite nebulous at this point, so what ACO trends do you think are most promising?

Jeff: While no one is certain what form ACOs will ultimately take, the concept is generating not only interest, but activity. Hospitals, health systems, health plans and employers are making plans, piloting concepts and taking the steps necessary to form or become part of an ACO.

Sandra: The most profound change is the recognition that the care relationship with the patient now extends beyond the hospital doors upon discharge. There is no doubt that more incentives will continue to be placed on reducing readmissions and reducing the overall costs of care no matter what form ACOs will take in the future. The priority of better management of patients once they return home is and will continue to get significant attention.

This new partnership moves NoMoreClipboard into the patient centered medical home.  What do you see as the leading drivers of the medical home?

Jeff: As incentives shift, so must the orientation of the provider community. This is especially true for primary care providers who will assume greater responsibility for managing those with chronic conditions – providing them with a medical home where care plans are developed, deployed and carefully managed. As more hospitals and health systems acquire primary care practices, those practices become more than a source of hospital referrals – they serve as the front line in managing the care of patients who are discharged from the hospital to ensure quality and guideline adherence. This role is not only critical to improving outcomes and reducing cost, it also improves the real and perceived value of PCPs. Technology is no longer a barrier to enabling medical homes at reasonable costs.

You’ve focused on ease of use for patients.  Tell me some ways you’ve made this simple for users.

Jeff: One of the benefits of working with iMPak is their health system connection – Meridian Health in New Jersey is one of the owners. Meridian has experienced how difficult it can be to get certain patient populations to use electronic tools – be it a computer, a smartphone or an electronic medical device. Rather than throw in the towel on collecting electronic data from these patients, iMPak has developed simple devices that require little or no training and are ideal for those patients who say “I will never, ever use a computer.”

Sandra: iMPak health journals are used to collect subjective information using a push button journal – “smart” paper stock with an embedded chip that collects and stores patient responses to condition-specific questions. iMPak is also developing screening devices that are the size of a credit card and collect objective data with minimal patient effort. Both health journals and screening devices use touch and post technology so that when the device is placed on a Near Field Communications (NFC) reader, data is automatically downloaded safely and securely.

There are a lot of different medical home devices on the market.  What differentiates the iMPak product from the competition?

Sandra: The biggest differentiator is the form factor. These devices were designed with the technology-averse in mind. There are millions of people who simply will not use a computer, download an app or place an electronic home monitoring center on their kitchen counter. A significant percentage of these individuals have chronic conditions and can really benefit from sharing electronic data with a health coach or care manager. iMPak has cracked the code for these patients with devices that collect electronic data in a way that is simple, elegant and not at all intimidating.

The other major difference is the time and cost required to develop and deploy these solutions. Unlike complex medical devices that usually take years and millions of dollars to develop, iMPak journals and screening tools can be customized rapidly and affordably.

These differentiators are attracting the attention of organizations interested in partnering with us to develop and deploy purpose-built solutions for a wide variety of use cases ranging from chronic disease management to improving medication therapy.

What are the top 3 benefits someone will glean from using iMPak with NoMoreClipboard?

Sandra: Patients who either lack access to information technology or avoid its use now have an easy, anywhere way to share health information with family members and clinicians who are providing them with care.

Jeff: Family members helping take care of loved ones can now access a complete health picture through a PHR – from the latest in subjective and objective data reported by the patient to a comprehensive health record.

Clinicians, health coaches and other care advocates now have a solution designed to manage patient populations that tend to be difficult to manage – those with serious conditions who are technology averse or lack technology access. Clinical staff can now collect electronic data from these patients, and are provided with up-to-date reporting and alerts that identify those patients who require intervention much earlier.

What’s the biggest barrier to adoption of medical devices in the home?

Jeff: That depends on the home and the people using them. We are focused on homes where the adoption of high-tech, complex medical devices is extremely unlikely for any number of reasons. That does not mean these patients are not candidates for using medical devices. It does mean the devices must be carefully selected to fit the technical capabilities of the target population.

Sandra: Many devices in the home are overwhelming for the great majority of people so they were not being used. iMPak Health has designed its devices in an easy-to-use, intuitive form to overcome some of these intimidation factors

In what ways is a doctor involved in this medical home model?

Sandra: iMPak and NoMoreClipboard are collaborating to provide end-to-end solutions that connect physicians, patients and family members – giving each individual in the care equation a valuable tool to communicate and share information.

The iMPak devices are designed to help patients collect and share electronic health information in a user-friendly form factor. Captured data is then available to patients and their family members via NoMoreClipboard.

Jeff: This same data is also directed to a clinical portal that a doctor, case manager or other care advocate can use to manage a patient population. Collected data populates the portal, giving clinicians a dashboard view of patient status. Data is compared against a rules engine, and alerts identify at-risk patients who require more aggressive intervention.

The doctor seems to be an incredibly important part of medical home models.  What has been doctor’s reaction to this product?  How do you plan to get more doctors to accept this new and evolving model of care?

Jeff: Most physicians we talk to support the use of patient-facing technology, but they are quick to point out how many of their patients are not tech-savvy – senior citizens, rural patients, safety net patients, etc. When we put an iMPak device in the hands of these doctors, their reaction is amazing to watch – you can almost see the light bulbs go on.

As physicians learn that we can provide a complete solution that includes an easy-to-use clinical portal with a rules engine, reporting capability and visible identification of those patients who require additional intervention, we expect interest in this new model of care will grow.

Is it essential that the patient have their medical record in NoMoreClipboard?  What value is gleaned from the data the device provides together with the medical record?

Jeff: The iMPak device data alone is incredibly valuable – subjective and objective data collected from a patient as they experience symptoms or engage in therapy. Adding medications, allergies, conditions, medical history and family history to that data paints a more comprehensive picture. If a clinician can easily see in a combined view what medication form and strength a patient is taking along with the patient’s reported response to that medication, it is that much easier to make rapid and informed clinical decisions.

Do you plan to integrate more devices with NoMoreClipboard?  Will they all be from iMPak or will you work with other medical device manufacturers?

Sandra: NoMoreClipboard and iMPak are working on a complete line of devices, with an initial focus on pulmonary and cardiovascular conditions, as well as health and wellness applications. We are also talking with a number of potential partners about developing purpose-built solutions to support specific use cases. iMPak and NoMoreClipboard also have flexibility to work with other organizations as it makes sense. If a NoMoreClipboard client wants us to integrate with other devices, we can certainly do so. If a hospital system wants to integrate iMPak data with existing healthcare IT applications, they have that freedom.

Currently this product seems focused on the senior population. Do you see this or other related products eventually reaching the wider population?

Sandra: While seniors are a natural fit, any patient population on the wrong side of the digital divide is an ideal candidate for iMPak solutions. This includes underserved populations in urban or rural areas without regular access to technology. These devices are affordable, they are portable, and they are easy to use. We believe these devices can help overcome disparities in care.

This seems like the first step in addressing the patient centered medical home and facilitating ACOs.  Where do you see this going in the next couple years?

Jeff: As we talk to patients with chronic conditions, what keeps them up at night is the difficulty of gathering, organizing and managing all their health information, and making sure that all their doctors have the latest information and are talking with one another about what it means and how to proceed. When we talk to physicians, they describe the challenge of managing transitions in care, gaining access to all the information they know is out there somewhere, and working with patients, families and fellow clinicians to develop a coordinated plan of action.

It is pretty clear that incentives will migrate from fee-for-service to paying for a focus on wellness, prevention, and more thoughtful management of chronic conditions. While the care models (and their labels) that support this will evolve, we believe there will be increased effort to connect patients, family members and clinical teams. Electronic tools will play an important role in fostering dialog, facilitating care coordination and keeping everyone up-to-date based on their role in the care continuum. Significant value can be realized by developing “care networking” tools that combine the power of healthcare IT and social networking on an integrated platform.

John’s Note: NoMoreClipboard, in collaboration with iMPak Health, will launch and demo this new comprehensive solution for achieving a successful medical home or accountable care organization at HIMSS Booth #7902.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

Request an Appointment and Send Your Record Using a PHR

Posted on October 29, 2010 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.

I recently sat down with Jeff Donnell from NoMoreClipboard. We had a fascinating all around conversation, but one of the most fascinating things he told me was the story of his last visit to his doctor’s office. I’ll do my best to recount what he told me.

When he decided he needed to go see the doctor for a visit his wife suggested that he call the doctor to make an appointment. Of course, Jeff “eats his own dog food” and decided that instead of calling for an appointment, he’d request an appointment through NoMoreClipboard. So, he logged into his account and sent off the request for an appointment with his PHR attached. Pretty interesting idea no?

Don’t ask me why, but when possible I’d much rather request something through my computer. Maybe it’s sitting on hold while you wait to talk to someone that’s turned me off to the phone call, but the idea that I could request an appointment online even if the doctor isn’t on NoMoreClipboard is a pretty attractive feature for a PHR.

Of course, since Jeff’s doctor wasn’t on NoMoreClipboard, his appointment request and health record were faxed to his doctor’s office. He got a call from the doctor and scheduled his appointment. The story certainly doesn’t end there.

When he arrived at the doctor’s office he wondered if they’d have his record or not. They handed him the standard clipboard to fill out all the paperwork. He still said nothing and dutifully filled out the paperwork. No one said anything about the record he’d sent until he was with the doctor and the doctor realized that Jeff was the one that sent in his PHR. I guess it was the talk of the office when that fax came in.

Obviously, the idea of requesting an appointment and faxing in your health record using a PHR still has a ways to go. In fact, NoMoreClipboard’s goal is to work with doctor’s offices like these so that the office gets the person’s health record on the forms that the doctor’s are use to getting it on. I think that’s a smart strategy. Not to mention the idea of the patients driving their doctors to use and work with a PHR provider. I think they call that Word of Mouth advertising right?

I’ve been thinking about this for a while when I recently talked with someone from Microsoft’s HealthVault division. I quite frankly asked this gentleman why I should use a PHR. Obviously, if I was a patient with a chronic or complicated illness I could see a compelling use case. However, what’s the use case that will drive and motivate healthy individuals to use a PHR. So far I really haven’t heard a good answer.

Requesting an appointment and not having to fill out that same lengthy cumbersome paperwork is the closest I’ve thought of.