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Ignoring the Obvious: Major Health IT Organizations Put Aside Patients

Posted on November 18, 2016 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.

Frustrated stories from patients as well as health care providers repeatedly underline the importance of making a seismic shift in the storage and control of patient data. The current system leads to inaccessible records, patients who reach nursing homes or other treatment centers without information crucial to their care, excess radiation from repeated tests, massive data breaches that compromise thousands of patients at a time, and–most notably for quality–patients excluded from planning their own care.

A simple solution became available over the past 25 years with the widespread adoption of the Web, and has been rendered even easier by modern Software as a Service (SaaS): storing the entire record over the patient’s lifetime with the patient. This was unfeasible in the age of patient records, but is currently efficient, secure, and easy to manage. The only reason we didn’t switch to personal records years ago is the greed and bad faith of the health care institutions: keeping hold of the data allows them to exploit it in order to market treatments to patients that they don’t need, while hampering the ability of other institutions to recruit and treat patients.

So I wonder how the American Health Information Management Association (AHIMA) can’t feel ridiculous, if not a bit seamy, by releasing a 3000-word report on the patient data crisis this past October without even a hint at the solution. On the contrary: using words designed to protect the privileges of the health care provider, they call this crisis a “patient matching” problem. The very terminology sets in stone the current practice of scattering health records among providers, with the assumption that selective records will be recombined for particular treatment purposes–if those records can be found.

A reading of their report reveals that the crisis outpaces the tepid remedies suggested by conventional institutions. In a survey, institutions admitted that up to eight percent of their patients have duplicate records in the institutions own systems (six percent of the survey respondents reported this high figure). Institutions also report spending large efforts on mitigating the problems of duplicate records: 47 percent do so during patient registration, and 72 percent run efforts on a weekly basis. AHIMA didn’t even ask about the problems caused by lack of access to records from other providers.

To pretend they are addressing the problem without actually offering the solution, AHIMA issues some rather bizarre recommendations. Along with extending the same processes currently in use, they suggest using biometrics such as fingerprints or retinal scans. This has a worrisome impact on patient privacy–it puts out more and more information that is indelibly linked to persons and that can be used to track those persons. What are the implications of such recommendations in the current environment, which features not only targeted system intrusions by international criminal organizations, but the unaccountable transfer of data by those authorized to collect it? We should strenuously oppose the collection of unnecessary personal information. But it makes sense for a professional organization to seek a solution that leads to the installation of more equipment, requires more specialized staff, tightens their control over individuals, and raises health care costs.

There’s nothing wrong with certain modest suggestions in the AHIMA report. Standardizing the registration process and following the basic information practices they recommend (compliance with regulations, etc.) should be in place at any professional institution. But none of that will bring together the records doctors and other health care professionals need to deliver care.

Years ago, Microsoft HealthVault and Google Health tried to bring patient control into the mainstream. Neither caught on, because the time was not right. A major barrier to adoption was resistance by health care providers, who (together with the vendors of their electronic health records) disallowed patients from downloading provider data. The Department of Veterans Affairs Blue Button won fans in both the veterans’ community and a few other institutions (for instance, Kaiser Permanente supported it) but turned out to be an imperfect standard and was never integrated into a true patient-centered health system.

But cracks in the current system are appearing as health care providers are shoved toward fee-for-value systems. Technologies are also coalescing around personal records. Notably, the open source HIE of One project, described in another article, employs standard security and authentication protocols to give patients control over what data gets sent out and who receives it.

Patient control, not patient “matching,” is the future of health care. The patient will ensure that her doctors and any legitimate researchers get access to data. Certainly, there are serious issues left, such as data management for patients who have trouble with the technical side of the storage systems, and informed consent protocols that give researchers maximum opportunities for deriving beneficial insights from patient data. But the current system isn’t working for doctors or researchers any better than it is for patients. A strong personal health record system will advance us in all areas of health care.

Will Personal Health Information Exchanges (PHIE) Lead the Consumer Medical Record Revolution and Bridge the Gap Between PHRs and EHRs? (Part 2 of 2)

Posted on August 5, 2015 I Written By

The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.
Cora Alisuag, CEO, CORAnet Solutions
Be sure to check out part 1 in this series where we talked about the movement towards an empowered patient who controls their health record.

Lack of Interoperability Continues to Hamper Patient Record Access

However, it has been six years since the HITECH Act passed, yet most Americans seeking medical care are still unable to obtain their full medical records for a variety of reasons. Some hospitals will simply not release them or proprietary EHR system vendors not allowing hospitals, let alone patients, direct access.

This capability also comes at a critical time as enormous obstacles hamper the ability of people to obtain their medical records. This is documented in the ONC’s “2015 Report to Congress on Health Information Blocking” which concludes that it is apparent that some health care providers and health IT developers are knowingly interfering with the exchange of health information in ways that limit its availability and use to improve health and health care.

This situation is only going to worsen as the Centers for Medicaid and Medicare (CMS) is considering a change to the EHR meaningful use rule that requires five percent of patients must view or download or transmit their health data to only one patient; not one percent, one patient.

Blue Button Not Gaining traction

In the meantime, other PHR technology has been introduced, but has not gained popularity including forays from Microsoft and Google. The ONC and other government organizations’ initiative to adopt and use the Blue Button platform for exchanging healthcare data between clinicians equipped with electronic health-record systems and patients with mobile computing devices is stalled, according to a recent survey by the not-for-profit Workgroup for Electronic Data Interchange (WEDI).

WEDI questioned 274 providers, health plans, HIT vendors and claims clearinghouses in the Second Annual Survey of Industry Awareness of Blue Button, conducted late in 2014. Only eight percent of respondents noted that their organizations actually used Blue Button, down from 15% of survey respondents in 2013.

PHRs Largely Unpopular

PHRs joined the lexicon of medical terminology several years ago as a convenience way for consumers to have copies of their medical records. It was largely born out of EHR’s lack of interoperability and access. However, as far back as 2009, a Health Affairs article detailed the major factors behind the slow adoption of PHRs. The article reviewed some of the reasons and includes cost, access, interoperability, security concerns, and data ownership.

Because health records which include clinical data, laboratory results and medical images do not flow freely among multiple organizations due to lack on EHR interoperability, PHRs do not automatically receive data. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process. For most consumers, this lack of safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up-to-date likely will not be used. Unlike PHIEs, the API-EHR connectivity connection is the missing link in PHRs.

However, the authors of the Health Affairs article offered a challenge. They described a gap between today’s personal health records (PHRs) and what patients say they want and need from this electronic tool for managing their health information. They noted that until that gap is bridged, it is unlikely that PHRs would be widely adopted, but noted that in the future; when these concerns are addressed, and health data is portable and understandable in content and format, PHRs will likely prove to be invaluable.

“While we all agree that lack of interoperability continues to stymie patient health record access and PHRs might not be the ultimate solution, but if a PHIE can bridge the gap by accessing EHR data through an open API while offering the security and convenience of a PHR. I believe PHIEs offer a solution that should satisfy the spontaneity of millennials’ and more frequent use of middle-aged and elderly users,” says Tiffany Casper, RNC, CNM, MSN and President of EMR Consultants which helps medical organizations transition to EMR systems.

About Cora Alisuag
Cora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.

Will Personal Health Information Exchanges (PHIE) Lead the Consumer Medical Record Revolution and Bridge the Gap Between PHRs and EHRs? (Part 1 of 2)

Posted on August 4, 2015 I Written By

The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.
Cora Alisuag, CEO, CORAnet Solutions
It has only been about two generations since traveling medicine shows were common forums for medical information. Phony research and medical claims were used to back up the sale of all kinds of dubious medicines. Potential patients had no real method to determine what was true or false, let alone know what their real medical issues were.

Healthcare has come a long way since those times, but similar to the lack of knowing the compositions of past medical concoctions and what ailed them, today’s digital age patients still don’t know what is in their medical records. They need transparency, not secret hospital –vendor contracts and data blocking, like the practices being questioned by the New York Times. One patient, Regina Holliday resorts to using art to bring awareness to the lack of patient’s access to their own medical records.

Testifying in July 2015 before the Senate Committee on Health, Education, Labor & Pensions, Direct Trust President and CEO David C. Kibbe, MD MBA, has urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”

“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues.

There are many reasons patients want access. Second opinions, convenience, instant access in a medical emergency and right of ownership—I paid for them, I own them. Other reasons patients need to view their records is for accuracy and validity. Inaccurate record keeping has even caused the EHRI Institute to cite incorrect or missing data in EHRs and other health IT systems as the second highest safety concern in its annual survey, outlining the Top Ten Safety Concerns for Healthcare Organizations in 2015.

Healthcare system executives, from CIOs to CEOs are very aware of the increasing requirements from patients asking for their records and the various state and federal laws that come into play. However, they are also aware that by making it too easy for patients to access records they risk liability and HIPAA issues. They also don’t want to provide documents that can easily enable cost comparisons or raise questions about charges.

Consumers Uniting

Riding the wave of interest in accessing personal medical records are organizations like Get My Health Data. Org. The organization was founded in June 2015 as a collaborative effort among leading consumer organizations, health care experts, former policy makers and technology organizations that believe consumer access to digital health information is an essential cornerstone for better health and better care, coordinated by the National Partnership for Women & Families, a non-profit consumer organization. On July 4 it launched #DataIndependenceDay to create awareness for the HIPAA law which states that patients must be granted access to their health information with very few exceptions. An update to those laws that was finalized in 2013 extends these rights to electronic health records.

Despite the introduction of Personal Health Records (PHRs), Blue Button technology and product introductions from blue chip technology leaders such as Microsoft and Google, there has been no significant, unifying technology to ignite pent up demand for their medical records by consumers. This lack luster interest and ongoing interoperability issues might be the unifying force to drive many consumers to consider Personal Health Information Exchanges (PHIEs) as an alternative to EHRs and Health Information Exchanges (HIEs) that unnecessarily duplicate data and risk HIPAA violations.

Will PHIEs Ignite the Patient Record Access Movement?

Frost & Sullivan, in its research report, “Moving Beyond the Limitations of Fragmented Solutions Empowering Patients with Integrated, Mobile On-Demand Access to the Health Information Continuum”, identifies Personal Health Information Exchange (PHIEs). They are described as providing individual patients, physicians, and the full spectrum of ancillary providers with immediate, real-time access to medical records regardless of where they are stored by using an open API.

The PHIE can provide access to the entirety of an individual patient record, regardless of the number of sources or EHR systems in which the patient data resides. This technology is made possible through fully interoperable integration servers that can access any EHR system with available APIs and portray the integrated data in a viewable, secure and encrypted format on a mobile device.

By leveraging the powerful simplicity of open APIs, PHIE technology can also access medical records in a way that is much more comprehensive than the closed EMR portals commonly used by doctors’ offices. Despite their pervasive use, these portals are cumbersome and expensive for patient’s use. The portals also include the same lack of interoperability that plagues hospital EHR systems.

“PHIEs can be the breakthrough everyone has been waiting for; challenging every consumer health organization, third-party payer, hospital, ACO network, and Congress to recognize the need to move away from proprietary systems. Adoption of this technology would also demonstrate the healthcare industries’ commitment to allowing patients access to their own records,” notes Dr. Donald Voltz, an anesthesiologist at Aultman Hospital in Canton, Ohio who leads a campaign for EHR connectivity.

“If done correctly, PHIEs can lead in the consumer health information campaign for change, interoperability now, quality and safety through license relationships with hospitals, payers, telecommunications companies, mobile device firms and large employers. Interoperability issues could be a thing of the past and lead to integration with leading EMR systems, integration with HIEs, VAR agreements with health and wellness IT firms and application distribution through the online market place with Google Play and iTunes,” says Voltz.

Tomorrow in part 2 of the series we’ll talk about current interoperability efforts and the challenges they face.

About Cora Alisuag
Cora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.

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?

PHR Are Like Early Email

Posted on July 31, 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.

In response to Anne Zieger’s post on PHR, John Tempesco offered this powerful insight that’s worth sharing:

PHRs will become popular when the patients don’t have to enter most of the data themselves. As more and more EHRs and HIEs begin to automatically interact with PHRs and patients have one central place to go for all their health information, they’ll catch on. Having a PHR now is like the early adopters of cell phones or email – there are few people to have conversations with.

It’s a really interesting comparison to email in the early days. I unfortunately wasn’t on email early on so I can’t say exactly what it was like, but I’ve heard stories. The interesting thing is that HIE’s seem to be suffering some of the same problem. HIE’s are often like early email since only a few people are on board with it. Plus, imagine if email required some sort of third party agreement to let you email each other?

EHR software on the other hand could become widely adopted and connected to a PHR. The biggest problem there is the major lack of standards for sending that health information. Until we solve the standards problem, I don’t think a PHR will be able to connect to the hundreds of EHR software vendors.

Sharing Your Profile with a Physician Using MyCrisisRecords

Posted on May 22, 2012 I Written By

MyCrisisRecords is a valuable new product that allows your personal health record to be accessed through a QR reader, a USB drive, or by calling a 24/7 hotline.  This can be invaluable to emergency personnel who can almost immediately have access to your health history in an emergency.

This video demonstrates how simple it is for a physician to gain access to your record.



More information can be found at their website:

Watch the video.

Two Primary Obstacles to PHR Adoption per Epic

Posted on May 11, 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 recently happened upon the interoperability page on Epic’s website. Yes, I realize the irony of Epic and interoperability in the same sentence. In fact, that’s why I was so intrigued by what Epic had on their website about interoperability.

I’ll leave what they called the “physician-guided” interoperability using their Care Everywhere product for another post. In this post I just want to highlight their “freestanding Personal Health Record (PHR)” section. I was most intrigued by what Epic lists on that page as the “two primary obstacles to patient PHR adoption”:

Lucy [Epic’s PHR] is free of the two primary obstacles to patient PHR adoption:
1. There are no advertisements on Lucy.
2. Epic will not sell patient data for secondary uses.

I find this really intriguing. Let’s look at each one individually.

First, I can’t say I’ve ever heard someone say that the reason they aren’t using an EHR is because of the advertisements. I’m sure there are a few out there that wouldn’t enjoy the ads and might not use a PHR because of them, but I believe they are few and far between. Plus, PHR use has been so low that most haven’t used a PHR enough to have seen ads. So, that’s not an obstacle. Not to mention, what PHR software has ads there now? As best to my knowledge Microsoft HealthVault, NoMoreClipboard and even the now defunct Google Health have never shown ads before.

Now to the second point about selling patient data for secondary uses. This could potentially be a bigger issue. There’s little doubt that there’s value in aggregate health data. A PHR is a legitimate way to collect that aggregate health data. Some certainly have some fear of their individualized health data being learned and so they don’t want to input their health data into a PHR. However, I believe there’s a larger majority that don’t care about this all that much. Sure, they want to make sure that the PHR uses proper security in their system. They also don’t want their individual data sold, but I expect a large user base doesn’t really care if aggregate healthcare data is sold in order for them to get a product that provides value to them.

In fact, this highlights the real problem with PHR software generally. To date, the PHR has offered little value to the patient. This is the primary obstacle to patient PHR adoption. I’ve hypothesized previously a couple things that could change that patient value equation: physician interaction in the PHR and paper work completion.

The real problem with PHR software is providing the patient value, not ads or sold patient data.

Patient Relationship Management Taking on the Patient Portal and PHR

Posted on May 8, 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.

The other day I had the chance to get a demo of Avado‘s PRM (Patient Relationship Management) system from Dave Chase. I’d seen a lot of the writings of Dave Chase throughout the internet. He’s been really smart to go after a number of really high profile tech blogs to get some good exposure for Avado. This isn’t a good strategy for a lot of healthcare IT companies, but it can work really well for the right ones. Either way, I was fascinated by many of Dave Chase’s writings and so I knew it would be an interesting experience.

Needless to say, Dave Chase and Avado are looking at the physician patient relationship quite different from many others. At some point, I may do a full write up of the Avado service, but I think this slide that Dave Chase showed me summed up the comprehensive way that Avado looks at the physician patient relationship. Take a look at the comparison of Avado with a patient portal (I wish PHR was included in the chart as well):

I love companies that look at situations in a really comprehensive manner. Avado seems to be a company that does that. I think it’s still early to know if Avado will be able to execute on this comprehensive approach, but I think it’s a good starting point. Many who have looked at patient portals and PHR software in the past probably wondered why many of the things listed in the chart above weren’t features of the portal or PHR.

I must admit, my next idea for this list is to take it and see how the various PHR and portals handle each of the items on the list. Considering the new emphasis on the patient portal thanks to meaningful use stage 2, physicians might want to give a little extra thought into what the patient portal they adopt is able to do.

PHR Options for Meeting Meaningful Use Stage 2

Posted on March 29, 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.

An EHR vendor recently asked me for some suggestions of PHR or portal options that they could use with their EHR software. Turns out that this is going to be particularly important given the changes in meaningful use stage 2 that require you to not only share medical information with the patient, but the patients have to actually access that information as well (unless that gets taken out in the MU stage 2 rule making process). Regardless, the question of which PHR and/or patient portal solutions was an interesting question. Here’s my answer to him (with a little bit added):

I only know of a few and you’ve probably heard of the ones I know about. I’m also not sure of the price of the various options really [He wanted to know of an inexpensive option]. Here’s what I know:

I like what NoMoreClipboard has done and that they’ve been doing it a really long time. They have a good understanding of how to work with many different vendors and also sizes of practices or healthcare institutions. Plus, you can be sure they’re going to be on top of all the meaningful use stage 2 requirements you’ll need to meet.

I also know that Medical Web Experts was working hard on a patient portal. I’m not sure how far it’s come since I first talked to them though. It might be one worth checking out. Just be sure that they can meet the meaningful use stage 2 requirements.

Then, of course you have Microsoft HealthVault. Everyone seems to know about them. I’ve heard that they’re a bit of a challenge to integrate with. Hopefully they also don’t have the same fate as Google Health. Although, Microsoft has a much better position in healthcare than Google ever did.

Coincidentally, I also was just emailed about a brand new book just released by O’Reilly Media about HealthVault and how to integrate with it. It’s called Enabling Programmable Self with HealthVault: An Accessible Personal Health Record. I’ve heard it’s a pretty technical book that would be quite useful if you decided to go with Healthvault for your PHR.

What other PHR and/or patient portal options are out there? I’m sure there are more that I’m missing and have probably just forgotten about them.

I’ll be interested to see if meaningful use stage 2 will drive the return of the PHR.

Full Disclosure: NoMoreClipboard is an advertiser on this site.

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.