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Patient engagement: Check me out in ‘US News’

I’ve just had my first story published in a major national magazine, or at least the online version of one, namely US News and World Report. It’s about patient engagement strategies for hospitals and medical practices in the context of EHRs, for the magazine’s “Hospital of Tomorrow” feature, and I’m getting good feedback so far. Needless to say, I’m pretty excited. Check it out here.

Also, I’ll be presenting on Tuesday at 11:30 a.m. EDT at the American Telemedicine Association’s Fall Forum in the non-American (but very North American) city of Toronto. It’s there because this year’s ATA president is Dr. Ed Brown, president of the Ontario Telemedicine Network, right there in the T.O.  Steve Dean of Falls Church, Va.-based Inova Health System’s Inova Telemedicine Program and I will be counting down a top 10 of mobile apps we deem to be prominent, successful or highly useful. (The description in the online program is wrong as of this writing.)

September 7, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More on Blue Button Plus and MU2

My last post, based on comments from Frost & Sullivan health IT analyst Nancy Fabozzi at last week’s Healthcare Unbound conference, has generated a bit of controversy. Fabozzi said that “Blue Button Plus is totally disruptive,” possibly eliminating the need for some providers to get full-fledged patient portals in order to meet Meaningful Use Stage 2 standards.

In the comments under that post, David Smith of HealthInsight.org, a health improvement consortium in three Western states, correctly pointed out that MU2 requires not just that providers give 50 percent of patients electronic access to their records, but also that 5 percent of patients actually view, download and/or transmit information back to their doctors or hospitals. I also got an e-mail from a GE Healthcare executive reminding me that of the view/download requirement as well as the fact that EHR technology had to be certified by an ONC-approved certification and testing body.

The viewing and downloading certainly can be accomplished with Blue Button Plus apps or widgets. In fact, ONC’s Lygeia Ricciardi has said Blue Button Plus could be part of the Stage 3 rules.

Transmitting would seem to necessitate a portal since HIPAA demands — and patients should expect — security when sending protected health information over the Internet. Standard e-mail doesn’t cut it, but e-mail following Direct Project protocols does. MU2 already sanctions Direct Project for health information exchange between healthcare entities. There is no reason why it can’t work for individuals as well, as Dr. Deborah Peel’s Patient Privacy Rights Foundation is trying to facilitate.

This might be a bit unwieldy, asking each patient to set up a Direct e-mail address, but remember, providers only need 5 percent to do so in Stage 2. I see it as perfectly feasible that some small physician practices could bypass the portal and just make do with freely available resources like Blue Button Plus — though Blue Button Plus app developers likely will charge fees — and open-source Direct standards.

UPDATE, July 18, 12:40 a.m. CDT:

HHS itself says Blue Button Plus meets MU2 standards.

From http://www.hhs.gov/digitalstrategy/open-data/introducing-blue-button-plus.html:

Blue Button Plus is a blueprint for the structured and secure transmission of personal health data. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology in the following ways —

Structure: The recommended standard for clinical health data is the HL7 Consolidated Clinical Document Architecture or Consolidated CDA. The C-CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button Plus adopts the requirements for sections and fields from Meaningful Use Stage 2.

Transmit: In alignment with Meaningful Use Stage 2 standards, Blue Button Plus uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.

It sounds to me like compliance is just a matter of making sure that a Blue Button Plus app is certified as an EHR module.

July 17, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Blue Button Plus is totally disruptive’

AURORA, Colo.—”Blue Button Plus is totally disruptive,” Frost & Sullivan health IT analyst Nancy Fabozzi just told me at the Healthcare Unbound conference. Why? Because the enhanced Blue Button Plus format can eliminate the need for healthcare providers to invest in patient portals in order to meet Meaningful Use Stage 2.

I tend to agree. The Stage 2 rules don’t require a portal, just the ability to transmit records securely from provider to patient. Providers, whether they be hospitals, clinics or even small physician practices, can just put a Blue Button widget on their Web site and give patients easy access to their medical records, transferred securely by the Direct protocol, itself a disruptive force for health information exchange.

Longtime readers might recall that I had dissed Blue Button in the past. More than once, in fact. That’s because the original Blue Button format was plain, unstructured text when it was an experiment at the VA. My opinion changed this week, when I realized that Blue Button Plus adds structure such as the Continuity of Care Document, and third-party vendors like Humetrix, make of the iBlueButton mobile app, provide additional context.

I don’t think this will kill the portal business because portals provide additional services such as secure messaging, appointment scheduling, refill requests and online bill payment. But it will make a lot of providers think twice about springing for an advanced portal when Blue Button Plus will fill the Meaningful Use need so easily.

July 12, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Guest podcast: Suzanne Leveille from OpenNotes

I now present the latest health IT-related podcast from Sivad Business Solutions, an interview with Suzanne Leveille, research director of OpenNotes, a project to give patients online access to the entirety of their own medical records, including the visit notes from clinicians. Leveille describes a trial at Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. She reported that not one of the 105 participating physicians asked for the access to be shut off after a year. In some cases, patients even discovered errors and prevented adverse events.


Here is the description from Sivad:

A pleasure to welcome Suzanne Leveille to the program today. Suzanne is a professor of nursing at The University of Massachusetts-Boston, and the research director for OpenNotes.

OpenNotes is an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians.

As a patient, you have the right to read the notes your doctor or clinician writes about you during or after your appointment. Having the chance to read and discuss them with your doctor or family member can help you take better control of your health and health care.

As a healthcare professional, you may build better relationships with your patients and take better care of them when you share your visit notes. Our evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care.

Some highlights from the conversation include: the dramatic improvement between patient and doctor communications; how they overcome potential push back and resistance from physicians; patients became more engaged in their personal health care; OpenNotes has been pleasantly surprised at the patient engagement; how advanced technologies and mobile technology are going to impact the future of this idea; and how they are planning to spread the word and get more patients and doctors improving communications and care with OpenNotes!

 

May 16, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Patients with complex cases don’t want multiple provider portals, Rady CIO says

How about some real, original content for a change? Yeah, that’s why you started coming to my blog in the first place, isn’t it? You’re tired of nothing but video embeds from others and short, offbeat attempts at humor.

I recently interviewed Albert Oriol, CIO of Rady Children’s Hospital-San Diego, for a story that will appear elsewhere (read: a paying client) soon, but I had a lot of material I left out of that story. I get to use some of the rest here in a little experiment to see what it does to this site’s traffic.

Obviously, pediatric hospitals aren’t eligible for the Medicare side of meaningful use, which is why the threshold is lower for qualifying for Medicaid bonuses. Pediatricians and children’s hospitals only need to have 20 percent of their visits with Medicaid patients, compared to 3o percent for other providers. Rady meets that standard and already has attested to Stage 1.

Oriol, however, does not like the way the rules are written, calling some of them “well-intentioned mandates with unintended consequences.” For example, providers must offer portals for some of their patients – 10% in Stage 1, rising to 50% in Stage 2. But patients with complex conditions go to multiple providers, each of which may have unique portals. “It’s inconvenient for them to go to many different portals,” he says.

He also is frustrated with having to build reports knowing that many of the items will not apply to pediatric subspecialties. “It’s not the best use of resources,” Oriol says.

The two things at the top of mind for Oriol these days are telemedicine and advanced analytics. Rady is expanding its telemedicine program to support rural areas in Imperial County, a poor, isolated jurisdiction east of San Diego County along the Mexican border. He believes this will provide value and convenience to primary care physicians and patients alike.

On the analytics front, Rady is working on a demonstration project with California Children’s Services (CCS), a managed care program for children in the state’s MediCal system with certain diseases. “We’re going to bring in data from other providers,” Oriol says.

The hospital also is “taking a big step forward” in innovation and discovery by partnering with industry to research technology and the analytics of technology, according to Oriol.

 

April 28, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

I’m speaking at the Health Technology Forum in SF

If you’re in Northern California, or plan to be, I will be on a panel at the Health Technology Forum’s 2013 Innovation Conference: Platforms for the Underserved on Friday, April 19, in San Francisco. I’ll be sharing the podium with Jan Oldenburg, Aetna’s VP for provider and patient engagement, in a breakout session on patient engagement. (There will be at least one other panelist, still to be determined.)

We’re still working on the details, but I suspect this session will cover what it means to be an engaged patient, the 5 percent portal usage requirement in Stage 2 of meaningful use, the relationship of patient engagement to patient satisfaction and the technologies and strategies that are and are not working. Since it is an innovation conference, I might have to play the role of reality checker like I often do when I venture into the Bay Area. :)

 

March 29, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

My first portal experience

Yes, after all these years of writing about EMRs, EHRs, PHRs, patient portals and the like, I have had my first real personal experience with a patient portal, courtesy of my internist.

He still has a small practice, with four other physicians, including one fresh out of residency. Those small practices are a dying breed, but this doctor is changing with the times, too. He recently offered a concierge option for a few hundred patients. I declined because I don’t need to reach him that urgently.

The portal has been in place for a couple of years, and I may have logged in once or twice before to set up an account, but didn’t really do anything other than look around. This time, prompted by an e-mail informing me of a new URL, I logged in and checked my medication list. I remembered that another doctor had changed the dosage of one of my medications a while back, so I fired off a secure message informing this practice of the change. (It was a new URL presumably because the EHR vendor formerly known as Sage Healthcare adopted the Vitera Healthcare Solutions name a year ago and was switching its customers to a common, white-labeled portal.)

I also looked at some of my test results from a year and a half ago just to confirm that everything was more or less OK then, though I did see one abnormality with my HDL cholesterol. I last went for a physical in March 2011, about a month after I ungracefully cut my face open on a bathtub in Orlando during HIMSS11, so I was probably due. This practice lets patients request appointments — not actually choose open slots — online, so I sent my request. Tonight, about 24 hours later, I got my confirmation, and I’ll be seeing the doc in a couple of weeks.

It’s not a perfect system, but it was convenient enough for a night owl like myself who might not remember to call during business hours to make an appointment or simply not want to wait on hold or press a bunch of buttons to navigate a telephone menu. I did not see the Blue Button option to download my record that the federal government is pushing private vendors to adopt, but I’m sure that will be there by the time the practice is ready for “meaningful use” Stage 2 in a year or two. I don’t have a PHR anyway, so I wouldn’t be able to do anything with the data other than print it.

I suppose I should set up an emergency PHR at some point, even though I doubt any hospital or specialist I might get referred to would take the time to download my data from a USB drive or log into someone else’s portal. Untethered PHRs simply don’t fit physician workflow. That might change in MU Stage 2 when providers will have to send electronic discharge statements and patient summaries during transitions of care, but I’m still not convinced a patient-controlled PHR will be the right vehicle for these data transfers.

 

October 31, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Epocrates building EHR for small practices

Has this been reported before, or have I just not been paying close enough attention?

Yesterday at the Mobile Health Expo in New York, Sean Handel, vice president of subscriber business at Epocrates, said that the San Mateo, Calif.-based company known for its mobile medical reference tools, is building an EHR for small physician practices. “A significant portion of that product will be a patient portal,” Handel said.

Handel also said to expect to see more integration of mobile apps into clinical systems as more people shift to tablets from traditional PCs. That’s no surprise. We have so little integration now that it really can only go up.

While I’m being slightly cynical, I leave you with this thought from Google’s Dr. Roni Zeiger:

Vocera's CEO points out: in 1980s only MDs and drug dealers had pagers. Drug dealers have upgraded.
@rzeiger
Roni Zeiger
June 23, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Healthcare can take a lesson from airline fees

Here’s an idea so radically simple, it just might work.

All the new fees airlines have imposed in the last few years seem to be as popular as a trip to the doctor. But healthcare should follow at least one example to make trips to the doctor a bit more palatable–and safer, too. Plus, practices can benefit from greater efficiency if not also a little extra revenue.

When booking a ticket, airlines now charge somewhere in the range of $15-$25 to speak to a live person, either on the phone or at the airport. That’s because they want you to use their automated, online reservation systems. Customers generally don’t mind doing the work because they get to pick the flights, routings, times and prices most suited to their own needs and they enter all their personal data themselves. It’s more accurate and it saves time and money for the airlines. If customers want the added assistance of a real human being, they can pay for the service.

A medical practice should operate the same way. Let patients book appointments online. Let them fill out their medical histories online, too. Link the data they enter to practice systems so appointments go right to the practice management system and patient history goes to the EMR that most physicians will have (right?) by 2015 or so. You save staff time–even some physician time in the case of medical histories–and avoid errors that come from having to interpret patient handwriting and key their information into the system.

Give patients a financial incentive to use these automated options. Some practices already charge administrative fees to handle the paperwork our inefficient health system often requires. Waive those fees for anyone willing to enter data online rather than making an appointment over the phone or filling out the dreaded clipboard while sitting in the waiting room.

If you’re not comfortable charging an administrative fee, consider waiving co-payments for patients choosing the self-service option. Many of those charges go uncollected anyway.

October 27, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Another health IT reality check, this time with a patient portal

Remember about 16 months ago when I shared the experience of my own internist’s practice struggling to adopt an EMR?

I went back to the doctor this week for a routine checkup and found that some progress had been made. For one thing, my own doctor charted the encounter electronically. And, much to my pleasant surprise, the practice had started up a patient portal. I discuss my experience with the portal in FierceEMR today.

As a side note, a practice manager from, of all places, Guam, recently contacted me about the original blog post, wanting for me to get him in touch with the practice I wrote about because he was considering the same Sage Intergy system. I was happy to oblige, as was the office manager of my physicians’ practice.

August 12, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.