From her hospital bed, the little old woman gathered herself beneath her tissue-paper thick blankets and wondered about many of the things she’d face in her future. Though the room wasn’t cold, wringing her hands through the folds of the cheap cloth were all she could do to keep herself calm.
The television blared above her prone body; it made the only noise except for the rasp of her short breath. Occasionally, an orderly passed by but made no effort to breach the curtain door, and made her way down the hall.
A newspaper lay unopened at her side, not a word of it read, mostly because of the glaucoma in her right eye. Thus, the television called out, it being the only thing to steer her thoughts back from the darkness and confusion that seemed to take hold.
A relatively healthy 95-year-old women prior to the automobile accident (that consequently was not her fault), she seemed to suffer the unimaginable at her age and come out alive. Though doctors wouldn’t guarantee her recovery during the first few days, they were more optimistic now that her broken leg, broken arm, fractured wrist, broken shoulder and cracked ribs had not killed her.
She’d made it this far, they reasoned; and if the whole experience didn’t kill her then certainly it would make her stronger.
So alone she sat, except for when the occasional visitor stopped by, much of the time scared and most of it confused.
In came the food, out went the plates. In came a doctor, what was left were his orders. The occasional nurse checked her machines and gave her a pill; conversation was limited to, “How are you feeling today?” or “Are you in pain?”
There’s no surprise she feels out of place. Clearly, thoughts of giving up come to mind and she wonders if she’ll be able to survive the three or four months of required physical therapy for her to recover.
Even worse off, without any real family to guide her through, she sat quietly trapped in her own thoughts.
Finally, at one point, randomly looking at the computers in the room, she said softly, “Everything is mechanical now.” It was a statement, like something said in fear and loathing. She wrung her hands some more and closed here eyes.
When the nurse came in, the old lady requested a pain pill and the nurse left to retrieve it. Upon her return, the nurse handed over the small white pill and a shot of water and said she’d stay until she was sure it had been swallowed.
Thirty seconds later she was gone, again. Alone, the old woman tried to remember her home and its warmth and did her best to recall a lifetime – nearly a full century – in which she’d been engaged lovingly by family and friend.
It’s all mechanical, now, she said again, wondering in silence as her companion, the television, blared on.
The business of explanation deserves its place in healthcare, at least as far as the patient is concerned. In their interactions with their physicians, be in at an office visit or in the emergency room, there’s a great deal more need for those providing the care to walk through the experience with those receiving the care.
Even if it’s a tedious experience for the physician the importance of drawing and engaging the patient can not be understated.
Really, from start to finish, every interaction with every patient should contain some sort of “educational” component at least as far as the care continuum is concerned. During their visits, all patients have questions in which they need/want answers to that ultimately may not be vitally important to the caregiver, but are to those receiving the care.
Even during the documentation process, physicians have a great opportunity to learn more about lives and health choices of their patients, especially if they can get them to speak about the office’s electronic health record system.
Perhaps I’m the outlier given my passion for technology and health IT, but I use my doctor’s use of technology during my office visits to engage my physician. Maybe it’s the reporter in me, but I always seek opportunities to use props or interactions to develop deeper relationships with those around me. Though my physician may think his EHR beyond my comprehension, I like to surprise him and dive right into and ask him about its capabilities.
What can it do?
Why did he choose it?
What does he track the most?
What’s he tracking about me?
Why did he buy it?
Then, when the ice is broken, I dive into more broad-based questions:
Why does he practice?
What is he most passionate about from a care perspective?
Why he chose to practice the field he did, and so on …
Essentially, in the eight minutes he’s taken to see me, I’ve learned enough about him to probably write a profile.
My point is, by taking a peripheral interest in someone even in an extremely short amount of time, there are benefits to be gained. I try to make it an art form and get at people’s stories without them even knowing. Try it sometime. Next time while at a party, observe just how many times someone actually asks you a question about anything. I’ve gone through hours of social engagements without having to answer a single question.
My point is, it’s easy to engage people of all levels even without them knowing it if you get them talking about the one thing they all want to talk about: themselves.
This tactic, if used by physicians, could get all of the information they need out of their patients even if their patients don’t want to be engaged.
According to a new study published by the Journal of the American Medical Association, patients with online access to their medical records were more likely to engage with their physicians, in person and through electronic communication.
Apparently, this is the case for patients of all ages despite whether or not they were diagnosed with a chronic condition.
Likewise, for these same patients, there financial outlay for services was also greater than their counterparts who had no such access to their medical records online.
The Journal suspects a few reasons for this, including: “patients need ‘better, faster, cheaper’ processes of care for diagnosing, treating and monitoring their health. Online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access. Members might have activated their online access in anticipation of health needs. Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system.”
These results really do seem to mean that there is a verifiable correlation between patient portals and patients’ ability to access records online whenever they want. The findings also suggest that the portals, and subsequent secure electronic communication, encourage patients to interact with their physicians, ask questions, seek treatment and engage.
Even with the spike in expense these folks are adding to the system, this is probably some of the most positive insight to come out, and support the healthcare community, especially as they embark on their role of working toward stage 2 meaningful use attestation.
However, it’s worth pointing out that the one thing that seems to be generating the most buzz in relation to this data are the healthcare expenses the individuals are generating, and I just don’t understand. Someone please help set me straight here. Why is this a bad thing?
If I’m speaking out of turn, please correct me, but here’s how I see this playing out, assuming the information released by JAMA is true.
First, patient portals really do seem to be engaging patients as long as they know to use the system, how to use it and what to use it for. Because they are using the system, they are becoming more concerned about their health and having conversations with their physicians about their concerns.
Next, they want to address their health concerns, so they seek the counsel of their professional healthcare provider. Said counsel costs money and they are paying for the care they seek, therefore, helping build their physician’s practices.
Additionally, because patients are using the system, the practices are meeting the minimum requirements for mandates and will be able to successfully attest to stage 2.
Once the patients receive the care they need, they return to their lives until another ailment shows its head, at which point they return to the portal and continue to engage.
All said, you have an engaged patient population who look to create and value long-term relationships with their physicians and their physicians are able to support and build their practices, and, wait for it … support their patients.
It’s the circle of “life,” if you will. As the population scales beyond those included in the survey, this model is likely going to be the new normal.
Please, please, correct me if I’m wrong, but isn’t this exactly the type of news and headlines everyone with an investment in meaningful use was waiting/hoping for?
Healthcare reform was ignited by ARRA, which became the catalyst for much of the changes currently taking place in the health IT landscape, and though meaningful use is profoundly changing the way data is collected, according to some we’re a very long way away from actually being able to do something specific and positive with it.
Everyone in the healthcare community is focusing on regulation and meeting the mandates of the reform, from a healthcare technology perspective. Things get a little lopsided when the discussion turns to how the information gathered in meaningful use relates to clinical outcomes.
According to Dr. Akram Boutrous, who leads the consultancy BusinessFirst Healthcare Solutions, right now there is simply no way of collecting all of the data available in the healthcare community on a global level.
As far as he and others are concerned, under the current healthcare reform model there’s too much attention being placed on healthcare technology, including electronic health records, when there is still a mighty void between the tools used to gather the data and the tools (which don’t yet exist, he says) used to analyze the data.
“There are still many tools required to predict what is most likely going to happen in a given scenario and the best course of action to take,” Boutrous said.
He describes the current health IT landscape like an iPad without apps to use on it. “You can look at it, but you can’t do anything with it.”
This means we’re back where we have always been – in a land of silos where the information they contain stays contained without any real chance of it going anywhere to do any good.
Without interoperable systems that can communicate on a much larger scale, there’s certainly no room for even discussing the advancement of the ACO concept. “I’m pessimistic that ACOs as defined [in health IT] will provide meaningful change in healthcare,” he said.
The catalyst for change, he thinks, is the payer community and non-government organizations. Even though the federal government set the foundation for health reform, it won’t be able to maintain a successful program, and innovation will fall by the wayside.
“The non-government side of the world has taken the bull by the horns and made some very innovative advancements,” he said, while the public sector sought clarification of the reform mandates through court and legislative actions.
Until better tools can be implemented and adopted, and a culture change embraced, we’re simply not going to see models like ACOs develop according to the timeline many industry “experts” claim.
Until there are actual tools that provide meaningful support to the community and allow for some sort of global analyzing of specific populations and data sets in real time, healthcare will remain a production-based market where accountable care remains nothing more than an idea.
The market needs more than static components and databases, and health IT needs to evolve and incorporate more capabilities to that make possible, and engage in information exchange before we can begin to move to an accountable care model.
I’ve always been a sucker for trivia. In most cases, the information that sticks in my head is useless and, well, trivial. People — including those that know me best — often shoot me quizzical looks and wonder where the hell I came up the crap that pops out of my mouth. Most of the time I shrug and respond with the I’m-so-stupid-sorry-for-breaking-the-silence, “What.”
But, in healthcare, this kind of mindset set has a place; maybe it’s just a data place of mind sort of thing. Nevertheless, I’m comforted by all of the (sometimes) useful technology information floating around, and today, I’m proud to share a kindred spirit at HIT Consultant, who posts an incredible plethora of devourable data worthy of sinking your teeth into in the piece, “80 Mind Blowing EMR and Meaningful Use Statistics & Trends.”
Feel free to check out the full course, but for a primer, let’s dig in here.
• According to the list, 75 percent of patients are willing to go online for health information. Not surprised by this one bit. I’d argue the number is low. Check out this article by American Medical News for more on the subject. We spend our lives online wherever we can get online. If we have access to the web, we’ll be on it; this isn’t necessarily mind blowing, just trivia, and a reality.
• Next up, financial troubles at the practice level. Interesting topic, but given the conversations I’ve had with physicians I’m not surprised. More than 40 percent of physicians have financial troubles, and given the overwhelming reform practices face, it’s no wonder the private practice is being ambushed.
• More than 70 percent of hospitals employ full-time staff to scan charts into their electronic systems. WOW! Seriously? This doesn’t sound efficient to me. Someone please explain.
• “Solo practitioners are particularly unlikely to be using EHRs or to have plans to implement them. Also, older physicians are less likely to be pushing for adoption of HIT.” Again, no surprise, though, it’s sad. Truth is, both of these segments will be out of private practice in the next three years under the current healthcare structure. No joke.
• Just a bit more than 20 percent said their EHRs made them more efficient and only 6 percent said their making more money with their systems. Again, not surprised by this data. These are PR talking points EHR vendors push to sell their systems. Pay attention, you’ll probably see some CEO on this site talking the same points sometime soon.
• Apparently, according to a study reposted by Becker’s Hospital Review, 91 percent of physicians want/are interested in mobile EHRs. I don’t buy it. I’d like to see the data, but I bet it’s a flawed report. Physicians are too concerned with their in-practice solutions, mandates and reform. We haven’t tipped that far in the mobile direction yet. Not possible; just another PR talking point from a vendor.
• “Each patient visit requires approximately 10 to 13 pieces of paper.” That is shocking.
• Top 5 EMR vendors by number of users are:
o Care 360
Care 360 is in the Top 5? Hmmm.
• The feds believe they’re on the hook for more than $20 billion of taxpayer’s money for meaningful use before the program wraps. This is one of those facts that I’m not surprised by, but I am, if you know what I mean. It just makes me look side ways.
And the list goes on and on, some shocking pieces of trivia, some less so. The point is there’s much to consume, some more positive than others. But, HIT Consultant does make a great point: a lot of the data available doesn’t point to a land of milk and honey. On the contrary, there’s a lot of disappointment in health IT.
There’s apparently much to learn and much to improve. Everything is yet to be perfect, while some things are wonderfully, wonderfully good.
After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.
You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.
With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.
All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.
“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.
“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.
Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.
On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.
The more likely model now will become the one where physicians become employees.
“Healthcare reform essentially is putting the private practice out of business,” he said.
In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.
“This is the reality of what we’re seeing in the outside world.”
Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.
With the patient engagement quandary hanging its head over the next phase of meaningful use, healthcare leaders of all kinds continue to wrestle with how to meet mandates that are beyond their control.
Previously, the assignment was simple: do this, get that. But here, in stage 2, there’s a little outlier – required patient engagement – that has some physicians worried about how they are going to handle their second attestation.
Even though there are rumblings that CMS may look the other way when dealing with patient engagement, or decides not to enforce it, at least in the beginning, or chooses not to audit this measure, it’s still a mandate and it’s being taken seriously for all providers seeking the second set of financial incentives.
Some practices are taking measures that they haven’t had to in the past or at least with as much passion as they are now. They are marketing and advertising directly to patients, even if the campaign extends only to the interior of their own practices.
Such is the case for Dr. Stephen Bush, of Fox Valley Women and Children’s Health Partners in St. Charles, Illinois.
The first step in the process, Dr. Bush said is the implementation of a patient portal, which is though to help get the practice’s patients engaged or, in the very least, getting them more involved in their care protocols.
“The problem is, patients have to sign up to use the portal,” Bush said. His worry, though, is when pushing patients to engage, that if patients are pushed too hard, patients push back and essentially disengage.
“We receive significant push back from patients who get upset when trying to engage too much,” Bush said. Examples include posting too many times on Facebook or posting too many tweets to Twitter. According to Bush, patients will stop liking the practice on Facebook and stop following on Twitter if they feel the practice too involved socially.
Bush said his practice is working to implement new marketing and educational strategies to prepare for the patient engagement mandate, just to be safe, even though there’s little that can be done to audit how often patients use the portal after they have signed up.
There also may be too much attention put on patient portal’s capabilities, he said.
“They are not education tools, and they’re not meant to provide better healthcare, and in no way does it educate the patient,” he said.
Despite the patient engagement portion of the Stage 2, Bush said meaningful use is needed and ultimately, will help patients become more informed and get them involved in their care, which may help reduce costs overall. “The management of healthcare for patients is important, and can make lives better and healthier,” he said.
“All physicians are concerned about their patients are being taken care of and informed. Meaningful use gets patients involved. Patients now deal with things when there is a problem occurs rather than managing a healthy lifestyle.”
Physicians are trying to engage patients, and always have. Eventually, a change will come to the landscape, but as long as patients remain laissez-faire, there will be some push back when they are pushed.
I heard a stat recently that it would take eight years to view all of the videos loaded to YouTube each day. With such a volume of content flooding the market, it makes sense to have a plan.
Social media isn’t such a new phenomenon and it absolutely has an impact. As far as patient engagement is concerned, many say it’s one of the only ways to draw patients into the fold; especially important now, of course.
According to a new post from ClickZ, a marketing news site, almost 90 percent of all businesses are utilizing some sort of social media effort (I think that number is a bit high), but it’s very obvious that not as many of these campaigns are even remotely as impactful as they could be.
Establishing a successful program takes a little practice and patience, and probably a little luck. It helps, though, to identity mistakes and to try your hardest to avoid them.
Here are some of the biggest, courtesy of the folks who know at ClickZ:
Not having a plan. No matter the business sector or the business, you have to have a plan. The plan includes strategic objectives and, well, planning. Simply opening some accounts and posting your thoughts isn’t a plan. Plans include goals, and goals are something you work toward and attempt to measure. Just posting any old thing typically doesn’t produce anything of value and, therefore, is pretty much a waste of time.
Not optimizing content. Don’t simply post the same content to all of your social sites. It will grow redundant and bore your audience. According to ClickZ, you have to optimize your content. If you don’t, “You’ll end up with content that isn’t right for the medium, and people will start to ignore you. Take a few extra minutes to customize your post for each medium.”
Posting whatever comes to mind. Don’t simply write whatever comes to your mind and throw it on the web for the world to see. This seems pretty intuitive, but it’s a good reminder that there are often boundaries, especially in healthcare. Think about what you want to write, try to make it interesting and relevant. Think, think, think.
Forgetting not to show not tell: I quote directly from ClickZ. “Stop telling people what you want them to believe about your business and start showing them.” Show them with reports, videos, blog posts and observations. ‘Think about your key value proposition and point of difference, and figure out how to show people via social media.” Good point.
Are you boring? If you don’t have a “voice” and come of as un-insigthful, chances are, you’re boring. “Think about how to make your message interesting to your audience: compare it to something else; use a picture or video; find a more relevant way to share your angle. Just stop being boring.”
Losing focus. Stop trying to speak everyone’s language. Reel it in. Focus your message and stick to your strong points. You know what you do well, why you’re an expert; it’s time to focus speak your mind, but speak of the things in which you know well. Speak your mind, and speak your heart, but stay on point.
With these tips, and your best practices, there’s a good chance you’ll develop an engaged audience.
Perhaps one of the easiest ways to engage patients in the patient engagement process, especially as it relates to meaningful use Stage 2, is to let them know that you are trying to engage them.
Since CMS announced the patient engagement requirement as part of meaningful use, physicians and practice leaders who hope to attest and receive federal incentives have voiced their concern over the requirement since it’s the one element beyond their control.
“The push back from providers is because it’s the one thing they can’t control; they can’t make patients ask for a patient summary and force them to download it,” said Amit Trivedi, healthcare program manager at ICSA Labs, which is a vendor-neutral testing and certification firm that works with EHR vendors. “Originally, I thought it would be upheld. I still don’t think they’ll drop it, but it’s possible they (CMS) may modify it or choose not to audit it.”
Essentially, the patient engagement portion of Stage 2 most likely won’t be dropped, but, according to Trivedi, enforcement of the mandate may not happen right away.
Still, Trivedi says the healthcare community shouldn’t walk away from the patient engagement debate simply because patients don’t seem interested in or accessing their health record. On the contrary, now is the time to begin moving in the direction of creating more awareness with the consuming public.
By taking the approach that if patients don’t ask for something because they don’t want it is faulty, Trivedi said. The same arguments were made by technology vendors prior to meaningful use who he said claimed certain enhancements just were not important to physicians and their patients. However, once incentives were announced and mandates issued, vendors quickly jumped on board to upgrade their systems to meet the new need.
Patient portals are an example of one such tool. Prior to meaningful use, they were considered Cadillac-like add ons that were wanted only by a few practitioners. With meaningful use, they are necessary and required component of the systems.
“You may never be able to make patients download their records, but you have to advertise and make the data available” said Trivedi.
Healthcare is entering the age of a new demographic and though there may be little desire to engage with the current generation, upcoming users are not going to be so patient in seeking their health information. For many, having access to their records will be a right, Trivedi said. Making data available to the public and encouraging patients to access and use it is nothing more than a cost of business.
Other than advertising to patients about the capabilities, Trivedi suggests taking the message to those who truly need access to it, for example, parents of young children and caretakers of the elderly. Though there’s simply no way that a majority of consumer patients will be engaged patients, at least in the short term, it’s much more likely that targeting specific population sets, like those mentioned, will help move the population forward and get people to take greater ownership of their care (or at least the care of those they are caring for).
After all, even with all the data collection and its analysis, its potential for improving greater health outcomes across the population and the move toward structured and transportable data, it ultimately we won’t find the results we’re looking for if the patients are not engaged.
Help me understand, if you will, where the soul of meaningful use lies. I’ve seen the rules that have been made final and I’ve heard the stories of folks in the field that have had their lives and practices changed because of it.
But all of this just doesn’t seem to lead to a very innovative end.
Sure, the technology is needed in healthcare as the antiquated use of paper continues to overwhelm, but what’s the real proposition here? As far as I’m concerned, some of the real questions remain unanswered, and I am slightly suspicious as to why the feds are so heavily involved.
Granted, I shouldn’t be surprised given all the money that’s been spent in numerous non-government areas (like cars, banking and solar), but let’s peel back here a little and ask why the industry really needs the incentives. Let’s agree that on its own, the healthcare industry would have adopted the technology and was doing so; the incentives just moved adoption along much more quickly. So, why are the feds involved? Agree with me or not, they want our data.
This is the coup d’état. Collected data leads to predictive analysis and evidence-based treatment protocols. This leads to the dissolution of independent care protocols and removes independent will and turns healthcare into committee care.
Getting care is going to be similar to applying to government grants and scholarships. I’m oversimplifying the matter here, but please, let’s admit that there is a price that’s going to be paid for the federal incentives.
That said, my soap boxing out of the way, I’m back to my original question: Where is the soul of meaningful use?
Let’s take a look at the upcoming Stage 3. In large part it’s a lot of increased measures and new “patient engagement” provisions such as: giving patient the opportunity to request amendments to their records online, requiring electronic health records to receive, generate or access appropriate immunization recommendations, and requiring EHRs to be able to query other entities for outside records.
(Yawn.) (Wipe my eyes.)
These are valiant efforts and worthy of exploring, certainly. But, where is the real innovation that we’re supposed to be seeking? Where’s the game-changing approach to healthcare information that blows our minds? This is a technology based process after all and I think we need to begin demanding more of the technology we employ.
The technology is not holding us back, either. It’s us and our continually lowered expectations. If we’re going to take some risks then those risks need to be real risks and not some marketing speak for a data grab slight of hand.
From my perspective, about 90 percent of the technology vendors in the space do just enough and nothing more. Their investments are in sales teams, not in research and development.
But how can you blame them when the one leading body of the mandated changes is asking so little of the community.
What this is beginning to feel like a bunch of self-appointed “decision” makers trying to affect change of a program that’s been in place for decades, in the end, no matter the tinkering, may be nothing but waste having been accomplished.