Guest post by: Sarah Armstrong, a consultant at ARRYVE, a strategy consulting firm.
A recent study published by the RAND Corporation indicates that implementation of electronic health records (EHR) has not yielded the cost reduction predicted in 2005[i]. Their study identified process efficiency and patient safety savings as two primary outcomes of EHR implementation, leading to a forecasted $81 billion annual drop in healthcare costs. Instead, costs have risen significantly. RAND cites a number of reasons for this: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of healthcare providers and institutions to reengineer care processes to reap the full benefits of health IT.
While the latter can be attributable to the inability or unwillingness of care providers to change, the former places blames on the institutions’ IT departments and software companies. These parties know that disparate EHRs leave a significant gap, but providers are not empowered to bridge the gap. Furthermore, software companies may struggle to differentiate themselves should they modify their product to be compatible with that of a competitor. Assuming either option presented a real possibility, modified software products and altered care processes lie years down the road at best.
If something breaks, you fix it. Fixing this problem will not be easy, however, and many opinion pieces point to our federal government as the catalyst required to affect change. But instead of a major, time-consuming overhaul by the producers and users of health IT, I propose we consider incremental ways to mitigate some of the effects of the problem. I see great opportunity for 2013 to be a year not of rigorously planned change, but of simple workarounds. Specifically, these workarounds would be performed by the people most affected by 1) poor or nonexistent interoperability of EHRs and 2) their caregiver’s inability to effectively use the technology: patients.
Consider the primary problem that arises from non-interoperable health IT systems: incomplete patient data. This problem manifests itself in many ways. For patients, treatment options may be redundant, medicines prescribed may counteract each other, and they may find themselves repeating information they already gave another provider. For providers, if their patients seek care outside their facility and do not fully report their medical history, the current state of health IT does not afford them a way to see the full picture. Additionally, the quality of a provider’s aggregate patient data diminishes.
I would argue that incomplete patient data has long been a problem associated with paper medical records. So why the recent finger pointing at EHRs? Could the problem be attributed to behavioral changes on the part of both providers and patients? Within the past five years, I have changed primary care physicians twice. I have listed the names of my previous physicians, but neither has asked me to obtain my old records. Because I have not been asked to procure these, I have not troubled myself with the task.
A patient unfamiliar with health IT or health information privacy laws might think that listing their previous physician’s name (or current specialists’ names) automatically transfers their medical record. Unless a patient signs for a record transfer, caregivers must rely on what is optimistically a factual and complete patient history form that is often filled out during the minutes before an initial visit. Years of medical care are rewritten according to one’s ability to recall vaccinations, test results, and allergies, as well as the accuracy of a data analyst inputting the record into the patient’s brand spanking new, and likely abbreviated, EHR.
Patients want the best care and we look to our caregivers to tell us what to do. We may not always listen (e.g., quit smoking, exercise, etc.), but people consistently identify their physician as the person they trust most. A simple but powerful mitigation plan for addressing incomplete patient data could be to involve patients more closely in their care:
In addition to obtaining high-level health information in the intake form, ask new patients to procure their old records. Evaluate the records and input the most important details into the EHR.
When calling with appointment reminders, ask patients to bring all current medications and supplements to the medical center. An easy task for many, it can only help providers diagnose and suggest treatment options.
During the visit, ask if the patient has sought care elsewhere. A simple question, it would likely jog one’s memory that, yes, they did see the eye doctor for an annual exam or received a flu shot at the pharmacy since their last visit.
Providers would also benefit from involving patients more closely in their care. Not only do they have countless reasons to deliver care based on complete data, but many also want to publicize to prospective patients that they provide quality care. Complete patient data helps legitimize providers’ quality claims. For example, by asking all female patients about recent cancer screenings, they can truthfully state the percentage of patients who are current on these screenings. Without asking this question, a primary care clinic might report a lower percentage of current screenings among its patients than is accurate, since they would not take into account those performed by outside providers (e.g., OB/GYN, dermatology, etc.).
When discussing the ineffectiveness of EHRs, invite all affected parties to the table. I have confidence that behavior modifications aimed at mitigating the side effects of a rapidly evolving landscape, keeping the best interests of everyone at heart, will serve us all well. I dare say that the cumulative effect of millions of small modifications will reach further and quicker than one major change by software manufacturers or Uncle Sam.
Sarah Armstrong is a consultant at ARRYVE, a strategy consulting firm, with a diverse mix of industry experience ranging from healthcare to software. Healthcare engagements have encompassed strategic planning, process design, revenue cycle, compensation planning, market analysis, quality management and regulatory compliance at academic medical centers, children’s hospitals, and both primary care and pediatric practices.
[i] Arthur L. Kellerman and Spencer S. Jones, What It Will Take To Achieve The As-Yet-Unfulfilled Promises of Health Information Technology, Health Affairs, 32, no. 1 (2013):63-68
Who would have thought that intelligent virtual assistants could be used as patient engagement tools? The same virtual assistants that live on websites you might traffic that help you find site details, search the site or ask more detailed questions about information contained on the site.
Apparently this is the exact line of thinking of the folks at Next IT, a company that develops virtual assistant technology. According to Victor Morrison, vice president of healthcare markets, virtual assistants are the “silver bullet” to the patient engagement quandary.
The Washington state-based technology firm currently supports several major companies including United and Alaska airlines, Gonzaga University, Amtrak and Aetna. Though it’s only current healthcare experience is on the payer side, the company entered into a partnership with a major pharmaceutical company a few weeks ago and is expected to bring a new virtual assistant “personality” to market in a few months, said Morrison.
Next IT has partnered with Aetna for three years, creating for the company through its Human Emulation Software, “Agent Ann,” a virtual assistant that lives on Aetna’s registration page of its website. There, Ann provides immediate assistance to new members visiting the site for the first time. Ann debuted in early 2010 when many new members were first beginning to use their plans, and “she” is available to members 24/7, making it easier to do business over the web.
Members are able to type in their questions, using their own natural language and get the information they need to continue registration. Results show that she’s having an impact.
According to Next IT’s website, more than half of people registering on the website for the first time engage with Ann, “Because Ann does such a good job walking members through registration, Aetna reported that during the fifth month after implementation, they saw a 29 percent reduction in calls to their member-service technical help desk.”
Because of Ann, Aetna is seeing a reduction in operating expenses while still providing the service that members expect.
Most impressive, though, is that half of all people registering on the Aetna site engage Ann. Even Aetna’s covered members using the member’s only site are able to use Ann to view claims, look up physicians for services and even estimate the amount a service will cost with a specific physician.
According to Morrison, the system used by Aetna will be considered somewhat light in relation to what Next IT has planned for the clinical setting. Specifically, it will be more proactive depending on a patient’s needs, he said.
“Interactive virtual assistants are the magic bullet for patient engagement,” Morrison said. “What we can do is create and interface with smart phone and smart devices.”
With the right interface, which can be created to incorporate voice activation, like what’s found in Siri, tools like virtual assistants that are employed by large and enterprise health systems may be able to create a link with a patient, to interact with and monitor activity on a regular basis and to engage them through a protected portal such as a patient portal.
Ultimately, tools like Aetna’s Ann, and the one used by the U.S. Army, which have personalities and back stories built into their profiles (designed to create trust with users, Morrison said) will be able to push information, reminders and updates to patients who sign up with the service to help them stay engaged with their caregivers.
“Once we understand the patient and we begin to engage, we can push information to them to push engagement,” said Morrison. “We’ll be able to ping them with a text message, and push medication reminders. We’ll even be able to ask them questions like ‘How are you feeling today.’”
Depending on the patient’s response, if after a certain number of non-positive responses, the assistant will be able to automatically schedule an appointment with a physician or manage some other pre-established message to the patient’s care provider to ensure the patient is being contacted to ensure proper care continuum.
But, the assistants’ interaction can be set up to be much more than pushing information; they can actually engage individual with medication reminders, for example, and provide guidance for recommended doses, where to take an injection (in situations where that is appropriate), and improve patient understanding of a procedure or medication.
Patients can set up reminders through their smart devices, schedule appointments and can rate their health experience and how they feel, which can help physicians begin to create a comprehensive patient case history.
Based on this, virtual assistants may contribute to a more engage patient population, especially if people are able to so easily interact with them as is showcased in the video. Where patient portals and other engagement strategies, like social media, may be lacking, this technology may, in fact, be the magic bullet Next IT believes it to be.
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.
HIE expansion about supply and demand? Well, if you read this blog regularly, you’ll know that I spend a good bit of time perusing HealthIT.gov. Though it’s not flashy and overwhelming, the site is informative and actually provides a great deal of information, which says a lot since it’s a government property.
What HeatlhIT.gov does well is provide a nice primer of information about a variety of subjects from meaningful use, electronic health records and health information exchanges.
In addition, the site puts everything in plain and simple language for all the world to understand.
For example, take a look at the reasons why health information exchanges are important to the healthcare landscape:
The ability to exchange health information electronically is the foundation of efforts to improve healthcare quality and safety. HIE can provide:
The connecting point for an organized, standardized process of data exchange across statewide, regional and local initiatives
The means to reduce duplication of services (resulting in lower healthcare costs)
The means to reduce operational costs by automating many administrative tasks
Governance and management of the data exchange process
And for good measure, here are a few examples of how health information exchanges are benefiting the healthcare landscape. Some of these concepts are a bit obvious and overstated here, but still this provides a nice starting point in support for the soon to be possible movement.
Benefits of health information exchanges:
Provide a vehicle for improving quality and safety of patient care
Provides a basic level of interoperability among EHRs maintained by individual physicians and organizations
Stimulates consumer education and patients’ involvement in their own healthcare
Helps public health officials meet their commitment to the community
Creates a potential loop for feedback between health-related research and actual practice
Facilitates efficient deployment of emerging technology and healthcare services
Provides the backbone of technical infrastructure for leverage by national and state-level initiatives
I’m not alone in the belief that I feel HIEs’ most important role is one of creating interoperable opportunities to connect physicians and their patients to a web of other care givers and health community members.
It seems that the closer we get to HIEs and their overall acceptance in healthcare, doesn’t it seem like we take two steps back?
What are some of the hurdles keeping HIEs from reaching their full potential? Glad you asked.
Cost has to be the clear front runner. As I’ve previously stated, the questions remain – who’s going to pay for them? The government clearly wants a healthy HIE community because it is believed that they will lead to greater adoption of EHRs while vendors want part of the action so they can charge physicians to transfer data through the networks. Vendors can’t figure out a financial model for them and until they can get someone to pay for them, there may be little movement here.
Another hurdle of HIEs is that for those that exist, the data often exists in silos. Problem with siloed data is that the data doesn’t go anywhere. Sounds a lot like an EHR, but an EHR may be more user friendly and robust. Just saying.
Finally, lack of standards impede their advancement. More development for standards is required for the variety of HIEs to be able to communicate. Profiles, like the need for structured data in EHRs, will help advance the cause and promote their development.
Ultimately, HIE expansion will most likely come down to basic business 101: supply and demand. When the population demands it, we’ll see the supply increase and in so doing, we’ll see cost containment, industry wide standards and completely interoperable systems that will completely open up the health IT market place.
Healthcare big data is a big story, and it’s only going to continue being one. It’s a story I like and am intrigued by, but it’s not very sexy. Because of this, the only pieces of information about it seems to be very technical.
Until we actually see how big data changes lives, there’s just not going to be warm and fuzzy stories about it. So, cold and technical it is; nonetheless, I’m still fascinated.
In searching information about the subject, because I too want to know more from a ground floor level, it was nice to come across a nice piece about big data on the Cleveland Clinic’s website.
So, getting right into it, here’s an interesting piece of trivia about healthcare big data directly from the Clinic: “The amount of data collected each day dwarfs human comprehension and even brings most computing programs to a quick standstill. It is estimated that 2.5 quintillion bytes of data are created daily, so much that 90 percent of the data in the world has been created in the last two years.”
Healthcare big data is essentially large amounts of data that’s difficult to manipulate using standard, typical databases. Essentially, big data is very large pieces of information that ultimately, when captured can analyzed, dissected and used to monitor segments within a given sect.
Healthcare big data, it is thought, is what will drive change in care outcomes. What’s interesting, though, is that even though there’s a tremendous amount of data available for use, it’s just not being collected in a structured manner.
Collecting structured data is a must if we are going to begin putting some muscle to the bone of the new healthcare ecosphere we’re putting in place. You don’t have to take my word for it; IDC Health Insights research director Judy Hanover spoke of the same subject recently here.
But, to prove my position, I’ll let Cleveland Clinic make the point: “Unfortunately, not enough of this deluge of big data sets has been systematically collected and stored, and therefore this valuable information has not been aggregated, analyzed or made available in a format to be readily accessed to improve healthcare.”
Also according to the Clinic, if all of the data currently available were used and analyzed, it would be worth about $300 billion a year, reducing “healthcare expenditures by almost 8 percent.”
At the heart of healthcare big data is the hope that it can eventually help providers become predictors. Essentially, big data is like a big crystal ball, or so it’s been said.
According to Cleveland Clinic: “In this way, analytics can be applied to better hospital operations, track outcomes for clinical and surgical procedures, including length of stay, re-admission rates, infection rates, mortality, and co-morbidity prevention. It can also be used to benchmark effectiveness-to-cost models.”
Predictive analytics: That’s what it’s all about.
With all of the attention being given big data and warnings about being prepared for big data so it doesn’t sneak up on you – like meaningful use and ICD-10 – are valid and should be taken seriously.
Efforts are currently underway and available for big data processing and by managing data, “This dynamic data management technology makes data analysis more efficient and useful. Access to these data can also significantly shorten the time needed to track patterns of care and outcomes, and generate new knowledge. By leveraging this knowledge, leaders can dramatically improve safety, research, quality, and cost efficiency, all of which are critical factors necessary to facilitate healthcare reform,” writes Cleveland Clinic.
Big data is a catalyst for change, and without sounding caustic, will be a bigger deal than electronic health records currently are. Without a commitment to it, practices and healthcare systems will be left behind.
The misconceptions about healthcare information technology, specifically electronic health records, are rampant even as the technology matures and begins to saturate the market.
More of the technology’s capabilities are known now by the average healthcare insider (physician, practice or hospital leader, for example) than even two years ago (before meaningful use). That’s understandable; however, those darned misconceptions continue to fly.
No matter where you look, there’s a top five or a top four and even a top three list of the biggest misconceptions about the technology.
So, today I thought I’d take a look at some of the “best” misconceptions about EHRs floating about the health IT stratosphere.
Electronic health records won’t save a practice any money: Though they alone may not save money from the moment go, over time and if implemented properly, they can help a practice save money in the long term. Ultimately, they create internal efficiencies such as reduced paper, easier and safer transfer of records to patients and specialists, reductions in the number of tests that need to be ordered, greater coordination of care. Plus, for some practices utilizing EHRs they’ve been able to increase the number of patients seen because of improved administrative functions.
Using technology in the exam room distracts patients and reduces the quality of the visit: Frankly, this is nothing more than a statement made without substance, and there’s really no difference between taking notes on paper or through a piece of technology from the patient’s perspective. Additionally, we all live in a technology filled world and patients are accepting of technology in their lives. In many cases, patients see technology in the exam room as a way to engage their physicians in their care. Physicians should see it the same way.
Electronic health records are not as safe and can be hacked: Never say never, and yes, there’s a bit of truth to that statement, but the fact is that paper records are simply easier to access than their electronic counter parts. And, since most data breeches are inside jobs, at least electronic health records allow for electronic auditing which can determine who, when and how often a record has been accessed.
EHRs are hard than paper to use: Perhaps depending on your comfort with your system, this may be the case, but clear investment in learning the system will pay long-term dividends. Electronic health records allow for searchable records with data that can be viewed, shared, downloaded and “filed” without having to print, manually scan, review and file the documents.
Electronic health records were created to facilitate meaningful use: Quite frankly, this is false. Clearly, EHRs have been available long, long before meaningful use was even a concept. They do facilitate meaningful use now that the process has been put in place for the program to thrive.
An electronic health record assures a practice of meaningful use: Not so. An EHR is the first step in the process. Meaningful use is about the process of using the technology and about using the data gained to improve patient health outcomes. Seeing the patient populations’ data allows physicians to begin to make changes to their approach to care, especially as it relates to chronic conditions.
Electronic health records are not available for every practice: There’s no way to objectively respond to this misconception. Truth is, there are hundreds, maybe even thousands of systems on the market, some of them designed for specialty specific practices. If you have been dutiful in your research and still determine that nothing meets your needs, either you aren’t ready or willing to make the switch or you are impossible to please.
Electronic health records can build patient loyalty. And using them within a practice and letting patients know about them and their uses, it is more likely that patients will return for service again in the future.
At least that’s the latest news from Kaiser Permanente.
Also according to the health plan/care provider is that patients are more loyal to a practice using an EHR if the practice is also using a patient portal for the patient to access their personal health records.
Accordingly, people using Kaiser’s personal health record to track their health, manage their care and access records through Kaiser’s My Health Manager (the organization’s patient portal) were more likely to stick with the Kaiser health plan than not in future plan years.
Though I maintain my fair share of skepticism about the study featured in the American Journal of Managed Care because Kaiser members are incredibly loyal (I know because I’ve worked with Kaiser members as a benefit plan communications director for a major government program in the region where the study was conducted) and they probably would not have switched plans regardless of the patient portal (and because the study seems somewhat self serving of Kaiser), there may be a nugget of truth here.
Apparently, according the study, Kaiser plan members who used the portal to view their medical records, make or change appointments and communicate with their doctor or other health provider electronically, where more likely to continue to pick the same plan in subsequent plan years.
The results are derived from more than 160,000 Kaiser Permanente Northwest members enrolled in a Kaiser plan between 2005 and 2008. Members who used the portal were more than twice as likely as nonusers to stay with the health plan during the period studied. “The only greater predictors of retention likelihood were more than 10 years of plan membership and a high illness burden,” the study authors wrote.
Essentially, the authors of the study suggest that EHRs integrated with a patient portal are more likely to create loyal patients.
Really, though, the findings of this Kaiser study are nothing new. As have been reported numerous times before, patients continually perceive healthcare technology positively, at least according to my perspective.
In the survey, patients said they felt more comfortable with physicians that used an EHR system, and more importantly, patients felt that the information contained in the medical record was more accurate when they physically saw information being entered electronically. Physicians using EHRs in front of their patients said they felt the most comfortable with the accuracy of the information contained in their records.
Additionally, in the survey I conducted, 45 percent of patients had a “very positive” perception of their physician or clinician documenting patient care with a computer or other electronic device, and patients believe that using an EHR will actually improve care outcomes in the long term.
Physicians and patients also agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHRs, as agreed upon by the two groups, were
They give physicians access to patients’ medical records and history in real time.
When appropriate, EHRs help the physician securely and seamlessly share information with other doctors, pharmacies and payers.
EHRs help physician make good decisions about patient care, ultimately driving the quality of patient care.
To put it bluntly, yes, there appears to be a great deal of patient loyalty for physicians using an EHR. Kaiser’s data only seems to strengthen this claim, and, certainly, it appears that integrating technology that’s “interactive,” such as a patient portal, helps foster this connection.
If nothing else, using an integrated EHR seems to generate greater patient engagement and may create more loyalty toward a practice, which ultimately builds stronger practices and potentially more word-of-mouth customer referrals, which help businesses grow.
Does healthcare technology actually interfere with patient care? Apparently so, according to a new study commissioned by athenahealth.
“Overburdened” physicians face pressures from continual government “intervention,” “increased use of and frustration with EHRs” and “administrative burdens.”
According to the study, physicians are disenfranchised.
Why? Well, according to athena’s study, there’s too much change. Perhaps that’s a bit of a blunt summation, but it seems to be the picture the study paints.
Nearly half the physicians interviewed for the study said electronic health records were not designed with the physician in mind while nearly two-thirds said the EHRs take away from their ability to engage with patients.
Some of this is obviously subjective opinion. Of course, there’s really no way to measure whether or not patients feel put off by their doctors entering data during the visit. On the contrary, there are plenty of reports to suggest that patients actually appreciate that doctors use an EHR during the visit.
However, from the eye of the beholder (physicians), they’re the ones sitting in the practice day after day getting a feel for the moods of their patients in the exam room once the keyboard comes out.
Sadly, the conclusion they have come to as a collective population is that EHRs are significantly reducing the quality of care patients receive. Again, this is filled with opinion, but if it’s the mood conveyed, that mood is bound to rub off on the patient population and will affect their perception of the technology, too.
These same physicians – more than 80 percent of physicians in the study – also feel the future of the independent practice is not viable, and more than two thirds feel the quality of care will greatly diminish over the next five years because of all these continuous distractions, including technology’s pervasiveness in the practice space.
This is stark “reality” for the profession from the mouths of its professionals.
Interestingly, in a completely unrelated study by recruiting firm Jackson Healthcare, more than a third of private practitioners say they will quit private practice within the next 10 years because of “declining reimbursement, capitation, and unprofitable practice; business complexities and hassles; overhead and cost of doing business too high.”
Where they’ll likely end up is obvious: in a hospital setting or in a hospital-owned practice. Why leave? They said they fear economic factors facing private practice (the first reason given) and they don’t want to practice in the age of reform (second response), which may be quite difficult given the current climate of healthcare.
What does all of this eye-opening information mean?
Well, it doesn’t bode well for those concerned about the ever increasing shortage of healthcare providers.
Perhaps more troublesome, though, is that no matter how much time is spent educating and informing certain segments of the healthcare population, there are always going to be many who remain unconvinced that technology produces practice efficiencies and helps lead to better care outcomes.
Patient engagement will continue to become more popular as consumers take greater ownership of their care and begin to discover that their health information should actually be easier to access because of electronic health records and patient portals. However, patients must have reason to engage for this trend to become less of a trickle and more of a flood.
Healthcare technology is meant to allow more access to, and increase the availability of, patient’s health information. At least that’s one of the desired outcomes of the push (meaningful use and federal incentives) to lure physicians to adapt the systems.
Sterling Lanier, CEO of Tonic Health, succinctly sums up lack of patient engagement in a recent editorial published by For the Record magazine.
In it, he states that healthcare, like government, is filled with vernacular and jargon – HIEs, EHRs, ACOs, HIT, et al. – and the more these terms continue to be used, the less likely patient consumers are going to interact and engage with the healthcare community, and to take ownership of their own care outcomes.
As Lanier notes, and as I have often thought, to bring patients into the conversation, they have to be treated like consumers and they must have a reason to “buy” into the system. In this case, consumers must “buy” the information given to them. If they buy and own it, they’ll want more of it, or so goes the prevailing thought.
But simply speaking in terms the natives will understand isn’t enough. Consumers need to better understand how the technology they encounter at the doctor’s office helps produce better care outcomes. They may need some education and certainly they need some engagement once the systems are in place and being used during the visit.
Though patients will interact with the EHR less frequently than other technology they encounter, such as the patient portal (which they can actually use and interact with on their own), that doesn’t mean the EHR should be ignored during the interaction or treated as a foreign concept. In most cases, let’s remember, healthcare is actually behind many other consumer markets so consumers are actually more versed in the use and capabilities of similar systems outside their doctor’s office. Besides, we’re like children with devices and must test drive things like smart phones, televisions and computers as we learn to use them; we like to get our hands on the technology to try it out to satisfy our child-like need to see with our hands.
Even though patients can’t “touch” their EHRs, we can watch the information we provide our doctors being entered into the system; we can speak with our caregivers as they toggle and tab; and we can engage clinicians as they review our profiles and medical records. As a patient of a doctor with an EHR, I ask questions about the system: what it does, who makes it, why it was chosen and if it layout closely resembles the clinics’ past paper charts. I feel better about the little details and doing so makes me feel as though my doctor is listening to me during the visit.
Asking me these questions engages me more in my healthcare, and more than likely, engages my doctor in my care and outcomes.