The importance of social media can not be understated, and as a vehicle for communication, for many there is just no better option for cheaply and efficiently getting their message out.
However, just because something exists doesn’t mean you have to jump right in and use it without a plan (though your excitement in doing so is remarkable.)
And as you know, I spend quite a bit of time on this site encouraging physicians and practices to take the plunge into social media. But, as a small business, you might find some comfort in knowing you are not alone. There are countless other small business throughout the United States using (or trying to use) social media to engage prospective customers and bringing their message to the masses.
They’re efforts may not be entirely beneficial, but at least they’re trying.
Take a look at the following graphic, and let me know if anything resonates.
As far as social media use, 43 percent are using social media six or more hours a week. Remarkably, though, a third of CEOs and business leaders want to spend less time on social media, though, 63 percent of them spend just five hours or less on social media per week. The statement seems oxymoronic, but I shouldn’t be surprised; everyone is always trying to do more with less.
What’s not surprising, though, is that for the most part, small businesses are spending more time using social media to communicate their messages.
Where are they spending their time? Facebook has a 90 percent share; Twitter occupies 70 percent.
Finally, small business leaders are not overlooking the power of blogs (I haven’t). More than 55 percent of businesses just like yours are utilizing blogs to carry their message and to allow their thought leaders to share their, um, thoughts. Almost half of businesses with blogs spend between one and three hours to create each blog post, and finding and posting content is the most time-consuming part of the blog process (it is, by the way).
As you can imagine, I believe in social media and blogging (as is apparent from this publication’s existence) and it’s the future of communication and message development (take it from me, I’m a former reporter who watched the newspaper industry collapse because of web advancements like social media and blogs) and would like to see more prolific and active engagement from the healthcare community. Engagement on your befall means engagement on your patients and customers behalf.
Sure, some are doing it well, but not enough have gotten on the bandwagon. At least it’s encouraging to see that small businesses’ social media budget are on the rise.
Serving patients is a fundamental value of White Rose Family Practice and so is maintaining a work/life balance for the practice’s physicians and physician assistants. To make this combination of values work, Cathy Carpenter, MD, founder of the York, PA, practice, was naturally drawn to using new technology to improve patient care while finding efficiencies in delivering that care.
From its founding in the 1990s, White Rose has been ahead of the curve: adopting electronic prescribing before pharmacies had ever heard of the technology, assigning one of the earliest-available tablet computers to its physicians, and hiring part-time physicians long before that was considered acceptable.
According to Whitney Almquist, Business Manager, even in the transition from a paper record to the clinical module, White Rose went against the grain.
In converting some 14,000 charts from paper to electronic encounter notes, White Rose decided to scan entire charts, not just recent visits. It took about four years for a crew of several part-time college students using high-speed scanners to complete the task.
The payoff is two-fold: 1) no more paper charts in the building, and 2) all the data White Rose physicians need to determine how their patients are doing – and how the physicians are doing in treating them – is as close as the nearest computer, thanks to the reporting capabilities of the electronic record.
“Now there is so much clinical data that we can mine and report on,” Almquist says.
White Rose had a yen for reporting well before the purchase of its system. Using a practice management system in the years leading up to the EHR purchase in 2003, Almquist admits she was entranced by the practice management system’s power to easily produce custom reports based on claims data, patient visits and other practice management data.
Reporting is essential for the White Rose physicians. It’s also been key to the practice’s successful participation in a statewide Chronic Care Initiative led by the Pennsylvania Governor’s Office of Health Care Reform. Taking part in the program and its intensive training has paid off in the form of new insights into the care of diabetic and other patients with chronic conditions, as well as experience in quality reporting.
Since beginning participation with the program, the practice has created and used clinical reports to monitor its patients. For example, with diabetes patients, the practice’s care manager uses reports to track those patients’ blood pressure, cholesterol, and A1C levels, among other measures.
Almquist can quickly determine what percentage of the practice’s diabetic patients have had an annual flu shot or recently received an eye exam. She and the staff then can run reports showing the names of those who have not had the exams and contact those who need to come in – something not practical to do without an electronic health record.
Almquist also can quickly run a report to show providers exactly where each one stands compared to others in the practice care results and, importantly, how they match up to the goals the practice has set for chronic care.
If there was any doubt as to the usefulness of an electronic record, that was all expunged when White Rose applied to participate in the Governor’s Chronic Care Initiative, which was built on a model developed by Dr. Ed Wagner of Seattle, Washington.
From the beginning, White Rose did a good job of getting its diabetes patients back into the office for regular follow-up exams, Almquist says.
“What we did not realize, until we looked at the data as a whole, was that some of our patients had high A1Cs, high LDL cholesterol [and] blood pressure that needed better control,” she admits. “There has been improvement and I credit the reporting capacity of our EHR in helping us fight against clinical inertia – not taking more aggressive action. It’s helping us continue to push our patients to make changes in their behavior.”
Some practices have struggled to get on board with chronic care initiatives, like Pennsylvania’s, because their EHR was simply not designed to do population management or patient registries, says Colleen M. Schwartz, RN, Quality Improvement Coach for Improving Performance In Practice (IPIP). The national program, which trains chronic care providers in team-oriented approaches to treating patients with asthma and diabetes, is sponsored in part by the Robert Wood Johnson Foundation and the American Board of Medical Specialties.
“I’m not sure you can be a highly successful medical home without an EHR,” Schwartz says. “White Rose has been able to do incredible things and leapfrogged to the head of the group of practices we’re training.” Schwartz concludes: “White Rose Family Practice has been an incredible beacon and leader for the South Central Pennsylvania Region collaborative teams.”
Almquist says the increased focus on reporting has some unexpected side benefits, too. It has helped the practice to solidify its own care team by spreading around more of the duties to staff who haven’t always had a direct role to play in patient care. In the front office at White Rose, for example, a receptionist runs a weekly report that shows which diabetic patients, who are scheduled for near-term a follow-up appointment, have not yet had lab work done. She calls those patients, which allows her to get involved in care management, a key part of the chronic care model, as well as expands the variety of work roles she experiences.
“What is the purpose of collecting the data if you’re not going to use it to improve patient care?” asks Almquist. Good question.
White Rose Family Practice plans to begin tracking its success in scheduling colorectal screenings for patients. The plan is to have one of the practice’s nurses to follow up on patients who were scheduled for colonoscopy but didn’t get one.
Additional areas where the practice is doing more intensive follow up are immunizations and medication reconciliation for patients discharged from the hospital or seen in the emergency department within the past 24 hours. That reporting is helping improve staff productivity, too. Almquist says nurses use the reports to hone in on patients who most need the counseling.
Schwartz agrees with the utility of an EHR and adds that it also extends to improve patient care and education: “People are visual. When you have a report card from the EHR, people can see their blood pressure is trending down, their A1C going down. They can see that they have met most of the measures and are doing a good job of self management.”
Cathy Carpenter, MD, founder of White Rose, sums up the practice’s experience in using the EHR to manage and involve the practice’s providers and chronic disease patients in working as a team.
“We use the clinical data that we have created to provide better patient care. With an EHR, we are in position to cut down on healthcare costs, and to make people’s lives better.”
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.
Lack of healthcare interoperability continues to throw its weight in the road of progress, stopping much traffic in its tracks.
But you know that already, don’t you; you work in healthcare IT. That electronic health records lack the ability to speak with their counterpart systems is no surprise to you. In fact, it’s probably caused you a great deal of frustration since the first days of your system implementation.
From my perspective, things are not going to change very soon. There’s not enough incentive for vendors to work together, though they can and in many cases are able to do so. The problem, though, is that vendors are not sure how to charge physicians, practices, hospitals and healthcare systems for the data that is transferred through their “HIE-like” portals that would connect each company’s technology.
The purpose of this piece is not to diverge into the HIE conversation; that’s a topic for another day. However, this is a piece about what have recently been listed as the biggest barriers physicians face when dealing with the concept of interoperability.
The magazine cites a study in which more than 70 percent of the physicians said that their EHR was unable to communicate electronically with other systems. This is the definition of a lack of interoperability that prevents electronic exchange of information, and ultimately will fuel health information exchanges.
It is notable that 30 percent of physicians said that their EHRs are interoperable with other systems. That makes me wonder if this is a verified fact or perception only verified by a marketing brochure.
Another barrier, according to the report, is the cost of setting up and maintaining interfaces and exchanges to share information. According to this statement, physicians are worried about the cost of being able to transmit data, too, which puts them in line with vendors, who, like I said, are worried about how they can monetize data transfer.
An interesting observation from the piece: “Making progress on interoperability will be essential as physicians move forward with different care delivery models such as the patient-centered medical home and the medical home neighborhood.”
What amazes me about this conversation is that given the purported advantage employees gain from the mobile device movement and how BYOD (bring your own device) seems to increase a staff’s productivity because it creates an always-on mentality. I don’t think it’s a stretch to think the same affect would be discovered if systems were connected and interoperable.
An interoperable landscape of all EHRs would allow physicians and healthcare systems to essentially create their own always on, always available information sharing system that would look a lot like what we see in daily lives with the devices in the palm of our hands.
Apparently, everyone wants and interoperable system; it’s just a matter of how it’s going to get paid for. And moving the data and the records freely from location to location opens up the health landscape like a mobile environment does.
Simply put, this is one issue that seems to resemble our current political landscape: a hot button issue that needs to be addressed but neither side wants to touch the issue because no one wants to or is able to pay for it.
One of the problems with this approach is that if we wait long enough, perhaps interoperability also will be mandated and we’ll all end up on its hook.
So, let’s take a lesson from the mobile deice world and allow for a greater opportunity to connect healthcare data to more care providers on behalf of the patients and their outcomes.
The fact that mandatory Stage 2 patient engagement is considered one of the largest meaningful use hurdles should come as a surprise to no one. If it is, that’s somewhat similar to saying that the day before a presidential election you still haven’t decided who you are going to vote for.
I think at this point it’s pretty short sighted to disregard this fact. Healthcare reform does not (yet) reform patients; it’s still a set of mandates for those in the field, practicing in the field and drawing money from the system.
Meaningful use is meaningless as far as patients are concerned. In almost every case they don’t know what it is nor do they care. They’ll only care when one of two things happen. You can take this to the bank: 1.) they are forced to pay or contribute financially in some way or 2.) you take away their right to care (in other words, you mandate them to do something in some way.)
I speak from experience gained from my time leading communication programs for a mandated statewide health insurance program.
If we want to hold patients responsible for their health outcomes, we need to either take away their right in some regard or tax them for their behavior. This is also commonly known as a sin tax. You smoke and you pay the tax on cigarettes.
I’m being a bit overly dramatic on purpose and I don’t recommend either of the two points above, but we should be fully aware that putting meaningful use in the hands of the patients are going to produce disappointing results for every physician and practice hoping to achieve Stage 2.
Just because a practice implements a patient portal doesn’t mean patients will use it. I have used my doctor’s patient portal. Even as a technology enthusiast and healthcare writer, I don’t particularly find it fun to use nor do I find it really helps me engage with my physician. Sure, I can send some emails and pay some bills through it, but that’s just the case. To me, it’s more of a bill pay system and I’m sure I’m not alone here. How many of you enjoy using your credit card company’s online bill pay system?
The only good news on this front is that Centers for Medicare and Medicaid Services might have finally figured this out and may allow for an exception to the ill-conceived requirement, despite Kathleen Sebelius’ insistence that a measure of patient engagement be included in the Stage 2 requirement.
But, I’m not holding my breath that what’s best for physicians in regard to meaningful use attestation will be upheld, though, when the only response to physician frustration over the requirement because patients are not showing any interest is for physicians to “push” their users to use it.
In principal, that response is a lot like breaking a toothless law. Sure a law is on the books, and you broke it, but there’s nothing that you can do about it.
And, as anyone who works in communications understands, push communications only goes so far in the 21st century and not nearly as far as it may have 15 or 20 years ago.
Push and pull; now that’s the kind of conversations that engage. You give, you take; you speak, you listen.
Anything else is nothing but mandatory arrogance from political forces far from the field of actual care.
Safe guarding against healthcare data breaches is a proactive approach to protecting your practice, not a reactive one.
As has been noted recently by Healthcare It News, healthcare data breaches occur frequently, and as I have previously reported, most of them are inside jobs.
That aside (I’m not trying to dismiss the importance of this fact, just trying to move this piece along as I know your time is limited), many can be prevented by employing the proper information systems like two-factor authorization, but nevertheless, the costs of cleaning up after a breach is most more expensive than they are to prevent.
According to Healthcare IT News, healthcare data breaches are incredibly expensive procedures which are piled upon by investigations, notifications and follow up. With that, let’s take a look at some steps that you can take to safeguard against data breaches.
According to the magazine:
Cast a wide net: Ensure you assess your practice’s capabilities for dealing with a data breach. Establish a plan, bring in the practice’s appropriate leaders who can drive the practice forward and work to educate employees of the importance of data integrity. “This might include subject matter experts from cross-functional areas like IT and operations to human resources, or compliance and legal to other key supervisors or managers,” writes Healthcare IT News.
Here are a few additional points from the magazine’s report:
• establish protocols for tasks
• create timelines
• establish communication among the team to ensure everything runs as smoothly as possible.
Know thy data: Take stock of your data. Start with reviewing current and past projects, reviewing current documentation and how your practice typically gathers information. “One of the key components of any assessment is determining how personal health information (PHI) and electronic personal health information (EPHI) are received, stored, transmitted, accessed or disclosed. Once you have fully scoped your assessment, you can begin gathering the relevant data.”
Address your practice’s vulnerabilities: Known or unknown, this is the time in which you begin to putting your plan in place. This is the point of your plan in which you push play.
Document everything: Since you’ll need everything in writing as part of the process, you’ve got to prepare by making sure all of your processes, data and processes are in writing. According to the magazine, “Not only do those reports then become a historical document for an organization’s administration to refer to in the future, they’re also proof that a provider has performed due diligence around responsibilities for storing confidential data.”
Follow up and engage often: Don’t just put a process in place, but follow up on it. Adjust the process as needed and address any potential red flags immediately. Not doing so is paramount to failure. Silence is consent and if you become aware of an issue that you don’t address essentially is guilt by association.
Check your progress: Take stock of your risk assessment on a regular basis, “especially after a change in technologies, administration, regulations, or business operations.”
The meaningful use of data collected in an electronic health record continues to be the stump speech of Farzad Mostashari, National Coordinator for Health Information Technology.
He’s been pushing the message for months: those achieving or working toward meaningful use attestation need to get beyond just the financial incentives of the program, he says.
Physicians and their healthcare systems need to dig deeper and realize the importance of the data that they have at their hands. They need to realize just how to leverage the data to improve their patient’s health outcomes and lead those in their care down an educational path about the importance of their involvement in their care and how electronic systems can help improve their interaction with their care providers.
For meaningful use to work, those in the community need to make sure they’re using the data collected meaningfully. Meaningful use is a tool and it should be used as one; but unlike a simple jack knife, it’s a multi-purpose, multi-blade, do-it-all Swiss Army knife.
If used correctly, as a means for change rather than a singular solution for incentives, Mostashari believes that meaningful use can actually lead to population health management (the real reason behind meaningful use), more patient engagement (this is yet to be determined) and the creation of health information exchanges (yes, but we need interoperable systems before we see wide spread use of data outside their silos).
His ambitions are correct, and collectively, there is a fundamental agreement that meaningfully using EHRs will help accomplish all of these goals (though patient engagement may remain the stickiest of wickets). The problem here, though, seems to be that even though most physicians want to dive into the deep pool of big data, but they just don’t seem to be able to catch their breath.
In all walks of life we face the day-to-day grind of ongoing and seemingly never ending tasks that drive us further away from our goals. However, it’s different in healthcare. I just can’t seem to think of any other professional group (other than members of the military and police forces) under so much constant pressure to produce positive, long-term results for the people they serve.
In addition to making life and death decisions, our physicians and healthcare leaders are constantly facing the deluge of regulation and reform (meaningful use, ICD-10, HIPAA and even to a certain extend malpractice and 5010).
Healthcare professionals are overrun by details that have taken them into the weeds. Their days are long and their time is short. We can argue if electronic health records actually save them time and money. Depending with whom you speak, each person has an opinion as to its effect. Add everything I previously mentioned and it’s simply overwhelming.
I firmly believe that in a best case scenario, we’d be able to meet all of Mostashari’s proposed goals. Big data would (and can) lead to a changed system and provide real and personal stories of improved health outcomes. I believe that if we could clear away the clutter, we could begin building upon the foundation and create the best, most comprehensive, patient-serving healthcare system that produces results and actually changes lives.
But, for now, we live in a database world where no matter how meaningful we use them there’s still much left to be desired.
My time spent with a major EHR vendor was to educate members of the healthcare community (physicians, nurses, practice leaders, hospital administrators, etc.) and the general public (patients, consumers, people like you and me) about the benefit of electronic health records and how to navigate the EHR implementation process.
As you can figure, most of the talking points included operational efficiencies of the systems, how practices could improve their practices and save money without paper, how they could create the opportunities for bringing in more patients by using EHRs, and so on and so forth.
What is rarely talked about by the vendor community (and given my former seat at the messaging table, I think I’m qualified to make this statement) is the inherent challenges faced when implementing an electronic health record system.
That said, the following are some of the biggest hurdles practice face when they begin the EHR implementation process:
Training: You need training of your system. You need more than eight hours. You need more than 16 hours. Implementing an EHR is a major undertaking and it can take months, if not longer than a year, to truly implement. Even after that, you may need additional training.
Don’t make the mistake of contracting for the least amount of training offered by your vendor. Don’t be fooled into thinking less training means you’re saving money. The money you save on training now will be spent later when your staff fails to truly understand how to use the system. Purchase more than enough training and consider training super users who become true experts in the use of the electronic health record.
You must make sure you secure internal buy in. You need to establish an education program for your staff and create communication channels for your staff so that you can ensure the greatest level of buy in. during this process, explain the needs for the system and why the practice is moving in this direction. If this is a re-boot for your practice and you’re implementing a second or third system, discuss the reasons for the change and why it’s important to the health of the business.
Like employees, you must educate patients. The importance of this statement has never been as true as it is now especially give the move toward patient engagement through meaningful use Stage 2. Engaging patients in the EHR implementation will help create external advocates for your practice, as well as will lead you down the road toward educating them about the benefits of tools like patient portals. Education is key here. Work to create patient champions. Do not brush them off as individuals who are either not interested in the technology or as unsophisticated enough to understand the scope of your work. Doing so may lead to an epic fail of your long-term plans for a unified, smooth running, meaningful used practice.
Lack of a pre-implementation plan may kill the project from the start. An implementation plan means you’ll be able to perform a workflow analysis. Workflow analysis reveals practice inefficiencies and provide you insight into where you need to focus your efforts during implementation efforts. An implementation plan allows you to redesign processes, look for ways to create additional practice efficiency, increase patient and staff satisfaction, and align your goals with your long-term practice plans.
Lack of vendor transparency. Those who don’t seek it may find themselves owned by their vendor partners. You must ask questions, demand answers and don’t take their word for it. Vendors want long-term contracts that are sometimes as gray as possible. Review the contracts, never treat vendors as your friend (or, at least during the negotiation process) and ensure the best deal for your practice. Seek optimizations and customizations. Ask for referrals; call the referrals. Go on site visits, but make sure they’re not all hand picked by the vendor. To accomplish goal, consider reaching out on the web and aligning with practices in your area that use the system you’re thinking of purchasing. Do some independent research.
Un-needed long-term vendor contracts. Don’t sign long-term contracts unless it makes absolute sense. Some vendors require contract lengths in unreasonable lengths of time, like seven years. Granted, implementation is a major undertaking, but a seven-year contract is unnecessary and only serves the vendor. Be cautious of a deal of this magnitude. You wouldn’t sign a seven-year lease for a car, a property or anything else. Take a vendor move like this as a sign the vendor has plans to lock you for its own personal gains – to make itself attractive to potential buyers or to boost quarterly reports – not your own.
