Fund next year’s Post-it notes. You can. Through crowdfunding; which seems to have become one of the market’s hottest concepts.
There are other crowdfunding platforms available to the philanthropic among us who wish to contribute to the greater good however we can. Among them is the well-know mainstream effort known as Kickstarter. Then there’s Medstartr, the crowdfunder focused explicitly on healthcare products.
Enter Health Tech Hatch. Probably the newest kid on the block; perhaps or perhaps not the least well known in the space.
It’s approach to crowdfunding, to “fund next year’s Post-it notes” as it were, is one of the most inspiring I’ve seen on the topic. It’s a simple concept, but there’s a passion behind this one that I haven’t found elsewhere. It conveys to me the possibility that big ideas can become big things, and you, as a passionate supporter of a cause, can take part in the development of the idea for a contribution of a few simple dollars.
Health Tech Hatch is similar to others. Those with an idea can post a project to request funding for a variety of things including apps, programs and other items directed toward the betterment of healthcare as a whole.
Health Tech Hatch, though limited in scope and size, and seemingly with a limited track record for producing fully funded projects (I suspect it’s only a short time before that happens), the service is an effective and needed addition to the crowdfunding landscape. And, the service works exactly like its counterparts: Investors only pay if their project is fully funded, and Hatch works to bring entrepreneurs step by step through the process of finding funding.
Additionally, Hatch defines the process for a successfully funded project, including:
A well-thought-out budget
Creative, thoughtful rewards for funders
A realistic timeline
A name that stands out
An informative, entertaining video
A pretty picture
An enthusiastic write-up
An intriguing company description
On top of this, Hatch provides for the opportunity to test a campaign, using the experience of its advisory committee, to ensure a project has the best possibility of funding success.
According to Hatch, “Crowdfunding is all about collaboration, pooling resources to support someone else’s efforts … the process is a two-way street: We help entrepreneurs carve out a pathway to present their ideas to the world, while enabling funders to provide feedback, offer moral support and above all, finance next year’s Post-It — in both the for-profit and nonprofit worlds.”
Given the overwhelming amount of attention services like Hatch continue to receive (this site not excluded), it’s apparent that crowdfunding will play an overwhelming role in the development of new technology designed to serve the healthcare community, be it patients or providers. We’re discovering that sometimes taking the lead means we have to get involved. Healthcare technology continues to evolve away from a single provider (vendors) of technology. Individuals want to move the market, and perhaps crowdfunding through sites like Hatch create innovation, and reinforce the concept that big ideas can create big things.
Sites like Hatch help us believe that with a little effort and a little involvement, individuals can actually create the Post-It notes of tomorrow.
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.
There’s no doubt social media is currently dominating every corner of the business world, and in healthcare, given the new focus on patient engagement, this form of communication is clearly having an impact.
Those of us who continue to be intrigued by the art form (I like to think of it as an art form because there are no hard rules for participating in the online social scene) we try to engage an audience, carry on conversations with others and do our best to disseminate useful information that will keep the world engaged. What you say and Twitter is no different than what you say in person, except that it has the potential to be heard around the world. But, plainly put, how you portray yourself online or in person is how you will be viewed and judged.
If you say something stupid, there’s a great chance that you’ll be seen as stupid.
For healthcare professionals (for anyone, really), social media is a great way to gain exposure and to attract new patients to your practice. Plus, social media can be a great way to engage your current patients. Social media channels allow you to communicate, and it allows patients a way to contact their physicians and caregivers.
According to EMR Experts, this means that “health and well-being becomes something that patients can think about daily rather than once a year at their annual checkup.”
This is a classic case of in sight, in mind. If patients are seeing your information, there’s a great chance they’re thinking of you of their care.
Social media, as you most likely, is not a tool to simply be ignored. It’s a communication force to be reckoned with because, in most part because patients are already online seeking information about their health and their care. By implementing a program, you’ll likely engage them, so who better than to connect with than their own docs.
Again according to EMR Experts, “By using social media sites such as Facebook, Twitter and Google+, physicians are able to keep in touch with the majority of their patients and to provide them with accurate medical resources that they might not be able to find elsewhere online.”
Here’s the good news: it’s easy to go social, and it’s free. The investment you make is time. To establish yourself as a respected source, you have to contribute regularly to your sites. From that point, like you might with your patient portal (link), you can begin to market your site on your practice’s collateral.
Perhaps the biggest question physicians have about social media is what they should post and what type of conversations should they engage in?
Here are a few ideas:
Provide updates about your practice
Links to interesting medical articles, studies or news
Information about health conditions or symptoms
Asking questions of your community
Conduct polls about the services you provide
Discuss trend topics in healthcare and medicine
Highlight individual physicians and their specialties
To recap, why is social media so important? Because it’s social and you don’t want to be anti-social. Put simply, being social not only serves you and your practice, it allows your patients a direct channel to communicate with you and lets them engage you.
Communicate with other patients with similar conditions;
Find information about their condition;
Track their health/fitness goals online and share with friends/family/the community;
Get information from: HIE, public health agencies;
Find and rate healthcare providers and hospitals; and
Download, update, merge, store and share their health records.
Engaging in social media allows you an opportunity to engage in more in-depth conversations with the people you are charged with caring for. If for no other reason, direct communication with you patients as a potential opportunity to better engage them is worth any effort you are thinking of investing in a social media program.
Meaningful use stage 2 is moving in the direction of patient engagement. The next phase in the federal incentive program sets the bar for it, but certainly doesn’t leave it here. Certainly, patients were part of stage 1, but now, they must take greater ownership of their care; probably one of the only ways we’ll actually see the needle move in regard to long-term health outcomes changes for the population.
Engagement of the patients, it is believed, will move all patients toward better choices and possibly healthier lifestyles, which obviously makes for a healthier population.
But given all of the rhetoric on the subject, and the fact that each of us is subjective, aren’t we really talking about something rather subjective?
Say what?
Let me try to put it in terms that even I can understand: everyone talks about how patients must be more engaged – at the practice level, at the provider level and even at the vendor level (which is my belief) – but when it’s actually time to involve patients in their care, how is this done?
Well, one of the most popular answers is through social media sites like Facebook and Twitter. Bringing, or participating in, conversations about healthcare and interacting with patients online is considered to be a highly effective ways of reaching a broad audience, building a healthcare community, and educating and engaging patients.
But not everyone feels social media is the silver bullet. For example, I recently spoke with IDC Health Insights’ research director, Judy Hanover, who during our conversation said she thinks the healthcare community has become too infatuated with social media. She doesn’t see it as a truly effective means for engaging patients long term.
Certainly, social media has its place in building the physician/patient relationship, but its is limiting. Except for a very few people who like and want to share their personal health records online, most of us just don’t care to go into the specifics of our conditions in such a public forum.
So, the debate returns to healthcare information technology and the patient portal.
Online portals are designed to give patients anytime access to their health information. From a provider and vendor perspective, these tools have a great deal to do with meeting stage 2. For the patients, too, I suppose.
With the requirement that provider given patients access to online health information for viewing, downloading and transferring, and a second threshold requiring providers to push patient usage of this technology, it’s obvious the portal is a powerful player in this game.
I’ve written in the past about this issue and how the burden falls on the provider to engage patients through the portal to essentially secure incentive payments for stage 2.
Some do worry about their ability to meet the patient engagement requirement. I can imagine practices in rural areas or those that serve an older population may have some concerns.
Relying on a patient action to secure your incentive, especially after all of the work taken to meet the remainder of the MU requirements may seem like a blow to some. It would to me since my personality is one in which I like to have control of a project and not have to worry about outliers potentially derailing my progress (this sort of thing happens all of the time in school on group projects, right?)
So, how we do avoid this and encourage patients to use the portal?
What’s probably the best summation I’ve come across on the subject is in an interview Physicians Practice’s Aubrey Westgate conducted with Peter M. Kilbridge, a senior research director with The Advisory Board Company’s Information Technology. You can listen to it here.
Kilbridge’s perspective is valuable, and the tips he provides are easily accomplishable.
For example, to encourage use of the patient portal, practices should tell patients about it, and simply encourage them to use it and to talk about its capabilities. Highlight the portal’s capabilities, he says, and what it can do for patients and how it can make their live easier.
He says to highlight functions patients care about: viewing labs, sending questions, scheduling appointments. Follow it up by sending an email and paper mail reminder during about the upcoming visits or reminder
“Early success breeds confidence,” said Peter Kilbridge.
Still, the patients are truly empowered in stage 2, and all of the work invested on the part of the healthcare community might seem like it’s trivialized by the requirement needed to secure incentives.
Dr. Sumir Sahgal moved into private practice in 1999, leaving the hospital setting for good. For some reason, he felt he could do more, contribute more positively to the community, as a care provider if he was running his own practice.
Since then he’s built a thriving medical practice, Essen Medical Associates, that has 25 healthcare providers who provide services in 20 medical facilities including nursing homes, hospitals and in one of five multi-specialty offices (with more coming online) owned by the practice.
Based in the greater New York City metro area, Sahgal’s practice, a certified medial home, serves more than 15,000 active patients per year. But true to his calling in that he wanted to do even more to provide care to patients, in 2005 he started down a new path that, at the time, most of the people he spoke with said he was making a costly mistake.
Of the population he’s served, there were several dozen (80 patients, in fact) that were home bound. Other than the random hospital visit, they received no care. That is until Sahgal opened EssenMED House Call Service.
EssenMED House Call Service primarily provides care for elderly home-bound patients in the Bronx, Manhattan, Brooklyn, Queens and Westchester. It is currently one of the largest private medical house call programs in New York.
“We opened a house call practice in the Bronx and everyone thought we were crazy,” Sahgal said. “We serve some pretty tough neighborhoods.”
After six months, the practice’s leaders evaluated the program. It made no financial sense to continue the service, he said, but there was an inherent value in the service his practice provided, and that’s all that mattered. The house call service fit his patients’ needs and they were receptive, and word of the program spread.
First slowly and then much more quickly. In seven years, the number of patients has doubled each year. There are now 1,800 being cared for by Essen’s nine caregivers.
“Through word of mouth, patients kept calling,” he said, “and eventually we had enough volume that it created efficiency in the program. Patients gravitate to where they can get the best care.”
The investments the practice made in electronic and mobile technologies also helped. Without his EHR, he currently uses eClinicalWorks, and being able to access patient data through iPad, the house calling practice is almost no different than the office-based practice.
“Healthcare technology helps create efficiency, and since we’ve moved to eClinicalWorks, our coordination of care has gotten much better,” he said.
All of the information needed to care for patients is on hand through mobile technology. In many ways, his staff is just as efficient in the homes of the patients as they are in the practice setting.
Much of the business’ success can be tied directly to the current technology in place.
All of the information is available wirelessly through the practice’s server including labs and documentation. “It’s like truly transferring the office to the home,” he said. “We can prescribe directly from the patient’s house.
The technology has helped him grow his practice and open communication lines with colleagues and share information, as would be expected, making for a much easier documentation process, especially for staff members in the field.
“The technology has helped us improve care and increase patient engagement. With improved patient engagement, patients have better access to their health information, access their medications and communicate with us, which helps us improve care,” he said.
As devices and capabilities continue to improve, Sahgal is confident that the same can be said for patient care, which he’s extremely passionate about. He’s in the business of practicing health to help people have better or more comfortable lives.
His approach is also saving money for the overall system. The more home care is available to patients, the less likely they are to seek care in the hospital. Likewise, the more comfortable patients are as they manage their conditions or approach the end of their lives.
The patient’s response to the technology has been overwhelmingly positive, he said, especially when he’s able to provide video consultations with patients through his iPad and perform remote triages and blood pressure checks from miles away. The services provided by Essen save patients from unnecessary hospital visits and many thousands of dollars in the process.
At this point, one of the next things that can be done to improve care is for interoperable systems to be fully engaged and useable by caregivers despite the vendor in which they employ. But, for now, the technology is in place to allow for the patient to be the central figure in this play, not the technology.
Serving patients in their space and in their areas of comfort is not a common business model and is much easier now than it has been in the past. Dr. Sahgal says his work is his calling, something he does because he loves providing care.
It’s not always easier either: “You are in the field, there are environmental factors to deal with; we have our war stories. But we’re able to provide TLC in the patient’s home, where they are most comfortable,” he said.
Dr. Anne Brooks in 2012 at the site of several Habitat for Humanity homes.
The American Osteopathic Foundation recently named Dr. Anne Brooks the 2012 physician of the year, for several reasons in which I have described here.
In a nutshell, she’s compassionate, caring and loving of all her patients, and as a nun, it probably helps that she relies on a little help from above.
But, even with her country doctor ways in which she still makes house calls, helps teach her patients to read and write, and building community centers and Habitat for Humanity homes with her own hands, she’s connected technologically – using an electronic health record in her practice – and is informed of many of the latest issues affecting healthcare and healthcare policy.
As a practicing physician, she also serves in the hospital setting, and she drives care for patients while in people’s homes, caring for them in their own environments. As such, she is considered a partner by those lives she’s touched, and she’s seen a great deal of change at the practice level.
The following are a few of her observations from 20 years of practice.
How has patient care changed since you became a physician in 1983?
There are mid-level providers on the scene who are not always appreciated by the patients, who seem to think they need a doctor or by their physician colleagues who often look down on them because it’s a less intense training.
There are RNs who get a doctorate in nursing, but what we need is bedside nurses who care physically and emotionally for and about patients.What I see happening is often the best nurses end up being paper pushers because of new and complicated regulations and disease tracking and length of stay requirements.
Are the patients getting more involved in their care or do they just not care?
I think we need a health blitz in our school curricula so that kids and parents/caregivers all know how to care for an illness or accidents and how to eat healthfully, and the manufacturers of all the fat food would make and sell something much more nourishing so that diabetes and obesity would not cause so much ill health and lower the mortality rate. Change has got to start in the home, but in our case, many parents didn’t go to school so what they don’t know and what they need to know and do are two different things.
Behavior needs to change, too. For example, too many patients have no teeth and eat soft starchy foods which only puts on weight; kids get soft drinks in their baby bottles way early on. So we teach and teach and review and teach some more and a few people get fired up because they learn they have power — which is a big deal at our office — to empower each patient is our major goal. And when we see people actually making lifestyle changes it is incredibly rewarding.
Why did you decide to implement an EHR?
Because of the benefits of speed in communication, ability to quickly access past clinical info and dealing with the handwriting deciphering issue (fewer mistakes related to bad handwriting) the desire not to have to lug a pile of charts home to finish them; urging from forward-looking trusted colleagues; the availability of a grant; articles in medical journals that piqued my curiosity; and the ability to invite salespeople in to speak to the administrative team and then the staff, and pepper them with questions.
Are you more efficient because of an EHR or has there been little or no change?
Technically, I’d probably have to get someone to actually do a time study, but I feel more efficient, which removes some levels of stress for me.
When your career is over, what one thing will you want to carry on in your absence?
Patient-centered care given generously without regard to ability to pay meaning that every patient will get the best care.
I also want our patients to be welcomed with concern, care and compassion, and I want the caregivers to educate and empower patients so they can assume responsibility for their own healthcare, change their lifestyles, and learn how to pass on the education and empowerment to their families and friends.
And, I want caregivers to follow the M*A*S*H* model:
As we move toward an environment in which technology is more widely accepted, there’s little doubt tools that organizations like hospitals and health systems (individuals, too, for that matter) use to build their brands, educate their communities and engage patients are paying dividends.
At least for the organizations taking steps to utilize the tools.
According to a new survey by CSC (Computer Sciences Corporation) conducted in July and August, of 36 hospitals, the use of social media in the space is growing, and having some positive effects on the communities each serves.
In the survey, hospitals reported using social media to enhance their brands, create awareness and manage their reputations, as well as “to promote wellness and healthy behaviors through the dissemination of generic information for a general audience.”
CSC found that for organizations, direct engagement with individual patients remains uncommon and only one hospital reported that it uses social media in care coordination or care management, unlike some individual caregivers who actually use the tools to engage patient populations with generic care instruction or knowledge transfer.
Healthcare organizations, like all of us using social media, want to attract a large audience to our message and products. However, using social media for improved patient outcomes were not a popular objective according to the survey as less than 25 percent of organizations listing it as a primary objective.
Only a couple hospitals survey said they did not use social media at all, citing fear of liability or malpractice concerns, and concerns that users would post negative comments about the organization while some organizations do not get involved in social media because they do not feel they have the internal expertise needed to drive the program.
Now the real heavy lifting begins.
According to CSC, “The next step for hospitals and health systems will be to use social media more strategically. The risk and cost of doing so is relatively small, yet the upside includes potentially substantial performance improvements and the realization of sizable competitive advantages.”
Beyond building brands and managing messages, healthcare organizations may wish to think about more their products, long-term goals like driving patient engagement and improving healthcare outcomes.
To take action and begin moving a social media and engagement program forward, CSC recommends the following, and I quote:
Develop an overarching strategy of how to make social media work for you. Begin with easy areas, such as marketing and communications, proceed to patient education and announcements, and then look for ways to leverage social media to improve care and generate other benefits. Look for ways to connect patients to providers, or providers to each other.
Get involved in social media now at whatever level you feel comfortable with and/or have the resources to manage (do not take a wait-and-see attitude or it will be too late and your patients will find someone else to interact with). It is often possible to recruit savvy users internally who are excited about the technology
Pre-empt possible negative experiences by communicating openly about social media with employees and with patients. Develop a social media policy that outlines appropriate use for staff, and post a disclaimer on your site informing patients that information provided is not meant to serve as medical advice. Social media is a force for good; concerns about the use of social media are often overstated. Individuals are more likely to share positive health-related experiences via social media than negative experiences.
We’re here now, we’re ready and the tools are available to serve the greater good. It’s time to engage, damn the consequences.
Farzad Mostashari, national health IT coordinator, says more progress has been made in health IT in the last 20 months than during the last 20 years. It’s a statement he made during the first day of National Health IT Week in September.
Increased adoption of electronic health records and the push toward meaningful use have been the catalysts for this movement, most of which has been driven by the financial incentives associated with meaningful use.
The ultimate goal of meaningful use, and the subsequent adoption of the healthcare technology, is data collection. A subset is patient engagement.
To a lot of different people, patient engagement means a lot of different things. For some, it’s about patients having access to their information, and for others it has nothing to do with “giving” patients information, but more about making them the center of care, Mostashari said recently.
Health and its information are owned by its community, he said, and the community must have access to its information. Policies and practices need to be set in place to unleash and unlock the activities of the community.
One effort to encourage this is “Blue Button.”
“Blue Button is national symbol for the concept of ‘give me my data,’” he said during his address at National Health IT Week in September 2012.
But the effort is transcending patients. It’s being brought to the vendor community, and their commitment is being requested. Mostashari has challenged vendors to make it easy for consumers, by as early 2013, to view, download and transmit to another party their health information through Blue Button. Engaging the vendor community is exactly the kind of effort the market needs since they have a seat at the table.
So far, several vendors have committed to meeting the deadline for the challenge, which is by the HIMSS Annual Conference in early March 2013. The current list of vendors to accept the challenge (those deserving some recognition) include:
Alere Wellogic
AllScripts
AthenaHealth
AZZLY
Cerner
eClinicalWorks
Greenway Medical Technologies
Intellicure
NextGen
SOAPware
Engaging the vendor community in this effort, for an early push toward view, download and transmit, is the right thing to do and it’s encouraging to to see Mostashari putting ONC’s muscle behind this effort.
Vendors are the folks playing a huge part in the overall effort for a transformed healthcare system and they plan to gain the most because of it. As such, it’s good to see them encouraged to take greater ownership of this process and play a larger role in encouraging the patient engagement process.
