I’ve long been an advocate of HealthIT.gov, which I’ve profiled here multiple times for the guidance the site provides about electronic health records and ways to use the technology.
A new addition to the site is guidance for physicians about mobile health technology, which is beginning to pervade the healthcare landscape.
As healthcare workers and professionals continue to use mobile devices in the care setting, they’ll need accurate and helpful information to protect them and their patients from issues such as security breeches.
To that end, it’s nice to see the Department of Health and Human Services to assemble a series of tips and information to the public’s greater good.
The site features several articles and videos designed to offer support and education about using mobile device in healthcare.
For example, articles include topics such as:
How Can You Protect and Secure Health Information When Using a Mobile Device?
You, Your Organization and Your Mobile Device
Five Steps Organizations Can Take To Manage Mobile Devices Used By Health Care Providers and Professionals
For those who prefer video, topics covered include:
Worried About Using a Mobile Device for Work? Here’s What To Do!
Securing Your Mobile Device is Important!
Dr. Anderson’s Office Identifies a Risk
A Stolen Mobile Device
Can You Protect Patients’ Health Information When Using a Public Wi-Fi Network?
In addition, there’s also frequently asked questions and downloadable materials. All in all, the site is filled with a great deal of rich content.
On top of that, there’s a plethora of other information including tips for integrating privacy and security into a medical practice, building a health information privacy and security plan, information about health IT security resources, cyber security and mobile device security.
Simply put, this is a great resource for all of us in healthcare, patients included. Well done, well done, HealthIT.gov.
Can a business model be beautiful? Yes, it can, according to Hello Health’s Steve Ferguson, vice president of marketing.
The business model, and the way things get done, at Hello Health are what set it apart from other electronic health records in the market place, Ferguson said.
Hello Health was built from the ground up and launched by the private company Myca in 2008. It made its meaningful use certified EHR available in 2011. The Hello Health system includes everything needed to run a small practice, the area of the ambulatory market in which the company focuses.
Originally designed for single doc practices, the system now scales up, with practices of as many as 10 physicians using it.
At its most basic, Hello Health is a web-based EHR and patient health record, and it’s free to for qualified physicians to use. A qualified practice is typically one with 1,500 active patients on its panel. Unlike Practice Fusion, another well-known free cloud-based electronic health record, it’s not powered by ads, but instead is a revenue source for practices as monthly access subscriptions can be sold to practices’ patients, allowing the patient to access the system’s patient portal, where their personal information is kept.
The patient subscription model allows patients to schedule appointments, view lab results, communicate with their physicians through the HIPAA-compliant portal and, in some cases, view their complete record including visit notes.
Steve Ferguson, vice president of marketing at Hello Health
Those patients that don’t subscribe are still allowed limited access to the portal, but they can’t access all of the information available to them. Cost of monthly subscriptions range between $3 and $10, Ferguson said, but the average is closer to $5.
The annual revenue earned through patient subscriptions is $10,000 per practice, he said, with 30 percent of patients, on average, signing up in each of the practices Hello Health serves. In some cases, more than 50 percent of a practice’s patients have signed up for access to their health information.
Currently, the typical age of a Hello Health subscribing patient is 57 years old and has at least on chronic condition. The “indestructible” 30-something is less likely to subscribe to access to the portal, said Ferguson.
In some cases, patients are able to skip a practice visit or an in-office consult because of their prescription to Hello Health, Ferguson said, and practices are okay with it because they can still bill for the visit.
It’s a simple model, and with the number of portals currently available and the likelihood that access to them will increase alongside meaningful use stage 2, it’s a wonder why other vendors are not creating similar strategies.
“Companies are so in grained in the license model, and on paper it may seem easy to change, but it’s tough to change a business model,” Ferguson said.
Among another key difference between Hello Health and competitor systems is that it doesn’t charge for training and allows as much training as is needed so practice employees are comfortable using the system and are able to educate patients about the value of subscribing to the patient portal.
“Practices really have a partner in Hello Health,” he said. “We take extra time to implement and train employees so they can educate patients to use the systems and better understand the benefits of it.”
Ferguson said Hello Health is experiencing explosive growth, though, would not confirm the number of practices using the system nor the number of patient subscribers because the company is private. However, it is currently available in 27 states, with concentrations of users in New York, New Jersey, Texas, California, Georgia and Florida.
The value proposition to physicians is Hello Health’s business model and the fact that it is a revenue driver.
“Our differentiator is our business model,” Ferguson said. “Everyone tries to sell to the physicians, but most physicians are forced to push back because they can’t afford another bill.”
The fact that the system is free to implement and offers unlimited training is also a plus, he said.
According to the results of the 2nd Annual HIMSS Mobile Technology Survey, mobile technology is increasingly important to healthcare. Patients are obviously on board, but so are physicians and their employers.
Extensive adoption of almost every type of technology continues to take hold in the space, including smartphones, tablets, laptops and “movable workstations.”
An argument I remember hearing during my time in the vendor space is that if patients/consumers evolved into a mobile community, physicians would follow. Obviously, we’re seeing this prediction come true, but I can’t think of any reason why it wouldn’t be the case as it’s the type of technology that’s cheap, assessable, mobile and effective.
More so, according to the HIMSS study, “physicians are embracing new ways of collecting information and connecting with patients.” I do wonder, though, if physicians thought they’d be using their technology to connect with their patients as much as they have reported through the survey.
Surprisingly, (for me, at least) is the HIMSS reports that 93 percent of all physicians use mobile health technology in their day-to-day activities, and 80 percent use it to provide patient care.
A little less surprising is that nearly 25 percent have EHR systems that capture clinical information from mobile devices, and 36 percent allow patients to access information and health records using a mobile device.
The survey featured 180 individuals who “were directly responsible for some aspect of a healthcare organization’s mobile health policy shows that the number of mobile health programs in hospitals and individual practices increased.”
In my experience with this type of research, and as my former colleagues in research might point out, the sample size is statistically pretty small, though, and I’d like to see how the numbers would come out with an inflated sample size. I’d be surprised if 93 percent of physicians used so much mobile tech.
Finally, according to the survey, and I’m just reporting the facts here:
68 percent of participants reported that their organization already had a mobile technology plan in place
An additional 27 percent are currently developing theirs
Only 4 percent indicated that they had no plans to develop a mobile technology policy at the time.
Two thirds of participants report that they are in the process of developing a policy, expected to be completed in the next six months
25 percent anticipate completion of the policy within six months to a year
Two percent believe it will take more than two years to implement a program
The business of explanation deserves its place in healthcare, at least as far as the patient is concerned. In their interactions with their physicians, be in at an office visit or in the emergency room, there’s a great deal more need for those providing the care to walk through the experience with those receiving the care.
Even if it’s a tedious experience for the physician the importance of drawing and engaging the patient can not be understated.
Really, from start to finish, every interaction with every patient should contain some sort of “educational” component at least as far as the care continuum is concerned. During their visits, all patients have questions in which they need/want answers to that ultimately may not be vitally important to the caregiver, but are to those receiving the care.
Even during the documentation process, physicians have a great opportunity to learn more about lives and health choices of their patients, especially if they can get them to speak about the office’s electronic health record system.
Perhaps I’m the outlier given my passion for technology and health IT, but I use my doctor’s use of technology during my office visits to engage my physician. Maybe it’s the reporter in me, but I always seek opportunities to use props or interactions to develop deeper relationships with those around me. Though my physician may think his EHR beyond my comprehension, I like to surprise him and dive right into and ask him about its capabilities.
What can it do?
Why did he choose it?
What does he track the most?
What’s he tracking about me?
Why did he buy it?
Then, when the ice is broken, I dive into more broad-based questions:
Why does he practice?
What is he most passionate about from a care perspective?
Why he chose to practice the field he did, and so on …
Essentially, in the eight minutes he’s taken to see me, I’ve learned enough about him to probably write a profile.
My point is, by taking a peripheral interest in someone even in an extremely short amount of time, there are benefits to be gained. I try to make it an art form and get at people’s stories without them even knowing. Try it sometime. Next time while at a party, observe just how many times someone actually asks you a question about anything. I’ve gone through hours of social engagements without having to answer a single question.
My point is, it’s easy to engage people of all levels even without them knowing it if you get them talking about the one thing they all want to talk about: themselves.
This tactic, if used by physicians, could get all of the information they need out of their patients even if their patients don’t want to be engaged.
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.”
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.
Is health IT a crystal ball? Nope; not yet. For all of its good, health IT still lacks in so many ways. Health IT may save the masses, but not necessarily the individual at this point. As it matures and grows, no doubt it will fill some voids, but as far as its current capabilities, the information collected in the form of electronic health records, for example, is still nothing more than a repository of information gathered from the past.
What we need are technologies that hint or predict health outcomes before they happen. I’m not talking about broad brush analysis, but individual predictions for each person with a record.
Who wouldn’t want their medical cases charted and entered into an EHR if it could help physicians determine which conditions were going to impact them down the road.
It’s not lost on me that on the current road map, if all healthcare data is aggregated, there’s a hope that a population’s data may provide insight into predicting what’s in store for the said population.
To cite IBM, “As digital records and information become the norm in healthcare, it enables the building of predictive analytic solutions. These predictive models, when interspersed with the day-to-day operations of healthcare providers and insurance companies, have the potential to lower cost and improve the overall health of the population. As predictive models become more pervasive, the need for a standard, which can be used by all the parties involved in the modeling process: from model building to operational deployment, is paramount.”
Even though current forms of data collection are merely meant to gather information to help establish standard approaches to most types of care in which the care system will use to treat the majority of patients (evidence-based care, essentially) as a way to reduce costs to the system (health insurance providers not excluded), there is little push for technologies that could actually help determine, at the individual level, what may affect us and how to treat it before it becomes chronic or life threatening.
Let’s be clear: I’m not talking about predicting the obvious. For example, in cases where years of overeating and lack of exercise are present, no one needs to predict what the outcome is likely to be. I’m referring to other types of conditions that are, for the most case, unavoidable: MS, cancer, Alhzeimer’s, and so on.
Whoever begins to develop these technologies is going to set the market and turn healthcare on its head. These people, or this person, will be considered genius and their effects on millions of lives great. It might be science fiction of me to think this will ever happen, but it gives me hope to think it could happen.
Until then, if such a day ever comes, we have to wait and hope for the best like a dear friend of mine who recently was diagnosed with brain cancer. Ironically, she has always been an advocate for healthful living, living an active lifestyle, working with a major organization dedicated to lobbying for and providing hope to those affected by cancer, and even championing healthcare technology as a means to improve patient health outcomes and our health as a society.
But given all of these efforts, despite the wise choices she’s made to live healthy and help others, there was little that could be done to predict that she too would be in this situation, where if predictive technologies existed she could have benefited.
Now, because there is not a predictive crystal ball, despite all the technological gains we’ve made, she, like everyone else, must react rather than act.
Sad to think that even after all the billions being spent in healthcare technology and with all of the apparent advances, as individuals, are we really better off?
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.
