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.
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.
There’s no surprise that healthcare mobile technology is changing the industry. The movement has been underway for as long as the technology has allowed, and as the technology becomes more sophisticated, so do the ways the technology gets used.
In a recent annual research study by the Manhattan Group published by HIT Consultant, we continue to get a much clearer picture of how the U.S. physicians are using the Internet and mobile technologies in the workplace.
For the study, called “Taking the Pulse 2012,” 3,015 physicians in 25 specialties were surveyed.
Here are some of the high points.
In the United States, more than 85 percent of physicians use smartphones in the practice setting. This is up from 81 percent in 2011 and up from 72 percent in 2010. That’s 13-point jump in use of the devices in two years, but really, the number is not surprising. The devices help physicians in multiple ways, personally and professionally, there’s little doubt the increased use will continue and grow.
Next up: Tablet adoption among physicians has nearly doubled in the last years from 35 percent to 62 percent from 2011 to 2012. Clearly, that’s amazing. Of those, more than 80 percent are iPads.
Of all the tablets being used by physicians, more than half have used them at the point of care.
Regarding patient interaction and engagement, according to the Manhattan Group, 39 percent of practicing physicians communicate with patients via electronic means including email, secure messaging, instant messaging or video conferencing.
Personally, that number is higher than I expected, but it’s obviously only to grow much larger, especially as patient portals are implemented and meaningful use stage 2 looming.
Physicians also spend an average of 11 per week online for professional purposes, and those with three screens available to them – smartphone, laptop and desktop — spent more time in front of those screens than did their counterparts with just one or two screens.
What does all this data mean? You don’t need me to tell you that healthcare mobile technology is growing. It’s clearly safe to say that those of us (I’ll put myself in this group) that say healthcare is way behind the rest of society in technology use may not be able to make this claim any/much longer.
Mobile device use is exploding in all areas of our lives; healthcare is no exception. Physicians, like the rest of society, are seeing the benefits of the technology and taking steps to implement these devices into their work lives.
I believe we’re getting to the point where healthcare mobile technology will finally surpass the age of electronic health records and the shift in conversation will center around mobile health.
Like the conversations we been having for years about market/vendor contraction, the same goes for mobile health in that we’ve been talking about it for some time. Well, unlike vendor contraction, the days of mhealth are upon us and we’re seeing how a technology actually is changing a profession.
Healthcare big data is a big story, and it’s only going to continue being one. It’s a story I like and am intrigued by, but it’s not very sexy. Because of this, the only pieces of information about it seems to be very technical.
Until we actually see how big data changes lives, there’s just not going to be warm and fuzzy stories about it. So, cold and technical it is; nonetheless, I’m still fascinated.
In searching information about the subject, because I too want to know more from a ground floor level, it was nice to come across a nice piece about big data on the Cleveland Clinic’s website.
So, getting right into it, here’s an interesting piece of trivia about healthcare big data directly from the Clinic: “The amount of data collected each day dwarfs human comprehension and even brings most computing programs to a quick standstill. It is estimated that 2.5 quintillion bytes of data are created daily, so much that 90 percent of the data in the world has been created in the last two years.”
Healthcare big data is essentially large amounts of data that’s difficult to manipulate using standard, typical databases. Essentially, big data is very large pieces of information that ultimately, when captured can analyzed, dissected and used to monitor segments within a given sect.
Healthcare big data, it is thought, is what will drive change in care outcomes. What’s interesting, though, is that even though there’s a tremendous amount of data available for use, it’s just not being collected in a structured manner.
Collecting structured data is a must if we are going to begin putting some muscle to the bone of the new healthcare ecosphere we’re putting in place. You don’t have to take my word for it; IDC Health Insights research director Judy Hanover spoke of the same subject recently here.
But, to prove my position, I’ll let Cleveland Clinic make the point: “Unfortunately, not enough of this deluge of big data sets has been systematically collected and stored, and therefore this valuable information has not been aggregated, analyzed or made available in a format to be readily accessed to improve healthcare.”
Also according to the Clinic, if all of the data currently available were used and analyzed, it would be worth about $300 billion a year, reducing “healthcare expenditures by almost 8 percent.”
At the heart of healthcare big data is the hope that it can eventually help providers become predictors. Essentially, big data is like a big crystal ball, or so it’s been said.
According to Cleveland Clinic: “In this way, analytics can be applied to better hospital operations, track outcomes for clinical and surgical procedures, including length of stay, re-admission rates, infection rates, mortality, and co-morbidity prevention. It can also be used to benchmark effectiveness-to-cost models.”
Predictive analytics: That’s what it’s all about.
With all of the attention being given big data and warnings about being prepared for big data so it doesn’t sneak up on you – like meaningful use and ICD-10 – are valid and should be taken seriously.
Efforts are currently underway and available for big data processing and by managing data, “This dynamic data management technology makes data analysis more efficient and useful. Access to these data can also significantly shorten the time needed to track patterns of care and outcomes, and generate new knowledge. By leveraging this knowledge, leaders can dramatically improve safety, research, quality, and cost efficiency, all of which are critical factors necessary to facilitate healthcare reform,” writes Cleveland Clinic.
Big data is a catalyst for change, and without sounding caustic, will be a bigger deal than electronic health records currently are. Without a commitment to it, practices and healthcare systems will be left behind.
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:
