Should any of us really be surprised at this point, more than 20 years after the web really took hold in society, that so many of us turn to it for advice, guidance and a little help navigating our health diagnosis and outcomes.
According to a recent report featured in American Medical News, most of us in America are turning to the web to help in dealing with our symptoms. What has traditionally been a vehicle to identify the condition associated with our symptoms and has now taken on the role of confidant in all things healthcare related.
For example, we are hitting the web to research which physicians to see, what treatment options there are, services provided by care facilities and pharmacies, and thing else we believe will be useful to our longevity and comfort.
This is not surprising. We live on the web. Just this week I went online before deciding to call my daughter’s pediatrician to see what to do about her fever and if it was getting to high. While there, I also took a look around to find tips for breaking it and to see whether I should be packing her in blankets or letting her “breath.”
In the end, all of the information I found about my daughter’s condition turned out to be true and was verified by her pediatrician.
Apparently, this is exactly how about 75 percent of the rest of us feel. Granted, if I were in a real emergency or needed immediate care, I wouldn’t be hitting the web first, but I’m actually scratching my head a little about why this information, about people turning to the web, is such a revelation.
As we all continue to move online, the web is going to become more and more a part of our lives. And really, we’re already seeing services like telehealth and remote video consults filling voids where services are required.
On top of this, there are companies like HealthTap that actually allow patients to interact with a panel of physicians online and ask questions or seek medical guidance. Clearly this is the new normal, the present path.
So, again, I’m left wondering why it’s so interesting that three quarters of the U.S. population taps a few keys to find the best information available to them. If nothing else, this should mean we are the most educated patients in the history of mankind, which could lead to better results, and … wait for it … more engaged individuals.
I leave you with the following bit of info about others like me (though I’m without chronic condition), pulled directly from American Medical News (thanks, guys!):
Chronic care patients rely on information online
A Manhattan Research survey found that 54 percent of patients who use the Internet say their healthcare decisions, including choices of physicians and medications, are influenced by information they find online. And 79 percent of patients diagnosed in the past three months with a chronic condition are likely to use what they see online. Percentages of patients who are influenced by online health information by conditions:
From her hospital bed, the little old woman gathered herself beneath her tissue-paper thick blankets and wondered about many of the things she’d face in her future. Though the room wasn’t cold, wringing her hands through the folds of the cheap cloth were all she could do to keep herself calm.
The television blared above her prone body; it made the only noise except for the rasp of her short breath. Occasionally, an orderly passed by but made no effort to breach the curtain door, and made her way down the hall.
A newspaper lay unopened at her side, not a word of it read, mostly because of the glaucoma in her right eye. Thus, the television called out, it being the only thing to steer her thoughts back from the darkness and confusion that seemed to take hold.
A relatively healthy 95-year-old women prior to the automobile accident (that consequently was not her fault), she seemed to suffer the unimaginable at her age and come out alive. Though doctors wouldn’t guarantee her recovery during the first few days, they were more optimistic now that her broken leg, broken arm, fractured wrist, broken shoulder and cracked ribs had not killed her.
She’d made it this far, they reasoned; and if the whole experience didn’t kill her then certainly it would make her stronger.
So alone she sat, except for when the occasional visitor stopped by, much of the time scared and most of it confused.
In came the food, out went the plates. In came a doctor, what was left were his orders. The occasional nurse checked her machines and gave her a pill; conversation was limited to, “How are you feeling today?” or “Are you in pain?”
There’s no surprise she feels out of place. Clearly, thoughts of giving up come to mind and she wonders if she’ll be able to survive the three or four months of required physical therapy for her to recover.
Even worse off, without any real family to guide her through, she sat quietly trapped in her own thoughts.
Finally, at one point, randomly looking at the computers in the room, she said softly, “Everything is mechanical now.” It was a statement, like something said in fear and loathing. She wrung her hands some more and closed here eyes.
When the nurse came in, the old lady requested a pain pill and the nurse left to retrieve it. Upon her return, the nurse handed over the small white pill and a shot of water and said she’d stay until she was sure it had been swallowed.
Thirty seconds later she was gone, again. Alone, the old woman tried to remember her home and its warmth and did her best to recall a lifetime – nearly a full century – in which she’d been engaged lovingly by family and friend.
It’s all mechanical, now, she said again, wondering in silence as her companion, the television, blared on.
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.
Healthcare reform was ignited by ARRA, which became the catalyst for much of the changes currently taking place in the health IT landscape, and though meaningful use is profoundly changing the way data is collected, according to some we’re a very long way away from actually being able to do something specific and positive with it.
Everyone in the healthcare community is focusing on regulation and meeting the mandates of the reform, from a healthcare technology perspective. Things get a little lopsided when the discussion turns to how the information gathered in meaningful use relates to clinical outcomes.
According to Dr. Akram Boutrous, who leads the consultancy BusinessFirst Healthcare Solutions, right now there is simply no way of collecting all of the data available in the healthcare community on a global level.
As far as he and others are concerned, under the current healthcare reform model there’s too much attention being placed on healthcare technology, including electronic health records, when there is still a mighty void between the tools used to gather the data and the tools (which don’t yet exist, he says) used to analyze the data.
“There are still many tools required to predict what is most likely going to happen in a given scenario and the best course of action to take,” Boutrous said.
He describes the current health IT landscape like an iPad without apps to use on it. “You can look at it, but you can’t do anything with it.”
This means we’re back where we have always been – in a land of silos where the information they contain stays contained without any real chance of it going anywhere to do any good.
Without interoperable systems that can communicate on a much larger scale, there’s certainly no room for even discussing the advancement of the ACO concept. “I’m pessimistic that ACOs as defined [in health IT] will provide meaningful change in healthcare,” he said.
The catalyst for change, he thinks, is the payer community and non-government organizations. Even though the federal government set the foundation for health reform, it won’t be able to maintain a successful program, and innovation will fall by the wayside.
“The non-government side of the world has taken the bull by the horns and made some very innovative advancements,” he said, while the public sector sought clarification of the reform mandates through court and legislative actions.
Until better tools can be implemented and adopted, and a culture change embraced, we’re simply not going to see models like ACOs develop according to the timeline many industry “experts” claim.
Until there are actual tools that provide meaningful support to the community and allow for some sort of global analyzing of specific populations and data sets in real time, healthcare will remain a production-based market where accountable care remains nothing more than an idea.
The market needs more than static components and databases, and health IT needs to evolve and incorporate more capabilities to that make possible, and engage in information exchange before we can begin to move to an accountable care model.
I’ve always been a sucker for trivia. In most cases, the information that sticks in my head is useless and, well, trivial. People — including those that know me best — often shoot me quizzical looks and wonder where the hell I came up the crap that pops out of my mouth. Most of the time I shrug and respond with the I’m-so-stupid-sorry-for-breaking-the-silence, “What.”
But, in healthcare, this kind of mindset set has a place; maybe it’s just a data place of mind sort of thing. Nevertheless, I’m comforted by all of the (sometimes) useful technology information floating around, and today, I’m proud to share a kindred spirit at HIT Consultant, who posts an incredible plethora of devourable data worthy of sinking your teeth into in the piece, “80 Mind Blowing EMR and Meaningful Use Statistics & Trends.”
Feel free to check out the full course, but for a primer, let’s dig in here.
• According to the list, 75 percent of patients are willing to go online for health information. Not surprised by this one bit. I’d argue the number is low. Check out this article by American Medical News for more on the subject. We spend our lives online wherever we can get online. If we have access to the web, we’ll be on it; this isn’t necessarily mind blowing, just trivia, and a reality.
• Next up, financial troubles at the practice level. Interesting topic, but given the conversations I’ve had with physicians I’m not surprised. More than 40 percent of physicians have financial troubles, and given the overwhelming reform practices face, it’s no wonder the private practice is being ambushed.
• More than 70 percent of hospitals employ full-time staff to scan charts into their electronic systems. WOW! Seriously? This doesn’t sound efficient to me. Someone please explain.
• “Solo practitioners are particularly unlikely to be using EHRs or to have plans to implement them. Also, older physicians are less likely to be pushing for adoption of HIT.” Again, no surprise, though, it’s sad. Truth is, both of these segments will be out of private practice in the next three years under the current healthcare structure. No joke.
• Just a bit more than 20 percent said their EHRs made them more efficient and only 6 percent said their making more money with their systems. Again, not surprised by this data. These are PR talking points EHR vendors push to sell their systems. Pay attention, you’ll probably see some CEO on this site talking the same points sometime soon.
• Apparently, according to a study reposted by Becker’s Hospital Review, 91 percent of physicians want/are interested in mobile EHRs. I don’t buy it. I’d like to see the data, but I bet it’s a flawed report. Physicians are too concerned with their in-practice solutions, mandates and reform. We haven’t tipped that far in the mobile direction yet. Not possible; just another PR talking point from a vendor.
• “Each patient visit requires approximately 10 to 13 pieces of paper.” That is shocking.
• Top 5 EMR vendors by number of users are:
o eClinicalWorks
o Epic
o McKesson
o Care 360
o Allscripts
Care 360 is in the Top 5? Hmmm.
• The feds believe they’re on the hook for more than $20 billion of taxpayer’s money for meaningful use before the program wraps. This is one of those facts that I’m not surprised by, but I am, if you know what I mean. It just makes me look side ways.
And the list goes on and on, some shocking pieces of trivia, some less so. The point is there’s much to consume, some more positive than others. But, HIT Consultant does make a great point: a lot of the data available doesn’t point to a land of milk and honey. On the contrary, there’s a lot of disappointment in health IT.
There’s apparently much to learn and much to improve. Everything is yet to be perfect, while some things are wonderfully, wonderfully good.
After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.
You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.
With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.
All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.
“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.
“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.
Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.
On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.
The more likely model now will become the one where physicians become employees.
“Healthcare reform essentially is putting the private practice out of business,” he said.
In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.
“This is the reality of what we’re seeing in the outside world.”
Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.
With the patient engagement quandary hanging its head over the next phase of meaningful use, healthcare leaders of all kinds continue to wrestle with how to meet mandates that are beyond their control.
Previously, the assignment was simple: do this, get that. But here, in stage 2, there’s a little outlier – required patient engagement – that has some physicians worried about how they are going to handle their second attestation.
Even though there are rumblings that CMS may look the other way when dealing with patient engagement, or decides not to enforce it, at least in the beginning, or chooses not to audit this measure, it’s still a mandate and it’s being taken seriously for all providers seeking the second set of financial incentives.
Some practices are taking measures that they haven’t had to in the past or at least with as much passion as they are now. They are marketing and advertising directly to patients, even if the campaign extends only to the interior of their own practices.
Such is the case for Dr. Stephen Bush, of Fox Valley Women and Children’s Health Partners in St. Charles, Illinois.
The first step in the process, Dr. Bush said is the implementation of a patient portal, which is though to help get the practice’s patients engaged or, in the very least, getting them more involved in their care protocols.
“The problem is, patients have to sign up to use the portal,” Bush said. His worry, though, is when pushing patients to engage, that if patients are pushed too hard, patients push back and essentially disengage.
“We receive significant push back from patients who get upset when trying to engage too much,” Bush said. Examples include posting too many times on Facebook or posting too many tweets to Twitter. According to Bush, patients will stop liking the practice on Facebook and stop following on Twitter if they feel the practice too involved socially.
Bush said his practice is working to implement new marketing and educational strategies to prepare for the patient engagement mandate, just to be safe, even though there’s little that can be done to audit how often patients use the portal after they have signed up.
There also may be too much attention put on patient portal’s capabilities, he said.
“They are not education tools, and they’re not meant to provide better healthcare, and in no way does it educate the patient,” he said.
Despite the patient engagement portion of the Stage 2, Bush said meaningful use is needed and ultimately, will help patients become more informed and get them involved in their care, which may help reduce costs overall. “The management of healthcare for patients is important, and can make lives better and healthier,” he said.
“All physicians are concerned about their patients are being taken care of and informed. Meaningful use gets patients involved. Patients now deal with things when there is a problem occurs rather than managing a healthy lifestyle.”
Physicians are trying to engage patients, and always have. Eventually, a change will come to the landscape, but as long as patients remain laissez-faire, there will be some push back when they are pushed.
My fascination with the benefits of patient portals continues to grow as the technology continues to grow in popularity.
Given their resurgence in popularity over the course of the last three or four years, and with the latest push for patient engagement through stage 2, clearly they have a very strong future in the practice of healthcare for the foreseeable future; probably until a game-changing technology moves us beyond the era of EHRs.
Until quite recently, patient portals have been viewed as a novel concept, and, overwhelmingly, practice leaders and physicians kept coming back to how they were going to get patients to actually use the communication systems, and, likewise, what benefit would they deliver the practice if the patients used them.
It’s safe to say we’re now living in a different time than even just a few years ago. People are more mobile, landlines have been cut and actually using a phone to make a call is essentially going to the way of the tube television.
We’re in an always on society where access to information, regardless of the subject, must be had. As you’re well aware, portals don’t necessarily come automatically with your EHR; they’re not bolted on, in other words. They cost money in addition to what you pay for your practice management system and electronic health record. In some cases, they’re actually quite expensive, or have been known to be in a traditional sense.
And, if the case could be made to invest in the technology (practice portals that is), the most obvious question often went unanswered: How can a practice bill for the time spent by its physicians when administering it and when responding to communications from patients, for example.
I digress. This is all water under the bridge. Everyone knows this stuff. It’s been overworked and underpaid.
The feds now require portals to play a huge part in health IT through meaningful use. Insurance companies are now jumping on board and allowing physicians and practices to bill for the time they spend administering data collected through portals, and patients have become so engaged in their mobile lives that it’s only a short matter of time before portals are utilized as heavily as online banking and ATMs, let’s say.
When I began thinking about this post, I thought of grandiose ways in which I could depict the usability of the portal and speak to its ever-increasing importance to the world of heath IT, but I just don’t think I can sum up their benefits better than simply listing them, as they speak for themselves.
As we know, patient portals can increase patient engagement by providing secure access to medical information online. Additionally, they allow physicians to:
Send and receive messages to and from doctor’s office
Communicate with patients through secure messages
Post lab and imaging results
Send reminder notices to patients
Post patient consent forms
Make billing information available
Provide patient education materials
With patient portals, patients can:
View and enter medical history
View and update allergy and medication lists
Send messages to their doctor’s office
Complete registration forms
Update demographic information
Request appointments and prescription refills
Obtain patient education materials
View account statements and pay medical bills
Not a bad day’s work for a fascinating bit of technology that’s changing the face of healthcare IT.