There’s a special place in my heart for electronic health records. Having worked with one of the largest vendors (at the time; the company has since shed about 20,000 of its physician users) I understand their capabilities and how they can benefit a practice beyond just how they are marketed. EHRs are one of the reasons I started this blog, in fact. If I could spend more time on them and keep people interested in this site, I would, but not everyone feels that way I do about them so I’m forced to broaden my horizons and cover a variety of other topics.
Alas, I also feel we’re entering their final days glory days. I believe 2013 will be the year of transition in which we as a market decide that EHRs are foundational and that other, new technologies are emerging that will either make EHRs better or render them essentially useless. Until then, though, I’ll allow myself to continue to focus on them from time to time and hopefully you’ll find the information relevant, which brings me to today.
Found an interesting piece in Executive Insight magazine by Meditab’s VP of Marketing, Kirk Treasure. Though Treasure makes the claim (like most EHR vendors continue to do) that EHRs are increasingly important to the continued streamlining and delivery of patient services, but he says, because of a recent KLAS report, that practices and health systems are becoming dissatisfied with their EHR vendors and their systems.
This really comes as no surprise and has been expected. Some of this has to do with vendors trying to get by on the status quo while some of this has to do with crippling meaningful use regulation. Some of it has to do with promises not kept or promising too much (which is usually the case), but again, there’s nothing surprising here. It’s where we are in the market.
According to Treasure, there are two reasons for this wave of provider dissatisfaction.
One: “Many physicians are basing their decision primarily on cost factors, not realizing that cheaper is not necessarily better.”
Two: “Many practices are not 100 percent comfortable with their own internal processes, and as a result, purchase an EHR system that does not satisfy their needs.”
Treasure warns those in the market for an EHR to take their time to evaluate their needs and future goals of the practice then look at what they can realistically afford to invest in a system. “It’s important to weigh out whether or not a perceived expensive initial cost will save you money in the long-run,” he said.
“Next, analyze your workflow to see which processes you would like to maintain and what areas you would like to improve,” he added. “This will help in cultivating efficiency and organization throughout the practice, while ensuring that your EHR system supports your goals.”
Treasure continues his golden advice. Vendors need to look for systems that meet the specific requirements of their practice and to understand that there is no “one-size-fits-all solution,” even within the same medical specialty. Once a list of vendors has been narrowed down, check references (this is an absolute must) and try to speak with several clients that have been using the system for at least a year. According to Treasure, “They can tell you about any obstacles encountered during the implementation, their support experience and the benefits from making the switch.”
Here are some other suggestions to purchase the right EHR system for your practice and avoid a costly mistake, from Treasure:
• Understand the total cost of ownership of each vendor’s pricing structure. For example, some cloud-based vendors provide EHR services on a subscription basis. Paying $400-$600 a month for a five-year contract period would result in a $30,000 commitment plus the initial investment for implementation and training. Alternatively, the total cost of ownership for a server-based office system with a $10,000 upfront cost and a $200 monthly maintenance would only be $22,000.
• Look for hidden costs in the contract, such as additional fees for in-person training, document management services, EDI setup, or annual maintenance fees in addition to the monthly support costs. Also, watch for provisions that allow the vendor to increase fees during the course of the contract.
• Ask the vendor if the system will accommodate any potential changes in your practice model. This could include, for example, joining an accountable care organization (ACO), adding telemedicine services or expanding upon the practice concentration in the future (i.e. bariatric, weight management, etc.).
• Consider the EHR system from the point of view of the patient, as well as the physician and office staff. For example, is the EHR system easy to use in the examination room? Does it provide reports on waiting times or other service delivery issues?
• Be sure that you “own” the data under the terms of the contract. Some vendors charge a fee for exporting the data to a new system before the contract expiration date.
• See if there are provisions that would allow you to get out of a contract after six months or a year. This is essential if the system ends up not working for you.
• Finally, be sure you are comfortable with the vendor. In many cases, a smaller or mid-size company can provide a higher level of personal service. That’s an important consideration in helping physicians and office staff take advantage of the many potential benefits of deploying an EHR system customized to the needs of the practice.
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.
Patient engagement strategies proliferate, experts pontificate and lay people ponder, but as we wait for the dust to settle, there are few tangible suggestions that truly claim to guide physicians and practice leaders in the steps to take for actually engaging their patients.
Though meaningful use requirements mandate physicians provide secure messaging and patient portal capabilities as a requirement for attesting, but what can those at the practice level actually do to get patients more involved in their care and foster the spirit of meaningful use?
According to Jason Fortin, senior advisor at Impact Advisors, a healthcare consultancy, there may be some simple, more traditional paths to patient engagement.
For example, other than focusing on creating social media campaigns to drive traffic to sites and brick and mortar practices, “But, they shouldn’t abandon regular mailings and telephone calls to patients,” he said. “Don’t abandon all the arrows in your quiver.”
Essentially, patient engagement can be a long a drawn-out process that requires a great deal of investment. Short-term returns may not be what practices hope for, but they’ll pay off in the long run.
For the time being, patient portals are designed to fill the patient engagement voice. Unfortunately for some, adding one more system to their roster and another log in to track, there’s more likely the chance that unless it provides some sort of concrete benefit, patients may not be interested in pursuing a relationship with their physicians through it.
Real change in regard to patient engagement is most likely a generational issue that we don’t see manifest for several years. If patients (now or in the future) are going to be engaged, whatever the tool used to reach them will most likely have to fit into people’s daily lifestyles.
Patient engagement tools will need to evolve beyond bill pay and appointment setting systems. Most likely, they’ll have to be along the lines of a Facebook or a Twitter.
Fortin says whatever the tool and no matter its capabilities, it needs to “transcend” and impact the population. For any sort of system or technology to work long term it needs to be “integrated into people every day lifestyle otherwise folks are going to have a difficult time maintaining their interest in using it,” Fortin said.
But the traditional vendors, those that produce the patient portals to compliment their electronic health records are not spending their time focusing on innovation and advancing the technological offers to clients, Fortin said. On the contrary, most vendors are mired, or choose to be mired, in the technological requirements of meaningful use.
In this regard, meaningful use is quite singular in its focus and is restricting innovation of new technology.
Until we’re able to develop or capture new technologies to engage patients (I trust the free market will come up with something), healthcare professionals need to come up real and tangible strategies for action items that they can put in place to create an environment where patients feel safe enough to engage.
In the meantime, maybe your fingers should do the talking and a postage stamp can be employed to save the day.
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.
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.
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.
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.
