ONC’s HealthIT.gov published the following graphic aimed directly at consumers, expanding on its education strategy. For those that live in health IT, much of the information included here has been seen multiple times. Perhaps there is little new here.
However, there are a few nuggets that I personally find of interest that are worth sharing. According to the the feds, “between 2001 and 2011, the number of doctors using an EHR system grew about 57 percent, making it easier for you and all of your doctors to coordinate your care, and often reducing the chance of medical errors.”
Now that studies have suggested that about 66 percent of the population would switch to a doctor using an EHR versus one not using one, we’re going to see this stat is every piece of collateral in support of the effort; in fact, that same story has been reported here at this twice (this makes the third time). That detail is included here, too, as we would expect.
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.
As the self-proclaimed ONC Blue Button movement gains steam and more members of the public sign up to make sure their data gets downloaded, it seems the Office of the National Coordinator, among others in the fold, have borrowed a marketing campaign from office supply chain, Staples.
The “Easy Button” is vernacular for something that get done at the press of a button, even if said task isn’t necessarily as easy as just pushing as button. Obviously, that’s the point.
Same goes for the Blue Button. From a marketing perspective, the concept is genius. With the simple push of a button, you too (read: “consumer/patient”) can have instant access to every last bit of your media records and personal health information like never before.
With the campaign just getting started, there are already more than one million people who have signed up for the Blue Button service (sounds sort of like “black tie event” when I read it like this). Eventually, the movement will take hold, no doubt, and the consuming public will be on board like never before. I anticipate Blue Button will grow enormously, similar in nature to the culture that social sites the likes of Facebook and Twitter have become. Not that we’ll sit around sharing our records with those who “like” us or posting comments about each others ailments and conditions, I think people will perceive blue button to have the same value.
It’s about access to information – information that until now many people have not realized they owned or had access to – instantly, as long as Blue Button is available to them.
That’s the catch after all, isn’t it? Blue Button has to be available to consumers for them to be able to push that little easy button. Seems like there are only a couple things that might keep someone from it. The most obvious is that a patient’s physician must have a meaningful use EHR in place. Another is that the practice must choose to offer the service.
It goes without saying, then, that consumers without insurance most likely won’t have access to Blue Button as they’ll likely not have access to a regular physician with a certified EHR. The current healthcare reform may change this slightly as more people will be “encouraged” to insure themselves. And, as practices move to EHR, access to Blue Button will increase.
All of these details are beside the point. Right now, it’s about the marketing. Making sure patients know that the health information that is rightfully theirs can be in the palm of their hands as easily as pushing a little button.
As we know, or so we’ve hypothesized, that the more you can engage patients in their care, the better care they’ll take of themselves.
And you’ve got to hand it to the ONC. Creating a message that directly engages the public rather than hoping that physicians and their vendors will carry the task is something I have long advocated for.
So getting us, as patient consumers, to engage in and to own our care really took little more effort than developing an app and marketing it directly to the people.
While the final 50 or so percent of ambulatory physicians decide whether to implement electronic health records and others re-evaluate their technology plans, which may include switching the systems they use, it seems like as good of a time as any to continue the series I started about the steps that need to be considered when selecting an EHR.
At this point in the process, you’ve obviously gained the understanding that it’s an arduous process and requires a great deal of planning. But, you know that. You’ve done the planning and you’re beyond examining how implementing the system will affect your practice’s workflows.
So, when you’re gearing up to finally take the plunge, or if you’ve decided to get out of the water and dive back in, the Office of the National Coordinator provides the following guidance for moving forward with these EHR implementation tips.
Here’s a concise breakdown:
Get to know as quickly as possible how vendor and its products will help you accomplish your goals. Test drive the product and never take the word of a salesperson without vetting it with other professionals using the product. You might also shy away from vendor-provided references as they tend to receive incentives from the vendors for giving them. And, according to ONC, “Provide the vendor with patient and office scenarios that they may use to customize their product demonstration.”
Clarify pricing of the entire implementation prior to signing the dotted line. You want complete pricing for all things including: hardware, software, maintenance fees and upgrade costs, interfaces for labs and pharmacies, cost to connect to health information exchange (HIE), customized quality reports, etc. If it’s offered, ask for the price and get it in writing. Every time the deal changes, get a new written quote.
Like pricing, define implementation: amount of time, schedule of completion, and availability of trainers and what’s included in the training.
Ask lots of questions about data migration and how much it’s going to cost. Ensure a structure for the data rather than simply allowing for a dump of information. “Clarify roles, responsibilities and costs for data migration strategy,” the ONC suggests. The amount of data you need to transfer, the more complex the process will be.
Know whether you’ll be better off with on-site server or a hosted, Saas solution.
Can the system be integrated with other systems easily? If so, ho much does it cost?
Privacy and security capabilities and back-up planning: are there any?
Is your proposed vendor stable? Will it be sold or divested? Does the vendor have a strong local presence? Are those practices leaders in the local market? Do you hear good things about said vendor?
Can the system connect to an HIE? How much does it cost?
Is the length of the initial contract much too long – like a five or seven year lock in – and does it potentially keep you from exploring alternative options should you need to make an earlier exit?
Finally, according to the ONC, though it may seem a little off topic, “Consider costs of using legal counsel for contract review verses open sources through medical associations.” Nevertheless, seek legal counsel before accepting the vendor’s agreement.
The best time to protect yourself from a poor decision involving the vetting and purchase and an EHR is during the shopping and review process. Take time at the beginning of the process to ensure you know what you’re getting, what you’re paying for and, ultimately, what type of vendor partner you’re going to get once the ink on the contract has dried.
When I go to the doctor for a check up of another ailment, I understand that the record kept regarding my care is ultimately mine. Not because I’m told, not because I’ve asked (though I have on some occasions), but because the information collected comes from me. Without my providing it, my physician would not have it to keep it.
Maybe it’s my make up, but I pride myself on knowing what others often consider trite and trivial. For most, knowing who owns their health record is exactly that, trivial.
Interestingly, though, is that for every person with a health record, there are the same number of people with a care provider to tell them that the record is theirs. So why then doesn’t everyone know that their health record is theirs?
I don’t think the answer to this question lies in the patient apathy or the population’s potential indifference toward their health outcomes. Innately, I believe people do care.
The point I’m making here is that I think the ONC’s latest effort to market direct-to-consumer (DTC) information is well intentioned but perhaps the burden for doing so is misplaced.
Do we think physicians and their practice colleagues should be spending their time doting on the ownership of their patient’s health record? Is anything other than patient health and outcomes a priority they should be focused on? The ONC thinks so, and given meaningful use and the increased pressure providers face to record and provide results of meaningful health outcomes, physicians are being arm twisted to ensure this level of grassroots marketing provides the ends to the ONC’s means.
Certainly, we as consumers must continue to receive information and education to keep us informed about the world of health IT. It’s true that very few actually understand just how far back healthcare technology is from the mainstream in regard to use of technology. But, as I’ve said before in this very forum, should all of the responsibility for this lie on the providers’ shoulders?
Not so, in my opinion. Sure, physicians and care givers can be advocates to consumer enlightenment, but more of the responsibility really should go to the health IT vendors. After all, they are the ones selling the products to the physicians. It behooves them, and enriches them, the educate consumers to the value of the systems’ worth and how help improve health outcomes.
Sending this message to consumers, and helping to educate them of the benefits of these systems, will go a long way toward convincing them that their physicians need the systems. If consumers find value of these systems, they’ll let their wallets do the talking and give their business to physicians and practice that employ health IT.
And, if the physicians are truly going to be “the sales force for health IT,” perhaps it’s time the vendors started incentivizing these walking billboards the ONC wants them to be.
In continuing a series based on HealthIT.gov’s “How to Implement an EHR,” now seems like an appropriate time to seek additional insight into how to prioritize your implementation plan and identify critical tasks to perform when putting your system in place.
As the HIT world continues to reel from continuous change – meaningful use stage 2, ICD-10 postponement and mobile health among the biggies – like any commercial market, there’s bound to be some constant ebbs and flows.
Selecting, and changing, an EHR are bound to happen no matter what else is going on in the market. So, though much of the market may be focused on regulation and reform related to EHRs, there are still practices who haven’t yet implemented, and there are practices that are looking to get out of their current solutions.
According to the Office of the National Coordinator (ONC), “Building an EHR implementation plan becomes critical for identifying the right tasks to perform, the order of those tasks and clear communication of tasks to the entire team involved with the change process.”
Implementing an EHR is really about implementing a change management process: new rules, new ways of doing things and new things to learn. That’s an oversimplification, but it essentially hits the mark.
Setting up an implementation plan (the plan should be in place before the implementation begins) first starts with segmenting tasks into three categories, according to ONC:
What new work tasks/process are you going to start doing?
What work tasks/process are you going to stop doing?
What work tasks/process are you going to sustain?
The three categories help determine the future work environment of the practice; how things will work after the change.
Obviously, if you are moving from an existing EHR, you’re probably going to be more familiar with how things will work once the system is in place, with a few exceptions. However, moving from paper to electronic records means there are going to be a great number of changes that, if not accounted for, may cause some initial hurdles along the way.
Your next steps should include:
Mapping your current workflow and analyzing how you get things done
Mapping how the EHR will affect your workflow, and how you hope it will enable you to perform certain tasks or functions like how you plan for them to create more efficiencies and reduce duplicate processes?
Creating a backup plan to address issues that arise during implementation. This is crucial as issues beyond your control will come up and if you’re not prepared for them, they could derail your process and set you back. Think of worst case scenarios and plan for them to happen then hope for the best. No implementation is ever the same as another; each are there own experiences.
Building a project plan to blueprint the transition then appoint a team member to manage the plan.
Identifying data that must be transferred to the EHR either from paper or from the previous EHR (charts are the most obvious example here)
Finally, find out what can be transferred to the new system like patient demographics and schedules.
Once this point has been reached, you can bring other parties into your plan, like consultants and vendors, to get the plan rolling and potentially start the implementation.
According to the latest Centers for Disease Control and Preventions’ National Center for Health Statistics survey of 2011 EHR adoption trends, released on July 17, use of EHRs is up to 55 percent of practicing physicians. That’s a 5 percent increase from 2010, also according to a CDC survey.
The survey of 3,180 physicians was funded by the Health and Human Services Department’s Office of the National Coordinator for Health Information Technology. More than 55 percent of all physicians use and EHR (and more than 86 percent of physicians in practices with 11 or more physicians use an EHR). Physicians also value their current EHRs more compared to past iterations of the systems and, finally, respondents said the care they provide to patients is better than in the past because of the EHRs.
Problem: there’s no data in the survey to support this final claim.
Obviously, EHRs are intended to improve care, whether at the individual level or at the practice level. However, physicians accessing patient data through the records should be tracked and made quantifiable.
Practices using EHRs have the power to change lives for the better, manage care and ensure proper care is provided throughout a patient’s care plan. Practices can and should track how care initiatives have changed with the implementation of an electronic health record and how their patient populations’ health benefits.
Simply stating that patient care has improved when a practice uses an EHR is an immeasurable statement. Innovative practices find ways to track these outcomes whether it means there are fewer chronic conditions among their patients or that their patient populations’ life expectancy actually increased over a period of time (as can be measured and in some cases has been done).
The ONC needs to do more to encourage physicians to move beyond meaningful use stimulus, which is driving the increased use of EHRs. And while the data collected from surveys such as this are important, as I continue to say, they don’t tell the whole story of how technology can improve healthcare.
And throwaway statements indicating immeasurable “facts” does nothing more than generate misleading headlines.
