It has only been about two generations since traveling medicine shows were common forums for medical information. Phony research and medical claims were used to back up the sale of all kinds of dubious medicines. Potential patients had no real method to determine what was true or false, let alone know what their real medical issues were.
Healthcare has come a long way since those times, but similar to the lack of knowing the compositions of past medical concoctions and what ailed them, today’s digital age patients still don’t know what is in their medical records. They need transparency, not secret hospital –vendor contracts and data blocking, like the practices being questioned by the New York Times. One patient, Regina Holliday resorts to using art to bring awareness to the lack of patient’s access to their own medical records.
There are many reasons patients want access. Second opinions, convenience, instant access in a medical emergency and right of ownership—I paid for them, I own them. Other reasons patients need to view their records is for accuracy and validity. Inaccurate record keeping has even caused the EHRI Institute to cite incorrect or missing data in EHRs and other health IT systems as the second highest safety concern in its annual survey, outlining the Top Ten Safety Concerns for Healthcare Organizations in 2015.
Healthcare system executives, from CIOs to CEOs are very aware of the increasing requirements from patients asking for their records and the various state and federal laws that come into play. However, they are also aware that by making it too easy for patients to access records they risk liability and HIPAA issues. They also don’t want to provide documents that can easily enable cost comparisons or raise questions about charges.
Riding the wave of interest in accessing personal medical records are organizations like Get My Health Data. Org. The organization was founded in June 2015 as a collaborative effort among leading consumer organizations, healthcare experts, former policy makers and technology organizations that believe consumer access to digital health information is an essential cornerstone for better health and better care, coordinated by the National Partnership for Women & Families, a non-profit consumer organization. On July 4 it launched #DataIndependenceDay to create awareness for the HIPAA law which states that patients must be granted access to their health information with very few exceptions. An update to those laws that was finalized in 2013 extends these rights to electronic health records.
Despite the introduction of personal health records (PHRs), Blue Button technology and product introductions from blue chip technology leaders, such as Microsoft and Google, there has been no significant, unifying technology to ignite pent up demand for their medical records by consumers. This lack luster interest and ongoing interoperability issues might be the unifying force to drive many consumers to consider Personal Health Information Exchanges (PHIEs) as an alternative to EHRs and Health Information Exchanges (HIEs) that unnecessarily duplicate data and risk HIPAA violations.
Will PHIEs Ignite the Patient Record Access Movement?
Frost & Sullivan, in its research report, “Moving beyond the Limitations of Fragmented Solutions Empowering Patients with Integrated, Mobile On-Demand Access to the Health Information Continuum”, identifies personal health information exchange (PHIEs). They are described as providing individual patients, physicians, and the full spectrum of ancillary providers with immediate, real-time access to medical records regardless of where they are stored by using an open API.
The PHIE can provide access to the entirety of an individual patient record, regardless of the number of sources or EHR systems in which the patient data resides. This technology is made possible through fully interoperable integration servers that can access any EHR system with available APIs and portray the integrated data in a viewable, secure and encrypted format on a mobile device.
By leveraging the powerful simplicity of open APIs, PHIE technology can also access medical records in a way that is much more comprehensive than the closed EMR portals commonly used by doctors’ offices. Despite their pervasive use, these portals are cumbersome and expensive for patient’s use. The portals also include the same lack of interoperability that plagues hospital EHR systems.
Wolters Kluwer recently released a gem of a survey fit for the bandwagon of health IT topics currently underway.
On its head, the survey results are intriguing and the data does provide some insight into what the American public is thinking when led to think a certain way about a specific topic that, quite frankly, most don’t know much about.
Now, I’m not saying Wolters Kluwer data is flawed. On the contrary, the firm, which makes its living producing qualified data, knows what it’s doing. What I’m implying is that Wolters Kluwer is producing a survey with data collected by an audience that doesn’t truly understand the topic in which it’s responding to.
Let’s dive in and I’ll explain.
According to the survey by the Philadelphia-based company, 80 percent of consumers believe the greater “consumerization” of healthcare – or the trend of individuals taking a greater and more active role in their own healthcare – is positive for Americans.
“Survey data suggests many Americans feel that a greater role in their care is not only good, but necessary, with 86 percent of consumers reporting that they feel they have to take a more proactive role in managing their own healthcare to ensure better quality of care.”
Let’s start here. As a member of the healthcare community, I’ve helped produce similar reports based on surveys I have even helped write, produce, analyze and release to the public. Does that mean my data was a good as Wolters Kluwer? No, not at all.
My point is that there is nothing new here. Nearly every survey of the American public about healthcare tends to suggest that they need to be more involved in their care. All Americans want to take greater control of their car until, seemingly, it’s time to do so.
Even the results suggest that Americans have the information and tools available to them to take on more responsibility.
“Most consumers also say they feel prepared to take on a greater role in managing their own healthcare, with 76 percent reporting that they have the information and tools to take a more proactive role in healthcare decisions ranging from choosing healthcare providers to researching treatment options. Despite feeling prepared, only 19 percent report that they have their own electronic Personal Health Record (PHR).”
Well, there’s the catch. There always something holding people back; no, it’s not the fact that when it comes time for the rubber to meet the road no one is ready to actually start their journey. If only everyone had access to a PHR, everyone would clamor to be more involved in their care.
Certainly, most of us know that this is simply an excuse so no one has to take responsibility for their actions. And, when PHRs are readily available, some other hurdle will keep Americans from moving forward with their engagement.
Finally, of the 1,000 respondents, Wolters Kluwer suggests that a mind boggling 30 percent of Americans want the same experiences with their physicians as they have with other consumer interactions, such as while shopping, traveling or lodging, complete with choices and control.
Here’s where my suspension of disbelief ceases. There’s just no simple to explain this nor is there very much credibility in the statement. The flaw in this piece of detail, in my opinion, is that we’ll never be able to have the same experiences with our physicians as we can with our travel agent or the baker in the local supermarket.
Physicians, after all, develop a much more intimate with their “consumers.” I mean, physicians see us naked and stick us with needles and get a lot closer than the clerk at your local department store. There is simply no way the relationship nor the experience is going to be the same. Which brings me back to my original point: the survey just seems to try to be so much more than it is seemingly as a result of trying to be part of a larger conversation.
But, to mitigate against the risk of you thinking I’m holding out on you, here are the remaining results. Let me know if you agree with my assessment:
According to Wolters Kluwer: “When it comes to choices about physicians, assuming that experience levels and care reputations are similar, consumers rank costs of visits and procedures (20 percent); technologically advanced offices, including the ability to communicate via email with doctors and nurses, schedule appointments online (19 percent); location of practice/office (19 percent) and friendliness of staff (14 percent) as the top four factors influencing their decision.”
Among other findings from the survey:
Women (85 percent) are more likely than men (74 percent) to believe the “consumerization” of healthcare is positive
More women (81 percent) than men (72 percent) feel that they have the information and tools to make their own healthcare decisions
More women (59 percent) than men (50 percent) strongly agree that they need to take a more proactive role in managing their care to ensure better quality of care
Consumers aged 35-54 (60 percent) are the most likely to strongly agree that they need to be more proactive about their care, with those aged 55+ (56 percent) coming in second and younger adults (47 percent) being least likely to agree
Though there no longer necessarily a “season” for trend and projection pieces, but given our place in the calendar year, it’s appropriate that analyst firm Gartner recently released its latest piece, “Healthcare IT Trends to Embrace/Health IT Trends to Avoid,” published recently on CIO.
The following tips are part of a larger article about big data that, other than being a bit of a clumsy read, is worth a look. One of Gartner’s top healthcare analysts, Vi Shaffer, opines about the current state of healthcare and how those in it can begin to embrace the changes ahead.
So, without further ado, here’s some of the things you should definitely do (according to Gartner, that is), if you’re seeking ROI. I’ve made some edits to the list in points not relevant to this blog.
Big data. Along with big data, you need to make sure you’re making a move to structured data collection. In its most simple terms, you need to make sure that all of the data being collected in the practice is being collected in the same fashion, and that all of the same data is being collected. Once your data gets “bigger,” you’ll be better able to work with and analyze it. According to Gartner, “This may take time to implement, but it will have a “transformational” benefit and organizations that implement all facets of big data by 2015 can expect to start to outperform their competitors by as much as 20 percent.”
E-visits. “This facet of telemedicine is catching on now that EHR systems and patient portals include secure messaging. Success comes with setting expectations and enforcing policies,” Gartner says.
Wireless health asset management. Putting RFID chips on anything that moves—equipment as well as patient wristbands—is an “increasingly routine component of cost and patient care quality management.” Since there’s a lot to monitor, CIOs must collaboration with clinical engineering or biomedical device departments.
According to Gartner, the following are four healthcare IT trends to avoid. For various reasons, I don’t agree with any of these reasons, do you?
Patient decision aids and personal health management tools. These appear largely in the form of interactive apps that educate patients or help them make care decisions, such as seeking treatment or undergoing surgery for a particular ailment. Though, Gartner says their effectiveness is questionable and adoption remains low, I’m not sure I’m convinced that they should be avoided. There is some value to these programs, especially if they help with patient engagement and education.
Personal health records. “The concept is attractive, as it gives patients ownership of their data, but poor usability and vendor disinterest have hindered adoption. Only with a government mandate, as is the case in Australia, does PHR adoption seem to catch on, Gartner says. Patient portals, which connect patients directly to their caregivers, are more popular.” Not only are they more popular, they are required through meaningful use and, if leveraged properly, can be quite effective in helping drive engagement and education.
The patient-centered medical home. “There’s been much discussion of making this a reality, especially in light of the accountable care organization model, but information exchange challenges and a reimbursement model unfavorable to insurers hinder adoption.” Again, not sure if I agree with Gartner. I don’t have any hard reasons why except that for some, they actually have proven successful. Check out this piece for more about a practice that clearly has leveraged the PCMH successfully.
Patient self-serve kiosks. “While these can streamline patient registration and payment collection, the ROI isn’t there, Gartner says. Most organizations are better off focusing on meaningful use or the conversion to the ICD-10 code set, which must be done by Oct. 1, 2014.” Again, for some organizations, these are simply good tools help streamline the patient intake process. They may not improve ROI, but they can get people into the practice more easily and to their physician without the cumbersome paper and pen approach.