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Why Do Chronic Patients Not Access Their EMR?


What a fascinating picture and result. For those who can’t see the Twitter image, it says that 55% said “I don’t know how to access my medical records” and 17% said “I trust that my medical records are accurate, so I don’t need to access them.” The later number is probably lower than reality as well. I expect that more people feel that way, but most don’t want to admit it since there’s a chance they’d be wrong.

These numbers are interesting after writing my post, “Do you hate portals?” I wish they would have asked how many people didn’t access them because they hated them (ie. they didn’t enjoy using them).

I’ve often said that most patients don’t care about portals, but chronic patients are the exception. These numbers seem to largely illustrate that, but it also looks like many with chronic conditions want to use them but not enough to actually figure out how to use them. I hope that these numbers are tracked over time. I wonder if 3 years from now those numbers will be dramatically different.

June 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Do You Hate Portals?

I was really interested in this summary of today’s #HITsm Twitter chat. Do people hate portals?

I think if we look at the portals as they stand today, it’s fair to say that people hate portals. They can’t remember their login. They’re complicated. They don’t solve the problems they want them to solve. There are too many of them. It’s just a mess.

I think we all agree that the idealized patient portal would be something we all value. Here are the characteristics of an idealized patient portal:

  • One Login
  • All Health Data from Every Provider (Yes, that includes labs, x-rays, etc)
  • Messaging with Clinic Staff
  • Messaging with Provider
  • Refill Requests
  • Appointment Request
  • Bill Payment
  • One Standard Health History (Intake) Form Accepted by All
  • Data from Personal Health Sensors and Trackers
  • Smart Notifications and Processing of Data

I’m probably missing something, but this list does a pretty good job covering what the ideal patient portal would look like. If someone could execute this patient portal, then we would all love to use it and there would be near universal adoption of it (minus a few people who don’t get on a computer). Sure, we’d still complain about the user interface or some other thing because we love to complain, but we’d all use it just the same.

There are actually some providers who have completed this list for everything that they control (ie. they don’t include data from other providers, don’t handle the intake forms for other providers and don’t do the sensor data). These providers have seen some pretty good traction with their portals, but they wane in use since just having one provider on it isn’t as compelling as a portal that has our entire health history. For many providers you might only see them every 3-5 years (or less). After 3 years, it’s just easier to pickup the phone than to figure out the portal.

This is the reason why Kaiser’s portal has been quite successful. They control the whole spectrum and so they can get pretty close to the above portal nirvana. Until we’re able to do something like that across the spectrum of healthcare in one place, many people will hate their portal (or maybe I should have said “their dozens of portals”).

I personally wonder if we’ll ever get there. If we do, I think it will be some company which goes in and solves one element in a way that provides immediate value to everyone involved. Then, they’ll layer the other features on top of it until they create the portal that everyone loves.

June 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital CEO Resigns Over Failed EHR Implementation

The social media world has grabbed on to a story at Athens Regional where it looks like the poorly done Cerner EHR implementation has “forced” the CEO to resign. Before I talk about the story, I’ve been amazed at how many tweets and retweets there have been for this story. It’s like the proverbial rubber neck we all get when we pass a car accident. I guess reading about a CEO resigning over a failed EHR implementation is must tweet HIT.

Getting back to the story, it seems like the real death nail in this hospital CEO’s coffin was when the doctors started dropping their privileges at the hospital. Here’s a quote from the story linked above:

“The Cerner implementation has driven some physicians to drop their active staff privileges at ARMC,” noted the letter. “This has placed an additional burden on the hospitalists, who are already overwhelmed. Other physicians are directing their patients to St. Mary’s (hospital) for outpatient studies, (emergency room) care, admissions and surgical procedures. … Efforts to rebuild the relationships with patients and physicians (needs) to begin immediately.”

The comments on the article are quite interesting with one doctor talking about how doctors were finally taking control and pointing out the harm these EHR systems are causing. Obviously, I think that’s a huge stretch. Uncooperative doctors can contribute to the harm an EHR can cause as much as the EHR software itself. Although there is a subset of doctors that feel like they need to start a revolution against EHR.

The reality is that the job of hospital CEO isn’t easy. That’s why they get paid millions of dollars (at least a lot of them). In fact, leadership in general is not easy. It’s a hard balance to know when you should trust your team and when you need to dig a little deeper and find out what’s really going on. Either way, this story should be a huge warning to hospital CEOs that they better have a deeper relationship with the hospital CIO.

I’m always surprised when a hospital still doesn’t have the hospital CIO as part of the executive team. Going forward, your EHR and other healthcare IT is going to be one of the biggest factors in the success of your organization. This story illustrates that really well.

I think we’d all agree that the number one thing you can do as a leader is make sure you hire and retain the very best employees. This story is a great example of why your EHR and how you implement it matters when it comes to getting and retaining the very best people. Plus, this is only going to become more important as technology continues to improve.

I obviously don’t know the particulars of this specific story. No doubt there are a few hundred views of what happened. Although considering the stories of what’s coming out, I’m guessing there is plenty of blame to go around. The hospital CEO was just the scapegoat for much larger issues.

Let this be a warning to hospital leadership. Make sure you’re paying enough attention to healthcare IT. It’s now an integral part of what you do.

June 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

VA Hospital Waitlist Story – Let’s Discuss

I saw this above link on Twitter, and I was reminded of the VA Hospital Waitlist story. I’ll admit that I haven’t dug into the story deeply myself. I mostly understand that numbers were fudged because they bypassed the official waitlist system with one of their own. The article above points to this being a possibly much larger problem.

I’d like to turn this over to readers and hear your thoughts about what’s being reported, but more importantly, what can we learn from this story?

I look forward to reading your thoughts and discussing this story in the comments.

June 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Best Thing For Epic Might Be to NOT Win the DoD Contract

For those not familiar with the Department of Defence (DoD) EHR contract that’s being bid on right now, check out our post about the $11 billion EHR contract. Yes, you’re reading that right. That’s $11 billion with a B. I believe that would be the largest single EHR contract ever (I believe Kaiser was $4 billion to start).

Needless to say, this is an enormous contract that will make some outside companies very rich. I can’t even imagine what $11 billion of EHR consultants and software would look like. That’s a lot of EHR jobs to go around, but I digress.

Most people in the industry seem to believe that Epic is the front runner in the race. Considering the number of large deals that Epic has won, Epic winning the DoD EHR contract would be a safe bet. Although, I wonder if the best thing for Epic would be for them to not win the DoD contract.

Sure, Epic would take a short term PR hit if someone else like Cerner wins the DoD contract. You can already predict the press headlines talking about the fall from power as Epic loses to Cerner (similar to when Cerner won the Intermountain deal over Epic). That would have some damage to Epic’s reputation, but not really. It’s not like any other hospital in the US thinks that their contract would be anything like the DoD EHR contract. In fact, many of the hospitals purchasing Epic EHR will be grateful that Epic resources aren’t being tied up on a new $11 billion contract while their “small” $100 million EHR project languishes.

Indeed, the best thing for Epic might be for it to NOT win the DoD EHR contract. Let’s remember that Epic has a really good history of successful EHR implementations. Sure, there are a few examples where the Epic implementation hasn’t gone so well. However, I think the general view of the industry is that Epic implementations generally go well. In fact, there are stories of Epic contracts so stringent that when an Epic implementation starts to go bad, Epic comes in and takes over to make sure that the implementation goes well.

Long story short, Epic has the best reputation of any hospital EHR vendor when it comes to successful EHR implementations (especially large ones). Epic winning the DoD EHR contract could do a lot to tarnish that reputation.

One might argue that if Epic’s successful with the $11 billion DoD EHR contract, that it will be a boon to their current reputation. That’s fair, but the DoD EHR implementation would be unlike most other EHR implementations. First, the DoD doesn’t have a sterling reputation for successful healthcare software projects. That will likely become an issue for anyone who wins the contract. Second, we’re talking about a government entity with layers of red tape and bureaucracy. A small company like Epic (small in government contractor terms) isn’t going to carry the same weight as they usually do in their other hospital EHR implementations. Epic, the control company, won’t be able to control the DoD EHR project the same way they usually do.

One could use the same argument I used above about why even if Epic gets the DoD contract and fails, it won’t tarnish their reputation since hospitals realize that the DoD is unique. However, the difference between losing a bid and a failed $11 billion project is very different. The failed DoD EHR bid will be covered once and then generally forgotten. A failed $11 billion contract can carry on for years as timelines are delayed, budget overruns are reported, discontent leaks out, he said-she said occurs, and the media churns and speculates on what’s happening with the DoD EHR project.

We all think that winning an $11 billion contract would be great. Indeed, that’s a lot of money and would be an enormous win worth celebrating. The only question is how long will the celebration continue? If I’m Epic, I wouldn’t be too sad if I didn’t win the contract. In the long term, it might be for the best.

June 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Epic Insider Article

If you read this blog, then you’re probably as interested in the secretive Epic as me. So, you’ll love this article in the Madison paper from a former Epic employee talking about what it was like for him to work at Epic.

I’m sure I’ll do some more posts about a number of topics in this article in the future, but I was most intrigued by the strong culture that they’ve created at Epic. I always knew that it was the case, but it was really interesting to see it described first hand.

The donut day story in the article was a great example. You have to read the whole story in the article to know what I mean (go ahead and read it and I’ll be here when you get back).

While I’m someone who agrees that the company should be looking at the root causes for “Why” you do something, the story also makes me wonder if they get blinded by one vision and can’t see that there could by multiple Why’s for a certain task. I think this could apply to Epic and interoperability. They’ve taken a hard line because of a certain why that they have, but it seems to ignore the other 10 reasons why they should be more open. I think that this type of thinking will eventually catch up to them.

The other part of the article which struck me was all of the different ways that they approached hiring, managing, promotion, etc. No doubt hiring and firing the right people is the hardest thing to do in any business. Although, this insight from the article made me wonder if Epic is missing out on an opportunity to be even more than they are today:

Epic is teeming with talent but every year the company loses many employees it would have preferred to keep. There’s no silver-bullet solution to the turnover problem, but one place to start might be hiring more people who have worked in health care and can leverage their experience to connect with end users. One person from my project team who worked as a nurse before Epic hired him demonstrated exceptional rapport with a roomful of practitioners because he’d actually performed the relevant work in a clinical setting.

Diversity can be really beneficial to a company and I wonder if Epic couldn’t benefit from some diversity.

May 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Homegrown versus Vendor Supported Order Set Solutions

I was reading through a whitepaper from Elsevier which asks a good question, “Are Your Order Sets in Order?.” The whitepaper discusses a lot of important issues related to order sets including integration with EHRs, order set workflow, evidence based content, regulatory requirements and next generation order set solutions. These are all really important and interesting, but I was intrigued by the discussion of a homegrown versus vendor-supported order set solution.

I’ll admit up front that I’m a strong proponent for a vendor supported order set solution. In the past this might not have been the case because the technology wasn’t there to integrate a third party vendor’s order set solution into a hospital’s technology stack. However, today that’s just not the case.

What I think is happening is that many organizations started doing their own order sets because that was really the only viable option at the time. Plus, there were probably a few that were arrogant about their order sets being better than what anyone externally could create (although, this is probably a much smaller group). Once the cultural of internally created order sets was created, it’s been really hard for organizations to get out of that cultural rut of homegrown order sets.

I think we’re quickly reaching the point where the home grown order set creators just can’t keep up. Plus, in many cases organizations invested in the creation of the order sets, but didn’t put in the proper maintenance expense to keep them up to date.

The order set whitepaper I mentioned says that their survey found 36% of hospitals used vendor supported order sets while 37% used homegrown ones. That only leaves a quarter of hospitals that aren’t using an order set solution. I think that number will continue to decrease as people realize the value of incorporating standardization into their ordering workflow. Plus, I think we’ll see an increase in hospitals using vendor supported solutions as well.

Do you agree or disagree with this prognostication? Where are order sets heading in the future?

May 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospitals Need to Diversify – What’s It Mean for EHR?

In a recent article on Health CXO, they made the following comment:

In the report “Building Value: Investments Aimed at New Priorities Create Opportunities for Not-For-Profit Hospitals,” experts at the New York-based financial firm note that the decline in inpatient volumes seen over the past several quarters is no fluke but rather a long-term trend driven by health reform. This means that hospitals that want to remain successful need to look beyond just inpatient services and become full-service health systems that are able to follow the patients to the lower cost and frequently higher value outpatient setting. [emphasis added]

This trend is definitely worth noting. We’ve discussed the acquisition of outpatient clinics a number of times, but never the trend of declining inpatient volumes. The article suggests that the key to viability for a hospital will be to diversify into outpatient services. I’m not sure all hospitals want to become full-service health systems and so it will be interesting to see how this plays out.

Assuming this trend continues, I’ll be interested to see what this means for a hospital’s EHR strategy. Will they go with the one big EHR across their hospital and ambulatory environment? If you look at these recently posted EHR market share statistics, you can see that this method is happening a lot. As the deals get larger, I think we’ll see push back against moving to one unified EHR software. That presents an interesting opportunity for what Alan Portela and Airstrip are doing. Not to mention the need for a private HIE.

May 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Time for Government to Step Out of the Way of EHR and Let the Market Takeover?

The always interesting and insightful John Moore from Chilmark research has a post up that asks a very good question. The question is whether it’s time for the government to get out of the EHR regulation business and let the market forces back in so they can innovate. I love this section of the post which describes our current situation really well:

But as often happens with government initiatives, initial policy to foster adoption of a given technology can have unintended consequences no matter how well meaning the original intent may be.

During my stint at MIT my research focus was diffusion of technology into regulated markets. At the time I was looking at the environmental market and what both the Clean Air Act and Clean Water Act did to foster technology adoption. What my research found was that the policies instituted by these Acts led to rapid adoption of technology to meet specific guidelines and subsequently contributed to a cleaner environment. However, these policies also led to a complete stalling of innovation as the policies were too prescriptive. Innovation did not return to these markets until policies had changed allowing market forces to dictate compliance. In the case of the Clean Air Act, it was the creation of a market for trading of COx, SOx and NOx emissions.

We are beginning to see something similar play-out in the HIT market. Stage one got the adoption ball rolling for EHRs. Again, this is a great victory for federal policy and public health. But we are now at a point where federal policy needs to take a back seat to market forces. The market itself will separate the winners from the losers.

His points highlight another reason why I think that ONC should blow up meaningful use. In my plan, I basically see it as the government getting out of the EHR business. I do disagree with John Moore’s comments that the government should step away from interoperability. If they do, we just won’t have interoperability. I guess he’d make the argument that value based reimbursement will force it, but not in the same way that the rest of the EHR incentive money could force the issue.

I have learned that to really get out of this game or even do what I describe will take an act of congress. HHS can’t do this without their help. Although, they could get pretty close. Plus, maybe they could exert their influence to get congress to act, but I won’t be holding my breathe on that one.

May 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Shifting Patient and Provider Dynamic: Evolution of Patient Care – Breakaway Thinking

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
The relationship dynamic between patient and provider is shifting.  Providers are no longer viewed as the sole investigator and lone decision maker. This societal shift is a result of changing social and regulatory pressures: increased self-empowerment, government regulations and incentives aimed at patient-centric care, access to care through the Affordable Care Act, and access to internet and application-based self-diagnostic tools. For many patients, being able to access their own information and results is now an expectation and in some cases a necessity to save lives. There are many applications, search engines, and patient portals that allow patients to quickly evaluate symptoms, learn about possible causes, and find appropriate medical facilities. For a patient with heart attack or stroke symptoms, these tools can reduce complications and potentially save his or her life.

With access to this type of medical information, providers are no longer seen as veiled mystical healers; they need to commiserate with their patients to achieve the best clinical outcomes. Physician leaders are also echoing this sentiment. CT Lin, MD CMIO at the University of Colorado Hospital & Health Sciences Center presented “The Man Behind the Curtain” at the 2013 Breakaway Group’s Healthcare Forum. This event brought together 100 influential healthcare executives for discussions and presentations around optimizing healthcare IT adoption. During CT Lin’s presentation he expressed the importance of sharing real-time results with patients. By sharing health data CT Lin found a direct correlation between improved patient engagement and clinical outcomes.

At the University of Colorado Hospital, CT Lin conducted his own research initiative to demystify the man behind the curtain with a program called, “We Make Mouse Calls.” The study was modeled after a similar research project at Yale University and evaluated patient communication and perception of overall care. Over the course of six months, 300 patients utilized an online messaging system for prescription refills, specialist referrals, and appointments. After six months, patients were surveyed about their experience. Patient satisfaction with providers dramatically improved amongst this group- 86 percent of patients expressed improvement in communication and care. Patients felt very satisfied and empowered with direct access to their providers. In contrast, a control group of patients who were not privy to the online messaging system expressed marginal satisfaction with their provider before and after the six-month period.

Years later, CT Lin took his research a step further by releasing real-time results to patients using the Hospital’s online platform. Patients were provided some guidance on what results would be available and the normal parameters for these results. The implications of this study were quite profound.  By sharing real-time results with their patients, they noted increased patient trust and empowerment, increased understanding of their condition(s), and an increased adherence to their treatment. With the curtain pulled back and the data revealed providers were able to directly improve clinical outcomes.

Healthcare providers must embrace the shifting dynamic of patient care. Access to clinical data is no longer a privilege of earning an esteemed medical degree. It is now a requirement of providing and receiving care in a patient-centric model. Providers and patients that do not adapt may continue to experience lower clinical outcomes than those that evolve. At the risk of becoming extinct, providers have no other option than to adapt this this model.

To view CT Lin’s presentation from the 2013 Healthcare Forum click the following link: http://vimeo.com/67149315.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

May 21, 2014 I Written By