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Cleveland Clinic Expands Access To EMR Information

The Cleveland Clinic is stepping up patients’ access to their medical information by providing secure online access to most of the data stored in their medical files. The newly-available data will be accessible through the Clinic’s existing patient portal, MyChart, according to EMR Daily News.

Currently, patients who use the Clinic’s MyChart app can view a limited list of data , including their after-visit summary, medications list, allergies, immunization records, preventative care details, laboratory results, and radiology reports. If they want to see any more of their information, they have to get a hard copy of their patient record.

However, the new MyChart EMR offers patients access to just about every type of information doctors can see, including pathology records, x-ray reports, physician notes and lists of current health issues doctors use to describe a patient’s health status. It will also offer access to recent concerns and known diagnoses.

This marks the most recent of several steps the Clinic to expand patient access to their medical records. Earlier this year, EMR Daily News notes, reports associated with medical images including MRI, CT, ultrasounds, and mammograms were made available online through MyChart. Starting this month, the Clinic will start automatically releasing pathology reports to patients through MyChart, though there will be a delay which gives the patient a chance to have talked to their doctor about the report prior to seeing it.

The EMR system is expected to be fully transparent to the patient sometime next year, Clinic leaders say.

Expect to see a series of announcements of this kind, folks. Increasing healthcare data transparency is clearly on everyone’s agenda, and though leading organizations like the Cleveland Clinic may be at the forefront, what they’re doing is likely to become the standard for hospitals and clinics in the not-so-distant future.

The PHR Concept Is Dead

For several years, the healthcare community has struggled with elusive beast known as a personal health record. The PHR was designed to fill a hole in the sharing of electronic health data by getting patients involved with filling in gaps in their own health information via a Web browser.

The idea is not new. In fact, according to WIkipedia, the idea of a “personal health log” goes all the way back to the 1950s, though scientific literature didn’t begin to take it on until after 2000, the Web encyclopedia says. So for decades, healthcare professionals have looked at ways in which private individuals could do more to document changes in their own health.

Fast forward to today, and what have we got? A bunch of approaches which involve the consumer in their medical data, including:

Patient portals: Typically, these portals offer access not only to various forms of basic clinical data — such as test results — but also a means of setting appointments with doctors’ offices and a means of communicating with physicians via secure e-mail.

Direct access to EMRs: In some cases, the portal established by a healthcare organization offers some limited direct acccess to EMR data, offering patients a look at a broader cross-section of data.

Giving patients access to doctors’ notes: Of late, some organizations have been experimenting with giving patients direct access to their doctors’ notes, experiments which have largely been satisfying to parties on both sides of the equasion.

Certainly, these approaches involve patients more in their health information, but at the same time, in no way make him or her responsible for maintaining their own health records electronically.

If you’ll notice, the core notion of a PHR – that patients should keep their doctors informed of med changes, allergies, procedures and the like — appears to have dropped out of the picture completely. It seems that after struggling with getting patients involved in being data entry clerks, it works much better to give patients access to data and encouraging them to learn from what they see.

In other words, despite much earnest effort, it appears that the core PHR concept is dead. Long live its better-adapted successors.

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June 11, 2013 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital IT Systems PHR

Tags:Patient Acces Patient Portals Personal Health Record

Boston Children’s Creates Special Adolescent PHR

Creating PHRs for adolescents is trickier than preparing them for adults. While childrens’ and adolescents’ PHRs are usually controlled by parents, there are some areas in which teens have a right to privacy, including any discussions about sexually transmitted diseases, reproductive health, substance abuse and mental health information.

At Boston Children’s Hospital, they’re grappling with the problem of a creating a PHR which protects the adolescent’s right to privacy and confidentiality of such information without sealing parents out of areas which are public. This is a difficult problem, given that confidential information is generally seeded throughout EMRs, writes the hospital’s Fabienne Bourgeois.

To address the complex problem of giving adolescents appropriate access to their PHRs, BCH has developed a custom-built portal to meet both hospital and adolescent patient needs, Bourgeios says.

Adolescent patients and parents access the portal separately, through linked accounts. Parents have sole access until the child turns 13, at which point both get access. At 18 years, the patient becomes the sole owner of the portal account, and unless other constraints exist, the parent link is deactivated, she notes.

Within the portal, sensitive content has been identified and tagged, such as pregnancy-related labs, genetic results, confidential appointments, and possibly sensitive problems and medication. Right now this data is filtered from both parent and adolescent accounts, but in the future it will flow only to the adolescent account. “This solution does take a lot of time and effort, but best replicates current clinical practice,” Bourgeious notes.

This is quite an interesting project. It’s good to see researchers taking on unique privacy challenges involved in treating adolescents. Any efforts which engage a population in their own health and make them confident their privacy will be protected are to be commended.

Patient EMR Access May Be The Biggest Cultural Shift

As most readers probably know, U.S. doctors are skittish about giving patients full access to their medical records. That fact was underscored by a recent Accenture study, which concluded that 65 percent of doctors think patients should only have limited access, and 4 percent feel patients should have no access.

While I have no proof of this, my gut feeling is that these results aren’t just a snapshot in time, but rather a sign of a stubborn problem that’s not likely to melt away quickly. Though much of the high-level thinking about EMRs counts on building collaborative patient relationships over shared records, that thinking may be flawed.

Why are doctors hanging back from full and free disclosure of electronic health data?

* Self-consciousness: Doctors may say things in records that they’d be a bit embarrassed to reveal. To some extent, this is a problem whether the doc is using paper or an EMR, but EMRs are trickier for doctors to use, adding to the awkwardness factor if a patient questions their work or feels offended by the commentary.

* Poor collaboration skills: If patients get to see their records, they’re likely to become all e-patient-ish and want to have more control of their care. Old-school doctors aren’t trained to think this way, nor are they likely to want such a relationship temperamentally.

* Low digital comfort generally: Even among younger physicians, there are those that are naturally wired and those that only use computing devices when they must. I’d argue that when you toss in the generation of doctors who trained 100 percent on paper, you’re looking at a large population of physicians who may never quite be on board with touchy-feely data sharing.

Bottom line, data sharing with patients requires a cultural shift which a surprising number of healthcare pros seem ill-equipped to embrace. I believe it is this cultural shift — from patient as object of notes to patient as co-creator — which will ultimately pose the biggest obstacles to getting value from EMR investments.

Yes, it’d be nice to think that as doctors get more used to living with EMRs, a large number will loosen up, but I doubt that’s the case. Let’s hope the cynic in me is wrong this time.

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April 15, 2013 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT PHR

Tags:Accenture Patient Data Access

Hospitals, Health Systems And Clinics Adding Portals, But Consumers Not Synched Up

With Meaningful Use Stage 2 requiring that 5 percent of patients use them, a growing number of health systems, hospitals and clinics have rolled out patient portals, according to a recent study by KLAS. In fact, 57 percent of providers now offer a portal, typically connected to their enterprise EMR, KLAS found.

The thing is, somehow these efforts aren’t reaching consumers. In a new Wolters Kluwer Health survey of 1,000 consumers, only 19 percent said that they have access to a personal health record.

It’s not that patients don’t want to be engaged in their health — 80 percent of respondents said greater control of healthcare is positive — but it seems that they either don’t like or don’t know how to find the portals available to them.

Ultimately, the broad mass of consumers simply don’t seem to see a crying need to use portals as of yet. Seventy-six percent of respondents to the Wolters Kluwer survey said that they have the information and tools they need to manage basic healthcare functions such as choosing providers and researching treatment options, clearly dwarfing the number who care to look at their own patient data.

That being said, there’s a small (but I’d argue, growing) minority of patients who do take connections with providers seriously. Nineteen percent of respondents told researchers that the ability to communicate via e-mail with doctors and nurses and schedule appointments online was an important factor in choosing a medical practice. In other words, there’s clearly a wired contingent out there which would probably respond well to a truly useful portal.

How can hospitals and clinics get patients engaged in PHR use? My gut instinct is that consumers won’t give a hoot about PHRs until they become a tool that’s part of their medical or hospital visit. If doctors work with a PHR, turning the visit into a collaboration, patients will be motivated to follow up and review what they’ve learned.

I guess what I’m saying is that we should start by getting doctors engaged with PHRs as a means of getting patients involved. If they do that, PHRs will go from being some Web site to a valuable tool for sharing care information. If not, don’t expect the number of PHR-interested consumers to climb anytime soon.

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December 17, 2012 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems Meaningful Use PHR

Tags:Enterprise EMR KLAS Patient Portal Wolters Kluwer Health

Patients Accessing Online Medical Records Use More Services

In previous postings, I’ve noted that for various reasons, doctors using EMRs are tending to bill for more E/M services. This has CMS in a bit of a tizzy, and definitely deserves attention from the industry. (See also this post about EMR and Upcoding)

Now, a study appearing in the Journal of the American Medical Association seems to have identified another vector for increased use of services. According to the study, patients with online access to medical records and clinicians consume more clinical services than those without access.

The JAMA authors drew this conclusion after studying the consumption of clinical services by members of Kaiser Permanente Colorado, a group model IDS. The Kaiser unit was studied from March 2005 through June 2010, reports Becker’s Hospital Report.

What made the Kaiser unit a good choice was that not only did it have an EMR in place, it also launched a patient portal in May 2006 allowing patients secure access to health records details such as test results, care plans and active medications.

Researchers found that members who used the MyHealthManager portal, which gave access to the EMR, had increased rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters and hospitalizations during the study period.

I was surprised to find out that JAMA researchers generated this data, especially the ED and hospitalization rates, which seem to have to been markedly different between the two groups.

It did occur to me that perhaps the sickest patients are using the portal, or that those who aren’t using the portal aren’t very engaged in caring for their health, but such relationships are rarely that simple. Besides, the researchers did group patients by “propensity scores” which took patient age, sex, utilization frequencies and chronic illnesses, so we aren’t looking at populations that simply self-selected into the sicker and more healthy.

In any event, I’m glad I stumbled across this study and could share it with you. Knowing that these patterns exist, just in case they turn up in your health system. They’re certainly worth bearing in mind.

Contest Offers Prizes For CCD Redesign

When EMRs are the gossip of the week at TechCrunch (a popular tech startup website), you know our little EMR thang has gone mainstream. And TechCrunch is indeed one of a series of sites trumpeting the news of a design challenge intended to make the Continuity of Care Document more usable.

The White House’s Health Design Challenge, working with a community of philanthropic angels and mentors known as Designer Fund, asks designers to transform the CCD (and by extension the Blue Button output) from a consumer-hostile mess into something easily used by the following groups:

An underserved inner-city parent with lower health literacy
A senior citizen that has a hard time reading
A young adult who is engaged with technology and mobile devices
An adult whose first language is not English
A patient with breast cancer receiving care from multiple providers
A busy mom managing her kids’ health and helping her aging parents

The ONC and VA, which seem to be spearheading the effort, are providing for twelve winners. First place for best overall design gets $16K, second place $6K and third place $4K. They’re also distributing $8K per category across winners for best medical/problem history section, best medication section and best lab summaries.

The design is expected to not only improve the visual layout of the record, it’s also supposed to make it easier for a patient to manage their health, enable medical professionals to digest information more efficiently and help caregivers support patients. Tall order for a messed-up text file? Well, we’ll see what design superbrains can do.

In part because the VA hopes to use the new designs to support its Blue Button initiative and its MyHealtheVet patient portal, all entries have to be submitted under a Creative Commons license. Curators will select a final design — which may include elements from various winning entries — and open source the code on code-sharing commuity Github.

Adolescent Data Needs Stronger EMR Protections, Group Says

The American Academy of Pediatrics is calling for changes to EMRs to protect the privacy of adolescent patients, whom, it says, don’t currently get the same level of protection as adults.

According to the AAP, there are several reasons adolescents don’t enjoy the same privacy protections as adults.

For one thing, there are the legal issues. HIPAA doesn’t provide specific guidance on adolescent privacy, and the medical industry hasn’t put clear standards in place outlining when adults can access an adolescent’s health records either.

What’s more, states vary in how they handle this issue, according to the AAP report. State laws typically allow minors to consent for their healthcare on the basis of their status — for example, if they’re a pregnant or parenting teen — and on the basis of the services they seek – such as STI diagnosis and treatment or contraception. However, while state and federal laws provide protection of privacy when minors consent for their own care, privacy protections differ widely.

To make sure adolescent privacy is protected across all data platforms, the AAP is recommending a set of principles that it feels should ideally govern not only EMRs, but also PHRs and HIEs. These include :

* Creation of a set of criteria for EMRs that meet adolescent privacy standards

* Creating and implementing technology for EMRs which would allow determination of who has access to, or ability to control access to, any part of the adolescent medical record.

* Making it possible for adolescents to record consents and authorizations according to privacy laws using the HL-7 Child Health Profile DC.1.3.3 standard

* Flexibility within standards to allow for protection of privacy for diagnoses, associated lab tests, problem lists and any other documentation containing confidential data.

* EMR systems must be able to apply state and federal confidentiality rules when assembling aggregate data to prevent identification of individuals.

The AAP has a lot more to say, but in summary, it seems to be putting the burden for protecting adolescent privacy largely on EMR vendors, though I believe it’s hoping members will advocate for these changes as well.

Either way, it doesn’t work well if there’s a protected class (certain adolescents) whose rights simply can’t be protected adequately with today’s technology. Time to get on this issue, I’d say.

Building Usable EMRs: What About The Patient?

I think most of us reading HealthcareScene.com blogs like this one would agree that for EMRs to become more usable, the process of developing them will have to change. Specifically, everyone seems to agree that if vendors and physicians don’t work together on usability, we’ll end up with with system after system that nobody wants.

But what about patients? Do they have a role in making sure EMRs are usable? According to Jon Mertz, the answer is a definite yes. As Mertz sees it, it’s not good enough for vendors and physicians to talk shop to one another — patients will have to be part of the conversation. I think he makes a lot of sense.

Talking with EMR vendors is a good way for physicians to get more of what they want, but it’s not enough, Mertz argues, I think quite persuasively. It’s also important for physicians to ask patients want to see in an EMR, especially so given that patients will eventually have access to all of that information. “Patients add an essential perspective to how an [EMR] should be used,” Mertz writes. “It is a system to serve them and their care.”

Vendors should also be talking to patients as well as physicians, Mertz suggests. “Even though physicians, clinicians, and administrative personnel are the primary users of an EHR, their solutions benefit patients, too. Information in an EHR will be viewed and carried forward by patients, so they can provide a valuable perspective on usability.”

The final step in this cycle is to develop a patient base which actively uses EMR data and is quite willing to offer feedback on how the process is working. Specifically, they need to be capable of letting hospitals, physicians and other providers know how their access to data is working, especially if the form they’re getting in doesn’t serve their needs.

I really appreciated Mertz’s take on getting patients involved in the EMR usability process. It’s a point that doesn’t get made often enough — and will definitely need to be talked up more in the future. After all, without patients feeling comfortable with their data, the ultimate goals of Meaningful Use aren’t attainable.

#EPICUGM 2012 Offers Tantalizing Hints

This week Epic held its annual user group meeting (#UCG2012 or #EPICUCG), complete with a full-stage Journey tribute, Wayne and Garth and tantalizing promises of neat features to come.

Because we weren’t at the conference, we took a dive into the tweetstream to see what some of the highlights were.

A big crowd

Attendance at the event was enormous, even by the standards of jaded little me:

RT @gruntdoc: #EPIC #EPICUGM 14K here, about 7.4K are clients, rest Epic staff; 10 countries rep’d. #UGM2012

— Luis Saldana (@lsaldanamd) September 11, 2012

Funny business

The event kickoff included a tribute to Journey’s “Don’t Stop Believing,” presumably performed by Epic’s multitalented staffers. I liked the Wayne’s World kicker at the end, as did the audience, which seemed to do a lot of un-IT-like giggling.

Happy smiling people

If the tweets are any indication, a fair number of attendees found #UCG2012 to be something of a rush:

the best part about #ugm2012 … knowing I’m not the only one out there who is truly excited about what this software can do. truly #epic

— Chuck Bedel (@DRBEDEL) September 11, 2012

Fascinating factoids

Along the way, attendees did some of Epic’s PR on their own, tweeting such facts as:

RT @nickgenes: CEO Judy Faulkner says Epic is installed in over half of US academic medical centers #UGM2012Wow! That’s wild

— Matthew Rogers (@RogersMatthew) September 11, 2012

And there was this interesting note on the relationship between advanced EMR deployment and being an Epic customer:

RT @nickgenes: Only 1.2% of US hospitals are at top HIMSS stage for #EHR integration — and 3/4 of those hospitals are at Epic’s #UGM2012

— MTS Healthcare (@mtshealthcare) September 11, 2012

Features afoot

All of the enthusiasm was fine. I get it: Rah rah rah Yay Epic! But on to some meatier stuff. Apparently some interesting new features are on the way:

In upcoming Epic release, patients will be able to log into myChart and download their records to a PDF #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

#ugm2012 good news, Epic is going to have an opt-in for benchmarking across Epic hospital systems. Terrific!

— GruntDoc (@gruntdoc) September 12, 2012

Mobile payments to be built into Epic myChart. Can also sign up via mobile for paperless statements #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

Sadly, though, on the subject of interoperability, no Original Thoughts seemed to be under discussion:

Epic will use protocols from #DirectProject to push information to outside EHRs #UGM2012

— Robert S. Miller, MD (@rsm2800) September 12, 2012

Maybe the whole “walled garden” thing will be fixed by, oh, UCG2020?

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September 13, 2012 I Written By Anne Zieger

Filed Under: Community Hospitals Hospital EHR Hospital EHR Company Hospital EHR Vendor Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Company Hospital EMR Vendor Hospital Healthcare IT Hospital IT Systems PHR

Tags:#EPICUGM #UGM2012 Epic Systems Hospital EHR Hospital EHR Company Hospital EHR Vendor Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Hospital EMR Company Hospital EMR Vendor

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- Doctors Favor Tablets Over Smartphones For Clinical Work (1)
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