Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Patient Engagement and Collaborative Care with Drex DeFord

Posted on August 7, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

#Paid content sponsored by Intel.

You don’t see guys like Drex DeFord every day in the health IT world. Rather than following the traditional IT career path, he began his career as a rock ‘n roll disc jockey. He then served as a US Air Force officer for 20 years — where his assignments included service as regional CIO for 12 hospitals across the southern US and CTO for Air Force Health — before focusing on private-sector HIT.

After leaving the Air Force, he served as CIO of Scripps Health, Seattle Children’s Hospital and Steward Health before forming drexio digital health (he describes himself as a “recovering CIO”). Drex is also a board member for a number of companies and was on the HIMSS National board and the Chairman of CHIME.

Given this extensive background in healthcare IT leadership, we wanted to get Drex’s insights into patient engagement and collaborative care. As organizations have shifted to value based reimbursement, this has become a very important topic to understand and implement in an organization. Have you created a culture of collaborative care in your organization? If not, this interview with Drex will shed some light on what you need to do to build that culture.

You can watch the full video interview embedded below or click from this list of topics to skip to the section of the video that interests you most:

What are you doing in your organization to engage patients? How are you using technology to facilitate collaborative care?

The Cost of Encouraging Patient Engagement

Posted on June 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

We all know that healthcare providers want to encourage patient engagement to ensure patients have the information they need to manage conditions and share information with other providers. There has been a longstanding push for the adoption and maintenance of personal health records for many years to give patients the power to share and disseminate information wherever it is needed. We have seen a remarkable new interest in this with Meaningful Use and population health initiatives. Since HIM professionals are charged with maintaining and producing legal copies of records, we are aware that the tasks surrounding these processes can be very expensive. This is especially true if any of the tasks are not handled properly and breaches of protected information occur.

My concern is that lately I have heard many discussions that are pushing for more access yet with fewer costs to patients to encourage patient engagement. Some are even pushing for patients to have “free” access to records- paper or electronic. Don’t get me wrong, I am a huge proponent for patients having copies of their records and I personally keep copies of my own records. The Office of Civil Rights (OCR) recently published further guidance on charging for records. In a nutshell, the OCR says: “copying fees should be reasonable. They may include the cost of labor for creating and delivering electronic or paper copies; the cost of supplies, including paper and portable media such as CDs or USB drives; and the cost of postage when copies of records are mailed to patients at their request.” The OCR actually has the authority to audit the costs of producing records if they feel your organization is violating this patient right and overcharging for release of information.

Living in a state such as Florida where the state law has allowed facilities to charge up to $1 per page means most facilities have charged $1 per page without blinking an eye. The latest OCR guidance has led to questioning if that amount is actually “reasonable” or true to cost. Afterall, HIM professionals must use expensive systems, supplies, and labor costs to produce these records. Many organizations have outsourced release of information functions (another cost) but it is still the responsibility of the custodian of records to oversee the processes for compliance.

That being said, it is beneficial for HIM departments to evaluate the expenses and methods used to produce records as technologies and laws change. Dr. Karen Desalvo of the Office of the National Coordinator (ONC) strives to lead the EMR interoperability movement. At the top of the ONC’s list of commitments is consumer access to records. HIM professionals should continue to assist in the quest for interoperability and electronic data sharing at the notion of patient engagement. We must lead patients to use EMR patient portals and facilitate the efficient electronic data sharing among healthcare providers. We must be creative in lowering overhead costs to produce and maintain the records in order to ensure costs are affordable for healthcare consumers. There will always be costs associated with this important task, whether on the provider’s end or the patient’s end, just as costs are incurred with most services or products in every industry.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

3 EHR Gaps That Hinder Systematic Chronic Disease Management

Posted on May 2, 2016 I Written By

3 EHR Gaps That Hinder Systematic Chronic Disease Management

The following is a guest blog post by Andrei Khomushka.

An EHR typically contains multiple highlights of patients’ health, including observations, lab results, diagnoses and treatment plans. However, this data might be insufficient for systematic chronic care management, and there are 3 key reasons for that.

1. Interrupted care setting

Most EHRs are built around the idea that patients control their conditions to the extent that they can arrange timely appointments with their doctors should disturbing symptoms arise. However, the no-shows rate is still high (up to 55%, according to Family Medicine, 2013), and chronic patients often tend to overlook and mistreat symptoms. Leading to occasional appointments in acute situations. This breaks patient data and thus care delivery. So, EHRs can’t show the real picture of a disease progression.

Only continuous care and health tracking can help prevent, or at least detect early complications and exacerbations. As EHRs simply don’t have the tracking functionality, providers need additional solutions bound to their EHRs. For example, mobile patient apps connect individuals and caregivers, allowing the former to sync medical devices and continuously share their health data with doctors, thus ensuring remote monitoring of health status. Then, this information is automatically analyzed and aligned with the EHR so it’s always up-to-date.

2. Lack of patient engagement

As individuals can’t access EHRs directly, they don’t provide any patient engagement elements. Patients can only interact with the EHR data (to some extent) by visiting the patient portal. Here is your chance to engage them. With the standard functionality, such as appointment scheduling, e-billing, lab results checking, portals allow setting goals, sharing achievements across social media, exploring interactive learning materials and more.

However, systematic chronic care is more effective when a technology is proactive and connected to a patient’s daily life (patient portals can’t beat mobile patient apps here). This way, when multiple personal encouragements, guidelines and notifications are already in your pocket, it’s easier to control a chronic condition.

3. Patient-generated data missing

Most EHRs can’t collect and store patient-generated information such as physical activity, nutrition, daily subjective and objective. To benefit from daily updates of patients’ health statuses, we suggest implementing a separate solution integrated with the EHR. This will automatically process and analyze data to identify condition changes that require a physician’s attention. Then, the solution will notify both the patient and the health specialist about the disturbing patterns and suggest scheduling an appointment or test.

Afterword: Reducing the gaps

Overcoming these limitations is essential for a systematic care of chronic patients in the comfort of their homes. However, a thorough rebuild of an EHR is not realistic. Instead of investing substantial time and budget in making the EHR something it is not supposed to be, we recommend creating a holistic solution based on a chronic disease management system (CDMS), which will be connected to the mobile patient application and the EHR. You can find more about CDMS and its benefits in our recent chronic disease management entry.

Revival of the Physician-Patient Relationships via Electronic Technology

Posted on February 9, 2016 I Written By

David Chou is the Vice President / Chief Information & Digital Officer for Children’s Mercy Kansas City. Children’s Mercy is the only free-standing children's hospital between St. Louis and Denver and provide comprehensive care for patients from birth to 21. They are consistently ranked among the leading children's hospitals in the nation and were the first hospital in Missouri or Kansas to earn the prestigious Magnet designation for excellence in patient care from the American Nurses Credentialing Center Prior to Children’s Mercy David held the CIO position at University of Mississippi Medical Center, the state’s only academic health science center. David also served as senior director of IT operations at Cleveland Clinic Abu Dhabi and CIO at AHMC Healthcare in California. His work has been recognized by several publications, and he has been interviewed by a number of media outlets. David is also one of the most mentioned CIOs on social media, and is an active member of both CHIME and HIMSS. Subscribe to David's latest CXO Scene posts here and follow me at Twitter Facebook.

One of the latest fads in healthcare is patient-engagement. This is not a new concept at all, but has been practiced in some form for decades. However, with the availability of electronic technology, physicians and healthcare institutions have now embarked on new ways to engage patients. For many years now, there has been a discord in patient-physician relationships. Patients have often felt that healthcare workers never spend adequate time on their cases, rarely allowing them to participate in any decisions and almost never explaining the details about their medical disorders. This bitterness has led many patients to seek alternative healthcare options.

There is now preliminary evidence that use of electronic technology can help improve patient-doctor relationships and also lead to effective treatments and better outcomes.  Patient engagement using electronic technology is also not a new concept. It was first attempted when the Internet was developed in the mid 90s, but failed to gather storm because the technology was relatively new and there was no such thing as androids. The available mobile phones of that time were largely redundant devices that were only used for communication.

Today, almost every healthcare institution and many healthcare workers have web pages that provide educational information to patients. This was the first step in engaging patients. However, with the present availability of mobile devices, the healthcare industry has been able to leap forward. Many clinics now have Apps that give patients access to information, such as: when the doctor will be in the office; how long the wait will be in the ER; possible diagnoses of medical disorders; billing information; and future appointments. Some healthcare practitioners have gone one step further and even offer teleconferencing for patients who are not able to make it to their appointments.

The current strengthening of the patient-physician relationship is further evidenced by the fact that doctors are now encouraging patients to play a greater role in their healthcare and make informed decisions. Shared decision making is now a universal theme in many healthcare institutions. Patient portals can help patients better manage their chronic disorders like diabetes, arthritis, asthma or hypertension. More importantly, this method of engaging patients allows for faster responses from healthcare workers, who now have dedicated staff to answer mobiles phone queries from patients. For example, pharmacists are now able to use mobile technology to help patients better manage their medications, by recording their intake and advising the patients on how to avoid drug interactions.

With the rise of electronic technology, many patients now have most of their medical information, such as medical history and list of medication, stored on their mobile devices which makes it easier to share with healthcare workers when necessary. This dynamic flow of information not only streamlines care, but also fosters continuous and consistent care between the patient and physician. An example of this continuous care may be found in software programs that identify patients in need of particular services, such as annual mammograms, pap smears and chest x-rays. Once these patients are identified, the healthcare workers are able to contact them right away to advise the patient of their specific required medical service, while the software system assists in preventing missed appointments by sending reminders.

Notwithstanding the above, however, patient engagement via use of electronic technology is not without problems. The first and foremost problem is security. Mobile phones routinely get misplaced or stolen and the medical data could easily fall into wrong hands. Secondly, the elderly who make up for the majority of patients in the USA are not usually tech savvy, with very few of them using such mobile devices. Even those who do have a mobile phone are not well versed with Apps or retrieving medical information online.

Additionally, in order for mobile devices to be effective for patient engagement, the healthcare workers need to be efficient in supporting the technology to capitalize on its potential benefits. Even today, one of the most common complaints made by patients is that healthcare providers often times do not return phone calls in a timely manner or even at all. So in order to engage patients, healthcare workers also need to be play an active role. Just sending medical information to a mobile device is not what patients want.

No matter how advanced technology has become, patient engagement via electronic means will never replace the soothing voice or touch of a healthcare provider in the office. It is clear that patient engagement is vital for a successful physician-patient relationship. In fact, there is strong evidence that patients who participate actively in their own care have better medical outcomes and fruitful relationships with their healthcare provider. However, it is important to remember that patient engagement is a two way street. Electronic technology can do wonders for healthcare providers and healthcare institutions, but make no mistake, it can also become a detriment very quickly if not applied and supported adequately. In essence, healthcare providers must remember that current electronic technology can only serve as an assisting tool in managing patients – it cannot act as the healthcare provider itself.

If you’d like to receive future health care C-Level executive posts by David in your inbox, you can subscribe to future Health Care CXO Scene posts here.

Does Telemedicine Require a Higher Degree of Health Literacy?

Posted on December 8, 2015 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week’s #HITsm chat was hosted by Joe Lavelle aka @Resultant on the topic of #telemedicine. It was a lively chat with many interesting insights and opinions. Two tweets in particular caught my eye:

and

Both these tweets got me thinking about how patients approach a #telemedicine encounter. Do patients feel they need to be more self-aware about their own health or be more health literate in order to participate in #telemedicine? Basically are telemedicine patients more active in their own care than those that see doctors in-person?

I was really curious to learn more about the patient side of the experience so I reached out to a friend who uses #telemedicine to see a specialist. When I asked my friend (who asked me not to use her name) if she treated telemedicine appointments any different than regular appointments she laughed. It turns out that before telemedicine was made available to her, she did not have easy in-person access to a specialist she needed. This was a function of living in an out-of-the-way rural area that only has a small Urgent Care Center nearby. Here is what she had to say about telemedicine:

After I was diagnosed with my illness, I had to start using telemedicine to see a specialist – otherwise I would have to drive 3+ hrs to the city to see him. I do prepare for my telemedicine visits a little differently than people who see a specialist in-person. I keep my own personal health diary. It’s basically a journal where I jot down how I’m feeling. I note any symptoms I have or any changes in my health. I review my health diary each telemedicine visit. I also bring any test results or other information that I may have. I also write down the questions I want to ask so I don’t forget.

I remarked that this is a lot of preparation for a doctor visit and that she must consider herself really engaged in her care. She didn’t think so: “Colin, if I don’t do these things, I won’t get anything valuable from the doctor. I do the things I do because I HAVE TO. I don’t really have a choice. My specialist doesn’t have a lot of tele-appointment slots so if I don’t get everything I need, I have to wait a long time. ”

It’s only a sample of 1, but I have to say that I consider my friend to be in the actively-involved-in-their-own-health category. In her case geographic circumstance is the primary motivation for her active involvement. I wonder if patient engagement will be an unintended benefit of telemedicine. I am definitely going to be watching to see if this happens. In the meantime I would be very interested in hearing from other people about their telemedicine experience.

Thoughts on Leveraging EMRs Effectively

Posted on September 28, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Whenever I scan Twitter for #HIT ideas, I find something neat. For example, consider this intriguing tweet:

I say intriguing not because the formula outlined will surprise anyone, but rather, because it captures some very difficult problems in a concise and impactful manner.

Here’s some thoughts on the issues Portnoy raises:

* Optimization:  Of course, every healthcare IT organization works to optimize every technology it deploys. But doing so with EMRs is one of the most difficult problems it is likely to encounter. Not only do IT leaders need to optimize the EMR platform technically, they may also face external demands placed by ACOs, HIE partners and affiliated providers. And it’s also important to optimize for Meaningful Use functions.

* Workflows:  Building workflows that address the needs of various stakeholders is critical, as pre-designed vendor workflow options may be far from adequate. While implementing an EMR may be an opportunity for a hospital to redesign workflows, or to enshrine existing workflows in the EMR interface and logic, hospital leaders need to take charge of the workflow implementation process. Inefficiencies at this level can be costly and will erode the confidence of clinical teams.

* Revenue capture:  When properly implemented, EMRs can help providers generate more complete documentation for claims reimbursement, which leads to higher collections volume. As time has shown, difficult-to-use EMRs can lead to physician frustration, and in turn, cut-and-paste re-use of existing documentation — which is why carefully-designed workflow is so important. But if they are used appropriately, EMRs can boost revenue painlessly.

* Patient and provider engagement: True, IT needs to take the lead on getting the EMR in place, and must make some important deployment decisions on its own. Still, hospitals will have trouble meeting their goals if patients and providers aren’t invested in its success, and without patient interest in their data I’d argue that meeting long-term population health goals is unlikely. On the flip side, if clinicians and patients are engaged, the feedback they offer can help hospitals shape not only the future of their EMR, but also the rest of their clinical data infrastructure.

If there’s any common theme to all of this, I’d submit, it’s participation. Unlike most efforts corporate IT departments undertake, EMR rollouts are unlikely to work until everyone they touch gets on board. Hospitals can invest in any EMR technology they like, but if providers can’t use the system comfortably to document care, patients don’t log on to access their data, or revenue cycle managers don’t see how it can improve revenue capture, the project is unlikely to offer much ROI.

Best of Breed in Patient Engagement?

Posted on June 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve been thinking more about the future of healthcare IT, I wrote that I think the next major healthcare IT product could be a Care Management System. Maybe it will go by a different name, but the functionality that’s described by a care management system is already going into place. Regulations are headed that direction and every organization will need to have a care management system.

At the core of a care management system will be functionality that engages the patient. I use that term in the broadest sense possible and not the fully corrupted meaningful use version of patient engagement. I’m talking about truly engaging the patient in their care in a bi-directional way that includes communication, support, education, social influence, and more.

As I consider the broad possibilities around patient engagement, there are hundreds of companies (possibly thousands) working in this space. Some are working with diabetic patients while others are focused on cardiac issues. Others are using text messages while some startups are leveraging full smart phone applications. A few tie in with the EHR vendors and many don’t. A hospital system is going to need a patient engagement solution that cuts across all of these slices.

With that in mind, it begs the question, “Are we going to implement and manage a cobbled together “best of breed” solution for patient engagement?

If EHR history tells us anything, most hospitals will adopt some point patient engagement solutions and then over time they’ll realize that the best of breed approach to patient engagement has gotten unwieldy and they’ll start looking for an all in one patient engagement solution. In some ways, this has to be the path forward. There’s no all in one patient engagement solution today. So, hospital systems have to choose to either sit on the sideline and wait for the all in one system to arrive (like many did with EHR software) or they have to go best of breed to start while the all in one patient engagement solutions come together.

I’m not sure this path is such a bad thing. It’s good for a health system to understand patient engagement in a smaller way before expanding across the entire system. We’re starting to see more of this happen in hospitals. However, be sure to keep your eye on the long game being one unified patient engagement system.

The Future of…Healthcare IT

Posted on March 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As part of HIMSS 2015, they’re holding a blog carnival where people throughout the healthcare IT community can contribute blog posts covering 5 different topics. Each topic looks at “The Future of…” and then “Connected System, Big Data, Security, Innovation, and Patient Engagement.” I thought the topics were quite interesting, so I created a post for each of the 5 topics. Here’s links to each of them:

I’d love to have you chime in on each of the topics that interest you. Let me know if you agree or disagree with my commentary and prognostication. Even better, feel free to write your own blog post on any or all of these topics. They are important topics that will make up much of what happens in healthcare IT.

Are there any other “Future of…” topics you wish would have been discussed?

Health IT, Mobile Devices and the “Smart Patient”

Posted on February 27, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This week, Dr. Geeta Nayyar, MD, MBA, is at HIMSS. Among the reasons she’s there is that she believes in the power of health IT play a key role in the creation of “smart” patients, patients  who are educated, involved, and engaged in their care.

In a blog item she wrote from the show, Dr. Nayyar suggests that health IT is central to patient engagement — and will eventually be at the center of a concept known as Personal Health IT.  I found this to be a fascinating idea, one which, as care devolves from centralized machinery to a dialogue with mobile devices, is likely to take the healthcare world by storm.

As she notes, mobility will be an essential element in any smart patient strategy, given the potential for mobile devices and apps to educate, inform and motivate patients around the clock.  But patient engagement also calls for technology in the hospital or physician’s office. For example, she notes, this could include kiosks for updating a patient’s EMR, large display screens in exam rooms were doctors and patients are both few scans, lab reports and other findings together as a team.

After a physician encounter, a patient can then meet with another staffer who could download the Providers app to a smart phone or tablet, demonstrate how an e-prescription would work or even pass along a thumb drive with evidence-based studies, clinical instructions or relevant websites as part of a take-home package for patients, she suggests.

Dr. Nayyar concedes that for many clinicians, this will prove to be a disruptive experience and a dramatic change from traditional clinical and business protocol. What’s more, there are some patients who are not ready on that level, she admits.

But the notion of a mobility enabled smart patient strategy strikes me as an excellent idea. From Dr. Nayyar’s blog, it seems clear that this is all of the experimental stage but it seems to be heading in a very intelligent direction. What do you think?

8 Elements of Total Patient Engagement

Posted on October 17, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across this great whitepaper that looks at 8 Elements of Total Patient Engagement. I love that someone dug into the topic of patient engagement like they did in this whitepaper. It’s not a comprehensive look at patient engagement, but it sure provides a great starting point for organizations that want to become more patient centered. Take a look at the first 4 elements to get a taste of what I mean:

1. Understand how to synthesize and deliver actionable information to patients
2. Facilitate engagement in all settings across the continuum of care
3. Activate patients at their convenience
4. Integrate seamlessly into IT systems and workflow

I love number 3 and 4 on this list. Far too often we translate patient engagement into more work for doctors and patients. These points indicate that we need to make patient engagement an integral part of what we’re already doing. Plus, patients need to be able to engage at their convenience or the reality is that they won’t engage.

The reality is that if an organization doesn’t start engaging patients more, they’re going to miss out on so many opportunities. These 8 elements are a great place for any healthcare organization to start evaluating their patient engagement strategy.