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Why Do Chronic Patients Not Access Their EMR?

Posted on June 10, 2014 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.


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.

EMRs Now A Patient Draw At Hospitals

Posted on November 5, 2013 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.

In the past, the mere fact that a hospital had adopted an EMR wasn’t news in and of itself — at least not to a hospital’s current and potential patients. After all, hospitals didn’t let everyone know when they upgraded its network or added backup storage facilities, right?

These days, however, EMR adoption has become a consumer attraction, enough so that hospitals announce their go-live with press releases and public spectacle.

One example comes from Colorado Springs, CO-based Memorial Hospital, which is part of the University of Colorado Health system. Memorial, which launched its EMR this past weekend, spent $30 million on an Epic system.

The launch comes complete with a portal, My Health Connection, allowing  patients to access their medical records, request appointments online, communicate with doctors via secure e-mail and receive test results. The portal is also intended to make it easier for doctors throughout the UCHealth system to access patient records.

The Memorial press release announcing this milestone lumps the Epic implementation in with a laundry list of accomplishments aimed at selling consumers on the facility, including the hiring of 30 physicians, Chest Pain Center Accreditation with PCI and Primary Stroke Center Certification.

As this announcement points up, an EMR launch is seen as a consumer marketing win, not just another project completion by the IT department. Of course, that’s the case partly because the launch comes with the release of a portal offering convenient data access and appointment scheduling. But I’d argue that EMRs have grown sexy enough in consumers’ minds that the mere use of one has some cachet by itself.

Now, this marketing strategy can backfire if the EMR launch goes poorly. For example, I’m sure the C-suite execs at Sutter Health were dismayed when the nurses’ union there went public with safety concerns about the Epic EMR implemented across the system.

For the most part, though, I think we’ll see hospitals bragging about their new EMR if it offers any advantage to consumers. EMRs have become a prominent enough part of medical care that implementing one wins the institution some brownie points.

Patient’s Take On Making Hospital IT Patient-Friendly

Posted on September 4, 2013 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.

Today I was talking with my mother about her experiences with hospitals and IT. My mother, you should know, is so computer averse that she won’t send or receive e-mails — she leaves that to Dad.  But despite her fear of home computing, she’s got some interesting opinions about how hospitals should use health IT to involve patients in the care process:

* If possible, she suggests, hospitals should assess a patient’s “electronic IQ” to see how comfortable they are with using technology. I liked this because it could apply not only to in-hospital info sharing but also the patient’s ability to participate in remote monitoring or other mHealth modalities.

*Give patients access to a schedule (via an app on a tablet, perhaps) which tells them when various tests, procedures and clinician visits are likely to happen. This not only calms the patient, it helps keep the family in synch with the patient’s routine, she notes.

* Display results of key tests — or if clinicians are concerned that patients won’t understand them, at least register when the results have been received, so  patients know their care process is progressing. She’d be happy with a note that said: “Dr. X will be in to discuss the results of your CT scan shortly.”

* Allow the patient and their family/caregivers to make notes within the system of what they want to discuss with clinicians.  Otherwise, as she rightly points out, they’re likely to forget what they wanted to say when the nurse or doctor swoops into the room with their own agenda.

Actually, my mother’s vision is already largely in place in at least one facility. As I reported last year, the Mayo Clinic has already begun a program using content- and app-loaded iPads to move the patient through their inpatient stay. Not only does the Mayo implementation do everything on my mother’s wish list, it also allows patients to report on pain levels and exchange messages with doctors.

Let’s hope more hospitals find a way to use IT to make the care process more transparent for patients. While it calls for a not-inconsiderable investment in time and resources, it seems like an excellent way to keep patients engaged in their care.

Cleveland Clinic Expands Access To EMR Information

Posted on June 12, 2013 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.

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.

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

Posted on December 17, 2012 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.

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.

Patients Accessing Online Medical Records Use More Services

Posted on November 29, 2012 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.

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.

What Do Patients Need From EMRs?

Posted on November 14, 2012 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.

As we’ve noted countless times in this space, EMRs aren’t going to get any better unless vendors and doctors communicate freely. But what about catering to the needs of patients.  But given that by Stage 3 of Meaningful Use, EMR data will need to be accessible to and available for comments by patients and caregivers, it’s time patient needs were taken into account.

In that spirit, here’s my list of a few EMR features that might benefit patients and their caregivers. Bear in mind that this is me speaking as a patient and family caregiver, but perhaps that’s a good thing.

Patient data needs

*  Multiple views of the data:  Doctors are used to standardized reports, but patients and their families will still be learning the game.  Patients should be able to do pull data by history, by current status, by lists of drugs, allergies and other key factors affecting current care, as well as by a simple overview similar to patient discharge papers.  It should be possble to pull down these reports into Word, PDF, Excel and other popular formats for re-use.

* Access to contextual data:  Being able to fit data into a larger context is very helpful. As a caregiver, I’d want to know if the pulse ox number my asthmatic son was low relative to other asthma patients, particularly pediatric asthma patients. I’d also want to compare his current number to numbers from the past, preferably in easy-to-read chart form.

* Links to medical information: If I’m reading a report on my care, and I run into medical terminology I don’t recognize, I should be able to pull up a pop-up window and search for the definition of that term. I should also have access to full-length reports on my condition — from validated sources such as WebMD — to give me a broad understanding of my care.

* Ability to comment on data and notes:   While I realize this could become very time-consuming for doctors, it might be worth the trouble to give patients the ability to comment on elements of the data or notes. (A Microsoft Word-style comment function would probably be sufficient.)  To contain the time doctors need to spend, comment functions could be constrained to medical notes and other areas where impressions could be clarified or corrected — rather than the entire EMR data set.

*  Portal:  Portals, of course, are on the way regardless. But I wanted to underscore, as the caregiver to two chronically-ill family members, that accessing data through an organized interface will be a welcome method for skimming key indicators and raising the questions I need to ask doctors.

* Mobile access:  Another obvious one. Patients are as likely to access data on the road as physicians are. Patients need an adequate mobile app which offers a reasonable amount of access to key EMR data on a real-time basis.

Readers, what other types of data access do you think patients and caregivers need to participate effectively in care?

AHA Slams MU Patient Portal Requirement, Pundits Slam AHA

Posted on May 7, 2012 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.

As readers know, CMS is now reviewing comments on the proposed rules for Stage 2 Meaningful Use.  Not surprisingly, one of the reviewers who’s sent in a critique is the American Hospital Association (AHA), which a few days ago sent a 68-page barrage complaining about the burden imposed on hospitals by on Stage 1 MU requirements.

Yesterday, the AHA made another MU move, this time slamming CMS’s Stage 2 proposal that hospitals be required to offer patients access their protected health information via a portal.  As I noted in the previous post on AHA, I’m surprised at how late to the game AHA is — trade groups like these aren’t known for their delicacy — and this notion has been in the air since well before CMS made it an official proposal.

Anyway, in its current letter to CMS on portals, the AHA has given them a big thumbs-down. “CMS’s plan is not supported by current technology, raises significant security issues, and goes beyond current technical capacity,” the group argues in its issue brief.

The AHA argues that with systems integration levels still dicey, hospitals are being asked to offer data in a way that may end up violating HIPAA. (Unspoken additional thought: “And then you’re going to blame us, aren’t ya, huh, you meanies!”)

Since AHA issued the statement, talking heads have popped up to bash the AHA’s position, arguing that the hospital group is dragging its feet just as the most important part of the work has begun, i.e. empowering patients to share, use and benefit from their own health information.

Well, yes and no. While I’m known for ridiculing the trade group talking heads in this business, I’d wait just a minute before we declare the AHA to be the bad guys here.

On the one hand, I can see where people are frustrated with hospitals picking this moment to complain about the task at hand. It’s not as though they’re hearing about it for the first time.

On the other hand, creating a really bulletproof portal is no joke, either, and there’s definitely some truth in the notion that making it everything it should be is very tough.  Hey, there’s no point in denying it; creating a patient portal may remain a part of MU Stage 2 requirements, but it’s not going to be a walk in the garden for hospitals.  Let’s not come down on them too hard if they flinch.