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Contest Offers Prizes For CCD Redesign

Posted on November 19, 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.

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.

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?

PHR Concept Maturing, But Still Not Popular With Consumers

Posted on July 23, 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.

Folks, what do you think would happen if you asked, say, five or ten of your non-HIT friends what a PHR was?  And if you explained it to them, how many would actually have used one?  Thirty percent?  Twenty percent?  My friends ranked at about ten.

Given the benefits that would result if patients paid close attention to their health data, it’s certainly a shame that few know what PHRs are. It’s not as though we in the industry aren’t trying to get the word out and the tools into the right hands, but so far progress is slow and many promotional efforts are quite new.

Take government. Just last week ONC launched its own effort trying to move the PHR puck forward on the ice. The ONC launched a video contest, “What’s In Your Health Record??” in which individuals and groups are invited to submit short videos explaining how PHR use has improved their care. The agency plans to hand out six awards totaling $7,200 to lucky winners.

Private industry hasn’t given up either. In June, the AARP launched a partnership with Microsoft in which the senior advocacy group set plans to offer an “AARP Health Record.”  The Health Record, which is powered by Microsoft HealthVault, is free to AARP members.  I haven’t found a stat telling me just how many seniors have signed up, but color me skeptical.

I’ve been carping about the flaws in the PHR concept for several years now, and I have to admit that it’s matured. Originally, most of the benefit of the PHR was supposed to be that it offered extra access to medical data in an emergency situation.  Clearly, that can’t have been a compelling proposition, because it didn’t exactly drive consumers to use them.

Today, though, the idea of the PHR has broadened into a patient self-advocacy tool, one which — if used appropriately — can concretely reduce risks and improve the quality of care. There’s even consumer-lite friendly versions of PHRs, such as the intriguing Cake.com.

But the reality is, many patients simply don’t feel up to or don’t bother to pay that much attention to what their doctor is doing. It’s going to take a lot more outreach, and a lot more education, to get patients on board.

Make Consumers Want Their PHR

Posted on June 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.

This week, Microsoft announced that it was launching a new PHR product in cooperation with the AARP.  The AARP Health Record which will be connected with Microsoft HealthVault, is free to AARP members.  Yay! Uh, well, maybe not so exciting.

Honestly, most of what it’s offering is a big  yawn from where I sit. I admit it would be pretty neat if the elderly started using connected health applications to monitor their chronic conditions and work more closely with doctors. And the ability to import your prescription list from your pharmacy is a nice time saver.  But basically, this appears to reinvent a wheel nobody wants on their car in the first place.

I’ve been watching employers, tech companies and providers do their little dance on the catwalk for several years, and in almost every case, the PHR doesn’t really engage anybody.  (I confess to being mildly interested in using the PHR my insurance company offers, but the very fact that I write this blog makes me different than most consumers.)

If you want to get people excited about using a PHR, you’ve got to offer them some payback. You’ve got to give them something they want in exchange for becoming a health data clerk:

*  Reward them directly:  Why not send consumers a small but smart gift when they’ve used the PHR a certain number of times?   A small card and a free cup of cafeteria coffee can work wonders.

* Give them what they want:  By this point, patients should be able to log on and make appointments, check lab results and the like.  Predicate their using the good stuff on their having shared the basic info needed to get started with their PHR.

* Market the heck out of it:  When Kaiser Permanente launched a portal/PHR a few years ago, it spent millions blanketing the airwaves, local TV, mailboxes and other media promoting its benefits. This worked, after long and patient efforts.  If the info you need from the PHR is that important, follow KP’s example.

I’ve been screaming about how little good PHR efforts were, including MS and Google’s, for as long as the term has existed. Maybe this one will be different somehow?  Perhaps, but I wouldn’t bet my last pocket change on it.

EMR Helps Philly Hospitals Reduce Readmissions

Posted on December 23, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The pressure is on to reduce readmissions, and hospitals are hoping to leverage their ginormous investments in EMRs to help the job along.  Well, here’s a case where that actually happened.

A recent survey of 29 Philadelphia-based hospitals concluded that facilities submitting patient readmission data to the Health Care Improvement Foundation had seen a significant drop in readmissions over 18 months, according to Information Week.  The project, known as PAVE (Preventing Avoidable Episodes: Smoothing the Way for Better Transitions), focused on medication management, personal health record use and care transitions.

(Editor’s note: While IW once focused on broad enterprise IT issues, I’ve been impressed lately by the excellent job it’s done covering health IT. You may want to check it out.)

The 18 Philly hospitals that submitted the data saw a 7 percent drop in 30-day same-hospital readmission rates. More than 400 patients avoided readmission, representing a savings of $4 million just for the third quarter alone. That fell short of the project’s goal of a 10 percent reduction rate, but it’s pretty neat anyway, no?

The hospitals accomplished the readmissions reduction by building on tried and true quality improvement processes, largely focusing on transitions of care. But their efforts were enhanced greatly by EMRs and other forms of health data management, the magazine reports.

Having seen what can be done, nearly all of the hospitals are now implementing or evaluating a series of “passports,” documents compiling critical information on hospital care transitions, payor relations/utilization management, discharge and medication management. (My hunch is that the passports are being turned into pathways within the EMR; if I’m right, that seems like a real missed opportunity.)

Unfortunately, neither the  Health Care Improvement Foundation nor the magazine spelled out how the hospitals used their EMRs, though it’s obvious that they must of used data analytics tools.  And we don’t know which EMRs the hospitals have in place, which might offer some insights.

By the way, the PHR pilot was a bust. Researchers found that patients who’d get the most out of PHRs were least likely to maintain one. The group threw in the towel and developed a heart failure education book designed to educate patients in self-management.

All told, it’s good to see concrete demonstrations of  how EMRs can help hospitals meet critical goals.  While EMRs may still be a resource drain, perhaps they’ll finally be able to give something back.