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For Hospitals: Tips On Working With An EHR Consulting Firm

Posted on April 19, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Even if you are a very experienced health IT pro, managing your relationship with an EHR consultant in no joke. There’s a lot at stake and only so much time to meet your goals.

Not only that, there are lots of ways a project can go wrong, such as 1) ending up with an EHR platform that’s no more or even less useful than it was before, 2) finding out that your newly updated or optimized EHR doesn’t work correctly or 3) spending a lot more than you expected on the contract.

That being said, you might benefit from the tips on working with consulting firms offered on the ever-insightful HISTalk site. My favorites include the following:

  • Don’t let consultants burn billable hours with your vendor or other consultants without your participation or approval.
  • Remember that the #1 job of consultants is to create fear, uncertainty and doubt (FUD) that you can survive without them.
  • Don’t be fooled by the sample resumes consulting firms provide during the selection process. In most cases, it is unlikely those will be the resources on your project. Bait and switch is common.
  • Call lots of references. Not the ones they gave you, but others on their “we’ve worked for every health system in the country” logo slide. Find out who is on their A team and get them.
  • Check their quoted number of employees (many firms are 70% temporary staffers). Go to LinkedIn and see how many people actually list them as an employer.
  • Interview the actual consultants who will work with you and ask hard technical questions.
  • Be aware that some firms might try to get you fired so they can put their replacement in as interim leadership and bill for it.

Wow, that’s a dark picture. You have to brace yourself for consulting firms which may be palming off inexperienced people on you, attempting to get you fired, trying to make you completely dependent on them and costing you more money than you planned to spend. It’s not a pretty picture.

On the other hand, few healthcare organizations can do completely without consultants, or the health IT consulting business would exist in the first place. Eventually, you’re probably going to have to bite the bullet and hire outside help. Just be aware of some of the risks associated with choosing the wrong consulting company.

Yes, hiring such a firm can be a bit concerning, but if you spend enough effort on the search you have a good chance of finding the right organization. Bottom line, if you’re skeptical, thorough and willing to go the extra mile research-wise, you can find a consulting firm that will serve your purposes and help you achieve the goals you wouldn’t be able to achieve without their help.

Hospital Patient Identification Still A Major Problem

Posted on April 18, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey suggests that problems with duplicate patient records and patient identification are still costing hospitals a tremendous amount of money.

The survey, which was conducted by Black Book Research, collected responses from 1,392 health technology managers using enterprise master patient index technology. Researchers asked them what gaps, challenges and successes they’d seen in patient identification processes from Q3 2017 to Q1 2018.

Survey respondents reported that 33% of denied claims were due to inaccurate patient identification. Ultimately, inaccurate patient identification cost an average hospital $1.5 million last year. It also concluded that the average cost of duplicate records was $1,950 per patient per inpatient stay and more than $800 per ED visit.

In addition, researchers found that hospitals with over 150 beds took an average of more than 5 months to clean up their data. This included process improvements focused on data validity checking, normalization and data cleansing.

Having the right tools in place seemed to help. Hospitals said that before they rolled out enterprise master patient index solutions, an average of 18% of their records were duplicates, and that match rates when sharing data with other organizations averaged 24%.

Meanwhile, hospitals with EMPI support in place since 2016 reported that patient records were identified correctly during 93% of registrations and 85% of externally shared records among non-networked provider.

Not surprisingly, though, this research doesn’t tell the whole story. While using EMPI tools makes sense, the healthcare industry should hardly stop there, according to Gartner Group analyst Wes Rishel.

“We simply need innovators that have the vision to apply proven identity matching to the healthcare industry – as well as the gumption and stubbornness necessary to thrive in a crowded and often slow-moving healthcare IT market,” he wrote.

Wishel argues that to improve patient matching, it’s time to start cross-correlating demographic data from patients with demographic data from third-party sources, such as public records, credit agencies or telephone companies, what makes this data particularly helpful is that it includes not just current and correct attributes for person, but also out-of-date and incorrect attributes like previous addresses, maiden names and typos.

Ultimately, these “referential matching” approaches will significantly outperform existing probabilistic models, Wishel argues.

It’s really shocking that so many healthcare organizations don’t have an EMPI solution in place. This is especially true as cloud EMPI has made EMPI solutions available to organizations of all sizes. EMPI is needed for the financial reasons mentioned above, but also from a patient care and patient safety perspective as well.

Hospital Mobile Device Initiatives Can Improve Patient Satisfaction

Posted on April 17, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Without a doubt, hospitals have many reasons to implement mobile technology, which can offer everything from improved communications to logistical support. But the benefits of these rollouts may offer more than operational benefits. At least according to data gathered by the following survey, hospital mobile initiatives almost always improve patient experience and satisfaction.

The study, conducted by Vanson Bourne on behalf of Apple-based mobile device management company Jamf, draws on a survey of 600 global healthcare IT decision-makers based in the US, the Netherlands, France, Germany and the United Kingdom. Respondents worked in both private and public healthcare organizations.

Researchers found that 96% of healthcare IT decision-makers currently implementing a mobile device initiative felt that it had a positive impact on patient experiences and satisfaction. Also, 32% reported that they saw a significant increase in patient experience scores.

The survey also found that among institutions currently implementing or planning to implement a mobile device initiative, the devices are most likely used in nurses stations (72%), administrative offices (63%) and patient rooms (56%). In addition, survey participants anticipate that mobile device use will expand to both clinical care teams (59%) and administrative staff (54%). What’s more, 47% of respondents said they plan to increase mobile device use in their institution of the next two years.

To exert better control over these efforts, hospitals can leverage a mobile device management solution. However, the survey found that only 48% of healthcare IT decision-makers had full confidence in their MDM solution’s capacity to do its job. That’s down from 59% in 2016.

Also, as data sharing increases via mobile devices and apps, data security becomes even more important. However, many health IT leaders aren’t sure they can pull this off. Their biggest challenges included data privacy (54%), security/compliance (51%) and keeping software properly patched (40%).

But they don’t think MDM tools can solve the problem. Ninety-five percent of respondents said their current MDM solution could stand to offer better security options, and almost a third (31%) of respondents thinking about mobile device initiatives were holding off because they weren’t sure they could secure the devices adequately.

Unfortunately, the health IT world seems to have made little progress in securing mobile devices over the past year. In a similar Jamf study conducted last year, 88% of respondents were concerned about managing security, data privacy (77%) and blocking inappropriate employee use (49%).

Health Orgs Were In Talks To Collect SDOH Data From Facebook

Posted on April 9, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

These days, virtually everyone in healthcare has concluded that integrating social determinants of health data with existing patient health information can improve care outcomes. However, identifying and collecting useful, appropriately formatted SDOH information can be a very difficult task. After all, in most cases it’s not just lying around somewhere ripe for picking.

Recently, however, Facebook began making the rounds with a proposal that might address the problem. While the research initiative has been put on hold in light of recent controversy over Facebook’s privacy practices, my guess is that the healthcare players involved will be eager to resume talks if the social media giant manages to calm the waters.

According to CNBC, Facebook was talking to healthcare organizations like Stanford Medical School and American College of Cardiology, in addition to several other hospitals, about signing a data-sharing agreement. Under the terms of the agreement, the healthcare organizations would share anonymized patient data, which Facebook planned to match up with user data from its platform.

Facebook’s proposal will sound familiar to readers of this site. It suggested combining what a health system knows about its patients, such as their age, medication list and hospital admission history, with Facebook-available data such as the user’s marital status, primary language and level of community involvement.

The idea would then be to study, with an initial focus on cardiovascular health, whether this combined data could improve patient care, something its prospective partners seem to think possible. The CNBC story included a gushing statement from American College of Cardiology interim CEO Cathleen Gates suggesting that such data sharing could create revolutionary results. According to Gates, the ACC believes that mixing anonymized Facebook data with anonymized ACC data could help greatly in furthering scientific research on how social media can help in preventing and treating heart disease.

As the business site notes, the data would not include personally identifiable information. That being said, Facebook proposed to use hashing to match individuals existing in both data sets. If the project were to have gone forward, Facebook might’ve shared data on roughly 87 million users.

Looked at one way, this arrangement could raise serious privacy questions. After all, healthcare organizations should certainly exercise caution when exchanging even anonymized data with any outside organization, and with questions still lingering on how willing Facebook is to lock data down projects like this become even riskier.

Still, under the right circumstances, Facebook could prove to be an all but ideal source of comprehensive, digitized SDOH data. Well now, arguably, might not be the time to move ahead, hospitals should keep this kind of possibility in mind.

Health Leaders Go Beyond EHRs To Tackle Value-Based Care

Posted on March 30, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the broadest sense, EHRs were built to manage patient populations — but largely one patient at a time. As a result, it’s little wonder that they aren’t offering much support for value-based care as is, as a recent report from Sage Growth Partners suggests.

Sage spoke with 100 healthcare executives to find out what they saw as their value-based care capabilities and obstacles. Participants included leaders from a wide range of entities, including an ACO, several large physician practices and a midsize integrated delivery network.

The overall sense Sage seems to have gotten from its research was that while value-based care contracts are beginning to pay off, health execs are finding it difficult support these contacts using the EHRs they have in place. While their EHRs can produce quality reports, most don’t offer data aggregation and analytics, risk stratification, care coordination or tools to foster patient and clinician engagement, the report notes.

To get the capabilities they need for value-based contracting, health organizations are layering population health management solutions on top of their EHRs. Though these additional PHM tools may not be fully mature, health executives told Sage that there already seeing a return on such investments.

This is not necessarily because these organizations aren’t comfortable with their existing EHR. The Sage study found that 65% of respondents were somewhat or highly unlikely to replace their EHR in the next three years.

However, roughly half of the 70% of providers who had EHRs for at least three years also have third-party PHM tools in place as well. Also, 64% of providers said that EHRs haven’t delivered many important value-based contracting tools.

Meanwhile, 60% to 75% of respondents are seeking value-based care solutions outside their EHR platform. And they are liking the results. Forty-six percent of the roughly three-quarters of respondents who were seeing ROI with value-based care felt that their third-party population PHM solution was essential to their success.

Despite their concerns, healthcare organizations may not feel impelled to invest in value-based care tools immediately. Right now, just 5% of respondents said that value-based care accounted for over 50% of their revenues, while 62% said that such contracts represented just 0 to 10% of their revenues. Arguably, while the growth in value-based contracting is continuing apace, it may not be at a tipping point just yet.

Still, traditional EHR vendors may need to do a better job of supporting value-based contracting (not that they’re not trying). The situation may change, but in the near term, health executives are going elsewhere when they look at building their value-based contracting capabilities. It’s hard to predict how this will turn out, but if I were an enterprise EHR vendor, I’d take competition with population health management specialist vendors very seriously.

Are We Going About Population Health The Wrong Way?

Posted on March 29, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For most of us, the essence population health management is focusing on patients who have already experienced serious adverse health events. But what if that doesn’t work? At least one writer suggests that though it may seem counterintuitive, the best way to reduce needless admissions and other costly problems is to focus on patients identified by predictive health data rather than “gut feelings” or chasing frequent flyers.

Shantanu Phatakwala, managing director of research and development for Evolent Health, argues that focusing on particularly sick patients won’t reduce costs nearly as much as hospital leaders expect, as their assumptions don’t withstand statistical scrutiny.

Today, physicians and care management teams typically target patients with a standard set of characteristics, including recent acute events, signs of health and stability such as recent inpatient admissions and chronic conditions such as diabetes, COPD and heart disease. These metrics come from a treatment mindset rather than a predictive one, according to Phatakwala.

This approach may make sense intellectually, but in reality, it may not have the desired effect. “The reality is that patients who have already had major acute events tend to stabilize, and their future utilization is not as high,” he writes. Meanwhile, health leaders are missing the chance to prevent serious illness in an almost completely different cohort of patients.

To illustrate his point, he tells the story of a commercial entity managing 19,000 lives which began a population health management project. In the beginning, health leaders worked with the data science team, which identified 353 people whose behavior suggested that they were headed for trouble.

The entity then focused its efforts on 253 of the targeted cohort for short-term personal attention, including both personal goals (such as walking their daughter down the aisle at her wedding later that year) and health goals (such as losing 25 pounds). Care managers and nurses helped them develop plans to achieve these goals through self-management.

Meanwhile, the care team overrode data analytics recommendations regarding the remaining 100 patients and did not offer them specialized care interventions during the six-month program.  Lo and behold, care for the patients who didn’t get enrolled in health management programs cost 75% more than for patients who were targeted, at a total cost of $1.4 million. Whew!

None of this is to suggest that intuition is useless. However, this case illustrates the need for trusting data over intuition in some situations. As Phatakwala notes, this can call for a leap of faith, as on the surface it makes more sense to focus on patients who are already sick. But until clinicians feel comfortable working with predictive analytics data, health systems may never achieve the population health management results they seek, he contends. And he seems to have a good point.

Hospitals Centralizing Telemedicine, But EMR Integration Is Still Tough

Posted on March 26, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the past few years, large healthcare providers have begun to offer their patients telemedicine options. In the past, they offered these services on an ad-hoc basis, but that seems to be changing. A new survey suggests that hospitals and health systems have begun to manage this telemedicine service lines to a central office rather than letting individual departments decide how to deliver virtual care.

The survey, which was conducted by REACH Health, polled more than 400 healthcare executives, physicians and nurses as well as other healthcare professionals. REACH, which offers enterprise telemedicine systems, has been conducting research on the telemedicine business for several years.

Forty-eight percent of respondents to the REACH Health 2018 Telemedicine Industry Benchmark Survey reported that they coordinated telemedicine services on enterprise-level, up from 39% last year. Meanwhile, 26% said that individual departments handled their own telemedicine services, down from 36% in 2017.

The providers that are taking an enterprise approach seem to have a good reason for doing so. When it analyzed the survey data, REACH concluded that organizations offering telemedicine at the enterprise level were 30% more likely to be highly successful. (Not that the company would draw any other conclusion, of course, but it does seem logical that coordinating telehealth would be more efficient.)

The survey also found that telemedicine programs provided by both behavioral health organizations and clinics have expanded rapidly over the last few years. Back in 2015, REACH found that many behavioral health providers and clinics were at the planning stages or new to delivering telemedicine, but according to the 2018 results, many now have active telemedicine programs in place, with clinic services expanding 37% and behavioral health 40%.

While healthcare organizations may be managing telemedicine centrally, their EMRs don’t seem adequate to the job. First, most survey respondents noted that the telemedicine platform wasn’t integrated with the EMR. Meanwhile, nearly half said they were documenting patient visits in the EMR after remote consultations had ended. In addition, more than one-third of respondents said that EMR doesn’t allow them to analyze telemedicine-specific metrics adequately.

Whether REACH’s solution solves the problem or not, I’m pretty sure they’re right that integrating telemedicine services data with an EMR remains difficult.

In fact, it seems obvious to me that while hospitals are still tweaking their programs for maximum impact, and getting paid for such services is still an issue, telemedicine won’t become a completely mature service line until collecting related data and integrating it with off-line patient care information is easy and efficient.

 

Mayo Clinic Creating Souped-Up Extension Of MyChart

Posted on March 19, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As you probably know, MyChart is Epic’s patient portal. As portals go, it’s serviceable, but it’s a pretty basic tool. I’ve used it, and I’ve been underwhelmed by what its standard offering can do.

Apparently, though, it has more potential than I thought. Mayo Clinic is working with Epic to offer a souped-up version of MyChart that offers a wide range of additional services to patients.

The new version integrates Epic’s MyChart Virtual Care – a telemedicine tool – with the standard MyChart mobile app and portal. In doing so, it’s following the steps of many other health systems, including Henry Ford Health System, Allegheny Health Network and Lakeland Health.

However, Mayo is going well beyond telemedicine. In addition to offering access to standard data such as test results, it’s going to use MyChart to deliver care plans and patient-facing content. The care plans will integrate physician-vetted health information and patient education content.

The care plans, which also bring Mayo care teams into the mix, provide step-by-step directions and support. This support includes decision guidance which can include previsit, midtreatment and post-visit planning.

The app can also send care notifications and based on data provided by patients and connected devices, adapt the care plan dynamically. The care plan engine includes special content for conditions like asthma, type II diabetes chronic obstructive heart failure, orthopedic surgery and hip/knee joint replacement.

Not surprisingly, Mayo seems to be targeting high-risk patients in the hopes that the new tools can help them improve their chronic disease self-management. As with many other standard interventions related to population health, the idea here is to catch patients with small problems before the problems blossom into issues requiring emergency department visit or hospitalization.

This whole thing looks pretty neat. I do have a few questions, though. How does the care team work with the MyChart interface, and how does that affect its workflow? What type of data, specifically, triggers changes in the care plan, and does the data also include historical information from Mayo’s EMR? Does Mayo use AI technology to support care plan adaptions? Does the portal allow clinicians to track a patient’s progress, or is Mayo assuming that if patients get high high-quality educational materials and personalized care plan that the results will just come?

Regardless, it’s good to see a health system taking a more aggressive approach than simply presenting patient health data via a portal and hoping that this information will motivate the patient to better manage their health. This seems like a much more sophisticated option.

Intermountain Creates Virtual Hospital

Posted on March 16, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of years ago, I wrote an item describing the Mercy Virtual Care Center, a four-story, $54 million venture which describes itself as a “hospital without beds.” The Center, which launched in October 2015, has more than 300 staffers. After one year of operation, the Virtual Care program had cut emergency department visits and hospitalizations by an impressive 33%.

Now, Intermountain Healthcare is following in Mercy’s footsteps. Last month, Intermountain announced a launch of its virtual hospital service, Connect Care Pro, which brings together 35 telehealth programs and more than 500 clinicians. Its goals are to supplement existing staff and provide specialized services in rural communities where some types of care are not available.

Unlike Mercy’s offering, Connect Care Pro’s services aren’t located in a single building, but according to Intermountain, it can still provide much of the care that you find at a large, sophisticated hospital. It describes its approach as clinically integrated and digitally enabled. (I’m not sure what clinical integration looks like in telehealth, so I’d love to hear more about that in the future.)

In explaining why Connect Care Pro matters, Intermountain tells the story of an infant admitted to a southern Utah hospital which needed intensive services. Because the infant was supported via Connect Care Pro, it received a remote critical care consultation rather than having to be transferred to a different ICU in Salt Lake City. Avoiding the transfer saved over $18,000 and allowed the baby’s parents to remain in their community.

Now, all Intermountain Healthcare hospitals, including 10 of its rural hospitals, use the virtual hospital’s services to build on their existing offerings. Also, nine hospitals outside of the Intermountain system have signed up to use Connect Care Pro.

While I might’ve missed something in my searches, from what I can tell few hospitals systems have gone to the trouble of creating a fully-fledged virtual hospital service, though many are offering telemedicine options to support rural hospitals and clinics.

Part of the reason may be financial. After all, as noted above, Mercy did spend more than $50 million to create its hospital without walls. However, I’d argue that the main reason for hospitals haven’t created similar centers is that they simply don’t understand their benefits, and to some extent may be in denial about the extent to which medical care is becoming decentralized.

Despite the costs and effort involved, I do think we’ll see more virtual hospitals emerge over the next few years. I just don’t think most hospital systems are ready to move ahead just yet.

Health Leaders Say Automating Patient Engagement Efforts Will Have Major Impact

Posted on March 12, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the last few years, many vendors have rolled out products designed to engage patients further in their care. According to a new study, these solutions may be just the tip of the iceberg. In fact, many healthcare executives see patient-facing, engagement-enhancing technology as critical to the future of healthcare, according to a new study.

The study, by the World Business Group, focuses on technology that can link patients with care in between visits to their primary care center. Patient engagement technologies, which they call “automated care,” have the potential to bridge such gaps by providing AI-based assistance to consumers.

The survey, which was also backed by Conversa Health, drew on direct interviews and survey responses from 134 health execs. The researchers looked at how those execs viewed automated healthcare technologies, how these technologies might be used and whether respondents plan to adopt them.

Respondents were clearly very enthusiastic about these tools. Nearly all (98%) said they believed automated healthcare will be important in creating a continuous, collaborative relationship with providers. The survey also found that 87% of respondents felt that automated healthcare will be helpful in getting patients to engage with their own care.

The next step, of course, is throwing resources at the problem — and it’s happening. Seventy-nine percent of survey respondents said they expected to work on integrating automated healthcare in their organization within the next two years. Also, 44% said that they had a chief patient experience officer or other executive with an equivalent title on board within their organization. This development is fairly new, however, as 40% of these organizations said that the role has existed for two years or less.

Meanwhile, several respondents felt that automating patient healthcare could generate a positive feedback loop. Forty-nine percent of those surveyed reported that they were either integrating or have already integrated patient-generated health data, which they expect, in turn, to integrate into the patient experience efforts.

Among organizations working with patient-generated health data, 73% were gathering patient health histories, 64% treatment histories, 59% lifestyle or social data, 52% symptoms data, and 32% biometric data.

Thirty percent said they were beginning to integrate such data and collect it work effectively, 28% said they could collect some PGHD but had trouble integrating with their systems, 14% said they were just beginning to collect such data and 9% said they were not able to collect this data at all. Just 19% reported they were fully able to collect integrate PGHD and use it to improve patient experiences.

All told, it appears we’re on the cusp of a major change in the role patient services play in provider outreach. It will probably be a few more years before we have a good idea of where all this is headed, but my guess is that it’s heading somewhere useful.