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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.

 

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.

Pilot Effort Improves EHR Documentation

Posted on February 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.

Though EHRs were intended to improve medical documentation, in many cases they seem to have made documentation quality worse. Despite their best intentions, bogged-down physicians may resort to practices — notably excessive copy-and-paste usage — that turn patient records into bloated, unfocused data masses that don’t help their peers much.

However, a pilot program conducted by a group of academic medical centers suggests using a set of best practice guidelines and templates for progress notes can improve note quality dramatically. The pilot involved intern physicians on inpatient internal medicine rotations at UCLA, the University of California San Francisco, the University of California San Diego and the University of Iowa.

According to a related story in HealthData Management, researchers rated the quality of the notes created by the participating interns using a competency questionnaire, a general impression score and the validated Physician Documentation Quality Instrument 9-item version (PDQI-9).

The researchers behind the study, which was published in the Journal of Hospital Medicine, found that the interns’ documentation quality improved substantially over the course of the pilot. “Significant improvements were seen in the general impression score, all domains of the PDQI-9, and multiple competency items, including documentation of only relevant data, discussion of a discharge plan, and being concise while adequately complete,” the authors reported. Even better, researchers said notes generated by the participating interns had about 25% fewer lines and were signed 1.3 hours earlier in the day on average.

One side note: despite the encouragement provided by the pilot, the extent to which interns used templates varied dramatically between institutions. For example, 92% of interns at UCSF used the templates, compared to 90% at UCLA, 79% at Iowa and only 21% at UCSD. Nonetheless, UCSD intern notes still seemed to improve during the study period, the research report concluded. (All four institutions were using an Epic EHR.)

It’s hard to tell how generalizable these results are. After all, it’s one thing to try and train interns in a certain manner, and another entirely to try and bring experienced clinicians into the fold. It’s just common sense that physicians in training are more likely to absorb guidance on how they should document care than active clinicians with existing habits in place. And unfortunately, to make a real dent in documentation improvement we’ll need to bring those experienced clinicians on board with schemes such as this.

Regardless, it’s certainly a good idea to look at ways to standardize documentation improvement. Let’s hope more research and experimentation in this area is underway.

Deep Learning System Triages Terminally Ill Hospital Patients

Posted on January 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.

Researchers at Stanford have developed a new tool designed to coordinate end-of-life care for critically ill patients. While the pilot study has generated screaming newspaper headlines (“AI tool predicts when people will die!”) researchers say that the system is best thought of as a triage option which helps hospitals and hospices provide timely palliative care to those who need it. It can also help terminally ill patients — most of whom would prefer to die at home — make plans for their passing and avoid dying in their hospital bed.

According to an article in tech publication Gizmodo, the Stanford set-up combines EHR data with other sources of information such disease type, disease state and severity of admission. The information is then processed by a form of AI known as deep learning, in which a neural network “learns” by digesting large amounts of data.

To conduct the study, researchers fed 2 million records from adult and child patients admitted to either Stanford Hospital or Lucile Packard Children’s Hospital. The system then identified 200,000 patients who met the study’s criteria. In addition to clinical criteria, the system also reviewed associated case reports diagnoses, number of scans ordered, number of procedures performed and other data.

After reviewing 160,000 case reports, the deep learning system was instructed to predict the mortality of a given patient within three to 12 months of a particular date using EHR data from the previous year. The algorithm included a requirement to ignore patients who appeared to have less than three months to live, as this window was too short for providers to make preparations to offer palliative care.

Then, the AI algorithm calculated the odds of patient death in the 3 to 12-month timespan extending from the original date. Its predictions turned out to be quite accurate. For one thing, it predicted patient mortality within the 3 to 12-month window accurately in nine out of 10 cases, a performance that few clinicians could match. Meanwhile, roughly 95% of patients considered to have a low probability of dying within 12 months actually lived beyond that point.

It’s worth noting that while the deep learning tool made fairly accurate predictions of patient mortality, the system doesn’t let healthcare providers know what treatment patients need or even how it makes its predictions. Luckily, researchers say, the system allows them to get a look at individual cases to better understand its deductions.

For example, in one case the system predicted accurately that a patient with bladder and prostate cancer would die within a few months. While there were many clues that he was near death, the system weighted the fact the scans were made of his spine and a catheter used in his spinal cord heavily in its calculations. Only later did the researchers realize that an MRI of the spinal cord most likely suggested a deadly cancer of the spinal cord which was likely to metastasize.

It’s worth remembering these results were produced as part of a pilot project, and that the predictions the system makes might not be as accurate for other data sets. However, these results are an intriguing reminder of the possibilities AI offers for hospitals.

To Avoid Readmissions, Hospitals Trying Post-Discharge Clinics

Posted on December 12, 2011 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 recent years, hospitals have been under increasing pressure to keep their readmission rates low. The next bump in the road comes in October 2012, when Medicare will begin cutting back on reimbursement for facilities whose readmit rates are too high.

Hospitals are already hard at work at preventing readmissions due to preventable medical errors, which may not be reimbursed at all by Medicare at all. But it seems like they’re still far behind in the care coordination department.

In fact, research suggests that they’re facing an uphill battle, in part because patients often don’t get the kind of follow-up care they need.

In theory, fragile patients  should move smoothly from inpatient care to their PCP, ideally a medical home equipped to coordinate whatever follow-up care needs they have. Few primary care practices are up to speed yet, however.  In fact, some aren’t even sure when their patients are discharged.

How bad is the problem? According to one study quoted in The Hospitalist, only 42 percent of hospitalized Medicare patients had any contact with a primary care physician within 14 days of being discharged.

One solution to this problem might be a “post-discharge” or transitional care clinic offering primary care on or near a hospital’s campus, the article notes. This makes sense. After all, it’s more likely a patient will follow through and get follow-up care if it’s convenient to do so.

The idea behind these clinics isn’t to replace the patient’s existing PCP; instead, the clinic’s hospitalists, advance-practice nurses or PCPs are there to make sure patients absorbed their post-discharge instructions and are compliant with the meds prescribed during their stay.

Some hospitals have invested significant resources in building out transitional clinics, including Beth Israel Deaconess Medical Center, Seattle-based Harborview Medical Center and Tallahassee (Fla.) Memorial Hospital, which partnered with a local health plan to kick off the effort.

That being said, the idea is a new one and few other hospitals have taken the plunge as of yet. It will be interesting to see whether this approach actually works, and particularly, whether one model of transitional care stands out.

P.S.  I’d particularly like to know whether hospitals can accomplish some of these objectives by monitoring patients remotely after they’re discharged. After attending last week’s mHealth show, I’m betting remote monitoring would be cheaper than setting up a new clinic. Can’t wait to see whether hospitals try that route!

 

 

 

News nuggets: Provocative news briefs from around the Web

Posted on June 15, 2010 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.

Here’s the first of my occasional posts sharing news briefs of interest (directly or indirectly) to the hospital world.

For future issues, please free to pass along interesting items if you see fit.  Just  drop me an note and I’ll take a look.


This Week’s Updates and Info

Aussie hospital proposes use of Tasers to subdue violent patients
http://bit.ly/czSxqw

Great McKinsey case study w/ chart:  Tracks how need for heart surgeons fell in the UK
http://bit.ly/aas21P

2009 Health Insurance CEO Compensation Study
http://bit.ly/9tleD3

The Pitfalls of Accountable Care Organizations
http://bit.ly/9giVya

AMA: One in five claims processed inaccurately by health plans
http://yhoo.it/dt6IAM