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Posts Tagged ‘Meaningful Use’

Patient Information Really Doesn’t Matter

We live in a world of information, everywhere we turn someone is collecting information about us. The technology advancements over the last 10 years are mind-boggling, but new technology is usually escorted by apprehension as our privacy continues to diminish and security is anything but secure. From cookies on Patient Information Really Doesn't Matterthe internet to a basket analysis at the supermarket, “big brother” is always watching.

The healthcare industry is no different. Healthcare organizations are surrounded by data: clinical, operational and financial; internal and external; structured and unstructured. There is so much information that healthcare providers don’t know what to do with it. The problem with healthcare is not a lack of information. The problem is healthcare organizations often have disparate systems that lack continuity. The absence of interoperability within IT infrastructures ultimately means that the right information is not available to the right people at the right time. Healthcare organizations can have all the information in the world, but if the information is not cohesive and can’t be used efficiently to improve clinical outcomes than information really doesn’t matter.

In order for healthcare organizations to improve outcomes, communication between systems is paramount. Despite industry standards such as EDI/X12, HL7 and CDA, information delivery is not effective. Most healthcare organizations understand the importance of untangling the interoperability web, but those same organizations don’t know where to begin.

Government regulations such as Meaningful Use Stage 2 (MU2) are putting additional pressure on healthcare organizations to improve the quality of care, coordination of care and population health management. A strong interoperability backbone that provides system connectivity is the key to attaining MU2. Interoperability transforms information into key insights that drive better clinical outcomes and improve the lives of individuals and communities.

Do you understand the importance of interoperability but not sure where to start? Perficient will be teaming up with technology partners IBM and Oracle to bring you 2 complimentary webinars:

Tackle Healthcare Interoperability Challenges and Improve Transitions of Care
Thursday, September 25th @ 12 CT
Learn More and Register

Engage Patients, Reduce Manual Processes and Drive Key Insights with Interoperability
Tuesday, October 2nd @ 2 CT
Learn More and Register

The Meaningful Use Marketing Fail Keeping VPs up at Night

In a recent chat with the VP of a large health system, I learned what keeps him up at night.  His organization, like many across the nation, has invested mountains of time and money in Meaningful Use Stage 2.  Like most health systems (all but 11% says research groups like KLAS) they chose to invest in the patient portal modules available through the EHR vendor.  This Blog_What-Keeps-You-Up-at-Night2is largely because most Meaningful Use patient portal decisions are being made by IT, as opposed to business.  At the top of the list in IT decision making criteria is integration with EHR.  So, VPs like my new friend at this large health system are able to cross off the features required via Meaningful Use quite easy.  All except one…

They are having a heck of a time getting patients to actually adopt the patient portal technology.

It appears as though the “if we build it they will come” concept hasn’t quite held true in the case of patient portal.  In fact, the statistics are rather staggering.  Recent research discussed in the HealthData Management article entitled “Patient Portals Not Yet Go-To Platform for Patients” reveals:

  • Almost half of patients don’t even know if their physician has a patient portal
  • 11 percent are confident their physician “does not” offer one

And here is the kicker for a recovering marketer like myself:

  • Less than half of those surveyed–49.2 percent–report actually being shown a patient portal by their primary care physician either during a visit or outside a visit

And why is this keeping folks like my VP friend awake at night?  Well, first and foremost it is because healthcare providers like him are fans of patient engagement and want to provide patients with the tools they need to stay healthy.  Taking it a step further, Meaningful Use Stage 2 is a financial incentive.  The criteria for getting those incentive dollars are not met when you build a patient portal.  They are met when a critical population of patients adopts the technology. Early results are in, and patients are not adopting.

So, what’s the the underlying problem here?  Well, it’s multifaceted, but much of the error falls in building patient portals that are not user centric.  he user, the patient, is and should be the center of our universe.  However, it is oftentimes not the department of IT, the department largely in charge of Meaningful Use, that invests in stores of knowledge like user experience.   I’ve also been met with many blank stares across conference room tables when I ask healthcare provider portal teams about campaigns their marketing team have created to drive attention to the portal and journey maps that have been created across their patient digital experience to drive patients into the portal.  In my opinion, Meaningful Use is one of the biggest marketing fails I’ve seen in my career thus far.  There is not alignment between IT and the rest of the organization on the measures needed to drive patient engagement.  In my opinion, which has now been validated by this research, a campaign that does not also consider physician adoption of portal technology is a campaign waiting to fail.  If the physicians are not using it, then their patients will not either.

This is why I began the dialogue a few of months back on what the market says you need in your patient portal.  The market, which in reality is simply cumulative actions of patient populations, is the most important input into the creation of a successful patient portal.  You can see some of the components of a user centric patient portal in that series:

 

 

 

 

What the market says you need in your patient portal

I had an interesting chat with some healthcare execs a few weeks back.  We were discussing the real impact of increasingly shifting regulatory compliance deadlines.  Think about it: when the government puts forth direction, and incentive, to effectuate a certain change that often leads to healthcare executives realigning their own strategies in favor of this mandate.  This means, in the case of Meaningful Use, putting off previously considered initiatives in favor of the new ticking patient portal time bomb.  When the timeline then gets shifted, sometimes again and again, it can seem like a cruel joke.

As we are all well aware, the Meaningful Use timeline is now delayed.  The Centers for Medicare and Medicaid Services has added a third year to Stage 2 of the EHR meaningful use program and has delayed the start of Stage 3 until 2017. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2.  It is now expected that in fall of 2014 CMS will release a notice of proposed rulemaking for Stage 3 along with the 2017 Edition of the ONC Standards and Certification Criteria, which will outline more details of the new timeline. The final rule, with all requirements for Stage 3, would follow in the first half of 2015.

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With these facts as the undercurrent to our discussion, our conversation ventured into a discovery session on what true patient engagement means and whether strategies should adhere to government regulations or, instead, market demand.  Want to guess what side of that debate I argued from?  Yes, there are providers that will continue to drag their feet.  I’m not saying that Meaningful Use is not warranted because yes, indeed, it is.  However, the market will ultimately be the truest driver for competition among healthcare providers seeking to engage with patients.  As a result, the forward thinking strategists in healthcare organizations nationwide should have their sites on the marketplace horizon.

What does the market think of patient engagement?

For the answer to this question I refer to a report by Frost & Sullivan that was released before the delay was announced entitled “U.S. Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012–2017″.  This report predicted growth in the patient portal market over the next five years.

“The need to fully engage patients as a member of the care team is fundamentally about encouraging individuals to become more involved with their healthcare, so they will be motivated to make behavioral changes that can positively impact their health status. That need will only grow as the healthcare system moves towards accountable care and value-based reimbursement. The importance of this movement cannot be underestimated.”

The report then categorized those EHR module patient portals (aka “The Meaningful Use Portal”)  as “Patient Portal 1.0.” and qualified these solutions as not being capable of providing the “advanced interoperability and functionality needed to support clinical integration, accountable care and ongoing and sustainable patient engagement.”  No arguments there.

However, they also predicted a significant disruption in the years to come.  The report states that as healthcare reform and transformation advances, providers will seek new ways to engage patients and influence behavior using connected health and will increasingly look for more advanced solutions that are proven to consistently motivate sustained behavioral change. These solutions are referred to as “Patient Portal 2.0.”  The report estimates that this new era of patient engagement will make its way to reality between 2015 – 2017.

Setting Patient Portal Strategy to Market Demand

The Patient Portal 2.0 that the market requires relies on a host of functions that think outside the confines of Meaningful Use.  If you want to develop a portal that truly reaches out into a population and makes a difference, then you must, better than anyone else, understand the purpose of the portal.  You must know to whom your portal is targeted.  I’ve never met two patient populations that are the same, which makes implementing an out of the box portal for every population a bit discomforting.  You must devote a lot of time to figuring out what motivates your intended audience.  That understanding must be crystal clear before you even consider how the portal should be designed.  Document, in detail, what your experience needs to communicate with the patient.  What kinds of tools best match this experience?

Want some ideas on what others are doing to meet market demand?  Here are some features that the market is currently pushing towards:

  • Telehealth that moves beyond the virtual visit
  • Dynamic scheduling
  • Social collaboration
  • Gamification and serious games
  • Avatars for personalized health coaching
  • Health information exchange across diverse care settings
  • Integration of clinical and financial data,

Any others you are seeing out there in the marketplace?  I’d love to hear about them in the comments section below.

Happily Ever After: The Benefits of Patient Engagement – #HIMSS14

Once upon a time last year, in a town not too far from you, there was a big hospital where a bright, young physician was providing care to a sick, old patient.  Okay, let me save you some time.  This fairytale, unlike those you are used to, doesn’t end simply by having Prince Charming (the physician) swoop in and save the beautiful, damsel in distress (patient).  This fairytale has a bit of twist that changes the standard storyline.  This twist is referred to as Patient Engagement.

Changing of the Patient-Provider Fairytale

patientengagementThe concept of patient engagement has changed the way providers tell their patient stories.  It is no longer, once upon a time, a patient was sick, the physician cured him/her, the end.

The fairytale now reads more like this…

  1. Patient came in.
  2. Physician introduces him or her to supporting characters (care team).
  3. The patient and physician discuss the plot (disease state) with alternative endings (treatment options).
  4. They co-write the script (care plan), including ideas for props (patient education, care communities, etc.) that will enhance the story.
  5. The physician quickly publishes (uploads to portal) the manuscript and associated material for review and follow-up (provides email, direct scheduling option, mobile alerts, etc.).
  6. And instead of “the end”, it is more like, “to be continued…”

Patient engagement is not a new concept, just one that has been brought to the forefront as part of the healthcare industry’s increased efforts around coordinated care. Read the rest of this post »

A Love Letter to Meaningful Use – #HIMSS14

It seems appropriate on Valentine’s Day to write love letters.  This is my letter of adoration to Meaningful Use.  In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills.  My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons.  I could wax poetic about the ease of checking on appointments and reviewing lab results.  The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy.  It was love at first click.

A Love Letter toInstead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic.  I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications!  I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila!  Several hours later, I received an email confirmation from the pharmacy that they were processing my order.  Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.

My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software.  I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view.  I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life.  This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past. Read the rest of this post »

Connected Health Trend Countdown: #5 The Meaningful Use Timeline

Top TenWe’ve rounded the bend on our countdown of the Top 10 Trends in Connected Health in 2014.  You may be surprised to know that this is the first time a government propelled trend has been mentioned on this countdown.  Here it is:

Trend #5: The Meaningful Use Timeline Shift

I like to refer to this trend as the “shiny object”.  It seems to me that any time discussions of consumer engagement arise, everyone defers to Meaningful  Use Stage 2, and the patient portal is prescribes, for the answers.  Don’t get me wrong, enabling patients with the ability to view and download their medical record is great.  I just don’t believe it is all that groundbreaking.  If you consider the entire patient digital experience, the patient portal is all the way at the tail end.  Then, if you only use the metrics and means described in Phase 2, your ability to engage consumers on the portal is still very limited.

With all of that being said, as we are all well aware, the timeline is now delayed.  The Centers for Medicare and Medicaid Services has added a third year to Stage 2 of the EHR meaningful use program and has delayed the start of Stage 3 until 2017. Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2.  It is now expected that in fall of 2014 CMS will release a notice of proposed rulemaking for Stage 3 along with the 2017 Edition of the ONC Standards and Certification Criteria, which will outline more details of the new timeline. The final rule, with all requirements for Stage 3, would follow in the first half of 2015.

Great more time to get engaged with consumers, right?

Not so much.  As it stands now, approximately 50% of hospitals in the country have some type of portal technology.  The great majority of these (approximately 89% by some accounts) were or will be acquired as an add on to the already installed EHR system.  The timeline delay means that the timeframe for giving patients, what I believe to be, the bare minimum in engagement is still years off.

So, how much longer will it take to get real consumer engagement on that portal? For the answer to this question I refer to a report by Frost & Sullivan that was released before the delay was announced entitled “U.S. Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012–2017″.  This report predicted growth in the patient portal market over the next five years.

“The need to fully engage patients as a member of the care team is fundamentally about encouraging individuals to become more involved with their healthcare, so they will be motivated to make behavioral changes that can positively impact their health status. That need will only grow as the healthcare system moves towards accountable care and value-based reimbursement. The importance of this movement cannot be underestimated.”

The report then categorized those EHR module patient portals as “Patient Portal 1.0.” and qualified these solutions as not being capable of providing the “advanced interoperability and functionality needed to support clinical integration, accountable care and ongoing and sustainable patient engagement.”  No arguments there.

However, they also predicted a significant disruption in the years to come.  The report states that as healthcare reform and transformation advances, providers will seek new ways to engage patients and influence behavior using connected health and will increasingly look for more advanced solutions that are proven to consistently motivate sustained behavioral change. These solutions are referred to as “Patient Portal 2.0,” and will rely on functions like health information exchange across diverse care settings, integration of clinical and financial data, dynamic scheduling, social collaboration, gaming, avatars for personalized health coaching, and virtual visits.

The report estimates that this new era of patient engagement will make its way to reality between 2015 – 2017.

The Meaningful Use Timeline Catch

As we move towards the holy grail patient portal described in the Frost & Sullivan report, the data points they used in their analysis need to be understood.   They specifically mention the Stage 2 requirements as a major factor in this trend along with accountable care and consumer demand. One can extrapolate from these criteria that the delay in Meaningful Use Stage 2 also denotes a delay in their original forecast for Patient Portal 2.0 as well.  Using my very best back of the napkin estimates, I believe this will mean true patient engagement behind the firewall will finally become a reality somewhere in the middle of 2016 – 2019.

Once that time finally arrives, I’ll be there with bells on (as some say).

 

Connected Health Trend Countdown: #8 Sharing Notes with Patients

Top TenOur Countdown of the Top Connected Health Trends of 2014 brings us to:

#8: Sharing Notes with Patients

The more obvious driver of this trend is Meaningful Use.   However, there is a separate market push for patient record access, which is being driven by consumer engagement.  As luck would have it, there was a Healthcare IT News article on this very topic that surfaced yesterday entitled “Consumers now calling for Meaningful Use” by Eric Wicklund.

Where the general trends of the marketplace are concerned, the participatory care movement has been a big catalyst of this trend.  For those not in the know, this movement is being driven by patient advocates through the Society for Participatory Medicine.  This group is driven towards an industry where:

“networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners”.

Quite an admirable cause, indeed.

The Results are In

Back in October, the Journal of Participatory Medicine published a study documenting patient perception of increased data access.  This study surveyed Kaiser Permanente members who had viewed at least one test result online in the last year.  There were a total of 1,546 respondents. The findings showed:

  • Patients that were able to view their lab results online overwhelmingly reacted positively to being able to do so
  • Survey participants reported high levels of satisfaction, appreciation, calm, happiness, and relief
  • Few were confused, upset, or angry at being able to see lab results online
  • After reviewing results online, the most common actions were discussing results with family and friends, looking up information online, or making a graph of results over time

What provider wouldn’t want to own survey results like these?

Opening the Book on Doctor’s Notes

What do you think would happen if doctors handed their notes over to patients in an effort towards patient engagement?  The great thing is, we already know.  OpenNotes is a program that gives patients online access to the notes of their doctors, nurses and other clinicians.  The notes may contain:

  • History of present illness (what the patient told the clinician)
  • Physical exam findings (blood pressure, heartbeat, lung sounds)
  • Lab, radiology, pathology, or other results
  • Assessment or “impressions” (the clinician’s  diagnosis or documentation of symptoms
  • The treatment plan

Patients who read their notes have reported many benefits, which include:

  • Better understanding of health and medical conditions
  • Improved recall of the care plan
  • Feeling more in control of care,
  • Taking better care of themselves
  • Doing better at taking medications as prescribed
  • Strengthening the partnership between patient and physician

Health Plans & the Shared Medical Record

Another, oftentimes unconsidered, source in the drive for demand of record sharing is actually the health plan.  Having a storied history of largely ignoring the B2C relationship, Affordable Care and the drive towards the management of chronic conditions has brought us a health plan that is very interested in helping members gain access to their records.  Understanding that patients typically don’t want their health plan involved in their care, health plans are finding consumer engagement tactics that involve providing members with tools that the provider has been slow in implementing. Access to medical records is one of those tactics.

The Truly Open Book

Driving towards a world where the patient can gain easy access to their medical records is an important trend.  However, what I am most interested in seeing would have to take us another big step forward (don’t blame me, I was born that way).

We will truly have a foundation towards participatory medicine when sharing notes is a two-way street.   Patients have a lot of data to share as well.  The true power of consumer engagement will surface when both the patient and the clinician are able to collaborate over their shared open book.

Positive evidence that Health IT improves patient outcomes

Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies) Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome. Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.

Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies)
Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome.
Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.

This is a fascinating report on a study by RAND researchers about meaningful use. It shows strong evidence that Health IT improves patient outcomes, specifically quality, safety, and efficiency outcomes.

Michael Furukawa Director at the ONC , and Meghan Gabriel, Economist at the ONC, presented the results from this study in a blog post on HealthIT Buzz. They asked RAND to:

…examine recent evidence on the effects of meaningful use functionalities on quality, safety, and efficiency outcomes. The study was the largest and most comprehensive assessment of the health IT literature to date.

Perficient’s Top 5 Healthcare IT Blog Posts of 2013

It’s been an amazing year of breakthroughs and challenges in the Healthcare IT space. Let’s take a look back at our 5 most popular blog posts of 2013:

Perficient's Top 5 Healthcare IT Blog Posts of 2013

7 Healthcare Ideas for Google GlassMartin Sizemore

There was a lot of buzz around Google Glass this year, but in this post Martin Sizemore moves past the flash and buzz to discuss some very practical and powerful potential uses of this technology.

The Quantified Self: 6 Trends to Watch ForMelody Smith Jones

The idea and implementation of the quantified self was a very hot-topic in both healthcare and retail. The benefits of such detailed measurement span from individual to medical professionals. Melody Smith Jones talked about 6 of these trends.

Establishing Data Governance – Part OnePriyal Patel

Big Data was a big buzzword this year. With mountains of data, comes the need to manage it properly. Priyal Patel discussed the importance of managing all of that powerful data.

10 Mobile Health Apps for DoctorsJamie Churchill

Mobile apps can be a great benefit to doctors, but only if you can find the ones that are truly beneficial. Jamie Churchill broke down the top 10 mobile apps for doctors.

Meaningful Use for Mobile HealthPriyal Patel

The growth in mobile use has been astounding. In this post, Priyal Patel dove into how healthcare can best use mobile technology to benefit patients.

 

 

Top 5 Technology Trends in Healthcare – October 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

 HCBlog Top5 Trends

Mobile Medical Applications

Last month, the FDA released its final guidance for developers of mobile medical applications. The FDA will focus on regulating potentially harmful apps instead of policing applications that pose minimal risk to consumers. These more harmful apps include those which are using mobile technology to make a specific diagnosis and those which transform mobile devices into a regulated medical device.

Patient Engagement and Connected Health

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified-self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

Read the rest of this post »

Meaningful Use for Mobile Health

Stop reading this blog and look up.  What do you see?  I bet the majority of you, especially if you are in a public place, will see most people with their heads down looking at their cell phones (be honest, are you reading this blog on your phone?).  Am I right?  I bet I am!  You can’t go anywhere these days without seeing people, from the ages of 9 to 90 on a cell phone.  More and more people are using their cell phones as the ultimate go-to for information.   And why not, it has truly become a one stop shop – you can do pretty much everything with a few taps on your cell phone…including managing your health.

Did you know the number of U.S. adults using mobile phones for health-related activities, including looking up health information, grew from 61 million in 2011 to 75 million mobile healthin 20121? That is an increase of 14 million in one year!  With numbers like this, it is no surprise that healthcare organizations are looking to mobile health as an effective tool in helping them not only improve patient care, but also address the demanding regulatory requirements placed upon them, specifically Meaningful Use (MU).  “Mobile health refers to health-related services that are supported by mobile devices, such as cell phones and tablets. Mobile health technologies can help physicians monitor patient health, collect medical data, deliver information to patients and colleagues, and even provide care at a distance2.” Read the rest of this post »

Top 5 Technology Trends in Healthcare – August 2013

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

HCBlog Top5 Trends

Personalization of Medicine

Personalized analytics have the power to improve care outcomes for patients by drawing data from a complete view into their care coordination. Healthcare analytics and big data hold the key to being able to provide personalized care and prevention. By integrating personal health records with EMR data, providers have a 360 view into the history of the patient and the care they require.

Interoperability

Interoperability plays a key role in ensuring systems can communicate with each other to share information. It helps to reduce redundant data entry, speed access to information and create a real-time flow of information through an enterprise IT system. The key benefit of creating interoperability is to improve the visibility, sharing and re-use of data collection between disparate healthcare applications and devices.

Read the rest of this post »