Christina's Considerations

Why is no one using our patient portal?

A while back I wrote an article on why patient portals aren't being used.  It was written while I was in a fatigued frenzy as a patient trying to find a diagnosis.  Since then, I continue to experience the healthcare system and identify opportunities to improve communications with patients.  My most recent recommendation to home health organizations is to actually get a portal so patients can confirm treatment dates.  To practices who have a portal with forms to be completed prior to a procedure being scheduled, make sure they are the most current version and the save function actually works; to avoid wasted time and rework.

Here is the original article written for Multibriefs...

Patient portals and the functionality they offer have the potential to increase access to service, improve convenience and more effectively engage patients and consumers. They can also increase efficiencies for both patients and their providers.

It is for these reasons that most providers, payers and technology vendors have at least considered offering patients and consumers access to these online tools. Unfortunately, some of those who have adopted patient portals complain that they have made the investment, only to realize low adoption and utilization rates.

So, why might patients not be using your patient portal?

Many patients — especially those with low health or tech literacy rates — may have heard of your portal, but don't understand the benefits to them individually. Or perhaps, there are barriers to them acting to gain access; such as believing they aren't tech savvy enough or simply not having the motivation to change old habits.

Aside from providing access to a platform, the provider/payor/vendor also needs to invest in strategies that facilitate user education, training and adoption. In some cases, this requires turning to family caregivers who need access themselves in support of the patient, or who can help them learn and navigate the most relevant areas to them personally.

In other cases, the provider/payor/vendor needs to reflect upon the targeted population and the usability of the portal, its functions and offerings. A few examples of user complaints include:

It is difficult to register and gain access to the portal

Not enough relevant info — such as a list of imaging studies completed, but no access to the report or results

Staff and/or providers don't respond to messages in a timely manner — if at all

Appeals and grievances can be submitted through the portal, but the decision is mailed through the U.S. Postal Service, resulting in delays

A recent Black Book Research poll found that 96 percent of patients report leaving their doctor's office with limited knowledge of how to use the patient portal. Of the 40 percent who attempted to use the software in 2016, 83 percent said it was too complicated. For benchmarking purposes, this means only 7 percent of patients found the portal simple enough to use.

An excellent way to identify opportunities to improve your patient portal is to assess the portal design, functionality and alignment with your patient needs and interests. Some questions to reflect upon include:

Is there statement that reassures patients of the portal's security measures and privacy safeguards?

If there is a delay in when test results or reports are released to patients, is that clearly communicated?

Can patients complete routine questionnaires online and make periodic updates to their information?

Would an online appointment summary of key findings and/or follow-up add value for patients who don't remember everything the physician tells them during the encounter?

Is it easy for patients to see summaries, reports and results and forward them to other providers on their care team?

Are engaging tools and resources available to guide patients on self-management activities, such as suggested apps, medical device options/recommendations or multimedia educational content?

Can patients message both administrative and clinical staff to avoid frustrating call trees and phone tag?

Can users securely upload documents to attach to their messages or add to their medical record?

Another technique is to gain insight to the patient perspective by obtaining feedback from your population by asking a pool of patients to assist you with user testing. This would include feedback on the ease of gaining access, navigating the site, their assessment of resources and information, and completing transactions, such as requesting an appointment, messaging, bill pay, etc. User testing by patients and their family caregivers can also help you determine whether:

the site easy to navigate at home for all segments of the population

the portal accommodates the patient's, or family caregiver's, learning needs

the resources, information, functionality are relevant to the patient population(s) served and provide value to users

patients want to see other online tasks accommodated by the portal, such as requesting medication refills, bill payment

your patient want to upload data, such as glucose levels, daily weights or information from wearable sensors for trending and alerts to both the provider and patient when some intervention is needed.

Patients have become accustomed to this technology in other areas of their lives, such as retail, banking, travel and general communications. They expect it from their entire healthcare network, starting with their providers and payors of care.

Mental Health Informatics

The current issue of the Annals of Family Medicine includes two articles that deal with mental health and information technology.  There are many assumptions about mental health in the age of digital health, so perhaps the findings of this research will give patients and providers some additional insight  This will help improve decisions to support self-management activities.

Mental Health Apps - This study examined how mobile health apps frame mental health; including who is affected and how to manage symptoms.  Of the 61 apps identified, 34 (56%) addressed panic/anxiety/stress, 16 (26%) focused on mood disorders and 11 (18%) addressed well-being or other issues.  The two dominate findings are that poor or fragile mental health is ubiquitous and users can easily manage their health with apps.  However, the sufficient scientific data for the claimed benefits was not offered.  In addition, the representation of users does not match with the actual diversity found in the population of those with mental illness. 

Access to Clinic Notes - This study assessed patients who had access to primary care clinic notes through secure online portals.  Patients with at least one mental health diagnosis were compared to those without; and both had similar perceptions to online access to notes. Most patients had positive perceptions about OpenNotes and were similarly enthusiastic about the utility of reading their doctors notes online.

The results of both studies highlight  the importance of providers/physicians recognizing the risk and benefits of information technologies that are available to their patients.  In the case of apps, physicians will want to address use of mental health apps by their patients and educate them on normal mental states and the importance of supports when needed.  This is to challenge the possibility of over self- diagnosis and implication of individual responsibility for mental well being.  Conversations should include a limitations of app use and the importance of seeking clinical attention for important or enduring psychological distress.

Physicians may also want to consider that access to clinic notes may help patients engage more actively in their treatment and improve communication and build more trusting relationships.  It might also stimulate more non-judgmentally written notes to further strengthen the patient-physician relationship.  I would also add that clinical notes reflecting the conversation may also help patients improve their compliance with physician recommendations and the treatment plan. Yes, it may be appropriate to block some parts  available online for certain patients due to safety reasons, but in a family practice this should be a small population.

The findings from both of these studies do point to the increasing reality, which is that patients are going online and using tools for information and tools to better manage their mental health.  It is the responsibility, and in the best interest interest, of physicians to have informed conversations with their patients, as appropriate.

Med School 101 - for patients & their caregivers!

Another book, another physician author!  Like my last review on pain, this one is directed at patients and their caregivers for improving their experience.  Kilbourn Gordon III, M.D., an ER physician, wrote “Med School 101 for Patients,” as a step-by-step guide highlighting the importance of communication and information within the patient care experience.  In other words, patient and/or self-advocacy and speaking up.

According to his guide, the patient must play a direct role in being comprehensively prepared when receiving an evaluation or treatment. Since visits can be limited to as little as 15 minutes, the patient preparation and involvement in the visit becomes paramount. Relying on his real-life interactions with patients and their styles, he guides readers in preparing for their doctor viits.  He stresses that everything that happen during this session being important, including your preparedness, personal notes, questions and your expectations of your caregivers - starting with the doctor.

 

Since I have had my own experience in the delayed diagnosis of Guillian Barre Syndrome, I was truly delighted to see that he includes strategies for uncovering the correct diagnosis when no physician has been able to uncover the medical truth.  Dr. Gordon encourages patients to become proactive participants in their own assessments and therapies.  While it took me 8 months of fighting and proactive searching for an answer, and one more month until I could finally receive the needed treatment, it has unfortunately taken others years to get to the point where I find myself today. 

 

Doctors are human and can be wrong!  Yes, even the best and the brightest, like my neurologist with stroke expertise,  can miss something important.  Since it is the patient who suffers, or doesn't, it really is up to us to drive our destiny and not become victims of the healthcare delivery system.  I've always believed that if you work hard, you can attain your goals.  The goal of a proper diagnosis and the right treatment is no different!

 

If you read the book and have any remaining questions, leave a comment and I'll find a way to get you an answer!

 

 

My GBS Progress

In August of this year I posted on the mostly frustrating journey for me to be accurately diagnosed ... and finally treatment.  Now that my anxiety and stress levels have been greatly reduced, due to treatment that is helping me improve, I want to go back a little.  This will be more of a hodgepodge, rather than a timeline.

• When I told my neurologist of my diagnosis from the neuromuscular specialist at UCLA, his response was "Wow!"  He did say my post was excellent and added that he was most concerned about ruling out Multiple Sclerosis and other more common diseases.  I think he understood my feedback and this is truly appreciated.
• When I first saw my neurologist he sent me for an MRI.  The technician, upon seeing me drag my feet as I walked in, kindly asked if anyone had mentioned MS.  Yes, they had, but do I need him to ask me that?  No, technicians, please don't offer up your "suspected diagnosis".  All it does is add to my stress and anxiety.  Having a cousin with MS, had already raised this fear. Also, if something goes wrong, your risk manager won't appreciate this inappropriate comment.
• When I show up for an appointment, and there is a really sick person next door, please communicate with me and let me know why I'm sitting in the treatment room for an hour... with the lights going out.  If you send in a resident/fellow to "take care" of me, as attending, you need to clearly communicate your expectations. If you don't, you can expect a really frustrated patient.
• I was sent to physical therapy for my ataxic gait.  No amount of PT will improve paralysis without treatment. So, if I'm not improving and reporting that I'm getting WORSE, politely suggest that I see my doctor again.  Don't wait until insurance denies further treatment. 
• Oh, and don't get me started on not returning patient calls for an appointment, snail mailing documents instead of uploading them on the expensive portal the hospital administrator's tout (instead asking if I have a FAX), and confusing signage ... for people who can't really walk or stand and get fatigued EASILY! 

For my readers who want an update, I'm doing better after three rounds of IVIG infusion therapy.  Thank you to all of the thousands of blood donors who made this treatment possible.  Thanks also go out to my insurance company who paid for this really expensive treatment.  (If it works, they will pay, and I'm good with this.)

I started PT again, this time for my hands.  While my walking has improved greatly, and I'm no longer falling routinely, I still struggle with my grasp, strength and typing.  This is slowing down my ability to return to work.  Yes, I could use Dragon, but not for everything.  The most exciting aspect of this PT is that it is virtual therapy.  More on this in a later post.

Next week, I'll start my final treatment in this initial plan.  Then I'll see my doctor and we will discuss the progress and what is next. 

One parting tip.  This past Winter/Spring it was cold and (thankfully) wet.  My hands and feet ached and were painful, as well as, super sensitive.  The nerves were in a tizzy and they let me know it.  Super soft socks and gloves made this bearable. As we approach a new winter, keep this solution in mind.  I continue to add to my new store, because of the idea planted in my mind by my grey aloe infused socks and gloves.  I wonder what color I'll try next!

Dr Drew: Not Just a TV Doc

Dr. Drew Pinsky and a few other doctors have voiced their concerns about what they see with their clinically trained eyes.  They have asked questions and prompted reflection aimed at ensuring that the next President has been fully vetted.  In healthcare environments, we encourage all staff to SpeakUP if they see something that just isn't right and we train them on situational awareness strategies. This helps us ensure patient and environmental safety.

So, Dr. Pinsky speaks up and voices his concerns; based on his observations of Hillary Clinton and potential symptoms she has exhibited, in addition to the report released by her physician.  The next week, CNN cancels his TV show, because it seems some in the media would prefer to hide their head in the sand.  

Would we expect our healthcare professions to do this in healthcare environments? Or even on the street if they saw someone exhibiting signs of  a stroke, choking, or other serious condition? Taking it one step further.... use of telehealth is exploding around the country and world and this means patients are not always standing in front of the doctor.  But, physicians can still use their training and experience to identify symptoms from observing and listening to a patient -- just as they can if they were standing in front of us.

We have military professionals critique defensive strategies, we have environmental experts critique air and water public policy.  We also have political consultants critique what and how a candidate says anything; and perhaps the underlying meaning.  But, we can't have physicians bring up their concerns for what they see in a presidential candidate's health?  I say, yes we can, and we have an obligation to hear them out and as voters ask the right questions.  Remember, these physicians are voters, too!

Why do I write this?  Because I worked with Dr. Pinsky between 1990 and 1995 at Las Encinas Hospital in Pasadena, California.  The psychiatric/chemical dependency hospital has been around since 1905 and when we were there, we received referrals from other physicians and hospitals when they had nothing more to offer the most complex of patients.  I was responsible for daily operations, including  safety, risk and medical staff credentialing.  

My personal and professional observation is that Dr. Pinsky cared deeply for his work and his patients.  He extended his care to the radio back in the 1990's to educate teens and young adults on behaviors that impact health on the show Love Line.  We both saw the issues that came into the hospital and he attempted to slow the flow of hospitalizations by educating young people.  We were both young, and he was an ideal candidate to have serious conversations with those who had questions.

Not long ago, Dr. Pinsky gave up over an hour of his time for an interview.  He is now quite the celebrity, but he took time out of his schedule to help my daughter with a science project on body image of teen girls.  I knew his years on Love Line and working at LEH had given him some insight, so I recommended him to my 13 year old daughter as the ideal "expert" for her project.

I've always said if anyone in my family needed treatment for chemical dependency, I would call Dr. Pinsky. He isn't just a TV doc, he is a competent and professional physician with the training to observe behaviors and identify warning signs and symptoms.  Let's listen to the good, the bad and the ugly.  Our national safety depends on it!

Design vs User Experience

I almost freaked out thinking I had lost a graphic that I use in my work with health informatics, as well as, performance and process improvement.  Just to make sure I don't electronically mis-place it again, I'm adding it to my blog to my blog where I collect interesting digital information.  In addition, I get to share it with you!

The lesson here is to design new processes and workflows with the needs of users in mind, instead of simply looking at some from our own narrow perspective.  If you don't know what users want and need, then ask them to try out the new process and workflow to see what they think and to provide feedback that can then be used to make adjustments.  That is user-centric design!

Consumer Understanding Of Health Insurance Terms

Health literacy is an issue for many Americans, in part because healthcare has its own language. Hospitals and Health Networks Magazine has a great graphic in their May issue based upon a survey of Texans.  So I thought I'd jump off from their list and give my own definitions of the terms in plain English to help any consumers out their Googling "define co-insurance", etc .  

Co-Insurance: Some people are covered by two insurances.  This can occur when both spouses have insurance plans that cover each other through work or older adults who have Medicare along with a private insurance plan.  One plan will be deemed primary for each individual and the second plan will pick up the cost of co-pays, deductibles and perhaps costs associated with "non-covered services" of the other plan.  If both a husband and wife each have a plan, their employer's plan will be their primary insurance and their spouse's plan will be their secondary or "co-insurance" plan.

Max out-of-pocket:  This is the maximum dollar amount you can expect to pay for your portion.  Many insurance plans limit the amount the patient has to pay and after that has been met, they cover the rest of the costs -- usually for the year.  This really helps patients with major injuries, illnesses or diseases.  For the average American, we never reach the maximum out-of-pocket.

Covered services:  These are the healthcare services that are covered by your specific plan.  Most don't cover elective procedures like plastic surgery (face lifts, breast implants, etc). Some will cover things like orthodontics, acupuncture or chiropractic, but others do not.  When comparing policies, look  to see what is or isn't covered and determine which policy better fits with your family's specific healthcare needs.  Sometimes, the lowest price plan isn't the best given your health history.  It could cost you more  if your children need braces or you rely on acupuncture for pain relief.  If services aren't covered, the patient is responsible for the cost.

Provider network: This is a good one!  The provider network is the network of physicians and other clinicians who are available to provide care to the plan's patients.  If you choose an out-of-network provider, expect to pay more.  Some plans won't pay anything for out-of-network providers.  This means that if you have a relationship with a physician that has gone back over 20 years and you sign up for a new insurance plan and he/she isn't "in the network", then your new insurance may not pay for his/her services.  If you have specific clinician preferences always compare the networks of different plans.    Another thing about networks is that some plans pay so low, that they have a hard time recruiting new physician and the ones they do have may not be accepting new patients when you call for an appointment.   Before you select a plan, call of few of the physicians you might need to see how soon you can schedule an appointment - one week or four months; if at all.  And, go online to Yelp, Vitals, Healthgrades or some of the other physician review sites just to see what patients have to say about these physicians.  

Premium:  This is the amount you pay for the insurance plan you have selected. If you use an employer-sponsored plan, your employer will often deduct this amount from your paychecks for you to pay the premium for the entire group.  If you get insurance on your own, you will pay the premium according to the terms of your plan.  Just because you pay a premium, doesn't mean you get all of your healthcare for free. 

Deductible: This is an amount the insurance plan specifies that the patient needs to pay before the insurance kicks in.  Usually, preventative services like annual physicals, mammography, etc. are excluded from the deductible requirement.  Some plans may also apply portions of the cost for each encounter to the deductible. 

Co-Pay:  The patient's portion of the cost of the care.  If you have an 80/20 insurance plan, the insurance company will pay 80% and the 20% is your co-pay.  The idea is for patients to feel a bit of the pain in their pocketbook to minimize unnecessary care and to help keep costs down.  Co-pays are in addition to the amount for the premium.

As you can see, there are several ways for patients to become responsible for paying healthcare costs.  This is why it is important for patients and their family caregivers to understand the conditions of their health plan.  The Affordable Care Act has resulted in some cost shifting to accommodate the newly insured and those receiving subsidies to help them "afford" insurance.  This means that many Americans, if they haven't noticed it already, will begin to see an increase in not only their premium, but also deductibles, co-payments and their responsibility for non-network providers.  Those who enjoy great insurance coverage provided by their employers also need to be aware of the impending "Cadillac tax" - again to help subsidize the cost of the Affordable Care Act.

John Stossel: You can't email your doctor!

John Stossel was recently treated for cancer and he had a couple of observations about health IT and men needing to listen to their leading lady when they say "it is time to see a doctor."

Last year I thought I could message my doctor when she announced she now had secure messaging.  Silly me, she meant she could send me messages, but I still have to call her.  As for filling out forms, tel me about it!

We, patients/consumers/family caregivers, need one  place to enter information and then the technology to slice and dice the information for whoever needs it in whatever form they want.  I don't care.  I just want to fill in my address, phone number and medical history once and then update as needed.  Well said, Mr. Stossel!

Health Information Technology for Healthcare Leaders

For the last two years I've been presenting a six-week online seminar exploring health information technologies for the American College of Healthcare Executives. This followed an invitation from them to write a column on technology for the 2007 issues of Journal of Healthcare Management and their willingness to publish my book on social media in 2010.

My journey into health information technology began in 2004 and at one time a blogger buddy referred to me as the "RHIO queen."  Given my passion for hospital leadership and administration I still think it is funny that I developed expertise in this area and a title. However, back in 2004 I could see the importance of healthcare leaders understanding technology applications and was a bit frustrated that some of my peers weren't willing to learn.  

I worked hard to catch up and keep up with my own learning, knocked on a few doors and maintained some patience.  Today, I'm so pleased to see that healthcare leaders have taken a much more active role in developing their own understanding of the technologies and the importance of implementing the right tool for the right purpose and right auidence.  More and more, they also recognize the importance of having a clear strategy and clean workflows before any applying technology tools.

Healthcare leaders play a crucial role and their decisions can instantly impact the spark of innovation and success of an implementation.  That is why it is so important that they develop at least a baseline understanding of the technologies, risks and rewards.

Today we start the second six week seminar of 2012 and I look forward to working with a new group of healthcare leaders to envision innovative applications in their organizations for the benefit of our patients!

There is still time to register, so consider joining us!  For more information Click Here!

Meaningful Use: Transforming Patient Engagement

This morning sent out a press release for Tower and also want to also share it with my blogosphere readers.  As always, I'm interested in your thoughts and hope you will consider leaving a comment. (PDF Version of Press Release)

The Office of the National Coordinator for Health IT (ONC) and The Centers for Medicare & Medicaid Services (CMS) has released the long awaited final requirements for State 2 Electronic Health Records Incentive programs.  Included in the rules is an emphasis on patient engagement.

 New rules specific to patient engagement include:

•  The “provide patients with an electronic copy of their health information” objective is being replaced with an “electronic/online access” core objective.
•  A new core objective for eligible providers is “use secure electronic messaging to communicate with patients on relevant health information“
•  CMS proposed two new core objectives related to patient engagement with measures that require patients to take specific actions in order for a provider to achieve meaningful use and receive an EHR incentive payment.  For both, the threshold was lowered from the proposed 10% of patients to 5% in the final rule.  CMS also recognizes broadband availability limitations in some provider practice areas and introduced an exclusion.
•  Patient and Family Engagement is one of the six key health care policy domains of which all providers must selection at least three for clinical quality measures (CQM) and reporting.  These are the CQMs that reflect the potential to improve patient-centered care and the quality of care delivered to patients. They emphasize the importance of collecting patient-reported data and the ability to impact care at the individual patient level as well as the population level through greater involvement of patients and families in decision making, self care, activation, and understanding of their health condition and its effective management.
•  More than 50% of all unique patients seen by the eligible provider are provided timely (within 4 business days) online access to their health information.  More than 50% of all patients who are discharged from the inpatient or emergency department of an eligible hospital or Critical Access Hospital have their information available online within 36 hours of discharge.

The ONC final rule complements the newly released CMS final rule and reflects their commitment to promote patient engagement and safety.

 As hospitals and other providers prepare to comply, they must first acknowledge that this isn’t just an issue for their IT departments to address.  Instead, attaining meaningful use of one’s electronic health records/systems for patient engagement will require the collective involvement and collaboration of disciplines from across the organization… clinical, operations, information services and communications/marketing.

“Healthcare leaders will need to be strategic and put every decision in the context of the patient experience.  Having an effective patient strategy will lead to happy customers, staff and a healthcare organization exceeding their business objectives” said Dr. Sue Sutton, CEO at Tower, a patient experience consulting group based in Los Angeles, California.

The approach required is one of re-defining patient engagement across all touchpoints, both physical and virtual, to positively transform the patient’s experience – as perceived by the patient. “The research tells us where the patients are going, but institutions aren’t paying attention. If the approach taken doesn’t actually engage patients, the organization won’t meet the meaningful use criteria and they may actually lose some patients to healthcare providers who have implemented more patient-centered engagement strategies“, added Dr. Sutton.

Enterprise portals can facilitate electronic access by making information within existing systems available in a more patient-friendly manner.  The portal helps accomplish the goal of compliance with the MU criteria, but it does so at the same time it can accommodate additional features and personalization for enhanced engagement and a better patient experience.  Ultimately, this is what will lead to improved outcomes – the ultimate goal of meaningful use.  

CMS will audit healthcare providers who are participating in the meaningful use program and will focus in on those who show substantial noncompliance.  For detailed information, see

 CMS Final Rule Regulations                   ONC Final Rule Regulations

CMS Final Rule Fact Sheet                    ONC Standards and Certification Final Rule Fact Sheet

Patient Engagement & Their Experience: The Virtual Touch Points

My new collegues at Tower seem to like the fact that I envision and write about the application of technologies to improve the work that has to get done in hospitals.  Since my work is now focused on re-defining patient experiences across all touch points (physical and virtual), we created a paper that highlights opportunities to engage consumers and patients using technologies for an enhanced web experience.

Patient Engagement and Their Experience: The Virtual Touch Points was prepared just in time for this week's Patient Experience Conference and it ties my long-term passion for improving care for the benefit of our patients to the role of information technology.  

The paper explores the drivers for transforming the way healthcare organizations engage consumers, patients and their families and the web-based opportunities across the continuum of care from pre-admission through post treatment follow-up and across all departments.  It describes how virtual engagement can enhance patient experiences and satisfaction with provider encounters.  It also highlights the role of key technologies, such as, enterprise portals, social media, mobile applications, business intelligence and telehealth.

According to our CEO, Sue Sutton, RN, PhD, “It is important to address the needs of patients where they are in their experience and tie disparate information systems together to present a seamless interaction for patients and their family caregivers.  Providing access to self-management tools and creating opportunities to help enhance their encounters with the system contributes to more engaged and accountable patients.”

The team at Tower has helped expand my view of technology applications, which we all agree, is an important strategy to enhancing today’s patient experiences, as well as, contributing to more efficient business and care processes, better outcomes and lower costs.

BYOD or BYOT

Just before HIMSS12, I learned about BYOD/BYOT (Bring Your Own Device/Technology).  Evidently, businesses and some healthcare organizations are encouraging, or allowing their employees, to use their latest and greatest (personal) mobile gadgets (smartphones, tablets, etc) to connect into their information systems. 

Now, it may seem that this policy will help reduce equipment costs and allow employees to use the latest technology, but it makes my Mobile Governance and Tablets in Healthcare posts even more important reads for healthcare leaders.  Why, because the organizations may find themselves paying out much more for costs associated with data breach assessments, reporting, fines, liability, etc.

For those of you who like data, consider iHealthBeat's report on a healthcare mobility survey that found:

• 85% of respondents said their organization has a BYOD policy, but the organizations vary in the amount of data they allowed personal mobile devices to access.
• 53% of respondents said their organization only allows personal mobile devices to access the Internet;
• 24% said their organization provides personal mobile devices with limited access to hospital applications; and
• 8% said their organization provides personal mobile devices with full access to the hospital network (Dolan, MobiHealthNews, 2/23).

Additional findings include:

• EHR applications are the most widely supported application on mobile devices, with 60% of respondents saying their organization supports the use of mobile EHR apps. The next most widely supported mobile apps include picture archiving and communication systems, secure messaging and voice-over IP (Computerworld, 2/24).
• More than 75% of respondents said their organization provides Internet access to patients and hospital visitors, but 58% said they use open networks without password protection to do so (Jackson, FierceMobileHealthcare, 2/23).

My hope is that these organizations (especially the 8% allowing full access to their network and the 15% without a policy) have already implemented the necessary safeguards to protect their systems and personal health information from accidently beaches, malicious attacks and HIPAA violations.

The Patient's Checklist

I've always promoted self and family advocacy in healthcare situations.  As an administrator, I strive to create and environment for the patient to get the best and safest care possible.  However, the healthcare system is heavily dependent upon humans and mistakes and errors happen.

A new book, The Patient's Checklist, provides guidance to healthcare consumers and family members on just how to go about the process of ensuring that you are getting the best and safest hospital care possible. It also includes some basic checklists that can help you stay organized if you don't have access to a personal health record.The checklists include:

1. Before You Go: Tips to be better informed, prepared, proactive.
2. What to Bring: Practical (and personal) items to bring to help you maintain your humanity and sanity in the impersonal and chaotic world of a hospital.
3. During Your Stay: Tips to both increase your comfort during a hospital stay and partner more effectively with your care team.
4. Master Medication List: A user-friendly log to track all prescribed medications during your hospital stay.
5. Daily Medication Log: A daily log to help ensure that for any medication given, it’s the right drug, the right dose, at the right time—and that it is meant for you!
6. Daily Journal:  A brief but important way to chronicle each day of your hospitalization.
7. Discharge Plan: Tips to begin planning for your discharge now in anticipation of the complexities of home care.
8. Insurance: Tips to navigate our overly complicated insurance system.
9. Doctor Contacts: How to keep an organized list of all your doctors.
10. Family & Friends Contacts List: A way to consolidate contact information for family and friends so everyone can help in the best ways possible.

For my fellow administrators, the book also includes stories... stories of how errors, oversights and mis-communication affected patients and their families.  Is it any wonder that patient experience is included in CMS' Value Based Purchasing program?

The only advice I would add is for patients and their advocates to not be afraid to speak up! First, seek out the manager of the unit or hospital nursing supervisor.  If he or she can't resolve the problem, ask for the Patient Advocate or assigned case manager.  Next in line is the Director of Nursing.  And, if she or he can't help.  Find the administrator's office and request a meeting to discuss your concerns with the quality and safety of the care being provided.  If this doesn't seem to work, just contact me and I'll share a few additional options that you have available.

Also see the Joint Commission's Preventing Errors in Your Care and other resources on their site.

Three Steps Towards Adopting EHRs

I'm a featured blogger of Healthworks Collective and they recently invited me to write a guest post putting EHRs into perspective for their readers. The article defines the landscape, addresses a couple of real challenges related to privacy and security and describes the role of social media.

I think my readers will also like the results and hope you enjoy your visit to the Healthworks Collective Community.

PHR School of Hard Knocks

The Healthcare Blog has a great post from one of my old RHIO connections, Missy Krasner.  She shares her thoughts about personal health records given her role with Google Health prior to its demise last week.  I really do agree with her view, especially the part about consumer interest being relative to their health situation.  It is the same for health related social networking.

What is Meaningful Use?

IT types can be some really creative people.  In this post, I'd like to share Dr. Ross Martin's latest Rap on Meaningful Use.  If your asking "What is Meaningful Use?" this is a fun way to learn.

 

Health in a Networked Life

Markle identified some interesting social and cultural findings in their survey Health in a Networked Life.  They include:

• Many doctors and patients surveyed believe key information is lost in their health care conversations.
• A majority of the doctors surveyed indicate a preference for modern communications tools. Three in four doctors say they want to be able to share patient information with other professionals electronically. Roughly half prefer computer-based means to share information with their patients.
• A clear majority of the public and doctors agree that patients ought to be able to download their personal health information online and share information electronically with doctors.
• Roughly 80 percent majorities of both the public and doctors agree it is important to require participating hospitals and doctors to share information to better coordinate care, cut unnecessary costs, and reduce medical errors.
• Majorities of both groups also agree on the importance of measuring progress and setting goals for improving the nation’s health in chronic problems such as heart disease, asthma, diabetes, and obesity.
• Roughly 4 in 5 of both groups express the importance of privacy protections as a requirement to ensure that public investment in health IT will be well spent.
• The public and doctors overwhelmingly support privacy-protective practices, such as letting people see who has accessed their records, notifying people affected by information breaches, and giving people mechanisms to exercise choice and request corrections.
• The public and doctors are largely unfamiliar with the details of the new health IT incentives, suggesting that education and outreach will be vital to the success of the program.

 
Study overview      Survey findings

SoCal HIMSS 2nd Annual HIT Conference

The Academic Alliance of the HIMSS Southern California Chapter is hosting a Health IT Conference on March 9th from 7 am to 5 pm in Los Angeles.  I've been invited to participate in the Tele/Wireless panel to focus on the role of social media and telehealth applications.  

This is a wonderful opportunity for cross-collaboration and learning between faculty, students and health professionals, so I hope you will plan to attend if you are in the region.

HIMSS HIElights on Telehealth Networks

The latest issue of the HIMSS HIElights newsletter includes an article I wrote to stimulate some conversation about infrastruction options; specifically the availability of telehealth networks in some communities.  If you are part of an HIE or RHIO, I hope you will share your viewpoint by sending it to nvitucci@himss.org . 

You are also welcome to add a comment here.

HIE & Meaninful Use Stage 1 Matrix

HIMSS has released another great resource -- created by one of their exceptional HIE workgroups.  The HIE and Meaningful Use Stage 1 Matrix provides insights on the HIE implications of Meaningful Use requirements, highlighting various perspectives including public health, PHR and providers.

Digifit: Its automagic!

I just learned of a cool technology in my own backyard.  The geek doctor has one every week, but he is a CIO and I'm an administrator.

Digifit uses wireless technologies (Apps) to help users track their health and fitness data -- automagically!  Why is this important? 

Well, we have this huge transformation going on in healthcare that will move our emphasis on prevention and taking responsibility for ones own health.  However, we are human and don't always keep up with inputing data, such as, our heart rate, calories burned, weight, etc.  However, wireless technology is now here to help us make the process a little more easy and fit better into our busy schedules.  More importantly, the data captured can also be uploaded to a PHR and/or shared with our health care providers, allowing us to have a more meaningful conversation during our visits.

Health and Fitness hasn't really fit well into healthcare historically, because our system was focused on caring for disease, illness and injury.  I suspect this will start to change as Accountable Care Organizations and other providers start to look for ways to help individuals better manage their weight, which in turn, helps them manage their diabetes, hypertension and other chronic diseases.  I can also see employers facilitating the use of these tools to help them better manage their insurance costs.

So, this is my cool technology and it comes from right here in Santa Barbara!  Let me know what you think, especially if you give it a try.  It is available for the iPhone and I understand will be available for Blackberry's soon.

mHealth Conference - Day 2

The day (for me) is starting with one of my board members presenting on Longitudinal Health for Diabetes Care.  Today's highlights include:

• Ohana Health - Feasibility study with 15 patients selected by outreach workers using modem connection of glucose uploads to an advanced web-based care management system.  Starting 5 patients with blue tooth enabled smart phone for glucose uploads.  Patients and physicians responding well to printed graphs and tables of the glucose reading - opportunity for talking point with patients.  Patients are able to use the technology as long as they receive some education.
• Longitudinal Health is a care delivery system that allow continuous interaction between the care team and the patient using mHealth technology and integrated with other health information technologies.  Includes contextually and temporally relevant decision support and use of social support networks for patients and their families, as well as, for health workers and care team members.
• Individualized care - pattern recognition application based on algorithm with responses and interactions with the application and care team are additional data points.  Over time, the patient relationship is improved by tailoring messages and contact based on the individual responses.
• Effective HIT systems move data from EMR to a clinical data repository (CDR), where additional data can be added from the mobile device.  In the CDR it is organized and data is sent back to the EMR and messages to the PHR.
• Watch for data overload and show value for physicians and other providers. 
• Chronic disease will be managed by a team, not just a physician.
• Need to educate health plans and government on understanding new technology.
• New relationships are coming:  Health plans and cell phone industry.
• As a society need to decide between motivating and medicating.
• Telehospice - (WA State and Missouri) Reimbursement is an issue -- Can CMS see value in care of patient in the home?  Patient prefer audio/visual, not just telephonic care.  Facilitates responding to patients (pain, suffering, etc) in the home - now!
• Social networking in palliative and end-of-life care is growing.
• Review of a planning template for starting a patient on remote monitoring.
• Mobile loop to reach the patient is an enabler.  Use of mobile technology requires new workflows, agreed goals, building a story between the patient and physician, creating guideposts and generate wisdom for both the patient and doctor.
• Community design - convert thoughts to achievable actions (silence is golden), organize service providers in a geography to create a footprint, and consider the delivery system.
• Outcome based measurement is more meaningful when it is noisy (dialogue vs. numbers)
• A lot of discussion about the role of social media.  :)
• Mobile apps are especially beneficial for rural physicians, wilderness medicine, home visits, disaster relief, emergency.
• At the end of the day, physicians are really going to care about the outcomes.
• Telemedicine drivers identified in Triple Tree  mHealth survey.
• Home telemedicine - keeping patients with chronic diseases in their home.

 

mHealth Conference Notes - Day 1

I'm at the San Diego mHealth Conference and thought I'd share some of my observations with readers.  If you have any questions or other perspectives, please leave a comment.

• Spyglass Survey: 90% of physicians using smart phones
• Telecare & Telemedicine, Connected Health and Wireless Health - all connected
• Doctors aren't going to wait to get back to their office to look up information
• Over 80% of patients consult the Internet for a second opinion and increasing numbers are using their smart phone
• Movie: Catfish premiers Sept 17 and it is the first social networking thriller
• Effective healthy changes will come from customizing apps to the person, engaging their existing social network of friends and family, extending their social network to peers combined with captivating and addictive rewards and incentives.
• Intimate digital relationship:  consumer must trust entity they are giving their information to.
• Need:  Premium to maximize your health vs. fee-for-service system.
• discovery of mirror neurons:  a neuron that fires both when an animal acts and when the animal observes the same action performed by another.
• Forrester Research: 95% of healthcare enterprises rely upon smart phones.
• mHealth - on the person
• Pricewaterhouse Coopers Survey:  Healthcare Unwired: New Business Models
• Providers want (and need) evidence at the point of care - can we create an app for mobile devices that will address:  access (search); tailor (if not found send when it exists); retrieve (download, highlight and annotate); archive (practice library with metadata, search and sort); share (output to video, email, export, EHR, send to professional network with annotation); write (use metadata to cite while you write to build reference list or pull data from EHR or article brought in by the patient to add)?  Lets create an integrated solution!
  • Safari is closest with access,tailor, share, write; but can't retrieve or archive.
  • Want Ping (for music) functionality in this app
• Security in uncontrolled environments - we really need to follow where the data goes between the mobile device and its destination. There are a lot of people/organizations involved in the process, so hospitals and other providers need to ensure that risk assessments are completed.
• Patch that not only measures calories burned, but also the number consumed which then triggers education!(ooohhh!)
• Need regulatory predictability because mHealth is moving so rapidly.
• Smart phones may not be needed for some of the 20% of patients who consume 80% of the care/costs.  Others, like boomers, may not want to look like a senior and want an app for their smart phone.
• Wireless networks do drop packets of data, so what safeguards are in place to ensure that data makes it to desired destination.
• Where does health and wellness leave off and the line to something that assists with diagnosis and treatment crossed (necessitating FDA approval).  Need to draw a brighter line between the two.  The mHealth Regulatory Coalition is forming to draft guidance and submit it to the FDA to facilitate this process. 
• Outcomes, predictability and data relevancy is essential.
• Automotive industry is a good place to look to see what is coming in the future.  One example is, people pay for OnStar to monitor the health of their car.  Should our health system support an OnStar for monitoring our health?
• Mobile health keeps coming back to patient behaviors.
• The role of telehealth and social networking were mentioned often.

 A lot of great things to think about as we look toward mobile health and remote monitoring. 

Remote Monitoring: Diabetes

The upcoming mHealth Conference (September 8 & 9 in San Diego) will include a presentation by one of my NRTRC board members on the topic of remote monitoring with the Native Hawaiian Health System.  It focuses on transforming the care for patients with diabetes from an episodic office based model to longitudnal care using blue tooth technology, a web based intelligent application that is integrated with the EHR and a smart phone to provide a continuum of care for primarily type 2 diabetes patients.

If you are attending the conference, I look forward to meeting you there!  Conference Brochure

The Crossroads of Telehealth, EHRs & HIE

The NRTRC has released a new white paper on the subject of the intersection between telehealth, EHRs & HIE.  The paper reviews some of the recent disruptors that will require a new approach to the healthcare delivery system.  It also describes how the telehealth infrastructures can be leveraged to facilitate health information exchange, especially in rural areas.

Your response to the paper is welcome.  Just leave a comment to join the conversation.