In The Know - MEDSEEK News and Expert Opinion on the eHealth Industry

Why People are Signing the Petition on change.org >> ONC: Engage Patients & Families in their Health - Enhance Meaningful Use Stage 2

“Patients with chronic conditions spend less than 0.01% of their lives interacting with their health care providers. Patient engagement through access to their health data and supporting education and information is essential so that a portion of the remaining 99.99% of their time can be dedicated to managing their own healthcare.”

“I believe that knowledge is power, and to be better informed with respect to our own healthcare will help us to be active & responsible participants in managing our health.”

“Patient portal technology is critical to helping me take control of my health management and will help reduce healthcare costs in the long run.”

“Positive patient outcomes begins with patient empowerment which can only occur when patients and families are engaged in their health and health care.”

“Because it is important for us to be engaged and have easier access to our medical information. This helps us take control of our own health and makes it easier for us to do so by creating and empowered society you make a healthier population.”

“I believe everyone should be able to know as much as possible, about their own health situation, in order to make the best individual care and management choices.”

“Health is a function of participation. As Leonard Kish articulates so well in his blog, http://ideasarecheap.posterous.com/acos-and-moneyball-medicine-part-iv-high-prob, we to stimulate innovations in designing next generation of consumer-centric ehealth solutions and ecosystems (including EMRs, PHRs, HIEs)and which creating network effects through an "architecture of participation." Keeping Patient Engagement in MU will be a key driver to move us from provider to consumer centric approaches.”

“I am an educated, informed and competent person who expects access to information that will help me better manage my most valuable asset, my health.”

“Health care is way behind in technology. There's no excuse for paper transactions and delays in client information anymore.”

“As a patient with a chronic disease, managing my health through my own tracking (spreadsheets) is archaic and error-prone. Having the ability to access my medical records through a secure patient portal will help me better manage and be educated about my condition.”

Add your name to the ever-growing list of patients who demand to be included in the healthcare equation. Sign the petition today!

View and manage my health online? Not so fast. The HIT Access Battle. What’s at stake for you.

As the deadline to file comments regarding Meaningful Use Stage 2 is Monday, May 7^th, many organizations and individuals are weighing in passionately about the proposed rule. And the battle for patient engagement and accessing our health information online continues...

The American Hospital Association (AHA) publically released their 68 page comment letter expressing opposition specifically to many of the Patient & Family Engagement measures proposed in Stage 2. Rick Pollack, executive vice president of the AHA states, "Taken as a whole, the proposed requirements for meeting stage two raise the bar too high.” Among their comments, the AHA articulates apprehension for providing patients the ability to view, download and transmit their protected health information via a patient portal, stating “The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity.” Additionally they have suggested that the currently proposed 36 hour turn-around time for patients to have access to their health information is too aggressive and should be extended to 30 days. Cue the flood gates for e-patients and patient engagement activists to respond to the AHA’s strong stance.

Christine Bechtel, vice president of the National Partnership for Women & Families and a member of the HIT Policy Committee reacts to the AHA’s letter saying, “It shows that, when it comes to patients’ access to their own health information, the group (AHA) has little interest in advancing Meaningful Use criteria that would result in tangible benefits for patients.” In regards to AHA advocating for a 30 day timeframe for patient access to their health information, Bechtel states “No patient in this day and age should have to wait a full month for access to their own health information, which is vital to their ability to get and stay well. And no hospital should want to do this--especially with payment penalties for unnecessary readmissions about to be put in place.” ePatient Dave also weighs in on AHA’s comments in a message to HHS Secretary Sebelius, “American healthcare is the world’s most costly and is often far from effective. Give Us Our Damned Data –Let Patients Help!”

These two opposing sides of the battle for Patient Engagement roar on, begging the question--as a patient and family member, do you deserve the right to access your health information and equip yourself with knowledge to manage your most valuable commodity, your health? To let your voice be heard, sign the petition to keep Patient Engagement in Meaningful Use. To further support the effort, please comment on the official regulations site before May 7^th.

Stay tuned for MEDSEEK’s comments to CMS about the proposed rule for Meaningful Use Stage 2. For additional information on keeping the Meaningful in Meaningful Use, see our 9 part blog series.

Healthcare - At What Cost? The Need for Price Transparency Continues to Grow

With Meaningful Use, ACOs and the move towards quality-based reimbursements, hospitals are making great strides towards putting the patient at the center of care, except when it comes to cost.

The success of healthcare reform depends upon hospitals and providers engaging patients and equipping them with the tools they need to manage their own health. These tools include secure Internet access to personal health records and family accounts, the ability to go online and self-schedule appointments, see labs and test results, request prescription refills, and communicate with physicians and care team members, ask them questions and share information from home health monitoring devices.

Healthcare providers are forgetting that patients bear the brunt of spiraling healthcare costs and are being forced to shop around for healthcare services, to become healthcare consumers. While great strides are being made to support the patient, the emergence of the healthcare consumer is being ignored.

Consumers expect to be able to compare prices. It’s possibly the single-most important factor when making a major purchasing decision, and there can be no doubt that healthcare services can be major purchases. So why don’t healthcare consumers get to see the price tag before they buy? After all, hospitals provide quality scores, patient charters, and other consumer-like information. Why not the cost?

Read the recent LA Times article:
Healthcare pricing still a struggle for consumers
Comparison shopping for medical procedures can involve a web of billing codes and arcane terminology, despite efforts in California to simplify things.
http://www.latimes.com/business/la-fi-adv-medical-prices-20120415,0,7106684.story

9 Things That Will Take the MEANINGFUL Out of Meaningful Use - #4 Fail to integrate the patient portal into your over-arching eHealth strategy

There’s no doubt that the Office of the National Coordinator is orchestrating a digital health transformation. Federal recommendations for Meaningful Use Stage 2 require provider adoption, patient and family engagement, and health information exchange. These requirements, which are synergistic with patient expectations, will help address the aging population, fundamental shift in reimbursement, and quality issues associated with multiple sources of patient records, but a patient portal alone is insufficient to meet the acute need for strategic patient engagement and patient care coordination. Hospitals and health systems need a long-term strategic digital health plan.

Due to the fundamental market shift in reimbursement models that is underway, hospitals are attempting to reinvent their care delivery model to prepare for the new risk and reward-based plans. This is leading to rapid acquisition of physician assets, provider consolidation, and the establishment of Patient Centered Medical Homes to help with Care Coordination. Patient Activation, Population Health Management, and Telemedicine are all essential in order to reduce costly readmissions and reduce the burden of chronic disease. Hospitals will need to dig deep into processes and systems to see where more efficient tools can be put in place and will need sophisticated analytic capabilities.

Transformative changes are particularly critical as hospitals gear up to care for an increasingly sick and aging patient population. The Baby Boomer generation is so big, it’s literally been coined the “Silver Tsunami.” Nearly two-thirds (35 million people) of the Boomers have at least one chronic health condition and that trend, unfortunately, is expected to continue to rise. That explains why, on average, Medicare recipients see seven physicians a year across four different practices and the average hospital has to coordinate care for 229 physicians across 117 practices. The costs associated with treating these patients and coordinating their care are staggering. Most hospitals need help prioritizing their IT budget and developing a strategic IT plan that will help control these costs.

To better balance margins, their comprehensive digital health strategy further needs to incorporate digital tactics that are proven to attract and retain more well-insured patients. This strategy needs to account for the reality that, according to the Deloitte 2011 Survey of U.S. Health Care Consumers, two out of three patients are already willing to switch providers just to gain online access to their medical records. That means the first hospital in a competitive marketplace to offer a competitive patient portal is going to have a significant jump on dominating ePatient market share.

Healthcare organizations need a consulting partner that has extensive experience helping hospitals realize new cost savings through precision marketing, process automation, online communication, self-service, patient activation, and reduced utilization. They need to be the experts in identifying digital health tools that will improve the bottom-line and prepare the organizations for survival in the “new era” where there will be less money, overall, in the system.

Choose a partner with a proven ability to help hospitals generate new sources of revenue by finding and attracting high-value patients, generating repeat business, cross-selling profitable services, and driving well-insured patients to money-making assets like centers of excellence and surgery suites. The strategic eHealth plan should outline how any IT nvestment you make will help you influence patient behavior and sway utilization patterns on both sides of the equation, leading to balanced margins.

9 Things That Will Take the MEANINGFUL Out of Meaningful Use - #3 Wait too long to get started

To put it bluntly, if you don’t already have or are not well on your way to having a patient portal in place, you are in trouble for Stage 2. The proposed rule requires both physicians and hospitals to make patient health information available online AND demonstrate that at least 10 percent of patients are accessing it by calendar or fiscal year 2014, respectively. This is no small undertaking, as just implementing a patient portal can be a long, albeit rewarding, process. In addition, additional time must be allowed to achieve the enrollment and adoption measures.

To help healthcare organizations understand why they simply cannot afford to wait two more months, weeks or even days to embark on their patient portal journey, we’ve worked hand-in-hand with patient portal project leaders at some of the nation’s largest health systems to identify the key phases that all patient portal projects must go through on their way to successful adoption.

1. Plan – Successful patient portal projects require considerable planning. If the portal is ever to deliver on its promises of engaging and activating patients, it's essential to tie the project into the organization’s overarching clinical and IT strategy. During this phase, health IT leaders will need to plan for the infrastructure costs, as well as the costs associated with having the proper support mechanisms in place for patients and physicians. This is when you must also determine your rollout strategy – will you soft launch to employees only, will you start with physician offices first, hospital patients first, or go live with all patients at once? Whatever your strategy, you need to assume there will be cultural resistance and plan accordingly to overcome it.

2. Design - This requires involvement from a cross-functional team of stakeholders, most of whom are juggling competing priorities. Don’t be tempted to back down here…getting the right people on the project team upfront is important― and their grass roots support will prove to be an important component of overcoming physician and staff resistance later on. Think carefully about the rollout strategy you identified in the planning phase and prioritize portal features to drive adoption at each phase. Your vendor should offer their expertise here, but focus groups and patient surveys can also be helpful in understanding which features are most desired in your market. Be ambitious, but know that you don’t need to add all features at once or you may not go-live within the required timeframe.

3. Build – The amount of time required to build the portal framework, incorporate outlined features and functions, and integrate data from backend systems varies greatly depending on your portal strategy. Portals developed in-house will undoubtedly take the most amount of time because employed resources are highly unlikely to have experience with similar projects and are more easily distracted by competing internal projects. Systems integrators or custom-build vendors will be quicker than in-house resources, but not by much, since everything will still be designed and built from the ground up. Vendors who offer out-of-the-box software can deliver in the shortest amount of time, but you want to be sure their solution is highly configurable to accommodate your organization’s specific workflow and business objectives.

4. Test - When patient portal projects run behind or need to be accelerated, it’s tempting to cut down the testing phase and that’s a big mistake. All of the work you’ve done in prior phases to ensure the right features and functions are included and to overcome cultural resistance will be negated if you prematurely expose the portal to physicians and staff before it is ready for primetime. Testing not only exposes areas where the portal may not be performing 100 percent as designed, but it often reveals opportunities to adjust and improve workflows. Existing workflows may be incorporated during the design phase, but when these are exposed through the portal, it is common for organizations to identify things they want or need to change to support new efforts to better engage patients and families as partners in the care process.

5. Train and Support - Coordinating training and developing internal support systems is essential to the project’s success. Financial staff, front office staff, back office staff, clinicians, administrators, everyone is impacted by a robust patient portal and training plans need to be comprehensive and thorough so that everyone can be enthused about and effective at using the portal to improve patient care and satisfaction. Ensure training is relevant to the audience, take it to their working environment whenever possible, and again consider offering incentives to encourage participation. Make sure everyone knows how to obtain support and reassure them that responses will be quick and dependable.

6. Launch – This is the phase where the proverbial rubber meets the road and all your planning, creativity and hard work come together. Launch is comprised of myriad activities including portal promotion, patient enrollment, responding to requests for support, and system adjustments.

7. Reinforce - After the launch phase, you’ll need to reinforce desired behaviors and measure your success against thresholds outlined during the planning phase. Be open to suggestions from patients, clinicians and staff and communicate go-forward plans for enhancing the patient portal on a regular basis.

To better understand how much time should be allotted for each of these phases, click here to request a free copy of a sample patient portal implementation timeline. The sample timeline that will be provided is based on MEDSEEK’s Blueprint™ implementation methodology, which ensures patient portal project success by leveraging strong, effective and proven best practices and processes.

iHT2 Summary: Creating Value Based Care ACOs

At iHT2 in San Francisco, we learned that as we get closer to the notice of proposed rulemaking for ACO’s (possibly next week?) existing organizations are closely looking at how they can move from volume based to value based care.  Comments were made by many throughout the event, including Mark Blatt Director, Global Healthcare Strategies, Digital Health Group Intel Corporation, that while Congress is incenting us with $40B in upfront dollars, the government (much like GM) will go bankrupt if it does not squeeze $400B out of the system in the coming 10 years.  As part of this revolution, healthcare organizations – which have done little to change in the last 10 years – are being forced to rapidly evolve in a compressed amount of time if they want to remain solvent in the coming future. 

ACO’s are not a “project” and the serious healthcare organization is quickly aligning with payers/employers and physicians, looking at technical and physical infrastructure and contemplating continuity of care models that will ultimately make the patient the focal point of care.  HCO’s will be required to look at managing populations in order to build healthy communities and are currently putting together the right technology and tools to be prepared to electronically exchange data and measure the impact of their efforts.

Other countries such as Sweden have dramatically reduced the number of hospitals from hundreds to double digits all while seeing overall improvements in the populations care and at a lower cost.  Americans are poised to see dramatic changes in the way their traditional physician and the care team perform their job and the level of participation and prevention that will require them to manage their own care.  Get ready for the revolution.

Learn more about how to become an accountable care organization and download Accountable Care Organizations: The Next Steps

Bob Cushman
Sr. eHealth Consultant, MEDSEEK

What are your grandparents doing online?

Where do your grandparents spend their time?  When they aren't spoiling their grandchildren they are almost all online.

Today, there are 69.6 million grandparents in the US, and this number is expected to grow to over 76 million between now and 2015. In a recent report, Nielsen reveals this growing market segment of Internet users (they account for nearly 32% of the active audience!) is one to watch closely. So, where do these tech-savvy grandparents spend their time when they are online?

It should come as no surprise that sending and reading emails was the number one online activity. But it was closely followed by accessing their online personal health records.

Grandma may not be an avid texter and might not check into her social media accounts on her smartphone right now, but she will be soon. Mobile use as well as social media activity is also increasing as the older population increases their usage of smartphone apps.

It's an undeniable fact: our grandparents are active, connected, spend money and are online. Just last August, Pew Internet reported that the fastest growing demographic for Facebook and other social media were age 50 and older.

Marketing professionals, especially those in the healthcare market, MUST include this segment in your marketing plans or you will miss a significant opportunity.

Click here to view the Nielsen Wire Article: U.S. Grandparents Share More than the Love.

Do you remember having a computer that wasn’t mobile?

For the first time smartphones are outselling computers, according to an IDC report that documented the surge of smartphone purchases in the fourth quarter of 2010.  Interesting note, when CNN covered the IDC headline, they did not reference smartphones; instead they referred to smartphones as “mobile computers”.

Let me ask you, true or false: “I never leave home without my wallet or purse, my keys and my smartphone.”

So what does that mean to those of us in health care?

Many us are getting ready to go to HIMSS11 in Orlando in two weeks. We will see many sessions and vendors highlighting Meaningful Use, EMRs,  HIEs and ACOs – a glimpse at the foundation of what will become the future of health care. But I wonder… with all of these changes taking place, what will be the buzz at HIMSS in five years?

The stethoscope was invented in 1816… 200 years later, will we still be using one? How much will IT advance? Will social networking take a bigger share of healthcare information? Stage 1, 2 and 3 of Meaningful Use will be complete. HIEs will be deployed. NHIN will be in place. ACOs will be the norm. What will be new on the horizon?

I predict:

• a new mobile eHealth ecoSystem will emerge

• tablet computers will replace laptops just as they’ve have replaced tower computers

• MP3 downloads of discharge instructions will replace CDs just as CDs replaced paper documents

• live video discussions with a physician from my smartphone or tablet computer  will replace specific face to face office visits

                       …and the list goes on.

Yet as we face the challenges of 2011, 2016 doesn’t really seem that far away. Does it?

Have you hired your hospital’s Social Media Manager yet?

If you haven’t…  you will  soon. There is no denying the impact of Facebook, YouTube, Twitter and other social medial online resources. We have seen the rise of patient-focused social websites such as Patients Like Me and the impact they have on patients and their families. The HITECH Act will continue to encourage the use of the internet as a primary channels to improve health care.

In the not too distant future, it is easy to see how these types of sites will become much more integrated into engaging patients and their families with their own health care – especially as the patient becomes a “partner in care” as part of the growing ACO movement. 

A recent article in American Medical News describes how Seattle’s Swedish Medical Center has hired a Social Media Manager to interact with patients and families – and physicians as well. Do not make the mistake of looking at social media websites as fads… they aren’t. Those who embrace social media and build a social media strategy into their marketing plans and into their internal programs will be counted as the leaders, not the followers.

Click here to read the full article.

Are you ready for Stage 2 of Meaningful Use?

I know many of you are saying, “I’m not done working on Stage 1 yet, why would I worry about Stage 2?”

Consider this:  The earliest a hospital can begin to apply for Meaningful Use incentive payments is October of 2011. To begin receiving money, you are required to show 90 days of continual Meaningful Use compliance. Hospitals will need to begin this cycle by July 1 of 2011 – which just so happens to be the exact same time when we should know the requirements for Stage 2!

What does this mean to hospitals? You must “have an end in mind,” one of the 7 Habits of Highly Effective People, according to the book written by Steven Covey. We do not have the exact requirements for Stage 2 and 3 yet, but we have enough knowledge and information to predict what is to come. In order to get the maximum incentive dollars available, you must be in the game now. If you are not far enough along in the planning or implementation process to tackle the objectives of Stages 1 and 2 and have a plan to get Stage 3 by 2013, you will miss out on receiving the maximum dollars allowed.

A recent e-CareManagement blog post is asking the question “What will be needed in Stages 2 and 3?” 

What technologies are involved?

• Stage 1: mostly existing functionality of current EMR offerings, with enhancements to achieve specific MU objectives
• Stages 2 and 3: EHR (electronic health record) technology platforms and thousands (yes, thousands) of applications, many of which are early in-development or not-yet-dreamed-of.

For example, the Patient Centered Primary Care Collaborative recently described the range of technologies that will be necessary to fully implement the Patient Centered Medical Home:

Definition of Health Information Technology and Exchange (HIT&E):  Any computer hardware, software, electronic service, and/or related technologies that provide or enhance the capabilities of the patient centered medical home across the community . These may be installed solutions, service solutions, or solutions provided in some way by a third party (health plan, community organization, RHIO, etc) and could include – but are not limited to – EMRs, PHRs, EHRs, interactive web portals, patient or population registries, e-prescribing software, communication platforms such as secure e-mail, online scheduling, connectivity to home monitoring systems, data aggregation and reporting services, electronic decision support tools, and other online or web services that accept and process personal health data for the purpose of supporting better health care decisions.

The takeaway? Planning is not about 2011; it really is about 2015 and what hospitals must do today to meet the Meaningful Use requirements in four short years.

Click here to read the entire blog post.