I’m old, and I’m not cool.

I’ve hidden these two flaws fairly well, but a recent high-profile tech acquisition has forced me to let the cat out of the bag. I’ve never used Tumblr (or Instagram for that matter), and I can’t force myself to close my Yahoo! account. I’ve checked that email address for the last 12 years. I fondly remember when my boyfriend/husband set it up for me in an Internet café in Amsterdam. He had been demanding for some time that I rid myself of my @uga.edu address. Graduation was looming and it was time for something more adult, more cool.

My how times change. It’s people like me, apparently, that are holding Yahoo! back and what prompted it to purchase Tumblr. As I’m sure you’ve heard (especially if you’re not cool like me and listen to NPR all the time), it paid over a billion dollars to acquire the micro-blogging site in an effort to get its ads in front of Tumblr’s 100 million users – most of which are young, cool and influential amongst their peers. It’s a demographic most marketers can only dream about having dropped in their laps. Now it’s up to Yahoo! to not screw it up, as CEO Melissa Mayer so succinctly said during a recent conference call.

News of the acquisition got me wondering, are EMRs cool? I think there’s certainly a hip factor around certain parts of healthcare IT. Openness, innovation, mobile health, social networking and bow ties seem to be in right now, but I’m not sure I’d go so far as to call any one particular EMR cool. Though athenahealth and Practice Fusion jump to mind as fairly cool from a branding perspective. Epic certainly seems to have won the word-of-mouth game, so perhaps it can be lumped into the cool category as well.

Perhaps the fact that only three brands come to mind is a good thing. I hope that most companies are spending more time focused on development than branding. Surely players in this most sacred of spaces would never acquire one company over the other purely to latch onto a coolness factor? I could understand the business acumen behind the decision to acquire a start up in the “hopes of gaining an edge in growth,” which is how a recent Wall Street Journal article described the Yahoo!/Tumblr transaction. Goodness knows there’s no shortage of start ups in healthcare right now.

How do you define cool in today’s world of healthcare IT? Is it about technology, branding or some unidentifiable “je ne sais quoi?” Share your comments with me below.

John’s Editorial Note: If Jenn’s not young and cool, then the rest of us are in real trouble.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.

* Make workflow changes gradual:

Too often, medical practices assume that they can implement an EHR without making major changes to their workflow.  The reality is, however, that many processes which worked fine on paper don’t work when you switch to using EHRs, Guerrero notes. So how do you go about making changes without upsetting and confusing staff and clinicians?  The idea, she says, is to make sure changes happen gradually. Giving people time to adapt to changes helps a lot with staff morale. (It doesn’t hurt to explain how the changes will benefit both staff and patients, either.)

* Ask for feedback:

Bearing in mind that changes to workflow will have to be made, how do you choose which changes come first? One way, Guerrero says, is to ask the people who are using the EHR which processes are slowing things down the most.  Be sure, she recommends, to include doctors, nurses, front desk and even billing staff in collecting feedback — after all, virtually any part of the practice can be affected by the EHR.  Once you’ve figured out which areas are the most troublesome, arrange them in order of importance so you can take them on in the most effective manner.

* Educate patients:

Now that Meaningful Use has pushed practices into making patient health data available to them, it’s time to encourage them to use it. That being said, patients may be overwhelmed by the amount of data being presented, especially when interpreting lab results, Guerrero suggests.  To reduce the impact of this change on patients, and avoid confusion, make sure you help them understand what they’re looking at and how it can help them improve their healthy, she says. And make sure let patients know you’re available to help answer questions.

Topic One: What does #healthcare innovation mean to you? How do you define it?

T1: Innovation in health means patient at the center, literate in healthy actions and equipped to engage. #HITsm

— Jon Mertz (@jonmertz) May 17, 2013

T1: 80/20 rule is important consideration in innovation. You don’t innovate to solve small probs #HITsm — Ryan Lucas (@dz45tr) May 17, 2013

#Innovation born/made – same nature/nurture question as all of life. Innovation can be born of desperation, but some generally prone. #HITsm — Mandi Bishop (@MandiBPro) May 17, 2013

T1: Innovation isn’t something you discuss! It’s something that you do.There is no formula for it. #HITsm

— Keith W. Boone (@motorcycle_guy) May 17, 2013

 

Topic Two: Do you see innovation in #medicine different than in public health, if so how?

T2: No (wo)man is an island – to extend the water references #MetaHITsm #HITsm

— Ryan Lucas (@dz45tr) May 17, 2013

T2: IMO Diff is the focus. Innov in Medicine= Early diagnosis & cure; Innov in Pub Health = Disease Prevention. #hitsm contd.. — Anshu Jindal (@AnshuBJindal) May 17, 2013

T2: Innovation in healthcare and public health is very different, IMO. Public health has a much large # to serve. #HITsm — Chad Johnson (@OchoTex) May 17, 2013

T2 – innovation in medicine needs to be more concerned with SAFETY as it directly interacts with patient #HITSM

— johnmoehrke (@johnmoehrke) May 17, 2013

Topic Three: What are effective methods of globally diffusing innovative ideas/tech when it comes to getting healthcare user buy-in?

Thing about tweeting knowledge. It’s not the tweets. It’s the social digestion of complex ideas that’s the ticket. #HITsm

— Melody Smith Jones (@MelSmithJones) May 17, 2013

T3: I compare #innovation to #socialmedia. It needs to stop being a thing that you conquer & become the fabric of your biz. #HITsm — Michael A. Gaspar (@MichaelGaspar) May 17, 2013

The problem with getting innovation out is that so many big companies control healthcare and don’t want to allow innovation in. #HITsm — EMR, EHR and HIT(@ehrandhit) May 17, 2013

T3: formative research, culturally on target, branding and marketing are not secondary thoughts #HITsm

— teawithpaloma (@teawithpaloma) May 17, 2013

 

Topic Four: Can you name any examples of tech & innovations developed in U.S. that have translated elsewhere, & vice versa?

T4: mHealth has developed disparately in US and worldwide-cycle continues to innovate and teach new things #hitsm

— teawithpaloma (@teawithpaloma) May 17, 2013

It would be innovative for the US to adopt the unique patient identifier used abroad. #HITsm

— Mandi Bishop (@MandiBPro) May 17, 2013

T4: Innovative business model at @medtronic entered new market by screening 20k people & implanted pacemakers in 2k patients in India #HITsm

— Cole Manship (@comanshi) May 17, 2013

What flows through you into the world?

It’s a powerful concept to consider what we’re doing of good in the world. In fact, he asked some follow up questions for those of us in healthcare.

Are you in healthcare to do good? Or just to make money? Or just to provide for your family? Or just because you have no other choice?

I remember when I first got my job in healthcare I was really empowered by the idea that maybe something I did could help save someone’s life. It’s amazing how the mundane gets in the way of that broader vision. Although, I feel pretty good about what flows through me into healthcare IT and EHR. It just can always be more. I hope you’ll join me in thinking about this idea this weekend.

Parental musings aside, I believe smart devices certainly do have their part to play when it comes to educating or even conditioning healthcare consumers, especially in the area of gamification. This point was driven home when I overheard my oldest say to my youngest as they played on the iPad, “Your health value isn’t high enough. You need to add more broccoli.”

“Smoothie Master” from TabTale was their game of choice. As the name implies, they were tasked with becoming masters of smoothie creation. I’m still not sure if this game is winnable in the traditional sense, but my seven year-old did explain to me that you could win points for adding healthy ingredients.

TabTale doesn’t seem particularly invested in promoting a healthy lifestyle, as it also has similar apps for mastering the art of making pizzas and hamburgers. But, their inclusion of a health value scoring system does make me wonder if this younger generation will grow up with an inherent sense of what behaviors will keep them healthy in real life. (The irony being that all the broccoli in the world won’t do them any good if they stay glued to the devices that are helping provide this type of education.)

Now, if I can just figure out a way to “gamify” the health value of the broccoli I fix at home so that my kids will eat it and think they have “won.” Let me know in the comments below if you’ve figured out a way to take virtual culinary successes offline and into the real world of kid-friendly cuisine.

The initiative grows out of a pilot, funded by a $1.4 million grant from the Robert Wood Johnson Foundation. The OpenNotes project, which lasted 12 months, brought together 105 primary care doctors with more than 19,000 of their patients, in an effort to see how both patients and physicians were affected by the sharing of doctors’ notes after each encounter, according to Healthcare Informatics.

The study group included 24 Geisinger primary care docs and 8,700 patients.  The rest of the patients and doctors  were drawn from Harborview Medical Center, Seattle, Wash., and Beth Israel Deaconess Medical Center.

Results from the pilot, which were published in the October 2012 Annals of Internal Medicine, showed that patients strongly favored seeing their physician’s notes.  Also, tellingly, no doctors asked to opt out at the study’s end.

Findings showed that patients did indeed read their notes and felt more a part of the care process when they did. Roughly 11,200  patients (or about 82 percent) opened at least one note found in their EMR.

Of patients who opened at least one note, 77 to 87 percent across the three study sites said that OpenNotes made them feel more in control of their care.  Doing so also helped them adhere to their medication regimens, the magazine said. Only a few patients reported higher levels of worry, confusion or offense due to seeing the notes.

Patients liked having the notes access so much that 85 percent reported that it would influence their choice of providers in the future.

It seems that opening up a patient portal isn’t quite the pandora’s box that some thought it could be.

First I should make it clear that I’m a great patient. I have extreme respect for the doctors I work with and follow their care plans to a T. For example, as a child I took accutane. That requires you to take pills twice a day. I think there may have been 1 or 2 times I missed taking my pills in 6 months. That’s pretty good if I say so myself. Regardless, I’m quite good at following the doctors care plan for me. Over time I have developed what I call a trust but verify approach. I trust that the doctor is doing what’s best, but I do like to confirm my understanding of why it’s being done when its a complicated situation. I don’t do this for things like common coughs and colds.

With this in mind, I was kind of blown away recently when someone told me about their 20 year old son who’s a diabetic. This patient and his parents had been dealing with his disease for about 15 years. As part of dealing with the disease they’d studied it and the various treatment and management options in depth. As he said, “we set a Google Alert and have read every study and discussion about the topic for 15 years.”

After moving, this diabetic patient went to see a new doctor who had just gotten out of medical school. A short discussion started and the patient quickly realized that he knew a lot more about his condition than his new doctor. What a challenging situation this must be for the new doctor.

I think most doctors are ok with this situation and have been dealing with chronic patients that know a lot about their disease for a long time. However, the availability of medical information is helping a lot of patients to be very well informed on their health issues. I wonder if a doctor use to treating well informed chronic patients has lessons we can apply to well informed general patients.

No doubt we’re in the stage of learning a new dance with a new partner. I’m not suggesting that we should change who’s leading the dance. The doctor should still be the lead for a lot of reasons. However, I am saying that the leader shouldn’t be surprised when their dance partner wants to provide some feedback on the choreography they’re doing. The leader might just find that working together they can produce even better results.

Side Note: It seems appropriate that I should use a dance analogy with the So You Think You Can Dance premiere tonight.

According to Gates, a nice tidy sum of $5.5 billion will be necessary to vaccinate enough children to finally push out the disease. The question arose as to whether or not this money will be spent wisely. Could it be put to better, more effective use fighting other healthcare conditions, such as malaria, that affect greater numbers of people? Gates made the point that once polio is eradicated, the enormous amount of money already being spent on fighting it can then be spent on these other issues – a statement that to me didn’t seem to sit well with Siegel.

Now, if you’re in healthcare, chances are money crosses your mind a few times a day. And if you use an EMR, you’ve likely voiced an opinion or two on whether it has lived up to its promised value. I think Gates’ point above on cost effectiveness of disease eradication – the most expensive disease gets eradicated first to free up its funds for other healthcare causes – can be applied to the EMR ROI debate.

Yes, healthcare is expensive. Yes, current and possibly future EMRs may not have the best interfaces or give the ideal user experience. But, given time (perhaps a lot of time), they will ultimately help springboard immense cost savings throughout the industry. I consider them the backbone of interoperability, especially when it comes to health information exchange and accountable care – two notions that might just become the norm once EMR utilization finally reaches critical mass.

Stage 2 Meaningful Use will likely see a shift in the market, and from what I’ve read thus far, is causing providers to think about Meaningful Use in a new way. It might be a hiccup in this journey to cost savings, but it will likely separate the wheat from the chaff as far as vendors go. Hopefully, only effective products will be left standing, which will in turn make it easier for providers to use EMRs in the most effective way.

Money will of course be on everyone’s minds at the upcoming HFMA ANI show in Orlando. This has got to be one of my favorite events as it is smaller than HIMSS but still has that bustling, breaking news vibe. I’ll be interested to hear from providers their opinions on the recent push for greater price transparency when it comes to hospital costs, and how they are feeling about EMRs as of late. It will also be interesting to see how vendors are helping these providers meet Stage 2 and patient engagement head on.

Will you be at the ANI show? Drop me a line in the comments below and let me know what you’re looking forward to learning about or seeing the most.

Use of #EMR or #EHR shot up from 18% in 2001 to more than 57% in 2011. [INFOGRAPHIC]: bit.ly/SMUY5N

— ONC (@ONC_HealthIT) May 6, 2013

I always love to grab the various EHR adoption numbers. Seems like most are hovering around the 60% number now. This one says 57% EHR adoption.

#EHRs take time to use, but is that time well spent? Dr. Peter Basch says it is. The story: bit.ly/15Al1q9 #millionhearts

— ONC (@ONC_HealthIT) May 7, 2013

Of course, this is coming from ONC’s Twitter account, but I’m always happy to read someone’s story. If you’re willing to put your name to it, I’m willing to read it and see what you have to say. Plus, he takes a realistic look at some of the benefits of an EHR in a real matter of fact way.

Microsoft’s HealthVault guru Steve Nolan talks about his vision for electronic medical recordsthenextweb.com/microsoft/2013… #EMR #digitalhealth

— Kate Rogers (@Kate_E_Rogers) May 12, 2013

This is probably the most focused and well written description of the real reasons why EHR software is a disappointment today. Unfortunately, the issues described are a fundamental problem with the healthcare system and something unlikely to change in the near future.