The 2013 SHSMD Annual Conference in One Word

SHSMD Annual Conference

Having spent my week at SHSMD schmoozing with the biggest gathering of healthcare strategy, planning, communications, marketing and PR professionals that the Society has ever had, the current state of our industry can be summed up in a single word:

Uncertainty

We’ve been on the cusp of major industry shifts for a few years now, but for all of the discussions and debate, no one is really sure what our industry is going to look like three years from now.

This week saw the biggest step to date in terms of actual implementation of the ACA (AKA Obamacare) and we’re still playing a guessing game to determine what its real meaning to our service mix and financial picture will really be. Obamacare applies leverage to the edges of the healthcare system, but doesn’t dictate what the care delivery system will look like or how it will work.

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What Health Reform Means for the Healthcare Web

We’ve written quite a lot about health reform in its various forms including Meaningful Use, ACOs, ACA, and medical home. But a question that I received this week made me realize that I’ve never written specifically about health reform’s impact on your hospital’s online strategy.

Greater Organization Complexity

Merging, acquiring, and employing docs and the many flavors of business relationship between hospitals, clinics and insurers that are emerging under reform means that your brand is getting pretty complicated. This isn’t just a question about names and logos – your website has suddenly become the front door to a very complex and likely changing mix of doctors and services. Your job is to make it simple for every site visitor to get the information they want. I strongly recommend our webinar on using the Web to support complex organizations to dive into the topic in greater detail.

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Transforming Meaningful Use Check Boxes into Differentiators for Your Hospital

There are a lot of reasons hospitals are embracing patient portals. And Stage 2 of Meaningful Use (MU), particularly the rule requiring hospitals to provide more than one-half of inpatient or emergency department patients with the ability to access admission information within 36 hours of discharge, is a certainly right up there.

But patient portals offer more benefits than just checking a box on a MU requirement.

That’s the focus of an article published in For the Record, the bi-weekly publication for the Health Information Management Association.  Experts – including our own Ben Dillon – weigh in on the issue of effectively using patient portals to help patients take a more active role in managing their own healthcare.

The article, Patient Portals: A Window to Information details why portals appeal to patients and discusses how hospitals can market the availability of a portal, transforming MU requirements into a selling point.

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Comments in Response to the Meaningful Use Stage 2 Notice of Proposed Rulemaking (NPRM)

Geonetric submitted comments this morning on the proposed Stage 2 requirements for Meaningful Use. We share those comments here:

As we look forward to the next stage of Meaningful Use (MU), we are excited. While the MU Stage 2 NPRM focused attention on a number of areas that most providers avoided in Stage 1, there were some pleasant surprises, particularly in the area of patient and family engagement.

Engagement

Most important is newly proposed requirements for patients to actually USE the software. The ultimate goals of healthcare reform require patients to be partners in their care. New models of care don’t work without robust patient engagement.

Patient engagement is an area which we, as an industry, are currently weak. The absence of criteria in Stage 1 for the actual use of deployed tools has led many EHR vendors and provider organizations to take a “check the box” mentality. The result: a lack in usability from many patient-facing technologies deployed during Stage 1. The newly proposed metrics will overcome this.

I hope these requirements were not put into the NPRM with the intent of being sacrificed. I anticipate there will be negative comments in this area. In fact, I’ve already heard some in the industry suggest these items were added so they could simply be removed later as a way for CMS to appear responsive to public comments.

Stage 2 patient engagement requirements are a reasonable and necessary step to verify the meaningful use of consumer-facing technology. Not only will vendors be required to improve tools that are unusable today, but provider organizations will also be required to incorporate these technologies into clinical practice.

It is certainly possible to look to different metrics of patient access and use. For example, we need further clarification as to what constitutes a secure message under §170.314(e)(3). Certain platforms use messaging as an unstructured way to communicate what should be managed as structured data, and I’d hate to see a further move in that direction as an unintended consequence of these requirements.

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Meaningful Use Stage 2 Ushers In the Age of the Patient

We’ve had a few weeks to wrap our heads around the Meaningful Use Stage 2 Notice of Proposed Rulemaking (NPRM) and it’s clear that the Feds are looking to shake up the industry a bit. Why? It’s time to pursue the true objectives underlying healthcare I.T. adoption in HITECH.

Meaningful Use Stage 1 has been successful in moving the industry toward medical record adoption. The hurdles for demonstrating Meaningful Use in Stage 1 are low, but have caused organizations to begin implementing basic infrastructures – and this will turn out to be a good foundation for what’s to come. Unfortunately, Meaningful Use Stage 1 requirements have not broken the boundaries that exist between providers, hospitals and patients.

As we predicted, Meaningful Use Stage 2 seeks to give everyone involved the data they need by placing renewed focus on sharing information between providers, submitting public health data, and engaging patients and families.

The requirements around engaging patients and families have been amongst the most often deferred by provider organizations in Meaningful Use Stage 1. The NPRM clearly establishes that this goal of the HITECH Act isn’t going away and raises the bar significantly for connecting with patients and their families online.

Meaningful Use Stage 2 Criteria
The following is a summary of the Meaningful Use Stage 2 criteria for patient and family engagement (with comparison to Meaningful Use Stage 1 in parenthesis):

  • Of all patients who are discharged from the inpatient or emergency department:
    • More than 50% have their information available online within 36 hours of discharge (Stage 1 was 10% and optional)
    • More than 10% are provided patient-specific education resources identified by Certified EHR Technology (Stage 1 was optional)
    • More than 10% view, download or transmit to a third-party their information during the reporting period (New)
  • Of all unique patients seen by the eligible providers during the EHR reporting period:
    • More than 50% are provided timely online access to their health information (timely is defined as within 4 business days after the information is available) – ( Stage 1 was 10% and optional)
    • More than 10% view, download, or transmit to a third-party their health information (New)
    • A secure message was sent by more than 10% of unique patients (New)
  • For office visits:
    • Clinical summaries provided to patients for more than 50% of office visits within 24 hours (Stage 1 was within 3 days)
    • Patient-specific education resources are available for more than 10% of all office visits (Stage 1 was optional)

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Obamacare, The Problem Child

In a series of high-stakes court battles, the Patient Protection and Affordable Care Act (PPACA) has viciously torn its way through the legal labyrinth. From a high-level procedural posture standpoint, many lower courts have heard cases involving PPACA.

U.S. District Judge Roger Vinson ruled that the individual health insurance mandate falls outside the federal authority in the Constitution, and that the provision could not be disconnected from PPACA; therefore concluding the entire Act must be struck down. In the converse, members of a three-judge panel at the District of Columbia U.S. Circuit Court of Appeals ruled 2-1 that the individual health coverage mandate is constitutional. The dissenting judge on the panel argued that the federal Anti-Injunction Act prohibits the federal courts from considering suits seeking to block implementation of new federal taxes, at least until they incur some sort of penalty. The 4th Circuit Court of Appeals agreed with that judge, dismissing two PPACA cases concerning the individual mandate, finding that the suits were barred under the Anti-Injunction Act.

The Eleventh Circuit Court of Appeals dividedly affirmed Judge Vinson’s decision in part; the panel agreed that the mandate was unconstitutional, but held that it actually could be severed from the rest of the Act, allowing the rest of PPACA to remain. The federal government declined to seek review by the Eleventh Circuit and instead petitioned for the U.S. Supreme Court to review the panel’s ruling. On November 14, 2011, the Supreme Court agreed to hear the case, and here we are today; the commencement of that hearing.

Does the problem child have a future?

Every child has a future. In this case, even if PPACA is struck down, all parties seem to agree that future healthcare reform will draw at least in part on Obamacare. However, in this case, of the four issues the Supreme Court has agreed to hear, the key issue is the constitutionality of the individual mandate.

According to a CMIO post, if the Court upholds the individual mandate it will go into effect in 2014. If they strike it down, the Court will then consider whether the mandate is severable from the remainder of the law, which will determine whether PPACA’s other provisions survive. If the Court decides that the individual mandate is “inextricably linked” to PPACA as a whole, they will likely strike down the entire Act.

One of the most frequently asked questions in regard to the individual mandate is, “What does the provision mean for those who don’t purchase healthcare?” Individuals who can but choose not to obtain qualifying health care coverage under this law will be required to pay a penalty as part of their income tax returns. In 2014, the penalty is $95 or 1% of the individual’s income, whichever is greater.

However, according to NPR, PPACA provides a vast system of subsidies to help people afford health insurance. Subsidies are available to people on a sliding scale, up to 400% of the poverty level. This year that would be a family of three with an income up to $76,360 and a family of four up to $92,050. Even then, if there’s no affordable policy available, people can be declared exempt. And most of those with insurance provided by their employer will meet the requirement automatically, so they won’t have to do anything.

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Meaningful User Adoption

Medical Records, patient portal, user adoption, meaningful use stage 2The latest version of Meaningful Use Stage 2 was recently released (see Ben Dillon’s blog post ), and there are two items related to how patients access health information and providers online that I found fascinating. The proposed rule requires that online access to health information and secure messaging be available to 50 percent of patients and – more importantly – 10 percent of patients must use them.

We Can Do Better!

Meaningful Use Stage 1 rules required hospitals and eligible providers to make information available to patients in an electronic format. What sounded like a promising step forward for patients has turned out to be nothing more than files delivered on CD-ROMs or via a “secret,” un-promoted patient portal. In short, it was only marginally better than the current medical records request process.

We can do better, right? Allowing patients to digitally access health information isn’t easy, but we’re committed to solving this in a way that puts consumers at the center of the experience.

To help health consumers understand the benefits of actually using your patient portal, you’ll have to focus on more than just the clinical and I.T. aspects. You’ll need to focus on the patient experience too. It’s essential that you create a value proposition that convinces patients to adopt your technology. This means implementing software that makes it easy for consumers to interact with your organization and retrieve their health information.

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More Insights on Meaningful Use Stage 2

As the conference room, and then the overflow room both surged beyond their capacities with HIMSS attendees looking for insights on Stage 2 of Meaningful Use, I began wondering if there would be anything for the presenters to say. Rumors of a new Notice of Proposed Rulemaking (NPRM) have been swirling for weeks with the date gradually slipping back. Checking Twitter again confirmed that nothing had yet been released this morning.

But we soon learned the NPRM was submitted this morning and will be released to the world later this week. Most importantly, our presenters were allowed to start sharing the important details.

Today’s Meaningful Use Stage 2 discussion was a joint presentation with Farzad Mostashari and Steven Posnack from ONC joined by Elizabeth Holland and Travis Broome from CMS.

The presenters all reiterated that the committees involved have all stayed the course with the intent of the legislation, Stage 1 rules and discussions to date.  And, as advertised, most of the information shared was to be expected. Still, with so many different stakeholders involved, it was good to get some confirmation about the direction they’re proposing.

The major themes (and in the time available, we weren’t able to get much more than themes) are as follows:

Streamlined Process
The regulations should be clearer and more flexible. Much of the feedback that the committees took to heart seems to have been in areas where the process didn’t fit the situation. Organizations can now implement only what they need to achieve compliance rather than installing software simply to check a box. Likewise, vendors working on modular certification won’t be required to test against criteria that do not apply to their tools.

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Healthcare Marketing: Four Big Trends for 2012

As the director of product strategy, part of my job is to keep a watchful eye on industry trends and ensure our VitalSite content management system stays a step ahead of market needs. That doesn’t mean I have a crystal ball, but it does mean I am in a unique position to evaluate what’s a trend – and what’s just a temporary buzz. Here are four areas I think will get a lot of attention this year.

Beyond Mobile
There was enormous buzz about mobile in 2011, and not without good reason. Geonetric clients saw steady growth in mobile visits throughout the year. Headed into 2012, I think we’ll be seeing less hype, and more substantive focus on the value that can be delivered by a variety of devices – not just phones – to create integrated experiences for health consumers.

Continued Smart Phone Growth
While growth in the use of mobile devices for Internet consumption was tremendous in 2011, we won’t see any slow-down in 2012. Expect a big jump in January as consumers take to the new smart phones and tablets they received as gifts, then a return to consistent month-over-month growth throughout the remainder of the year.

Forecasts indicate that overall internet consumption on mobile devices will exceed that on traditional computers by 2015.

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Creating Online Value for Health Consumers

As the saying goes, you never have a second chance to make a first impression. This has never been as true as it is for websites. The minute visitors encounter your site they’re making judgments: How credible is this site? How easy it is to complete my task?

You have the power to ensure your hospital’s online presence makes a good first impression. So how do you want visitors to feel? What experiences do you want to create for them? What reasons are you giving them to

The first interaction consumers have with your organization could occur online – perhaps they’re using the Web to learn about your services or to find a provider. Consumers could be familiar with your organization and just visiting the site for the first time – perhaps to look up a diagnosis. Regardless, every visitor has certain expectations that need to be met.

Here are some aspects to keep in mind as you work on delivering value to site visitors:

  • Compelling Design: Before visitors have a chance to make an appointment or even read your content, they see your visual design. How does your design communicate your organization’s brand? Is it antiseptic or caring? Does it look like it was designed specifically for your hospital or does it look like a free template? Visual design offers more than just aesthetics, it establishes credibility.
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Defending the EHR

Is your electronic health record (EHR) too expensive, slow and inflexible? Is it painful to use?  If it is, have a look at Extormity, and then perhaps you’ll feel a little better. Extomity’s tagline is “Expensive, Exasperating, Exhausting.” Extormity  is certified by SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s.  After  looking at the site, you’ll at least get a good laugh out of the spoof on the worst of the EHR industry today.

The Extormity gag was taken a step further at HIMSS 2011 with an actual interview with the CEO of Extormity.  Full of excellent lines like “We store sensitive patient data on old 8-tracks, no one ever steals REO Speedwagon 8-tracks” and “We’re a Manackled® patient portal.  If you like tethered portals, you’re going to love Manackled® portals.”

We all laugh because we’ve all seen little bits of this in the real world of EHR vendors.   What Extormity isn’t hitting on is the very real question – are EHRs improving care and outcomes as they’re implemented today?

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HIMSS Keynotes Discuss Success of Incentive Program

Wednesday morning’s HIMSS keynotes were from   The Honorable Kathleen Sebelius, United States Secretary of Health and Human Services, and Dr. David Blumenthal, National Coordinator for Health Information Technology, discussing the progress of EHR adoption under the ARRA HITECH program.

Sebelius and Blumenthal discussed just how far the industry has come. When the Obama administration came into the White House, only 2 out of 10 doctors had even a basic EMR.  That number is now up to 3 out of 10; with 4 out of 5 hospitals and 2 out of 5 individual physician offices intending to qualify for ARRA HITECH funds.  Clearly this incentive program has accelerated the adoption of digital records technologies across the healthcare spectrum.

The process of establishing the final Stage 1 Meaningful Use criteria was collaborative, albeit lengthy. It’s taken a lot to get to this point including the development of a process for selecting certification bodies, the creation of a network of Regional Extension Centers to assist with EMR adoption, and the Beacon Community grant program along with many other efforts.

I would have to agree that overall the political support for these initiatives has been robust and bipartisan.  This is evident if you look back at keynote speakers at the HIMSS conferences over the past few years, which range from Newt Gingrich to Al Gore.

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H&HN Article Relays Obstacles of ACO Adoption

As I learn more and more about Accountable Care Organizations (ACOs) two thoughts come to mind.  The first is the immense potential that this set of sweeping changes represents when it comes to bending the healthcare cost curve while improving overall health.  The second is an overwhelming bewilderment at the twisted mess that will need to be sorted out to actually make ACOs a reality.

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The Best Path to a Valuable Patient Portal

As meaningful use creates increasing focus on patient portals, we’re hearing rumors and questions about the lessening importance of the traditional website. Or worse yet, that I.T. – working with a software vendor – owns responsibility for the hospital’s patient portal, and marketing – working with an agency – manages the organization’s website.

Here at Geonetric, we look at it differently. We believe a strong website, built on a robust content management platform, creates the foundation that’s needed for an effective patient portal. And we believe I.T. and marketing need to work together to make this a reality. Here’s why.

First, your website and patient portal need to share a common user experience . Marketers have already learned that website visitors don’t want to wade through navigation that mimics your organizational chart to find information or have to enter technical terms – like clinical cardiac electrophysiology – into your site search to find a heart specialist. And I.T. knows that asking patients to remember separate logins for distinct platforms with differing levels of usability creates a logistical nightmare. Both are correct – and the two teams working together will create an integrated user experience that ensures adoption.

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Hospital Marketing and I.T. – Irreconcilable Differences?

Photograph of the torso of a man in a dress shirt and tie.The curtain rises to the scene of a psychiatrist’s office.  Dr. Ben* leans back in his chair wearing a smoking jacket with an unlit pipe in his mouth.  He ushers in a disgruntled looking pair, one fidgeting with a new iPad, and the other clutching a portfolio containing the creative concepts for the hospital’s new integrated marketing campaign.

Dr. Ben: Come in. Sit down.  I understand the two of you are having some issues in your relationship…

Marketing: Issues!  That’s an understatement!

(I.T. glares at Marketing.)

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