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.

Continue reading

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.

Promoting a Different Set of Services

The mix of services, where they’re promoted and who receives that promotion will be changing as changing payment models come into play. For example, primary care promises to be a central strategic offering as medical home models become the norm. Be prepared to provide better support for more service lines digitally and look to take those offerings to health consumers in new and different ways.

Increased Focus on Physicians

A new focus on employed physicians means many of you will be allowed to promote certain doctors for the first time and there’s now a strategic imperative to fill some waiting rooms! That means that you’ll be marketing physicians more than ever before.

Keep in mind, though, that marketing physicians doesn’t mean a bunch of advertising for hundreds of individual doctors. It means finding how to differentiate their practice and helping the right patients get connected to them. Most advertising should represent the organization or particular service offerings rather than physicians (see “Relationships,” below).

Wellness and Sickness

While we’ll need to help health consumers navigate the system when something’s wrong, nothing will be more profitable for our organizations in the future than keeping our patients healthy. Building digital tools and content that support good health and the management of chronic conditions will become very important. There may also be a role for digital-based communities for these areas as well.

Relationships

Some of the changes coming along could make healthcare a very transactional business. Greater use of convenient care services and physician extenders mean that the relationship that was once central to primary care – that between physician and patient – is just not going to be as central in the future.

But the goal isn’t to make the system transactional. The whole point of medical home is to provide more coordinated care across a given patient’s needs.

We therefore need to replace (or at least supplement) the relationship between patient and doctor with one between patient and health system. How do we do that? Begin by providing a single point of access to a patient’s information through a patient portal across all of their interactions with the health system – primary care, specialists, emergency department, classes, and support groups. The system should also provide all of the important health and appointment reminders to the patient in a consistent, coordinated way. That is pretty difficult without a customer relationship management system that works across secure digital channels, traditional mail and inbound and outbound call center operations.

What Won’t Reform Impact?

Looking at all of those changes together suggests that the role of the Web is going to change pretty dramatically in the coming years. Today, we’re there to build awareness and support transactions. But in the future we’re going to have a greater role to play throughout the stages of a patient’s relationship with our organization, from health consumer – proactively reaching out, building awareness, guiding them to access the system in appropriate ways, and promoting wellness as the foundation of their relationship with the health system – to patients – being their gateway to the healthcare system, central point for coordination of care, conduit to support resources from healthcare professionals and peers and their road map for better management of their health.

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.

Check out the article to learn more!

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.

Continue reading

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)

Continue reading

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.

Continue reading

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.

Geonetric’s Patient Portal Enhances the Patient Experience

Geonetric’s Patient Portal has always been focused on the patient experience – ensuring health consumers can find and use the information sent from their providers. It’s easy for patients to use and helps you take a gradual engagement approach to adopting the technology.

The portal includes functionality, such as secure messaging, electronic health records, chronic disease management diaries, device support software, and health risk assessments to help providers monitor and control patient behavior. It also provides patients with clinical summaries, electronic copies of their health records, timely access to electronic information and patient-specific educational resources to help patients improve their health. Our portal is ONC-ATCB certified and meets current meaningful use requirements for engaging patients and families. It’s also built to be flexible so it can support the Meaningful Use Stage 2 regulatory decisions as they are finalized.

If you’re looking to implement a consumer portal for a more personalized Web experience, or a full-fledged patient portal integrated with your electronic medical system to deliver clinical data, talk to us about our portal solutions.

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.

Continue reading

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.

Integrated Experiences
“In-store mobile” picked up speed during the 2011 holiday season as several retailers, including Target and Best Buy, introduced apps with features designed for use while shopping in the stores. I predict we’ll be seeing this trend take off inside healthcare facilities as well.

Consumers are increasingly leaning on mobile technologies to provide information and help with decision making wherever they go. Savvy healthcare systems will focus on using customer journey mapping techniques to create seamless patient experiences.

eReading
Starting early with the iPad2 and winding up the year with the Kindle Fire, 2011 brought a wide range of devices uniquely geared toward reading. Now what will we do with them? With consumers snatching up Kindles at the rate of one million per week at the end of 2011, we’re likely to see an increased interest in delivering content to eReader platforms via publishing, newsstand, and in-book advertising platforms.

Internet TV
From set-top devices like Roku and Boxee to features built into HDTVs, DVD players, and DVRs, a rapidly increasing number of consumers are accessing Internet-based content through their televisions. Over-the-top-TV (OTT), as it’s known in the industry, is taking another bite out of commercial television.

This trend underscores the importance of putting video – especially YouTube – in your marketing mix. Several sources have pegged YouTube as the third most popular search service, behind Google and Facebook, and a large number of Internet TV devices include YouTube functionality.

Getting Found
Along with the new diversity of communication channels comes an intensification of the findability problem – how do you connect with the right audience at the right time?

Content Strategy
Everyone has been doing more with less in the last few years. Combine this with the broadening array of digital media and it seems obvious that a solid content strategy is essential to ensure content investments are paying off.

As a discipline, content strategy really gained footing in 2011. We’ve seen this manifested as a shift away from a heavy focus on the visual design, toward ensuring the right content is in place across multiple channels. Organizations thinking about a site refresh are more likely to be talking about enhanced content rather than only a new look for the home page. I expect 2012 will continue to see a growing understanding of the importance of content as the foundation of an effective online strategy.

Social Search
Perhaps the biggest trend in SEO is the increasing importance of social and local search. It’s not just about keywords, it’s about “who you know” and “location, location, location.”

Google’s search results factor in Twitter, Google+ and the searcher’s location. Meanwhile, in addition to Facebook, consumers are increasingly using location-based and deal-based social networks to find information on businesses and their communities.

This year we will see marketers cultivating relationships with content curators, community leaders, partner organizations, and employees to get linked, increase their clout, and lead their tribes.

Digital Care
Changes to healthcare business models, technological demands, and new standards of patient care are continuing to challenge care providers. While solutions are still evolving to meet these needs, the next year should see interesting developments in digital caregiving.

Meaningful Use: Stage 2
The next stage of meaningful use is scheduled to be finalized mid-year. This set of criteria includes benchmarks for patient usage of portals, ability to secure message with providers, and generally increased availability of information specified in Stage 1. Other criteria, if adopted, will broaden the electronic information available, including lists of care team members and longitudinal care plans, enabling additional patient portal features.

This means increased pressure to not only put patient portal technology in place, but ensure patients are actually using the portal.

Accountable Care
The Accountable Care Organization (ACO) guidelines recently released by the Centers for Medicare & Medicaid Services (CMS) accentuate the trend toward accountable care. Meanwhile, more health systems are working in cooperation with large employers to provide care under pay-for-performance models.

The patient-centric requirements of this model offer an opportunity for online experiences that not only enable better communication, but help make a difference in clinical outcomes. While much of the technology implementation of the past few years has been internally focused on care providers and support, expect a shift toward technologies that really engage the patient. From social health support networks involving patients, families, and care providers, to new connected medical devices and wellness tools that provide support for changing behaviors.

Big Data
Big data describes the enormous, unwieldy datasets that are becoming an increasingly important source of information for businesses. For healthcare marketers specifically, big data offers opportunities to harness the power of customer relationship management (CRM), interpret billing and claims data, or to improve patient outcomes and satisfaction. We expect to see a growth in the use of big data over the coming year.

Interpreting Claims Data
As an example, last month a new CMS rule enabled increased access to claims data. This opens the door for more visibility into the performance of care providers and organizations. This change in transparency will undoubtedly have repercussions as ratings sites, care plans, and employers attempt to mine this profusion of data.

Keep Your Eyes Open!

From creating their first mobile sites to building a YouTube library, most healthcare marketers began to concentrate on many of these developments throughout 2011. In the coming months, it will be time to take the foundation to the next level. Some trends will be easier to keep up with – like investments in content strategy and location-based SEO – others, like ACOs and pay-for-performance models, will require the entire organization to refocus its efforts. Regardless, these are all areas cutting-edge healthcare marketers should be watching.

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.
  • Targeted Content: Visitors often visit hospital websites when they’re newly-diagnosed and are looking for information about their condition or services you have available. Think through the content consumers seek and create information architecture and navigation that directs them to that information.
  • Optimized Pages: Traffic on many hospital sites originate from search engines, so most visitors never see the home page. That’s why each page on your site should be optimized as if it were a landing page for the topic. Consumers won’t dig through your site to find information. Pages should have relevant information and links that direct them to more information. For example, health library information should link directly to related service line information, hospital news and physicians.
  • Calls to Action: Health consumers are action-oriented. They may start a search looking for service information, but their real goal is to sign up for a treatment or get more information. Therefore, you should place calls to action throughout the site. Service line information should lead to signups for related newsletters, relevant classes or screenings, and the ability to make appointments with specialists. Making these actions easy to perform leads consumers to return to the site, especially “frequent flyers” such as parents with children and those with chronic conditions that require regular treatments.
  • Personalization: Personalizing the online experience is key. Patient portal accounts improve the experience by pre-filling forms, maintaining lists of care team members, providing a unified calendar of upcoming appointments and classes, and allowing patients to access their healthcare record and send secure messages to physicians.

The end goal for your online strategy isn’t to increase traffic; it’s to connect consumers to the services they need from your organization. And you can easily do this by making some basic changes to your website.

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?

A recent Stanford study concluded the following:

“A team from Stanford University in California analyzed nationwide survey data from more than 250,000 visits to physicians’ offices and other outpatient settings between 2005 and 2007. They found electronic health records did little to improve quality, even when there was ‘decision support’ software that gives doctors tips on how best to treat individual patients.”

There are a number of individual facilities that have demonstrated dramatic improvements in quality that they attribute to their EHRs.  Big players in the healthcare space including Kathleen Sebelius, Secretary of Health and Human Services, and David Blumenthal, National Coordinator for Health Information Technology, have been pushing the message in speeches regularly that EMRs improve quality.

There are also a great many “maybe ifs.”  In the past, the biggest of these was “Maybe if these EHRs have decision support,” but this study undermines that idea.  Here are some other “Maybe ifs” that are floating out there today:

  • Maybe if we looked at the secondary uses of the EHR data, outcomes could improve and costs could go down
  • Maybe if they looked at more current information, outcomes could improve and costs could go down, certainly the technology has improved since 2007
  • Maybe if some of the decision support systems were smarter, outcomes could improve and costs could go down

I don’t buy it.

Here are my “Maybe ifs”:

  • Maybe if we changed the way  healthcare was practiced, outcomes could improve and costs could go down
  • Maybe if we changed patient behaviors, outcomes could improve and costs could go down

In my experience, automating inefficient manual processes only improves things in a small number of scenarios.  It doesn’t work in patient care.  Patients aren’t getting more or better information from providers.  Providers routinely ignore recommendations from decision support systems.  Doctors don’t need to chase down the paper chart. But other than that, very little has changed.

Those organizations that are delivering noticeably different results aren’t doing so because they have an EHR.  They’re doing so because, at least in part, the information technology is enabling meaningful change in the way that they deliver care.

But even that doesn’t matter a great deal if patients don’t change their behavior.  Are they staying healthy?  Getting preventative screenings? Following their physician’s directions when they leave the office?  If they don’t get up and move, lose weight, eat well, stop smoking, take their medication and go to the physical therapist, outcomes will continue to be mediocre.

Let’s face it, patient behavior isn’t going to change when they only see their care provider once or twice a year. It’s going to require more connection, engagement, counseling and coaching to make that happen. That’s a big shift in the way that care happens.

After all, if your plan isn’t to do things in a better way, then you may as well install Extormity.

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.

But there is still much to do to accomplish the goals of HITECH and now healthcare reform.  ONC is committed to making Meaningful Use Stage 2 criteria reasonable and achievable.  This will move requirements forward, but there is also continuing standards work to be done – particularly in the area of interoperability.

There is a need to be doing more than just deploying technology.  Vendors and hospitals must also be making the operational changes necessary to allow this technology to have the maximum impact.  To accomplish this, the HIT community cannot operate at the margins of the healthcare system; rather they need to be deeply involved in its development.

The federal government is also looking to vendors to do more to help small healthcare organizations get the technology deployed. This includes offering financing and other flexibility in purchasing and implementation.

In the end, the goal is to have improvement to the health of individuals and populations while improving the efficiency of the healthcare system.  But will these great technologies be created in the U.S. or overseas?  To date, many of the firms receiving certification and delivering products to the industry are in the U.S. which will also provide a favorable economic impact.

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.

Futurist Ian Morrison sets the stage for these challenges brilliantly in a new article in H&HN.  His insights (which he refers to as his 10 Laws of Accountable Care) deftly highlight the need for patients and providers to be informed and committed participants in the relationship for ACOs to work. He also notes that within this structure, as in any change, there will be winners and losers.

It’s a good read well worth a few minutes of your time.  In the end, the thoughts of Mark Smith, M.D., M.B.A., president and CEO of the California Healthcare Foundation sum up the current ACO climate well: “The accountable care organization is like a unicorn, a fantastic creature that is vested with mythical powers. But no one has actually seen one.”

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.

And your website needs impressive functionality that can be shared with your portal. Marketing understands the value of cross promotion and putting information at the user’s fingertips. This translates into interactive capabilities that engage your site visitors. If a visitor is researching a newly diagnosed condition, does your site show the related locations for treatment and detailed information about related providers? Does it filter appropriately to avoid wading through a list of doctors that are outside the preferred traveling distance or don’t accept the necessary health insurance? Does it automatically offer related classes or events that introduce the visitor to your hospital and begin to drive a deeper relationship? As we move to the patient portal, that level of interactivity becomes even more personalized – reinforcing a medication regimen or helping a patient interpret a lab result. And I.T. is typically the gatekeeper, managing how that personalized information moves securely from one system to another. So when you add a patient portal to your website, both teams need to work together to ensure functionality that is seamless and provides increasing value to the user.

As you move down the path to implementing your patient portal, look for ways to leverage the skill sets and knowledge from both marketing and I.T. This is the only sure path to aligning your portal with your site and getting the real value you’re looking for. The result of this integrated approach will be a unified online experience – connecting with potential patients and building ongoing relationships.

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.)

Dr. Ben: Everyone just take a deep breath and relax.  This is a safe place where we can talk through our challenges with one another without being attacked.  We need to get to the root of the conflict between you so that we can begin to repair your relationship.  To do that, we’ll first try to understand where you’re coming from.  No interruptions and no attacking one another.  Agreed?

(Marketing and I.T. grunt noncommittally while avoiding one another’s gaze.)

Dr. Ben: Excellent!  Marketing, why don’t you begin?

Marketing: It just doesn’t feel like I.T. thinks I’m important.  My projects are never a priority and if my systems go down, it sometimes takes hours before they’re fixed.

We’ve never had a great relationship, and I’ve dealt with what I’ve had to work with, but things are really coming to a head around this whole meaningful use thing.

I.T.: That’s my problem, not yours!

Dr. Ben: Now, now.  Remember our rules.  Marketing, please continue.

Marketing: You see!  This is exactly my point.  I.T. is just dismissive of me.  But we’ve been moving down this meaningful use path, and I need be involved!

Dr. Ben: And how does that make you feel?

Marketing: I just don’t feel like my expertise is respected.  I want to be a strategic contributor for the new initiatives at our hospital, but I.T. just waltzes along without listening to a thing that I say.

Dr. Ben: Ok.  Good start.  I.T., what do you see as the problem here?

I.T.: (Sighs) Marketing really wears me out, and I just don’t think they understand the priorities.  It’s not that I think Marketing’s stuff isn’t important, but let’s face it – if the website goes down, nobody dies.

Dr. Ben: That’s a good perspective.  What about the meaningful use process that you have underway?

I.T.: I honestly don’t understand why Marketing would want to be involved.  We’ve got our checklist and our project plans.  When we get the systems rolled out, we’ll let Marketing know in case they want to put up a billboard…

Marketing: That’s all that you think we do!  Brochures and billboards??!?  Marketing is so much more that that!

Dr. Ben: Calm down.  Slow, deep breaths, please.  Let’s keep this on topic.  Marketing, why do you think you should be involved?

Marketing: Granted, we’re not the only ones I.T. needs to keep happy.  This is different, though.  Meaningful use takes I.T. somewhere they’ve never been before: to the consumer.  Patient portals are part of the solution set for Stage 1 of meaningful use and the idea that I.T. is going to be constructing the online experience for patients is scary!  We know how to communicate effectively with health consumers.  Have you ever seen I.T. try to carry on a conversation at the hospital holiday party?

Dr. Ben: Let’s not resort to personal attacks, now.

I.T.: Thank you.

Dr. Ben: Marketing has a point, though.  What about the patient portal?

I.T.: Well.  We’re approaching them like any other I.T. systems.  We have a set of features that meaningful use requires these things to do and we only consider solutions that do those things.  We then grok for an optimal combination of cost and general level of headaches they’re likely to cause us and make a selection.  I’m guessing we’ll get the portals from our inpatient and outpatient EMR vendors and then add on the portals from our scheduling vendor and our lab vendor…

Marketing: How many portals are you talking about?  And they’re all going to have their own logins, right?  Oh, and I suppose none of them will work if you’re not already a patient.  And what does “grok” mean?  Is that a word?

Dr. Ben: Take it easy.  Remember, no interrupting!  I.T., have you given much thought to the overall patient and consumer experience?

I.T.: That’s not how my success is judged.  I need to make certain information available to patients after an encounter with one of our physicians or the hospital and then have other information available to those patients on-demand.  If we turn around that data in a timely fashion and have on-demand information for enough patients, then we qualify for meaningful use dollars.

Dr. Ben: Marketing, how does that sound to you?

Marketing: I.T.’s missing the point.  Sure, that’s what the meaningful use regulations say, but we’d really like people to use it.  Meaningful use doesn’t require that, but it’s really important to making the effort worthwhile.

Let’s look at how this patient portal is going to get used.  In most cases, the woman of the house is managing healthcare for her spouse and kids.  She’s going to need to make appointments, fill out the paperwork, check test results and pay the bills for four or five people.  She needs to manage all of that in one place, not with separate logins let alone to two or three different portals!

This can really differentiate us in the market if we do it right.  But the solution that we put in place needs to be easy to use, and I’ve seen what our EMR vendors think a user interface should look like.  Oh, and we need to use consumer-friendly terminology and provide a lot of supporting information.  Our patients didn’t go to med school after all.

And health reform is going to push more and more out through the portal.  eVisits and patient self‑directed care are just around the corner, and…

I.T.: Whoa!  None of that’s on my radar right now.  At this moment I need to get the functionality out there so that I can check the box on my meaningful use attestation.

Marketing: And do you want to rip it all out a year from now and start over?

I.T.: Ideally? No.

Marketing: So I think we need to talk.

Dr. Ben: Well, our time’s up, but I think we’re making some real progress here. Let’s take what we’ve learned a step further.  I.T., could you bring this meaningful use checklist to the next meeting, and Marketing, could you make a list of value-added features you want included in the patient portal?  I really think a solution that will make you both happy is within reach. See you next week.

Doctor’s note:

Met with new patients I.T. and marketing. Apparent that the two bring different skill sets to the table and are motivated by different goals when it comes to meaningful use compliance. Although they both began the session hostile, by the end they seemed open to at least hearing the other side’s perspective.  For the sake of the patients, I hope we can reconcile their differences.

*Note: I’m not a real doctor, but I play one in this article.