Blue Button is Driving a Patient-Centered Revolution in Health Care
The Blue Button approach is a simple concept: A patient is provided with a highly visible, clickable button to download his or her medical records in digital form from a secure website offered by their doctors, insurers, pharmacies or other health-related service.
People can log into this secure website to view and have the option to download their health information, so they can examine it, check it, and share it with their doctors and others as they see fit.
The Blue Button download capability is a tool that can help individuals get access to their information so they can more effectively participate in and manage their health and health care.
Broader use of the blue button approach also offers opportunity to mobile app and software developers working in the burgeoning consumer e-health field. As the blue button download capability becomes more widespread, we expect to see more and more apps designed to take the data individuals can download and turn it into useful information and valuable tools used to manage one's health like reminders to get preventive services or refill a prescription, or a list of the lowest price outlets to order medications.
The EHR market is changing. And that’s a good thing for reputable EHR vendors, physicians and the healthcare industry.
The state of the electronic health record (EHR) industry is changing for the better, as consolidation thins-the-heard, leaving reputable EHR vendors - helping physicians - improve the healthcare industry.
In the coming months, before the Meaningful Use Stage 2 attestation begins, we will see the exit of more EHR companies who only launched to collect those government incentive dollars.
Physicians, likewise, who rushed to adopt systems to collect the incentives and avoid the penalties, will replace software that is too expensive, too cumbersome, and prevents them from achieving Stage 2 and beyond.
This time, however, the physicians who are searching for a new EHR system have the advantage. Physicians have a product market with lean, cloud-based systems providing better service and support.
"In short, better days are ahead for physicians and the healthcare industry" - says Michael Brozino, CEO of simplifyMD.com
Electronic record-keeping systems are popular in areas such as supply chain management, customer relationship management and resource planning to name a few, but their effectiveness in health care organizations is only recently being measured. Cost-benefit studies have been performed to ascertain whether electronic record-keeping systems can really cut costs for primary care physicians and hospitals over the long term, and results have been largely positive.
Electronic records greatly decrease the number of costly mistakes as well. Billing errors are much less frequent, and collections efforts are more efficient. Mistakes in drug prescription leading to bad reactions are virtually eliminated. Laboratory and radiology utilization become more efficient as employees spend less time shifting through papers and more time performing productive activities.
According to a study published by the Partners Healthcare System in Boston, average annual savings from utilization of electronic records are $86,400 per year for a single health care provider. The research team compared operational costs under an electronic system to those of a traditional paper-based record-keeping system for a period of five years using data from its own organization as well as published historical data. See References for more information.
Direct costs for implementing an electronic record-keeping system include recurring software costs for license renewals, hardware costs for the machines that facilitate the use of the records and labor costs for those who install and maintain the system. There is also an opportunity cost associated with lost productivity as employees take time to become familiar with the new system and procedures.Benefits
There are many more benefits than costs associated with switching to electronic medical records. Labor costs are decreased significantly, as time no longer needs to be spent manually pulling and delivering charts, performing transcription of doctor’s notes and manually sorting through accounts receivable documentation.
A way for treating clinicians to gather patient records using information about a patient, sometimes involving HIE aggregation, non-targeted query is being used in different ways by several HIEs currently.
While overly-prescriptive policies are often considered a hindrance to innovation, national guidance on non-targeted query might be helpful in the long run.
A growing national HIE service, the eHealth Exchange, supported by the public-private nonprofit Healtheway, includes non-targeted queries for its 40 participating organizations, codified in its trust agreement.
That trust framework stipulates that participants querying for data for treatment reasons, in turn, have to respond to authorized requests.
Another approach to query, based on linking EHRs, has been developed by the western Pennsylvania HIE ClinicalConnect. The HIE’s access is entirely coordinated through participants’ EHR systems.
The HIE’s model could be described as “front-end” EHR requesting. it ensures that patients have a relationship with the requesting provider, that the patient is able to opt out (per Pennsylvania privacy law), that the provider actually needs the requested information (since s/he may already have it in a patient’s digital chart), and that clinician access can be monitored to safeguard against breaches.
More than half of U.S. doctors have switched to electronic health records and are using them to manage patients basic medical information and prescriptions.
The Department of Health and Human Services says it has reached a tipping point as it seeks to steer medical providers away from paper records.
Advocates for electronic health records say they have the potential to make medical care safer and more efficient. In 2015, the federal government will start penalizing providers that haven't begun using electronic health records in reimbursements they get for treating patients.
But some doctors have been cautious about changing long-standing practice, saying that typing into a computer while talking with patients requires more attention than taking notes by hand. Others are concerned that electronic systems don't allow for enough family history or fail to highlight the important parts of a patient's medical record.
David Blumenthal, who preceded Dr. Mostashari as national coordinator at HHS, said the agency had made a conscious decision not to push providers too far too quickly.
"It's a matter of getting people on the escalator and moving them steadily up to higher and more demanding uses. You can't get from the bottom of the escalator to the top in one step; you have to take them along for the ride," he said. Dr. Blumenthal said he expected most of the remaining providers to come on board within five years.
Critics say the protection for intellectual property is causing less innovation. Many firms use patents as barriers to entry, suing upstart innovators who trespass on their intellectual property even en route to some other goal.
The argument for patents is that, without the monopoly they grant, inventors will not make discoveries, and if they do, they won't share them.
So inventors get 20 years of protection against imitators. The counterargument is that patents are often used defensively to deter rival innovators and thus to discourage innovation.
Patents are supposed to prevent imitation, but in practice, imitation is often more costly than innovation. Most patent disputes are not about firms copying each other's inventions but about two companies discovering simultaneously the next step in an innovative process.
Yet patent law can't easily handle that type of situation.
The glaring exception is pharmaceuticals, where testing for safety and efficacy makes innovation extremely costly, but where imitation can be cheap. In these circumstances, patents are not only necessary but might be strengthened. Elsewhere they should be weakened and shortened.
If there was an overall theme at the HIMSS Media/Healthcare IT News ICD-10 Forum, it was this: Don’t wait to get your house in order for ICD-10. Though the October.
Though the Oct. 1, 2014 deadline for the transition from ICD-9 to ICD-10 is more than a year away, most of that time will be required for getting ready, experts warn.
In an interview with Healthcare IT News, Farzad Mostashari, MD, national coordinator for health information technology, said his best advice for providers is to begin prepping for the change now.
Jill Wolf, VP of compliance for VitalWare, LLC, a speaker at the forum, echoed that – and advised health organization to try coding 200 claims into ICD-10 as a test, to see how easily they transfer from ICD-9 and what kind of documentation is needed to code for ICD-10. Then, take that information to the doctors to use in training them for ICD-10.
Why should you do it now? Wolf said she thinks that doctors “really need a good database” of ICD-10 data for the education piece. Doctors respond better to training, when data is used. “They don’t want you to train them based on national averages," she said. "Show them their own data. They will be much more receptive to those results."
Healthcare organizations are rapidly trying to reinvent themselves in light of the new rules of the game. One could argue it officially started October 1, 2012 with Medicare's readmission penalties.
People are calling this the “no outcome, no income” era. While it may look the same from the outside, I can’t think of a bigger change facing an industry.
Almost overnight, what a healthcare provider was previously rewarded for (e.g., ordering tests, hospitalizations, etc.) they will now get penalized either directly or indirectly.
Many “Innovation” organizations that have been set up in virtually every health system in the country (and most health plans and pharma as well).
The innovation groups have been established to respond to the daunting changes their organizations are facing. Unfortunately, the way they are being setup are practically guaranteeing they will fail to prepare organizations for healthcare’s trillion dollar disruption.
The lesson for healthcare providers is that new reimbursement models such as various accountable models (e.g., ACOs, Health Homes, etc.) will have entirely different success metrics. They will also have new competitors.
One of the tricks for healthtech startups is to find those pockets of the market that are aggressively moving to new models.
It was striking that they never brought up EHRs when asked what are the keys to success in improving outcomes for patients with chronic disease.
As the Age of Agility hits healthcare it’s imperative that the innovators are free to unleash innovation critical to the enterprise’s long-term survival. Shackling or under-resourcing new lines of business only guarantees they won’t be there when the present fee-for-service model wanes
A survey of 1400 doctors reveals the top five ways they are using tablets and smartphones in their clinical practices.
In a clinical work setting, doctors who have electronic health records said they use their smartphones in clinical settings every day to:
Send and receive emails (65 percent);
Use apps (51 percent);
Instant messaging (50 percent);
Researching information about medications (35 percent);
Communicating with other physicians (32 percent).
But switch “smartphones” to “tablets” and you get this response:
Send and receive e-mails (52.4 percent);
Accessing electronic health records (50.6 percent);
Accessing diagnostic information (41.7 percent);
Research information about medication (33.3 percent);
Staying up to date with medical journals and papers (29.8 percent).
The findings in part confirm what we already knew, particularly abut physicians’ interest in sending and receiving emails.
And it’s maybe not so surprising that physicians would prefer to access EHRs on a wider screen than what a smartphone can offer.
But those companies focused on messaging between physicians and other healthcare professionals get some more validation with the finding that half of physicians use their smartphne every day for instant messaging.
Many physicians are not seeing the expected financial return on investment after EHR implementation. Why is that?
How you implement the technology has a lot to do with the results you achieve.
The bigger issue is how the compensation system is designed. If physicians are operating in a fee-for-service environment, then many of the gains of EHRs -- for instance, in quality, safety and patient engagement -- aren't reflected in revenue.
Physicians are doing more work and delivering better care and service, but the added value is not reflected in the reimbursement.
We're seeing lower pay, not higher, despite doing more and more meaningless data entry work with EHRs. We are often not finding return on our investment with the additional work.
When value is added, it should be reflected in increased physician reimbursement. It's a question of whether there's a return on investment with electronic health records.
Executive director of the block island medical center, barbara baldwin, comes to this position with experience from leading other healthcare agencies
With the national Affordable Health Care Act (ACA) scheduled for implementation in January, 2014,
How will the Electronic Medical Records (EMR) requirement impact the medical center?
Paper health records will be obsolete. Healthcare providers will be required to convert to electronic records. The cost of making this switch could be high. However, if the medical center can accomplish it by 2014 it will reap back some financial benefits.
Incentives are being offered not only by the federal government, but also by insurers. It will not cost us as much to do it if we can establish meaningful use, that is, demonstrate that we can see a specified number of Medicare and Medicaid patients within a certain time period, then we qualify for these financial incentives.
Counterbalancing the expense of implementing the electronic records are the benefits. They will facilitate transport off the island. The electronic record can arrive before the patient, allowing preparation at the mainland facility. There will be better continuity of care. The record can be summarized and shared easily.
One interesting component of the ACA is that the government has requirements for insurance companies to report what they do in the same manner so that someone can look at five different insurance plans, for example, and compare them.
The website Healthcare.gov explains what benefits will be available to the public.
The U.S. is leading the way in connected health. Historically, the U.S. has been a laggard in mobility behind the mobile operators in Europe and Asia, and consumer centricity of European mobile solutions
Large and established healthcare leaders pluck the best ideas and IP from mHealth pioneers.
Some quick observations from last week’s Convergence Summit include:
The U.S. is leading the way in connected health. Historically, the U.S. has been a laggard in mobility behind the mobile operators in Europe and Asia, and consumer centricity of European mobile solutions (i.e. messaging, mobile payments, and more customized data plans).
In a turnabout, the rest of the world is now looking to U.S. leadership in connected health and open to exploring the best ideas and companies, as noted by the increasing presence of overseas telcos and companies at the WLSA.
The U.S. is leading the connected health revolution but there is plenty of opportunity for global solutions.
Connected health companies are real, disruptive and getting noticed. The iAward Finalists for 2013 where an impressive lot, measured by factors that include clinical, operational or consumer relevance, size of addressable market, and demonstrated traction. Not only do the twelve finalists check those boxes, they are led by credible management team and have very cool approaches to solving healthcare problems.
Carenet Healthcare Services
Qualcomm Life, Inc.
Trice Imaging, Inc.
Connected health is empowering consumers and will improve the overall system: Health plan members and hospital patients are consumers…plain and simple. They are looking for solutions that range from self-management of chronic conditions, to caring for loved ones, to connectedness with their care provider.
We’re watching with interest the recent news that an iPhone urinalysis app is garnering the first FDA inquiry of medical apps. Venture capital and strategic company enthusiasm for connected health innovation has been strong for three years, and we hope it will be supported by federal regulators and not hobbled by them.
Progress remains unclear for how Defense/VA would end up with an integrated EHR by the end of 2013 promised by Frank Kendall, undersecretary of Defense for acquisition, technology and logistics.
Air Force Lt. Col. Melinda Morgan sent a statement that shows the EHR and integration remains a work in progress.
She said Hagel has assigned AT&L “responsibility for developing and executing a plan to acquire and deploy interoperable health data records and to modernize the clinical software used throughout DoD. We will report on these plans when they are complete, to include program office roles, program names and IOC dates.”
The above, while appreciated, obviously does not provide much insight on the progress on a mega-billion project that has already been in the works for a decade.
One reason for the employers’ passivity in paying health care bills may be that they know, or should know, that the fringe benefits they purchase for their employees ultimately come out of the employees’ total pay package. In a sense, employers behave like pickpockets who take from their employees wallets and with the money lifted purchase goodies for their employees.
The correct economic argument is a bit more nuanced. Employees do not care about the cost of their benefits; they care about the benefits.
If an employer can procure the same benefits at a lower cost, the employer need not increase wages one iota. In this regard, there is nothing special about health benefits.
Suppose an employer offers employees the use of company
cars. Workers don’t care what the employer paid for the cars, and if the employer can purchase cars at a deep discount, it will pocket the savings.
Could employers do more to reduce healthcare spending?
Employers have dramatically increased deductibles in recent years, and this has had some effect.
Employment-based health insurance has passivity weakened the demand side in health care in determining prices. It is one thing to “worry” about health care costs. I have been at hundreds of conferences at which employers have done that. It is another thing “to do something” about it, and passivity is not it.
MMRGlobal, Inc., a provider of Personal Health Records, MyEsafeDepositBox storage solutions, and electronic document management and imaging systems for healthcare professionals, announced that it will offer a program for healthcare providers they...
MMRGlobal, a provider of Personal Health Records (PHRs) and MyEsafeDepositBox storage solutions announced that it will offer a program for healthcare providers they can use to offset the entire cost of a 4medica Certified for Meaningful Use Integrated Electronic Medical Record (EMR) system for any size practice.
Ahe physician's office has to do is activate one patient per day per physician in the practice to a MyMedicalRecords Personal Health Record during the first month, and the EMR system is free.
As long as 30 patients stay in the system, the EMR program remains free. When additional patients are activated, MMR pays the physician or group practice 30 percent of the incremental PHR revenue.
Based on a three physician practice, adding only one patient per day to the PHR could result in the practice receiving more than $100,000 over three years. This is in addition to the $44,000 in U.S. government stimulus money paid to each physician in the practice.
The program is part of the Company's MMR Stimulus Program, which continues generating reimbursement revenues to offset the cost of providing access to a patient's personal health information in accordance with requirements under Stage 2 Meaningful Use starting in January 2014.
This program shows how PHR adoption can self-liquidate the cost of 4medica's Electronic Medical Record system and how a licensing or strategic business relationship with MMR integrating the Company's products, services, patents and other intellectual property can generate revenue for an EMR provider through additional sales of its products.
A study by PwC's Health Research Institute reports that adoption of PHR usage will increase significantly and how simple patient engagement during check-in, prep and consultation results in patient's usage of PHRs.
The hospital that chooses to separate itself from the pack will recognize that much of an individual’s satisfaction with their interaction with the hospital happens outside of the hospital’s four walls. It happens before they are admitted and after they are discharged.
The Total Quality of a Person’s (patient & non patient) Encounter (TQE) is equal to the sum of the Patient’s Experience (HCAHPs) plus Patient Satisfaction (all of the other interactions they have with people, process, and systems.)
One way to know how your hospital is doing with TQE is the following.
If your hospital has not totally reinvented those interactions since the advent of the iPad, and defined a TQE strategy, your TQE is well below what it could be.
These gripes are basically a cry for effective Physician Leadership. About half of doctors are employed physicians and that number is rising rapidly as the industry consolidates to grab the bonus pools soon available to groups large enough to qualify as ACOs.
This move to become employed physicians is so popular, I have even seen articles lamenting “the death of private practice”.
What is certain is that thousands of doctors have traded in the leadership of their practices for a W-2 and the honor of working for MegaHealthCorp in the last few years.
Here are the four things employed doctors dislike the most and my suggestion of the best way to avoid these in your organization.
1) Being “Bossed Around by Less Educated Admins”
2) Not Being Able to Make Decisions About Staff and Personnel
3) Having Less Authority over Billing and Charge Coding
4) Being Forced to Use New Equipment and Technology
What Don’t Employed Doctors Complain About?
The reason is simple. Most groups don’t enforce them Many organizations have established guidelines, they can even be built into the meat of the EMR, however few are strictly enforcing them at this time.
As ACOs grow and shoot for quality bonuses, you can certainly expect that to change.
Health information technology (health IT) provides an opportunity for health care providers to share health information in a timely and secure manner across care settings to support patient-centered care, particularly during transitions from one care setting to another
Patients who receive long-term & post-acute (LTPAC) services typically have co-occurring health conditions, such as diabetes or high blood pressure.
These, patients are likely to encounter multiple care settings, requiring ongoing communication to and from each service point.
Health information technology (health IT) provides an opportunity for health care providers to share health information in a timely and secure manner across care settings to support patient-centered care, particularly during transitions from one care setting to another.
When multiple physicians are treating a patient following a hospital discharge, information about the patient’s care is missing 78% of the time. Innovations in health IT can facilitate transitions across provider settings and ultimately improve the health outcomes for this patient demographic and reduce cost to the health care system.
Since HITECH’s enactment, adoption of basic EHR systems by office-based physicians grew by over 80% between 2009 and 2012.
Stage 2 of the EHR Incentive Program will take an important first step in supporting the needs of persons who receive LTPAC services by requiring eligible providers to send care summaries during transitions of care, which may include LTPAC providers.
As EHR adoption and interoperability requirements continue to advance in the acute care and ambulatory care sector, it will be increasingly important for LTPAC providers to adopt EHRs that have the capability of exchanging standardized clinical data with care partners.
The report looks at the demographics of online research related to healthcare activities and includes: Researching health Plans and medical practitioners, Researching medical treatments and Use of telehealth.
The Department of Commerce has released a new report looking at how we use the Internet. The report, Exploring the Digital Nation: America’s Emerging Online Experience, is a follow-up to the DOC’s 2011 report on home Internet usage.
Key findings from the report include:
72% of Internet users between ages 25 and 64 reported looking up health plans or practitioners online.
42% of Internet users went online to find health information for self-diagnosis or treatment.
Rate at which Americans used the Internet for medical research did not vary dramatically by age group, with 42% of Internet users between 25 and 44, 42% between 45 and 64, and 38% ages 65 and older conducting this type of research online.
While researching health plans and finding medical information are common activities, the data suggests Internet users are far less likely to interact electronically with their healthcare professionals. Just 7% of Internet users reported going online to access medical records, participate in video conferencing with a doctor, or take advantage of remote procedures such as heart rate monitoring.
8% of Internet users in urban areas reported engaging in telehealth activities, compared to 4% in rural areas.
They suggest that the report findings make it clear that Internet users are going online to get information about health insurance, providers, to assist in self-diagnosis and for treatment of health issues.
These activities may allow Internet users to “leverage online information to make more-informed choices about their healthcare.”
Less than 5 percent of physician practices have made “significant progress” when rating their overall readiness for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital...
New research out this week by the Medical Group Management Association shows “only 4.8 percent of practices reported that they have made significant progress when rating their overall readiness for ICD-10 implementation.”
“It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades,” said Dr. Susan Turney, president and chief executive officer of the Medical Group Management Association.
The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system.
The current ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers.
Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services has urged a delay in implementing the new codes.
The dea generation phase of the Blue Button Patient Codesign Challenge is now closed. Almost 4,000 people visited this site, 1200 actively participated by posting ideas and voting for their favorites. And 81 great ideas were posted.
The week of June 17, developers will learn which ideas to focus on and will begin posting their early stage concepts and screen shots (if applicable) on Health Tech Hatch.
Share your idea, it's simple! Click on the link "Post a new idea." It will ask you to complete the sentence: "Build me a Blue Button-enabled tool that...." Click enter. Then explain your idea in 2 or 3 more sentences. To protect us from abuse, enter an email address or validate your identity with Google or Facebook. Your great idea is posted.
Next vote for the ideas you like best. Everyone gets three votes, and yes, it is okay to vote for your own idea. The most popular ideas will appear on the front page, but all ideas can be seen by clicking on the "Build me a Blue Button...." link.
You can also make comments on other people's ideas, and share you own idea and encourage others to participate by clicking on the Facebook and Twitter links.
E-Patient is a term used to describe individuals who use the Internet and other tools to seek out, share and sometimes create information about health and wellness.
While EHRs continue to evolve and technologies like patient portals become more common, providers have the opportunity to drive improvements in quality by encouraging patients to become an active participant in their own care.
If you're just considering what you want to do as a career, in this age of high tech, it may include electronics.
Like many other young adults, Amy Speanburg was unsure about the career path she should choose. She started out with a liberal arts major but during her freshman year, things took a surprising turn.
"I was home on a break and I woke up one morning and I couldn't see out of my right eye,” said Speanburg. She was diagnosed with a detached retina.
"I am developing what's called neovascular glaucoma, which is a very painful form of glaucoma,” said Speanburg.
After undergoing numerous surgeries, she gained a new perspective and a new desire to work in the medical field
"Every person I came across treated me so well and made me so comfortable. I was so scared and they made me feel so much better.
So, I decided at that point, that I wanted to become a nurse,” said Speanburg.
With her new career path in nursing she went full steam ahead, she got her masters and is working in a medical surgery unit but also specializing in what's called InfoMedics.
"The clinical setting has changed. Now, when you go see your healthcare provider or visit a hospital most likely, your record is called an electronic medical record. Our records are all computerized and hopefully soon to be portable,” said Mary Lee Pollard, Dean at Excelsior College School of Nursing.
"I was picked to be part of this group of nurses that helped develop electronic medical records because previously were documenting on paper. From the time I started nursing to now, it's completely different,” said Speanburg.
The Dept. of Health and Human Services announced it has surpassed its goal of having 50% of doctors and 80% of eligible hospitals using electronic health record systems by the end of 2013.
HHS Secretary Kathleen Sebelius said May 22 that as of the end of April, more than half of doctors and other eligible professionals and more than 80% of eligible hospitals have received Medicare or Medicaid incentive payments for the meaningful use of EHRs.
“We have reached a tipping point in adoption of electronic health records,” Sebelius said.
HHS data show that EHR adoption among physicians has increased from 50,000 in January 2012 to nearly 300,000 in April 2013.
Eligible hospitals showed an increase from fewer than 2,000 to nearly 4,000 during the same time period.