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DOCtalk with Dr. Gregg 9/16/14

September 15, 2014 News No Comments

When Meaningful Isn’t

There are just so many times in a physician’s life when Meaningful Use just doesn’t mean anything.

Picture this:

A beautifully pregnant mother is preparing for the birth of her very first child. The pregnancy is uncomplicated, except for the fact that the child is now breech. Despite the best efforts of a wonderful obstetrician, the infant remains in breech position and the decision is made to deliver the baby via Caesarian section.

The surgical suite is fully prepped and the procedure proceeds with no untoward signs. The fetus’ vital signs are being monitored closely and show no indications of any distress. The section proceeds uneventfully until …

… until the moment of delivery, the moment when everyone expects a beautiful, normal, well-developed fetus to be delivered as a beautiful, healthy, well-developed new baby. Only …

… only it isn’t.

It isn’t beautiful. It isn’t normal. It isn’t well-developed.

The wonderful expectation is a flaccid, blue, non-responsive handful of tissue that appears, for all intents and purposes, as if it was intended for something, anything, other than the beautiful life for which it was anticipated. It looks bloated. It looks lifeless. It looks almost other-worldly in its exposure to life outside of the womb.

The neonatal team, fully ready, is nonetheless aghast. This is not the delightful new entry into the world that was expected. This is trauma. This is drama. This is a potentially horrific outcome to a marvelous prospect.

The lifeless form is handed over from the obstetric surgical team to the awaiting neonatal resuscitation crew. Drying. Bagging. Intubating. Chest percussions and every life-inducing mechanism are begun. The lifeless form remains lifeless.

One minute. Two minutes. Five. And more.

The form looks abnormal, but the abnormalities are indescript. There is normalcy amidst gross abnormality. There is life despite blatant lifelessness. There is something that calls the team to heroic measures despite protocols that call for cessation of all heroism.

The team persists.

And, thank God, the team prevails.

Spontaneous breaths are induced. Heart sounds begin where no heart sounds had been. Movement and facial expressions show that life has emerged where no life had once been. Stabilization ensues.

The nearest tertiary care neonatal center mobile team arrives via life flight and begins its superb “assess, address, and de-stress” routine. They load the non-diagnosed, non-normal , non-categorizable newborn into a now-safe haven of neonatal nurturing in their life flight-enabled neonatal incubator. They roll out, fly off, and proceed to care for this newborn child that only moments ago was a mass of nondescript protoplasm incapable of independent life.

Fast forward eight years. Standing in a coffee shop queue. A beautiful woman approaches, an amazing smile upon her lips. She greets you with the warmth of a thousand suns as she proclaims, out loud and to no one in particular, that you are the one who saved her child’s life. Her child. The now-diagnosed “gifted” wunderkind of third grade. The remarkably abnormal, normal girl who astonishes her teachers on a daily basis.

Think back. Did you document every moment? Did you record for an auditor who may never come the minute details of the indescribable moments of non-life before life? Did you capture the essential details that would allow for appropriate upcoding and enhanced reimbursement? Did you ensure transition of care documentation? Did you check off all the bullet points that insurance company column-and-row counters seek? Did you show Meaningful Use via “meaningful” digital documentation detail?

Seriously … does any of that matter when this mother stands before you with her look of indescribable gratitude?


From the trenches…

“Do not let your grand ambitions stand in the way of small but meaningful accomplishments.” – Bryant H. McGill

dr gregg

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 9/16/14

September 15, 2014 News No Comments

Top News


IT, consulting, and outsourcing services firm Cognizant agrees to acquire TriZetto, a developer and licensor of IT services for healthcare providers and payers, for $2.7 billion in cash. The deal will create a combined company with over $3 billion in revenue from its healthcare operations. Cognizant posted a total revenue of $8.8 billion in 2013.

HIStalk Practice Announcements and Requests


HIStalk sponsors, don’t miss out on the chance to be a part of our annual MGMA “Must-See Exhibitors Guide.” Fill out this brief form by September 30 to ensure a spot in the digital guide. I’ll also include contact information for companies not exhibiting but looking to schedule one-on-one meetings. I’ll be reporting from the exhibit hall, plus as many great after-show networking events as I can squeeze in. Hopefully, I’ll also find time to sneak away to marvel at the most decadent chocolate fountain on the Strip.


September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include an overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions, and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in the “It’s All About the Data” series, the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

Announcements and Implementations


Pacific Medical Data Solutions launches a comprehensive revenue cycle management service to help physicians streamline front and back office billing practices, and medical coding.


New Jersey Physicians ACO selects the eClinicalWorks Care Coordination Medical Record for population health management. Founding ACO member Vinod Sancheti, MD noted that the eCW solution was chosen in part for its strong track record with primary care-focused ACOs.


Amazing Charts parent company Pri-Med releases the InLight EHR, featuring a Watson-like technology that enables the EHR to learn from its users, and then organize and offer information in a manner that best suits physician workflow.



NextServices and Quantta partner to offer new mobile and Web enterprise solutions for multispecialty groups, ambulatory surgery centers, and hospitals; data-oriented apps for remote healthcare delivery; and integration of Quantta’s analytics services into NextServices’ enki EHR.

Government and Politics


The App Association and a consortium of startups including CareSync, AngelMD, and AirStrip send a letter to Representative Tom Marino (R-PA) expressing frustration with HHS over the lack of developer-friendly online resources related to HIPAA privacy rules. Some developers are apparently relying on government information last updated in 2006, well before the release of the iPhone and other mobile devices. The group also asked that HHS provide better guidance on how health data can be stored in the cloud.


New Zealand announces it will invest US$2.5 million in a nationwide initiative to encourage patient portal adoption amongst physician practices. The portals, currently used by 35,000 New Zealanders, are part of that country’s eHealth vision that aims to introduce e-prescribing, care plans, and a clinical data repository of patient information in 2014. For perspective, New Zealand is home to 4 million residents, while the U.S. is home to over 317 million.


National Health IT Week enters its second day of festivities. The ONC Consumer Health IT Summit kicked things off in Washington, D.C., yesterday, highlighting such themes as the Blue Button initiative, and policies and programs fostering patient and consumer engagement. You can view the official agenda for the rest of the week here.


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Alan Santos is promoted to CEO of Pyramid Healthcare Solutions, and Manoj Malhotra (Salient Business Solutions) is appointed chairman of the company’s board.


James Prowant (Lehigh Valley Physician Group) joins the Mount Nittany Physician Group (PA) as COO.


Andrew Ferrier is appointed chairman of Orion Health.


Media outlets report that Lana Moriarty (HRSA) joins ONC as acting director for consumer e-health. Apparently one of her first duties as a digital consumer healthcare advocate was to create a Twitter account, just in time for National Health IT Week festivities. ONC continues to look for a permanent director. Check out this job listing to see if you qualify.

Research and Innovation


Tute Genomics launches MyGene, a cloud-based  patient results portal that enables healthcare organizations to share validated clinical genetics findings directly with patients. The technology may help primary care physicians overcome their hesitancy to incorporate genetics services into their care routines, among other barriers to adoption noted in new research. They include insufficient knowledge and competence related to genetic medicine, lack of knowledge about genetic risk assessment, concern for patient anxiety, a lack of access to genetics, and a lack of time. I have to assume that physicians already having trouble coming to grips with EHRs may not jump on the genomics portal bandwagon.


Global Kinetics Corp. receives FDA clearance for its wearable that helps detect Parkinson’s disease symptoms. The wrist-worn Personal KinetiGraph also offers medication reminders, and creates automated reports that neurologists and other caregivers can use to identify signs of neurological disorders.


The 2014 Survey of America’s Physicians finds that 85 percent of physicians surveyed have adopted EHRs, up from 69 percent in 2012. However, 46 percent indicate the technology has detracted from their efficiency, and just 24 percent say it has improved their efficiency. The survey findings tie into the American Medical Association’s call for an overhaul of the EHR, particularly as it relates to usability and higher-quality patient care. I’d love to hear how these results correlate with the experience of HIStalk Practice readers who are working “in the trenches,” as Dr. Gregg likes to say. Let me know if you’re interested in sharing your take with our audience.



Azalea Health donates its EHR software, services, and training to a dozen rural school clinics in Coffee County, Georgia. The donation is part of its commitment to the Rural School-Based Telehealth Center Initiative.


Pediatrician Charles McCormick, MD makes an interesting comparison between EHRs and the No Child Left Behind program:

“The use of templates is what makes an EMR so much like the public school use of No Child Left Behind, where children were taught to memorize information that would later appear on a test rather than teaching children how to think independently. As a physician, I do not want my thinking to be limited in any possible way by a template that I need to fill out in order to create a note. Every patient is different, and not a single one of us fits into the same box. We are, unfortunately, dumbing down medical care providers just like we dumbed down our teachers.”


Central Utah Clinic notifies 31,677 patients that one of its servers was “compromised” by unauthorized intruders in June. The server held some patient information, and a subset of written imaging and radiology reports dating back to 2010 and earlier. There has so far been no indication that patient information was stolen.


Doximity partners with U.S. News & World Report to offer the online Residency Navigator tool to help fourth-year medical students objectively assess residency programs. The tool ranks top programs based on physician survey results, and sub-specialization and board-pass rates, among other data points.

Sponsor Updates

  • PerfectServe will discuss methods for improving healthcare at four leading industry events this fall.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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HIStalk Practice Interviews Kyna Fong, Co-founder and CEO, Elation EMR

September 15, 2014 News 1 Comment

Kyna Fong is co-founder and CEO of Elation EMR of San Francisco.


Tell me about yourself and Elation EMR.

I founded Elation with my brother, Conan. Our dad’s a family doc and so as kids, we helped him build his practice from scratch. We did everything from rooming patients to billing and negotiating with insurance companies, to installing all the equipment in IT. I managed his practice, and hired and trained all his staff for almost a decade. He was a paper hold-out for as long as possible, but we convinced him to let us build the Elation EMR live in his practice, basically using it as a lab.

Prior to Elation, I did something quite different. I was an economics professor at Stanford. A few years ago, I was fortunate to be nominated as a Robert Wood Johnson Foundation Health Policy Scholar. There I saw firsthand the huge chasm between how policy makers and administrators envisioned technology would transform healthcare and what was actually happening on the front lines of care in my father’s practice and in his colleagues’ practices. It was that exposure that made me passionate about creating technology that supported and strengthened the patient-physician relationship.

At Elation, we built a clinical platform from scratch focused on bringing physicians and patients closer together. We’ve optimized our EMR for the clinical needs of the provider, rather than optimizing for compliance or administrative purposes.

As for my job as CEO, I make sure that we’re focused on our key priorities, that we execute effectively, and that, most importantly, we continue hiring passionate, phenomenal people. Along with Conan, I outline our vision and ensure our strategic direction stays true to our mission and values.

Are your typical customers are on the ambulatory side?

Yep, our typical customers are indeed on the ambulatory side. Our typical provider tends to have long-standing relationships with patients and deliver longitudinal care. As a result, she often has a disproportionate number of complex patients with multiple chronic conditions. Communication is a key part of the service she delivers to patients, and she often coordinates care with a lot of other caregivers as well.

Our providers span most specialties. Over 30 specialties are represented in our current client base, which includes a couple of thousand users from across the country. They range from working in solo practices to 20-plus provider practices.

While many of our users have switched from other systems, we’ve actually noticed a substantial number of "paper hold outs" switching over, too. We’re excited by how our product maintains a lot of the benefits they would miss on paper.

How do you see physicians at different-sized practices using the EHR?

Two of our earliest pilot customers were a solo doc and a 15-provider practice. We found there was little difference between the clinical tasks they needed to accomplish. Having a larger staff, however, does mean there are a number of different workflows to consider. That observation made us ensure early on that our product is workflow-agnostic and avoids unnecessarily locking the user into doing specific tasks in a specific order. In addition to improving the user experience, that approach has also minimized our need to customize extensively based on practice size.

It’s true that needs do differ quite a bit between a solo practice and large groups from a reporting and administrative perspective. As long as we have a system that engages providers and is a source of truth, then we have the data needed to address the range of reporting and administrative requirements. We can then make the data available in a flexible, customizable way via our API.

How do you plan to grow the company over the next three to five years?

It’s no secret that the biggest challenge we’re facing as an industry and as a society is the urgent need to deliver higher quality care at lower costs. At Elation, we aim to enable excellent care, particularly for those 20 percent of complicated, chronically ill patients that account for 80 percent of healthcare costs. Typical EMRs are designed as static repositories of information, but from the beginning we’ve been focused on delivering a dynamic, powerful, clinically-focused tool that empowers providers to manage the overall care of even the most complex patients. Elation’s really designed to be the most solid clinical tool in the provider’s arsenal. We feel this clinical focus addresses a fundamental need that nobody out there is positioned to address.

There’s clearly a mounting demand for something more than the first version of EMR that’s been pushed out there, and user surveys have all highlighted the growing provider dissatisfaction with existing systems. The surveys consistently find a third to about half of physicians are looking to switch EMRs. We’ve invested significantly in helping switch practices to Elation with minimal disruption, making sure we’re bringing up the data they need.

In terms of what we anticipate rolling out down the line, ultimately we want Elation to tell the comprehensive story of a patient’s health and make it securely accessible, adjustable, and actionable to anybody involved with the patient’s care so that caregivers and providers can be on the same page regardless of what system they use. We want to make sure that our system is available wherever needed, and that decision making is therefore informed, consistent, and generates the best possible outcome for the patient. The plan down the road is to expand the Elation platform and definitely bring us closer to these goals.

Each of your employees spends time shadowing physicians. How much time, and how does that clinical presence help shape their ability to do their job?

The number of hours varies, but the key for us is what employees see the physician doing during their shadowing sessions. We ensure that every single team member, including engineers, has at least one training session where they shadow a physician for an entire day – from when the doors open and the staff start preparing until the doors close. Shadowing for a complete day sheds light on the diverse context that physicians work in, and fleshes out a much more realistic picture than simply shadowing isolated activities independent of one another, which we found can be misleading.

People ask why we shadow and how it affects the product we deliver. One thing I will say is that it makes a tremendous difference when every single person who takes part in creating not just the product, but also the overall experience, has context for what’s going on in the practice. Even thinking and understanding the difference in context between being inside the exam room versus being between visits makes a huge difference. That ingrained awareness within the company creates so many valuable checks on the end-user experience that we ultimately deliver.

It’s really hard to understand the degree to which providers are constantly clicking, switching, and multi-tasking. With shadowing, you see with your own eyes how physicians deal with documentation while simultaneously returning phone calls, coordinating care with other providers, and communicating internally with staff. I think that seeing that drills into us the importance of details and how frustrating even the smallest details can become. I think we end up having a much more flexible product because of the shadowing and really trying to expose ourselves to the user’s experience.

Why choose the name Elation?

We wanted our focus on user experience to come across first and foremost. It’s the emotion we want users to feel when they’re using our product. We thought it would express our commitment to that as a company.

You made the case recently that Elation has more satisfied customers than Apple – a pretty bold statement. How are you measuring customer satisfaction?

We use the Net Promoter score, a universally recognized method that companies of all types across the world use to measure customer loyalty and experience. The reason we chose the comparison sample is because Apple has really set the gold standard for simple and intuitive user experience, as well as deep customer loyalty. That’s the bar we want to hold ourselves to.

Traditionally, B2B businesses haven’t been held to the same high bar as consumer businesses, because selling to businesses used to mean that you could rely on restrictions and long-term contracts and switching costs to really capture the customer. But the world is changing. We don’t lock our customers into long-term contracts. We have to earn their business month after month, so it’s really important for us that we know whether or not we’re delivering.

We also have deep influence from Ideo, a design consulting firm whom we’re grateful to have as our supporters. We believe if we continue delivering a phenomenal, delightful experience to our users, we’ll come out on top.

Do you see user experience becoming a true differentiator within the EHR market, especially as we’re seeing it continue to consolidate?

Yes, absolutely. As I alluded to before, I think customers in this market increasingly recognize and understand that an EMR whose user experience distracts and encumbers the physician is actually detracting from patient care. As patients become more complicated and costs become more critical to control, you see providers starting to demand an EMR that enables them to become more clinically effective and manage the patient’s overall care.

I think we’ll also see the market responding to systems that not only improve the physician’s user experience, but the patient’s experience as well. Within the EMR market, as data formats become more common and standardized, physicians will be empowered to move from EMR to EMR more easily. We’re already seeing a lot of that happen today, with well over half of our new users switching from other systems.

What’s your take on scribes, and how do you see your customers reacting to them?

Scribes are certainly an indication that EMRs are adding to the burden of physicians rather than lightening it. I can’t think of a single industry where technology makes its users less productive and everyone says, “Oh, that’s okay.” A lot of the EMRs out there, especially the ones practices rush to adopt to get Meaningful Use dollars, are built with the express purpose of shifting administrative and compliance burdens for physicians, which I think drives some of the demand for scribes. We couldn’t disagree more with that approach. At Elation, we’re definitely determined to lighten the physicians’ burden and enable them to keep patients as their first and foremost priority.

What lessons did your team learn from watching Practice Fusion go through its recent downtime?

We use Amazon, so we are a cloud-based service as well. While we do rely on third parties to help deliver our solution, we feel fully responsible for our users’ experiences. Based on our own experiences running a practice, we know access to records is critical, even if it’s only read-only. We make sure we have multiple levels of redundancy to ensure our users have access to their records any time. In fact, our users have access to back-up, read-only versions of our system that we run as a separate site on completely independent infrastructure.

Also, our customers can reach us any time and get a response within 30 minutes for all urgent issues.

We definitely place support and responsiveness as top priorities, ensuring our practices always have access to their records in order to deliver care. Those qualities are the two most frequently referenced in our customer testimonials.

Any concluding thoughts?

Our first resolution is simple: Focus on physicians so they can focus on their patients. We all know technology has enormous potential to enhance patient care and reduce costs, and to make that a reality, we need to start with an intuitive, clinically-focused tool that physicians can actually use and rely on for care, even for the most complicated patients. The rampant productivity loss and provider distraction we see today only hurts patients in the end. We’re determined to work with providers to change that and really enable them to focus on delivering excellent care to their patients.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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From the Consultant’s Corner 9/12/14

September 12, 2014 News No Comments

Onboarding Financial Systems: Three Strategies for Mitigating Risk to Revenue

For the past several years, healthcare organizations have invested significantly in EHRs given the Meaningful Use incentive opportunities. Another driver for EHR implementations and upgrades has been expanding clinical integration and alignment activities, which often involve deploying a common EHR to coordinate care and share clinical information across the continuum of patient care.

Although organizations are still focusing on EHR optimization and other clinical informatics initiatives, including MU Stage 2 and ICD-10, they are also starting to replace revenue cycle applications as part of a broader IT strategy that involves using a core vendor to support patient access, clinical, and revenue cycle requirements.

A single platform capable of reporting clinical and financial information provides efficiencies for managing patient populations and competing in value-based reimbursement arrangements. A core vendor platform also allows organizations to reduce their dependence on interfaces, providing cost efficiencies and limiting potential workflow bottlenecks. Moreover, these integrated systems can reduce the likelihood of lost charges and improve overall claim lag.

Beyond a Software Upgrade
Replacing revenue cycle technology – such as patient financial accounting and practice management software- is not just an IT exercise. In fact, I recommend taking the opportunity to redesign business processes to gain efficiencies, improve effectiveness, and also enhance the patient experience. New systems should not merely replicate manual or other outdated processes, but also reflect redesigned workflow and optimized staffing levels and structure.

In my experience, an effective implementation requires robust change management to help people understand and adapt to both the new system and the new way of doing business. For instance, some organizations choose to create a single business office that marries hospital billing and professional billing, resulting in one statement and one point of contact for customer service. To be successful with this model, organizations must appreciate and respond to the risks involved, as people are being asked to do things they have never done before. Whether implementing a system change or a broader organizational redesign, these organizations must proceed in a manner that minimizes the impact on revenue cycle productivity and limits cash flow disruption.

Three Strategies to Minimize the Risk to Revenue
As healthcare organizations consider replacing their revenue cycle applications, executives must pay careful attention and develop ways to mitigate risk to revenue. Here are three strategies to keep in mind.

1. Build a business intelligence model that parallels the change.
I strongly recommend collecting, monitoring, and responding to key metrics before, during, and after implementation to quickly catch problems and head off potential cash flow implications. When identifying critical performance indicators, think about comparing current metrics to future needs and determine which measures will fully demonstrate organizational performance. During this process, be sure to understand how the new system’s measurements compare with previous indicators to ensure apples-to-apples comparisons. It may be helpful to create a baseline measure of the new metrics using the old system to accurately measure change and monitor future performance.

Once you begin collecting data, be sure to report metrics to the right people at the right time, establishing who needs to receive reports and checking they understand the data’s meaning. I find it helpful when determining reporting frequency to look at the data recipient’s role in the organization – i.e., executive, manager, supervisor. For instance, patient access managers should have daily access to claim denial information to quickly identify and resolve issues, and lessen any negative effects to the revenue cycle. If these individuals do not receive reports until month end, it could have a major impact on revenue and workflow.

2. Create a comprehensive training plan.
When training staff on a new system, be sure to focus on operational and workflow changes, not simply new IT screens or functions. Training should cover the concepts behind a switch, the individual’s changing role in the department, and revised workflows as well as the system’s various nuances. Note that when designing a training plan, it can be helpful to evaluate vendor-suggested models against operational changes to support a more organization-specific approach.

3. Make sure the vendor’s implementation strategy can be tailored to meet the organization’s specific needs.
Most revenue cycle vendors have an established implementation plan that is based on best practices from current clients. While these plans have merit, you should not accept them at face value. Make sure you fully understand the impact of the vendor’s pre-configured strategy and system design. In most cases, organizations will have to balance an efficient implementation with risk to revenue, personalizing the vendor’s approach with organization-specific requirements.

One Part of a Greater Goal
Implementing new financial accounting and PM software inherently involves added risk to revenue across your organization. Combined with an EHR strategy, this investment can yield a broad, transformational change, which helps organizations report on clinical and financial information to manage population health and sustain financial viability. Organizations that pursue a well-considered implementation approach can reduce risk and optimize revenue, ensuring they remain nimble during these changing times.


Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

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Point-of-Care Apps: Next Generation

September 12, 2014 News No Comments

To make the most of the shrinking window of time physicians spend interacting directly with patients (as few as eight minutes these days), more doctors and clinicians are turning to point-of-care applications. According to a report from Epocrates, 86 percent of physicians have adopted various digital health applications to support patient education and interaction. With new apps debuting almost daily, it seems the very best distinguish themselves in two ways.

The patient education piece 
A clear, specific function
Physicians need a way to simplify complicated medical information, using tools and templates customized for each patient across a broad population. Visual tools should clearly demonstrate a patient’s condition, and enable secure sharing with the patient and other healthcare team members.

Apps should also fit the “80/20 Rule.” There is no “one-size-fits-all” solution. They should cover as much of the content needed as possible while still leaving sufficient flexibility for customization to fit the specific needs of the physician.

Usable and fast
Waiting more than a few seconds for a point-of-care app to load during an appointment won’t work. Even worse, if the app crashes and needs to be pulled back up, a significant portion of the available time in the physician-patient interaction is lost. These things have to work, every time, and quickly.

Traditional software measures success by keeping users in their apps as long as possible. The best point-of-care app, however, strives to minimize the time users spend within it on a per-patient interaction basis, while effectively achieving its goals.

High-value, clinically valid content
Peer-reviewed, painstakingly researched clinical guidelines based on the latest science take years to develop. They are the gold standard for content by which care is administered. But they don’t need to take years to deliver or operationalize in the field. Physicians and clinicians across the globe need access to the latest clinical guidelines at the point of care to ensure treatment decisions are informed by the best science has to offer.

The differentiator: synchronizing patient education with decision support (the digital health PB&J)
Simultaneously operationalizing clinical-practice guidelines and delivering patient education through physicians and clinicians at the point of care is what’s next. It’s time to put the peanut butter and jelly together.

The best patient care plan won’t work if the patient doesn’t understand how the plan works, doesn’t understand the implications of adherence (or, more importantly, non-adherence), and doesn’t confidently follow through. Similarly, a 100-percent compliant patient doesn’t produce desired outcomes if the treatment plan doesn’t follow consistent guidelines.

Within the interaction between physician and patient exists an information exchange of the highest importance. It sets the wheels in motion for all of the possible treatment choices and courses. The common goal (especially in cases like prostate cancer treatment), is to maximize the odds of success. The best way to do that is to enable physicians to make choices based on sound science with an educated, confident patient. The patient needs to understand the course of treatment and precisely how important it is to adhere to the plan to achieve the best outcome. Combined with implementation of the latest evidence-based protocols, the most efficient course of care for all involved (including payers) should materialize.

In the broadest sense, digital health apps do not solve a technical problem, but often a human problem. How then does the healthcare team as a whole humanize complicated material including the latest clinical guidelines and care planning? How do they communicate it to the patient and improve outcomes for the entire continuum of parties concerned?

The answer can only be found, and the PB&J enjoyed, when physicians, clinical associations, researchers, and manufacturers partner to find solutions to that problem in a mutual quest for better healthcare outcomes and experiences.


John Cox is the president and CEO of  Visible Health.

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Reader Comments

  • Dr. Gregg: As an Elation EMR user, I can tell you - in complete honesty, no exaggeration - that I and my staff are walking-talking ...
  • Jim Thompson, MD: EMRs are worst at documentation. The clinician's world does not easily lend itself to rigid structure. This means it i...
  • Marty Mercer: check this out, very interesting:
  • Charlie Harris: Hysterical. Well done Dr Gregg!...
  • Josie: Cannot stop laughing! This is the funniest post EVER. Thanks, Dr. Gregg, for brightening my day. Toooo funny!...