By now you’d be hard-pressed to work in high-tech and not have read an article or two (or ten) on Cloud Computing. But how much of The Cloud is just hype and how much are businesses moving to it? I found this really interesting infographic on the benefits of Cloud Computing for small business (SMB).
One of the most interesting things to me is that security of The Cloud is listed as both a benefit and a reason SMBs have not yet moved to The Cloud. This is certainly true in healthcare where hospitals and physicians must be concerned with HIPAA compliance and protecting PHI.
One of the best analogies I’ve heard on this came courtesy of my wife (who knows much more on this topic than do I). People feel that driving a car is safer than flying primarily because they are in control of the car – this despite the fact that statistics show otherwise – flying is in fact safer. Similarly, if they are not directly responsible for their IT infrastructure, they perceive decreased security. But Cloud vendors are focused on data protection and security – often more so than companies hosting and supporting their own applications and databases.
So how should vendors market Cloud Computing given the above benefits and concerns? Vendors often fall into a comfortable pattern of touting the cost-saving benefits of The Cloud alone. This would not only ignore the many other benefits, it would also presume cost is a customer/prospect’s primary need when if fact they may be more focused on agility, performance or some other benefit. I like the pragmatic approach that Ken Ostreich espouses – one that is focused on matching customer needs with a vendor’s solutions.
Much has been made about the Health Information Technology Policy Committee’s (HITPC) recent recommendation to the National Coordinator for Health Information Technology. Their recommendation, described in a presentation on June 8, 2011, was to delay the transition from stage 1 to stage 2 meaningful use requirements by one year. The problem with this recommendation, or more accurately with how it has been reported and interpreted by some, is that it’s only a delay for a relatively narrow group of hospitals, namely those who have or will attest to meaningful use in Federal FFY 2011. As of June 2011, this list included only about 40 hospitals out of 340 total eligible providers and eligible hospitals submitting for reimbursement.
The following table illustrates the impact of the recommended delays for hospitals attesting to meaningful use in FFY 2011:
In short, the timeline for Stage 2 for any hospital whose start year is after FFY 2011 has not changed. It’s only hospitals who decided (and were able) to demonstrate and attest to MU in the first program year that have been given an extra year between stages 1 and 2. The reason – if the Final Rule for Stage 2 isn’t released until Summer 2012 as expected, that would leave these early-adopters (and their vendors) approximately 3 months to plan for and implement the necessary infrastructure, software, training, etc. for Stage 2. That’s obviously an unreasonably short time frame that everyone, including ONC missed.
So what does this mean for hospitals and software vendors? At least three things:
- Although the timeline for Stage 2 has only changed for early-adopters, the broader market feels as if they have more time to make strategic and tactical plans for Stage 2, whether that includes purchase, upgrade or something else.
- This perceived extra time means they have an opportunity to make a more thoughtful/informed decision that will have a greater likelihood of success.
- Waiting on Stage 1 means hospitals actually have LESS not more time to decide on and implement a Stage 2 strategy (early-adopters get the extra year, later adopters will have the same short turnaround). A higher Stage 2 hurdle means it will be even more important that a hospital’s Stage 1 strategy and decisions will help them satisfy Stage 2 as well.
The answer, of course, is absolutely not. But this August, 5,000+ cyclists will once again gather in an attempt to inch closer to an elusive cure. As one of those cyclists, I humbly ask for your support as I raise money for life-saving cancer research and treatment at the Dana-Farber Cancer Institute. I will be riding in the Pan-Mass Challenge for the 5th consecutive year – 190 miles to the tip of Cape Cod along with approximately 5,000 other cyclists from across the country and beyond. Each of us will raise over $4,200 a piece on behalf of The Jimmy Fund.
Once again, 100% of your donation will go directly toward cancer research and treatment through The Jimmy Fund. This year I will ride in memory of Bill, Dave, Elizabeth, Gordon, Irina, Jennifer, John, “Coach” Johnny, Johnny, Noah, Nora and Tyler, and I am riding on behalf of Betty, Carolyn, Don, Jeff, Judy, Julie, Kristin, Lori, Mike, Paul, TJ and Tracy. Please let me know if there are others for whom I may ride.
Training (outdoors) year-round for rides in New England can be a challenge as the temperature and road conditions makes things interesting. In an attempt to get rid of my February legs even earlier this year, I started training for this year’s PMC by completing the annual Harpoon Brewery-to-Brewery (B2B) ride last month – 148 miles in one day, all for free beer. Why ride a few miles to the local store when you can pedal 148 to the actual brewery? This earlier and heavier training schedule required fighting additional bed suck (when your bed pulls you under and won’t let you get out to train) as well as cashing in on even more bike coupons (certificates implicitly granted by spouses or significant others which permit participation in cycling-related activity).
As has become tradition, Taylor, with an assist from Logan, will randomly draw from a list of all donors for a chance to win $200. You can choose from one of the following, easy methods to donate:
1) Make a donation using eGifts: The following link will take you to my Pan-Mass Challenge Profile (http://www.pmc.org/egifts/HU0001), which tracks progress toward my goal. You can also go to www.pmc.org, click on eGifts and search for me by my ID (HU0001) or name to make a donation.
2) Text to Give to My Ride: Just text “PMC HU0001” to 20222 to donate $10. You will receive a message asking you to confirm by replying “Yes.” It’s that easy!
3) Mail in a payment: Checks can be made payable to the PMC, Jimmy Fund, DFCI, or any combination of the three (please don’t make it out to me). Please send your checks directly to me so that I can process them with the standard forms, etc. If you would prefer to send your check directly to the PMC, however, please include a note indicating you are sponsoring me and send the check to: PMC, 77 4th Avenue, Needham, MA 02494.
With the exception of 2008, both the total and average contribution by donor has risen each year. The total number of donors has remained remarkably steady while the number of repeat donors continues to increase. Let’s keep the trajectory going in the right direction!
I wrote my very first blog post almost exactly one year ago. The topic – physicians aren’t technology-averse, they are just averse to technology that doesn’t meet their needs. An article published today by the American Medical News says “For years, many advocates of information technology viewed physicians as computer-phobic Luddites, slow to adopt and benefit from health IT. As it turned out, many doctors are enthusiastic users of technology. The key is for them to find something that serves their needs, rather than being forced to bend to the needs of the technology or the institution behind it.”
I couldn’t have said it better myself (actually, I did). The article cites physicians’ adoption of mobile technology, which vastly exceeds that of the general populace (5x greater), as a primary example of physicians adopting technology. The article continues to describe the App Challenge sponsored by the American Medical Association. Any U.S. physician, medical resident or medical student is eligible to submit an idea for a physician-focused app with winners to receive a $1,000 American Express gift card, a $1,500 Apple store gift card and a round trip for two to New Orleans for the AMA House of Delegates Interim Meeting in November. Great prizes and great idea.
mHeath has definitely greased the skids for successful physician use of IT, but the common theme is applications that support their workflow will be embraced by the physician community.
On it’s “face” (sorry, couldn’t help myself) it seems contradictory at best. How can spending more time with technology actually increase (and improve) the amount of time a physician spends with a patient?
But that’s just what a recent study found – moving certain functions online (namely, administrative functions like scheduling, bill pay and insurance verification) provides an opportunity for more efficient and productive doctor-patient visits (study results). While it only makes sense that taking care of largely administrative tasks online could improve this interaction, it goes beyond the transfer of work outside the actual visit. Providing patients with access to their health information as well as general wellness information increases personal engagement in their health, something that all providers should strive to achieve, particularly as they become more financially responsible for outcomes.
The key, according to a report by Arash Mostaghimi, MD in the Annals of Internal Medicine, is to provide “ubiquitous access to information instantly.” According to Mostaghimi, it’s not about the communication tool (e.g., email vs. social media) as much as it is about providing information by whatever methods patients prefer. This will likely take time, however, as adoption of Personal Health Records (PHRs) by providers and patients alike has been slow. And doctor-patient communication by email remained constant (and low) at 2.9% between 2003 and 2008 according to published by the Journal of Medical Internet Research. Time contrains, privacy and security, and lack of compensation are all listed as contributing to slow physician adoption.
According to Mostaghimi, waiting for the ideal or a standard technology won’t work. Physicians need to familiarize themselves with the kind of communications their patients prefer. As payment continues to move toward value- and outcome-based payment, physicians will continue to have the incentive to engage patients in their own health and improve the quality of the doctor-patient interaction.
Today, Manhattan Research announced that 75% of U.S. physicians own some form of Apple device while, unlike the general consumer market, the iPhone continues to dominate Android among physicians.
Overall, smartphone penetration among physicians has already exceeded earlier analysts’ projections of 81% by 2012. Why has Apple dominated the device market and why has smartphone adoption among physicians exceeded that of the general population?
The answer to why Apple is actually pretty simple – apple has the iPad while Android is still waiting for a real market entry to compete with Apple’s popular device. The iPad has captured physicians’ attention like no tablet (or device) before, and this trend is likely to continue as more EHR venders provide access to their systems on this device. Another potential reason for Apple’s dominance could be as simple as the availability of healthcare-related apps. Developers have shown a willingness to create apps on the iOS platform more often than on the Android OS. Of course this could be a chicken-egg scenario – more apps and more market share beget more vendors developing on the platform and the opposite. Whatever the reason, more vendors support iOS than do Android at this point. It’s also possible healthcare organizations prefer the closed app approval process required of the App Store. The open source nature of Android app development has lead to higher incidence of malware attacks, something healthcare organizations are sure to want to avoid.
As for why smartphone adoption among physicians continues to be higher than the general population – smartphones and tablets support physician workflow in many ways like no device before. Physicians are inherently mobile, whether simply rounding from floor to floor to lab in the hospital or traveling from hospital to different physician offices. Simply put, a smartphone or a tablet fit within a lab coat better than a laptop or a computer on wheels. Due to their screen size and form factor, these devices run applications that must focus on efficient user interaction and experience with near instantaneous “boot up” time.
Bottom line, where physicians’ are involved, smartphones and tablets appear to cure what ails EHR adoption.
In the movie Driving Miss Daisy, the lead character refuses to accept a driver despite her son’s insistance and her inability to purchase car insurance. She eventually relents, agreeing to have Hoke drive her everywhere. The rest is Oscar history.
Physician groups and hospitals are hiring “drivers” to deal with the impact of EMRs on their practice of medicine. Unlike Daisy, who resisted a driver, physicians are willingly hiring scribes to input data into EMR systems. Some blame the perceived disconnect between provider and patient when an electronic system is introduced – the hypothesis is that patients feel the physician is paying attention to the computer rather than their needs. Turns out patients actually have greater confidence when their information is entered directly into a system. Similar studies and surveys have linked patient confidence to providers’ use of technology. The larger reason for the growth in scribe use is because “new record-keeping systems, which are touted as a way to improve efficiency and quality, slow down” physicians so much that they hire others to input the data for them.
The largest scribe companies have doubled their employee base and provided greater than 6x the number of hours of coverage over the last few years. Some are even turing down more projects than they take. Is this a good thing? Other than providing gainful employment and invaluable exposure to pre-med students, I’m inclined to think this is a net negative development. EMR systems must better support physician workflow and minimize data entry burden.
Many systems expose physicians to additional fields and alerts that don’t exist in their current clinical workflow – does the patient require a translator and does he/she need transportation are two relatively simple examples. Other examples include questions typically answered by a clinical pharmacologist rather than a general practitioner – transferring this from a pharmacist to a physician introduces new workflow. Unless these additional fields have clinical value that physicians should be expected to answer and/or would impact medical decision making, they only serve to decrease productivity thereby negatively impacting technology adoption.
EMRs also introduce new data entry requirements with the keyboard as the only option. Voice recognition, tablet and digital pen technology have all advanced to the point where data entry shouldn’t disrupt the traditional physician-patient interaction.
Technology has slowly but steadily removed the need for transcriptionists – let’s not introduce scribes as the transcriptionists of the HITECH era.