The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
In my previous post I talked about the benefits of using social media in a medical practice and I said that the next post in the series would take a look at the tools, techniques, and social media platforms you should use to help you realize the benefits of social media. This will not be an exhaustive look at social media platforms or the way to get the most out of them. However, it will be a good place for you to start and will offer some techniques that those who’ve started might not have heard about.
First, a word of warning. When starting to work with social media, be sure to pace yourself appropriately. As you start working with a specific social media platform, you might want to start “sprinting” and dive really deep into the product. That’s a great way to develop a deep understanding of the platform, but it’s not sustainable. After doing a deep dive into a social media platform, find a sustainable rhythm that your practice can sustain long term.
Social media is a marathon, not a sprint.
Facebook – With nearly 800 million active users, it’s hard to ignore the power of Facebook. Given these numbers, the majority of patients are on Facebook and they’re likely talking with their friends about their doctors. Unlike many other social media platforms, most people are connected to their real life friends on Facebook. That means the focus of your work on Facebook should be to help your most satisfied patients be able to remember to share this with their friends as the need arises.
On Facebook this usually takes the form of a practice Facebook page that your patients can “like.” Invite your patients to like your Facebook page when they’re in your office or through your patient portal. You can even test some Facebook advertising using your internal email list to get your patients to like your page. However, the most important thing you can do is to make sure you regularly update your Facebook page with quality content. That way, they will want to like your page when they find it.
When it comes to content, put yourself in the shoes of your patients and think about what content you would find useful as a patient. Don’t be afraid to post things that represent the values of your practice, but may not be specific to your practice. In most cases, what you’re sharing on Facebook is more about helping that patient remember your practice as opposed to trying to sell them something. For example, it’s more effective to post something entertaining that your patients will like and comment on than it is to post some dry sales piece that they’ll ignore.
Twitter – Similar to Facebook, you want to create a two step process with Twitter. First, think about content you can post to your Twitter feed that would be useful to your patients and prospective patients. No matter what marketing methods you employ to increase Twitter followers, if your Twitter account isn’t posting interesting, useful, funny, entertaining, or informative content, then no one will follow you.
Second, find and engage with people in your area that could be interested in the services you offer. Finding them is pretty easy thanks to the advanced Twitter search. When you first start on Twitter you’re going to want to spend a bit of time on that search page as you figure out what search terms (including location) are going to be most valuable to your clinic. Sometimes you’ll have to be creative. For example, if you’re an ortho doctor, you might want to check out search terms and followers of a local youth rec league.
Once you find potential patients on Twitter, follow them from your account and engage with those you find interesting. Just to be clear, a tweet saying “Come visit our office: [LINK]” is not engagement. Offering them answers to their questions or links to appropriate resources (possibly on your website, blog, or Facebook page) is a great form of engagement. You’ll be amazed how consistently following and engaging with potential patients over time will build your Twitter profile. Once they’ve followed your account, you have created a long term connection with that person.
As I suggested in my previous post, Twitter can be a great way to find patients, but it can also be a great way for your practice to connect and learn from peers and colleagues. I’d suggest using different accounts for each effort. The tweets you create for each will likely be quite different so don’t mix the two. However, the same search and engagement suggestions apply whether you’re connecting with patients or colleagues. The search terms will just be quite different.
Physician Review/Rating Websites
There are dozens of physician rating and review websites out there today. Some of the top ones include: Health Grades, Angie’s List, ZocDoc, Yelp, Google Local, and many more. Which of these websites you should engage with usually depends on where you live. In most cases one or two of these websites are dominant in a region. For example, Yelp is extremely popular in San Francisco while Angie’s List is very popular in the south.
Discovering which one is most popular in your region is pretty easy. Many of your patients will have told you that they found your practice through these sites. However, you can also do a search on each of these services and see which ones are most active. A Google search for your specialty and city is another way for you to know which services are likely popular in your area.
Many of these sites will let you claim your profile and be able to respond to any reviews. Do it (although, don’t pay for it). Responding to reviews is a powerful way to engage your patients. If they post a bad review, keep calm and show compassion, understanding, and a willingness to help and that bad review will become good. Plus, that negative review could be an opportunity for you to improve your practice. If they post a good review, show gratitude for them trusting you as their doctor.
Once you’ve discovered which website is most valuable in your region, encourage your satisfied patients to go on that site and post a review of your practice. In some cases that might be handing the patient a reminder to rate you as they leave. In other cases, you might send them an email after their visit asking for them to review you on one of these sites. With mobile phones being nearly ubiquitous, a sign in the office can encourage a review as well.
There are hundreds of social media platforms out there today. However, if you focus on the platforms and techniques I mention above, you’ll be off to a great start. Mastering these techniques will make sure you get the most value out of your social media efforts.
Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.
In my note of two days ago, I discussed the challenge that Theranos is presenting to the two major reference labs in the U.S., Quest Diagnostics and Lab Corp (see: Finally, Some Important New Details about the Theranos Business Model). Although the focus of that note was on Theranos, my arguments got me thinking about the business models of these two large companies. It occurred to me that there might be fundamental flaws in them such that a new entrant into the lab testing market, Theranos, could threaten their core business with what could be described as disruptive innovation. The purpose of today's note is to discuss these potential flaws that are listed below:
The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.
By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.
EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.
The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.
Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.
One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data. One way to bridge this gap is through standardized role-based education.
Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort. Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT. As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.
Xerox is a sponsor of the Breakaway Thinking series of blog posts.
Neuroprosthetics is a relatively new discipline at the boundaries of neuroscience and biomedical engineering, which aims at developing implantable devices to restore neural function. The most popular and clinically successfull neuroprosthesis to date is the cochlear implant, a device that can restore hearing by stimulating directly the human auditory nerve, by bypassing damaged hair cells in the cochlea.
Visual prostheses, on the other hand, are still in a preliminary phase of development, although substantial progress has been made in the last few years. This kind of implantable devices are designed to micro-electrically stimulate nerves in the visual system, based on an image from an external camera. These impulses are then propagated to the visual cortex, which is able to process the information and generate a “pixelated” image. The resulting impression has not the same quality as natural vision but it is still useful for performing basic perceptual and motor tasks, such as identifying an object or navigating a room. An example of this approach is the Boston Retinal Implant Project, a large joint collaborative effort that includes, among others, the Harvard Medical School and MIT.
Another area of neuroprosthetics is concerned with the development of implantable devices to help patients with diseases such as spinal cord injury, limb loss, stroke and neuromuscolar disorders improving their ability to interact with their environment and communicate. These motor neuroprosthetics are also known as “brain computer interfaces” (BCI), which in essence are devices that decode brain signals representing motor intentions and convert these information into overt device control. This process allows the patient to perform different motor tasks, from writing a text on a virtual keyboard to driving a wheel chair or controlling a prosthetic limb. An impressive evolution of motor neuroprosthetic is the combination of BCI and robotics. For example, Leigh R. Hochberg and coll. (Nature 485, 372–375; 2012) have reported that using a robotic arm connected to a neural interface called “BrainGate” two people with long-standing paralysis could control the reaching and grasping actions, such as drinking from a bottle.
Cognitive neuroprosthetics is a further research direction of neuroprosthetics. A cognitive prosthesis is an implantable device which aims at restoring cognitive function to brain-injured individuals by performing the function of the damaged tissue. One of the world’s most advanced effort in this area is being lead by Theodore Berger, a biomedical engineer and neuroscientist at the University of Southern California in Los Angeles. Berger and his coll. are attempting to develop a microchip-based neural prosthesis for the hippocampus, a region of the brain responsible for long-term memory (IEEE Trans Neural Syst Rehabil Eng 20/2, 198–211; 2012). More specifically, the team is developing a biomimetic model of the hippocampal dynamics, which should serve as a neural prosthesis by allowing a bi-directional communication with other neural tissue that normally provides the inputs and outputs to/from a damaged hippocampal area.
Each year Google releases it’s top trending searches in the US and the world. This list isn’t the most frequently searched terms (according to Google the most popular searches don’t change) but is a year versus year comparison of what terms were trending in 2014.
US Trending Searches:
ALS Ice Bucket Challenge
Global Trending Searches:
ALS Ice Bucket Challenge
Pretty interesting look into 2014. Also amazing that a mobile app (Flappy Bird) made the list for the first time. There’s two healthcare terms: Ebola and ALS Ice Bucket Challenge. I wondered what this list would look like for healthcare IT. So, I decide to take a guess at what I think would be the trending healthcare IT terms of 2014:
What do you think of the list? Would you order it differently? Are there terms you think should be on the list?
I have been reluctant in the past to write much about Theranos because the founder, an entrepreneurial prodigy named Elizabeth Holmes, does not speak to the press much. I have posted some information about the company in connection with its relationship to Walgreen's (see: Retail Chain Drug Stores Ramp-Up Their Healthcare Delivery Services). At any rate, a long article about Theranos and Holmes by Ken Auletta has recently been published in the New Yorker and it contains some very important details (see: Blood, Simpler). It's a very long piece so I have copied some significant quotes from it below in italics followed by my analysis and interpretation of the quote:
In summary, I don't see any flaws in the Theranos business model although it's quite radical when compared to the IVD and reference lab industry as it stands today. Holmes is going about her business in a quiet and methodical way. There's a lot more to discuss about Theranos. I will return to the company in subsequent notes. I am interested in their approach to IT. However and if I were the CEO of Quest or LabCorp, I would be very,very worried.
If you’re like me and sometime gave your email to Healthcare.gov, then you’ve probably getting the daily reminders this past week about December 15th being the last day you can sign up on the Health Insurance Exchange if you want to get health insurance coverage starting January 1st. I wish they would have made the email system a little smarter and let us click a button that said “Already got my insurance this year.” Although, I appreciate that they’re just trying to make sure that everyone knows the timelines.
Based on the news coverage (or lack therof), it seems that Healthcare.gov has survived without any major issues this year. One thing that has annoyed me about the emails is they keep telling me how many people’s health insurance is getting subsidized on the exchanges. It seems that about 8 out of 10 people who get insurance from the exchange are getting a government subsidy.
I guess that means I’m in the 20%. Maybe their marketing is working great for those who can get the subsidy. However, it has the opposite impact on someone who does’t get the government subsidy. In fact, my insurance costs have nearly doubled since pre-Obamacare days.
Turns out, that because I wasn’t getting any government subsidies for my insurance, it was better for me to just go direct to the insurance company. That’s what I did and the process was super simple. In fact, I signed up for a plan that included ZDoggMD’s Turntable Health. I’m especially excited to do e-Visits and text message my doctor as needed. Plus, I’m going to have to see about tapping into the free yoga classes and demonstration kitchen. You can sure I’ll be writing more about this in the future.
I found this piece from HIStalk to be quite interesting:
A Kaiser Health News story called “Federal defense contractors find a new profitable business: Obamacare” notes that HHS’s business purchases doubled to $21 billion in the last decade and are rising, making it the #3 contracting agency, beating out NASA, Homeland Security, and the combined spending of Departments of Justice, Transportation, Treasury, and Agriculture.
Sorry if this post was a bit of a rambling rant. I just saw the deadline and needed to get it out of my system. I think the next 5 years we’re going to see a dramatic change in healthcare as we know it. As a blogger, that means I’ll have plenty to write about. As a patient, I have some cause for concern.
John Lynn, prolific blogger and health IT media magnate, and I are teaming up again for the second year to produce and deliver a marketing conference focused on helping digital health, health IT, and medical device innovators. We’re going to be providing actionable advice and specific techniques you can use to cut through the noise when trying to market healthcare and medical tech products to physicians, hospitals, health systems, ACOs, patients, and similar customers. Called The Healthcare IT Marketing Conference, last year’s event covered very important subjects by some of the world’s best experts on those topics and we’ll continue the tradition again in 2015.
Learn the difference between Marketing, Advertising, PR, and Branding
Everyone tells small companies that they need to “do marketing” but that’s really hard to do so I started with a quick visual to explain what it means. It comes from Marty Neumeier on pages 24 and 25 of ZAG by way of the Brand Autopsy Blog (which I highly recommend reading) and illustrates the differences between Marketing, Advertising, PR, and Branding. It’s a wonderful visual and clearly shows that small companies should focus on marketing and free PR, shoot for branding and probably eschew advertising until they have enough money. Our expert speakers at HITMC know the difference and will teach you how to make sure you’re not taking the wrong steps.
Learn how to conduct appropriate market research
Lots of (even innovative) companies don’t do basic market research so we will cover:
Learn about the different kinds of of Business Models to consider
Learn about major healthcare industry fallacies
Selling to the healthcare community is very hard and there are many myths that our conference will dispel:
Learn how to align the Payers, Beneficiaries, and Users (PBU) of your Health IT or MedTech product
There are three distinct groups you’re marketing and selling your products to:
I call this the “PBU alignment” problem. In a complex environment like healthcare, the three groups are often not the same — if you can find a market in which the payers, the beneficiaries, and the users are all the same then your sales job is easy. However, that’s commonly not the case. Let’s take a look at the typical example of a complex product like an electronic medical records (EMR) software package in the era of ARRA, HITECH, and meaningful use (MU). The “payer” may ultimately be government reimbursements through Medicare, the “beneficiaries” are the healthcare insurance firms and the government agencies that need the MU data, and the “users” are the doctors and staff at physicians offices and hospitals. Why has it taken decades for EMRs to be sold to just a tiny fraction of the total industry? Because the PBU alignment hasn’t been reached — until the users, beneficiaries, and payers of the products all understand the value and are willing to work together to achieve a goal it will be tough.
Join us at the conference to talk with experts on the PBU lesson and advice for your product. Figure out the PBU alignment problem and see how you’ll sell to each of the groups and make the right arguments — you do it right and you’ll make money. If you forget the complexities of the PBU and you’ll be languishing, too.
Go home with many tips and tricks:
On 11/9/14, I posted a note suggesting that wearable health monitoring devices might be a means to lower health insurance costs (see: Wearable Health Monitoring Devices: a Means to Lower Insurance Costs?). I drew a parallel to the electronic monitoring device offered by Progressive Insurance called Snapshot that plugs into your car, monitors your driving habits, and then enables you to a reduced premium if your drive safely. Oscar Health Insurance is now bringing this idea to reality for health insurance (see: This Insurance Company Pays People to Stay Fit):
Oscar Insurance bills itself as a “new kind of health insurance company,” one that uses a combination of technology and transparency to bring the stodgy insurance industry out of the Dark Ages. And now, it’s giving the industry a particularly firm kick towards the future. ...Oscar [has] unveiled a new initiative that will provide every Oscar member with a free Misfit fitness band. But in an industry that’s infamous for nickel-and-diming its customers, what’s even more progressive is that Oscar is going to pay its members to actually use them....Counting steps with a fitness tracker like Misfit, he says, is a good place to start. In recent years, fitness trackers have grown beyond the cottage industry of quantified selfers, so much so that even Apple is ready to seize on the opportunity. But having an insurance company...recognize these devices as an actual health intervention lends the entire fitness tracking industry a new level of legitimacy. Oscar members can order their new Misfit on the Oscar iOS or Android app. It syncs to the app automatically, so users only need to strap it on and get to walking. Users who already have a fitness tracker can also connect it to the Oscar app using Apple HealthKit, but that takes a bit more set up. Oscar’s algorithms determine how many steps each member should aim for in a day, based on that person’s health data. Each day a member surpasses that goal, he gets $1. When he accrues $20, he can cash out in the form of an Amazon gift card.
I don't know anything about the Oscar Insurance Company and am not recommending the company. I also don't know anything about its coverage or cost of its insurance. I do think that the idea of paying the holder of a health insurance to walk daily is very smart. All of this reminds me of a note I posted related, in part, to the fact that people who had dogs and took the trouble to walk them were healthier (see: Learning from the Demographics of Doggie Death). Here's a quote about dog-walking in Australia:
46% of households in [New South Wales, Australia] had a dog and, overall, dog owners walked 18 minutes per week more than non-dog owners. However, more than half of dog owners did not walk their dogs, and were less likely than non-owners to meet recommended levels of physical activity sufficient for health benefits. If all dog owners walked their dogs, substantial disease prevention and healthcare cost savings of $175 million per year might accrue.
So, if you are not interested in the Oscar insurance approach, another alternative would be to buy a dog and walk it daily. This should also improve your mood.
In a recent HIPAA compliance survey of 1,000 medical practices and 150 medical billing companies, NueMD found some really startling results about medical practices’ understanding and compliance with HIPAA. You can see their research methodology here and the full HIPAA Compliance survey results.
This is the most in depth HIPAA survey I’ve ever seen. NueMD and their partners Porter Research and The Daniel Brown Law Group did an amazing job putting together this survey and asking some very important questions. The full results take a while to consume, but here’s some summary findings from the survey:
The most shocking number for me is that only 35% of respondents had conducted a HIPAA risk analysis. That means that 65% of practices are in violation of HIPAA. Yes, a HIPAA risk analysis isn’t just a requirement for meaningful use, but was and always has been a part of HIPAA as well. Putting the HIPAA risk assessment in meaningful use was just a way for HHS to try and get more medical practices to comply with HIPAA. I can’t imagine what the above number would have been before meaningful use.
These numbers explain why our post yesterday about HIPAA penalties for unpatched and unsupported software is likely just a preview of coming attractions. I wonder how many more penalties it will take for practices to finally start taking the HIPAA risk assessment seriously.
Thanks NueMD for doing this HIPAA survey. I’m sure I’ll be digging through your full survey results as part of future posts. You’ve created a real treasure trove of HIPAA compliance data.
For the last few years, the major retail pharmacy chains (i.e., Walgreens, CVS, and Rite Aid) have taken steps to position themselves as the first rung of the healthcare delivery system. They have begun to offer various types of walk-in, low-intensity services staffed by nurses or nurse practitioners. Pharmacists have also begun to provide flu shots and other type of vaccinations. CVS recently made a very bold statement by no longer selling cigarettes. Walgreens is offering lab testing on a pilot basis with Theranos (see: CVS Stops Selling Tobacco; Walgreens Works with Theranos for Lab Testing).
Similar entry-level healthcare services are also being offered in free-standing urgent care centers staffed by physicians that are competing, in part, with hospital emergency rooms. These facilities offer imaging and care of minor trauma (see: Rapid Growth of Urgent Care Clinics; Cost Competition for Hospital ERs).
The major retail drug store chains are thus going "all in" as convenient, local health centers and now also providing telemedicine-based physician services in selected stores in collaboration with MDLIVE (see: Walgreens moves into telemedicine with MDLIVE deal). For further reading, here's an article discussing the relationship between Obamacare and telemedicine: With ACA, Telemedicine In 'Perfect Storm' For Coverage). Below are some more details from a recent story about the wide range of services being offered by the retail drug chains:
Drugstore chains have been expanding healthcare services to provide a way for patients to see doctors outside of normal physician hours without having to go to an emergency room for non-emergencies. Walgreens’ move to adopt MDLIVE as a telemedicine provider echoes similar moves by rivals such as CVS and Rite Aid, but it also supplements the company’s other initiatives.....Customers will be able to access doctors by email, text and video through Walgreens’ app for various acute conditions. Although the service is initially available to customers in California and Michigan, the plan is to roll it out to other states in the next year. MDLIVE got started in 2006 in Sunrise, Florida and has provided telemedicine services through employers such as Cigna. It also has a HIPAA-compliant system that helps payers and providers collect and share clinical data from patient medical records, lab results and in-home biometric devices for real-time risk assessments and wellness advice. Last month... [MDLIVE] acquired behavioral health “teletherapy” company Breakthrough Behavioral to add more specialized services. Several telemedicine companies have added mental health services and teledermatology to make them easier to access from home. It also offers a second opinion service. Walgreens has been developing a healthcare strategy with a goal of complementing physician services and to provide a way to share these touch points with physician practices. Last year, Walgreens began offering a service to diagnose and treat chronic conditions in its clinics. Diabetics visited the store an average of 20 times a year....It is also collaborating with Theranos to roll out physician-ordered diagnostic test collection centers at stores around the country. Rite Aid partnered with telemedicine provider HealthSpot for a pilot in its Ohio stores, CVS is doing a telemedicine pilot at 28 sites in California. Walmart is collaborating with Humana.
One of the most interesting questions from all of this is to what extent the competition from drug store chains will affect local hospitals and physician practices. I think it's really going to hurt, particularly in smaller towns for smaller hospitals. With this increasing competition in healthcare and CMS ratcheting down Medicare reimbursements, many small hospitals can no longer compete and are even declaring bankruptcy (see: Some Hospitals Experiencing Financial Distress and Even Bankruptcy). That's why many of them are seeking affiliations or mergers with larger regional hospitals. Such arrangement create referral possibilities for specialized care with patients returning to their home turf for primary care (see: Big hospital merger increases pressure on the little guys). Here's a quote from this latter article that helps to explain what is going on:
The economics of health care are shifting against hospitals as the payment model moves from the traditional fee-for-service, which rewards administering more care, to models that pay based on outcomes and reward providers for keeping people healthy. Individual hospitals and small systems have a harder time competing in such an environment because they lack the scale to reduce per-patient costs significantly.
The thing about the Internet is that you never know when something is going to go viral or spark heated debate. (Actually, it’s a fairly sure bet that anything involving politics, religion or sports will lead to heated debate, generally of the lowbrow variety.)
Less common is informed, intelligent discussion on the Internet. Something I wrote early yesterday for Forbes.com has, happily, fallen into this category.
My post, “Hype Around Healthcare Wearables Runs Into Reality,” is far from the most inflammatory piece I’ve written about overblown hype in healthcare innovation, or, as Dr. Joseph Kvedar called it, “irrational exuberance,” borrowing a line from former Federal Reserve Chairman Alan Greenspan.
It’s also far from the most-viewed item I’ve had on the Forbes.com platform since I started about six months ago. However, it’s generating a lot of discussion on Paul Sonnier’s Digital Health group on LinkedIn. As of this writing, there are 28 comments, or more than one per hour since the original post went up at 9:54 am EST Wednesday.
I haven’t decided yet if I’ll throw in an additional two cents, since I did, you know, already give my opinion in the actual post.
I recently delivered a lecture about integrated diagnostics and integrated diagnostic servers at an interim meeting of the International Society for Strategic Planning in Radiology (ISSSR). Here is a copy of my lecture for your review: Integrated Diagnostics & Integrated Diagnostic servers: the Perspective of a Pathologist. On slide #5 of the slide deck, I define integrated diagnostics as the aggregation of pathology and radiology test and procedure results from complex patients to facilitate their analysis and interpretation and to increase the quality and reduce the cost of care. I proceed in the lecture to suggest that these goals are best accomplished by the deployment of integrated diagnostic servers that I have discussed in a previous note (see: Development of Integrated Diagnostic Servers by Pathology and Radiology). It became clear to me during the subsequent discussion of these ideas with audience members that one of the major barriers to integrated diagnostics is the "culture" of pathology and radiology. To facilitate further discussion, here's the best definition for organizational culture that I could find on the web (Organizational Culture):
Organizational culture is the behavior of humans within an organization and the meaning that people attach to those behaviors. Culture includes the organization's vision, values, norms, systems, symbols, language, assumptions, beliefs, and habits.
The primary purpose for integrated diagnostics is to help clinicians arrive at a diagnosis for a patient faster, better (i.e., more efficiently and effectively), and less expensively. If my claim is correct that some aspects of the organizational cultures of pathology/radiology are antithetical to this goal, it's important to try to understand where within the vision, value, and norms of these two specialties the problem lies. I personally think that it's in the following two assumptions made by pathologists and radiologists regarding the operation of their departments and the pursuit of their careers:
In pathology, we frequently cite our increasing number of tests per year and increasing revenue, compared to expenses, as a justification for budgetary increases. This approach flows from the fact that we operate under a fee-for-service model where an increasing test volume is more remunerative. However, I also believe that we are slowly moving to a value-based healthcare delivery system where reimbursement is based on more efficient and effective care delivery (see: The Strategy That Will Fix Health Care). Hence, this particular facet of the pathology/radiology culture must quickly change to adapt to the provision of faster, better, and less expensive services.
I will refer to the pursuit of greater specialization in pathology/radiology as the "siloing" of the fields. In pathology, we even develop silos within silos: for example, pathology>surgical pathology>GI pathology>liver pathology. Similar trends exist in radiology. Although there are pleas for training more generalists to serve as data integrators, I don't think that this will happen. There are too many rewards for academics for a specialized practice. This is the reason why I advocate the use of software tools installed on integrated diagnostic servers (e.g., heuristics, business rules, and algorithms) to perform most of the heavy lifting in terms of mapping optimal integrated diagnostic workups for patients.
Note also in the lecture that I describe the need for the creation of virtual department of diagnostic medicine. I use this term to describe close collaborative, daily interactions between pathologists and radiologists without any disruption of the formal boundaries of these two medical specialities.
Join the #hcldr tweet chat tomorrow at 8:30 pm, ET, as HL7Standards.com contributor Leonard Kish moderates a chat on patient engagement.
Get full details on the chat in the post Do We Have Patient Engagement Backwards?, published on the Healthcare Leadership Blog.
The following topics will be discussed:
And, if you haven’t already, be sure and download Leonard’s new, free, comprehensive patient engagement eBook, titled, “Patient Engagement is a Strategy, Not a Tool. How healthcare organizations can build true patient relationships that last a lifetime,” published right here on HL7Standards.com.
"All patient and care records digital,
real time and interoperable by 2020."
|"Clinicians in primary, urgent |
and emergency care, and other key transitions
of care contexts will be operating without paper records by 2018."
|"Patients have access to their hospital,|
community, mental health and social care services records by 2018."
"By April 2016, commissioners and providers
must publish "road maps" showing how they
will develop interoperable digital records
and services by 2020."
I’ve been having some Internet speed issues as of late, so I searched online and found a speed test. Turns out my download speed is a less than lightning fast at a mere 7.8Mbps – even though I pay for 24Mbps. I called up my Internet provider and had a conversation that went something like this:
Me: I am getting less than 8Mbps speed and I am paying for 24Mbps.
Customer “Service” Guy (CSG): What are you using the Internet for?
Me: Mostly email and online reading. No streaming videos or anything like that.
CSG: Sometimes the speed appears slower because of the websites you are on.
Me: OK…so how do I make it faster?
CSG: Would you like to upgrade your speed to 45Mbps?
Me: Only if I don’t have to pay more.
CSG: Actually it’s $X more a month.
Me: No, I don’t want to pay more. I just want to get the 24Mbps speed I am paying for.
CSG: That’s not something I can help you with.
I confess: I hung up on customer “service” guy. And then I began to ponder how it is that we’ve become a society that fails to take responsibility when problems arise. For every person that steps forward and says, “yep, there’s an issue, let’s figure it out,” another dozen are either ignoring the problem because “fixing” is not part of their jobs, or, quickly placing the blame on someone or something else.
Anyone who has worked in IT knows exactly what I mean. A customer’s system goes down and the software folks blame it on the hardware; the hardware guys blame the Internet provider; the Internet provider blames the customer…and so it goes. And no one is happy.
A more tragic example: Thomas Eric Duncan, the first Ebola patient to die in the U.S., went to the ER with stomach pains, fever, and a headache. Despite telling staff he came from Liberia, the information was overlooked by the physician and Duncan was released. By the time he returned to the hospital a few days later, his condition was severe and he eventually died. Between the first and second hospital visits, Duncan could have infected dozens of people – though thankfully that doesn’t seem to have occurred.
When everyone began asking how the hospital could have missed the Ebola diagnosis with the first visit, hospital officials were quick to blame a glitch on the Epic EMR. However, the EMR was apparently just a convenient scapegoat.
After Epic raised a bit of a fuss, the hospital admitted the fault did not, in fact, lie with the EMR. Let’s face it: the hospital PR folks initially blamed the computer because they thought it sounded better than admitting the doctor made a mistake and didn’t fully read the patient record.
And what about the VA’s appointment scheduling scandal?
Several dozen VA facilities apparently kept “secret” waiting lists for veterans waiting to see a doctor while maintaining “official” waiting lists for reporting purposes. Employees were essentially ordered to cook the books to create the appearance that appointments were made within the VA’s 14-days-from-request goal. The secret list scheme continued until a retired VA doctor came forward as a whistleblower. By the time the truth was revealed, dozens of veterans had died before ever seeing a physician; more than 57,000 waited over 90 days to get an appointment.
How many people were aware these lists were being created and maintained? Hundreds? Thousands? Did they remain quiet because they feared losing their job? Didn’t want to get anyone else in trouble? Didn’t think it was their job to say anything?
Maybe the world needs some sort of 12-step recovery program that encourages people to readily admit when there’s a problem, and, encourages more personal responsibility. Seems like a better alternative than practicing avoidance and continuing to allow the buck to stop on someone else’s desk.