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Support for Electronic Health Information Varies With Use

Posted on Mon, Jan 05, 2015
Support for Electronic Health Information Varies With Use

Most support for research use when consent is obtained; least for marketing use without consent

TUESDAY, Dec. 16, 2014 (HealthDay News) -- Consent and purpose are important for public support of secondary uses of electronic health information, according to a study published in the Dec. 16 issue of the Annals of Internal Medicine.

David Grande, M.D., M.P.A., from the University of Pennsylvania in Philadelphia, and colleagues conducted a nationally representative survey involving 3,064 African-American, Hispanic, and non-Hispanic whites to examine public support for secondary uses of electronic health information under different consent arrangements. The perceptions of uses of electronic health information were assessed according to patient consent, use (research versus marketing), and framing of the findings (abstract description versus specific results).

The researchers found that the mean ratings of appropriateness of health information use varied from a low of 3.81 for marketing use when consent was not obtained and specific results were presented to a high of 7.06 for research use when consent was obtained and specific results were presented. Scenarios in which consent was obtained were rated as more appropriate than those in which consent was not obtained (difference, 1.01; P < 0.001). Scenarios in which the use was marketing were rated as less appropriate than those in which the use was research (difference, −2.03; P < 0.001). The respondents rated unconsented research as more appropriate than consented marketing (difference, 1.13).

"Although approaches to health information sharing emphasize consent, public opinion also emphasizes purpose, which suggests a need to focus more attention on the social value of information use," the authors write.

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DIY Healthcare System: What is Health Reform and What’s its Special Connection to Quality, Safety and Accountability?

Posted on Wed, Dec 24, 2014
DIY Healthcare System: What is Health Reform and What’s its Special Connection to Quality, Safety and Accountability?

BY: TOM PECK

“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

What is Health Reform and What’s its Special Connection to Quality, Safety and Accountability?

Dr. Nash asked attendees to consider these critical questions:
 
  • Are our efforts aimed at reforming healthcare or reforming health?
  • Can we align population health and health reform? How?
  • Have we reached the tipping point and are we ready to embrace reform?
  • Can we change the economic incentives to move from volume to value?
Health reform builds on five pillars – a national quality improvement strategy, quality measure development, value-based purchasing, prevention and wellness and new entities and authorities.

In order to achieve health reform, the country must address payment reform. There are four underlying concepts guiding these efforts:
 
  • Tying payment to evidence and outcomes rather than per unit of service (no outcome, no income)
  • Bundling payments for physician hospital service by episode or condition
  • Reimbursement for the coordination of care in a medical home
  • Accountability for results – a commitment to patient management across care settings.

Dr. Nash highlighted several payment models currently in existence or development including incremental fee for service payments for value, bundled payments and accountability for population health (risk-based payments). Nearly one-third of the nation is testing some form of bundled payment arrangement. He described the medical home concept as it relates to bundled payments for chronic care and disease carve-outs.

A medical home:
 
  • Relies on the team
  • Provides care for all
  • Measures performance
  • Encourages regular innovation
  • Includes mental health, PharmDs and more
  • Encompasses navigation and care
  • Requires management
  • Supports care through health information technology
  • Led by physicians

Accountable care organizations (ACOs) have emerged as the driving force behind population health. Dr. Nash predicted consolidation in ACOs and reminded attendees that a well-oiled primary care physician machine is necessary to keep the ACO running efficiently and effectively.

RELATED ARTICLES:
DIY: Healthcare System: What is Population Health, Anyway?
 

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New Fitness Trackers Have Patients Wearing their Heart (Rate) on their Sleeve

Posted on Thu, Dec 18, 2014
New Fitness Trackers Have Patients Wearing their Heart (Rate) on their Sleeve

By Dr. Adam Corley

With the holiday shopping season in full swing, many of us are trying to decide what gifts to get for our friends and family.  Healthcare and fitness items often make it to the top of many people’s wish lists as they prepare for the upcoming year and the resolutions that they plan to make. Even for those who are not necessarily inclined towards exercise and fitness, gifts to encourage or facilitate a healthy lifestyle are often popular.
 
Over the past few years, there has been an explosion of electronic items that collect data about lifestyle, fitness, sleep, and other health metrics. Many of these small devices are wearable and transmit data to smartphones or computers. Consumers, personal trainers, and even physicians can use the data to make healthcare, fitness, and lifestyle adjustments.
 
Practice Fusion, a cloud-based electronic medical record company, asks a survey question of their 20,000 physician consumers every Friday. Recently, the site queried doctors about whether their patients had asked about incorporating data from wearable devices or other healthcare apps into their medical record. Of the 353 doctors who participated, 15% responded yes. 
 
In the likely event that you're presented with data captured from electronic health trackers, use the tips below to provide patients with reasonable expectations for use of this information.

Here are some ideas of what can really be achieved with wearable fitness trackers
 

  • Understand your baseline.  Most of us aren’t really aware of how our daily activities add up.  How much are you really on the move? Are you sedentary more than you realize? A fitness tracker can provide a decent idea of what your baseline activity looks like.
  • Track and balance your calories.  There is a tendency to overestimate our caloric output and underestimate how many calories that we take in. Tracking calories burned both with routine daily activity and with exercise can give you the perspective that you need in order to plan meals, work-outs and activities.
  • Understand how you sleep.   Many wearable fitness devices provide data about how long you sleep, how often you move or get up, and some even try to estimate how long you spend in each stage of sleep. Though there is some question about the usefulness of the data about restlessness and movement, making sure that you get enough sleep is clearly beneficial.
  • Motivate yourself.  Knowing that your activity is being tracked and recorded can be very motivational. Aiming for your daily and long term goals and tracking them with your device can inspire you to stick with your fitness plan.
  • Track your progress. After you understand your baseline activity level and calorie output, set your fitness goals, make sure that you’re sleeping enough, and appreciate your new found motivation, you can track your fitness progress. Viewing your successes and set backs over time allows you to adjust your diet and activity to maximize and appreciate your success.

While some doctors don't believe there is a place in the hospital for fitness trackers, the fact that 15% of patients are currently using these devices and presenting the data to their doctors means there needs to be an awareness by physicians about how to handle the data while being honest about its usefulness and its limitations, all while making sure the patient feels like a partner in their care and not shut out of the process. It may not help us cure any major diseases, but by following the guidelines above, hopefully you and your patients can have meaningful conversations about how health trackers can help facilitate a healthy lifestyle, which could prevent a few.

ABOUT THE AUTHOR
Adam Corley, MD, FAAEM, FACEP, is a Regional Medical Director for EmCare and practices at Brazosport Regional Health Center in Houston, TX.
 

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DIY Healthcare System: What is Population Health, Anyway?

Posted on Wed, Dec 17, 2014
DIY Healthcare System: What is Population Health, Anyway?

BY: TOM PECK

“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

What is Population Health, Anyway?

In an effort to address the challenges outlined in the IOM report, one approach has emerged as promising – population health management. What is population health and is it the answer? Dr. Nash said the concept is attributed to David Kindig, who espoused it 35 years ago. The concept looks at health outcomes (morbidity, mortality and quality of life) and their distribution within a population, health determinants (medical care, socioeconomic status, genetics) that influence the distribution and policies and intervention (social, environmental and individual) that impact these determinants.

"The take home message," said Dr. Nash, "is that medical care is 15 percent of the story the other 85 percent are the messy social determinants of health. Four determinants– smoking, unhealthy diet, physical inactivity and alcohol use -- account for 40 percent of all deaths in the US."

A study by the Bipartisan Policy Center examined what makes us healthy. The results showed that individual behaviors such as diet, exercise and education determine 50 percent of an individual’s overall health status while genetics comprise 20 percent and access to care makes up the remaining 10 percent. The ironic fact is that as a country, the US spends 88 percent on medical services, eight percent on other activities and only four percent on healthy behaviors.

While population health seems to be the magic pill to cure the healthcare system of its ills the facts are that most healthcare organizations don’t have the resources or scope to build a comprehensive population health management program. Doing more of what we are already doing won’t address the many factors that affect the health of a population that extend beyond the realm of traditional medicine. Successful population health management initiatives will cover between 250,000 and 500,000 lives so healthcare organizations will be required to add new components to their care delivery infrastructure, recruit new talent and develop a culture of innovation.

Dr. Nash’s organization, Thomas Jefferson School of Population Health, published the first textbook on the subject, Population Health, Creating A Culture of Wellness. The school also publishes a population health management journal. Dr. Nash also cited the Trust for America’s Health Report, A Healthier America 2013: Strategies to Move from Sick Car to Health Care in the Next Four Years, as an important addition to the library of knowledge on the subject.

Consider this fact: the US spends under two percent of its health dollars on population health and there is no dedicated federal funding stream to address chronic diseases that comprise 80 percent of the total disease burden in America. It’s sad but true that only three percent of the US population exercises for at least 20 minutes three times a week, doesn’t smoke, eats fruit and vegetables regularly, wears seat belts regularly and is at its appropriate body mass index.

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Studer Spotlight: Connecting with Patients While Using Electronic Health Records

Posted on Tue, Nov 25, 2014
Studer Spotlight: Connecting with Patients While Using Electronic Health Records

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com

CONNECTING WITH PATIENTS WHILE USING ELECTRONIC HEALTH RECORDS
By: Barbara Roehl, MD, MBA


There’s no substitute for “connecting” with the patient. Effective communication and demonstrating empathy is a critical component to quality patient care. New technologies such as Electronic Health Records (EHRs) can seem like a barrier for physicians and providers looking to build a connection.

According to a New England Journal of Medicine article (Wolpaw, MD, D.R., Shapiro, Ph.D. D; N Engl J Med 2014; The Virtues of Irrelevance 370:1283-1285, April 3, 2014, DOI: 10.1056/NEJMp1315661), personalized opening comments, “convey that we see patients as unique”, “reveal that we have shared experiences”, “are observant and attending to details”, and “indicate that we are open to a conversation.” All of these help to put the patient at ease and establish a therapeutic relationship.

As healthcare is getting even faster paced, and with an increased focus on productivity and utilization of EHR’s becoming the norm, how can we maintain the “connection” in our encounters with patients? As a practicing physician, I personally have been through two EHR implementations in the ambulatory setting, and currently planning for a third (one in inpatient setting and heading for a second), here are a few tips and tricks that can make a big impact:

Briefly review the chart prior to entering the room so the beginning of the encounter isn’t dominated by staring at a screen while rifling through the EHR to find basic information. Be clear on basics of their care, including last visit and needs for this one (prescriptions, referrals, etc.). Make sure the patient’s first and last name are known. If a note was made during the last visit of something special in their life, such as a birthday, wedding, or vacation, ask briefly about it. Patients will be more forgiving when we document in the computer if we’ve already made them feel we’re interested and listening.
Don’t forget your AIDET®.

An important part of AIDET® is the “A” for Acknowledge. This step helps us make a connection to patient. In addition to eye contact, smiling, addressing by name, sitting down, and shaking hands, opening the encounter with a personalized, genuine statement can help make a connection that will make the rest of the encounter more collaborative and satisfying. It can also make the patient more tolerant when we use EHRs.

Include EHR as part of the “Acknowledge” step. State why we use it and how it helps in patient care. Specifically indicate that we will periodically turn to EHR to capture important points for the patient’s shared care plan. When we aren’t documenting in EHR, it’s important to have good eye contact. When we do turn to use EHR, be sure to indicate what you are doing. For example, “Just let me capture that important information”, “Just a moment while I include that in your treatment plan”. Use whatever verbiage and phrasing that feels comfortable while acknowledging the transition to and from the computer.

Don’t forget the “T” in AIDET®: Thank You. Thank the patient for visiting us and close warmly. Don’t let documenting on the computer get in the way of a gracious end to the encounter, complete with eye contact, a hand shake, smile and genuine pleasantry.

Manage up the EHR (or at least don’t manage it down), just as we manage up the rest of the care team. This helps to create overall confidence in the care provided. 

A great way to engage patients with the EHR is through the use of graphics and visuals. For well child visits, try showing the growth curve. For chronic disease, show trending graphs for blood pressure, weight, A1Cs, or lipids. This is an excellent opportunity to be transparent with our patients and provide detailed explanations that patients appreciate.

Pay attention to body position in relation to the patient and computer. Is the physical layout of the office conducive so we can sit, talk, and document the encounter with an unobtrusive computer set-up, facing the patient? If not, think about rearranging the room. Consider seating the patient at your EHR station with proximity to both you and the monitor.

Try utilizing a scribe during patient visits. This allows providers to remain solely focused on the patient while the scribe captures plan of care notes in the EHR. Make sure that you inform the patient of the scribes name and role.

As we move into a more electronic age, let’s not lose the connection to purpose and connection to patients. It doesn’t need to add significant time to a visit and can make a big impact. When we connect, the patient feels it, and so do we. It’s equally as good for the patient as it is for the physician. Happier patients lead to happier doctors. It connects to purpose, worthwhile work and why we got into healthcare in the first place. Connecting adds purpose and meaning, for both patient and doctor.

Additional Resources:

Gain additional tools, tips and perspective during the Physician Partnership tracks at Studer Conferences
Download the AIDET® Guidelines and Key Words document to gain tips for physicians and providers implementing AIDET®.

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