But will patients use your patient portal?

When we speak with new clients, this is a constant concern, and we do understand it.  All these tools for patient self-service are great, but how do you know if patients will actually take the time to sign up and use the new services?

We now have enough experience to definitively respond to this question.  The short answer to “will they use it?” is “Yes, but you have to have staff buy-in, and you have to promote it.”

A Tale of Two Practices

I’d like to demonstrate with a brief personal story.  When I last visited my primary care provider a few months ago, I went through the usual annual physical regimen.  Part of that included an EKG and to my surprise, my doctor found a potential heart defect — a right bundle branch block — that could be nothing but that I should get checked out by a cardiologist just in case.

So I booked an appointment with the cardiologist, got an echo, and fortunately the cardiologist considered the episode completely benign.

Now fast forward a few weeks, and I was asked by my insurance agent to gather all my medical records, which sent me back to both clinics.  At this point, 3 weeks into the request, I am still waiting for a copy of my report from both practices.

What is significant about this rather uninteresting story?  Well, both of these providers have patient portals, and in both cases absolutely no effort was made by anyone — doctor or staff — to inform me about the portal, get me to use it, encourage me to get my results online, etc.

Finally out of sheer curiosity, while checking out from my cardiologist appointment, I pretended that I didn’t know they already had a patient portal on their website.

Me: “Do you have some kind of online service I can use to see my medical record or book appointments in the future?”

Staff Member: “Oh, I think they were trying to set something up but it’s not set up yet, so I don’t think we have anything.”

That’s an interesting response because (a) it was inaccurate, and (b) the fact that there’s a “they” and not a “we” tells me this person has zero ownership of the patient portal initiative.  Because I know the industry, I happen to know this cardiology practice pays about $600/month, or $7,200/year for this service, and what value are they getting out of it?  Well, in my professional estimation, none!

What a High-Utilization Practice Looks Like

In contrast to the two practices above, as the CEO of Omedix, I obviously study utilization data across our clients to see how things are going.  One of our highest-utilizing clients is less than 10 doctors, in primary care, and run by a younger-than-average practice manager who has an iPhone, iPad, and loves technology.

In his practice, all staff were introduced to the portal and encouraged to tell every patient who calls that they could have booked their appointment online.  The signs that we sent them to promote the portal are posted in their office.  If you call their phone line and are on hold, the patient portal is promoted, and most important of all, the staff generally recognize the value of the portal and appreciate it as a better way — in most cases — of communicating with their patients.

How to Build Adoption and Utilization

The takeaway above is basically to gain staff buy-in and promote the portal to get usage out of it.  Here are some other tips:

Perhaps the most important element in ensuring patient adoption is staff training. When your staff speaks to patients about transactions that could have been handled online, they should politely tell them so. When your staff checks patients out, they should inform them of the patient portal, or even help register them on the spot.

Think of each patient interaction as an opportunity to enroll your patients in a more efficient, preferred way of communicating with them. The investment will ultimately save you time and money by empowering you to communicate with your patients in a way that is easy and efficient for your practice.

When an online service is simple and intuitive, both user satisfaction and return visits increase. Look for a patient portal solution that is easy to use, makes it easy to sign up, and is easy to get to.  All the staff at any practice are patients themselves, so just pretend you’re a patient at your own practice and see what you think.

¹http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=1096

The investment is particularly significant for our clients, who will see even more rapid feature releases and additional innovations that deliver better ways of engaging patients.

We also view the investment as an endorsement of our success to date, and the new market we are essentially breaking open—patient engagement.

Healthcare moving in a new direction

The tides of healthcare are moving in a new direction. Healthcare must become increasingly consumer-centric, but practices today generally lack the tools necessary to seriously engage patients in ways that make a measurable impact in their operational efficiency, or in the patient experience.

The promise of patient engagement is to go from a patchwork of solutions from multiple vendors — patient portal, website, patient reminders — and unite them all under a single integrated platform.

That means you have just one integration system to manage, your patients receive one integrated experience, and each of your solutions becomes more powerful and less expensive.

It’s a disruptive change, and we’re thrilled to be leading the market in setting a new vision for how medical practices will engage their patients.

Investors with a strong track record

Back to our financing, the round was led by Long River Ventures with participation from Canal Partners, plus a national roster of private investors. We are proud to have assembled an amazing team of investors who have already added immense value to Omedix. Will Cowen of Long River Ventures has been added to our Board of Directors, and Jim Armstrong of Canal Partners is an observer to the Board.

New career opportunities at Omedix

And, of course, we will be accelerating our hiring! Omedix holds a unique position in the healthcare industry as a developer of outstanding software and provider of superb customer service.

If you are interested in helping us build great software (software engineers) or in selling it (sales), visit our careers page and submit an application at http://omedix.com/careers.

Check back for updates

We have more exciting news in the pipeline that we’ll be sharing later this year. Please check back for the latest updates.

Congratulations to all of the Omedix team who worked hard to make this possible, and to our clients who have entrusted us with their patient relationships.

Best regards and the best of health,

Josh Padnick
CEO

But what I find is probably the most common “one big thing” is online registration. It seems almost unthinkable that when you go to a doctor’s office you still fill out all your registration forms by hand. And yet, that’s the healthcare world we live in. At the recent Winter Health IT Summit I attended, one heated panel member made the point that while you fill out those medical practice registration forms by hand, you can use your iPhone to place an order for a burrito at the nearest Chipotle.

The fact that Chipotle has more a sophisticated online experience than your typical medical practice is not the subject of this post. For this post, I wanted to describe how practices have solved the online registration problem to date. I’ll also mention how Omedix can help you, but I’ll put that toward the end. So let’s get started. Starting with the least high-tech and going to the most high-tech, how do medical practices handle the registration process?

Paper Forms

The lowest level of registration process is the hallowed paper office form. The patient arrives at the office — possibly with completed forms that have been mailed to them — and either hands them to the office staff or sits down to fill these out by hand with old-fashioned pen or pencil. Because the forms are usually comprehensive, the process typically takes 15 – 30 minutes.

Staff then painstakingly translate the information written on the form into the Practice Management System to fill out information in the patient’s account.

Summary:
The latest 1950′s technology in the modern medical practice.

PDFs on Your Website

One of the questions I was always surprised to get when we first started building websites for medical practices is “Can we put PDF forms on our website?” It turns out that is trivially easy to do, so we don’t even charge extra for it. You just give your webmaster an electronic copy of your form, he converts it to a PDF and uploads it.

The patient can now at least access the form at their leisure. Unfortunately, they still have to fill it out by hand since the PDF is almost never enabled for online submission.

Summary:
The latest 1990′s technology in the modern medical practice.

Fillable PDF’s

About 1 out of 250 times, we run across a practice that has paid someone — in some cases Omedix! — to enable their PDF’s to be fillable. The result is that it’s the same old PDF form, but the patient can now type their answers directly on the form on their computer.

This is a great convenience of course, but there’s a reason the fillable PDF never really took off: The PDF can only be printed. Since it can’t be saved unless you have expensive Adobe Acrobat software, the general concern is that this is going to cause more frustration than it reduces.

Summary:
A rare bird, and there’s a reason it hasn’t thrived in the wild.

Online Registration

At last we enter the 2000′s! With online registration, your patients go to your website and typically log into a patient portal. On the patient portal they fill out “online forms”. This is a version of your old paper registration forms, but rendered online.

The patient fills out one or more forms and presses submit. Your staff then have a separate practice portal to log into to view the submission. The forms don’t integrate with anything, but they do show up in your practice portal. It’s not the perfect solution but it’s better than paper & pencil.

Even though this isn’t the ultimate solution, there are still some horror stories out there. The biggest problem is that some vendors have created an “online forms” solution but haven’t optimized their solution to render the kinds of forms your patient registration forms look like. The result is that the forms look bad. Really bad.

When a patient sees an endless wasteland of 100 sequential fields to fill in, it’s a bit daunting and they revert back to the comfort of paper. The other area where vendors often drop the ball is how the form renders for the practice. Doctors are accustomed to seeing the medical history form a certain way. Staff are accustomed to seeing demographic forms a certain way. When these patterns get interrupted, people’s first reaction is frustration. These issues can be overcome, but be sure to watch out for them.

Summary:
It’s not quite the Apple Store, but your practice can now go electronic with patient registration.

By the way, Omedix can help you with online registration. If you’d like to learn more, feel free to Contact Us.

Online Registration with Integration

This is the exact same solution as described above, but with one beautiful enhancement: some portion of the forms patients have filled out can be sent directly to your Practice Management and/or EHR system.

Summary:
We have online forms and we have backend integration. Life is at last very good.

Omedix can also help you with online registration with integration. If you’d like to learn more, feel free to Contact Us.

Final Thoughts

Amazingly, the story’s not quite over with this blog post. There is a complementary class of solutions to online registration, but we’ll leave that for a future blog post.

Your Website
Your website is pretty much what you think of when someone says “just visit my website.”  Its most distinguishing feature is that no username or password is required to visit your website.  You simply type in www.YourPracticeWebsite.com, and up pops all the content.  All medical practice websites today have the basics — profiles of the providers, locations with directions, accepted insurances, medical services, and some general information about the practice.  Many medical practice websites also have more interactive features like patient education, online appointment requests, online bill pay, and a blog.  Again, these features do not require a username or password.

Your Website is Primarily about Marketing
Ultimately, your website is really meant to play a marketing role in your practice.  It communicates what you do, it showcases the talents of your doctors, and it encourages people to make an appointment.  To see a good example, check out http://www.azfeet.com.  This entire site is pretty much engineered to help new patients learn about the practice, and when they’re ready, to make an appointment.  The site’s usefulness is measured in terms of how many online appointment requests and how many new patients it generates.

Other clients use their site for patient education or interactivity, but in my experience the overriding goal of the public website is appearing fresh to existing patients and attracting new ones.

Your Patient Portal
A patient portal is a special secure website your patients visit to do online what they used to only be able to do by phone.  This includes things like:

• requesting an appointment
• paying a bill
• requesting an Rx refill
• receiving lab results
• viewing upcoming appointments
• viewing their outstanding balance
• registering for their first visit
• viewing their medical record

The common theme among all these items is that they are specific to a particular patient. The patient portal has to know who you are before it can reveal medical record information to you, or let you renew a prescription.  This is the single-most important difference between a patient portal and a website.  A patient portal knows who you are.  A website doesn’t know anything about you.

Based on this one requirement — that the patient portal has to know who you are — companies like Omedix have created an entire infrastructure to allow patients to create accounts and practices to verify those accounts.  Patients must then identify themselves by logging in with a username and password.  Since they want to see private information about themselves and since this information is “Protected Health Information” as defined by HIPAA, the patient portal has to be secure, log access to the patient’s medical records, and meet several other criteria.

The Relationship Between Your Website and Your Patient Portal
At the end of the day, this is the simplest thing in the world.  The only relationship between your website and your patient portal is that your website should link to your patient portal.  And that’s it!

When Omedix builds websites, we often make a point of promoting the features of the patient portal on the website, but at the end of the day, we’re still just linking to the patient portal.

Summary
- Your website doesn’t know who you are when you visit it.
- Everyone who visits your website has the exact same experience.
- Your patient portal requires the patient to log in.
- Your patient portal starts by replacing phone calls.
- Then it goes on to give an “online healthcare experience”
- The only relationship between your website and your patient portal is a link
- However, you should also use your site to heavily promote the portal

This is our third consecutive year showing at the AAOE Conference (it used to be called BONES). This is basically the premier conference for the administrators of Orthopedic practices around the country. There are around 500 administrators total, and at least 50 different vendors.

A simple but meaningful thing kept happening to me today: I ran into people I’d met before, or clients of ours, or people I knew, or people I didn’t know but recognized from previous years. First of all, it dawned on me that running into people you know and had fun talking to is FUN! Some kind of neurochemical is released when it happens because it just makes me feel happy to catch up with people even if we’re only mildly acquainted. There’s something wonderful about strengthening a human bond; it’s very fundamental to our existence.

The week before last we began a new project with a 3-physician pediatric group in Scottsdale, AZ. I’d met the practice manager over a year ago and she expressed a strong interest in working together. She still researched us along with two other companies, and it still took a year before she was ready to sign a contract. At the end of our first meeting — which went very well and was also fun — we had an interesting exchange:

Her: You know, I actually compared you guys to two other companies. Do you know why I chose Omedix?

Me: Charismatic personnel?

Her: Haha, well, you were still around 1 year later. Both of the others had disappeared.

How does this all tie together? The “Life Truism” I referenced in the title is that business is built on relationships, that relationships are built on trust, and that trust takes time to build and is very precious. It’s so easy to look from afar at a company and try to see why they’re business strategy made them so successful and completely miss the point that if your clients don’t actually like you and trust you, nothing will ever happen.

Initially, our company is almost always evaluated based on price, quality, and features. But I feel like whenever I have a really good personal connection with a prospective client, we wind up getting the business. I feel like I enjoy my work so much more when I have a good personal relationship with our clients. It just makes the world such a happier place.

So, here at the AAOE Conference for Year #3, it’s kind of a cool feeling because we’re not strangers here anymore. People know us. People know we were here last year, that we’re here this year, and that we’ll be here next year. That kind of thing is powerful and builds trust.

I’ll write another conference post probably by the end of the conference — talking one-on-one with so many practice managers is incredibly enlightening — but for now it’s time to get some sleep!

This graph (if you can’t see it, click the “Read More” link below) was on this morning’s iHealthBeat. This is basically yet another indicator that patients are going to become increasingly choosy about where they get their medical care in the future.

Offering your patients the ability to view their medical records online doesn’t necessarily mean you show them the ENTIRE medical record. One of our clients recently saw a patient who he felt was making great efforts to acquire narcotics from him. In his encounter notes for the medical record, he mentioned this to advise other doctors in his practice. Does he want the patient to see that? No, but does he want the patient to see that he diagnosed her with endometriosis as well as the medications and dosages he prescribed? Yes.

One thing that’s interesting about so many of these technologies is that they raise uncertainty more than anything else. And in the face of uncertainty, we tend to gravitate toward the status quo. It’s becoming apparent to me that as we continue to release a stream of more innovative services, we’re going to have to put a considerable amount of effort into identifying the potential issues, laying out the possibilities, and genuinely helping our clients decide if a new technology is a good fit for them.

That having been said, there are some very exciting things on the horizon so stay tuned!

Well, I’m actually really glad I went. This conference is sort of like the little gem in the industry in my opinion: it draws a lot of very forward-thinking people from some very well-known institutions and some very cutting-edge ideas are discussed.
For the uninitiated, here’s the definition of Information Therapy:

Information Therapy (n.)
Prescribing the right information at the right time to a patient so that the patient is elevated from “passive receipient of care” to ” educated and empowered active self-monitor of the care being received.”

Basically, it just means that a diabetic patient 30 years ago may have blindly gotten their A1C Test just because their doctor told them to. But his modern-day counterpart was educated by his doctor about what the A1C Test really is, why it’s so important, and what the different ranges mean. In other words, the patient is now empowered to monitor what’s happening to him in his healthcare experience.

I wasn’t too sold on the concept when I first started going to this conference a few years ago but today I take a long, savory drink of this particular Kool-Aid. It’s really game-changing stuff.

I think what’s most interesting is that it’s something very concrete, so people have used it to launch other ideas about what it means to be a patient in the “new” healthcare paradigm. Basically, there’s a growing trend toward people seeing the patient as a partner in the care process, someone who has a proactive care plan and works in partnership with his doctor to achieve his personal goals. It means the patients is educated enough to know at least generally why he’s getting the tests or treatments that he is.

It means that it’s actually possible that the patient might know more than the doctor does about her particular illness because she obsessively researched it prior to her visit. Dr. Paul Wallace, Chief Medical Officer at Kaiser Permanente and a former practicing oncologist, humbly admitted that one his more enterprising patients frankly knew more about her ovarian cancer than he did.

This isn’t a failure on his part; there’s simply too much information on every different type of cancer for him to be the world’s expert. Rather, it’s an indicator that we live in a world overflowing with more information than anyone can reasonably process. That means that the days of the doctors as the untouchable lecturer of all relevant knowledge are sort of gone, and the days of the doctor as highly-educated consultant who works together with the patient to make the best decisions are beginning to come here.

It’s funny because I sat next to a girl who was developing a wellness program for her Care Management company (for the uninitiated, Care Management Companies are hired by insurance companies to proactively call members who suffer from chronic conditions and help increase compliance to keep costs down). Anyways, I cynically told her that by the end of the conference we would have yet another “we know the healthcare system is broken and if we just close our eyes and squeeze our fists we can all change it.”

I was actually proven wrong, though. The seeds of change are already afoot. Here are a few examples from the conference:

This is a paradigm-changing practice started by Dr. Rushika Fernandopulle, who had possibly the most difficult-to-spell name at the entire conference. Dr. Fernandopulle studied healthcare policy at Harvard and utlimately decided the current system delivers systematically “crappy” care (his word; I like it). So he created a new model of primary care, which is supported by a different kind of labor setup and a different kind of business model.

Renaissance Health charges its patients $20 – $40/month and in exchange the patient goes from “episodic care” (i.e. visit doctor when I get sick) to having a proactive medical partner who works together to manage your current health and prevent future illness.

The sense of realism is what struck me most. Dr. F talked about a patient that had 5 co-morbidities. They determined that for her to do everything that was “optimal” for each condition would have required around 3 hours per day. So instead of unrealistically saying “go do these things” and then forgetting about her, they worked together to create a “care strategy”, they prioritized the list, and then they focused on the 1 or 2 issues that mattered most to her.

Dr. F also talked about how he wanted to change the paradigm of “protect the doctor from the patient at all costs” to “strategically avail the doctor to the patient in conjunction with supporting resources.” He introduced positions in his practice like “health educator” that simply don’t exist in most other practices. Sadly, Dr. F complained, the IT they wanted was more optimized to help the doctor code for the highest possible reimbursement rather than communicate proactively with the patient.

I thought it was a phenomenal model, and I have so much respect for Dr. F for “doing” instead of just talking. I hope we’ll get the chance to work together.

These guys actually presented at last year’s conference, but I ran into their CEO, Jeffrey Greene and we chatted a bit. I obviously can’t share the details of our conversation, but just based off their public demo last year and other “winds” I’ve heard since, here’s another potential game-changer.

MedEnctive is a pay-for-performance company (for the uninitiated, that means they help setup incentive programs so that doctors who provide higher quality care are rewarded by earning more money), except that they set up a very clever incentive scheme: the patient is incentivized financially to engage the doctor (the patient gets 30 bucks if he can get the doctor to give him an information prescription) and the doctor can earn up to 10% – 15% more income per year if he gives the patient an information prescription and gets high satisfaction ratings from the patient.

The results from their first pilot were IMPRESSIVE. Like, I’m talking 30% overall cost savings in the system. That’s crazy! Crazy good, that is.

Finally, we have another game changer. This was the first conference I’d been to since Microsoft announced their HealthVault product last week, and their was a palpable excitement in the air. Essentially, MS has setup a Personal Health Record (that’s a medical record that patients can access and update) and set up an open, free interface for accessing it.

That’s huge. It means that Omedix systems can talk with some random EMR company we’ve never even heard of as long as both of us talk with Microsoft Healthvault. Here again we have the seeds of change being sowed.

Overall, I guess you could say I’m almost kind of euphoric. I feel like American Healthcare — in all its big, clumsy, excessively wasteful and inefficient glory — is finally beginning to lumber around to a better system. For the first time, I actually feel like there are things I can do as an entreprneur that are simultaneously fun, good for America, and profitable. Finally, capitalism works the way it’s supposed to.

It’s an exciting time in our industry…as much as I’m suffering from conference burnout, I can’t wait to go to the next one!

Most conferences are better for the people you meet than what you learn in the sessions. I thought the panels here were actually quite interesting (except for the insurance company one which was extremely boring and overly “health 1.0″), but the attendee list here was incredible: CEO of WebMD, Former CCHIT Head David Brailer, CEO of AllScripts, the list goes on.

During the boring insurance company panel I was joking with the woman next to me that I think someone forgot to tell them it’s a Health *Two*-point-oh conference, she laughed, we introduced ourselves and it turns out she was the head of Internet Services for all of Kaiser. Cool!

Anyways, here are what I saw as some of the key trends:

Key Trend #1 — Social Networks for Patients
Seeing some of the social networks for patients was pretty interesting. Personally, I felt the two best were:

www.DailyStrength.org — This was an online community built around different disease groups. Its core concept is basically “social network for patients” but the way it was implemented was clever and fun (I give you “Hugs Received Today”).

www.PatientsLikeMe.com — This concept was just amazing. The business model is another story, but the actual user experience is incredible. Hopefully you can see in the screenshot below, each patient joins a “disease community” (the example here is Parkinson’s) and reports their history of medication usage, symptoms, weight, etc. The brilliance is in how the data is visually shown. Trends over time and relationships between, say, medications and symptoms are clearly visible. Your data can also be compared against that of other patients. Although it’s limited to chronic diseases and moreoever to just a few diseases, the potential to connect patients throughout the country (world?) is really amazing.

Key Trend #2 — Social Networks for Providers
There was also a panel on these. Sermo.com is basically the leader in terms of both visibility and number of physicians registered. Within3 was also interesting, though Sermo appears to be focused around connecting physicians to each other whereas Within3 seems to center around connecting physicians to other healthcare researchers or industry members.

Key Trend #3 — Everyone Remains Pissed Off at the Healthcare System but No One in Incentivized to Do Anything About It

Okay, so this is me ranting, but it’s just getting so frustrating. Even at a conference like this where discussions were all about the next generation of healthcare, the “the system is broken and we KNOW we can fix it someday” attitude was still quite prominent.

I agree the system’s broken — defensive medicine, perverse incentives for doctors, rising premiums, unacceptably high numbers of hospital errors, 1 out of every 6 Americans is uninsured, etc. — but the problem is after a conference like this I go back to my world and think about how I can do a better job of helping our physician practice clients use the Web to become a better practice. I help them; that helps grow our business; but does the healthcare system itself change? Sadly, I don’t think so.

It’s like my (cardiologist) Dad says: “Some things are bigger than you.” It’s a defeatist statement from someone I know to be the anti-defeatist, but it’s kind of true.

Key Trend #4 — Patients Will Soon be Presented with “Find a Doctor” Services

There are a few startups I saw that aim to help patients find doctors and dentists the way they find what movie theater they want to go to:

www.xoova.com — Patients can search their zip code for a doc and learn about which one they like the best.

www.vimo.com — Vimo is the same concept as xoova, at least for finding a doctor. But Vimo is cool because they focus mostly on letting you shop for health insurance in a nifty online “apples to apples comparison” kind of way. Simple model, simple business, easy to make successful. These are my favorite kinds of business models.

Closing Thoughts

My first thought is that this is a reallly long blog post. I can’t believe you’re still reading this (j/k…I know it’s interesting stuff). My second thought is perhaps (*perhaps*) more profound:

It really is clear healthcare is undergoing a quiet revolution. Maybe I’m being ego-centric, but I think companies in our space have some of the greatest potential to effect change out of everyone. I mean, we help the doctors do cool things online that help them appeal to patients and become more efficient, and how do we earn revenue? The practices pay us money direct because we offer valuable services to them.

Case in point: Earlier this morning, I spoke with a wonderful client of ours who runs a 2-physician OB/GYN practice and she shared with me how they get now upwards of 5 online appointment requests PER DAY and how their website has really altered the dynamic of their practice — they get patients from search engines, patients read information about their condition before and after their visit, etc.

What if when we equip this client with our Patient Portal we linked them into “PatientsLikeMe” via some kind of cool partnership? What if we made sure that patients searching on xooma or vimo are guaranteed to find our clients for relevant searches? What if our doctors logging in get automatic access to sermo or within3?

The future is exciting and unknown. You can probably see now why I love my job so much. ) Thanks for reading!

For example, one physician here at the conference said that after she delivers bad news to a patient, she figures the patient retains maybe 25% of what she tells them if that. Information Therapy is about recognizing that this patient is at the step “just diagnosed with Heart Failure” and then making sure that patient receives an article, watches a video, or is otherwise educated about “You’ve been diagnosed with Heart Failure. What now?”.

Conferences like these are interesting because you meet so many different people from so many different areas of healthcare each tackling a similar problem from a vastly different angle.

For example, I’ve seen Patient Portals here from three different companies each selling essentially the same core Patient Portal to three different markets. If it happened that a patient’s insurance company purchased the Trizetto portal, his hospital purchased the MedSeek portal, and his doctor purchased the Omedix portal, he would have three different ways of accessing almost the exact same thing!

I’ve seen an incredible demonstration from MedEncentive on Pay-for-Performance. Traditionally, I haven’t been blown away by Pay-for-Performance, but they’ve set up their program in such a way that patients are actually financially incentivized toward compliance, doctors are financially incentivized to follow Evidence-Based Medicine, and both parties are aware that their actual performance will be rated by the other party (Matthew Holt does a much better job of explaining this on The Healthcare Blog).

One theme that seems to come up every single year at the Ix Conference (hidden though it may be) is that medicine practiced in an Integrated Health Sytem (like Kaiser, Group Health, Cleveland Clinic, etc.) has some serious advantages and incentive alignments versus the standard “private practice” model. Seeing the EMR and Patient Portal that the Cleveland Clinic has in place makes me teary-eyed, and another doc here admitted it makes him “drool with envy.” So maybe part of our job is to take the magnificence of a Patient Portal / Patient Education Infrastructure as seen in an Integrated Health System and make it available to a private medical practice? Or at least to adapt it to better fit the needs of that market, but still enable them to achieve that nirvana?

Other interesting trivia at the conference:

• What billion-dollar healthcare industry are most doctors not even aware of? Disease management. Crazy stuff.
• Healthwise is starting to get very sophisticated with its Patient Education. They are actually able to now generate patient education content specifically for the moment in time when a patient has been diagnosed with asthma but has not demonstrated compliance. WOW.

And finally, I’m starting to realize just how a big of a deal patient education can be for patients. In fact the phrase “Patient Education” doesn’t event really do the concept justice. Information Therapy on the other hand is huge. When patients are empowered and encouraged to learn about their own condition, they do learn about it. And when they learn about it, they are actually able to monitor the care they receive, to interact with their doctor in a more elevated and more efficient manner, and they are so much happier because they don’t just blindly meander through the healthcare system; they actively navigate it.

The trick is distilling all of that down to a concrete value proposition for a standalone medical practice. Is it enough to say “We offer patient education.”? Is it enough to just encourage patients to look at it and leave it at that? I don’t think so. I think the graph of Patient Education Utility looks like this:

In other words, you don’t get a whole lot out of the Patient Education if it’s just there, but if you really use it, integrate it, engage with your patients, etc. it can make a huge difference.

More thoughts to come down the line!

My job requires that I have at least a basic understanding of the different requirements of being “HIPAA-compliant” but this was an opportunity to get real confidence about exactly what has to be done to slap the “HIPAA-compliant” label on our services. What’s amazing to me is that it’s not that hard to officially list out what needs to be done to be HIPAA-compliant, but the government has done a terrible job of making it clear.

After many consulting hours and questions, I can summarize all the complexity of HIPAA as follows. Oh, and this list is for commentary purposes only; I very well may be missing information here. That having been said, here we go:

(1) HIPAA really stands for Health Insurance Portability and Accountability Act and has two “Titles”. When everyone thinks of HIPAA, they really only think of Title II: Administrative Simplification

(2) “Title II: Administrative Simplication” gave rise to five “rules”, only two of which most of us have to worry about — the Privacy Rules and the Security Rules

(3) The Privacy Rules are handled by the Office for Civil Rights within the Department of Health and Human Services and are officially outlined one-by-one here. The only relevants parts for a practice appear to be Part 160, Subpart C (talks about how you might get audited) and Part 164, Subpart E (talks about what you have to do and what patients’ rights are).

(4) The Security Rules are handled by the Centers for Medicare and Medicaid Services (CMS) within the Department of Helath and Human Services. Those rules are officially outlined here. There is a huge amount of text that doesn’t apply to most people, but the good stuff is in Part 164 and is broken down into Physical Safeguards, Administrative Safeguards, and Technical Safeguards.

(5) The rules are very open-ended, saying things like data should be encrypted but leaving open-ended as to which encryption algorithm you use. That means that being “HIPAA-Compliant” is not a certified stamp you earn when you pass a rigorous inspections. Rather, it is a self-assigned description that your organization thinks that it’s made a reasonable best effort to comply with HIPAA. In other words, “HIPAA-Compliant” really means, “we took a look at HIPAA and did the best we could.”

(6) And finally, there are a bunch of non-official templated HIPAA contracts or agreements that are floating around — Notice of Privacy Practices, Privacy Policy, Business Associates’ Agreement. These agreements aren’t official, just based on the stuff above.

And well, that’s it! As I understand it, that is the entirety of the complexity of HIPAA as it relates to an ambulatory practice and by extension a healthcare IT vendor. In my opinion, the government has done such a terrible job of making that clear. I could take two days and set up a website called “The Official HIPAA Resource Center” and leave out things no one cares about like legislation that was proposed and rejected. Because no one has setup a simple-to-use resource center, an entire industry of HIPAA consulting exists that capitalizes on people’s fear.

The reality of HIPAA is also that it was drafted not by clinicians, but by legislators who consulted experts on healthcare. So there is a ton of stuff in there that is a total pain to do. And for Healthcare IT vendors like us? We get a huge amount of latitude as to how we choose to implement HIPAA and apparently “HIPAA-compliant” varies quite a bit.

So, those are my thoughts on HIPAA. Patients should absolutely have privacy and security with their medical records, but the implementation of how that’s legislated leaves quite a bit to be desired. For someone not in the industry, this article must have been incredibly boring. But for the healthcare people, you probably share my frustration with this.