Friday, April 11, 2014

Meaning Use, Patient Portal: Engaged Patients and More :

The Patient Portal: Meaningful Use, Engaged Patients & More
Successfully Implement Patient Portal For MU2

Practices that have invested time and money in choosing, implementing, and converting to electronic health records are ready to reap the benefits—and patients portals are an important key to success. A well-implemented patient portal will help you achieve Meaningful Use incentives AND improve patient engagement and compliance while also simplifying time-consuming office tasks like reporting lab results and medical records requests. In addition to the financial and workflow benefits, patients are actually eager to connect with their physicians electronically. You just need to know how to make it all happen!

Laurie Morgan of Kareo suggests these strategies to help you.

  1. Successfully implement your patient portal
  2. Improve patient engagement, compliance, and outcomes
  3. Meet some requirements to attest for Stage 2 of Meaningful Use


Wednesday, April 16, 2014
1:00 PM Eastern, 10:00 AM Pacific

Although some practices have offered patient portals to their patients, the acceptance and utilization rates are poor.  This seems to be a unique issue for health care providers. It may be due to one of these, or all of the reasons listed here.

1. Poor education and/or training.

In most other industries computer registration is common, and access for information, trouble shooting and/or questions are done through a portal. Often times new patients (and old) are left to their own devices.

Remedies can include information printed on your practice brochure, with brief instructions on accessing the link, and selecting a password. This can also be mailed with the monthly statement, or an email blast to patients who have an email. Followup is essential via email.  Telephone waiting trees can also be used to inform patients while they wait on hold. Include something like this,

“If you prefer you can wait on hold or if you wish go to our web site to make appointments, select a refill or leave a question. Replies are usually made the same day.”

Portals should reduce the work load at the front desk and throughout the practice.  The patient can be sent a confirmation via email (if HIPAA secure)

Portals will be required for meaningful use attestation in Stage II requirements for attestation and incentives from Medicare.


Tuesday, February 25, 2014

Watch for the premier broadast event “Digital Health Space Week”

Watch for the premier broadast event “Digital Health Space Week”  The premier event will be on Friday, March 7, 2014, 5PM PST, 8 PM EST.  Check the Google + Events tab, for updates on content.

During the course of the next several months topics will include the use of Google + in health care.  Topics to include are: HIPAA Compliance, Helpouts, the use of Google Cloud in Medical Practice, Secure email plug ins for Gmail.

Mobile health apps:
Medical Applications at HIMSS 2014.
Medicine at CES 2014

Medicine and Gigabit Broadband Internet
Health Information Exchange, the current landscape and the future. HIT needs for Accountable Care Organizations

We are looking for speakers who have attended HIMSS2014, CES2014, and who are knowledgable in mobile health, health information exchange, Big Data, Accountable Care Organizations and HIT.  Remote monitoring, WiFi technology,

Please share this announcement with all your health related Circles and/or Groups relatred to health and/or HIT.



Digital Health Space is fortunate to produce these events and educational content  



The Evolution of Health Information Exchange, 2014

It can be said that the first part of the 21st Century in medicine has been the wave of information technology.  The capitalization of this relatively new department has diverted much funding from other needs in the health care industry.

The addition of HIT required federal underwriting. The ‘incentive’ was more of a negative reward/penalty instrument to force adoption of IT.  In order to maximize reimbursement from CMS hospitals are incentivized to reduce readmissions, and report meaningful use. Meaningful use follows a progressive course, escalating over time until fully implemented. Hospitals have many more stages than clinics or individual providers. Providers and hospitals alike must ‘attest’ to this functionality and demonstrate they are reporting. Failing to do so by a specific date is penalized by a reduction in reimbursement for services.

Much importance has been assigned to this effort, including improved outcomes, decreased expenses, improved patient experiences, transparency of information, accessibiliity of information for patients and providers and the unproven promises of ‘BIG DATA’

It will take some time to determine if these processes will  reduce expense or flatten the rate of inflation of health cost.  Built into and hidden from view is the cost of obtaining the data, and analytics.  A substantial IT investment and personell are added to the equation.  

The peverse nature of government is to spend more to save more…Government is fueled to expand and self-replicate ad infinitum.

Other industries such as the automotive business have profitted from BIG DATA, and it is hoped that by translating it to health care there will be dividends in treatments, cost reduction, safety, and better outcomes.
The Evolution of Health Information Exchanges

My  experience in this area began in 2005 as I led a group of physicians to consider a regional health information exchange.  It was a slow but fertile beginning.

We all focus on what is now and what lies ahead, that challenge can be justified by a brief but important look at our past accomplishments which are considerable.

Much has been accomplished, by many, and at relatively little expense in the planning phases of  HIE.  Early planning and project management time expenses were donated at no charge by physician leaders, medical societies, and interested vendors.

Well intentioned leaders do not have to spend billions of dollars to study or plan a project of this scope.  

These thoughts were corroborated as reviewed written and verbal correspondence for the early meetings of the Inland Empire Health Information Exchange (Riverside, Callifornia)

Neither can one forget the prescience of  President George W. Bush by forming the Office of the National Coordinator of Health Information Technology, Don Berwick M.D. and their successors.

Physicians were dragged into the mix as naysayers, not wanting more complex procedures to interfere with patient management responsibilities. We are now well along the way and there will be no turning back.

Even more than the abilit fo providers to exchange medical information is the added dividend for analytics, and support for accountable care organizations.


Sunday, February 9, 2014

Health Reform to 2014 and Beyond or Back to the Future




The More You Understand About the 2014 Changes,  The Better.

If you had not noticed.

I am retired from clinical practice, and  admit I miss seeing patients.  My career goals have changed as some of you have noticed.

During the last decade I became interested in health information technology and set out to communicate with fellow professionals.  Readers of Health Train Express and it's predecessor will see an evolution, beginning with electronic medical records, health information exchange, health reform, mobile health applications, remote monitoring, and telehealth. They all serve to integrate our health communications for providers and patients.

During the last 12 months I was diverted by the Affordable Care Act and  the promises of Accountable Care Act. The potential for these new paradigms are great, however the day to day activities of providers and hospitals will  increase their load, and without additonal reimbursements. Providers have been expected to make huge capital outlays for health IT, design,implement and use these new systems.  They are directed at reductions in reimbursements to allow the large growth in patient access.  i doubt whether there will ber an actual decrease in the gross outlays for health care.  However during the past two years there have been reports of a decrease in the rate of growth.

There are some key actions to implement changes:  These webinars are designed to address specific areas that will require action.


In the past decade there were some pre-paid and capitated models. The new paradigm is to approach payments connected to outcomes.  How they will be measured is open to great debate, and the subject should be addressed actively and with transparency before changes are made to avoid a catastophe such as the Health.gov benefit exchanges.  Some of these issues may be addressed by a 'global fee to hospitals and providers and/or medical groups as part and parcel of integrated medical systems.


The webinar addresses objective information for non-acute providers,practice and clinics on how to prepare for 2014 changes to the CMS EHR Incentiviei Programs.


GEMS is a term which most providers are not familiar. CMS on it's web site offers these white papers. 

     The compressed zip files contain 3 white papers.
     The Dxgem file addresses specifics of conversion from ICD9 to ICD10.

MDs Everywhere's Vice-President of Development, Doug Salas explains the impact of 14,000 ICD codes expanding to 70,000 will have on documenting


HIPAA has been around since the mid 1990'. Providers have always known the standards of ehtical private confidentiality.  HIPAA was designed for others, institutions who deal with large amounts of patient health and financial data.  Penalties and fines are impressively high and the law has been enforced agains several large hospitals and other custodians of health records.

Recording and Archived:  (In case  you cannot attend the webinar at it's schedule time) At the time of registration you will receive a link and a date, which can be downloaded to an Outlook  .ics file.

All of the webinars will be archived for later viewing






Friday, January 31, 2014

Health Software Vendors

Software and hardware age quickly in health care. Software and hardware evolve, change and become obsolete quickly in the course of five years. Much changed during this 1/2 decade as providers and hospitals geared up for the HIT revolution.

Just ten years ago (2004) EMRs were very few and only 10-25% of providers or hospitals had any type of electronic health record.   The concept of health information exchanges and interoperability were still seminal ideas. Mobile health applications were few.

Following the HITECH Act the progress has been staggering. On the one hand it stimulated the adoption of EHRs, on the other hand in a rush to capture the incentive and avoid penalties, users were coerced to obtain inadequate electronic systems which were not tested for ethnology or true user functionality.  Many were and still are a barrier to efficiency and do not instill confidence in physicians by patients when providers faces are embeded in their display, which minimized face-to-face contact.  Transference as most providers realize is a key component of patient reassurance and compliance.  Score two big negatives for the current generation of EMRs.

Many providers have invested in EMRs, some already had EMRs which were compliaint enough to be CCHIT certified for interoperability (necessary to use HIX (health information exchanges) to exchange data with diverse EMRs.  Some were able to be upgraded to satisfy Meaningful Use, Stage I.

However many of these pre-existing systems are now insufficient to be further upgraded due to the increasing complexity of reporting metrics to CMS and Health Insurers.  Now faced with ACOs (Accountable Care Organizations the EMR and HIX face the challenge of further requirements.

For some the time as come to upgrade their EMR even though it may be only five to ten years old.

There have been many reports about physician dissatisfaction with first, or second generation systems. Offerings are divided between small practice, medium size practices, and large enterprise integrated health systems.

Perhaps a measure of change can be found in a report from MarketWatch of the Wall Street Journal.  I find the WSJ to be a reliable source of change in markets as they measure financial changes early on.


EPIC has been the leading software vendor for large enterprise systems.  This year however KLAS has ranked athenahealth as the top vendor replacing EPIC as rated by thousands of health care providers across the U.S., athenahealth is now rated #1 in the following categories:

-- 2013 Best in KLAS Overall Software Vendor
-- 2013 Best in KLAS Overall Physician Practice Vendor
-- 2013 Best in KLAS Practice Management Service, athenaCollector(R), for the 1-10 and 11-75 physician segments
-- 2013 Best in KLAS Patient Portal, athenaCommunicator(R)
The old guard of HIT leaders is finally being displaced by more nimble, innovative models designed for health care's future - not for its past," said Jonathan Bush, chairman and CEO, athenahealth

Health IT in Asia at Health 2.0 India

Read more about it at Health Train Express including these topics of interest
  • Designing an improved patient experience for a Billion people
  • Trending – Startups, Funding and Accelerating Health 2.0
  • Health 2.0 in the village
  • Quantified self, wearable sensors and trackers
  • Mobile health in real life
  • Rise of big data and better decisions
  • Pharma and better outcomes
  • C-Level executives unplugged
  • Unmentionables amplified – Sex, Sport & Rock n’ Roll

Monday, January 27, 2014

Radiology One of the Highest Paying Medical Specialties

Contributions to this post are from:
Mike Bassett, 



One of the   principal determinants some medical specialties is salary. However, that is not the only factor in specialty selection by trainees.  Some of the other factors are:

Relatively good hours and call schedule
Flexibility of work locations
Group Practice insulated from  financial issues
Hospital based employment, an option
Support as consultant for most specialties
Technological advancements in CT, MRI, PET and other new imaging techniques

Fierce Medical Imaging reports that although Radiology reimbursement has flattened out and perhaps decreased there are an abuncance of job seekers in Radiology.



  1. Study: Two job seekers for every new radiology position
An analysis of the American College of Radiology job board suggests that for every job posted there are two radiologists seeking jobs, according to a study published online in the Journal of the American College of Radiology.

According to Anand M. Prabhakar, M.D. of the department of radiology at Harvard Medical School and Massachusetts General Hospital, while the general impression of the radiology job market has been "grim," there has been little research done tracking employment statistics. 
The researchers found that the during the study period, the mean number of new job seekers was 168 per month--twice as many as the 84 job postings found on average per month. 

No appreciable difference in the number of new job postings between 2011 and 2012 was found, while the number of newly registered job seekers ranged from 80 in May 2012, to a high of 418 in October 2010. October through November of 2010 represented one of the peak periods of job competitiveness (represented by the number of newly registered job seekers), along with August through November of 2011 and October and November 2012.
Consequently, the researchers concluded that there is a seasonal variation in interest in the ACR jobs board coinciding with the July 1 start date of fellowship training programs.

The study is a relatively short term study and in a period of rapid change with the Affordable Care Act and the imminent development of Accountable Care Organizations.

Radiology suffers from the same pessimism stimulated by reductions in earnings. 

In the face of what appears to be a shrinking job market, practicing radiologists have an obligation to those just starting their careers "to help them get through this difficult time," write David Levin, M.D., and Vijay Rao, M.D. in an article published in the April issue of the Journal of the American College of Radiology.
report last year by physician recruiting firm Merritt Hawkins illustrates how job prospects have declined for prospective radiologists over last several years. According to the report, demand for radiologists--Merritt Hawkins' most requested specialty in 2003--ranked just 18th last year.
The reasons for the fall in demand, according to Levin and Rao? Slowdowns in utilization and reimbursements; longer radiologist hours to maintain compensation levels (consequently decreasing the need to hire new radiologists); current radiologists deferring retirement; and the advent of picture archiving and communications systems and other digital enhancements that have increased efficiency.