As part of the process of setting our broader research agenda at Chilmark Research, we do a significant amount of secondary research combined with more limited, but highly focused primary research. We use this research to identify the “white spaces” where there appears to be a demand for some thoughtful, in-depth research and reporting that only an analyst firm such as Chilmark can provide. During that process, however, we often uncover some interesting trends similar to the HIE Snippets of the previous post.
Chilmark continues to follow the patient engagement realm, from mHealth Apps to PHRs, patient portals and personal health platforms such as Dossia and HealthVault. Recently, we have been receiving a significant number of inquiries from healthcare organizations that are developing IT strategies to meet Stage 2 meaningful use criteria to provide patients online access to their personal health information (PHI). We are also beginning to hear very early rumblings by a few forward thinking organizations on the use of new technology platforms, particularly mobile, to more deeply engage patients in managing their health in conjunction with impending value-based contracts. There have also been several announcements lately of roll-outs of Epic’s mobile patient engagement platform My Health. Lastly, earlier this week we had the pleasure to attend GE Healthcare’s Centricity Business National User’s Conference where we sat in on several patient engagement presentations. Following are some of the trends we are seeing that will be foundational to our future research on the topic:
HIE Vendors not up to task: A number of large healthcare organizations that have grown organically and through acquisition have a multitude of legacy IT systems from numerous vendors (not everyone is going Epic) in place. These organizations are now looking to link these systems together with an HIE solution and while they are at it, want to be able to provide patient access to their PHI. Problem is, most leading HIE vendors that have proven solutions for interfacing to multiple systems typically have poor patient-centric solutions. There are exceptions to every rule and companies such as RelayHealth and Kryptiq offer quite capable patient portals combined with secure messaging. But for those HIE solutions that lack such capabilities, healthcare organizations are having to look elsewhere to fulfill this need which is bringing business to MEDSEEK and Intuit Health.
Patient Portals interface first to transactions: Several of the presentations at the Centricity event were given by organizations with distinct clinical and administrative systems. Maybe it was just the venue, it was a Centricity Business Users’ Conference after all, but in each presentation on patient engagement the patient portal was driven from the admin-side. Sure, the portal could provide labs and some basic clinical data but it was really designed to help with the pre-registration process, appointment scheduling, secure messaging and Rx refill requests. Each organization we spoke to have plans to bring clinicals (some had Epic for clinicals, others Cerner) into the portal in the future to facilitate care processes for the truly sick, but that is a second order priority. This raises the question: Will front-end admin solutions, like Centricity’s Business Suite, become the core patient portal at the expense of those developed and offered by those from the clinical side of the fence?
Still in very, very early stages of mHealth App adoption: As mentioned previously, a number of organizations (Group Health Collaborative, Kaiser-Permanente, Stanford, UPenn Medical Center, etc.) have announced the release of an mHealth App for patient engagement, virtually all of them, My Chart instances. These releases are basically a mirroring of what is being done with patient portals mentioned above – enable transactional processes. We have yet to see anything, at any organization that has gone beyond pilot stage (e.g.WellDoc in Baltimore) in the deployment of a mHealth App to address a large at-risk population. This is puzzling for as we move to value-based contracts and accountable care, healthcare organizations will need to seriously rethink how they deliver health to chronic disease patients not just in the exam room, but at the patient’s home, in their car at work, wherever they may be to ensure compliance. mHealth can play a very effective role here but organizations’ reluctance to adopt is a chicken and egg scenario. There is not enough evidence to prove efficacy of mHealth Apps but if they don’t adopt, the evidence will not present itself. This will eventually break-thru, the question now is simply, when? And based on what we have seen in healthcare IT adoption to date, it could be a much longer wait than many VC firms and entrepreneurs currently have in their financial models.
John
I agree with your article and there has to be a change in mind-set for society to reap the benefits of patient engagement and mobile health apps. We need to understand how the mind-set has been formed.
Firstly where has the experience for enterprises or public bodies giving consumers/citizens (patients) control over what they do? It is from administrative self-service. Whether it is self-service procurement, changing your address on the HR system, updating Health Insurance coverage or finding out when the next garbage collections is, self-service has been about improving data quality, reducing staff and taking a swathe of cost out. This has a business case and is something most patients are comfortable with, so it is “no-brainer” to Healthcare Enterprises.
Secondly, your point about usage is well made, but there is a big barrier in my view. Whether it is a mHealth or Telehealth, there has to be an infrastructure created to support it which does typically have a large set-up cost (contact center, etc.) and as most organisations are only looking to pilot for one disease, the business case does not stack up. The fact that the infrastructure can be used for multiple conditions with little marginal cost for each is not enough to overcome the short-term instincts of decision-makers.
What will drive adoption is when solutions can be used to define clinical workflows that have the patient at the centre, taking part in it with the rest of the care continuum involved…surely what ACOs will want, as you point out? However this requires a hybrid, pluralistic approach and something that Healthcare IT has not been good at providing, solutions are too vendor-centric.
This is a thorny issue with many facets, perhaps we can hope there is an organisation that is ready to be bold and sail into “the unknown” firm in their belief that this is the future of healthcare, if we get the solution right.
Thank you, John, for attending CBNUC 11. We were pleased you could join our 600-plus GE customers at our annual Boston event. For the record, we did offer sessions that included content on the promotion of wellness, disease prevention, and chronic disease management. But with more than 100 unique seminars offered, it is quite understandable how you might have missed them.
Still, your post-conference summation of the “state of the patient portals market” is, for better or worse, quite accurate in my perspective.
Software vendors developing personal health IT (PHIT) applications typically do so by listening to the voice of their customers and translating their requirements into features and functionality. Up to this point, those voices have called for services that streamline patient access to the clinic and reduce cost of administrative and financial interactions. Given the economic realities of the current fee-for-service environment, these services must deliver a ROI to the healthcare organization (HCO) or providers will reject them.
Patient expectations are apparently aligned with those of the HCO. Study after study has communicated patient requirements loudly and clearly. The ability to schedule appointments, complete demographic and insurance forms, access medical histories, request RX refills, review after-visit-summaries and test results top their lists. These interactions are the key drivers of patient utilization today, even at fully integrated HCO’s that bundle insurance with health services and employ physicians and clinicians on staff.
While these forms of interaction may not be the artifacts of health interventions you are searching for, they are providing the business case IT managers and administrators need to increase their investment in PHIT.
Quality-based reimbursement models are emerging. HCOs of all sizes are investing in enhanced communication tools that will enable them to certify and capture value-based reimbursement. But these programs are nascent.
As you and your readers have discussed here before, American consumers are more comfortable ignoring their health risks than they are addressing them, especially if the negative effects lie in the future, or can be managed today with drug therapies.
Even so, Healthcare organizations will roll-out content and tools that enable connected communities of providers and patients as models of collaborative care and payment evolve. The challenge then for primary care providers will be as it is now for employers and health plans: consumer engagement. When our customers are ready to take up the challenge, GE Healthcare will be ready to support them.
From our experience it’s the cart before the horse. If you don’t create an enterprise customer experience strategy all the technology in the world won’t help you. Technology vendors are doing their best to try to address specific parts of the customer experience. Each organization has it’s own personality and requires a unique enterprise strategy which addresses it’s culture, services and marketing strategy. Patients deserve to have the personalized, interactions with their providers. This requires cultural changes that integrate the on-line and off-line services. The “how” to do this comes after the strategy has been developed. EMR, mobile devices, CRM and financial systems are all part of the implementation strategy along with process and cultural changes. Without a roadmap on how you want to engage your customers you are likely to not get where you want to go.
John: We at NoMoreClipboard continue with patient engagement pilot programs, some governmental, some commercial, some at Universities. We are gathering months and years of experience and will have some significant successes to report soon. One thing acting as a brake on implimentation is uncertainty, much of it politically generated. Meanwhile, hospital margins continue to be squeezed adding to the certainty that one place to find savings is a rollout of information technology.