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Can Open Notes Reduce Healthcare Disparities?  

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Can Open Notes Reduce Healthcare Disparities?  

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Researchers surveyed older, less, educated non-white, ESL patients on the use of open notes.

Findings:
-Patient Safety
-Patient Provider Relationship
-Patient Engagement
-Improved Interactions

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Empowering patients and reducing inequities: is there potential in sharing clinical notes?

Statistics from Altmetric.com

Patients who read their clinical notes via online patient portals ('open notes') report that doing so engages them actively in their care, improves their sense of control over their health and enhances safety.1-3 In several surveys, patients who are older, less educated, non-white or whose first language is not English report even greater benefits than do their counterparts.2-4 However, for many reasons, persons from these demographic groups are less likely to use health portals than other patient populations.5 Drawing on promising preliminary evidence,2-4 6 we suggest that open notes may, over time, prove important in the care of patients who are at risk of experiencing healthcare disparities.

Opening notes via electronic patient portals

Consumers seek convenience, speed and security for their online data. In more than 10 countries worldwide-including Denmark, France, USA and Sweden-growing numbers of patients can now readily retrieve their clinical notes via portals.7 Studies suggest that the practice of sharing notes does not produce major disruptions to clinical workflow,1 and that clinicians with longer-term experience with the practice are more positive about it.8 For patients, evidence suggests strongly that the benefits of open notes outweigh the risks. In a recent large US survey conducted across three health systems with over 22 000 respondents, most reported that reading their notes was very important for taking care of their health (73%, 16 354/22 520), feeling more in control of their healthcare (70%, 15 726/22 515) and remembering their treatment plan (66%, 14 821/22 516).2 Surveys in Sweden indicate similarly that many patients feel more empowered and involved in their care as a result of reading their clinical notes.9

Opportunity to improve health equity

Disparities in health outcomes reflect multiple, often interrelated factors. They include environmental, economic, and social determinants, along with issues relating to accessibility and variable quality of the healthcare delivered. ...

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# data[].attributes.attachment_link.title
Empowering patients and reducing inequities: is there potential in sharing clinical notes?

# data[].attributes.attachment_link.description
Patients who read their clinical notes via online patient portals ('open notes') report that doing so engages them actively in their care, improves their sense of control over their health and enhances safety.1-3 In several surveys, patients who are older, less educated, non-white or whose first language is not English

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OpenNote is a "movement" that was started to learn the effects of open and transparent communication between patients and their clinicians.
-Promotes improved patient safety and quality of care
-Goal is to standardize the use of OpenNote
-Collaboration of doctors, nurses, mental health professionals, patient advocates, social scientists, researchers, and communication scientists

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OpenNotes - Patients and clinicians on the same page

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OpenNotes is the international movement dedicated to making health care more open and transparent by encouraging doctors, nurses, therapists, and others to share their visit notes with patients.

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EasyHealth is an online advisor to aid the Medicare enrollment process and navigating through the system. I think this is such a wonderful idea. I have too many patients today struggling with the healthcare system and most are Medicare patients.

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EasyHealth, a startup targeting the Medicare experience, announces $135M Series A – TechCrunch

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EasyHealth, a startup focused on navigating the Medicare experience, announced a $135 million Series A round on Thursday. EasyHealth has a simple purpose: to help enroll, and follow-up with (more on this later), people eligible for Medicare. But the bigger picture is that the company is aiming to f…

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Color is a health tech company most recently known for self-COVID testing and reporting. With more funding, they may have the opportunity to build an interoperable system that can communicate these important results to healthcare providers, government, and employers.

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Health tech startup Color raises $100M at a $4.6B valuation

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Health tech startup Color has raised $100 million in Series E funding, bringing the company's valuation to $4.6 billion. This round means Color has now raised a total of $378 million, with this latest round specifically meant to help the company offer new programs that deliver the last mile of care...

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At-home DNA tests are becoming so popular, they are even being marketed as the latest and greatest holiday gifts. What companies fail to mention are the ethical concerns that come with these tests. One being, people fail to involve a medical professional when interpreting results.

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FDA Approves At-Home DNA Tests for 10 Diseases

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Customers can now order a $200 test from the company 23andMe, send in a saliva sample, and find out if they have a genetic risk for diseases, such as late-onset Alzheimer's and Parkinson's.

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Great article done on implementing a statewide telehealth system. Kearly et al. (2020) discuss the steps taken to implement this system including 1- assuring that all have access to resources needed for telehealth 2- collaborating with other governing bodies and 3- coordinating logistics across public and commercial parties involved.

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I currently work with patients who have Inflammatory Bowel Disease (IBD) and discovered that they have utilized gamification to create "IBD & Me" targeted to children and parents who have IBD. Great to see what we're learning in my actual practice!

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Great example of how data visualization can connect data patterns to tell a story

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The beauty of data visualization - David McCandless

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Data visualization can be helpful to improve patient engagement. For example, I had a patient with fatty liver disease who had a poor understanding of the risks and outcomes of untreated disease. She heard that fatty liver disease was very common in the United States and therefore wasn't too concerns about pursuing interventions to improve her outcome. Over 25% of Americans live with fatty liver disease, a condition that can progressively cause complications yet can be managed with lifestyle modifications. Using data visualization for patients like this can help them better understand the incident rates of both the disease and poor outcomes. In turn, they may be more inclined to take action to improve their health.

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"Big data doesn't matter on a fundamental level" 

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"Big data doesn't matter on a fundamental level" 

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Emotional Healthcare and Data Storytelling

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Great step-by-step guide for using data for storytelling

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Acknowledgments
This resource is for health organizations that want to publish reports, data or insights to harness the power of storytelling and bring data to life. Drawing from journalism techniques and research on psychology, sociology and science communication, From Numbers to Narrative walks you step by step through the process of crafting high-impact, data-driven health reports and insights.

With a data storytelling approach, your readers will be able to easily understand, absorb, and act on the data you're reporting.

Why are health reports often dense and boring? While they might be factually correct and contain nuggets of compelling data, they tend to have one glaring missing element: a storyline. Without a narrative, readers will quickly lose interest and won't be able to gain insights from the data, nor will they be compelled to act on it.

We no longer live in a world restricted to printed reports. Digital journalism has shown what's possible with online storytelling. There's an opportunity for health organizations to do the same.

A powerful example of data journalism and visual storytelling: Extensive Data Shows Punishing Reach of Racism for Black Boys, The New York Times' The Upshot

What is this guide and who is it for?

For data to be meaningful, they need to tell a story.

The guide shows you how to find the sweet spot at the intersection of big data, visualization and storytelling, to bring health data to life and drive policy and behaviour change. It's a practical resource for people who work in health care or health organizations to banish the boredom from their data-driven reports. With a data storytelling approach, readers will be able to easily understand, absorb, and act on the data you're reporting.

It can be challenging to shift to a new style and format of health reports. But good news - you don't need to change everything. This guide leaves plenty of leeway for your own decisions and creativity. It also covers a range of options. You can start by making a few valuable tweaks to your current reporting format, or push your reports forward with interactive data and advanced storytelling techniques. Where possible, we base our recommendations on the best evidence available, which will help you support the changes you make to your own products.

You can use this guide to:

Improve existing reporting

Start a new report

Present data that was historically just a regular report in story format

Tackle a complex health data topic you need to communicate

What is storytelling with data?

"Storytelling" has many meanings. In this guide, storytelling means telling a story through the way you select, organize, describe and visualize the health data in your overall report. At the most basic level, a story has a beginning, middle and end, in which "one thing happens in consequence of another."[2] You can use storytelling to tell stories within the broader report storyline, by including stories from patients, family caregivers, doctors, nurses and other health care providers, and even researchers.

Health data storytelling will only be effective if you can share your narrative through writing, data visualization, and design.

The 7-Step Process for Telling a Story with Health Data

1. Defining your report strategy and goals
2. Selecting data and generating insights
3. Conducting user research
4. Building a storyline
5. Writing a lived-experience story
6. Designing your report
7. Publishing and socializing your report

1. Defining your report strategy and goals

From the outset, you and your team should articulate why you're producing this report. A thoughtful strategy will guide your focus as you develop the report.

Why are you creating this report now? Consider these questions:

1. Have you identified an important or trending topic in health?

2. Are you shedding light on a new treatment or therapy?

3. Is the report looking at a specific disease or condition?

4. Will you be highlighting time trends, inequity issues for different populations, or geographic variations? How will this report help improve people's lives?

5. And importantly, do you have quality data available to support the right level of insight generation?

Once you've established the reasons for producing the report, you're ready to set some specific goals and outcomes for the project. These should align with the strategy and mandate of your organization. Your goals should also consider the main audience for the report.

Think about who you are trying to influence or educate with this report:

You can have multiple audiences, but narrowing it down to one or two main audience targets will help you achieve your goals and outcomes.

2. Selecting data and generating insights

Once you have a story strategy, the next step is to identify data sets that are needed for analysis. This means collecting, acquiring or accessing the data to begin analysis. Data can include health care indicators, or qualitative data such as patient interviews.

There are many ways to select data and generate insights for a report, but it tends to be an iterative process. First, make sure you have the right data at the start, otherwise you may look at the data that's readily available and realize you can't get the rich, meaningful insights that you need from it.

The question-based method is one of the best ways to organize and structure insights:

1. Frame a series of specific, key questions in a hierarchy that you want to answer with your analysis. For example:

What is the overall trend of this disease?

Does the trend vary by geography, such as by region, city, or hospital?

Do you see different growth rates by demographics or social determinants?

What is driving the trend? What are the related or causal metrics or indicators that impact this trend?

2. Identify which questions are answerable by the data (some data may not be available or reliable enough to answer the question).

3. Consider titling your data visualization with the key question. For example: How do the annual rates of hospitalizations for chronic fatigue vary across regions?

4. With the remaining questions you can answer, use a variety of data analysis techniques to generate the insights.

5. Understand that most of the insights produced won't make it into the final report.

The insights you generate can take on many forms, including simple statistics, percentages, regression analysis and even predictive models. In the "Designing Your Report" section of the guide we talk about how to visually present your insights. Regardless of the data's visual form, we recommend refining the insight until it's simple, specific and factual. For example:

"People in the north have a much shorter life expectancy than those in Ontario overall - 2.9 years lower than Ontario in the North West LHIN region and 2.5 years lower in the North East LHIN region."

(Health Quality Ontario, Health in the North report, 2017)

With some insights, the reader (especially an analytical one) might wonder, "What's the reason for that statistic or insight? Why was this included in the report? What's the underlying driver?" It's helpful to bring the answers to these questions forward as you continue to understand your audience and build your report.

Here are a few key considerations for generating insights:

Refine: If you haven't published a report before, you may need to refine your process and adjust how you do the analysis.

Align: Begin the analysis with the goal of finding insights that line up based on the focus of your report.

Ask questions: Generate a lot of insights. We've listed one method of structuring your analysis below. Finding the story in the data tends to be as much a science as it is an art.

Focus: Distill down to the most impactful and meaningful insights based on the criteria you establish. What should you include in this report and what can be saved for later or used elsewhere?

Fit the story: Evaluate the insights to decide whether they'll help drive your narrative.

3. Conducting user research

While you're getting the data you need and producing a good crop of insights, it's useful to learn more about your audience. Since user research is a broad topic, we're not going to delve into it in detail in this guide. A good understanding of your audience is one of the most important things you can do to produce a great story within your report, as it will help you frame the report to their interests. So if possible, get a user researcher to work on the project team. Here are a few key aspects of user research:

Define your audience: Drawing from your report strategy and goals, clearly define your audience and prepare a user research plan to engage with and understand your audience, their information needs and interests. Identify what value your report will have for each audience.

Define your objectives: Do the research with clearly defined objectives: who do you need to understand and what is most important to understand? Based on the objectives, select the appropriate research methods, such as interviews, surveys and focus groups.

Gather user perspectives: Even if it's not your current practice, take steps to incorporate user perspectives and feedback into the report creation process as it unfolds.

Develop personas: Personas can be a good way to illustrate the types of people that make up your primary audiences and inform important decisions as you work to create your report.

Scan the landscape: Consider doing a landscape scan up front to learn more about the types of reports already available, position your report and generate ideas.

Perform user testing: As you progress through the project, we recommend coming back to your understanding of the user on an ongoing basis and actively testing what you create with users. For example, engaging clinicians and patients will help to ensure the insights are clear, understandable and impactful.

As you move to the next steps, continue to advocate for the needs of your audience, in particular patients, so that the report is tailored to speak to them and tell them a meaningful story that resonates.

4. Building a storyline

If you've done research into your audience, you'll now have a good idea how to organize the data to build a storyline that meets their needs. There are a few things that would be good to know about your audience: their health literacy, their personal perspective on the topic, and their level of current knowledge and awareness of the topic.

Here are some tips to help craft your storyline as you assemble the report:

Make your headline a key finding

The simple technique of writing your key finding into a headline is commonplace in news and magazine features, because it works.

Journalists figured out ages ago that if you want people to read your content, you need to draw them in with an enticing headline. You can also add more context with a teaser - a bit of text under the headline that makes the reader want to read more. This will also force you to figure out exactly what you're trying to say in each of your chapters or sections. Alternatively, you can write a longer headline that summarizes the entire key finding and complement it with a secondary finding as a teaser:

There were nearly 1.3 million new starts of opioid prescriptions in Ontario in 2016

New starts of opioids decreased slightly in 2016 from 2013, by about 25,000, or 2%.
(Health Quality Ontario, Starting on Opioids, 2018)

Think about how the text flows

Graceful transitions between paragraphs will help keep the reader's attention. "Prose is architecture, not interior decoration," Ernest Hemingway said. Build your narrative with a logical flow between sentences and paragraphs.

You can take the easy route as we've done here and stick a series of titles atop each paragraph. Other transition techniques include:

The building block: Reinforce the idea set up in the previous paragraph, and then introduce a new concept.

The comparison: Introduce a new paragraph by comparing the data points you've described in the previous paragraph.

Cause and effect: Show how the data points in the previous paragraph influence the data described in the next paragraph.

Ninja level: Paragraphs just flow naturally and logically, without transition sentences.[3]

Whenever possible, make the data about people

People-izing your data will make it much more relatable than reporting abstract percentages. If you have a data point that 15.1% of Canadians are current smokers, you can say "more than 1 in 7 Canadians are current smokers." Even better, include the actual total number of people, as in this report from the University of Waterloo's Propel Centre for Population Health Impact:

"In 2017, the overall prevalence of smoking in Canada
was 15.1%, equivalent to approximately 4.6 million
Canadians."

Your health data will be much more impactful if you can show how many people are involved in a statistic. For example, a report that showed an increase in the percentage of family or friend caregivers who were experiencing additional distress included the number of additional distressed caregivers:

"More than 4 in 10 long-stay clients with caregivers (43.5%) had caregivers who experienced distress, anger or depression in relation to their caregiving role, or were unable to continue caregiving, in 2017/18. That was up from 33.8% in 2014/15, and represented more than 26,000 additional distressed caregivers." (Ontario Health (Quality), Measuring Up 2019)

Introduce a plot twist to make your reader care

Your story outline should include an element of surprise. Data storytelling consultant Jay Golden says a story "is not the shortest distance between two points. A story is a journey with a twist, a problem approached in an interesting way, that makes us care." Another way of thinking about the twist in your report's narrative is to find the data points that are surprising. If you have subject matter experts reviewing the data, ask them what they find most surprising. You'd be surprised how often this simple technique works to identify twists in your narrative.
For a report on palliative care, the doctor reviewing the data said he was shocked to see that more than two-thirds of patients receiving palliative care had an emergency department visit in their last month of life. This became the plot twist. Most people said they wanted to die at home, but about two-thirds of those receiving palliative care ended up in the ER near the end of their life, and most died in hospital. The report's narrative highlighted the tension between what people wanted, and the reality of what was happening in the health system.
Chunk your text

In 1956, cognitive psychologist George Miller discovered that people could only retain about seven chunks of information in their short-term memory. To make your narrative more effective, group your information into easily digestible chunks of related material.[4]
Key resource: How Chunking Helps Content Processing, Nielsen Norman Group
Use pull quotes and callouts

Pull quotes and callouts are invaluable devices to captivate readers skimming your reports. Take a few of the most interesting nuggets of text or data points, blow them up into a large font, and intersperse them throughout the report. These callouts can even tell a mini story of their own for a reader who does a quick scan of the report.

"THE WAY WE RESPOND TO MISTAKES AS HOSPITALS IS AS TRAGIC AS THE MISTAKES THAT HAPPENED" ( Vox.com article on hospital harm, by Sarah Kliff)

5. Writing a lived-experience story

Behind all health data, there are stories about people. In health care, those stories are often extremely powerful. So powerful that they can completely alter someone's viewpoint on a topic.

You don't need to have a professional writer on staff to include lived-experience stories in your reports. By following a few simple techniques, you can create great stories that capture the essence of what it was like for someone at the heart of your report topic.

"Patient stories offer valuable insights that go way beyond the statistics and the outcomes: they have the power to inspire, humanize, compel action, and challenge assumptions," says Jennifer Schipper, Interim Communications Lead at Ontario Health. "Our colleagues tell us that hearing patients and their experiences, and being able to ask thoughtful questions, really gives them insights that they wouldn't have by just looking at published literature or data."

While generally referred to as patient stories, these lived-experience stories can include perspectives from family or friend caregivers, health care providers, and researchers.

Anatomy of a patient story

Conflict: "There is no story without conflict," says patient storytelling consultant Franklin Street. Even good-news patient stories have an element of conflict if you ask questions about fears, which can help with empathy and memorability.[5]

Empathy: "Find elements of a story that are just uncommon enough to be unique but no so far out of space that it is difficult to create empathy," Street says.

Setting: Describe the scene, and don't overcomplicate the story with too many settings.

Plot: Take a page from Shakespeare, says Street, and tell your story in three acts: establish the characters, explore a problem they face, and then solve that problem.

3 keys to story selection

1. Diverse voices: "There's no one universal patient voice, so you want to make sure you have a process wrapped around having ethnic, age, socioeconomic and gender diversity," says medical communicator Dr. Seema Marwaha. "While difficult, that's worth the effort."[6]

2. Do a pre-interview by phone or email: A brief pre-interview will give you a sense of whether the patient's story is a good fit for your report. It will also let you gauge the patient's comfort level in re-living potentially traumatic experiences.

3. Let the patient tell their own story: Give the patient leeway to tell the parts of their story that are important to them, rather than checking off boxes related to specific data points. The most impactful patient stories go beyond medical details.

7 Best Practices for Patient Stories

1. Identify your goals - What's your purpose in telling these patient stories?

2. Write an invitation letter - Explain to the patient the context of the report, what kind of stories you're looking for, and how the stories will be incorporated into the report.

3. Consider emotions - Coach the patient through the possibility that recounting their story could make them angry, regret, grief or trauma.

4. Give options for story-gathering methods - Let the patient choose how they would like to tell their story, such as by phone interview, in-person interview, or email.

5. Ditch the jargon - Communicate with the patient in clear language, and avoid health care jargon and acronyms.

6. Obtain written consent - Get a standard release form written up for your organization, with check boxes for different types of publication and consent, such as print, audio, video, communications documents.

7. Assess risks - Ask the patient if publishing their story will create of any challenges or risks, and ask them to get publication approval from anyone else in the story who might be affected.

6. Designing your report

Design plays a critical role in creating a report that tells a compelling story. When it's done really well, the narrative, insights, data visualization, and patient stories all intertwine seamlessly. High-quality design and visual appeal is not an easy feat. Getting design resources involved early on and throughout the process will have a substantial impact on the success of the project from concept to launch.

Focus the design process on the audience and user research.

Presenting insights and data visualization

So much of telling a story with data involves presenting the insights you have in a simple, accessible and intuitive way. By its nature, data is often complex to analyze and communicate. Data visualization is both an art and a science: it's just as important to get the graph axes and units of measure right as it is to make the graph visually appealing.

Tip: to help your audience interpret the data, consider using a question as a chart title? For instance, "How are patient infection rates trending provincially?"

We suggest always using less complex visualization types, steering clear of trendy styles such as 3D graphs and bullet charts.

Infographic-style visualizations and report formats can be effective, but typically work best in narrower applications.

The visualizations you create should also match and be from the same family. Think of it as curating a number of art pieces as part of an art gallery exhibit.

Data visualization design is a topic in itself. Instead of covering it in this guide, here are some excellent resources:

For online reports, you can use static images of data visualizations, though they have constraints, including a loss of quality when zoomed, and potentially sluggish download speeds if large.

There are free and relatively simple embedded chart tools such as Google Charts that present data visualizations effectively.

Report design

For the report design itself, take an iterative approach by producing mock-ups, prototypes and then testing these with users before publication, and ideally at key points along the way as the report takes shape.

Depending on the report audience, you may need one or more formats: print, downloadable PDF (Portable Document Format), online digital or mobile format. Historically, reports have largely been designed to be printed. Though static formats such as PDF files have the benefit of being printable and available online, we recommend designing your report as digital-first rather than print and digital.

PDF-based reports don't work well on mobile devices and are not as easy to navigate and read. When you design for digital, you're creating a digital product that can be viewed in a web browser on a laptop, tablet or mobile phone. If you design your report for the small screen size of mobile devices (smart phones and tablets) it can act as a helpful constraint, keeping your content focused and succinct.

Across all formats think about the colour, theme and style that best suits the type of data and the audience. For instance, for a patient-oriented report on chronic disease, you may prefer to have a more informal theme versus a standard, corporate-looking layout.

Photography is a critical component of the report, especially if you're including patient stories. Choosing a photo that fits with your story can be a challenging and time-consuming process. Whenever possible, use real photographs of the people in your stories, instead of stock photography. When in doubt, take it out: don't include photos that could detract from the tone and message of your story.

Video, much like photography, can dramatically enhance the story you're telling if done well. Planning, cost and time to produce a high-quality custom video should be clearly understood up front. One trend is to use informal, phone-camera style videos that are more real and much more inexpensive.

Animation for data visualizations and insights should be used in select instances where you really want to draw attention to data. Too much animation can draw attention away from the actual power and impact of the data and story itself.

All of the design choices you make should line up with the original vision and balance readability, content and length. If you plan to issue multiple reports over time, think about coming up with a design language. Design language is the overall style that guides the design of a set of associated products, such as a series of reports on different cancer therapies.

7. Publishing and socializing your report

Publishing and then socializing your report is the last step and should be part of your overall plan.

Earlier in your design process you'll ideally have considered how your report audiences are going to receive and access the report. Here are three common ways that many organizations publish their reports, and their pros and cons:

1. Printing: A printed report is great to pick up and read, but is often costly and reduces the potential reach of the report. Some types of reports will continue to benefit from being printed - it comes back to your overall strategy and audience.

2. PDF: If you're printing copies you'll likely also have a PDF version available that can be posted on a website or distributed by email. Cost is much lower per reader than printing. That said, PDFs have a number of limitations that make your report less accessible and usable than designed-for-digital formats. For instance, viewing a PDF report on a mobile device can be cumbersome and frustrating, in particular having to zoom in to read text and charts. Also, PDFs are typically not created in a way that makes them accessible for people with disabilities.

3. Digital: If you're looking to maximize the reach and use of your report it's worthwhile to invest in producing a digital version. Converting your report to a digital format such as web page or mobile app means that it's designed to be viewed on a variety of devices, from laptops to mobile phones. The primary downside is that digital-first reports can require more resources and specialized expertise to produce than other formats. That said, for a large distribution report (e.g., over 100,000 readers) the cost per impression can be less than print, and you can ensure the report is easy to view across devices and accessible by all audiences.

Socializing and promoting your report to your audiences effectively will ensure that the right people read it and share it with others.

There are a variety of ways you can share and promote your report. For broad-scale reports and large audiences you'll typically want to use a multi-channel approach, combining a mix of communications across social media, internet, email, and potentially events and conferences. For more niche reports, if you have the specific audience in mind, how can you best contact them and get the report in their hands?

From an audience perspective, think about how readers of your report will find it. People who haven't received direct promotion via email will most likely discover it through an internet search.

Prepare to make your report more easily discoverable in search on Google, and optimize your report content and keywords to rank higher in search results.

One of the best ways to reach a broad audience is to pitch it to the news media. If your report tells a story, you're much more likely to attract media coverage, and elevate your report findings, leading to widespread promotion and increased interest.

Lastly, we strongly recommend setting up some form of report and audience analytics. With minimal effort, you can at least approximate the reach and use of your report and estimate its value and impact. At a minimum it's good to know how many views or downloads your report has amassed over time. You can also launch surveys at the time of the report launch to get direct feedback from readers on their experience to inform your work in future.

In his book, Houston, We Have a Narrative: Why Science Needs Story,[7] Randy Olson argues that "narrative deficiency is the biggest problem facing science," and advocates for creating a narrative culture within organizations. This is a noble goal, but it doesn't mean you need to follow every step of this guide. By the simple act of considering the story in the development of your health reports and insights, you're already on your way toward building that narrative culture. One small step toward a narrative approach is a giant leap for health data impact.

The authors thank the team at Ontario Health (Quality) who helped inform the work on health data storytelling that inspired this guide, with special thanks to everyone in the Public Reports, Digital, and Patient Partnering branches. Thanks to Susan Brien, PhD, Interim VP of Health System Performance at Ontario Health, and Julia Zarb, PhD, Program Director of the Master of Health Informatics program at the University of Toronto's Institute for Health Policy, Management and Administration, for their wisdom, guidance and support on this project.
Go back to the start of the guide

1. Lohr, S (2013). The Origins of "Big Data": An Etymological Detective Story. Retrieved from The New York Times: https://bits.blogs.nytimes.com/2013/02/01/the-origins-of-big-data-an-etymological-detective-story/

2. Frank, AW (2010). Letting Stories Breathe: A Socio-Narratology. University of Chicago Press: Chicago

3. Mascarelli, A (2018). Good Transitions: A Guide to Cementing Stories Together. Retrieved from The Open Notebook: https://www.theopennotebook.com/2018/09/25/good-transitions-a-guide-to-cementing-stories-together/

4. Moran, K (2016). How Chunking Helps Content Processing. Retrieved from Nielsen Norman Group: https://www.nngroup.com/articles/chunking/

5. Street, F (2018, August 23). The Anatomy of a Patient Story. Retrieved from Franklin Street: https://www.franklinstreet.com/insights/2018/08/the-anatomy-of-a-patient-story/

6. Milne V., Buchanan F, Tepper J, Petch J. (2017) How patient stories are re-shaping health care. Retrieved from Healthy Debate: https://healthydebate.ca/2017/09/topic/patient-centered-care-stories

7. Olson, R. (2015). Houston, we have a narrative: Why science needs story. The University of Chicago Press.

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From Numbers to Narrative A practical guide to bringing health data to life through storytelling By Christian Otte and Michal Kapral Acknowledgments This resource is for health organizations that want to publish reports, data or insights to harness the power of storytelling and bring data to life.

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These were great examples of how data can be used for storytelling. A strong starting point from both videos is they each had a focal question with very simple data. The focal question grasped the audience as the storyteller aimed to connect using relatable examples. As data was collected, the research continued to expand. Both presenters utilized multiple visual graphs which helped the audience understand the key points of the story being presented from data.

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The best stats you've ever seen - Hans Rosling

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My current practice utilizes Epic as an EHR, which utilizes many privacy factors including a password/authentication to get into the computer system and then into the patient's chart. Most patient's charts also include their photo in their profile which has helped our check in team correctly identify patients.

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Week 10 My experience with alarm fatigue

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Week 10 My experience with alarm fatigue

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I've worked on both a telemetry unit and a med-surg unit that had telemetry capability. I found that I paid more attention to the arrhythmia alerts on a telemetry unit likely because the patients were admitted specifically for their heart. However, on a med-surg unit our telemetry monitored patients were often there for observation for things like an electrolyte imbalance. Med-surg patients are also more mobile so I found that the alarms on our telemetry monitors would go off too often. These monitors also ran on AA batteries that needed to be changed so frequently. That too would set off the alarm that many of us would fatigue from. I think a great solution is to have a differentiating soft and hard alarm possibly with an added variable of flashing monitors if the alert needs more immediate attention.

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Great example on how anyone can use data for storytelling!

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Making data mean more through storytelling | Ben Wellington | TEDxBroadway

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Gamification is such a fascinating topic to bring into healthcare research! We have such advanced technology that can help us capture the data we need to keep progressing in medicine.

I decided to play Jerry the Bear. I thought this was such a cute app for young children. I enjoyed that they made small details very simplified. For example, hand washing really took the full 20 seconds to complete. I enjoyed making a snack for Jerry but I couldn't quite understand the conversion of the green and blue dots to carb and insulin ratios-or how this was going to be useful for the child. I also enjoyed that Jerry had a sister around to help notify the player when he needed his sugar checked. While the concept is there, I think it would be great if this app had more real life scenarios for a child to experience like adding a grocery store or adding more snack options to choose from.

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Alzheimer's and dementia hold a very special place in my heart. My grandmother suffered from Alzhemier's and it was truly the hardest thing to watch. To know that this disease is still not fully understood and we still don't have a cure for this, is one of my greatest motivations to stay in healthcare. I loved to idea Sea Quest Hero and utilizing "gamification" to collect data that will contribute to Alzheimer's research!

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Sea Hero Quest - Alzheimer’s Research UK

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Sea Hero Quest is a smartphone game that re-writes the rules on how we go about dementia research. Download for free and play your part in dementia science.

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I use Telehealth everyday for my job as a nurse coordinator. I see many many benefits and challenges to the system. A few benefits better access to care for patients in rural areas via video visits, quicker access to results, and an online messaging portal. Challenges of video visits is that both the provider and patient may rely too heavily on this form of an appointment that it then becomes a "burden" when an in-person appointment is needed. Another challenge is the reliance of online messaging with your care team. I have seen this online messaging as an easy way to communicate with your doctor but as a provider using this system, I also see how many patients abuse the messaging portal. Patients will write in length messages trying to relay all of their health information and concerns expecting an instant reply. When really, their concerns should be addressed in an hour long appointment.

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Building upon the strong foundations of the nursing model, APRNs can diagnose patients, prescribe medications, and initiate and manage patient treatments. Another distinctive difference from that of our nursing foundation is the ability to bill and be reimbursed for healthcare services, making APRNs "revenue-visible."

Federal and state governments struggle to reform healthcare to assure that it is accountable, safe, and cost-effective. Healthcare reform has historically been a long and winding road, and APRNs have gained significant ground along the way as policy makers recognize that the growing APRN work force can provide sustainable solutions to transform the current system. But barriers remain. In order for APRNs to be maximized to their fullest potential, outdated federal policies require revision. A primary example of where progress is needed is in disparate reimbursement rates. This problem is particularly evident in Medicare reimbursement rates, which gave rise to "incident-to" billing practices.

In 1997, Medicare expanded reimbursement for all APRNs (nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives) in all geographic and clinical settings. This allowed for direct reimbursement-but at 85% of the physician rate for the provision of the same services. This led some practices to bill for services provided by the APRN under the NPI number of the physician, in order to receive 100% reimbursement rather than 85%. This is known as "incident-to" billing, and it is only permissible in the outpatient clinical setting (CMS, 2019).

In order for the incident-to billing practice to be appropriate, the services and supplies must be delivered in compliance with state laws and should meet all of the following requirements (MedPAC, 2019):

The physician/APRN must be on site at the time that services are provided.

The care provided must be an integral part of the patient's normal course of treatment.

The initial service must have been provided by the physician/APRN, who must remain actively involved in patient care.

It cannot be applied to a new patient or an established patient with a new problem.

It is strictly used for follow-up of a physician's plan of care.

It does not include shared visits (e.g., seen by both the MD and the APRN)

Documentation by the NP should clearly reflect that services are provided "incident-to" the physician's delineated plan of care.

While billing incident-to is associated with a higher reimbursement, it is not always the best option for the patient-nor is it best for the practice. If a patient presents to the NP for follow-up of hypertension but also has a new complaint of sinus congestion, the NP must either transfer the care of the patient to the physician or wait for the physician to come see the patient. This scenario is not the most efficient business practice. The patient must wait, and other scheduled patients must wait, creating a backlog of patients.

In reality, this scenario is likely to occur several times a day as patients wait for their visit to introduce new problems they are experiencing. If performed correctly, both the physician and NP will be involved in the care of the patient for the day, since a new problem is presented. The 15% gained when billing incident-to is not likely to cover the time spent by both providers in the care of one patient, creating a revenue loss in this scenario.
References
It is scenarios like the one above that lead providers to ignore the very specific requirements set forth for incident-to billing and to simply take care of the patient. However, if audited, this unethical billing practice is sure to cost the providers far more than the 15% additional payment per patient was worth. The practice of billing incident-to is one of the most common causes of fines for fraudulent billing. And ultimately, services that are billed incident-to make the APRN a hidden provider with no credit for patient outcomes or service.

Various agencies are working to end incident-to billing. They include the Medicare Payment Advisory Commission (MedPAC), an independent agency established to advise Congress on issues affecting the Medicare program (MedPAC, 2019), and the American Association of Nurse Practitioners (AANP). MedPAC and AANP advise APRNs to bill directly for services provided and recommend the abolishment of incident-to billing (AANP, 2017).

American Association of Nurse Practitioners (2017). Centers for Medicare and Medicaid services: innovation center new direction. Position Statement/Request for Information to CMS. https://storage.aanp.org/www/documents/CMMI-Comments.pdf
About the author: Kathy Baldridge is a family nurse practitioner who is the president of the Louisiana Association of Nurse Practitioners. Dr. Baldridge is the director of psychometric testing and analysis for APEA and a featured presenter at APEA review courses and continuing education programs. She developed APEA's Guide to Billing & Coding in the Outpatient Setting. Learn more about this resource .
Centers for Medicare and Medicaid Services. (2019). Medicare benefit policy manual. Chapter 15, Section 60. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

Medicare Payment Advisory Commission. (2019). Improving Medicare's payment policies for advanced practice registered nurses and physician assistants. The MedPAC blog. http://www.medpac.gov/-blog-/the-commission-recommends-aprns-and-pas-bill-medicare-directly-/2019/02/15/improving-medicare's-payment-policies-for-aprns-and-pas

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why you should avoid incident-to billing

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Advanced Practice Education Associates | APEA staff

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Why You Should Avoid Incident-To Billing

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Building upon the strong foundations of the nursing model, APRNs can diagnose patients, prescribe medications, and initiate and manage patient treatments. Another distinctive difference from that of our nursing foundation is the ability to bill and be reimbursed for healthcare services, making APRNs "revenue-visible."

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I plan to do my A2 assignment on how informatics can help or somehow improve how nurse practitioners and other advanced practice providers bill for services. In doing my research, I came across "incident to" billing. I initially disagreed with this provision and knew I needed to do more investigating on the topic.

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E-Prescribing - Making Patient Care Effective and Efficient 

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E-Prescribing - Making Patient Care Effective and Efficient 

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I thought this was a great article. A few key benefits of e-prescribe that I didn't think about before:
-Better utilization of staff time
-Reduced readmission rates to the hospital
-Improved medication adherence

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Physicians are notorious for their handwriting. Patients face a tough time going through a paper-based prescribed medication. Nearly a decade ago, Electronic Health Records (EHR) brought a change in the way doctors prescribed treatment. The EHR platform enabled them to update medication details.
With the introduction of regulatory acts like HITECH (Health Information Technology for Economic and Clinical Health) and advancements in health IT solutions; pharmacists could receive prescriptions electronically. This act even made e-prescriptions mandatory in certain health situations. Combining providers and pharmacy systems reduced medication errors and paperwork.
Electronic prescriptions have been an essential part of the ambulatory care unit enhancing safety, quality, and timely healthcare processing.
E-prescriptions are a computer-based, electronically filling of prescription forms and transmission of same from the caregiver to the pharmacy.
The online prescription substituted paper and faxed prescriptions owing to its accuracy and on-time care delivery features. For any ambulatory care unit, a significant portion of prescribing happens according to the outpatient setting (meaning- facility that does not require hospitalization of patients). Outpatient setting views a considerable number of patients that comes on a daily basis for check-ups and thus this setting holds a great need for e-prescriptions.

Recommended Read: Latest Innovation in Healthcare 2019

E-prescriptions have gained tremendous popularity and are growing rapidly not because of the technological advancements, but because of the significant benefits it delivers to caregivers and patients. Though still at its nascent stage, e-prescribing is at its highest in the United States. Some controlled substances prevented physicians from e-prescribing, but after DEA (Drug Enforcement Agency) implemented rules for e-prescribing of controlled substances, the physicians and pharmacists started utilizing the same.
Many hospitals and healthcare establishments have switched to e-prescriptions for patient treatment. Initially, e-prescriptions were termed as a no-brainer, as it was computer ordered and people were doubtful whether they could read a physician's handwriting. The records and reports lead to a net positive effect of e-prescriptions; as they fulfill medical adherence. Lucidity is one of the most critical element of e-prescriptions that delivers an expansive patient safety advantage.

Evolution of E-Prescriptions

In the beginning, e-prescriptions were designed to assist pharmacies to save the delivery time of staff and other overhead costs along with fast & easy medication process. But gradually, it seemed that electronically filling of prescription forms, and sharing the same through electronic medium proved valuable in streamlining efforts and enhancing process operations at the pharmacy. As soon as these benefits came to the knowledge of the pharmacists, they were quick to adopt health-related IT solutions that manage e-prescriptions. Conversely, care providers were at a backhand to embrace e-prescriptions, as the process did not seem quite effective for them as it was for pharmacies. But looking at the decision support and timely care features offered by e-prescription solutions; physicians too made their mind to adopt the same.E-prescriptions evolved as it offered providers with enhanced patient safety by making better clinical decisions, reduced costs, and an improved workflow.
It was by the year 2008 that the pharmacies were open to e-prescriptions.

The World Health Organisation reported that more than 50% of patients around the world do not complete their prescribed medication, which had a negative impact on patient health contributing to prolonged hospitalization, re-admissions and even leads to patient death.
Introduction of e-prescribing has managed less legwork for patients making it convenient for them to get their prescription. E-prescriptions have improved medication adherence of patients.

Benefits of E-Prescribing

E-prescriptions can either be standalone applications or platforms for ambulatory care units or can be integrated with the existing Electronic Health Record (EHR) systems. The reason many healthcare providers consider the integration of e-prescriptions with EHR is that it contains patient data such as clinical information, lab orders & pathology results, and clinical decision support system. If an e-prescription is a part of , it becomes convenient for physicians to access all patient information and at the same time, he can share e-prescription with the pharmacist, ensuring efficacy and accuracy of treatment.
Enlisted here are some of the many key benefits of e-prescribing.

1. E-prescribing assist physicians in gaining full visibility of the allergies and previously prescribed drugs; as everything is documented & stored within the application. E-prescription also provides alert to the providers if the newly prescribed drugs may cause any severe symptoms. Instant notifications through e-prescribing help physicians to provide alternate medication, suggest substitute therapies and treat any allergies on time.Recommended Read: Instant Notification & Medication Alerts

How is Technology Transforming Healthcare at Home

2. No Delays as No Lost Prescription

3. Reduced Re-hospitalization

4. Faster Verification of Medical Insurance
Traditional prescriptions and outstanding medical bills need to accompany together for insurance claims. Manual verification of prescribed drugs and billing invoice of similar drugs takes a lot of time and effort. E-prescribing software tallies the prescribed drugs and pharmacy invoice and authorizes the purchase for insurance claims.

E-Prescription Adoption & Considerations

There has been a significant increase in e-prescribing adoption over the past few years. In case any healthcare organization has still not implemented e-prescribing solution, Almost all the hospitals and clinical systems that already have EHR will go with the decision of e-prescribing solution implemented so that they can connect with pharmacies in their network. There are some questions that hospitals and other healthcare providers should consider while looking to implement e-prescribing integrated with their EHR:Will the physicians use e-prescribing along with EHR? How secure is the health information network? Which security network is used by pharmacists? What is the acceptable transaction fees for any payment done on a platform? What are the steps to suggest e-prescription to patients?

1.

EHR allows the physicians to update patient medication details. However, it cannot transfer the same information to the pharmacy for faster treatment. Thus, clinicians & providers are less likely to use e-prescribing. But if e-prescription software is integrated with the EHR system, the caregivers will definitely intend to e-prescribe as it enhances the quality of patient care. 2. 3. 4.
This is another critical question to check with the software network provider about system and security. It is extremely essential that the network is compliant to HIPAA and other regulatory compliance so that sensitive patient information is kept protected. 5.
Since the pharmacies, retail and mail order outlets are the external elements for hospitals and healthcare givers; it is essential to keep a tab on the network they are connected through. E-prescribing is sharing of sensitive drug details pertaining to specific patient-id. Hence one should ensure secured network for implementation of EHR and integration of e-prescription solution with same.
When a patient receives medication from pharmacy through e-prescribing, some networks charge for transactions done on platforms or directly charge medi-claim providers for the same. One should clarify the charges before implementing e-prescribing with EHR.
The elderly population is less likely to go with e-prescriptions as they are more comfortable with paper-based prescriptions. It is essential for the caregiver to train the elderly patients about the e-prescription use and benefits.

Even if the above considerations are taken care of, there still lies a debate on the usefulness of EHR if e-prescribing is added as a vital functionality. The healthcare staff feels that the utility of EHR may reduce with the arrival of e-prescriptions. The collaboration of pharmacists and healthcare providers have engaged the patient as an essential component. E-prescriptions shared with patients via email and other channels; provide patients with more flexibility to shop from a pharmacy of their choice.There has been a significant gap in healthcare practices due to non-adherence. With e-prescribing, the system builds a bridge between providers and pharmacies to improve the overall process and ensure patient safety. E-prescription processes also provide transparency in the price of the prescribed drug and re-routes a prescription to some other pharmacy if the patient is not satisfied with pricing.
But since it is about improved patient care and quality health services; the hospitals and clinics have thoroughly adopted e-prescribing.

E-prescribing makes the medication management process effective and improves ambulatory care workflow. E-prescribing is changing healthcare delivery by reducing prescribing errors and saving on healthcare costs.
EngineerBabu has a track record of designing and developing numerous healthcare products. We have been able to successfully automate 120 hospitals with our solid expertise in this domain.
Check out our portfolio, how we developed an App to automate 120 Hospitals!
Consult us, if you are looking for a tech-partner who can take your product to the next level.

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E-Prescriptions & Its Benefits | Online Prescription - EngineerBabu

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Physicians are notorious for their handwriting. Patients face a tough time going through a paper-based prescribed medication. Nearly a decade ago, Electronic Health Records (EHR) brought a change in the way doctors prescribed treatment. The EHR platform enabled them to update medication details.

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Key benefits for patients, providers, and pharmacies

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Concept Series:

E-prescribing is the use of health care technology to improve prescription accuracy, increase patient safety, and reduce costs as well as enable secure, real-time, bi-directional, electronic connectivity between clinicians and pharmacies. This is achieved by providing prescribers with a secure means of electronically accessing health plan formulary, patient eligibility, and medication history at the point of care and securely transmitting the prescription electronically into the pharmacy's computer system. The purpose of this paper is to review the key features in many e-prescribing applications as well as some of the benefits and challenges.

There are many drivers contributing to the increased use of e-prescribing applications. Improved patient safety is probably the most important, because e-prescribing generates legible prescriptions that have been checked at the time of prescribing against the patient's electronic medication profile for possible harmful interactions. Medication errors and adverse drug events contribute to approximately 7,000 deaths a year, with an estimated cost for drug-related morbidity and mortality exceeding $77 billion a year. ¹ A minimum of 1.5 million preventable medication errors occur each year in hospitals, nursing homes and ambulatory care settings, according to the Institute of Medicine (IOM). IOM has recognized e-prescribing as one of the most promising tools to reduce such errors and recommends that all prescriptions be written electronically by 2010. ² The Massachusetts eRx Collaborative has documented this increase in safety: 2 percent of electronic prescriptions written in June 2006, more than 8,000 prescriptions, were changed by prescribers as a result of drug-drug or drug-allergy interaction notifications provided to prescribers through an e-prescribing system. ³

Data released in October 2007 by the Southeast Michigan e-Prescribing Initiative (SEMI), a broad coalition involving General Motors, Ford Motor Company, Chrysler LLC, the United Auto Workers (UAW), Blue Cross Blue Shield of Michigan, Health Alliance Plan, Henry Ford Medical Group, Medco Health Solutions, Inc. and CVS Caremark Corporation, also demonstrated that e-prescribing significantly reduced medication errors. The analysis is the first to look at the overall results of the SEMI program, which has generated nearly 6.2 million prescriptions using e-prescribing technology since its launch in February 2005. In October 2007, the program had nearly 2,500 physician participants electronically prescribing more than 282,000 prescriptions each month. Their findings demonstrated that e-prescribing substantially improved patient safety by alerting physicians of risks related to drug interactions and other potential medication problems. This resulted in a significant number of prescription changes, which prevented possible adverse events. Among a sample of 3.3 million prescriptions reviewed, a severe or moderate drug-to-drug alert was sent to physicians for more than 1 million prescriptions (33 percent), resulting in nearly 423,000 (41 percent) of those prescriptions being changed or canceled by the prescribing doctor. More than 100,000 medication allergy alerts were presented, of which more than 41,000 (41 percent) were acted upon. 4

Another driver contributing to the increased use of e-prescribing is that the population in general, including prescribers and physician office staff, has become more familiar with computer technology. Computers, PDAs, digital notepads and other computer-type devices are now commonplace. More physician offices use computerized office management systems and electronic medical records. The net cost of e-prescribing applications, computers and connecting to the internet or intranet through vendors and wireless networks have all decreased in price, making them more accessible. Lastly, all the key constituencies, prescribers, patients, pharmacies, health plans and prescription benefit management companies (PBMs) see the advantage in the promise of e‐prescribing.

The Medicare Prescription Drug, Modernization and Improvement Act of 2003 (MMA) requires that Medicare Part D plans must support e-prescribing by 2009. The MMA provides for the development of e-prescribing standards. All prescription drug plans participating in Medicare must have the capability to handle e-prescribing by 2009. The adoption of e-prescribing by prescribers and pharmacies is voluntary. Prescribers are not required to prescribe electronically, but if they do, they must use information technology that conforms to standards established by the Centers for Medicare & Medicaid Services (CMS).

Benefits to prescribers

When e-prescribing is fully implemented in the office environment, prescribers find that efficiency increases. When the prescriber enters the prescription into the e-prescribing application, the prescription is transmitted to the pharmacy and may be entered into the patient's medical record and integrated with the office billing system if these systems are linked electronically. Automated steps free up the prescriber and office staff from routine tasks and allow the staff to perform other functions. Such efficiencies translate into lower overall operating costs.

E-prescribing improves the accuracy of the prescribing function. The legibility issues related to a handwritten prescription are resolved. Of equal or greater importance, the data entry format, where the prescriber must choose the drug name, quantity and directions from an established list of choices, improves the standardization of the prescription writing process. Many e-prescribing applications will auto-populate the prescriber's commonly used medications with quantities and directions. This standardization streamlines the process and reduces the number of errors. The American Medical Association (AMA) has acknowledged the benefits of e-prescribing functionalities, including the ability to review patient medication histories, formulary information and safety alerts, in order to help reduce the risk of adverse drug events and out-of-pocket costs for patients. ⁵ In the SEMI initiative, nearly 56,000 lists of dispensed prescription histories were downloaded by physicians. ⁶

Many e-prescribing tools are able to connect to the patient's health plan or PBM information and provide feedback as to whether a specific medication is included on the organization's formulary, and if not, provide a list of formulary alternatives. This additional information available to the prescriber reduces the number of questions that patients or pharmacists dispensing a prescription ask regarding formulary issues. The prescriber is able to obtain that information as the prescription is being written.

E-prescribing applications have the potential to check drug information databases for appropriate prescribing guidelines, the patient's complete medication profile for drug interactions, and the patient's electronic medical record for disease contraindications. This resource allows the prescriber to review the chart while the patient is still in the office and to request additional information from the patient if necessary. E-prescribing enables prescribers to take advantage of larger medication history databases through electronic prescription data communication link organizations. Such organizations electronically route patient medication history and pharmacy benefit information to physicians in their offices and at hospitals in order to improve patient safety. ⁷ This feature saves the prescriber valuable time and effort and further reduces the number of errors or adverse events. ⁸

E-prescribing applications streamline communications between pharmacies and prescribers. The e-prescribing tool can automatically send the prescription to the pharmacy via a fax server or through secure electronic transmission of prescriptions. In addition, pharmacies have the capability to request refills electronically or to pose routine prescriber questions via the e-prescribing system rather than through a phone call to the prescriber. This process is more efficient because refill requests can be queued up and reviewed at the prescriber's convenience. The prescriber will be able to review those requests anywhere using a hand-held device (PDA) or a remote computer. The end result is increased efficiency and fewer pharmacy calls to the prescriber.

Benefits to patients

The benefit most evident to patients is increased convenience. Prescription orders sent via fax or electronically to pharmacies make it possible for patients to arrive at the pharmacy and have their prescription orders waiting for them. If a prescription order is sent to a mail order pharmacy, the patient does not have to mail it and may receive the prescription in the mail several days earlier. Refill orders will also be streamlined and processed faster.

As explained above, the ability to cross-check a new prescription order at the point of prescribing for drug interactions and the patient's medical conditions will result in a reduced incidence of adverse events. Warning checks for allergies and duplication of current medications can be communicated to the prescriber. There is the capability to cross-check the patient's prescriptions with their current insurance coverage and across other insurance coverage where the patient may be eligible for benefits.

Lastly, patients may be able to reduce their copayment expenses, because prescribers will have the patient's health plan or prescription benefit management company (PBM) formulary information available at the point of prescribing. This will make it easier for the prescriber to consider alternatives and to discuss options directly with the patient while the patient is at the prescriber's office rather than while the patient is waiting at the pharmacy. The SEMI initiative found that when a formulary alert was presented, 39 percent of the time the physician changed the prescription to comply with formulary requirements. ⁹

Benefits to pharmacies

E-prescribing has the potential to significantly improve pharmacy dispensing operations. Prescriptions that are electronically transmitted are more legible and can improve work flow. Systems exist for electronic prescriptions to automatically flow into the pharmacy's prescription filling software and prepare the label and paperwork ready for the pharmacist review. More effective handling of refill authorization and routine issues via electronic means will also improve the efficiency of pharmacy operations. Lastly, many of the issues currently resolved at the pharmacy level, such as benefit design, formulary alternatives, utilization management requirements, and quantity limits, will be addressed at the time the prescriber transmits the prescription, and a clean prescription will be received at the pharmacy.

Benefits to pharmacy benefit management companies (PBMs) and health plans

E-prescribing brings many benefits to PBMs and health plans. Studies have demonstrated that drug costs may decrease and plan performance may improve as a result of better formulary adherence, better drug utilization review, and fewer errors when the prescription claim is adjudicated. ¹⁰ PBMs benefit from simplification of the administrative process when the drug formulary is considered at the point of prescribing, because fewer prior authorizations are generated. In the future, there may be opportunities for improving drug utilization if PBMs or health plans are able to provide feedback at the point of prescribing, such as a patient's prior claim history from other prescribers. Savings from administrative simplifications and improved drug utilization can be passed on to payors, such as employers, that utilize PBMs and health plans to administer their pharmacy benefit. E-prescribing software also provides an opportunity for PBMs and health plans to implement clinical decision support tools, or electronic guidance, which encourages providers to follow recognized prescribing guidelines.

Challenges for e-prescribing

The e-prescribing industry is rapidly changing. The number of prescribers using e-prescribing tools is growing rapidly. Some of the challenges are briefly discussed below:

Usability/complexity: Some prescriber's offices do not make extensive use of computer technology. For those prescribers, introducing an e-prescribing application is a major hurdle. However, the trend is for most office personnel, as well as prescribers, to become more familiar with this technology.

Financial consideration: Determination must be made as to who has the financial responsibility to pay for an e-prescribing system.

Incorporation into workflow: This is a major factor in determining e-prescribing application success. If the e-prescribing tool is integrated with the office management, scheduling system, billing systems, and electronic medical records, then there is a greater potential for success.

Prescriptions for controlled substances: As of April 2008, federal regulations prohibiting controlled substances from being electronically prescribed continue to be an impediment to the widespread adoption of e-prescribing.

National standards: In order for all prescribers to communicate electronically with many different entities, pharmacies, PBMs, and health plans, it makes sense to standardize the data and information that is transmitted to each entity. The National Council for Prescription Drug Programs (NCPDP) has a long history of working with the pharmacy industry to build consensus for electronic claim transactions. NCPDP is doing the same with e-prescribing. NCPDP has been successful in developing a prescription order electronic standard (SCRIPT standard) and is working on developing other standards to support e-prescribing (e.g. SIG standard).

Security and privacy concerns: E-prescribing vendors have successfully addressed the concern regarding the transmission of electronic records from prescriber to pharmacy or between other entities. The current standard is to use 128-bit encryption and has been found to be effective in protecting electronic prescriptions or medical records. However, the U.S. Drug Enforcement Administration has not permitted the use of eprescribing for controlled substances.

Opportunity for new types of prescribing errors: Published studies conducted in hospitals using computerized prescription order entry (CPOE) have identified examples of computer-entry errors. One study found that a widely-used CPOE system facilitated 22 types of medication error risks. Examples include fragmented displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, and inflexible ordering formats generating wrong orders.¹¹ As e-prescribing systems are implemented, health care professionals must monitor for errors that these systems may cause in addition to the errors that they prevent.

Conclusion

For many, the definition of e-prescribing is much more than the simple description provided at the beginning of this document. E-prescribing has evolved from a data entry tool with a fax capability to a robust application with network connectivity to many entities besides pharmacies, and with strong error checking facilities. Vendors continue to improve their applications and to add more features.

Managed health care systems will in time integrate the electronic prescription record by linking it to other medical record systems. Although e-prescribing has many benefits, these systems have been slow to gain use nationally as a result of the capability, cost, training, and integration issues described above. However, the benefits of e-prescribing are becoming more apparent to all stakeholders.

1 Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs. Research in Action, Issue 1. AHRQ Publication Number 01-0020, March 2001. Agency for Healthcare Research and Quality.

² "Preventing Medication Errors," Institute of Medicine, July 2006.

³ eRx Collaborative Press release, eRx Collaborative Boosts Patient Safety with 8,000 Prescriptions Changed in June, September 5, 2006, available at http://www.erxcollaborative.org/Press%20Release%20September%202006.pdf. (Accessed January 4, 2008).

⁴ PR Newswire, "Southeastern Michigan e-Prescribing Initiative Reports Substantial Reduction in Medication Error Risks," October 29, 2007, available at: http://www.smartbrief.com/news/aaaa/industryPRdetail.jsp?id=DF023486-C27C-4DE6-8077-440E38BA6A4D. (Accessed March 28, 2008).

⁵ American Medical Association, "Health Information Technology: e-Prescribing Functionality," December 12, 2006, available at http://www.ama-assn.org/ama/pub/category/16704.html. (Accessed January 4, 2008).

⁶ PR Newswire, "Southeastern Michigan e-Prescribing Initiative Reports Substantial Reduction in Medication Error Risks."

7 "What is RxHub", www.rxhub.com. (Accessed November 16, 2007).

⁸ California HealthCare Foundation. E-Prescribing. Prepared by Petter Kilbridge, M.D., November 2001, available at http://www.chcf.org/documents/hospitals/EPrescribing.pdf. (Accessed January 28, 2008), p. 6.

⁹ PR Newswire, "Southeastern Michigan e-Prescribing Initiative Reports Substantial Reduction in Medication Error Risks."

¹⁰ Electronic prescribers' pharmacy costs decreased 3-3.5% due to increased use of preferred formulary brands and generics, in highly managed market. (eRx Collaborative Press release, eRx Collaborative Boosts Patient Safety with 8,000 Prescriptions Changed in June, September 5, 2006) and generics increased 4.8% vs. control. (Morrow C, Coleman M. The Role of eRx in Lowering Physician Drug Expenses. White paper published by Southwest Medical Associated, 2006) from Gorman Health Group/Pharmaceutical Care Management Association, Options to Increase E-Prescribing in Medicare: Reducing Medication Errors and Generating Up to $29 Billion in Savings For the Federal Government, July 2007. Available at http://www.pcmanet.org/assets/pdf/GHG-PCMA%20Options%20to%20Increase%20Eprescribing%20in%20Medicare%20July%2007%20FINAL.pdf (Accessed January 4, 2008).

¹¹ Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005; 293:1197-203.

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E-prescribing is the use of health care technology to improve prescription accuracy, increase patient safety, and reduce costs as well as enable secure, real-time, bi-directional, electronic connectivity between clinicians and pharmacies. This is achieved by providing prescribers with a secure means of electronically accessing health plan formulary, patient eligibility, and medication history at the point of care and securely transmitting the prescription electronically into the pharmacy's computer system.

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Health Information Exchange in California 

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Health Information Exchange in California 

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Here's what a Health Information Exchange Network can do for California

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Week 7 California Health Information Exchange 

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Week 7 California Health Information Exchange 

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California has a health information exchanges system called the California Trusted Exchange Network (CTEN). Instead of using public-private networks like many other states, California uses a regional initiative that is shared through voluntary self-governance. Based on their website, it looks like a fee is required to partake with a discounted fee for some. CTEN covers 39 of 58 counties statewide and includes various health care facilities including primary care, specialists, acute hospitals, social services, etc. Ways this platform is used are direct messaging, alerts, and text reports. One example I work with often is a COVID testing platform that links my self-swab results to my employer.

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California Association of Health Information Exchanges

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Unlike other states that chose to establish a single HIE or public-private network, California's strategy for health information sharing relies on regional and enterprise initiatives, each one meeting the unique needs of its participants. CAHIE was formed to promote collaboration to solve difficult policy and technology problems, and to facilitate statewide health information sharing through voluntary self-governance.

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This was an interesting article that breaks down the costs of an EHR. Just reading through it makes me realize how a practice would be deterred by the process of implementing a costly EHR system.

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38% of healthcare CIOs listed 'EMR optimization' as their organization's top area of planned capital investment over the next three years.

Which is not surprising when most practices cited increasing efficiency as their top driving factor for implementing EHR in the first place, according to EHR report data.

So, needless to say, EHR selection, implementation and optimization have become an intrinsic part of healthcare organizations' capital budgeting processes.

Yet despite the demonstrated importance of EHRs in modern healthcare practice, a great deal of uncertainty exists as to how to properly understand the financial case for EHRs, or how to build an accurate and workable budget for system selection.

This guide will address issues related to EHR cost and constructing an EHR budget particularly:

Justifying the cost of an EHR.

Identifying the benefits of a new EHR

Compiling EHR costs

Creating an EHR budget

We'll also look at the pricing of popular EHR systems.

1. Justifying the cost of implementing EHR

One of the major obstacles healthcare organizations face during EHR selection is uncertainty over whether the investment is justifiable, particularly if a practice is operating on thin margins.

First, and obviously an EHR investment must fit into a practice's existing short-term budget; however, one should not simply assume that the capital investment made into an EHR simply represents a regulatory requirement practices must fulfill. Rather, EHRs can provide significant benefits in the form of cost reductions when properly leveraged to:

enhance service delivery

reduce costs

increase revenue

Accordingly, when making the case to justify the cost of an EHR investment the following strategies can be effective in creating buy-in from decision makers in your practice:

A cost-benefit analysis focusing on specific elements of your practice such as quality of care, customer service or efficiency.

An ROI forecast featuring short-term and long-term projections.

An analysis that features the total cost of ownership in the short-term and long-term so that decision makers can be fully apprised of EHR-related costs.

2. Consider the benefits of EHR use

According to Health Affairs, practices can expect to cover the cost of EHR in approximately 2.5 years, and then receive an average of approximately $23,000 per year per full-time employee in net benefits.

Considering these findings practices in various settings, sizes and financial conditions can find some justification beyond simply complying with regulations.

Further evidence shows that when properly incorporated into a practice an EHR can provide an array of tangible benefits for a practice. The study outlined several areas in which an EHR can provide tangible benefits to a practice including:

increased efficiency

increased quality of care

reduction of waste

fewer medical errors

better organizational outcomes (e.g., financial, and operational benefits)

better societal outcomes (e.g., improved ability to conduct research, improved population health, reduced costs)

When viewed in light of these findings, the decision to invest in an EHR can be justified on a metrics beyond simple financial benefit.

Despite a variety of clear evidence supporting EHR's benefits, sorting out whether an investment in EHR can be justified can be a difficult task to undertake. This is because budgeting for EHR-related capital expenses and modeling return on investment for EHR can be a difficult and imprecise process if not engaged carefully.

When deciding whether to invest in an EHR a practice can rely on two tools:

ROI is a calculation of the most tangible financial gains or benefits that can be expected from a project versus the costs for implementing the EHR or suggested program or solution.
Use this EHR pricing guide to get accurate baseline prices for ROI calculations
An EHR Cost Benefit Analysis (CBA) is more comprehensive than ROI, and attempts to quantify both tangible and intangible costs and benefits. Whichever method a practice chooses, it is important to include all the direct and indirect costs that can impact the EHR investment.

3. Compile your EHR costs

Asking how much an EHR costs is the sort of general question that often results in an answer that begins with the phrase planners and project managers dread: "it depends."

The answer to how much an EHR costs depends on what a practice is buying and for how long they intend to use it. Accordingly it can be difficult to engage in an EHR price comparison without fully examining the variables that can affect the price of an EHR such as:

the exact features a practice requires

add-ons such as practice management or patient portal

cloud or on premises deployment

updating hardware to support the system

the scale of the installation

With the goal of creating a comprehensive model of costs, the cost of an EHR should be expressed in terms of not just the "out of the box" price, rather in terms of long-term and comprehensive cost estimates.

One of the most comprehensive and efficient measures for modeling long-term costs involves calculating the total cost of ownership (TCO). TCO is defined as a full assessment of information technology and services costs over time, representing an accounting of all costs (both short term and long term, and direct and indirect).

To illustrate, the following chart provides estimated average upfront cost, yearly cost, and five year total cost of ownership total cost of ownership for for on-site and SaaS EHR deployment. However, it is important to note that costs may vary based on the size of your practice and the features you want.
(Source: Michigan Center for Effective IT Adoption)
Although most organizations can pin down basic EHR-related cost estimates, TCO calculations are subject to variance based on the factors outlined above.

Choosing your EHR deployment method (cloud vs on-premise) and factoring in associated costs

Furthermore, the cost of an EHR over the long-term can also vary according to the method of software deployment.

As illustrated above, the five-year TCO for on-premise and cloud-based systems show that the cloud-based option cost $58,000 while the office-based option cost practices $48,000. Upfront costs for the cloud-based system were less at $26,000 while the office based system showed up front costs of $33,000.

However, when looking beyond the TCO of a cloud or on-premises system a number of factors such as reliability, hardware investment, EHR maintenance cost and security all factor heavily in overall cost estimates not reflected in the study above.

In addition to TCO estimates, practices should also be aware of implementation costs, related to setting up and launching an EHR:

What is the cost of a top EMR/EHR software implementation?

Implementation costs vary according to context and the implementation plan, as such it is difficult to provide an average cost of EHR implementation.

However, case-specific examples can offer some insight with regard to implementation costs. For example, the Health Affairs study cited above found that a typical multi-physician practice would spend about $162,000 to implement an EHR, with $85,500 for first-year maintenance costs.

They also estimated that the implementation teams spent approximately 611 hours "preparing for and implementing" the EHR system. Whereas according to a Medical Economics study of thirty primary care practices, average spemd was $5,900 on purchases related to hardware, software, peripherals, and network connections and about half of the practices averaged $3,094 for "IT and other outside support" costs.

The average cost of hospital EHR implementation would be higher given the larger scale. Estimates show that these costs vary widely for community hospitals, according to a survey from Community Hospital 100 and Anthelio, with some organizations paying less than $5 million and others more than $20 million to implement an EHR.

What are the hidden costs of an EHR implementation?

When engaging in an EHR implementation cost breakdown it is important to consider that implementation budgets should include direct costs such as:

software licensing

projected maintenance

consulting and training fees

labor including overtime

hardware (if required - usually only required for on-premise installations)

Further it is important to also consider indirect costs such as:

decreased revenue

lost productivity

decreased patient visits

When quantified, these can have a significant impact on how an implementation impacts the overall EHR budget.
For more on EHR implementation, check out our step-by-step EHR implementation whitepaper
Cost, incentives and deciding which EHR features you need

When considering the types of features needed you should determine which features can best further organizational goals. If your practice currently participates in the Meaningful Use program, your new EHR's features will need to ensure that a practice continues to qualify for incentive payments over the long-term.
Get ideas for new EHR features using this guide to 40 features to look for in your next EHR
Incentive payments for eligible professionals who demonstrate meaningful use of certified EHR technology can reach up to $43,720 under Medicare over five consecutive years and under the Medicaid EHR Incentive Payments.

Eligible professionals who do not successfully demonstrate Meaningful Use will be subject to a downward adjustment to payments for covered professional services.

4. Compile costs into a complete EHR budget

The process of budgeting for an EHR differs from constructing a practice's normal operating budget. An EHR budget contains several uncertainties that, if not taken into account, can result in costly mistakes.

However, when approached in a methodical manner which considers all potential contingencies, the risk of problems arising from a flawed budget can be reduced significantly. An EHR budget should contain, at a minimum the following components:

Hardware: servers, computers, printers, scanners, and other peripherals.

EHR software: all software costs including, additions and upgrades.

Assistance: IT contractors, legal support, system maintenance and installation consulting support; data conversion and workflow redesign support.

Training: initial and ongoing training for clinical staff and office staff.

Contingencies: potential productivity, revenue and patient-related gains and losses.

5. Pricing of popular EHR systems

The cost of popular EHR systems varies based on the system's application, its deployment, and whether any add-on features are included in the software package. In addition to these factors, pricing may vary according to whether the system is being purchased or leased or whether the software has a licensing structure whereby the price increases as more users or volume of data is processed through the system.

Given this variance in pricing, EHR cost can be a difficult line in a budget to forecast. Further complicating matters is the fact that that pricing information is not generally published online.

Therefore, if one is trying to obtain a broad overview of pricing for systems that may be considered during the selection process the request for information/request for proposal process will need to be used.

Despite the fact information regarding EHR software cost must be obtained during the request for information and request for proposal process a practice can still assemble a reliable and comprehensive cost estimate for systems that are under consideration in the selection process.

EPIC: Epic focuses on serving larger organizations such as health systems and hospitals. Epic's pricing starts at $1,200.00 for their self-hosted solutions, and $500,000 for large clinics and hospitals. Epic does not offer a free trial; however, it does provide a free demo presented by the vendor's sales representatives.

CERNER: Cerner represents the largest EHR vendor for inpatient providers and serves a wide range of ambulatory providers. Cerner offers both cloud-based and on-premise deployment options. Cerner's product range includes over 50 specialty focused products. Information collected from various online sources indicates that Cerner's cloud-based service begins at $25 per month and increases with more advanced systems and with the more expensive on-premise deployment. Cerner does not offer a free trial.

CARECLOUD: CareCloud offers EHR, Practice Management, Revenue Cycle Management, and Patient Experience Management software. This cloud-based service primarily serves the ambulatory market. Pricing for the EHR begins at $349.00 with add-ons costing extra. Carecloud does not offer a free trial, however, it does provide a free demo presented by the vendor's sales representatives.

ECLINICALWORKS: eClinicalWorks offers an EHR, practice management software, patient engagement, ACOs and PCMH tools, care coordination, and population health management tools. The EHR solution costs $449 per month, the EHR with practice management costs $599 per month. The company's revenue cycle management system is priced as a percentage of total billing (currently 2.9% of collections). Pricing information is available on the company's website. eClinicalWorks does not offer a free trial.

ALLSCRIPTS: Allscripts's open and connected health platform is primarily marketed to medium to small physician practices. Allscripts Choices, choices Allscripts offers an entire family of products, that include an EHR, revenue cycle solution with analytics, and a population health platform. Allscripts does not provide public pricing information. Rather potential users must contact the company to obtain pricing information. What is known from public information is that Allscripts does not offer a free trial and has a wide variety of pricing levels given the different combinations of features and products available.

This guide should give you a thorough overview on the cost of EHR, and give you an idea of how to estimate your expected budget for your project.

Jeff Green

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How much EHR costs and how to set your budget

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38% of healthcare CIOs listed 'EMR optimization' as their organization's top area of planned capital investment over the next three years. Which is not surprising when most practices cited increasing efficiency as their top driving factor for implementing EHR in the first place, according to EHR report data.

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Week 6 My Thoughts On Medical Record Access 

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Week 6 My Thoughts On Medical Record Access 

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I work in an outpatient specialty clinic and work directly with a electronic medical records (EMR). I have found many great things about the EMR and many bad things as well. The EMR has allowed our specialty providers to review prior work up and therapy, extensive health history, and has allowed for better multi-disciplinary communication. There is far less paper work involved and providers are able to keep a close track of their patients' health. With increased access to this information, patients and providers are able to work together more efficiently on care plans. Some challenges I have seen the EMR cause are disagreements with the patient in the few cases they don't agree with their providers, and abuse of the system giving patients the false hope that their inquiries will be addressed just as quickly as they were asked.

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Meaningful use is a very interesting concept that I didn't realize was behind the EHR that I currently use at work. In my position at an outpatient clinic, nurses are able to pend prescriptions for providers to sign. I often come across a built in safety mechanisms when prescribing medications if a patient has a listed contraindicated allergy. There are 'hard stops' for medications that are being prescribed that the patient has an allergy to and 'soft stops' if a patient has a listed allergy that may be an ingredient in the prescribed medication. Either stop will ask the provider to review the contraindication and review the allergies. I believe this has prevented many adverse reactions in my practice.

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Week 4 Data, Information, Knowledge, Wisdom 

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Week 4 Data, Information, Knowledge, Wisdom 

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DIKW hierarchy is a framework that grows data into wisdom. Data is a factual point. Information gives more context to a data point giving it more meaning. From this information, knowledge is applied to into something that has theoretical understanding. From this, we have wisdom that applied to an experience. An example of the DIKW hierarchy is the idea of water trending to the use of an umbrella. Water is the data point. Information we know about the water is that it fell from the sky. Common knowledge about water falling from the sky is that it is referred to as rain. Wisdom that can be applied to this knowledge is that one would use an umbrella when it rains.
DIKW hierarchy influences public health by finding common data points of a common population that can lead to a well studied preventative intervention. An example of this is linking the occurrences of rainy weather with increased rates of depression.

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Incentive program turned penalizing program

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The HITECH Act: Electronic Health Records and Meaningful Use

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By harnessing the vast datasets of biomedical information now available to us, we envision
a world in which we can prevent disease before it strikes and cure it decisively if it does.

This is the power of Precision Health. To predict, prevent, and cure disease - precisely.

Precision Health is a fundamental shift to more proactive and personalized health care that empowers people to lead healthy lives. It is in this spirit of possibility and promise that Stanford Medicine will be hosting the seventh year of this conference, bringing together international researchers and leaders from academia, health care, government, and industry to develop actionable steps for improving human health.
Predict. Prevent. Cure. Precisely.

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Precision Health is a fundamental shift to more proactive and personalized health care that empowers people to lead healthy lives. It is in this spirit of possibility and promise that Stanford Medicine will be hosting the seventh year of this conference, bringing together international researchers and leaders from academia, health care, government, and industry to develop actionable steps for improving human health.

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Interoperability: When two or more systems exchange and use the information

Standardize tools like EMRs

Standardize "common language"

Benefits doctors, hospitals, pharmacies, health plans, and patients

Goal: "make patient health information available when and where they need it"

This is an amazing idea and something that should have more focus the more we expand healthcare. One thing the COVID19 pandemic brought on was the increased use of Telehealth video visits. Interoperability will improve the care that is being offered virtually.

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Office of the National Coordinator for Health IT

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Week 3 How can interoperability enhance my current practice? 

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Week 3 How can interoperability enhance my current practice? 

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I work at a university hospital in a specialized Inflammatory Bowel Disease (IBD) clinic. This is an evolving subspecialty where many treatment options are experimental. We get many patients from very rural parts of California referred to us. Many of these areas are still using paper charting or do not share our EMR interface. This has caused lack of communication in important diagnostic results and treatment plans.
One example in particular is the contraindicated use of NSAIDs in IBD as it can cause a flare of the disease. A patient of ours went to their local ER for abdominal pain (a common symptom of an IBD flare), the hospital was unfamiliar with treating IBD patients and prescribed high dose NSAIDs which exacerbated the flare even more. If the local ER provider had access to our office notes, they would have been able to see our recommendations for an IBD flare available in the patient's chart. This includes the avoidance of NSAIDs.

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This week we learned about QSEN and HIMSS

QSEN (Quality and Safety Education for Nurses)  HIMSS(Healthcare Information and Management Systems Society)
QSEN: Equip nursing education contributing to KSA needs

Focus on patient center care while involving family

Pain culture

Evidence based practice is important to optimize health care and helps individualize care

Quality Improvement uses data to make changes to healthcare/improve outcomes

Use technology Minimize Risks/Improve safety

Use of information and technology to communicate within a healthcare setting

Consider the attitudes around change and adapting to technology

HIMSS: Organization that looks at impact of information in Nurses/health care organization

Impact on safety, workflow, and use acceptance

Tiger Initiative started around 2004 when President Bush declared it the year of medical technology

This movement NEEDS to involve nurses, as we are and will be the main utilizers

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What is Health Informatics?
Information to help make better decisions to improve health care

The use of technology, science, and data collection to improve healthcare outcomes.

Utilization of 'resources, devices, methods, guidelines and communication systems'

Collaboration amongst various organizations

Health Informatics For The Patient:

Improves access to medical records for various healthcare entities (insurance, outside hospitals, specialty clinics, etc)

Improves workflow of their health care providers

Allows for easier access to health information for patients

Can essentially improve health care costs

Health Informatics In My Practice:
We utilize CareEverywhere which is a shared electronic medical record interface that various institutions use. This is important for us because we are a very specialized clinic and by the time patients see us, they are often already seen by a few other providers who have performed some diagnostic testing. This helps trend the progression of their disease, understand what treatments they have tried already, and decrease the need to order tests that were already performed.

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Verifiable- The modern infrastructure using automated data to verify credentialing and simplify networking. 

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Verifiable- The modern infrastructure using automated data to verify credentialing and simplify networking. 

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"They are the people between the healthcare system and the patient, so to have access to their data, patients can form a relationship with them, which is a powerful position.”

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Less than a year after its $3 million seed round, Verifiable snapped up another $17 million for its healthcare provider credentialing API toolkit.

The Austin-based company's technology creates an infrastructure for healthcare provider data management that puts providers at the center. Verifiable founder Nick Macario told TechCrunch that data fuels critical operations across health systems and insurance carriers, like contracting, credentialing, enrollment, claims and directories. All of this is being done manually now, and often inaccurately, which is leading to billions of dollars of annual waste.

Verifiable's infrastructure manages healthcare providers and automates the verification of provider data, enabling automation of business processes like credentialing, payer enrollment and network management for virtual healthcare platforms, health systems and insurance payers. It is able to reduce credentialing turnaround times by over 70%, Macario said.

Insurance payers is the newest part of the company's expansion that includes verifying provider directories. For example, the information that pops up when someone performs an in-network search on their healthcare plan's website to find a certain provider in their area.

The Altman brothers led the $17 million Series A round and was joined by David Sacks/Craft Ventures and a group of individual investors including Flexport's Ryan Petersen, Rippling's Parker Conrad, Front's Mathilde Collin, Syapse's Jonathan Hirsch, Todd Goldberg and Rahul Vohra. Tiger Global and existing investors also participated in the round.

Macario was also planning to raise another round of funding, but he said the combination of an inflection point with the product and Jack Altman's continued investment interest made it a good time to start scaling the team.

Altman said the general space of healthcare technology has potential. It is also a topic near to him - his wife is a nurse. He was speaking to her about what Verifiable was working on, and she told him that there are still teams of people doing this.

"So much data is flowing through, and because healthcare is such a massive part of the country's GDP, there is so much potential that can be unlocked," Altman added. "I love Verifiable's positioning around the provider. They are the people between the healthcare system and the patient, so to have access to their data, patients can form a relationship with them, which is a powerful position."

In addition to expanding into insurance payers, Macario intends to use the new funding to double his team of 26 employees by the end of the year. The company has openings for engineers, operations and go-to-market talent.

Verifiable works with companies like Lyra Health, Talkspace, Modern Health, Headway, Wheel, Quartet Health, Forward and provider networks to automate credentialing, compliance processes and provider operations.

"Verifiable's infrastructure has verified hundreds of thousands of providers and we plan to continue to double down on providers, use cases and payers," Macario said.

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Verifiable secures $17M for its API that manages healthcare provider information

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Less than a year after its $3 million seed round, Verifiable snapped up another $17 million for its healthcare provider credentialing API toolkit. The Austin-based company's technology creates an infrastructure for healthcare provider data management that puts providers at the center.

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Patchwork Health - App for hospital staffing needs 

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Patchwork Health - App for hospital staffing needs 

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The tyranny of the Excel spreadsheet continues, especially in rostering staff. Nowhere is this more acutely felt in today's COVID-pressured hospital wards, which are now depleted not just by the disease but by staff burnout from patchy over- or underscheduling of staff hours. Two doctors realized this and decided to create a startup.

Patchwork Health has now raised £3.5 million from Praetura Ventures and BMJ New Ventures, the investment arm of BMJ (global healthcare knowledge provider and publisher of The BMJ).

Founded in 2016 by NHS doctors Anas Nader and Jing Ouyang, the platform is now used by over 70 NHS sites to fill vacant shifts and offer staff flexible working hours. It couldn't have come sooner: The NHS currently has 90,000 vacancies and 1 in 5 staff are said to be considering quitting due to stress and exhaustion.

Patchwork replaces this spreadsheet with a dashboard that predicts when temporary staff will be needed. Shifts are broadcast to an app and temporary staff use the app to select the shifts that suit them. The passporting of credentials, HR paperwork and payments are all handled through the same system. Full-time healthcare workers can have their personal preferences reflected in their rotas without leaving NHS wards with staffing gaps, the startup says.

Dr. Nader said: "We're already partnering with over 70 NHS sites to tackle the root causes of burnout, offer full-time and temporary staff more choices, and create stronger staffing foundations for hospitals. Through our technology and services, flexible work and safely staffed wards can go hand in hand."

David Foreman, managing director at Praetura Ventures and non-executive director of Patchwork, added: "From the moment we met Anas and Jing, we could see the passion for their business. Patchwork is helping to solve a staffing crisis in the NHS. They've made real strides over the last 18 months and have the potential to make seismic changes in the way we organise staff in one of the world's largest healthcare systems."

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Patchwork Health raises £3.5M to fix the staff scheduling disaster inside stressed hospitals

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The tyranny of the Excel spreadsheet continues, especially in rostering staff. Nowhere is this more acutely felt in today's COVID-pressured hospital wards, which are now depleted not just by the disease but by staff burnout from patchy over- or underscheduling of staff hours. Two doctors realized t...

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One step in the TIGER initiative's three -year action plan is education. This pillar focuses on the use of technology and how it can improve the learning experience and capabilities of disseminating knowledge. One experience that I had with this is the BLS courses offered by American Heart Association and my institution, Stanford Health Care. Their new learning model to renew a BLS certification is an online hybrid program. Users interact with online characters in various simulations. Quiz questions re very algorithmic. At the beginning of the course they informed that quiz question will repeat itself as a way to improve the learning experience. I found this interesting as I recall from prior in-person BLS classes, I would often forget the exam questions I had right after turning it in. When seeing these quiz repeatedly, I seemed to retain more information.

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An Initiative for Technology and Health Informatics Education

The Technology Informatics Guiding Education Reform (TIGER) initiative from HIMSS provides the global health workforce with innovative informatics/eHealth tools and resources to transform health for all.

The global TIGER network collaborates to integrate informatics/eHealth into healthcare education, certification, practice and research through an inclusive, interdisciplinary, intergenerational approach.

Education Reform

We create an environment that maximizes the possibilities of technology toward knowledge development and dissemination, driving rapid implementation of best practices as well as competency and curriculum development.

Interprofessional Community Development and Growth

We actively engage and collaborate with the global healthcare workforce, students and adult learners to encourage standardized, person-centered and technology-enabled processes to facilitate teamwork and relationships across the continuum of care worldwide.

Global Workforce Development

We foster a respectful learning community of diverse stakeholders that embrace shared values to drive innovation and technology around the world.

Global Recommendations

While informatics recommendations on competencies and education support the design of curricula and courses, they are unable to inform educators on how to customize content for local needs and requirements. That's why the TIGER International Competency Synthesis Project (ICSP) and the EU*US eHealth Work Project came together to describe and validate the TIGER initiative's framework of global informatics core competencies for health professionals.

Together, these projects compiled a recommendation framework of health informatics competencies (v2.0) to measure, inform, educate and advance development of a skilled workforce throughout the EU and U.S. and around the world. Although the EU*US eHealth Work Project has ended, we are compiling global case studies to continue bringing our findings to life, with a focus on all states within the EU.
Hear TIGER International Task Force Former Co-Chairs Ursula Hübner, PhD, professor, University of Applied Sciences Osnabrück, Germany, and Beth L. Elias, PhD, MS, FHIMSS, adjunct faculty, Panuska College of Professional Studies, University of Scranton, present these important project findings at the HIMSS19 Global Health Conference.
TIGER International Task Force

The TIGER International Task Force, seated under the HIMSS Professional Development Committee, provides our global community of 34 countries with knowledge, leadership and guidance in its efforts to reform technology and informatics education. It provides domain expertise through activities, projects and collaborations within the interprofessional community to support faculty, students, adult learners and providers.

TIGER Resources

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The Technology Informatics Guiding Education Reform (TIGER) initiative offers tools and resources for learners to advance their technology and health informatics skills and for educators to develop valuable curricula.

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Takeaway Points:

Smart Inhaler with GPS tracker is an interesting idea! It is designed to track what environments trigger asthma exacerbations for a patient. This can help customize treatment plan per customer

Goal: make healthcare more inclusive

Pick technology that is a best fit for the user (healthcare providers and patients)/Don’t want the latest and most complicated technology so it can be user friendly

Individualized recommendations via online portal that can be disseminated to areas that are hard to access/remote areas

Can use current data into AI/machine, this would be standard recommendations that can be accessed by anyone

Food Chatbot

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Using Big Data to Improve Healthcare Services | Tiranee Achalakul | TEDxChiangMai