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This article offers privacy and security solutions

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Abstract

Electronic Medical Records (EMRs) can provide many benefits to physicians, patients and healthcare services if they are adopted by healthcare organizations. But concerns about privacy and security that relate to patient information can cause there to be relatively low EMR adoption by a number of health institutions. Safeguarding a huge quantity of health data that is sensitive at separate locations in different forms is one of the big challenges of EMR. A review is presented in this paper to identify the health organizations' privacy and security concerns and to examine solutions that could address the various concerns that have been identified. It shows the IT security incidents that have taken place in healthcare settings. The review will enable researchers to understand these security and privacy concerns and solutions that are available.

Keywords

Electronic health records

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Security and privacy of electronic health records: Concerns and challenges

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Electronic Medical Records (EMRs) can provide many benefits to physicians, patients and healthcare services if they are adopted by healthcare organizations. But concerns about privacy and security that relate to patient information can cause there to be relatively low EMR adoption by a number of health institutions.

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The case studies this week were necessary in order for us to see the full picture. Small mistakes or holes in our systems can have deleterious effects on our patient's health. It's also important to note that although EHR systems can be beneficial, they can not replace our critical thinking.

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Leap in enterprise medical imaging technology enabling 4D interactive intelligent medical image views over the Internet
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LifeVoxel's HIPAA compliant SaaS platform, Prescient, is a leap in enterprise medical imaging technology, enabling 4D interactive intelligent views of medical images over the Internet and empowers physicians to access, analyze and manipulate imaging studies in real-time, turning any web enabled device into a radiology workstation.

The National Science Foundation recognized the technology as groundbreaking, awarding an NSF grant to LifeVoxel.AI for its advancement and adoption of Artificial Intelligence using GPU for medical imaging. The company's platform was also granted FDA 510K approval for use in the diagnostic interpretation of medical images and is protected by more than 12 international patents.

The $5 million seed round was raised from medical and radiology specialists, strategic medical technology investors and Family Offices. Sekhar Puli, Co-Founder, President and CEO of LifeVoxel.AI, shares, "Medical imaging and radiology needs dynamic solutions to replace the inadequacies in conventional systems. With this round of funding, we will be able to accelerate not only our vision to be the de facto platform for medical imaging applications across the globe but make significant strides in the Telehealth imaging and advanced tech-based AI solutions for the future of healthcare."

Kovey Kovalan, Founder and Chief Architect added, "LifeVoxel's vision is to improve patient outcome. Our patented cloud architecture enables AI adoption and real-time interactive visualization to facilitate challenging use cases such as rapid remote emergency care. The platform will be the foundation for future applications of AI enabled diagnostic support and immersive patient and physician engagement."

Dr. Sean Pakbaz, a neuro-interventional surgeon who co-developed the largest stroke treatment program in San Diego and an Advisor to LifeVoxel stated, "In stroke care, time to diagnosis and treatment is the most important factor in patient outcomes. From a clinical perspective, LifeVoxel's patented platform will enable instant engagement with the patient and their data from anywhere, reducing delays in intervention and greatly improving their quality of life after the stroke."

Puli leads the LifeVoxel.AI team along with founder Kovey Kovalan who services as Chief Architect. The leadership team also includes Michael Sossong, Chief Scientist, Kalyan Athota, Vice President of Engineering and Jason Momenthy, Vice President of Product Management and Marketing.

SOURCE LifeVoxel.AI

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LifeVoxel.AI Raises $5 Million Seed Round for its AI Diagnostic Visualization Platform

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Leap in enterprise medical imaging technology enabling 4D interactive intelligent medical image views over the Internet Tweet this LifeVoxel's HIPAA compliant SaaS platform, Prescient, is a leap in enterprise medical imaging technology, enabling 4D interactive intelligent views of medical images over the Internet and empowers physicians to access, analyze and manipulate imaging studies in real-time, turning any web enabled device into a radiology workstation.

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Data visualization is the next step for our patients to become empowered to take control of their health. Imagine if a patient could input their health data and compare themselves to other people their age. Also, imagine a formula that a patient could play with to see where they need their "numbers" so they can predict their long term health. Data visualization could bring a whole entire level of health comprehension and inspire the patients to adopt new behaviors.

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How politicians create their narrative, but we can do it too.

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The recent election has many people wondering what the future of American politics looks like. This article explores how data storytelling can help answer this question by providing insights into which messages resonate with voters and lead to increased voter turnout.

Political Data Storytelling is a powerful way for candidates, campaigns, and political parties to turn raw data into compelling narratives that inform their decisions on where to focus resources to maximize their chances of winning an election.

The first step in using data storytelling effectively is understanding your audience's needs so you can craft stories they want to hear. Once you know who your story will be told, it's essential not only to analyze the data but also to understand its implications so you can weave them together in a way that makes sense for your audience.

What is Data Storytelling?

Data storytelling can be used to help people understand data better.

Data storytelling is a data visualization technique that aims to incorporate storytelling in visual storytelling.

Data storytelling is a data visualization method that uses human stories to help people better understand & remember big numbers.

Data Storytelling is a data visualization technique where the story of the data becomes more important than the actual numbers. It's one way to make even dull statistics exciting and engaging for an audience.

Data storytelling is the process of converting data into a narrative that will help you communicate complex ideas to other people. This can be done with or without infographics, and it's beneficial for both business and personal use.

What is Political Data Storytelling?

Political Data Storytelling is the visualization of political data through storytelling to help facilitate critical thinking and understanding.

Political Data Storytelling is a thesis about how the spread of data and information has changed our relationship with the government.

Political Data Storytelling is the act of taking data and displaying it in an exciting way that will engage people to look at it.

It is the act of creating data-driven stories that are compelling, revealing, and shareable.

Political data storytelling is a way of analyzing political data and telling the story behind it.

The benefits of political data storytelling

It's a way to reach people who don't follow politics closely

Data storytelling can help create empathy for the lives of others

It enables you to understand your audience better and their needs

Political Data storytelling helps make the data more accessible to a broader audience

It is an effective way of presenting complicated information in a visual and engaging manner

It can be used for advocacy purposes, such as making people aware of political issues or advocating for specific policies

Data storytelling is an accessible way for people to use data

It helps people understand the importance of voting

Political parties can use data storytelling to reach out to potential voters

Data storytelling is a powerful tool in politics because it's so visual and makes politics more relatable

Political data storytelling is an effective way to reach a broad audience

It helps people understand the political process and how it impacts them

The information can be presented in many different formats, such as videos, infographics, or articles

This type of storytelling gives viewers a better understanding of the current political climate

The use of data storytelling can help you find interesting stories or angles that other people might not

Data storytelling is a great way to get your message across and make it more engaging

It's an excellent way to engage with the public on political issues

This type of storytelling gives viewers a better understanding of the current political climate

Ways to find the right story for your Political Data Storytelling

Find a problem that you are passionate about

Research the political parties' stances on the issue

Choose a side, then research how they want to solve the problem

Write your story by telling what each party's stance is and why it will work better than their opponents

Get your data ready

Find a story to tell

Decide on the best way to format and present your data

Make sure you have enough content for each slide and that it is engaging and interesting

Do your research to find out what people are talking about

Find a good story that will resonate with the data you're presenting

Get feedback from friends, family, and colleagues before publishing

Use a spreadsheet to organize your data

Find the story in the data by asking questions

Choose a narrative that matches your story's tone, mood, and message

Why storytelling is essential for your political analytics strategy

Storytelling is a powerful tool in politics. It's so important that I wrote an entire article about the power of storytelling and why it should be vital for your political analytics strategy.

The goal of political analytics is to find the story, not just the facts. Stories help us see and understand our world differently: they connect data to people and move us past more abstract ways of seeing and understanding reality.

The importance of storytelling in literature is undeniable. The same can be said for political analytics, but not enough people know that this field exists.

Storytelling should be at the forefront of your political analytics strategy.

Tips for telling better stories with your data using Political Data Storytelling

Understand your audience

Find the story that you want to tell

Find data that supports your story

Make sure your visualizations are clear and easy to understand

Identify the story you want to tell

Select data that will support your story

Find a way to use visuals, such as graphs or charts, to help tell the story.

Determine what type of narrative style best fits your data and purpose

Find a compelling narrative

Look for the story in your data, not just the numbers

Build a timeline of events to help tell your story

Use charts and graphs that are easy to understand

Avoid jargon or acronyms

Start with a story you want to tell

Gather data and make it visual

Find out what the data means for your story

Add context to the data, including why it's necessary or how it relates to other things going on in society today.

Tell the story using video, audio, images, text-based media, or infographics.

Understand the data

Find a story to tell

Create visuals that represent your story and how it's told

Make sure you have a hook to get people interested in your stories, like an interesting fact or question

Connect with them through social media and make sure they know when new content is available.

Conclusion

Political Data Storytelling is about creating a narrative that involves data and statistics to tell the story of an election. This type of storytelling often takes place before, during, and after an election to persuade voters on why they should vote for one candidate over another.

At Pragmatic Marketing Partners, we specialize in political data storytelling because it effectively persuades voters - contacts us today if you're looking for help with your campaign strategy!

One way to get in touch is by filling out our online form on this site or give us a call at +91 9848321284. Let's work together today!

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Political Data Storytelling: The Path from Insights to Election Success

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The recent election has many people wondering what the future of American politics looks like. This article explores how data storytelling can help answer this question by providing insights into which messages resonate with voters and lead to increased voter turnout.

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There is misinformation and preconceived notions all around us. If we can look at the data and give the numbers meaning, we can make informed decisions. Unfortunately, there are some people that draw their own narrative from the data. This easily digested narrative could be misconstrued and used against the greater good of mankind. I believe change for healthcare in the US is at our fingertips but we are all small pieces of the puzzle. A person that can look at the data objectively could tell a narrative to the nation's decision makers that it is in their best interest to invest in the poor, vulnerable populations.

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Once your business has started collecting and combining all kinds of data, the next elusive step is to extract value from it. Your data may hold tremendous amounts of potential value, but not an ounce of value can be created unless insights are uncovered and translated into actions or business outcomes. During a 2009 interview, Google's Chief Economist Dr. Hal R.Varian stated, "The ability to take data-to be able to understand it, to process it, to extract value from it, to visualize it, to communicate it-that's going to be a hugely important skill in the next decades." Fast forward to 2016 and many businesses would agree with Varian's astute assessment.

As data becomes increasingly ubiquitous, companies are desperately searching for talent with these data skills. LinkedIn recently reported data analysis is one of the hottest skill categories over the past two years for recruiters, and it was the only category that consistently ranked in the top 4 across all of the countries they analyzed. Interestingly, much of the current hiring emphasis has centered on the data preparation and analysis skills-not the "last mile" skills that help convert insights into actions. Many of the heavily-recruited individuals with advanced degrees in economics, mathematics, or statistics struggle with communicating their insights to others effectively-essentially, telling the story of their numbers.

The need for more data storytellers is only going to increase in the future. With the shift towards more self-service capabilities in analytics and business intelligence, the pool of people generating insights will expand beyond just analysts and data scientists. This new breed of data tools will make it easier for people across business functions to access and explore the data on their own. As a result, we're going to see an unprecedented number of insights being generated within companies than ever before. However, unless we can improve the communication of these insights we will also see a poorer insight-to-value conversion rate. If an insight isn't understood and isn't compelling, no one will act on it and no change will occur.

Data visualization expert Stephen Few said, "Numbers have an important story to tell. They rely on you to give them a clear and convincing voice." Any insight worth sharing is probably best shared as a data story. The phrase "data storytelling" has been associated with many things-data visualizations, infographics, dashboards, data presentations, and so on. Too often data storytelling is interpreted as just visualizing data effectively, however, it is much more than just creating visually-appealing data charts. Data storytelling is a structured approach for communicating data insights, and it involves a combination of three key elements: data, visuals, and narrative.

It's important to understand how these different elements combine and work together in data storytelling. When narrative is coupled with data, it helps to to your audience what's happening in the data and why a particular insight is important. Ample context and commentary are often needed to fully appreciate an insight. When visuals are applied to data, they can the audience to insights that they wouldn't see without charts or graphs. Many interesting patterns and outliers in the data would remain hidden in the rows and columns of data tables without the help of data visualizations.

Finally, when narrative and visuals are merged together, they can or even entertain an audience. It's no surprise we collectively spend billions of dollars each year at the movies to immerse ourselves in different lives, worlds, and adventures. When you combine the right visuals and narrative with the right data, you have a data story that can influence and drive .
Why data storytelling is essential
For thousands of years, storytelling has been an integral part of our humanity. Even in our digital age, stories continue to appeal to us just as much as they did to our ancient ancestors. Stories play a vibrant role in our daily lives-from the entertainment we consume to the experiences we share with others to what we conjure up in our dreams.

Modern-day storytelling is often associated with the popular TED conference series and its slogan of "Ideas Worth Spreading." Analysis of the most popular 500 TED Talk presentations found that stories made up at least 65% of their content. Throughout time, storytelling has proven to be a powerful delivery mechanism for sharing insights and ideas in a way that is memorable, persuasive, and engaging.

For some people, crafting a story around the data may seem like an unnecessary, time-consuming effort. They may feel the insights or facts should be sufficient to stand on their own as long as they're reported in a clear manner. They may believe the revealed insights alone should influence the right decisions and drive their audience to act. Unfortunately, this point of view is based on the flawed assumption that business decisions are based solely on logic and reason.

In fact, neuroscientists have confirmed decisions are often based on emotion, not logic. USC professor Antonio Damasio found patients, who had brain damage in an area that helped to process emotions (prefrontal cortex), struggled to make basic decisions when choosing between alternatives. Deciding on where to eat or when to schedule an appointment turned into lengthy cost-benefit debates for these individuals. Interestingly, these patients' decision-making skills were significantly impaired by the lack of emotional judgment. Emotion actually plays an essential role in helping our brains to navigate the alternatives and arrive at a timely decision.

When you package up your insights as a data story, you build a bridge for your data to the influential, emotional side of the brain. When neuroscientists observed the effects detailed information had on an audience, brain scans revealed it only activated two areas of the brain associated with language processing: Broca's area and Wernicke's area. However, when someone is absorbed in a story, they discovered it stimulated more areas of the brain. People hear statistics, but they feel stories. This subtle but important difference pays dividends for data storytellers in a few key ways:

Memorability: A study by Stanford professor Chip Heath (Made to Stick author) found 63% could remember stories, but only 5% could remember a single statistic. While 2.5 statistics were used on average in the exercise and only 10% of the participants incorporated a story, the stories are what caught people's attention.

Persuasiveness: In another study, researchers tested two variations of a brochure for the Save the Children charity organization. The story-based version outperformed the infographic version by $2.38 to $1.14 in terms of per participant donations. Various statistics on the plight of African children were far less persuasive than the story of Rokia, a seven-year-old from Mali, Africa.

Engagement: Researchers also discovered people enter into a trance-like state, where they drop their intellectual guard and are less critical and skeptical. Rather than nitpicking over the details, the audience wants to see where the story leads them. As mathematician John Allen Paulos observed, "In listening to stories we tend to suspend disbelief in order to be entertained, whereas in evaluating statistics we generally have an opposite inclination to suspend belief in order not to be beguiled."

In a previous article, I shared an account of Ignaz Semmelweis, a mid-nineteenth century obstetrician, who discovered hand washing could save countless lives but failed to communicate his findings effectively to a skeptical medical community. His data was ignored, his life-saving ideas were rejected, and he was sadly discredited by his colleagues.

Many bold, incredible insights will suffer a similar fate if they are not successfully molded into data stories. Uncovering key insights is one skill and communicating them is another-both are equally critical to deriving value from the data your business is now amassing. Data storytelling represents an exciting, new field of expertise where art and science truly converge. My hope is more data storytellers-from across an organization-will emerge to ensure the survival and adoption of more transformative insights.

Follow Brent Dykes on Twitter:
Follow @analyticshero

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Data Storytelling: The Essential Data Science Skill Everyone Needs

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With the influx of data and self-service analytics tools, we're going to need more people capable of communicating insights effectively. The next generation of data storytellers will not be limited to just analysts and data scientists. Everyone will need to know how to tell a story with numbers.

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The US opened up access to health records—how do patients use them?

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Since April, the US has required healthcare providers to allow patients full access to their medical records—a milestone in a decades-long effort by a group of researchers and patients. Joanne Silberner examines the impact so far, and whether concerns have been borne out Many have argued for patien…

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In most circumstances, I believe open notes would be beneficial for patients. It's important that we hold our clinicians to a high standard and that there is no judgment in their narrative. When it comes to a new diagnosis or a plan change, I also believe that it is important for the provider to have a face to face first. We do not want our patient's finding disinformation on the internet or misunderstanding the management plan.

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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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Your care is better when your medical record is complete and in front of the people who need it.

When they're caring for you, most healthcare providers can already access the health information they need and get automatic updates about treatment you received elsewhere. In cases when they can't, such as if a provider doesn't use an electronic health record that can securely share data, you can share your record with them using Share Everywhere.

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When they're caring for you, most healthcare providers can already access the health information they need and get automatic updates about treatment you received elsewhere. In cases when they can't, such as if a provider doesn't use an electronic health record that can securely share data, you can share your record with them using Share Everywhere.

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Alert fatigue can have detrimental effects on patient care. Important information can be easily missed. Working on a cardiac unit with constant alarms and bells create an environment of chaos. On a specific occasion one of my monitors was alerting for an arrhythmia, and before I had the chance to get to the monitor, a colleague silenced the alarm. Luckily, I was there to see the alarm then check on the patient because it was not a false alarm that was silenced. I imagine that I will face similar challenges while I am working as a primary care provider.

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Startups use tech, ‘gamification’ for public health problems

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Matthew Loper’s mission to use technology and science to revolutionize health care began when he observed vastly different outcomes for relatives with the same disease.

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Gamification allows for massive data points to be collected at one point. But where does the clinician fit in all this? Will there be a new type of provider that uses gamification to curate treatment for a patient's individual needs? I look forward to seeing how in the future gamification will be incorporated into clinical practice

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I'm shocked that it is still taking time to get the ball rolling with Telehealth. I suppose my greatest concern are the vulnerable communities that need the service the most not being able to access it. I'm also concerned about reimbursement for primary care providers. In addition, what if there are missed diagnoses because a patient hasn't been seen in the hospital? Will the provider be responsible even though the provider may not have seen the patient for several years?

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Centers for Disease Control and Prevention

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This is the 97th and final issue of the COVID Data Tracker Weekly Review.

Yesterday, May 11, 2023, marked the end of the federal COVID-19 public health emergency (PHE) declaration. This doesn't mean that COVID-19 is over, but the end of the PHE did initiate a cascade of updates to COVID-19 data collection, reporting, and surveillance. Some surveillance metrics will remain the same, but some will change in terms of reporting frequency, data sources, or availability.

The latest updates to CDC's COVID Data Tracker reflect these changes. The homepage has a new look, and there are also new landing pages for hospitalizations, emergency department (ED) visits, and death data, as well as visualizations of trends and maps. Several pages have also been retired, but COVID Data Tracker has a page with links to archived data and visualizations.

These are the most notable changes to COVID Data Tracker:

Hospital admission rates and the percentage of COVID-19 deaths among all deaths are now the primary surveillance metrics.

COVID-19 hospital admission levels replace COVID-19 Community Levels (CCLs) as the main indicator of county trends. COVID-19 hospital admission levels are comparable with CCLs.

Provisional death certificate data from the National Vital Statistics System (NVSS) will become the primary source for mortality surveillance, replacing aggregate death counts.

Aggregate case and death count reporting has been discontinued.

ED visit data will serve as an early indicator of COVID-19 activity.

County-level COVID-19 Electronic Laboratory Reporting data on test positivity will no longer be posted because national reporting of negative laboratory results is no longer required.

The National Respiratory and Enteric Virus Surveillance System (NREVSS), a voluntary reporting network of more than 450 laboratories, will be the new primary source for regional test positivity data and another early indicator.

Please see two new MMWR reports published May 5, 2023- COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration and Correlations and Timeliness of COVID-19 Surveillance Data Sources and Indicators -for more details about the changes.

The United States has mobilized and sustained a historic response to the COVID-19 pandemic. The past three years have been highly challenging in many ways, but together we have made significant progress to reduce the impact COVID-19 has on the health of people and our communities.

CDC will continue to report and monitor valuable data, like genomic surveillance; wastewater surveillance; vaccination coverage, safety, and effectiveness; and hospital-related outcomes, from sentinel surveillance platforms like COVID-NET. These data will help inform individual and community public health actions to protect those at highest risk of severe COVID-19, such as older adults and people with underlying conditions. People with weakened immune systems should consider taking additional prevention measures, developing a COVID-19 Personal Plan to protect themselves from severe COVID-19, and speaking to their healthcare providers about early antiviral treatment options to prevent severe disease, hospitalization, and death. And everyone, high-risk or not, should stay up to date with COVID-19 vaccines.

In the future, CDC will move toward integrating COVID-19 monitoring within a sustainable respiratory viruses surveillance strategy. CDC displays data for diagnosed or laboratory-confirmed COVID-19, flu, and respiratory syncytial virus (RSV) on the National Syndromic Surveillance Program dashboard (for ED visits) and the RESP-NET dashboard (hospitalizations).

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See the COVID Data Tracker Weekly Review, including information on U.S. cases, variants, testing, vaccinations, hospitalizations, and deaths.

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Data sets are important to find trends and make patterns more visible. The problem with data sets is that sometimes they can be taken out of context or skewed. For example, when talking about the efficacy of vaccines...Moderna has a slight edge over Pfizer but they are still both highly effective vaccines.

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Just plain numbers put on an easily digestible chart

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Data sets are crucial for the advancement and progression of healthcare. It's important for data to become more accessible and easily digested. Policy makers, researchers and health care workers can use these data sets to improve health outcomes.

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An official website of the United States government

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I think we know that healthcare needs to catch up to the technology that is available to us today. Even more important, is for the technology to be more patient accessible an user friendly. Portals like InstaHealth can empower patient's and their family members to take control of their health.

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A platform for patients to track, manage, and share the health of multiple family members in one portal.

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MENLO PARK, Calif., Sept. 3, 2020 /PRNewswire/ -- Saina Health today announced the launch of a powerful, interactive health data management tool called InstaHealth™ . Eliminating inefficient, antiquated technologies such as fax and legacy EMR systems, InstaHealth™ provides peace of mind and convenience by freeing patients from cumbersome health record collection processes. It allows physicians to gain instant access to complete patient histories with all underlying conditions, making it the perfect tool during the pandemic, at a time when emergency rooms see unprecedented numbers of patients and there has never been greater need for efficiency.

Sign up now for InstaHealth™ at https://sainahealth.com/account/sign-up.
The full suite of InstaHealth™ services is currently being offered to COVID-19 infected subscribers for free.

"InstaHealth™ is an easy-to-navigate graphic summary and health timeline that can be shared with physicians for a regular office visit, or a second opinion, telemedicine, or consultation," explains Amin Mobasher, CEO of Saina Health. "Currently, patients in California, Arizona, and Texas can subscribe for InstaHealth™ with a full roll-out expected over next month with the addition of new features and benefits."

The first such tool of its kind, patients can quickly and easily sign up, select the clinical locations they have visited, and authorize release of their records. No follow-ups or wait times are needed, since Saina Health does all the groundwork.

"Comprehensive access to personal health records should be an assumed right," says Sameer Sood, Saina Health Medical advisor and a primary care physician who has treated patients in the ER, clinic and over telemedicine. " Understanding risk factors and sharing of health data in this new age of COVID-19 and telemedicine is more important now than ever."

The company's essential services are free for all, while premium services range from $11.99-$25.99 a month for additional features and multiple family members.
About Saina Health
Digital healthcare company Saina Health is committed to making exceptional care effortless and easier for patients with InstaHealth™ services, a powerful, interactive health data management tool for patients. The company prides itself on putting patients and their family members first at every interaction, placing every member at the center and in control of their own health.
Contact Information
Jason Bernard Jr
Chief Partnership & Strategy Officer
[email protected]
https://www.sainahealth.com
YouTube: https://www.youtube.com/watch?v=kp-bVAofTio
LinkedIn: https://linkedin.com/company/sainahealth

SOURCE Saina Health, Inc

Related Links

https://www.sainahealth.com

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Saina Health Launches InstaHealth™ First-of-Its-Kind Health Record Collection & Sharing for Patients

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MENLO PARK, Calif., Sept. 3, 2020 /PRNewswire/ -- Saina Health today announced the launch of a powerful, interactive health data management tool called InstaHealth™ . Eliminating inefficient, antiquated technologies such as fax and legacy EMR systems, InstaHealth™ provides peace of mind and convenience by freeing patients from cumbersome health record collection processes.

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Affiliations

¹ King's College London, London, United Kingdom of Great Britain and Northern Ireland.

² Imperial College London, London, United Kingdom of Great Britain and Northern Ireland.

³ University College London, London, United Kingdom of Great Britain and Northern Ireland.

Affiliations

¹ King's College London, London, United Kingdom of Great Britain and Northern Ireland.

² Imperial College London, London, United Kingdom of Great Britain and Northern Ireland.

³ University College London, London, United Kingdom of Great Britain and Northern Ireland.

Abstract

Patient access to their own electronic health records (EHRs) is likely to become an integral part of healthcare systems worldwide. It has the potential to decrease the healthcare provision costs, improve access to healthcare data, self-care, quality of care, and health and patient-centered outcomes. This systematic literature review is aimed at identifying the impact in terms of benefits and issues that have so far been demonstrated by providing patients access to their own EHRs, via providers' secure patient portals from primary healthcare centers and hospitals. Searches were conducted in PubMed, MEDLINE, CINHAL, and Google scholar. Over 2000 papers were screened and were filtered based on duplicates, then by reading the titles and finally based on their abstracts or full text. In total, 74 papers were retained, analyzed, and summarized. Papers were included if providing patient access to their own EHRs was the primary intervention used in the study and its impact or outcome was evaluated. The search technique used to identify relevant literature for this paper involved input from five experts. While findings from 54 of the 74 papers showed positive outcome or benefits of patient access to their EHRs via patient portals, 10 papers have highlighted concerns, 8 papers have highlighted both and 2 have highlighted absence of negative outcomes. The benefits range from re-assurance, reduced anxiety, positive impact on consultations, better doctor-patient relationship, increased awareness and adherence to medication, and improved patient outcomes (e.g., improving blood pressure and glycemic control in a range of study populations). In addition, patient access to their health information was found to improve self-reported levels of engagement or activation related to self-management, enhanced knowledge, and improve recovery scores, and organizational efficiencies in a tertiary level mental health care facility. However, three studies did not find any statistically significant effect of patient portals on health outcomes. The main concerns have been around security, privacy and confidentiality of the health records, and the anxiety it may cause amongst patients. This literature review identified some benefits, concerns, and attitudes demonstrated by providing patients' access to their own EHRs. This access is often part of government strategies when developing patient-centric self-management elements of a sustainable healthcare system. The findings of this review will give healthcare providers a framework to analyze the benefits offered by promoting patient access to EHRs and decide on the best approach for their own specialties and clinical setup. A robust cost-benefit evaluation of such initiatives along with its impact on major stakeholders within the healthcare system would be essential in understanding the overall impact of such initiatives. Implementation of patient access to their EHRs could help governments to appropriately prioritize the development or adoption of national standards, whilst taking care of local variations and fulfilling the healthcare needs of the population, e.g., UK Government is aiming to make full primary care records available online to every patient. Ultimately, increasing transparency and promoting personal responsibility are key elements of a sustainable healthcare system for future generations.

Keywords: Electronic healthcare record; access to EHRs; benefits; literature review; patient access; patient portals.

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McCleery E, Christensen V, Peterson K, Humphrey L, Helfand M. McCleery E, et al. 2014 Sep. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011-. 2014 Sep. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011-. PMID: 27606392 Free Books & Documents. Review.

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national center for biotechnology information

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Impact of patient access to their electronic health record: systematic review - PubMed

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Patient access to their own electronic health records (EHRs) is likely to become an integral part of healthcare systems worldwide. It has the potential to decrease the healthcare provision costs, improve access to healthcare data, self-care, quality of care, and health and patient-centered outcomes. ...

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It is time that the meaningful use program turned into something meaningful. As of now doctors and patients still are not reaching important benchmarks. Vulnerable populations still are not getting the access or quality of health care that they need in our current system. I look forward to learning more about the Merit Based Incentive program in the future.

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Merit-based Incentive Payment System (MIPS) Overview - QPP

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The EHR implementation process can be a difficult time particularly due to the risks involved with getting the process wrong. As such, organizations, rightly, have many questions about the process particularly what it entails and how to go about it in a manner that positions them best for success.

What is EHR implementation?

Implementation is a term that is not specific to EHR systems, it refers to integrating a software-based service or component into the workflow of an organizational structure or an individual end-user. Therefore, an EHR implementation would refer to the process of planning and carrying out the integration of EHR software and components in a healthcare organization.

How long does EHR implementation take?

How long an EHR implementation will take depends on the context. Given the number of variables that can either increase or decrease the time needed for an EHR implementation the typical time needed for implementation vary according to setting and product. As such, one cannot easily find a standard timeline for EHR implementation. However, when creating an EHR implementation plan a certain amount of the uncertainty regarding timing can be eliminated as experts involved in the process can provide solid estimates regarding the amount of time needed to complete the implementation.

What are EHR implementation steps?

Moving beyond the general roadmap or checklist provided here, it's important to look at the steps involved in the EHR implementation process in a more detailed fashion. The EHR implementation process generally follows the following steps.

1. Selection team building: selecting and organizing the individuals who will be involved in selecting the EHR.

2. Requirements gathering: requirements gathering refers to the process of determining what features and functionality your practice requires in an EHR.

3. RFI and RFP: once the requirements list has been created the selection team will research potential vendors and then submit Requests for Information (RFI) and Request for Proposals (RFP) to prospective vendors.

4. Evaluate RFI and RFP responses: once RFIs and RFPs have been returned the selection team will evaluate these responses based on how well they adhere to the requirements list.

5. Ranking of vendors to create a shortlist: the top vendor/candidates will be narrowed down to a shortlist of 3 or 4 finalists who will then be asked to provide a vendor demonstration.

6. Vendor demonstrations: shortlisted vendors will conduct demonstrations of their products using presentations and simulations of their product for the selection team. The selection team will then have the opportunity to ask questions.

7. Selection: a vendor is selected, contracts are negotiated and the process moves forward to actually implementing the EHR product.

8. Planning and go-live preparation: with the help of the vendor the selection team and representatives from the vendor will plan out how the software and hardware will be deployed. Also, plans will be made for staff to be trained on the new system.

At this time a go-live date will be selected along with other milestones related to the deployment.

Your practice may not be ready to achieve success in these areas right now, but you and your implementation plan are going to change that using this 8-step checklist with all the stages of EHR implementation.

1. Build your EHR implementation roadmap

Roadmap. Checklist. Matrix. Template. Call it what you want.

The first stage in any EHR implementation plan is to outline all the tasks and processes which need to be executed by your team of physicians, practice managers, IT staff (and even patients). Key tasks include:

Recruit your implementation committee from stakeholder groups

Outline your expected implementation costs and define the total budget

Schedule your implementation (best done after your roadmap is complete)

Migration of patient and practice data

Create a user training program

EHR testing (unleashing it in a "live" practice environment at some point)

Clearly define go-live activities

Define critical success factors and evaluation strategies

Whether you choose to map these tasks in a checklist, roadmap or GANNT chart will depend on your practice's project management protocols but commonly used tools include:

Google Sheets - great for collaborating on roadmaps

Trello or Wrike - great for flexible project management (GANNT, calendar, checklists)

Asana - great for advanced "to-do" lists

2. Recruit your EHR implementation committee

With your implementation tasks defined you need people to execute each process on schedule and budget. The following committee members can be sourced from key stakeholder groups or external consultancy:

Project Manager - if you're reading this, you may have volunteered already

Application Analyst - responsible for data migration and cleansing

Application Developer - responsible for system customization

QA Test Engineer - responsible for system testing and performance

Physician Advocate - represent physicians and advise on training, data and testing

Nurse Advocate - represent nurses and advise on training, data and testing

Billing Advocate - represent billing department and advise on training, data and testing

Meaningful-Use Manager - required if MU attestation is required

Super-Users - early adopters for training programs

The makeup of your implementation team will depend on the scope of your practice, budget... and project manager's patience. A key decision to make at this stage is whether to bring in external EHR implementation specialists or consultants...

What does an EHR implementation specialist do?

"Things senior practice management will ask when presented with the bill."

The answer is everything. And, potentially, nothing. It's not the abilities of an EHR consultant that matter, it's how you use them to assist with any combination of...

Project scheduling and roadmapping

Data migration and cleansing

User training and change management

Testing and go-live activities

Security assessment

...just don't put them solely in charge of the budget (their paycheck).

3. Forecast your EHR implementation costs and define a budget

Now you have a team and a to-do list, you are in a position to ask...

What is the cost of EHR implementation?

The only answer one can give with some certainty at this stage is...

... approximately $6,000 more than you expected.

Having said that, a well-defined budget featuring the following elements should ensure no unexpected costs come out of the woodwork:

Hardware and network upgrades

Practice staff overtime and temporary staff

Productivity loss (some estimate as high as 50% reductions in patient throughput)

Customization consultancy from the EHR vendor

Vendor training fees

Consultancy costs

Data backups and storage (often bundled with cloud EHR costs)

A recent EHR report found that most practices can expect to spend around $6,200 per user of their software, so bear this figure in mind, in hand with the elements above, when considering your projected budget.

If you're looking for information on the upfront cost of purchasing EHR software, you can download our EHR software pricing guide here.

4. Schedule your EHR implementation

This is often the first thing practices work on. The problem with that approach is clear when you consider what impacts a schedule:

Luckily for you, you have now defined all three and can begin to add timescales to your roadmap outlined in step one. So the question is:

How long does an EHR implementation take?

611 hours is the simple answer.

The complicated answer is an analysis of our holy trinity of project attributes outlined above.

5. Migration of patient data and practice data

This is the point where the everyone has to keep their nose to the grindstone. Or their cleansed patient data to the well-formatted EHR database if you want to be literal.

Key stages in EHR data migration include:

Conversion of paper records to electronic records

Data cleansing and verification

EHR database setup

Mapping legacy data to new database fields

Data transfer to the new system

Testing and verification of legacy data

Testing and verification of new data inputs

Get this process right and the rewards are great... a 10% reduction in data errors to be precise.
To clarify this process, it is useful to produce a map of your practice data as shown above (source: Advance Healthcare Network)
6. Create a use training program

With $70,000 in annual savings and a 10% increase in productivity at stake, your EHR training program has a huge impact on the final ROI for your system.

Successful training programs include:

Super-users as system and program advocates

Clear communication channels with vendor support teams

Role-based training to ensure relevancy

Feedback loops to keep users in dialogue with project management

These steps should not be seen as silver bullets as one of the primary causes of EHR implementation failure is poor user adoption of the system.

7. Clearly define go-live activities

If there is ever a day to have a plan it is go-live day. Day one. The start of the rest of your life.

With that in mind, it is prudent to create a zoomed in version of your roadmap specifically for the days (or weeks) around your go-live date. This roadmap can include:

System testing processes (pre- and post-go-live)

Patient communication guidelines (including expected downtime)

Staff scheduling including required overtime or temporary staff

Modification of appointments and scheduling

Reporting processes for system and project evaluation (see step 8)

In-practice communications (signs on noticeboards etc.)

Network speed and reliability checks

Data backup processes

8. Define critical success factors and evaluation strategies

Congratulations, you made it through go-live. Or at the very least the planning process.

Now you should ask...

How can you evaluate your EHR implementation?

Evaluation of EHR implementation can take many forms and the best one for your practice will depend on your project goals:

Perform ROI calculations to assess profitability

Record patient throughput to assess efficiency

Survey patient satisfaction to assess quality of care

Survey physician satisfaction to assess user adoption and training

Analyse data error rates to assess data input and quality

A final thought...

Following these steps will produce a plan which gives your project a foundation. It is up to you and your team to execute this plan in the face of practice nuances, disgruntled users and missing data (even the best implementations experience these).

Kathryn Beeson

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EHR Implementation Plan: Your 8-Step Checklist

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The EHR implementation process can be a difficult time particularly due to the risks involved with getting the process wrong. As such, organizations, rightly, have many questions about the process particularly what it entails and how to go about it in a manner that positions them best for success.

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I can fully appreciate the massive effort it takes to implement a new EHR program. A hospital was in the stages of staff EHR training and had to hire travel nurses while  staff members were at EHR training. I can't imagine the exorbitant cost of all the travel nurses regardless of the other costs of EHR implementation.

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What is interoperability in healthcare?

Interoperability in healthcare refers to timely and secure access, integration and use of electronic health data so that it can be used to optimize health outcomes for individuals and populations.

Health data has always been challenging to access and share in a secure manner. The nature of health data creates a paradox: It's difficult to share because it's sensitive and requires a high level of privacy and security, yet the inability to access it when it's needed has potential to cause significant harm. A lack of interoperability can result in an incomplete understanding of an individual's or population's health needs, which can lead to poorer outcomes and higher costs.

As populations around the world age and people live longer, interoperability and data sharing are going to become increasingly critical for delivering effective healthcare. In the United States, the Agency for Healthcare Research and Quality has estimated that two out of three older Americans have at least two chronic behavioral or physical conditions. Treatment for people with multiple chronic conditions currently accounts for an estimated 66% of US healthcare costs.

In their nationwide roadmap (PDF, 3.5 MB), the Office of the National Coordinator for Health Information Technology (ONC) says the use of electronic health records (EHRs) has dramatically increased in the United States. Many hospitals now have routine access to medical records and patient data from outside providers, yet less than half of hospitals are integrating the data they receive into individual patient records. So although access to vital clinical data has improved, there's still a lot of work that needs to be done to bring stakeholders together to create an integrated data ecosystem.

In addition to helping physicians and other healthcare providers see a more complete view of their patients, health data interoperability helps organizations across the healthcare industry. If health information systems were more integrated, then health plans would be able to develop a better understanding of their utilization rates and demand for services. Government service providers would be able to access population data to see trends and meet their citizens' needs. Also, life science organizations would be able to leverage robust datasets to drive faster, more informed research.

With better interoperability, organizations would be able to stop regarding individuals as a patient one day, a health plan member the next and a consumer of health apps the next. Instead, decision-makers across the industry would be able start looking at how people access and use health information, regardless of its source, to drive better models of care, pursue better patient safety and improve experiences for the people they serve.

Healthcare interoperability benefits

Better care coordination

With access to data, clinicians have an easier time accessing a patient's most important health information, which can lead to fewer repeat tests, prevent inadvertent treatment interactions and reduce miscommunications.

Higher performance

When data can be combined more easily, it can also be analyzed more easily. Interoperability makes it possible for organizations to study data trends, past performance and make data-driven improvements in patient care and other areas.

Better experiences

Data interoperability can reduce the amount of redundant administrative work both within and outside organizations, creating a more satisfying experiences both for employees and for those they serve.

Fast Healthcare Interoperability Resources, also known as FHIR, is an open source standards framework for healthcare data that builds off of a previous standards framework called HL7. FHIR was created to make it easier for healthcare data to move from one system to another.

FHIR organizes data into resources like patient, conditions, medications and provides a standardized structure for how that data is organized and interpreted by different computer systems or applications. FHIR can also be used to structure financial data and workflow data, such as claims information, appointments and more.

Many major healthcare systems in United States have already adopted FHIR in their health IT practices. Medicare's Blue Button 2.0 initiative is based on FHIR and the Veteran's Affairs Administration has developed a FHIR platform called Lighthouse. Both provide platforms for patient access to healthcare information through FHIR.

The National Coordinator for Health IT in the United States has made FHIR a key part of the nationwide interoperability roadmap (PDF, 3.5 MB). New government regulations and interoperability rules are requiring wider adoption of FHIR, so it's vital for healthcare organizations, especially for ones that receive payments for Medicare or Medicaid services, to understand FHIR and incorporate it into their interoperability strategies.
Learn more about IBM FHIR Server

Modern consumers have high expectations when it comes to accessing information, and many now expect to have quick and continuous access to records about their health and care. That's why many healthcare organizations are building health information exchanges (HIE), which are specialized networks that rely on interoperable systems to share electronic health information seamlessly and securely.

Even though the adoption of EHRs was a good first step towards building HIEs, there are still many challenges that need to be overcome to achieve the level of interoperability needed to obtain the full benefits of HIEs. These challenges include:

Lack of standardization: Although standard record formats like FHIR and HL7 are becoming more common and new regulations are pushing EHR vendors to provide APIs that support interoperability, many providers and healthcare systems use customized EHR systems that can be hard to convert to a standard format and shared with others.

Security: Healthcare organizations can find it hard to balance the need for health information to be accessible with the need to secure sensitive information and maintain patient privacy, especially with the increasing number of cybersecurity attacks on healthcare systems (PDF, 1.3 MB).

Consent: By building digital health systems in which health information flows freely from provider to provider, it's not always clear when patient consent is needed and what level of consent is needed. Healthcare organizations are understandably cautious about this and tend to error on the side of not sharing information.

Professional burdens: When new tools for recordkeeping are introduced, people need to learn how to use them. Healthcare professionals are often wary about new systems since EHR systems often do a better job supporting administrative and billing workflows than clinicians' needs.

These challenges are not insurmountable. With advances in cloud computing, especially hybrid cloud, it's become easier for organizations to move and secure data in a consistent way. Cloud environments provide opportunities for organizations to build data pipelines that standardize data to an industry-standard format like FHIR and provide secure access to people who need it - whether they're payers, providers or patients themselves.

Learn about enabling health data interoperability
Read the article

In 2016, President Obama took a major step to solve information blocking by signing the 21st Century Cures Act, which requires EHR systems to provide a patient-facing API to maintain their federal certification. In 2020, the Centers for Medicaid & Medicare Services (CMS) issued a rule requiring health plans and providers who receive federal funds from their programs must take steps to make health information easier to access.

Most of the policies focus on encouraging payers to implement application programming interfaces (APIs) and data exchanges that provide secure access to their provider directories, patient claims data and other resources that would make it easier for data to be accessed in a timely manner. This access would give patients, as well as providers and payers, a more holistic view of the care people receive and support broader public health efforts.

See how mandatory interoperability standards will affect your organization.
Learn more about the CMS regulations

While many healthcare experts and leaders agree that better interoperability would improve healthcare overall, there are common challenges that healthcare organizations tend to face as they work on making their data and systems more interoperable. Let's explore those challenges and how organizations can overcome them:

Disjointed coordination
Improving interoperability requires strong coordination between different organizations, regulators and leaders as well as coordination within organizations. Regulators provide standards and rules for healthcare organizations to follow but organizations that want to be proactive about interoperability should consider creating a dedicated interoperability strategy and make interoperability planning a priority.

Limited budgets
Not all organizations have the financial or technical resources they need to invest in the technical resources needed to build a truly interoperable system. There may be some government grants available to update health records systems, so organizations should check to see if they're eligible. Many cloud vendors also offer pay-as-you-go payment models that could make technical expenses more affordable and predictable.

Diverse technology needs
Organizations need to follow different rules and regulations depending on what type of care they provide and where they're located, so many organizations have highly customized data. Organizations can help connect different internal and external systems through a hybrid cloud platform that gives them options to combine and integrate their data without sacrificing the customizations they need.

Legacy systems
Healthcare organizations with older legacy systems face the dual challenges of modernizing their systems while also meeting interoperability requirements. Organizations can meet both goals using a hybrid cloud approach to extract data from legacy systems and make it more accessible for modern applications and programs. This approach gives organizations the option to keep data moving while they work on updating their systems.

Interoperability for healthcare has four different levels that have been defined by informatics experts and the Healthcare Information and Management Systems Society (HIMSS). Some of these levels can be achieved today with existing healthcare IT architecture and IT systems, while others will require innovation and additional developments in patient-centered technology.

These levels include:
Foundational
This level of interoperability, also known as simple transport, is the most basic. Data is securely transferred from one system or device to another without interpreting the data or transforming it into a particular format. For example, a nurse downloads a PDF file of a patient's latest lab results from the lab's results portal, then manually enters the data into the patient's health record.
Structural
When structural interoperability, or structured transport, is achieved, all the data is standardized to a particular format so it can be interpreted by multiple systems or devices. This data is organized in a particular order so the receiving system can automatically detect specific data fields. Data standards like FHIR and HL7 provide structural interoperability so records can be consistent, centralized and easy to move between systems.
Semantic
The semantic level of interoperability, or semantic transport, involves exchanging data between systems with completely different data structures. Imaging systems provide a simple example - there are many specialized DICOM and non-DICOM formats for images. With semantic interoperability, images could be transferred from one system to another, interpreted and incorporated into the new system regardless of the image's original format or source. Yet determining what data to collect and transfer can be difficult, since systems have different ways of presenting the same information. For that reason, some experts argue artificial intelligence will be needed to achieve full semantic interoperability.
Organizational
Organizational interoperability involves the seamless exchange of data between various organizations with different requirements, regulations and goals. To achieve this level of interoperability, there must be policy and governance innovations as well as technological innovations to ensure consent, security and integrated workflows move smoothly between different groups. Though some experts say semantic is the highest level of interoperability, others say it is organizational interoperability.

Discover the stages of maturity along the path to interoperability
Explore the stages

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Interoperability in healthcare refers to the secure access and integration of electronic health data so it can be used to optimize health outcomes.

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I wonder if we were to quantify how much interoperability would improve patient care and decrease costs what that number would be. I know personally I have given a doctor a recent imaging results, only for him wanting to have a new image completed so that it would be uploaded into his system. This repeat imaging is has an effect on patient's health and finances.

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I think the TIGER initiative is essential for the future of health care. I have been using EMR systems for so long I can no longer imagine a world without it.

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Corporations, like Amazon, are constantly collecting our data. This is how they get to know us and predict what products we might be interested in. What if big data was used to help providers create individualized health care plans instead?

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

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TIGER offering strategic approaches to deliver health informatics education

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TIGER offering strategic approaches to deliver health informatics education

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Inside a Movement to Revolutionize Health Informatics Education

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How hiring informaticians can prevent burnout and inbox overload

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How hiring informaticians can prevent burnout and inbox overload

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For a FNP opening their own practice it would be advantageous to higher an informatician to customize your EHR system. One example, to manage drug interactions and alerts in order to avoid 50 different alerts that clinical contradict each other. Perhaps this will prevent inbox overload and primary care provider burnout?

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What is the role of informatics in primary care?

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Informaticians can act as intermediaries between health care professionals and programmers; provide technical support or system and network management; or engage in clinical research.

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Epic Systems researchers find 1 in 5 seniors takes a medication they likely shouldn’t

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For 30 years, doctors have been warned to avoid prescribing certain drugs to those 65 and up. Now, a study by health researchers at Madison-area Epic Systems offers further evidence

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Health informatics experts are currently analyzing data to offer up strategies to reduce inbox overload. Analysts also find that most inbox messages do not come from the most vulnerable or those that need the most care but from the younger, educated, and more privileged.

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Overflowing inboxes were a problem before the pandemic, but physicians and other healthcare workers recently have observed a pronounced increase in screen time -- and it's taking a toll.

Even Bob Wachter, MD, the chair of University of California San Francisco's department of medicine, tweeted about it last week, calling it the " biggest driver of MD burnout."

"The messaging has to be recognized," said Natalie Azar, MD, a rheumatologist and clinical associate professor at the NYU Grossman School of Medicine, who's been practicing for 20 years. "It's like quicksand, as soon as you start answering more questions, you're never caught up."

Healthcare workers acknowledge that electronic communication has its advantages, but the alerts, notifications, requests, lab results, and direct messages from patients -- all contained within their electronic health records (EHR) inbox, often the "In Basket" on EPIC -- are contributing to burnout.

It's especially tough, they say, in the midst of a public health crisis that has leaned increasingly on telehealth and has seen patient health concerns skyrocket.

"The messaging problem, the burden on clinicians, the burnout is not new. This was going on before the pandemic, it's simply just worse now," said Harry Saag, MD, also at NYU Grossman School of Medicine, and formerly the medical director for network integration and ambulatory quality there. "I'm not sure how much folks appreciate how much of a problem In Basket is for ambulatory doctors out there. It's a huge problem."

Medical informatics experts have offered up strategies for managing the daily deluge, but many workers say it's still not enough. Most agree on what needs to change: better compensation for time spent messaging, and more broadly, a shift in billing for healthcare services altogether.
The State of the Inbox
With the adoption of online health records and patient portals, online messaging has increased steadily since the early 2000s. In 2003, for example, a study using Health Information National Trends Survey (HINTS) data found that 7% of internet users had communicated directly online with a healthcare provider over the last year. By 2018, another study that used updated HINTS data found the rate rose to 36%.

Others have looked into time spent on inbox messaging. One study that tracked the inbox use of 1,275 primary care physicians found that, on average, they were spending almost an hour in their inbox messages -- but that didn't include time spent pulling up patient records, or other windows they looked at to prepare to answer a message.

"It's an underestimate for how much time they actually spend on inbox-related work," said Fatema Akbar, of the University of California Irvine, who led the study.

Another study used EHR data from 573 ambulatory doctors at NYU Langone Health to assess time spent on "work after work," (but not inbox messaging specifically). All of them spent time on the EHR outside of work, but those with the most scheduled appointments per week actually took on more work than their peers on days without appointments: 2.7 hours a day for those with the fullest weeks (four or more days of scheduled appointments) compared with 15.9 minutes for doctors who worked one day or less with patients.

"We only have so much bandwidth. And that's why everyone's working on their weekends, trying to keep up with their notes, their billing and compliance things, their online training," said Fred Pelzman, MD, a primary care physician and associate medical director at the Weill Cornell Internal Medicine Associates practice (who also contributes to MedPage Today). "I worry that so many people today are putting aside their own wellness at the expense of it."

Pelzman said he had 17 "baskets" or sub-folders within his EPIC In Basket and if he had to guess, deals each day with 10 to 20 requests for medical advice, 10 to 20 requests for refills, and 10 to 50 copy charts of his patients who had, for example, been seen by other providers who routed their opinions back to him.

That's on top of what Pelzman said could be 20 to 100 phone messages and another regular email inbox to sort through.

Azar said that if she didn't periodically check her EHR inbox, she'd accumulate around 30 to 40 messages a day.
Message Type Matters
Notably, a large portion of the EHR inbox burden is automated messages and those that aren't direct inquiries from patients. These include things like refill requests or notifications that a patient has visited another provider in the health system. "There are hundreds of different types of messages," said Pelzman.

In fact, one study of the Palo Alto Medical Foundation that included 932 physicians found that messages generated by EPIC far outnumbered those from their patients or coworkers. Of an average of 243 weekly In Basket messages, 114 were automated, 53 were from colleagues, and only 30 were from patients.

The study also drew the direct connection: getting more than the average number of inbox messages was associated with a higher probability of burnout and intention to reduce clinical work time.

Then there are patients who use messaging so frequently it becomes a substitute for in-person care.

"There's no magic number on the number of questions that you can ask your doctor in the message, but I have had patients send me five or six questions," said Azar. "If I spent what most of us who are conscientious practitioners and want to be thoughtful about our answers [would], that easily equals a visit."

She's had to clarify with patients what an appropriate use of messaging is. But the truth is, there are no agreed-upon standards -- especially in the pandemic era when patients are increasingly turning to online communication.

"More and more people are just sicker in general and need more access," said Adam Szerencsy, DO, medical director of ambulatory clinical informatics at NYU Langone Health. "But since we've scaled up telehealth, more people are using the portal and feel more comfortable using technology, so we're getting more messages. The healthcare system really needs to respond to all of that additional demand that's now coming through."
Not an Easy Fix
There's just more work now -- so why don't healthcare systems and hospitals hire more staff to triage and screen messages?

For one, it's expensive. "We have some ability to hire people to respond to those types of messages, but the reality is that it's a cost to do that," said Szerencsy, referring to the healthcare system as a whole.

"A business model for either a small private practice or even a large academic medical center or hospital system is going to say, is this worth it?" Pelzman said.

The problem isn't limited to just physicians. Staff whose job it is to sort messages are also feeling the burn. One Twitter user who identified as a triage nurse wrote that hiring more staff, "is a great idea except that I'm answering or forwarding 60+ msgs per 8 hr shift and still have to answer the nursing line, pend orders, help in-person visits, call results to pts, fill out disability forms, etc."

Even at NYU Langone, which has a dedicated off-site "patient access center" staffed by nurses to triage messages and calls, figuring out the process has been a challenge. For example, Denise Connolly, MS, RN, assistant director of clinical quality operations at NYU Langone, who runs a team of nursing staff at the patient access center, said they tried to tailor their workflow for routing messages to every location differently.

A doctor in one office might want lab results copied into the body of a message, but "invariably somebody will forget, and they'll copy and paste for the doctor who doesn't want it copied and pasted, and then their head will explode." She said they're implementing a standardized process for the entire system, but for now, "we kind of can't win."
Message Reimbursement
Then there's the issue of reimbursement. Doctors say they aren't paid appropriately for the time they spend answering messages.

"We've got to stop this, we can't just keep asking doctors out of the goodness of their heart, play on their emotions and say, 'Hey, can you take one more for the home team?'" said Saag. "Enough of that. It's just not good enough. It's not sustainable."

The other doctors all said they considered message management unpaid work. One physician said they could bill for services that almost fit the description -- online monitoring, for example. But another doctor in Michigan, Karl Nadolsky, DO, an endocrinologist and obesity specialist with Spectrum Health, said he does bill for this kind of work.

His administration notified doctors that three new billing codes from CMS as of 2020 cover "online digital evaluation and management services," which include generating prescriptions, ordering tests, and communication with the patient online (including email), over the phone, or any other digital method. These codes are separate from telehealth services.

Even here, there are a few catches. Newer codes for online care are typically not reimbursed "like a face-to-face encounter," said Szerencsy. One estimate by a specialized remote monitoring app is $15 for 5 to 10 minutes and $50 for 20 or more minutes of online work compared with, Nadolsky guessed, "well over $100" for an in-person visit.

These three codes only cover messaging that a patient initiates -- a small fraction of the total inbox load. Patient messages are also often sent within 7 days of a visit in which "evaluation and management services" were provided face-to-face, which Szerencsy pointed out can't be billed for, unless it's for an entirely new problem.

"The reality is that these billable interactions represent a fraction of all of the clinical work we are doing," he wrote in an email.

Nadolsky said that he and other colleagues have been pushing for a change like this, however, because it would save time and money for the healthcare system, insurers, and patients (who might have a small co-pay, depending on their insurance).

"There's definitely ways we need to improve, but at least it's a step in the right direction," he said.

Szerencsy said that at NYU, they use a number of strategies to reduce the inbox load before it gets out of hand. Many phone calls and messages are routed through their patient access center. For other messages that make it through to physicians, relevant clinical information for a refill is compiled for the doctor so they can avoid having to pull up years-old medical records or separate lab results. They also have support staff "pend" medication orders and refills for physicians to simply sign.

Some unnecessary notifications are even done away with altogether. For example, Szerencsy said, in a situation where a doctor orders a chest CT scan, then another doctor in the system sees the patient and realizes they don't need one, a notification would be generated for the first doctor. These kinds of alerts could potentially be phased out, Szerencsy said.
The Bigger Picture
But even these updates can't change another considerably more universal challenge -- that of equitable access to healthcare.

Many patient inbox messages come not from the most vulnerable patients, or those who need the most care, but from the younger, more privileged, and educated.

"So many of my patients don't use email, much less the patient portal. Meanwhile, patients who are tech savvy (and generally more privileged) use the EHR app," tweeted David Tian, MD, a primary care physician at Highland Hospital in Oakland, California.

A study using HINTS data suggests he's right. It found that the largest portion of people communicating with their healthcare provider online were also the most highly educated, had the highest income, and had the best health. Another study on health disparities in online communication showed that from 2011 to 2018, the gap between the most and least educated groups in patient-provider messaging had only increased.

Ultimately, experts said, it's a problem that's bigger than just a billing code or paring down automated alerts.

"We collectively have created a system that's transactional in nature," said Saag. "What we are seeing or will keep seeing is more folks leaving the workforce, more folks becoming burned out."

"Doctors, they don't want to put up with it anymore," he said.

Szerencsy, too, said more widespread changes would need to come from CMS at a policy level to free up more time.

Pelzman summed up an ideal workplace with fewer clicks and more direct care: "If we had to do real doctoring and nurses got to do real nursing and the rest of the stuff happened in the background, that would be a kinder, gentler world."

Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow

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Overflowing inboxes were a problem before the pandemic, but physicians and other healthcare workers recently have observed a pronounced increase in screen time -- and it's taking a toll. Even Bob Wachter, MD, the chair of University of California San Francisco's department of medicine, tweeted about it last week, calling it the " biggest driver of MD burnout."