Do People who Look Up Health Information on the Internet Visit Medical Professionals Less or More? (Part 1)

My sister is currently working on a new beauty product launch and has asked me to help her out. One of the tasks in her launch project is distributing a market survey to identify her target population and what this population would be willing to pay for a new product. Her survey inspired this month’s post.

Surveys, when designed appropriately, are a fantastic tool for getting feedback. In application development projects, this feedback can be used to drive anything from interface design to application training preferences. Surveys can also be used to determine the next logical project or initiative on which to embark.

I recently conducted a survey to gauge whether people who go on the Internet to research health information visit their doctors less or more. I also wanted to assess respondents' perceptions of the validity of the Internet as a tool in the provision of health care. This included respondents' perception of the accuracy of the information they found as well as their level of understanding of the information they found.

My #HITsm colleagues have been asking me for weeks to post the results. Well here they are – and they’re pretty interesting.

I started with an initial screening question asking respondents if they have visited the Internet within the past 12 months to look up health information for themselves or someone else. If the respondent answered “No” to this question, he or she was disqualified from completing the remainder of the survey.

For those respondents that answered “Yes,” they went on to complete a series of nine multiple choice questions. (For a list of the questions, please send me an email.)

The target population consisted of people who were accustomed to using the Internet for browsing or searching for content. The sample consisted of 89 respondents. The respondents were highly educated, with 88 percent holding an associates degree or higher. 76 percent of respondents fell into the 20-year to 40-year age range. Finally, 74 percent of the respondents were female and 26 percent were male.

66.7 percent of respondents, when asked what type of information they were looking for on the Internet, said that they were looking up symptoms (FIG 1).

FIG 1 

When asked if they made an appointment with a medical professional as a result of the information they found online, 63.1 percent of respondents replied “No” (FIG 2).

FIG 2

Based on these results, can we assume that people are using the Internet to self-diagnose? Are they subsequently deciding to not visit a medical professional after they conduct their online research? I conducted qualitative interviews with a number of people in this target population in order to attempt to answer these questions. One of my respondents, a mother of a 16 month old, said that she knew her child had a sinus infection based on the information she found online. When asked if she decided to make an appointment for her child to see a pediatrician as a result of this information, she responded that she already made the appointment prior to conducting her research online.

Based on these results and my qualitative interviews, we can reason that when people research health information online, they have already decided whether or not they are going to make an appointment with their doctor.

So why are people going online if they have already made this decision? The answer is clear; People go online to gather information in preparation for their upcoming appointment. These days, health care consumers are more involved in their health care. This population is proactive and efficient. They know that they have very little time with doctors during a visit. In order to make the most of this time, they go in prepared with information and questions and they expect to leave with answers.

Research like this is being used to drive public policy surrounding health care. This is nowhere more evident than in the criteria outlined in the Meaningful Use Program currently underway in our country.

The Regional Primary Care Coalition (RPCC) defines the Meaningful Use Program as “reimbursement incentives for medical professionals and hospitals that become compliant in the use of certified electronic health record (EHR) technology” (RegionalPrimaryCare.org, 2012). In stage one of the Program, one of the 10 measures listed in the Meaningful Use Menu states that providers must use EHR technology to provide patients with education resources that is specific to their diagnosis or state. Stage two of the Program takes this measure one step further by stating that providers must ensure that five percent of their patients access health information online. The criterion further states that the patients must take appropriate action based on this information.

We know that patients are going online to research health information. Now, doctors are required to make sure that their patients are accessing this information. How can we ensure that the Internet is providing accurate information in a way that patients can understand? In the next post in this 2 part series, I will review the survey respondents’ understanding of the health information they found online as well as their perception of the accuracy of this information in an attempt to answer this question.

The 5 Things Parenthood Taught me about I.T. Project Management

I recently read a fantastic article by my friend and fellow journalist, Daria Burke, about women having it all. In the article, Daria proclaims, “We must shift the perception that having a family is a hindrance to a successful career.” (Read Daria’s article here.) In other words, working mothers (and fathers) have a lot to offer on the job and need the support of their companies if they are to effectively lead. I couldn’t agree more.

The job of parenthood is the ultimate prep course for I.T. project management. Parenthood allows us to practice the skills necessary for successful project management everyday. How, you ask? Below, I’ve listed five ways in which parenthood prepared me to be an effective I.T. project manager.

1.) Negotiation. Its been said that negotiation is an art. It’s an art that I’ve perfected as a mother. Oh sure, I can muscle my way through any argument with my child, but what am I teaching him? And what am I learning? Negotiation requires us to build positive relationships. Positive relationships are integral to successful project management, and to parenthood.

2.) Delegation. Growing up, whenever my mother made me clean, I would mumble under my breath “When I have kids, I’m never going to make them do all this work.” Well, that was then. The fact is I need help, so I delegate tasks. Everyone in my family is responsible for their role in keeping the household running smoothly. Heck, I even have my extended family and friends pitch in when they’re available. Project management is no different. Project managers are not responsible for doing it all, we are responsible for ensuring that everyone knows what to do.

3.) Manage the triangle. Parenthood, like project management, has its own triangle. With enough time, money, and patience, my kid could be the smartest, most athletic, and most well behaved child in our neighborhood. Unfortunately, I only have two of those resources at any given time. The same holds true in project management. There are finite resources and infinite needs. Pick the most important needs on which to focus, remain flexible and adaptable, and breathe.

4.) Reuse, reuse, reuse. Code reuse in application development is one of the simplest concepts, yet offers the best returns. Reuse can and should be applied to every aspect of our lives, especially parenthood. Leftovers, household goods, clothing – reuse it all! Anything that prevents us from doing redundant work will not only save time, money, and energy, but our sanity as well.

5.) Every project has an end. Raising children is a project. And like every project, it has planning, initiation, implementation, monitoring, and closing stages. There are several projects I’ve worked on that I was glad to be done with, but raising my child will not one of them. Whether you’re glad to see a project come to an end or not, the most important thing is that you’ve learned from it. And if you’ve left the world a bit better after the close of your project, consider it a bonus.

Top 5 Reasons Why Established EMRs won't Cut it in Behavioral Healthcare

The federal government is considering extending the Meaningful Use Incentive program to eligible behavioral healthcare providers. The bill, called the “Behavioral Health Information Technology Act of 2012,” would redefine the term “eligible hospitals” to include residential or outpatient mental health or substance abuse treatment facilities. (Read the full text of the bill here.)

The bill is another step in the direction of the integration between primary healthcare and behavioral healthcare.

As with the originally defined eligible facilities, behavioral healthcare facilities would have to attest to the meaningful use of a certified EMR. This may prove to be harder than expected, as many established EMRs tend to focus predominantly on primary care.

With the introduction of this bill, the time has come to begin examining the gap between what established EMRs provide and what the behavioral healthcare industry needs in an EMR. Below are the top five areas where established EMRs may not currently meet the needs of behavioral healthcare providers.

1.)  Treatment plans. The concept of the treatment plan is relatively new in the primary care arena, however it is a practice that has been used for some time in the behavioral healthcare setting. Treatment plans are complex documents that reflect the prescribed treatment for the management of the patient’s disease. They are referred to as “living” documents because of the need to frequently update the document and because they are a reflection of the complexity of each individual patient and their diagnosis. Not only will a successful EMR application capture this complexity in electronic format, but also, the EMR will be able to preserve and present historical treatment plan data.
 

2.)  Social and behavioral data collection. Most state mental health and substance abuse agencies require large amounts of social and behavioral data to be collected during a behavioral health assessment. This data is used to determine if the services provided are appropriate for the patient. This data may include the patient’s current living situation, current and past family situation, social supports, sexual history, and past medical and behavioral health treatment history. Established EMRs may not allow for the complete capture of this information, nor provide for the analysis of this data. Successful EMRs will allow behavioral healthcare providers to collect the appropriate data. Furthermore, successful EMRs will be robust enough to facilitate analytics on this data, which tends to be highly varied and individualized.

3.)  Security and privacy. Although the protection of all health information is covered under several federal and state regulations, behavioral health data is “given heightened protection under the law” (HealthIT.gov, 2012). Successful EMRs will be agile enough to provide restricted access to behavioral health PHI based on federal and state laws as well as on the needs of the facility or provider.
 

4.)  Data exchange. A lawyer friend of mine recently told me that the future of healthcare is not in our hospitals – it’s in our communities. From long-term care facilities to stand alone behavioral health clinics, the importance of providing care along the entire continuum has never been more evident. For many behavioral health care patients, community clinics are the primary point of contact for treatment. An EMR that facilitates the exchange of data between larger health systems and community providers will be the EMR of choice as our healthcare systems move toward integration.
 

5.)  Documenting and measuring outcomes. Outcomes are king in the behavioral healthcare industry. It is by measuring the outcomes of prescribed treatments during and after episodes of care that the industry can make the case for increased funding. Successful EMRs will not only facilitate the capture and reporting of outcomes, but will also provide the ability to analyze outcome data.

RecoveryNet: Merging Behavioral Healthcare with the Patient-Centered Health Home

Ask Bob Lebman, President of RecoveryNet, where the large hospital behavioral health providers are failing patients and he’ll say “Access to treatment.”

“Right away, when a patient walks into a large hospital seeking alcohol or substance abuse treatment, you’ve lost them,” states Mr. Lebman. “They get the sense that it’s no loner personal, it’s no longer about them.”

In other words, patients become disengaged.

That’s why Mr. Lebman and several other substance abuse treatment facility leaders in the Rochester area started RecoveryNet 13 years ago. RecoveryNet began as a project to save Rochester’s community based substance abuse treatment centers. Since then, it has evolved into an innovative collaborative of 10 behavioral health providers, leveraging the power inherent in numbers to make a difference.

RecoveryNet’s main goal is to advocate for and protect community based substance abuse treatment as a care option for patients. The collaborative accomplishes this through several objectives. The first objective is to ensure uniformity among clinical documentation in use by all RecoveryNet partners. This allows the collaborative to track and measure outcomes among each individual partner agency as well as across the collaborative as a whole.

With the help of a grant from SAMHSA, RecoveryNet was able to mobilize all partner agencies to decide on and implement a common format for all clinical documentation. Additionally, the grant provided funds toward the implementation of an electronic medical record.

Three years after RecoveryNet began, the collaborative implemented Netsmart’s Tier, an EMR geared toward behavioral health care. Immediately after the implementation of Tier, one of the first health information exchange endeavors RecoveryNet embarked upon was an exchange between the Tier application and Monroe County’s Addiction Recovery Employment System. The Addiction Recovery Employment System, or ARES, is a web-based application that links to the County Department of Social Services. The exchange automated the electronic reporting of RecoveryNet’s ARES client outcomes directly into ARES.

Soon after, the collaborative was awarded a grant from New York State’s HEAL 5 initiative. The grant provided the resources to set up and administer cloud computing capabilities to the smaller RecoveryNet partner agencies that did not have the infrastructure in place to host the EMR locally. Additionally, the grant provided funding for the implementation of a RecoveryNet IT helpdesk.

The collaborative recruited a helpdesk technician, a database developer / administrator, and a network administrator to provide daily EMR support to partner agencies. Additionally, the RecoveryNet IT team is tasked with keeping tabs on any changes required in the EMR due to changes that occur at the state or federal level.

“This allowed the collaborative to bring EMR expertise in house, allowing us to improve the quality and timeliness of service to the partner agencies,” states Mr. Lebman.

Besides the economies of scale leveraged by having all partner agencies on the same EMR, the collaborative provides cost savings and efficiencies in other areas. For example, smaller partner agencies that do not have the resources to manage their revenue cycles can contract their billing functions to the larger partner agencies. Additionally, all partner agencies can take advantage of trainings, consultations, and knowledge transfer from other partners.

“The cost of these types of activities is included in the monthly fee all partners pay into the collaborative,” states Mr. Lebman.

Currently, RecoveryNet is implementing a primary care clinic on-site at one of the larger partner agencies. The clinic is slated to open this fall. The clinic will provide primary and OB/GYN care on site. Other RecoveryNet partner agencies can refer their clients to the primary care clinic while still continuing to provide substance abuse treatment services for the patient.

“We’re essentially building a patient-centered health home for our patients,” says Mr. Lebman, “That way, there’s no wrong door when patients come to us seeking treatment.”

This “no wrong door” approach works well for the other services the partner agencies provide. 

“If a woman with children and unstable housing walks into one of our outpatient substance abuse treatment clinics for treatment, we might refer her to the residential substance abuse treatment program at another partner agency instead,” says Mr. Lebman.

Perhaps the most useful thing to come out of RecoveryNet is the ability to track, measure, and report outcomes because in today’s behavioral healthcare environment, it’s all about outcomes.

“We know our programs work,” says Mr. Lebman, “But by working together, we can measure and report on the tremendous impact we have on the over 7,000 patients we see each year.”

For more information, please visit: http://www.asapnys.org/PDF/HealthcareReform/RECOVERYNETSMART.pdf

What’s the Next Big Thing in HIT?

Results versus relationships. Are the two mutually exclusive? Absolutely not, especially when one of the overarching goals of HIT project management is to develop and maintain relationships.

This is where some of the major players in the EHR field are failing. The larger EHR companies may have implemented enterprise EHRs in some of the larger health systems, however the lack of customer relationship management has caused their success quotient to decrease. What’s a success quotient, you ask? John Jantch, author of Duct Tape Marketing, defines it as “the value you create over the cost of the charge.”

In the case of the large EHR players, it can be stated as the level of customer satisfaction over the total cost of ownership (TCO) of the product. As the TCO of an EHR increases, even with customer satisfaction remaining unchanged, the company’s success quotient will decrease. But let’s face it, when the TCO of a product increases, customers usually begin to get pretty ornery. And the realities of the TCO of an EHR will only become more clear to hospitals and providers as the Meaningful Use money well dries up and they’re left footing the ownership bill. Couple the increasing TCO of EHR’s with poor customer relationships, and EHR company execs may find themselves spending increasing amounts of time conducting damage control. (Click here to read how Allscripts CEO, Glen Tullman, plans to improve customer satisfaction at his company.)

Obviously solutions that can easily interoperate and smart, intuitive user interfaces are some of the advancements on which EHR vendors must continue to concentrate. There is no doubt in my mind that we will get there. The evolution of information technology in any industry is always sloped upward towards increased innovation, more accelerated adoption and greater use. The healthcare industry is no exception.

However, a recent conversation with a practice administrator of a large anesthesiology group in Rochester, NY got me thinking about the future of HIT. During our discussion, she began to complain about her EHR vendor. “They’re just not responsive,” she stated, “When I call to ask if they could do something very specific and seemingly very simple to make our use of the system flow more smoothly, I was told no.”

I’ve heard similar stories of change requests falling into a “black hole.” As an HIT Project Manager, I can relate to the fact that when it comes to EHR’s, no change is simple. These are complex systems, and a change in something as simple as reconfiguring an input field on a medication form can have a profound effect on other areas of the system. However, telling your customers ‘No’ is akin to telling them that you don’t value their business. Simply not communicating with them is even worse.

Here is the point: if you value your customer’s expertise and experiences, they will trust you. And if they trust you, they will follow you and your technology. Even when your investors sue you.

So what’s the next big thing in HIT? Customer relationships, baby.