During his time as the National Coordinator for Health IT, Dr. Farzad Mostashari had a big job to do. Not only did he have to convince physicians and hospitals that EHRs were a good idea, he also had to herd healthcare providers towards the first stages ofmeaningful use, a program that is still seeing its fair share of backlash. Under the new ONC chief Karen DeSalvo, providers will be entering the second stage of the EHR Incentive Programs, which requires a greater focus on patient engagement and provider communication, an aspect of health IT adoption that Mostashari has been enthusiastically supporting all along.
From his post-governmental positions as a visiting fellow of the Engelberg Center for Health Care Reform at the Brookings Institution and a newly-minted member of the Board of Directors at Get Real Health, Mostashari isn’t letting his quest fall by the wayside just because he’s settled in to some new digs. Engaging patients in their own care and providing universal access to personal health records (PHR) is more important than ever, he told EHRintelligence, as providers look for strategies to reduce spending and galvanize patients to take charge of their wellness.
“We really need to consider the patient as a disruptive force in improving health care,” Mostashari said. “It starts with people being able to get access to their own health information so they can be empowered by the data. But the next step is to ask, ‘now that I can get it, why would I get it, and what can I do with it? How do I organize it, how do I understand it, how do I share it?’ At the ONC, we believed that rather than set up a central PHR for the country, as some countries have done, that if the policy makers help liberate patient data, there will be an ecosystem that helps patients do that. So that was a leap of faith. And what I’m glad to be able to do is to help support that movement by advising the board of one of the leading companies that’s making that idea come true.”
Get Real Health allows providers of all sizes to start up quickly with a customizable PHR portal, allowing patients not only to see their health information, but to interact with it. “We’ve built a site that we think is very interactive for the patient,” said Get Real Health President and founding partner Robin Wiener. “They can see real results. It’s not just a piece of paper. We give them actionable things to do, like adjusting their care plans. We can actually see graphs and gauges of how they’re doing. They can enter information, and some of our clients are already working with that.”
From his post-governmental positions as a visiting fellow of the Engelberg Center for Health Care Reform at the Brookings Institution and a newly-minted member of the Board of Directors at Get Real Health, Mostashari isn’t letting his quest fall by the wayside just because he’s settled in to some new digs. Engaging patients in their own care and providing universal access to personal health records (PHR) is more important than ever, he told EHRintelligence, as providers look for strategies to reduce spending and galvanize patients to take charge of their wellness.
“We really need to consider the patient as a disruptive force in improving health care,” Mostashari said. “It starts with people being able to get access to their own health information so they can be empowered by the data. But the next step is to ask, ‘now that I can get it, why would I get it, and what can I do with it? How do I organize it, how do I understand it, how do I share it?’ At the ONC, we believed that rather than set up a central PHR for the country, as some countries have done, that if the policy makers help liberate patient data, there will be an ecosystem that helps patients do that. So that was a leap of faith. And what I’m glad to be able to do is to help support that movement by advising the board of one of the leading companies that’s making that idea come true.”
Get Real Health allows providers of all sizes to start up quickly with a customizable PHR portal, allowing patients not only to see their health information, but to interact with it. “We’ve built a site that we think is very interactive for the patient,” said Get Real Health President and founding partner Robin Wiener. “They can see real results. It’s not just a piece of paper. We give them actionable things to do, like adjusting their care plans. We can actually see graphs and gauges of how they’re doing. They can enter information, and some of our clients are already working with that.”
While the requirement to be able to accept patient-generated data is still a ways off, potentially forming a piece of Stage 3, the 5% patient engagement threshold inherent in Stage 2 of meaningful use is staring providers right in the face. While many organizations still worry about getting their patients to log on and stay interested, Mostashari doesn’t believe this will be as problematic as some providers think.
“The meaningful use 5% requirement is really a way to get the ball rolling,” he said. “I think many providers will first begin to implement these sort of technologies in order to meet the meaningful use requirements, but they will continue to use them and they will really see the value in them if they don’t just do it for meaningful use, but to actually meet the demand of new payment models, of accountable care, of reducing readmissions, and of really understanding that most of what affects people’s health doesn’t happen in the hospital or in the clinic. It happens when they’re home, when they’re out and about, and being able to engage with them effectively is no longer going to be optional. It’s going to be a requirement – not for any regulatory reason, but for the modern delivery of healthcare.”
“We really need the market and innovators to work on and to find out what works,” he added. “One of the things that is really important is usability. It’s got to be really pleasurable to use that application. And that’s something that is a part of all of our other technologies that we use, but somehow, it has not been part of the health experience. The other piece is that it has to meet them wherever they are. It can’t just be about a web portal. That’s so 2002.”
“We need to help get the patient online,” Wiener agreed. And to keep them online, patient engagement tools need to be more than just novelties that may only be useful when an acute health event strikes. For Wiener, the value of staying in constant contact with online health tools is personal. “My son is a Type-1 diabetic, and there’s nothing more amazing than our alert system,” she explained. “He’s only 11, so he takes his blood sugar at school. It goes up into the data cloud and comes down and hits our system. If he’s over 300 or under 100, I get an alert on my phone. I don’t have to wait for the school to call me. I’m calling the school and asking what’s going on. And it doesn’t matter if I’m here in the US or in Australia or anywhere. I know what’s going on with him.”
“That’s the kind of stuff we’re going to need to use in order to keep patients engaged,” she said. “Because it’s real life stuff. It’s great to have data, but we need to do something with it and give patients tools that actually manage their health.”
It isn’t just about bringing PHR to the patient, either, Mostashari said. Providers need to learn how to accept the transformation of their roles and daily tasks that will come along with the advent of vocal, interested, knowledgeable patients. New health IT systems bring nothing but new questions, and that isn’t always easy to swallow for an industry that has typically relied on being the one with all the answers.
“I said at one of our policy committee meetings that we’re halfway through digitizing healthcare and 5% of the way through figuring out how to redesign our workflows to take maximum advantage of it,” he said. “That’s just part of the process of learning. It’s clearly going to be different, and by the same token, it can clearly be a lot better.”
“It’s not that hard to improve on today’s crazy workflows that we’ve kind of come to accept, like phone calls. It’s so difficult that doctors have to deal with incoming phone calls at the least opportune time, and manage the staffing demands of that. You’ve got to worry about the documentation of what you said on the phone call, and the patient actually understanding what you said. So being able to have secure messaging that you can rack and stack and have it be automatically documented and a digital paper trail is a hugely better workflow. But you have to learn how to do it.”
By implementing patient portals, most providers are also embracing the idea of patients being able to email or securely message their clinicians without the hassle of picking up the phone. “Many providers feared that if they let their patients message them, they were going to get bombarded with inappropriate emails ten times a day. They don’t,” said Mostashari.
“They really don’t. Providers have actually found that if, on occasion, someone does try to use it in a way that it’s not really meant to be used, they can just say, ‘You know what? You should come in for a visit, because it seems like it’s more complicated than we can handle through an online message.’ People love to be able to do it. Every organization that I’ve talked to that has implemented messaging or email has reported very high rates of patient satisfaction.”
High rates of satisfaction are exactly what Mostashari produced during his tenure at the ONC, and what he hopes to continue to bring in his new roles. “When I joined the federal government, there was a huge learning curve and I feel like it took a while for me to figure out what levers I had to push in order to have the greatest impact in that sector,” he said. “I’m enjoying learning about the levers of impact on the private sector side, too. I would never regret the time I spent in federal service. It was one of the most amazing times of my life and career, but I’m equally looking forward to figuring out what I can do in this context.”
“The meaningful use 5% requirement is really a way to get the ball rolling,” he said. “I think many providers will first begin to implement these sort of technologies in order to meet the meaningful use requirements, but they will continue to use them and they will really see the value in them if they don’t just do it for meaningful use, but to actually meet the demand of new payment models, of accountable care, of reducing readmissions, and of really understanding that most of what affects people’s health doesn’t happen in the hospital or in the clinic. It happens when they’re home, when they’re out and about, and being able to engage with them effectively is no longer going to be optional. It’s going to be a requirement – not for any regulatory reason, but for the modern delivery of healthcare.”
“We really need the market and innovators to work on and to find out what works,” he added. “One of the things that is really important is usability. It’s got to be really pleasurable to use that application. And that’s something that is a part of all of our other technologies that we use, but somehow, it has not been part of the health experience. The other piece is that it has to meet them wherever they are. It can’t just be about a web portal. That’s so 2002.”
“We need to help get the patient online,” Wiener agreed. And to keep them online, patient engagement tools need to be more than just novelties that may only be useful when an acute health event strikes. For Wiener, the value of staying in constant contact with online health tools is personal. “My son is a Type-1 diabetic, and there’s nothing more amazing than our alert system,” she explained. “He’s only 11, so he takes his blood sugar at school. It goes up into the data cloud and comes down and hits our system. If he’s over 300 or under 100, I get an alert on my phone. I don’t have to wait for the school to call me. I’m calling the school and asking what’s going on. And it doesn’t matter if I’m here in the US or in Australia or anywhere. I know what’s going on with him.”
“That’s the kind of stuff we’re going to need to use in order to keep patients engaged,” she said. “Because it’s real life stuff. It’s great to have data, but we need to do something with it and give patients tools that actually manage their health.”
It isn’t just about bringing PHR to the patient, either, Mostashari said. Providers need to learn how to accept the transformation of their roles and daily tasks that will come along with the advent of vocal, interested, knowledgeable patients. New health IT systems bring nothing but new questions, and that isn’t always easy to swallow for an industry that has typically relied on being the one with all the answers.
“I said at one of our policy committee meetings that we’re halfway through digitizing healthcare and 5% of the way through figuring out how to redesign our workflows to take maximum advantage of it,” he said. “That’s just part of the process of learning. It’s clearly going to be different, and by the same token, it can clearly be a lot better.”
“It’s not that hard to improve on today’s crazy workflows that we’ve kind of come to accept, like phone calls. It’s so difficult that doctors have to deal with incoming phone calls at the least opportune time, and manage the staffing demands of that. You’ve got to worry about the documentation of what you said on the phone call, and the patient actually understanding what you said. So being able to have secure messaging that you can rack and stack and have it be automatically documented and a digital paper trail is a hugely better workflow. But you have to learn how to do it.”
By implementing patient portals, most providers are also embracing the idea of patients being able to email or securely message their clinicians without the hassle of picking up the phone. “Many providers feared that if they let their patients message them, they were going to get bombarded with inappropriate emails ten times a day. They don’t,” said Mostashari.
“They really don’t. Providers have actually found that if, on occasion, someone does try to use it in a way that it’s not really meant to be used, they can just say, ‘You know what? You should come in for a visit, because it seems like it’s more complicated than we can handle through an online message.’ People love to be able to do it. Every organization that I’ve talked to that has implemented messaging or email has reported very high rates of patient satisfaction.”
High rates of satisfaction are exactly what Mostashari produced during his tenure at the ONC, and what he hopes to continue to bring in his new roles. “When I joined the federal government, there was a huge learning curve and I feel like it took a while for me to figure out what levers I had to push in order to have the greatest impact in that sector,” he said. “I’m enjoying learning about the levers of impact on the private sector side, too. I would never regret the time I spent in federal service. It was one of the most amazing times of my life and career, but I’m equally looking forward to figuring out what I can do in this context.”