iPads and health care – health IT managers slow down physicians’ clinical adoption

Doctors are using iPads in huge numbers for personal life project management. 80% of doctors are excited about using them in clinical practice. But when it comes to clinical applications, don’t confuse physicians’ desire for mobility with their current use of iPads in everyday practice.

What’s surprising is the “why” behind that phenomenon. It’s not a lack of desire; to a large extent, it’s a hospital-based system that’s not listening to physician demand for seamless mobility that fits with real-life workflow.

This was the light-bulb-over-the-head finding of Gregg Malkary of Spyglass Consulting. Gregg recently complete 100 in-depth interviews with switched-on doctors to assess their views on iPads and tablet computing in clinical practice.

I spent an hour with Gregg on the phone yesterday getting into the nitty-gritty of his qualitative research. “Doctors are going mobile,” Gregg said, “But hospital IT doesn’t see the physician as their client and they want to play by the old paradigm – ‘we’ll tell you what we’ll provide, and you’ll adopt it.”

Gregg observes that hospital management did not anticipate that consumer electronics would move at the “lightning pace” it did, capturing physicians’ attention in their everyday lives. Gregg found that now that hospital senior management “want to use the same devices [like iPads], that ‘real client’ of the hospital IT staff” are motivating the IT managers to take a new look at the role of tablets in the doctor’s office. Hospital execs, for example, want to use their iPads as their primary device to access email.

When it comes to clinical practice for doctors, we envisioned a future where the physician could use natural language speech recognition, which could streamline workflow. “Bring up lab results for patient John Smith,” Gregg asserted wearing a physician hat, “and there it is — the pertinent information I need in front of me to use with the patient in the exam room.”

I see this as Nurse Siri of the EMR for the iPad.

For now, Nurse Siri is a vision: doctors are largely productive on a big screen monitor driving throughput, facing incentives and reimbursement that drive him/her toward that workflow paradigm.

This is also an indictment of big iron health IT vendors who aren’t working as closely with clinicians as they could to disrupt the EHR offering. It’s the smaller, newer, more nimble start-ups and developers, Gregg says, who are bringing new-new tools to the mobile clinician.

He forecasted business casualties among some of the long-time health IT players, noting that some key staff are “defecting” the companies moving to start-ups and other vendors who are more innovative.

Read the details of Spyglass’s study.

Health Populi’s Hot Points: Physicians are often blamed for being technology laggards, uninterested in keeping pace with technological change (except when driven by reimbursement). The iPad, beloved to its users, disrupts that stereotype. Clinicians want to use iPads and tablets to go truly mobile and turbocharge their productivity in the exam room.

Doctors work in an ecosystem like all other workers do. In their case, that ecosystem extends beyond his/her nurses, associates, administrative team, to the hospitals with whom they affiliate. When the health IT staff at those institutions aren’t closely collaborating with their physicians, it’s a recipe for lower productivity, less satisfaction, and inevitably, less than optimal patient care. This realization found in Spyglass’s study should wake up the hospital C-suite. What’s good for execs who want to access their email on tablets is even better for clinicians who want to use mobile tools in collaboration with patients.

The state of health IT in America: thinking about the Bipartisan Policy Center report on health IT

There are few issue areas within the Beltway of Washington, DC, that have enjoyed more support across the political aisle than health care information technology. In 2004, George Bush asserted that every American would/should have an electronic medical record by 2014. Since then, Democrats and Republicans alike have supported the broad concept of wiring the U.S. health information infrastructure.

With the injection of ARRA stimulus funds earmarked in the HITECH Act to promote health providers’ adoption of electronic health records, we’re now on the road to Americans getting access to their health information electronically. It won’t be all or even most U.S. health citizens by 2014, but it will millions.

Just how solid is political support for health IT these days, then? An important report, Transforming Health Care: The Role of Health IT, from the Bipartisan Policy Center Task Froce on Delivery System Reform and Health IT published in January 2012, talks about the gaps and obstacles to achieving an interoperable, accessible health IT infrastructure.

The numerous challenges include:

- Misaligned incentives, driven by the volume-based health care payment model (discussed in Health Populi on January 31, 2012)
- Lack of health information exchange between health care providers and stakeholders
- Limited level of consumer engagement via electronic tools for self-care management
- Limited levels of EHR adoption, and particularly “meaningful use” by providers
- The lingering and large issue of privacy and security, with health information breaches continuing to erode peoples’ confidence in health information networks
- Multiple Federal priorities that are often competing for both attention and can be at cross-purposes.

To get to the vision of a national health information infrastructure, and to realize the full benefits of the HITECH investment in EHR incentives, these challenges must be first recognized and acknowledged, and dealth with openly and effectively.

Health Populi’s Hot Points: While there is uptake of EHRs reported by both hospitals and physicians who have signed up for HITECH incentives, the most current stats are that one-third of physician offices now have some form of EHR, and 61% of hospitals have filed intent to qualify for incentives.

We are on the road toward digitizing health care in America. But even Janet Marchibroda, director for the Center’s IT work, admits that there are miles to go to get to HIT Nirvana in the U.S.

Later this month, tens of thousands of health care analysts, providers, financiers and suppliers will meet up at the annual 2012 HIMSS conference. There, we will be treated to tours of new-new software, robotic hardware, data analytics programs and wireless-everything-in-health. As we tour the rich real estate at the Venetian Hotel and Conference Center, exploring Shiny New Things in health IT, we would be well-served to remember the caveats identified by the Center in this real-world report.

From volume to value: how health execs see the future of health care

Transparency and authenticity, constant and clear communication, and a drive toward value underpin the future health system — for those health leaders who can commit to these pillars of transformational change.

Leading Through Transformation: Top Healthcare CEOs’ Perspectives on the Future of Healthcare summarizes the interaction among 17 health execs who convened at the second CEO Forum held by Huron Healthcare Group. The report was released in January 2012.

Health leaders concur that regardless of the politics of the Affordable Care Act and its prospects for whole or partial survival beyond November 2012, market pressures in the health sector are driving health providers and suppliers to an environment of lower costs and higher quality. The current system as fragmented and volume-driven in unsustainable given the growing ranks of un- and under-insured, and growing role of government as insurer. The macro payment model for a health system that’s “built to last” is based on fixed payment or bundling, delivering higher quality at lower reimbursement rates.

Under that scenario, population health management is required. “We’re good at getting sick people better,” said David Feinberg of the UCLA Health System. “We fix people after they get hit by trucks. We don’t try to get the trucks to go more slowly.”

Care outside of the hospital setting is Job 1, then, where, as Surgeon General Regina Benjamin says, is where people, “live, work, play and pray.” This will also require thinking about “service lines from the perspective of the patients’ experience, not our experience,” noted Kate Walsh, President and CEO of Boston Medical Center, another attendee at the Forum.

Team-based care, with the patient at the center, will mean extending physicians’ productivity through working with complementary staff such as diabetes educators, nurse practitioners, nutritionists and other clinical professionals who can care for patients at the most appropriate point of their health journey. This approach is known as “maximizing the licenses” of staff members.

Hospitals will need to align physician staffs with this mission — which has recently meant acquiring doctors’ practices. But this ownership model isn’t the only way to align interests — other ‘rent,’ ‘borrow,’ or ‘share’ arrangements can also work. Regardless of that level of formality, success will be about building better personal relationships with physicians between institution and doctor.

Standardizing care is seen as a way to lower costs and improve quality. Ray Thompson of Trinity Mother Frances Health System thinks there’s $50 million to conserve through standardizing care. This means aggressively monitoring utilization of health resources in real-time, requiring smart use of data mining and analytics.

Keeping the staff’s collective mind of the prize of lower costs, higher quality, means leveraging new media like Twitter and Facebook and communications platforms such as webcasts and mobile phones to communicate with employees ongoing.

Health Populi’s Hot Points: It’s so easy to say the simple phrase, health care is moving from delivery and reimbursing based on volume, to value. That migration path, though, will be exceedingly bumpy and, I daresay, revolutionary. The disruptive change will mean…

• Team-based care, where doctors will work in partnership with other (“mid-level”) care providers
• Deep use of health information technology and data analytics
• Adoption and sustained use of social media and mobile technologies with both staff and consumers/patients/caregivers
• Staff with MBA skills for managing new payment models and cashflow/treasury functions
• Most transformational of all, the patient at the center of care.

Perhaps the most telling quote in the Huron report comes from Greg Brown, Chairman of Motorola who brought an external industry perspective to the Forum proceedings. He said, “People will only change when they viscerally see and feel the need for it.”

Health execs are currently saddled with falling credit ratings, growing patient bad-debt, disillusioned doctors, and increasingly demanding patients and caregivers in a national climate of a stalled macro-economy. That visceral time is Now.

We are all health illiterates: navigating the health system in a sea of paper and financial haze

“Older patients, caregivers, and family members face growing challenges in understanding and navigating the nation’s increasingly complex healthcare system,” begins a well-articulated column called Why Consumers Struggle to Understand Health Care, in U.S. News & World Report dated January 27, 2012.

Health literacy isn’t just about understanding clinical directions for self-care, such as how to take medications prescribed by a doctor, or how to change a bandage and clean an infected area. Health literacy is also about how to effectively navigate one’s health system. The first graphic is a schematic published in the New Republic in 2009 which illustrates the arcane Trip-Tik that is the U.S. health system. I often use this drawing in presentations when I’m addressing the topic of health literacy in America.

And that skill is in short-supply in the U.S., U.S. News reports. Donald Berwick, recent head of the Centers for Medicare and Medicaid Services, wrote with colleagues in Health Affairs that, ”Despite its importance, health literacy has until recently been relegated to the sidelines of healthcare improvement efforts.”

Lack of health literacy results in medical errors, patients presenting themselves to emergency rooms due to prescription drug dosing errors, asthmatic children through the ER revolving door when not regularly inhaling their medications, and overall sub-optimal health outcomes.

Health Populi’s Hot Points: One of my dearest friends is bravely battling multiple myeloma and, so far, so good. His clinical journey with the labyrinthine health system began in early December 2011 – about seven weeks ago.

He is on 23 medications now, administered at home. He was discharged from his inpatient stay without a system to help manage those meds at home. Home care workers get easily confused between names on bottles, some of which are called by their generic names, and some by their esoteric brands. He’s just completed many rounds of radiation, rang the bell in the facility to mark the end of that phase, and will continue a long phase of chemotherapy to be followed by stem cell transplant in a few months.

I spent an hour yesterday, January 29, 2012, at his home, helping his wife (another best friend) reconcile a four-inch-thick pile of paper explanations of benefit forms (EOBs) and bills from various health providers: two hospitals, two imaging centers, two clinical laboratory companies, an orthopedic surgeon, a nephrologist, and other providers whose specialties are hazy to me 24 hours later.

Ironically, the front of each of the few dozen envelopes from the health plan containing the EOBs included the pre-printed phrase, “Be green with Blue,” shown in the graphic. Even if the EOBs came through email, that wouldn’t solve the very un-green challenge of health literacy, and lack of health data integration where all of this should be populating a digital worksheet to help consumers and caregivers manage the countless transactions that get billed in the U.S. health system.

My friend is a hospital administrator with a clinical undergraduate degree and an MBA in health administration. I am a health economist who has consulted with hospitals, physicians, and every kind of stakeholder organization in the health industry for over 20 years. Together, we have at least 50 years of health care system experience.

We morphed the four-inch-pile of bills and EOBs into six bulldog-clipped folders of health financial categories and questions:

1. EOBs correctly reconciled to patient bills from health providers
2. EOBs without provider bills
3. Provider bills without EOBs
4. EOBs with denials from the health plan
5. A survey form from a third party administrator for the health plan asking to clarify the context of an inpatient procedure that may or may not be denied
6. A sixth category of “need more information.”

I won’t even go into the “patient’s responsibility” financial bottom-line (thus far – it’s only 7 weeks into what will be many months of health services from dozens of billing providers).

We are all health illiterates, my girlfriend and I remarked to each other over tea, exhaling over our six piles of prideful organizing. This is just the beginning. Now, to get the data into a Quicken Health spreadsheet…

The Connected Consumer – she loves her iPad, and she’ll be able to Connect for Health

She’s likely to be female, Facebooking, smartphoning, and digitally shopping. She’s the Connected Consumer, and she’s a lot older than you might expect: on average, 40 years of age, and with a mean household income of $63,000.

And Connected she is: in addition to having a PC or laptop computer, 43% have a smartphone, and 16%, a tablet.

Meet the Connected Consumer is a report from Zmags, a digital design company. Zmags surveyed 1,500 U.S. adults in November 2012 who owned a tablet, a smartphone and/or a computer, asking people their views on shopping, apps and the digital lifestyle.

Connected consumers shop across all 3 platforms – via tablets, smartphones and computers. Zmags calls this “device indifference.” The most common product category shopped-for on tablets are, not surprisingly, electronics, followed by books, toys, clothing, and music.

Tablet users did 87% of their holiday shopping using their devices, spending on average $325. And, 49% of tablet users anticipate shopping even more on their tablet in 2012.

Smartphone users are most likely to purchase music via their devices, followed by electronics, books, toys, and clothes.

For shopping, connected consumers don’t like using branded apps on their smartphones or tablets – instead, these shoppers like to go to websites and mobile sites, and 60% use digital or print catalogs and go directly to retailers’ sites to shop.

Zmags segments Connected shoppers by style of shopping: Savvy Shoppers look for the best, with 55% of them owning a laptop, PC and smartphone. Interestingly, 43% of Savvy Shoppers are tablet owners.

The most prevalent feelings Connected Consumers have about shopping are “happy,” “excited,” “thrifty,” “productive,” and “fulfilled.” Tablet owners feel particularly happy, excited, and productive.

Productivity seems like a major value among tablet owners: 29% say their motivation when they shop via tablet is convenience.

Facebook features prominently among Connected Consumers: 80% of them are active on Facebook. 57% of tablet owners follow their favorite brands on Facebook, versus 43% of all Connected Consumers. 22% of tablet owners also like to share good deals with friends on social networks.

Health Populi’s Hot Points: Consumers are digitally connecting across multiple platforms: in this study, Zmags looks into peoples’ shopping behaviors via computers (laptop/PC), smartphones and tablets. This is the consumer’s emerging multi-screen environment. People are accessing information and conducting transactions using several devices, and it’s clear one isn’t replacing another for the time being. Cable television is another platform where retail shopping is increasingly conducted, as well.

The adoption and enchantment with these devices can enable people to not only ‘shop’ for health services, but to receive these services in real-time at a distance. Traditionally “telehealth” has been thought to be delivered in a B2B sense, between health providers — say urban centered medical experts consulting remotely with physicians in the hinterlands.

However, Connected Consumers have the technology to enable care to be delivered at home and on-the-go. For example, Delta Airlines recently contracted with OptumHealth (a division of UnitedHealth Group) to provide telehealth services for the company’s very mobile workforce through the NowClinic online care.

As more consumers become Connected Consumers, they will be able to avail themselves to the growing opportunity of Participatory, Connected Health.

On the road to retail health: healthcareDIY and primary care, everywhere

At the ConvUrgent Care Symposium in Orlando, attendees from the worlds of clinics, ambulatory care, hospital beds, pharmacies, medical devices, life sciences, health information, health IT, health plans, academic medical centers and professional medical societies came together to share and learn about the morphing landscape of retail health.

The topline message: primary care is everywhere, and based on the response to my keynote talk this morning, every stakeholder segment gets it.

My mantra, courtesy of the U.S. Surgeon General Regina Benjamin: don’t look at health in isolation, that is, where the doctor and hospital are. Health happens wherever the person ‘is,’ and that is, as Dr. Benjamin says, where people “live, work, play and pray.”

Regular readers of Health Populi may be tiring of my repeating that mantra — but it cannot be overstated.

I created my presentation slide deck two weeks ago to meet the meeting organizer’s deadline. In the interim, several new signposts have popped onto the landscape of retail health, among them:

o The 2012 Consumer Electronics Show, that featured a plethora of connected health devices from body trackers to new-new digital glucometers. Jawbone, which mobile phone users know for its Bluetooth ear device, launched the Up wristband to compete with the likes of BodyMedia’s armband and the FitBit. And, speaking of FitBit, they promoted a new WiFi scale to compete with the Withings, and raised $12mm this week to support that launch. Withings, not to be outdone in innovation, promoted a new blood pressure monitor that plugs into iDevices (iPhones, iPads, iTouch’s) where data can be sent to doctors (a very important feature in the data-siloed U.S. health IT infrastructure).

o Telehealth has begun to get traction beyond being supported by grants from governments and foundations; evidence of this is seen in QuadMed’s announcement on January 16 2012 that the clinic group would partner with MDLiveCare to provide telehealth services to QuadMed’s worksite clinics. QuadMed was a pioneer in the world of worksite clinics, launching an onsite employer-based clinic for its QuadGraphics employees over 20 years ago. This initial site spawned a company called QuadMed which offers onsite health care to other companies (generally Fortune 1000 firms). Some of QuadMed’s customers are MillerCoors, Northwestern Mutual, and STIHL.

o Best Buy announced that it would be selling self-healthcare online programs branded by Aetna for managing smoking cessation, weight loss, stress management and fitness, through the chain’s Chicagoland stores for $19.99 apiece.

o Walgreens introduced a group of future-pharmacy stores around metro Indianapolis where the pharmacist “comes out” from behind the pharmacy wall to commune with patients/consumers, and health ‘navigators’ carry iPads that help customers connect with local health services information and providers. The stores also feature fresh food and offer other consumer-focused amenities, according to the company’s press release calling this new model a “health and living destination.”

Health Populi’s Hot Points: Signs of retail health are all around us, popping up as the primary care shortage/maldistribution drives pent-up demand among consumers for accessible, convenient, well-priced quality services and products.

This is HealthcareDIY. 52% of U.S. adults have done something to self-ration care in the traditional health care system such as skipping prescription fills (both initial and re-fills), cutting pills, postponing visits to doctors and dentists even when feeling unwell, and forgoing recommended medical tests.

At the same time, many health citizens are relying on home remedies, over-the-counter products, self-tracking devices, and other self-health tactics to manage health outside of the doctor’s office and hospital ambulatory clinic.

All well and good–to a point. It will be important to get patient data aggregated so that we can receive real-time feedback and therapeutic advice to improve our self-care efforts. It is early days for this. It is encouraging to see that Withings’ BP device will communicate to doctors’ offices. Most self-tracking devices can’t do this, yet, but we are on the way toward that data-liquid environment based on open standards and opening the kimono of APIs.

Runkeeper enabled self-trackers (like me) put our personal data collected by different devices on one “dashboard” in a Health Graph. This is a start.

Marrying those Observations of Daily Living (a Robert Wood Johnson Foundation-coined phrase) to “hard” medical data (such as our lab test results and digital imaging analyses) will be Nirvana. We’re on the road to getting ‘there.’

In the immediate term, patients will begin to have access to electronic copies of their health information based on meaningful use regs in the HITECH law. As more patients assume the mantle of engaged patient, they will begin to appreciate the power of knowing one’s numbers over time. Patient engagement (or activation, in the paradigm of sage Dr. Judith Hibbard), is a precursor to achieving optimal outcomes.

The Trust Deficit – what does it mean for health care?

Technology, autos, food and consumer products — two-thirds of people around the globe trust these four industries the most. The least trusted sectors are media, banks and financial services.

Welcome to the twelfth annual poll of the 2012 Edelman Trust Barometer, gauging global citizens’ perspectives on institutions and their trustworthiness.

This survey marks the largest decline in trust in government in the 12 years the Barometer has polled peoples’ views.

Interestingly, trust in government among US citizens stayed stable.

The top-line finds a huge drop in global citizens’ trust in government, with a smaller decline for business. There’s an interplay between these two forces: consumers call for increased government regulation over business due to public perception of irresponsible behavior — think financial crises in Greece and Portugal, food scares in the US food supply, and drug company quality issues in manufacturing plants.

The level of public trust in all industries fell or stayed flat. Of particular note to Health Populi readers is that trust in pharmaceutical companies fell from 61% of people believing the industry “does what is right” in 2011 to 56% in 2012. This was the largest percentage point drop across all 11 industries surveyed.

Who do we trust, then? Not CEOs and government officials. Instead, globally, people on the street trust experts, peers and “regular employees.” It’s trust in peers and employees that have substantially increased since 2004 — by 22 points for “people like me” and by 16 points for “regular employees.”

Furthermore, while trust in media isn’t tremendous, people trust in consuming several media sources to get informed.

And it’s social media that’s gained the most in percentage points compared with traditional news media. Nonetheless, traditional news media still rank first in trust vs. other sources of information about companies: 32% of people trust traditional news media, compared with 26% consuming multiple online sources, 14% trusting social media, and 16% trusting corporate sources.

Richard Edelman refers to this phenomenon as the “dispersion of authority.”

The survey was conducted among 25,000 online adults in October and November 2011, oversampling “informed publics” — people with college educations in the top quarter of income in their countries, who consume business media and follow issues in the news several times a week.

Health Populi’s Hot Points: Edelman’s prescription for re-building trust for organizations, public and private, are to practice “radical transparency” and to shape the public discourse, getting out in front of the news.

These implications are particularly important for stakeholders in health and health care. For health citizens to engage in health, they must first trust the organization with whom they’re considering engaging. Then, they must find that organization’s ‘voice’ authentic. This two precursors to engagement, trust and authenticity, were discovered in the 2008 Edelman Health Engagement Barometer.

Greater health engagement breeds better health outcomes, based on meta-analyses conducted by the Robert Wood Johnson Foundation, among others.

How to practice radical transparency in health care? By providing, fully disclosing prices, quality indicators, and making services as accessible as possible and practical. In the US, we expect to have Health Insurance Exchanges in place in 2014 that will array health providers’ and plans’ services and products in these terms; that will force transparency through regulation, and that regulation is none other than the Affordable Care Act.

What of shaping the public discourse in health? This requires engaging with patients in dialogue. Social media platforms can enable this discourse, among other strategies. It will take integrating media, messages and technology platforms to engage health citizens where and how they seek their personal brands of health engagement.

help comes to health care: well-designed front-of-pharmacy DIY health products

Less is more when it comes to health care utilization and outcomes. The U.S. allocates too many resources to a huge line item of waste in the health system – administrative (in terms of too many paper processes and staff to deal with them) and clinically (especially involving duplicated tests and ineffective treatments that aren’t based on evidence based medicine).

“Take less” is the tagline of the company called help which is found at the URL http://www.helpineedhelp.com/. 

This is a consumer-facing over-the-counter drug supplier. Their product line counts 7 mature products each packaged with the health complaint they target: “Help,”

• I have a headache = acetaminophen
• I have an aching body = ibuprofen
• I’ve cut myself = adhesive bandages
• I have a blister = hydrocolloid bandages
• I have allergies = loratidine antihistamine
• I can’t sleep = diphenhydramine
• I have a runny nose = phenylephrine nasal congestant.

The packaging measures about 3.25″ square and weighs virtually nothing to carry around in a pocket, handbag, backpack or business case. Packaging is biodegradable, bioplastic, and made from paper pulp. Each package contains 16 doses of the product.

Thus, help also means “less,” as a business philosophy: less waste and less dyes. But “less” to the help team also means less greed, less self-indulgence, less confusion, and less drugs.

The product line is carried at several retail pharmacy chains: I’ve seen it in Target and Walgreens nationally, and Duane Reade in NYC. It’s also found in some of my favorite consumer brand companies such as Virgin America and Morgan Hotels, among other retail channels.

Health Populi’s Hot Points:  Start with the importance of design: help’s packaging and overall concept is smart, clean, rational, and sensible at this point in economic time. Its philosophy of less-is-more and objective to lessen confusion are welcome corporate objectives in an era of too-much-healthcare and Overtreatment (click on the link to read more about Shannon Brownlee’s treatise on the subject, Overtreated).

I was delighted to discover this product line at my local Target store at a very visible end-cap in the pain meds aisle. Target is already an important force in well-designed health products and services. I waxed lyrically about Target’s Design of the Decade award from ISDA for the chain’s safe prescription pill bottles in December 2010 - elegantly designed, and targeting the significant public health problem of medical errors.

The help team has the opportunity to apply their smart precepts of great design and consumer engagement for other health products and services. They cut through confusion by being elegantly simple and clear, stating the clinical problem in a clean large font, along with the dose of the meds. The Drug Facts label on the back of the package is clear and states, “Help I have an aching body is a drug, not a sweet candy treat. We wouldn’t try to trick you by coating it with sugar.”

This offering represents the new breed of highly engaging products targeting the empowered DIY healthcare consumer.

Stop SOPA

Health Populi’s Hot Points: Please stop censorship in the United States of America. Click on this hyperlink to easily contact your Congressional representatives and express your opinion on SOPA and PIPA – two laws that would limit basic freedom in the marketplace of ideas and commerce.

Top 15 Hospitals are very wired

Congrats to the 2012 Top 15 Health Systems as crowned by Thomson Reuters today, shown in the chart. They are segmented by size, with large systems (>$1.5 bn), medium ($750mm – $1.5 bn), and small (<$750 mm). No matter their size, though, across the segments, these best hospitals share several traits:

• They demonstrate better patient outcomes in terms of better survival rates and fewer complications
• Better long-term outcomes
• They adopt evidence-based medicine
• They have better patient safety track records
• Their patients leave hospital sooner, which could result in the fact that
• Patients are more satisfied than consumers at other hospitals (with higher HCAHPS scores).

To accomplish these outcomes, all 15 have strong health IT infrastructures.

Health Populi’s Hot Points: I’ve studied the “Healthcare’s Most Wired” Health Providers from Hospitals & Health Networks and the Thomson Reuters Top 100 Hospitals for many years. It strikes me in 2012 that with meaningful use and patient engagement on the front-burner for providers adopting EHRs that a useful metric for these studies could be patient engagement.

This could take the form of percent of patients who request and receive a copy of their EHR; or, percent of patients who take advantage of patient portals or personal health records. We know from a survey conducted by the California HealthCare Foundation in 2010 that the more patients engage with their health information in a PHR, the more likely they are to ask questions of their providers and more deeply participate in their health care. The second chart illustrates this phenomenon.

And, greater engagement leads to better outcomes.

On a personal note, congratulations to ‘my’ personal health system, Main Line Health, where my doctors use an EHR, partner with me, and welcome my participation in my own care.