Patients and “Their” Medical Records: Crossing the Chasm

Jane Sarasohn-Kahn

This blog was originally published by Health Populi on July 17.

Most physician practices and hospitals in the U.S. have installed electronic health records (EHRs). But in a classic Field of Dreams scenario, we have made patients’ medical records digital, but people aren’t asking for them or accessing them en masse. “How do we make it easier for patients to request and manage their own data?” asks a report from the Office of the National Coordinator of Health IT (ONC), Improving the Health Records Request Process for Patients – Highlights from User Experience Research.

The ONC has been responsible for implementing the HITECH Act’s provisions, ensuring that health care providers have met Meaningful Use criteria for implementing EHRs, and then receiving the financial incentives embedded in the Act for meeting those provisions.

Now that the majority of health care providers in the U.S. have indeed purchased and implemented EHRs, it remains for patients, health consumers, and caregivers to take advantage of them. In my post on the EHR Field of Dreams effect, I highlighted research from the U.S. General Accountability Office that explored the question of how the Department of Health and Human Services should assess the effectiveness of efforts to enhance patient access to EHRs.

The ONC team conducted in-depth interviews with 17 patients to understand their health IT personae and personal workflows for accessing their personal medical records. The research also considered medical record release forms and information for 50 large U.S. health systems and hospitals, and interviewed “insiders” –health care stakeholders inside and outside of ONC — to assess how patients request access to medical records data and look for solutions to improve that process.

Why is it so important for people to access their medical records? By doing so, patients and caregivers can better manage and control their health and well-being, ONC notes, by preventing repeat tests, managing clinical numbers (like blood pressure for heart or glucose for diabetes), and sharing decision making with doctors and other clinicians — together, the process of patient and health engagement which boosts health outcomes for individuals and populations.

The general process of a patient requesting their health data works like this, illustrated by the patient journey of Melissa and Ava Crawford, a mother and toddler daughter portrayed in the ONC report:

  • A patient/consumer makes an initial inquiry
  • The consumer requests the records, which can be done via a paper authorization form (that is then completed and either mailed or faxed to a provider) or online via portal. Sometimes a consumer must write a letter request to the provider and mail or fax that paper ask.
  • The consumer waits for a response, which ONC calls “a bit of a black hole for consumers.” This can be as long as 30 days under the HIPAA law.
  • The health system receives and verifies the request, then verifies the patient’s identify and address.
  • Health systems then fulfill the records request, often a printed copy of the medical record that can be faxed or mailed, PDF files, or a computer disk (CD).

ONC conducted research into the consumer journey along this process to identify opportunities to improve the patient experience of requesting and receiving personal health information.

Most Americans see their doctors entering medical information electronically, and most people say accessing all kinds of medical information is important, the Kaiser Family Foundation learned in a health tracking poll conducted in August 2016. However, there are big gaps in the information available to U.S. patients online, such as prescription drug histories and lab results: two very popularly demanded information categories. And through the consumer-patient demand lens, 1 in 2 U.S. adults said they had no need to access their health information online, as the chart from the KFF poll attests.

How to bridge the chasm between self-health IT, providers and patients? The most effective patient engagement technologies are biometric measurement devices like WiFi scales and glucometers, apps, texting and wearables — with portals ranking last — according to physicians and clinical leaders polled in a New England Journal of Medicine (NEJM) survey published earlier this month.

The top benefit of engaging patients with these technologies is to support people in their efforts to be healthy, and to provide input to providers on how patients are doing when not in the clinic, this research found.

My friend and collaborator Michael Millenson wrote in the BMJ this month about patient-centered care no longer being “enough.” In this era of technology-enabled healthcare, and rising consumerism among patients, three core principles must underpin the relationship between patient and provider:

  • Shared information
  • Shared engagement
  • Shared accountability.

Michael quotes Jay Katz from his book, The Silent World of Doctor and Patient, who talked 35 years ago about the concept of “caring custody.” Jay explained this as, “the idea of physicians’ Aesculapian authority over patients’” being replaced with “mutual trust.”

It is not enough to build and offer a technology “meant” for patients and people to use for their health and healthcare. Trust underpins all health engagement, and must be designed and “baked” into the offering. Today, that trust is built as much on consumer retail experience (the last-best experience someone has had in their daily life, exemplified at this moment by Amazon) as in a new social health contract between providers and patients.

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Health Care Worries Top Terrorism, By Far, In Americans’ Minds

Jane Sarasohn-Kahn

This article was originally published in www.healthpopuli.com on February 8, 2017.

Americans-most-worried-about-health-care-costs-and-financial-situation-Monmouth-U-poll-Feb-2017

Health care is the top concern of American families, according to a Monmouth University Poll conducted in the week prior to Donald Trump’s Presidential inauguration.

Among U.S. consumers’ top ten worries, eight in ten directly point to financial concerns — with health care costs at the top of the worry-list for 25% of people. Health care financial worries led the second place concern, job security and unemployment, by a large margin (11 percentage points) In third place was “everyday bills,” the top concern for 12% of U.S. adults.

Immigration was the top worry for only 3% of U.S. adults; terrorism and national security represented 2% of the American public’s concerns.

In the 2015 Monmouth Poll, 15% said health care was their family’s main worry. Today, this issue is #1 for families across income categories and party affiliation. (more…)

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Health Care For All — Only Better, US Consumers Tell Consumer Reports

Jane Sarasohn-Kahn

This article was originally published on January 23, 2017, in http://www.healthpopuli.com/.

Availability of quality healthcare, followed by affordable care, are the top two issues concerning U.S. consumers surveyed just prior to Donald Trump’s inauguration as the 45th U.S. President. Welcome to Consumer Reports profile of Consumer Voices, As Trump Takes Office, What’s Top of Consumers’ Minds?

“Healthcare for All, Only Better,” Consumer Reports summarizes as the top-line finding of the research. 64% of people are confident of having access to good healthcare, but 55% aren’t sure they can afford healthcare insurance to be able to access those services. Costs are too high, and choices in local markets can be spotty or non-existent. The high cost of prescription drugs is part of consumers health cost confidence-gap (with Consumer Reports calling out the EpiPen pricing controversy growing in 2016).

After healthcare, U.S. consumers in Post-Trump America are most worried about:

  • Affordable education
  • Food safety and quality
  • The costs of living for energy, food, taxes, and housing, and
  • Personal data security and privacy. (more…)


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The Digital Health Gap For High-Cost, High-Need Patients

Jane Sarasohn-Kahn

This post was originally published on HealthPopuli.com on December 7, 2016.

health-affairs-mobile-health-apps-for-high-cost-high-need-patients-gaps-dec-2016

Several market forces are converging that boost patients’ ability to engage in their health and self-care, including peoples’ growing adoption of smartphones, demand for self-service and DIY lifestyles, and Americans’ growing responsibility as health consumers. Health consumers are using a growing array of self-health tools, enabled through digital technologies. However, these tools aren’t yet engaging some of the very people who need them the most: high-need, high-cost patients.

Research into this situation is discussed in the December 2016 Health Affairs article, Many Mobile Heaath Apps Target High-Need, High-Cost Populations, But Gaps Remain, published in the December 2016 issue of Health Affairs. For context, this research focuses solely on mobile health apps, and not the larger topics of telehealth and remote health monitoring. (more…)


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Healthcare Reform in President Trump’s America – A Preliminary Look

Jane Sarasohn-Kahn

This post was originally published on 9 November 2016 in http://www.healthpopuli.com/.

Trump-tweet-on-helath-careIt’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities.

Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including:

  • Extending health insurance to dependent children up to age 26
  • Closing Medicare’s “doughnut hole” (for Medicare Part D which covers prescription drugs for older Americans)
  • Covering people with pre-existing medical conditions
  • Covering preventive services, and
  • Providing subsidies that lower the cost of insurance.

What nobody likes is the direct consumer cost of health care — ACA’s lack of affordability, which was predicated on a competitive insurance marketplace and near-universal sign-ups for health insurance bolstered by a mandate for consumers to purchase insurance. Without these pillars in place, insurance companies have pulled out of local markets where they cannot be financially viable, leaving many consumers with only one choice for health insurance purchasing. Monopoly power in a local market means higher prices. Couple this with millions of consumers opting out of buying health insurance, leaving health plans with a sicker, generally older population to serve. Actuaries in health plans like a more standardized population with young, older, healthy, sick, and demographically diverse to be able to forecast utilization of health care services and, ultimately, the medical loss ratio (that is, patients’ costs incurred in the health plan).

Repeal-and-replace in Donald Trump’s healthcare world could result, in the short-to-medium term, in about 20 million Americans losing health insurance. The Commonwealth Fund estimated that this could increase the Federal budget deficit by between $330 bn to $550 bn over 10 years. (more…)

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Americans Have Begun to Raid Retirement Savings for Current Healthcare Costs

Jane Sarasohn-Kahn

ebri-changes-in-healthcare-usage-resulting-from-cost-increases

While American workers appreciate the benefits they receive at work, people are concerned about health care costs. And consumers’ collective response to rising health care costs is changing the way they use health care services and products, like prescription drugs. Furthermore, 6 in 10 U.S. health citizens rank healthcare as poor (27%) or fair (33%). (more…)


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Most Hospitals Offer Patients Electronic Access to Medical Records

Jane Sarasohn-Kahn

This post was originally published on http://www.healthpopuli.com/ on September 14, 2016.

Percent-of-hospitals-that-enable-patients-to-view-download-and-transmit-HI-grew-7x-between-2013-2015

The number of hospitals offering patients electronic access to their health information grew seven times between 2013 and 2015. Electronic health records access has gone mainstream in America, according to the latest findings by The Office of the National Coordinator for Health Information Technology (ONC-HIT).

The data are detailed in Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2012-2015, an ONC Data Brief.

Two in three U.S. patients can now view, download, and transmit their personal health information, shown in the bar chart. This hockey-stick growth, from 10% in 2013 to 69% in 2015, results from the HITECH Act, part of the Stimulus Bill which provided financial incentives to health care providers to adopt and implement electronic health records (EHRs). (more…)

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Money, Stress and Health: The American Worker’s Trifecta

Jane Sarasohn-Kahn

Financial stress impacts health, relationships, and work productivity and attendance for employees in the U.S. It’s the American worker’s trifecta, a way of life for a growing proportion of people in the U.S. PwC’s 2016 Employee Financial Wellness Survey for 2016 illustrates the reality of fiscally-challenged working women and men that’s a national epidemic.

Employees-say-financial-stress-impacts-health-first-PwC-survey

(more…)


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Digitizing Self-Healthcare with Google, Pfizer, Under Armour, Walgreens and WebMD

Jane Sarasohn-Kahn

How can digital technologies enable self-healthcare in novel ways? This was the theme of a meeting sponsored by Pfizer Consumer Healthcare and hosted by Google, with the title, “Advancing Consumer Health through New Technology and Next Generation OTC Healthcare” held on 12th April 2016 at Google offices in Manhattan’s Chelsea neighborhood.

Pharmaceutical brand drugs switching to over-the-counter packaged goods, the Cellscope Otoscope used by parents checking their young children’s earaches, connected shoes and earbuds for athletic enhancement, and omni-channel retail shopping….these are a few of the signals we see emerging to enable consumers’ to drive healthy behaviors, wellness and self-healthcare. Speakers from companies covering these market segments presented their views on health care consumers’ demand and use of digital tech for their own and their families’ health.

David Pogue, technology raconteur, moderated the session, kicking the discussion off with the scenario of a patient recently admitted to an ER with chest pain where clinicians took advantage of the patient’s Fitbit data. Based on that patient-generated data, the doctors were able to connect the data-dots in time to prevent the fellow from dying. Pogue ticked off many examples of tracking devices, covering sunlight exposure, posture, weight and BMI, heart-tracking t-shirts, smart shoes, earbuds, forks to slow down eating, and finally the SexFit Bondero for the gentlemen-folk. (more…)

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The Patient-Physician Experience Gap

Jane Sarasohn-Kahn

Today’s post first ran on Health Populi.

As patients continue to grow health consumer muscles, their ability to vote with their feet for health care services and products grows. That’s why it’s crucial for health care providers to understand how patients perceive their quality and service levels, explained in Patient Experience: It’s Time to Rethink the Consumer Healthcare Journey, a survey report from GE Healthcare Camden Group and Prophet, a brand and marketing consultancy.

The-Patient-Provider-Experience-Chasm-GE-Prophet-March-2016 (more…)


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Sleep And Health/Tech – It’s National Sleep Awareness Week

Jane Sarasohn-Kahn

The post below originally ran on Health Populi on March 9.

One in three people suffer from some form of insomnia in the U.S. With sleep a major contributor to health and wellness, we recognize it’s National Sleep Awareness Week.

As a health economist, I’m well aware of sleep’s role in employee productivity, absenteeism and presenteeism. U.S. companies lose 11.3 days of lost work performance per person who suffers from insomnia, according to research from a Harvard-based team published in the journal Sleep. The cost of this to U.S. business is about $63 billion annually.

Science writers at the BBC developed a long list of modern-life issues that deter us from sound sleeping. The major culprits are pervasive technology, lights, noise, heat, and stimulants (like alcohol and coffee), as illustrated in the BBC’s drawing of How We Live Now.

Some key health issues you may not know about sleep are that… (more…)


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Consumers Take Better Preventive Care of Pets Than Themselves, CIGNA Finds

Jane Sarasohn-Kahn

People Care Deeply About the Wellbeing of Their Pets Not So Much WellbeingThe post below first ran January 18 on Health Populi.

Nine in 10 pet owners know when their dog or cat is due for their shots. Eight in 10 women know the frequency with which they get manicures and pedicures. 80% of men know the mileage between old changes.

But only 50% of family health care decision makers know their blood pressure, and only 20% know their biometric numbers like cholesterol and BMI.

Americans are great at doing preventive care for their pets and automobiles; but not so much for their own bodies and health, finds the report CIGNA Preventive Care Research, a survey of 1,000 U.S. consumers between 25 and 75 years of age who have health insurance and are the health care decision makers for their families. The survey was conducted in September 2015. (more…)


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The Future 100 from JWT – Health Is Everywhere in 2016

Jane Sarasohn-Kahn

Today’s post first ran on Health Populi on December 9.

Food + Drink, Beauty, Tech + Innovation, Retail, Lifestyle…JWT pulls out their crystal ball for 2016, and I see health, everywhere.

JWT-Future-100_FINAL_COVER-HR-300x194The Future 100 – Trends and Change to Watch in 2016 is J. Walter Thompson Intelligence Innovation Group’s annual trend forecast, which I highly value and mine each year to help THINK-Health continue to hone our own environmental analyses for health and healthcare. [Here’s what I wrote one year ago about JWT’s 2015 forecast].

Health is baked into JWT’s 2016 trendscape, well beyond their “Health” chapter. (more…)

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Social Determinants Impact Health More Than Health Care

Jane Sarasohn-Kahn

imageToday’s post first ran on Health Populi on November 9.

The factors of where people are born, live, work and age — social determinants — shape human health more than health care. Yet in the U.S. much more resource per capita is funneled into healthcare services than into social ones.

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity was published by The Kaiser Commission on Medicaid and the Uninsured in November 2015, calling attention to the opportunity and wisdom of baking health into all public policy.

The social determinants of health (SDOH) include economic stability, the physical environment and neighborhood, education, food, community and social context, and the health care system, shown in the second exhibit. (more…)


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Insurance Should Pay For End-of-Life Conversation, Most Patients Say

Jane Sarasohn-Kahn

Today’s post first ran yesterday on Health Populi.

aging 18 in 10 people in the U.S. say that Medicare as well as private health insurance plans should pay for discussions held between patients and doctors about hatlhcare at the end-of-life.

The September 2015 Kaiser Family Foundation Health Tracking Poll asks people their opinions about talking end-of-life with their doctors. The vast majority of people support the concept and physicians being paid for holding such conversations in doctor-patient relationship.

The question is germane because the Obama Administration has announced plans to pay doctors for office visits to discuss end-of-life (EOL) issues with Medicare patients. (more…)


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