So You Work in Digital Health Communications….What Does That Mean?

I am a director of the digital health practice at Weber Shandwick, a global public relations firm.

If you ask my mother what I do, she will tell you “Sarah works for Facebook.” My father is wise and when someone asks what I do he says “Sarah, why don’t you come over here and explain it.” My friends think I have the greatest job of all time and just tweet all day for a living.

But, what do I really do? I help healthcare companies tell their story. And we tell this story using social media and emerging digital technologies to reach their audiences. In other words, I bring patients, caregivers and clinicians together to have a conversation, online.

Out of curiosity, I asked a few of my digital health colleagues to describe what they do. Fairly easy task, you would think. However, I did add one caveat. I asked them to describe what they do within the character limit of a social network of their choice.

Here are the answers I received:

Digital Health Communication  Digital Health CommunicationSarah_3

You can see that even our own team members offer slightly different perspectives on our work. In an emerging field, it can be expected that everyone’s definitions will differ.

My Definition of Digital Health

I subscribe to the simplest definition of digital health. To me, digital health is the intersection between digital and social technologies and healthcare. This can be anything from using mobile apps for biomedical care…to using online communities for social support and patient education…to using social networking sites for public health preparedness and prevention.

Our goal as digital health communicators is to understand this intersection and provide our clients the best counsel to navigate this emerging field. The most important thing we can offer our clients is confidence. Healthcare companies need to feel confident in the communications tactics they employ, especially in a highly-regulated environment. Research shows that lack of confidence is the one of the biggest barriers for healthcare companies to engage authentically with their audiences using digital and social media.

As digital health practitioners, we must have confidence in our knowledge of the regulatory environment. On top of this, we must use our creativity to help our clients find comfort and success navigating the grey areas. If you think it is hard to explain digital health to colleagues and friends, imagine how hard it is to explain this to a pharmaceutical CMO that has turned to traditional marketing tools his or her entire career. But, we must try.

Your parents may never understand, but it is important that you’re able to communicate what you do.  I challenge you to answer the same question I asked my colleagues. In 140 characters, can you explain what do you do in digital health?

- Sarah Mahoney

3 Reasons to Code Health Related Blog Posts Like an Office Visit

The advent of EHR software and the requirements to meet meaningful use have spurred a greater focus on the use of standardized code sets earlier in the patient care cycle.  Rather than jotting down COPD in a patient’s past medical history, providers are now selecting 496 Chronic Airway Obstruction from a drop down list.  As the stages of meaningful use progress, and providers become more familiar with various code sets it’s likely they will increasingly rely on them when searching the web.

With these things in mind, healthcare providers posting content online in reference to specific conditions and/or procedures may find value in coding their blog posts by adding ICD-9/10, CPT, DSM, NDC, HCPCS, LOINC codes, etc. as tags and/or categories.

Three reasons to code blog posts:

Helps others find your content.

  • With the global push toward electronic health records and increasing focus on structured data as a means of facilitating data exchange between disparate systems, more providers and provider agents are searching the web using diagnosis, procedure, lab, and medication codes.   For example:  It’s easier to copy and paste a CPT code from an EHR (e.g. 58545)  into a Google search rather than attempt to accurately spell, Laparoscopy, surgical, myomectomy.   Posted content including the CPT code in the text and/or associated as a tag or category is more likely to be found.

Helps you find your own content.

  • By attaching standard codes to posts in the form of categories and/or tags it is possible to create subsets of content which may be converted into tag clouds or unique URL’s including all posts that contain specific codes or combinations of codes.  WordPress allows its users to add a category name at the end of a blog URL to filter posts by that category alone.  Example:  A URL for all blog posts on this site associated with a category for congestive heart failure would look like this:  http://digitalhealthcommunication.drury.edu/category/428

Helps curation and/or data conversion services find and move content.

  • When the time comes to gather blog posts to be imported into a curation framework or other content management system, data migration engineers will be looking for reliable ways to parse the data.  Standard codes sets attached to text make it much easier to know what to move and where to put it.  For example: As meaningful use phase two approaches and electronic patient instructional/educational materials increase in use, existing blog content might prove helpful for re-direction to patients once it has been imported into a certified EHR software and attached to a chart.

Final tip:  If you’re writing a blog post and need a code for a disease or treatment, etc. just Google it.  Chances are someone has already posted about it and included the appropriate code.  If you can’t find an existing post with the code desired then Google the type of code you’re searching for followed by the text string “free lookup.”  You’re bound to find it.

Happy Coding!

 

 

 

 

Digital Health Technology – Don’t Forget Nonverbal Communcation

While recent studies trumpet the many virtues of electronic health records there are others warning of potential limitations.  One area of patient/physician communication that may be negatively impacted by widespread Health IT adoption is nonverbal communication.

A study published in Health Affairs (excerpt below) explains the potential benefits of implementing digital health technologies in an effort to confront the looming doctor shortage.

  • The Impact of Health Information Technology And e-Health On The Future Demand For Physician Services.  Jonathan P. Weiner, Susan Yeh and David Blumenthal.  Health Affairs, 32, no.11 (2013):1998-2004.  - We estimate that if health IT were fully implemented in 30 percent of community-based physicians’ offices, the demand for physicians would be reduced by about 4–9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4–7 percent.  Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2–5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings.  Abstract 

While the features of digital health applications may be of great value from an efficiency perspective there are other points of view to consider. A recent study published in the Journal of Participatory Medicine (excerpt below) describes the advantages of eye contact and social touch in the patient/physician encounter.  The study suggests that health IT should not hinder these nonverbal exchanges.

  • Nonverbal Interpersonal Interactions in Clinical Encounters and Patient Perceptions of Empathy. Enid Montague, Ping-yu Chen, Jie Xu, Betty Chewning & Bruce Barrett . Journal of Participatory Medicine.  Vol. 5, 2013. - Results: Length of visit and eye contact between clinician and patient were positively related to the patient’s assessment of the clinician’s empathy. Eye contact was significantly related to patient perceptions of clinician attributes, such as connectedness and liking. Conclusion: Eye contact and social touch were significantly related to patient perceptions of clinician empathy. Future research in this area is warranted, particular with regards to health information technology and clinical system design. Practice Implications: Clinical environments designed for patient and clinician interaction should be designed to facilitate positive nonverbal interactions such as eye contact and social touch. Specifically, health information technology should not restrict clinicians’ ability to make eye contact with their patients. Full Text

Digital health solutions exhibit multiple advantages as well as potential drawbacks that should be carefully measured and analyzed prior to their implementation.  Drury’s digital health communication students will delve deeply into these difficult questions guided by contemporary research and professionals working in the field.

For more information about Drury’s online graduate certificate in digital health communication please visit our website.

Graduate program connects students with digital health industry leaders & published research faculty.

Drury University has created an innovative learning environment by employing online collaboration technology to bring the academic and professional worlds together.  Students enrolled in the digital health graduate program will interact with, and learn from, leaders in health communication research as well as decision makers associated with the organizations shaping the future of digital health.

Academic

In addition to contributing multiple scholarly chapters and adjudicated conference papers, our curriculum design research faculty have published in a variety of peer reviewed academic journals.

  • ·         Communication Monographs
  • ·         Health Communication
  • ·         Health Marketing Quarterly
  • ·         Journal of Health and Mass Communication
  • ·         Health Information and Libraries Journal
  • ·         Social Science Review

Professional

Complementing the academic faculty, the program’s professional facilitators, classroom guests and curriculum advisers possess decades of valuable experience working with global leaders in health care technology:

The nexus of industry and academic experts produces a unique opportunity to learn not only how to develop and interpret digital health knowledge but also the practical application of that knowledge.

For more information about the program please visit our website and/or contact the program director, Jeff Riggins, with questions and comments.

Drury’s Digital Health program sounds great. But, how do I pay for it?

When considering whether or not to enroll in an advanced course of study there are many factors to take into account.  Time commitment, cost to benefit ratio, online versus in-person, reputation of the institution, etc. should all be carefully weighed.

The best programs usually require the greatest commitment, including tuition cost. Thankfully, highly respected, accredited, private, nonprofit universities such as Drury offer multiple avenues for students to defray expenses.

Listed below are 5 recommendations to help prospective Digital Health Communication students pay for the program.

1:  Apply for full acceptance to Drury’s graduate college as an MA seeking student (i.e. submit GRE scores, etc.) and complete the Digital Health Communication program as part of your graduate coursework while earning your Master’s in Communication.  This will allow you to apply for federal financial aid.

2:  Take advantage of employer sponsored tuition reimbursement programs.  Employees at leading health services corporations typically have access to $5k – $10k in tuition reimbursement each calendar year as part of their benefits packages.  Based on an employer’s tuition reimbursement level prospective students may spread courses out over multiple calendar years if needed.

3: Use federal programs such as Veteran’s educational assistance.  These programs normally pay for 100% of tuition costs for qualifying individuals.

4:  Pay as you go.  Drury will work with you to set up a payment plan to spread the fees out over the duration of the program.

5:  Finally, tuition and expenses paid by participants (out of pocket) may be deducted on federal tax returns.

Feel free to contact the DHC program director, Jeff Riggins, at jriggins01@drury.edu with questions about the Digital Health Communication program and/or Drury University.

Confessions of an Electronic Health Record (EHR) Consultant

Over the past 10 years I have implemented electronic health records systems (EHR) from California to The Virgin Islands and everywhere in between.   My travels have landed me in 75 unique airports and I honestly cannot tell you how many times I’ve traversed ATL, DFW & ORD.  In 2007 I turned down a trip to implement a hospice system in Hawaii because my wife was pregnant.  There’s no way a husband who wants to stay married goes to Hawaii and leaves an expectant wife home alone.  Sometimes we go to cool places but this vocation is not a glamorous one, not by a long shot.

O'hare terminal

Reality for EHR consultants usually involves driving for hours from the airport to the hotel and then on to the hospital in chilling darkness or driving snow.   It’s no coincidence that North Dakota and Minnesota are leaders in hospital EHR adoption.  I know because I was there.  For EHR consultants the work week is a blur of highways, airline terminals, rental cars, cheap hotel rooms, terrible food and hostile clients.

I have implemented systems for home health agencies, hospices (home and in-patient) rural and critical access hospitals, family practice clinics and specialty practices.  Regardless of the care setting or the role of the employee (i.e. clinical, administrative, records, billing, scheduling, etc.) the one thing they can all agree on is their dislike for the EHR guy.

I have been cursed out, threatened and harassed.  I have witnessed doctors, nurses, administrators, clerks and assistants break down into tears, quit their jobs and/or get fired.  In fact, one of the greatest compliments I have ever received was from a young medical assistant when she stated during an all-employee-meeting, “I don’t think this implementation has been that bad.  So far, no one has cried.”

Change is difficult to accomplish in any industry but healthcare is particularly tough.  It’s an extremely complicated ecosystem with multiple stakeholders and competing agendas.  I completely understand why staff may hate to see the EHR guy cross their threshold.  I represent changes in workflow that may shift burdens from one staff member to another and/or increase the level of difficulty related to some tasks while making others easier.  Many times the systems I install make some employees feel threatened as manual-time-consuming-tasks become automated.  At one home health agency an administrator whispered to me, “this software is great, I’ll be able to lay off three people.”    She didn’t actually let anyone go.  In fact, the opposite occurred.  She ended up adding staff as her census increased after fully implementing our system.

Probably the highest hurdle to get over is convincing skeptical providers and clinical support personnel that my intent, by implementing the EHR system, is to help them enhance patient care.  Initially, many providers see me as someone peddling technology that drives a wedge between them and their patients.  Sometimes it takes some convincing, but eventually they come to understand that our goals are the same.  If I didn’t believe that EHR technology was good for healthcare I wouldn’t be doing this job (see list of studies supporting the use of electronic health records at the end of this article).

The travel, long hours and stress take their toll but once in a while something happens that makes it all worthwhile.  Like the time a patient stopped me at a practice and asked me why I was there.  When I explained to him what I was doing there he said, “This is important work you are doing, thank you.”  Or the time while working with the ER night shift at a rural hospital when a man came in mid-heart attack.  I calmly stood by a skeptical nurse as she opened the patient’s electronic chart and clicked one button to order the full emergency cardiac work up including labs, radiology, respiratory, etc.  As the physician examined the patient she and I watched as the other departments swiftly responded to the electronic orders she had entered.  She looked at me and said, “Okay, now I get it.”

Less than two weeks prior to that night one of the ER docs had given me a public dressing down in front of the nursing staff.  He shouted that if the hospital expected him to use the EHR he would quit.  I was able to talk him down and continue the training session but the seed of apprehension had been planted and the nursing staff did not believe in what we were trying to do.  Then the heart attack victim rolled in and they saw the benefits of using the system first hand.  The physician did not quit and we got along quite well as the implementation moved forward.  Once clinical staff understood that I was there to help and that the systems worked, they warmed up.

It can be a hard, often thankless job but it can also be quite rewarding.  Especially, when you return to an agency, hospital or practice that has been on the EHR for a year or so and watch as they smoothly process patient data through the system.  No more scrambling about searching for charts and nervously adhering countless stickers to pieces of paper while standing at the fax machine asking, “Where’s the hole puncher?”  I love it when the staff members that treated me with disdain at our first meeting take me out to lunch and tell me that I was right and that they couldn’t imagine going back to the paper charts of the past.

I just smile and say, “I told you so.”  Then I ask, “how can we make it better?”

- Jeff Riggins

Representative studies regarding the effectiveness of electronic health records:

Escobedo, M., Kirtane, J., & Berman, A. (2012). Health Information Technology: A Path to Improved Care Transitions and Proactive Patient Care.  Generations, 36(4), 56-62.

Schriefer, S., Landis, S., Turbow, D., Patch, S. (2009). Effect of a Computerized Body Mass Index Prompt on Diagnosis and Treatment of Adult Obesity. Family Medicine, 41(7), 502-7.

Schenarts, P. J., Goettler, C. E., White, M. A., & Waibel, B. H. (2012). An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients. American Surgeon, 78(11), 1249-1254.

Redley, B., & Botti, M. (2013). Reported medication errors after introducing an electronic medication management system. Journal of Clinical Nursing, 22(3/4), 579-589.

McGuire, M., Noronha, G., Samal, L., Yeh, H., Crocetti, S., & Kravet, S. (2013). Patient Safety Perceptions of Primary Care Providers after Implementation of an Electronic Medical Record System.  Journal of General Internal Medicine, 28(2).

Goodman, K., Grad, R., Pluye, P., Nowacki, A., & Hickner, J. (2012). Impact of Knowledge Resources Linked to an Electronic Health Record on Frequency of Unnecessary Tests and Treatments. Journal of Continuing Education in the Health Professions, 32(2), 108-115.

Reed, M., Jie, H., Graetz, I., Brand, R., Hsu, J., Fireman, B., & Jaffe, M. (2012). Outpatient Electronic Health Records and the Clinical Care and Outcomes of Patients With Diabetes Mellitus. Annals Of Internal Medicine, 157(7), 482-489.

Calman, N., Hauser, D., Lurio, J., Wu, W. Y., & Pichardo, M. (2012). Strengthening Public Health and Primary Care Collaboration through Electronic Health Records. American Journal of Public Health, 102(11), e13-e18.

Kern, L., Barrón, Y., Dhopeshwarkar, R., Edwards, A., & Kaushal, R. (2013). Electronic Health Records and Ambulatory Quality of Care. Journal Of General Internal Medicine, 28(4), 496-503.

Hoffman, S., & Podgurski, A. (2011). Improving Health Care Outcomes through Personalized Comparisons of Treatment Effectiveness Based on Electronic Health Records. Journal of Law, Medicine & Ethics, 39(3), 425-436.

 

Wound Tracking with a SmartPhone and DropBox account

Recently, while on-site during an EHR (electronic health record) implementation a physician asked me if I knew of an easy way to import wound photos into patient charts. I asked him if he used DropBox and he said that he did. I walked him through the three step process and he was sold.

Anyone not currently a DropBox user will have to go to the site, sign up and install the application on their desktop and mobile devices (PC, MAC, iPhone, Droid, iPad, etc.). DropBox will create a folder on the desktop PC that may used to import files into an EHR application. Even the most rudimentary of EHR systems should allow users to import JPEG and .pdf files. Once this is done importing wound tracking photos is as easy as 1, 2, 3.

1. Use a SmartPhone to take a photo of the wound and choose the DropBox icon.

Screenshot_2013-05-03-11-49-47

2. Upload the photo to DropBox.

3. Access the EHR from a desktop computer, navigate to the DropBox folder and import the photo into the appropriate patient’s chart.

import_button

Wound_import

Depending on the functionality in the EHR program, imported photos may have comments added and/or routed to clinical staff for review, etc.

Wound_in_EHR

 

I’ve also walked providers and office staff through using SmartPhones to scan documents to DropBox using apps like Cam Scanner and then adding them to charts in a similar fashion.

Once the photos/documents have been imported into the EHR they should be deleted from the DropBox folder to make room for additional files and to help ensure that they are not mistakenly added to the wrong chart in the future. Since DropBox folders may be shared all of the members of the care team may add and update files for patients in their care.

DropBox encryption levels meet HIPAA data security standards and the user interface provides the ability to set passwords within mobile apps in addition to the security options already built-in to the device operating system. For example: I have my SmartPhone password protected and my DropBox app set with a different pass-code giving me two layers of security.

As digital health applications continue to evolve patients will likely be given access to upload their own wound photos via a patient web portal. This functionality could prove very advantageous to patients and providers alike by helping to cut down on unnecessary office visits for wounds that are healing well while also alerting clinicians to intervene sooner for wounds that are becoming problematic.

CMS reports EHR progress continues

On April 23rd The Centers for Medicare & Medicaid Services (CMS) released a fact sheet including an update on Health Information Technology progress.

Economic Impact:

  • According to the Bureau of Labor Statistics, more than 50,000 health IT-related jobs have been created since the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009.
  • As of February 2013, the Medicare and Medicaid EHR Incentive Programs have paid $12.6 billion in incentives to hospitals, doctors, and other health care professionals.

Adoption of technology:

  • E-Prescribing: Office-based physicians’ use of e-prescribing has increased from 0.8 percent in December 2006 to 53 percent through January 2013, and more than 94 percent of all pharmacies are now actively e-prescribing.
  • Hospitals:  between 2008 and 2012, the number of hospitals using EHR systems with certain advanced functionalities that go beyond the requirements of Meaningful Use Stage 1 (including physician clinical notes and electronic imaging results) more than quadrupled from 9.4 percent to 44 percent.
  • Doctors: Physician adoption of EHR systems with the same advanced functionalities more than doubled between 2008 and 2012, from 17 percent to 40 percent.

These compelling data add credence to the claim that, “now is the time to invest in Digital Health education.”

Digital Health Communication: Four Reasons to Seek Advanced Education

As 2014 marches on, buzz surrounding digital health continues to build.  

“Smart mobile devices and applications, working in concert with cloud computing, social networking and big data analytics, will be at the core of global health care transformation. These transformative technologies will continue to lead with ways to help rein in cost, broaden access, change behaviors and improve outcomes.” - Pat Hyek Global Technology Industry Leader, Ernst & Young

Considering the widely acknowledged need for advancement in health care technology, combined with the opportunities available for skilled individuals, now is the time to begin a program of advanced study in digital health.

The following is a list of four compelling reasons to seek advanced training in digital health communication:

  1. Digital health is the future of health care.  John Nosta’s article published in Forbes lists 10 factors explaining why he believes 2013 was the year of digital health.  “It seems that the stars are aligned. These glimmers of facts, figures, innovation and needs are converging on the year 2013.”  Google Glass was all the rage in 2013 offering myriad health care applications. The company’s recent acquisition of Nest and the unveiling of their contact lenses, has Google poised to break more new ground in 2014.
  2. Effective communication is recognized as a critical digital health success factor.  David Chase wrote an article for Forbes in the spring of 2012 suggesting that communication is the medical instrument of the future.  “With healthcare representing nearly 20% of the economy, it is inevitable that communications will be a key driver as the tectonic shifts in healthcare shake out. Ushered in will be an array of new technology players similar to consumer and enterprise arenas disrupting ineffective and expensive communication methods of the past.”
  3. Specialized education and/or skills are required to make an impact in digital health.  Larry Mickelberg’s piece for MediaPost highlights three broad areas of health care that make it difficult for the uninitiated to transition into the space (i.e. Healthcare is not discretionary, Healthcare involves multiple stakeholders with complex systems and payment structures & Healthcare skews older).  “In short, healthcare is far more about avoiding pain (of all sorts) than about seeking pleasure, it’s one of the most complex ecosystems in our society and its core target audience is older rather than younger. Healthcare is a parallel universe with its own strict ethical rules, its own cultures and its own high stakes.”
  4. Digital health employment opportunities continue to grow.  PricewaterhouseCoopers 2012 CEO survey revealed that the Health IT staffing shortage is worse than had been previously predicted.  “Seventy-five percent of providers are currently hiring new employees to support their IT priorities.”  Additionally, a survey of IT executives in attendance at the HIMSS 2013 conference, referenced by Lucas Mearian in ComputerWorld, concluded that finding and keeping skilled employees is their most pressing concern.  “It was the second year in a row that respondents to an HIMSS survey listed staffing as the biggest barrier to implementing systems that meet new U.S. healthcare technology requirements.”

Pwc 2012 Healthcare CEO survey

Digital health communication is an expanding field with much to offer those who endeavor to learn the ropes and contribute to the important work that must be accomplished.

For more information regarding Drury’s graduate certificate in digital health communication including how to apply, please visit the enrollment page.

 

EHRs Play Key Role in Fight Against Obesity

Based on data gained from recent studies, electronic health record (EHR) technology is positioned to make a significant impact in our country’s ongoing battle against obesity.

The United Health Foundation (2009) reported that the average American male gained 17.1 pounds between 1988 and 2008 and the average American female gained 15.4 pounds over the same period.  The gradual fattening of the population has created a generation of Americans unaware of the fact that their lifestyle choices may be negatively impacting their health.  Durant et al. (2009) found that people who did not identify themselves as obese were nine times more likely to recognize the possible health risks of their condition when informed of the effect of their weight on their overall health by their doctor.

A person with a body mass index (BMI) of over 30.0 is considered to be obese.  Converting a BMI of 30.0 into a human representation is equivalent to that of a 5’ 10” male weighing 208 pounds.  The next level, a 5’10” male weighing 244 pounds would fall into the morbidly obese category with a BMI of 35 or higher (UHF, 2009).  Without some sort of flag or prompt it could be quite easy for a provider to overlook a patient’s incremental weight gain over an extended period of time.

According to Schriefer et al. (2009) the inclusion of a BMI prompt in patients’ electronic health records increased the likelihood that physicians would diagnose obesity in obese patients and refer them for treatment.  Meaningful use certified electronic health records systems include automatic BMI calculation functionality and physician’s offices attesting to the meaningful use of EHR technology are required to gather vital signs including height and weight (used to calculate BMI) during each office visit.

Studies show that Americans are gaining weight and that people unaware of the associated health risks are much more likely to change their habits if their doctors address the situation.  Research also tells us that healthcare providers are more likely to treat their patients for obesity if prompted with BMI information calculated by the clinical records system.  Certified EHR systems provide BMI data to physicians as a matter of routine increasing the likelihood that they will use their influence to intervene and set the patient on a path to better health.

 

References:

United Health Foundation, American Public Health Association, & Partnership for Prevention. (2009). The American Profile: Weight gained over the last 20 years. 
Durant, N., Bartman, B., Person, S., Collins, F., & Austin, S. (2009). Patient provider communication about the health effects of obesity. Patient Education & Counseling, 75(1), 53-57.
Schriefer, S., Landis, S., Turbow, D., Patch, S. (2009). Effect of a Computerized Body Mass Index Prompt on Diagnosis and Treatment of Adult Obesity. Family Medicine, 502.