Healthcare & Technology

Are you HIPAA Audit Ready?

Do you need help? There are 169 requirements within the HIPAA regulations for which a CE or BA must demonstrate compliance or face harsh OCR fines…

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A New Year of Unprecedented Regulatory Uncertainty

By now, most healthcare organizations recognize the potential for significant change in operations due to the Medicare Access and CHIP Reauthorization Act (MACRA).[i] Organizations will be assigned to either the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Model (APM) tracks. That said, many report they are not ready for the changes and are evaluating consolidation opportunities since it is likely that providers in solo or small practices may receive negative payment adjustments due to the complexity of reporting.

MACRA isn’t the only concern healthcare organizations face in 2017. Both healthcare providers and payers have standalone data silos of systems and applications as well as infrastructure, putting cybersecurity at the top of their list of risks.[ii] Data governance is also needed for “real-time clinical, administrative, financial and health device data” to support non-FFS payment models.[iii]

All this, combined with the newly released Draft 2017 Interoperability Standards Advisory released by ONC[iv] means that the New Year will advance with notable uncertainty, both Regulatory and Political.

Take your holiday break to rest and relax; 2017 will be a busy year.

[i] Son, Yena, and Daniel Kuzmanovich. "Why many group practices are worrying about MACRA shift." Health Data Management. Source Media, 21 Dec. 2016. Web. 24 Dec. 2016.

[ii] Gaynor, Bill. "How Market Changes will Influence data priorities in Healthcare." Health Data Management. Source Media, 22 Dec. 2016. Web. 24 Dec. 2016.

[iii] Ibid.

[iv] Slabodkin, Greg. "ONC releases 2017 Interoperability Standards Advisory." Health Data Management. Source Media, 22 Dec. 2016. Web. 24 Dec. 2016.

HIPAA Audits: OCR becoming aggressive!

OK, so why now?

The HHS Office for Civil Rights (OCR) reports that settlement payments last year were $25.6 million[1]. Subsequently, they are reporting there will be an increase in HIPAA compliance investigations. With resources from settlement fines, OCR believes the industry has had adequate time to develop complete data security policies and procedures. Unfortunately, healthcare organizations are still lagging. But take notice there will be a higher number of investigations by OCR in 2017. That’s more than enough to ruin a good day.

To make matters worse, OCR is not always consistent with its audit process. In some cases, inspections occur over years during which the rules can change. Covered Entities (CEs) and their Business Associates (BAs) must conduct Risk Assessments on a regular basis to ensure compliance. That said, there is no definition of what a ‘regular basis’ means, or what entails a ‘comprehensive Risk Assessment’. They’re not saying HOW to do it, just do it.

Not surprisingly, OCR’s perspective on compliance is “sometimes a matter of judgment on the language in pertinent regulations.[2] ” More funds collected fosters expectations that OCR may increase the number of audits with additional resources funded by received settlements.

[1] Goedert, Joseph. "Why OCR is aggressively enforcing HIPAA compliance." Health Data Management. Source Media, 1 Dec. 2016. Web. 16 Dec. 2016.
[2] Ibid.

Healthcare: The 4th Industrial Revolution

The 4th Industrial Revolution is defined as “a fusion of technologies that are blurring the lines between the physical, digital, and biological spheres. It involves the transformation of entire systems across countries, companies, industries, and society as a whole.[i]” New technologies in health care include artificial intelligence, cloud computing, social media, data science, 3D printing, connected wearable devices, quantum computing, robotics, and genetics that are progressing at an exponential rate.[ii]

How will clinicians adapt to these massive changes in the way they work? According to Peter Senge, “Today’s problems come from yesterday’s solutions.”[iii] The causes of problems often arise from unintended consequences of prior solutions. Technology has become a disruptive force against our existing model of healthcare.

Disruption also comes in the form of ever-changing regulations. For example, consider the impact of Value-Based Reimbursement. Not only does an organization need to pay heed to the financial consequences of prescribed interventions, but also the organization and its physicians must learn the implications of the migration from Fee-for-Service to a much larger perspective of value over volume. Value-Based Purchasing is intended to improve delivery system models that link payment to improved health care quality.

How will it work? As explained on CMS’ website, the “Value Modifier provides differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a performance period.”[iv] The Value Modifier applies to physician payments based on performance in CY 2016. What does this mean to the physician? It means understanding and tracking quality metrics, generally provided by technology (the other disruptor). “90% of Medicare Will Be Value-Based Reimbursement by 2018.”[v]

Healthcare’s behavior patterns will require adjustment to reduce cycles of instability resulting from disruptions in regulations and technology.

[i] GmbH, Schattauer. "IMIA Yearbook: Are We Ready for the Fourth Industrial Revolution?" IMIA Yearbook. Schattauer GmbH, 10 Nov. 2016. Web. 12 Dec. 2016.

[i] Ibid.

[iii] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Doubleday/Currency, 2006. Print.

[iv] "ValueBasedPaymentModifier." Centers for Medicare & Medicaid Services. Centers for Medicare & Medicaid Services, n.d. Web. 12 Dec. 2016.

[v] Bresnick, Jennifer. "90% of Medicare Will Be Value-Based Reimbursement by 2018." Health IT Analytics. Xtelligent Media, LLC., 27 Jan. 2015. Web. 12 Dec. 2016.

 

Keep an open "mind".... your care is in someone's hands

Friday Fantastic Kate Davis tune

 

Are you ready for your HIPAA Audit? It’s coming soon in full force.

The Office of Civil Rights (OCR) has launched Phase 2 of their HIPAA Audit Program, seeking to expand its scrutiny to a much broader array of HIPAA-covered entities and business associates. In Phase 2, OCR will contact Covered Entities (“CE”) and Business Associates (“BA”) to perform desk or onsite audits that comprehensively examine data security practices and compliance with HIPAA privacy and security rules.

Until recently, smaller CE’s have not been a primary focus of OCR attention but now, with this “across-the-board auditing,” CEs and BAs of all sizes will undergo the possibility of HIPAA Audits. This changes the game for those who have ignored the possibility of HIPAA audits in the past. Now, organizations must get their “house in order” to ensure that a Risk Assessment has been performed, Risks are identified, and mitigation policies and procedures, put in place to avoid enforcement actions – many of which can be significant. “HIPAA fines are on the rise and getting larger.”[1] In addition, CEs are required to obtain satisfactory assurances that their BAs are complying with the Security Rule.

Implementing HIPAA compliance begins with a Baseline Risk Assessment that identifies areas in which CEs and BAs have high Risk exposure due to lack of policies, procedures and Security and Privacy Rule compliance. A Risk Assessment is one of the implementation specifications of HIPAA Security Rule—but by far, arguably the most important.

In addition, subsequent Risk Mitigation includes review and implementation of security controls that mitigate identified risks. Possible items may include encryption, employee training, governance of login credentials and security. Moreover, the Security Rule requires documentation for each implementation specification and a written sanction policy. The Privacy Rule requires a log of restriction requests made by patients as well as a log of PHI, access, amendment, and disclosure requests. The Breach Notification Rule requires documentation regarding how the HHS Secretary should be notified in case of a breach. The Omnibus Rule mandated changes to notice of privacy practices and introduced other modifications to the HIPAA Rules. Suffice it to say these regulations are non-trivial. Management must make compliance, their risk assessment and its mitigation efforts, a high priority in addition to ensuring that the right solutions are implemented.

OCR is committed to transparency about the process by posting the updated audit protocols on their website.  “The audit protocol will be updated to reflect the HIPAA Omnibus Rulemaking and can be used as a tool by organizations to conduct their own internal self-audits as part of their HIPAA compliance activities.”[2] Gathering an inventory of security objects (i.e. operations, assets, and workforce members) that create, access, maintain and/or transmit PHI, is foundational to Security Rule audit preparation.

Commercial off the shelf products may be helpful to the implementation of the Security Rule’s Safeguards. If a CE or BA is out in the Risk Assessment wilderness with manual reviews or only paper documents and spreadsheets, or no documentation at all, take a look at Expresso’s Risk Assessment software and all of the Risk Mitigation products available at The HIPAA Survival Guide. “Now that the stakes have changed, those who are unwilling or unable to adhere to HIPAA data security rules threaten not just their own businesses, but those of the public, including yours.”[3] 

[1] Robertson, Cam. "Why HIPAA Audits Raise the Stakes for MSPs as Well as Providers." Health Data Management. N.p., 06 Oct. 2016. Web. 06 Oct. 2016.

[2] "OCR Launches Phase 2 of HIPAA Audit Program." HHS.gov. HHS Office of the Secretary of Civil Rights, 2016. Web. 06 Oct. 2016.

[3] Robertson, Cam. "Why HIPAA Audits Raise the Stakes for MSPs as Well as Providers." Health Data Management. N.p., 06 Oct. 2016. Web. 06 Oct. 2016.

Population Health in Crisis: Patient Care Management

Where do nurses and doctors find the time to provide care beyond the office walls? Given the fragmented nature of the U.S. healthcare system, healthcare providers have increasingly implemented Care Management programs aimed at coordinating the care patients receive to improve quality, reduce per capita cost and improve access to care. Traditionally, coordination interventions follow from several perspectives: medical versus social; short-term episodic or acute care versus chronic and long-term care; and various points of access to the patient (e.g., patient targeting to find those in need of high-intensity services, managed care organization, or physician office practice).[i] 

Care Coordinators (a.k.a. Care Managers) provide outreach to at-risk patients to ensure they receive specialized attention related to needed services. They are a key liaison between the patients and their primary care providers. The general intent is to facilitate delivery of the right health care services in the right order, at the right time, and in the right setting.[ii] Recently, care coordination programs have gained a stronghold where managed care organizations, commercial vendors, academic medical centers, and private health insurers sought to implement mechanisms aimed at controlling costs, improving disease outcomes, quality of care, and patient satisfaction.[iii]

At a high level, a 2000 report, entitled, “Best Practices in Coordinated Care,”[iv] made the following five recommendations for Care Management programs:

1. "Programs should follow the three steps: Assess and Plan, Implement and Deliver, and Reassess and Readjust for all enrolled patients;
2. Programs should have express goals of prevention of health problems and crises, and of early problem detection and intervention;
3. Disease-specific programs should incorporate national evidence-based or consensus-based guidelines into their interventions;
4. Care coordinators should be nurses with at least a bachelor's degree in nursing; and
5. Programs should have significant experience in care coordination and should have evidence of having reduced hospital use or total medical costs."[v]

Care Management software comes in various shapes and sizes. Many fill the needs of Clinically Integrated Networks of Hospitals, Clinics, and practices; others come in smaller sizes to meet the needs of small practices. One such package is Stone Health Innovation’s Idea Care. Regardless of the size, certain capabilities should be part of the care management software solution as described below.

Care Coordination Components[vi] should include:

1. The ability to perform a clinical assessment.
2. Develop a Nursing Proactive Plan of Care (POC) separate but approved by the Physician.
3. Identification of participants in the patient’s care and their roles. This also includes those who are not authorized to view or speak to clinicians about the patient’s personal health information (PHI).
4. The ability to communicate to all team members, including patients and their family.
5. Ensure secure information exchange in communications and across care interfaces. Prevention and mitigation of interface issues for transitions and handoffs between settings of care.
6. Provide the ability to monitor and adjust care goals.
7. Evaluate health outcomes – a principle target. Also, identify issues in coordination and care that may impact outcomes.
8. Ensure ability to utilize standard protocols, evidence-based guidelines, self-management programs, and routine reporting and feedback.

Information provided herein serves as development for a working definition that may be a helpful step for others attempting standardization in the area of Care Coordination. Interventions can be demarcated by type that includes not only use of software, but also educational brochures, mailings and member letters, telephonic care management, in-person care management, call centers and self-monitoring devices. Providers may find patient profiling and reports that originate from registries and clinical information systems, electronic medical records, decision support and other electronic communication systems useful. The Agency for Healthcare Quality and Research (AHRQ) published research on care management entitled “Measuring Value in a Care Management Program.“[vii] AHRQ claims that a measurement strategy is critical for determining the value of a Care Management program and to ensure effectiveness in reaching its goals.

 

[i] McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun. (Technical Reviews, No. 9.7.) 2, Background: Ongoing Efforts in Care Coordination and Gaps in the Evidence. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44011/

[ii] Ibid.

[iii] Ibid.

[iv] Chen A, Brown R, Archibald N, Aliotta S, Fox PD. Best practices in coordinated care. March 22, 2000 [Accessed: January 30, 2006]; Available from: http://www .cms.hhs.gov /DemoProjectsEvalRpts /downloads/CC_Full_Report.pdf. [Reference list]

[v] Ibid.

[vi] McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 7: Care Coordination). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun. (Technical Reviews, No. 9.7.) 3, Table 6: Components of Care Coordination. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44012/

[vii] By Using Structure, Process, and Outcome Measures, a State Can Ensure That It Is Receiving a Complete Picture of Its Program's Value., AHRQ. "Section 7: Measuring Value in a Care Management Program." Agency for Healthcare Research & Quality. U.S. HHS: Agency for Healthcare Research and Quality, 2014. Web. 13 Sept. 2016.

Population Health in Crisis: Patient Engagement

In my first post in this series on Population Health, I stated that EFFECTIVE PATIENT ENGAGEMENT IS ALL THAT MATTERS. There is simply nothing more important than the patient if you are trying to deliver higher quality of care at a lower cost for a population of patients. When clinicians are dealing with many patients they generally do not have the time to effectively educate each individual patient in a manner that may help improve their wellness.

For example, patients with Diabetes require education about exercise and the kinds of foods that are suitable for someone with their condition. Likewise,there is a need to teach all patients, but especially those with comorbidities the importance of staying in compliance with their medications. The list can go on and on. 5-10 minutes with your doctor every three months will never suffice vis-à-vis the kind of information needed to support wellness. 

Almost everyone is using the Internet to search for articles on their conditions, however; often they may encounter information that is inaccurate for their specific circumstances. Nurse note here... “It is always best to check with your Doctor or Nurse” – but they may not be available when the patient needs a question answered. Now we have the role of the “care manager” in population health. The healthcare industry recognizes this obvious need but is struggling how to fulfill it.

One thing is certain as we have discussed before, conversations with the patient cannot take place in a multiplicity of places (e.g. patient portals for every specialist). It has to take place in one virtual space or it won’t take place at all. But, how is this possible if every doctor wants to use their own distinct virtual space to communicate? Enter a visionary startup Docola, whose platform allows the conversations to take place in a single virtual space no matter how many clinicians are treating the patient.

Using Docola’s Platform (or something akin to it) the conversation becomes centralized across all care providers. Care coordinators are able to pull the requisite patient information from multiple EHRs and other data sources to effectively educate the patient. In fact, Docola’s Platform is, among other things, a patient education platform. Now clinicians can choose from world-class clinical content publishers the educational courses that have the potential to make an enormous contribution to patient education, while at the same time ensuring that the patient conversation takes place.

The certainty of this approach for patient education is self-evident. The reason that we have not seen this type of system receive widespread success is that the healthcare industry, despite recognizing the need and potential of this type of Platform, is struggling to develop the business model(s) that would make it work. In short, the industry is struggling mightily to remove the shackles placed upon it by Fee-For-Service. However, disruption is coming.

Population Health in Crisis: From Cowboys to Pit Crews

In my last post, using Atul Gawande's TED Talk as an example, I discussed the need for healthcare training to transform itself from educating cowboys and cowgirls (i.e. fiercely independent and self-reliant clinicians) to coaching “pit crew” members.[i] Don’t hold your breath - this transformation will not happen anytime soon; clinicians were trained in a particular way for well over 100 years. Moreover, academia is the last industry in the world from which you should expect innovation. It’s not going to happen. That leads us to the question of knowing what type of professionals and skills are required to deliver on the promises of population health.

Healthcare workforce education has traditionally focused on a siloed approach and rarely offered students of diverse disciplines the opportunity to learn together in the classroom or through experience. This siloed approach has contributed to the constant problems faced in health care. What healthcare needs is a learning organization. A learning organization uses systems thinking to see the surrounding parts as a whole. It is an antidote for complexity and with the scale of complexity at its highest in Population Health initiatives, systems thinking can provide the discipline for “seeing the structures that underlie complex situations.[ii]” Interprofessional education and practice has shown to improve healthcare’s ability to provide high-quality patient-centered care.[iii]

Professional Services

As software and hardware continue their downward spiral toward more and more commoditization, services become the key differentiator. The professional services sector is becoming increasingly critical to the success of population health projects. That is why the main commercial population health vendors have ongoing initiatives to strengthen this part of their value propositions. Even the uninitiated quickly discover the myriad of complex skillsets required for the recipe that delivers on the promise—from HIT professionals to top notch clinicians—spiced of course with professionals who can bridge the gap between the two.

          All growth will come from intellectually based services.

          —James Brian Quinn

My primary complaint against a professional services led model is not that talented consultants do not bring significant value to the table, but that their business models often work to the detriment of providers, especially in the population health space. Here’s why. Maximizing billable hours is their principal mechanism for increasing revenues. They develop sophisticated techniques for achieving this end, including a never-ending obsession with account control. The goal from a provider’s perspective is to minimize the amount of time and risk it takes to develop and implement population health solutions. These two goals are diametrically opposed. In turn, when revenues begin to fall, they cut corners to compensate and as they push harder they begin to realize that the easy way out usually doesn’t work.[iv]

Consider the fact that for professional services, maximizing revenues for a given project requires providing more warm bodies and billable time instead of fewer. The key for providers is to hire a professional services organization that is thoroughly focused on doing more with less and transferring knowledge as fast as providers have the bandwidth to absorb it.

Although professional services continue to increase in importance, not all service providers have the best interest of their customers in mind, caveat emptor! The question you should ask any service provider is “How do you intend to reduce the number of project hours required for closure?” Enough said.

The Environment

During the dot.com craze, companies thought they could instantly manufacture a corporate culture of creativity by having a fully stocked kitchen, game rooms, casual dress code, and mandatory corporate fun activities. All of these culture creation props, for most of these companies, were as empty as their bank accounts. These perks are obviously nice to have, including a physical work environment that is conducive to creativity and personal productivity, but they are no substitute for a sincere corporate culture. The burden of consistently working 60-80 hour weeks for months at a time, and spending precious little time with those you love, will not be lessened by ten free diet cokes a day.

Shared Values

It is clear that a sustainable corporate culture must be built on a foundation of open communications and a shared set of core values, which include: honesty, integrity, respect, diversity, and profitability. Your shared belief system must permeate the entire organization and manifest itself in the day-to-day operations of the business. This common belief system should be self-evident.

Us Versus Them

The business press quickly killed a good-sized forest with all the print space that has been dedicated to the importance of cross-functional teams and communications. Despite this, organizational silos exist everywhere you look. Why do these walls remain when there is universal agreement that they significantly contribute to organizational dysfunction? Apparently, as previously mentioned, the walls remain because individual stakeholders often have a perceived vested interest in maintaining them. Nowhere are silos more insidious than in population health projects given the enormous amount of cross-functional support required for success.

One way to begin tearing down the walls is to eliminate physical barriers that exist between various departments. Have Nurses and Therapists intermixed in adjacent cubes or offices. While you are at it, throw in a Doctor as well. The daily communal contact will enhance cross-functional communications. Without encouragement from anyone, neighbors will begin to break bread, and perhaps have a drink together after work.

Another, perhaps better, way to improve cross-functional communications is to encourage Natural Leaders and individual team members to open dialogs with all business functions required to accomplish the mission. Frequently line executives prevent cross-functional communication because of their prejudices, fears, and insecurities. Learn to maneuver around these obstacles and watch as the communications process improves dramatically.

Talent Connoisseurs

Our people are our greatest asset.  We should all agree to abolish this statement from the business lexicon because at 99.9% of the companies that I have worked or consulted with (unfortunately) this statement is empty rhetoric and corporate propaganda of the worst kind. Most companies do not treat their employees as if they were the business crown jewels, and everybody knows it. Cut the baloney unless you can deliver the goods.

Everything else being equal (and of course they never are), the companies with the best teams will win more often than not. It follows that you will require excellent coaches and talent scouts to sustain an advantage. You better pay these folks well because they will be (and are) in high demand. Recognizing quality talent is a tricky business, and if you rely on Ivy League pedigree nonsense as your principal criteria, one of your competitors is likely to wind up with all the golden needles in the haystack.

The Recruiting Buzz

When I am brought in to help an organization build a team, the first question I ask is “What is your recruiting buzz?” Of course, I always get the expected response, blank stares followed by “What are you talking about?” In a labor market where quality talent is scarce, they are in the driver’s seat and are usually very selective when choosing new assignments—not unlike the best actors and directors in Hollywood.

Why would the best talent want to work for your company, and on this particular population health project? Your recruiting buzz answers this question. It is the story told to candidates to get them excited about your mission. Companies are often engaged in very cool and exciting projects, yet they do not know how to milk it for all it’s worth during the recruitment process. Don’t get me wrong; this is definitely not about selling a story that will vaporize as soon as the newly signed up candidate walks through the door. It is about presenting what your project has to offer in the best possible light. Without a great recruiting buzz you are unlikely to win your fair share of the best candidates. Build it. Practice it. And use it often.

[i] Gawande, Atul, MD. "Transcript of "How Do We Heal Medicine?"" Atul Gawande: How Do We Heal Medicine? TED Talks, Apr. 2012. Web. 28 Aug. 2016.

[ii] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Crown Business, n.d. Print.

[iii] Knickman, James, Anthony R. Kovner, and Steven Jonas. Jonas and Kovner's Health Care Delivery in the United States. 11th ed. New York: Springer Publishing, n.d. Print.

[iv] Senge, Peter M. The Fifth Discipline: The Art and Practice of the Learning Organization. Revised ed. New York: Crown Business, n.d. Print.

 

Population Health In Crisis: Lack of Communication

It is not the Internet, or the Internet of Things, or Big Data, or analytics, or a host of other technologies that are foundational to population health that will eventually transform healthcare. These technologies may be necessary, but they are certainly not sufficient. No, what will drive transformation is the way in which the medium will improve conversations that take place between human beings (i.e. between providers and patients). The improved human dialog is the change agent.

We need to insert the patient into the equation. Although this may seem obvious, it is one that the FFS model has ignored for well over 100 years. Everything else was a distant secondary consideration. Why has the patient been left out of the equation? Because unlike almost every other market you can imagine, in healthcare the patient historically was not the entity that paid for the services. Hence, from an economic perspective, the healthcare industry was free to ignore the very people they purportedly served.

Atul Gawande spoke about the need for communication and systems thinking in healthcare. In a TED Talk, he summed it up by saying “We’re all specialists now, even the primary care physicians. Everyone just has a piece of the care. But holding onto that structure, we built around the daring, independence, self-sufficiency of each of those people has become a disaster. We have trained, hired and rewarded physicians to be cowboys. But it’s pit crews that we need, pit crews for patients.”[i]

The very reason that population health is in a state of crisis is that the focus formerly has been on a million and one potential distractions with very little attention paid to how we were going to engage with the patient, and moreover exactly where was this engagement going to take place. A premise of the population health “movement” is that healthcare has to transform its view of the patient from a “clinical thing” to be examined and studied, to a natural person with whom we want to engage in a mutually beneficial dialog.

A few thousand years ago there was a marketplace. Never mind where. Traders returned from far seas with spices, silks, and precious, magical stones. Caravans arrived across burning deserts bringing dates and figs, snakes, parrots, monkeys, strange music, stranger tales. The marketplace was the heart of the city, the kernel, the hub, the omphalos. Like past and future, it stood at the crossroads. People woke early and went there for coffee and vegetables, eggs and wine, for pots and carpets, rings and necklaces, for toys and sweets, for love, for rope, for soap, for wagons and carts, for bleating goats and evil-tempered camels. They went there to look and listen and to marvel, to buy and be amused. But mostly they went to meet each other. And to talk.

Yes, markets contain prominent conversations. The Cluetrain Manifesto[ii] propelled this meme on the world’s stage over fifteen years ago. However, very few people intuitively understand the implications, and fewer still are leveraging the idea, as a way of doing business in healthcare. Enormous opportunities await any organization that finds its voice, and through it learns to have an ongoing conversation with its patients.

Further, patients are eager to have this conversation, as long as it is no more demanding of them then their use of Facebook, or WhatsApp, or Snapchat or whatever social media platform they choose to engage with. Moreover, it is clear that the conversation needs to take place in one virtual space, not hundreds. The idea of patient portals is DOA. Why? Because a patient is not going to visit twenty different portals to engage with all the clinicians (i.e. specialists) that our currently fragmented delivery system mandates.

 

[i] Gawande, Atul, MD. "Transcript of "How Do We Heal Medicine?"" Atul Gawande: How Do We Heal Medicine? TED Talks, Apr. 2012. Web. 28 Aug. 2016.

[ii] Rick Levine et al., The Cluetrain Manifesto: the end of business as usual (Cambridge: Perseus Publishing, 2000).