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Wednesday, May 31, 2017

This Is An Article The myHR Team Need To Take A Close Look At. Might Help A Little.

This appeared last week.

HIT Think How to build portals that entice patients to use them

Published May 23 2017, 4:09pm EDT
There will always be a segment of your patient population that just isn't interested in using a patient portal. But, over time, most people will want to electronically communicate with their healthcare provider—and they will want an engaging and useful online experience.
So what does a patient portal need to succeed?
Over time, a portal should become the foundation for more extensive electronic communications between patient and provider—a tiny seedling that will hopefully blossom into a collaborative relationship. So, what functionalities should patient portal tools have to succeed?
Perhaps the best approach for many care provider organizations is to follow a progressive strategy, starting with some basics and moving toward a robust tool that enhances the patient/provider relationship.
The starter set
According to polling data, patients want to schedule appointments, pay bills and view records online, and most providers don’t offer this trifecta. It makes sense to start with these three basic capabilities because they’re relatively easy to install and attractive to patients.
Beyond these three functions, it’s essential to look at portals from other functional perspectives as well as overall usability. Sure, you could build a portal that enables patients to view every data nugget in their record, but it won’t matter much if the tool is clumsy and ugly.
Core functional capabilities
Capterra, an organization that identifies ideal software solutions for specific business needs, talked to actual users (patients, in this case) to determine what’s optimal in the patient portal experience. Capterra has identified some core functional characteristics that the best solutions share.
  • Make it easy to sign up and log in. Patients get frustrated and tend to not use the portal if the very first thing they must do is prohibitively complex. Choose or create a tool that has automated password recovery and that is available to patients any time, night or day.
  • Give patients secure access to doctors. Patients want responses to medical questions from a doctor. Carefully consider this issue; patients told Capterra they don’t appreciate being shuttled to nurses or front office staff for answers to health questions.
  • Enable attachments. Patients want to be able to send attachments to physicians via email. Yes, this could enable an avalanche of iPhone images of poison ivy rash, but it may also keep patients out of the clinic, saving time and money.
  • Include automated alerts. Patients don’t want to just check occasionally to see if they might have a new message. They want to be notified electronically when something in the portal changes.
  • Make it easy to schedule appointments online. Mentioned above as one of the three foundational patient portal capabilities, the ability to make online appointments eliminates one of your patients’ pet peeves: waiting interminably on the phone instead.
  • Connect to the EHR. Many portals are a component in the broader EHR, and others are standalone but integrate with an EHR, so virtually all available solutions satisfy this requirement.
  • Make it mobile. Human beings are taking their technology with them wherever they go. Most people check and respond to email on a mobile device now, and they want solutions that are optimized for both mobile and non-mobile platforms.
  • Facilitate bill payment. Increasingly, just about every possible bill-paying scenario is available online. Moving forward, the patient-as-consumer will gravitate away from providers that can’t enable them to pay medical bills online as easily as they can pay the gas bill.
Some portals offer functionalities that just need to be “turned on;” others don’t and may require further IT development and customization. Either way, it’s clear that healthcare consumer online tools should approximate the experience of accessing other types of services. Yes, healthcare is different, but patients are also consumers who will shop for providers with modern electronic tools if their frustration exceeds a certain threshold.
Lots more useful ideas are found here:
If those responsible for the myHR were serious about doing what the consumer want they would be fundamentally re-doing the architecture of the myHR.
Dream on David.


Anonymous said...

You would need some proper Architects with a strong background in health informatics and computer sciences for that David. I believe Tim flushed them all down the privy. Still I am sure they can present something in power point that seems to be the tool of choice these days.

Anonymous said...

David, before you post this, and happy you don't as they will remove as soon as they read this. Look at the latest RFT for Interoperability from the ADHA. It demonstrates a breakdown of quality and process, currently the document was released with tracked changes, the first copy I downloaded seems to have been replaced as the first copy did not include the contract section. If they cannot manage to get a management document correct how can we trust their quality approach to clinical information

Anonymous said...

8:09am thanks. That is shockingly sloppy but it is probably a fair reflection of the organisation. I am also not clear what exactly they are after, seems a opening for some to make good money on an poorly define brief and obviously limited capacity to understand if what they get is useful or vaue for tax payers.

Anonymous said...

Slap happy failure is the new well planned success criteria. This document is amusing, misses the subject point completely. Like Data, Interoperability is good, don't ask why, is must be everyone says so.

Anonymous said...

Minter Ellison is shown as the Author in properties for the PDF Vs of the Interoperability RFT.

Anonymous said...

@ 8.09 AM "the latest RFT for Interoperability from the ADHA."

So the successful Tenderer (Contractor) commences 17 July 2017 and concludes 30 August 2017 – 6 weeks!!. OMG - Have a look at this crap. Who wrote it?

The major domains to consider when developing interoperability principles include …….

the prediction and prevention of illness; improvements in health and care outcomes; higher quality, safer and more effective health and care systems; and achieving financial sustainability in Australia's health system whilst demonstrating value for money.

Anonymous said...

I've just read the "the latest RFT for Interoperability from the ADHA" referred to above - Anon 8.09 AM. Have a read of Part B: Services – Tragically appalling and it gets worse the further in one reads – The First Key Deliverable, The Second Key Deliverable – this stuff is written by aliens from outer space. They are full of verbal bulls—t and they have no idea, not even a skerrick. Taxes being wasted by the truckload.

Anonymous said...

Who wrote it? - that is listed in the document, no idea who that person is and is certainly not recognised in this field. I suspect it is a tick the box exercise. Did the Board not close down the Standards and Interoperability team and make redundant those with the qualities needed to appreciate this art?

John Scott said...

Colleagues, if we were to accept the Description of Services as a genuine request for knowledge, ADHA would have:

1. to start with human relationships and communications and the necessity of shared semantics at this level BEFORE moving on to address the connectors to the technology sub-strata. This is the requirement for pervasive semantics and is something which broadly exists in health--because they have been developed over centuries.

2. to have a framework that embraced the manner in which human social networks use technology.

Essentially, the broad architecture would have to encompass:
- ‘Network’ of social relationship - because here we decide whether and under what conditions information will be exchanged;

- The information flows needed to support the choreography of healthcare and the conditions under which such information flows are permitted;

- Communications Services (technology) that can deliver the above flow of information; and,

- ‘Network’ of Technology and support services.

In all of the above there is an implicit assumption that medicos and other clinicians as well as patients and carers are motivated to change their existing behaviours.

Finally, assuming that a Strategic Framework for Interoperability, broadly matching these requirements, was produced, the real question is: How could ADHA continue with the MyHR?

Anonymous said...

4:50 PM The only name I can find is on Page 4 - Contact Officer Berne Gibbons,who since Sept 2016 is GM Operations ADHA - prior to that UTS, PwC, Slainte Healthcare, Telstra GM Health, https://www.linkedin.com/in/berne-gibbons-6286586/?ppe=1

Anonymous said...

I am not sure Telstra Health counts, those periods are before Telstra Health proper, I do recall Telstra use to have someone they sent to various events to showcase the Telstra brand. Still can't see the connection with Strategy or Interoperability wonder if the ADHA can spell semantics

Anonymous said...

Value back to the tax payer will be Covfefe, and the meaning behind this document is known to a select few

Anonymous said...

ADHA blog for the Interoperability thing - Sharing patient information across the Australian healthcare system is a complex issue requiring the alignment of policy, workflow, patient information, even business models.

These should be amusing conversations, I was hoping the ADHA would be a return to intelligent dialogue where real challenges could be worked through. Have we as a nation lost the ability to attract and retain eHealth experts in our national institute. Hope they are not talking with ONC and other national eHealth organisations. To think FHIR was born out of Australia and within a few years we have come to this.

Anonymous said...

My submission based on the RFT:
Transgressing the Boundaries: Towards a Transformative Hermeneutics of Digital Interoperability and the impact of the male Pei's as a scocial construct inhibiting and at best, intergration is genuinely an example of hyper-patriarchal society metaphorically manspreading into the global digital ecosystem.

Will give the ADHA something to chew over.

Unknown said...

To compliment this discussion that has referred to Patient Engagement (Thanks Anonymous)I provide this link from the NEJM this week (I have full text).

Bernard Robertson-Dunn said...

re: "RFT for Interoperability from the ADHA"

"A.2. Summary of Services
A.2.1. The Agency has a requirement for the provision of services to develop and implement an interoperability strategy for the digital health ecosystem in Australia with the work to be undertaken consisting of the scope of work as specified in this Schedule 1."

and in the next section

"A key theme of the National Digital Health Strategy will be to “support me in making the right healthcare choices, and provide me with options”. Achieving this goal will require an interoperable environment, supported by digital technology and standards."

So AHDA wants to create a whole "interoperability strategy for the digital health ecosystem in Australia"

Gee, that's impressive, a "digital health ecosystem". I wonder what that is, they don't say. But ADHA does want an interoperability strategy" to support it.


a) this is an impossible task. Healthcare and the healthcare ecosystem are far too complex endeavours to design, top-down. It's like trying to design the financial ecosystem but harder. Nobody in their right mind would even contemplate such a thing.

b) why is the federal government even thinking of attempting such a thing? Apart from the impossibility of the task, they have no authority to implement it. The healthcare industry (for better or worse) is full of independent participants who cannot and will not be told how to behave or operate. It's hard enough to herd federal agencies, never mind state governments and the private sector.

The issue of authority is the elephant in the room for everything the ADHA does. The agency and its parent the Department of Health have no authority to dictate to the health industry in the way it conducts its healthcare.

They can rant and rave all they like about the supposed benefits of MyHR but unless they are real and tangible, MyHR will not be used. Use cannot be dictated. It will probably just end up being a black hole for a hodge-podge of data and a sinkhole for money.

An "interoperability strategy for the digital health ecosystem" may well get developed by some management consultancy but it is most unlikely (IMHO) to get beyond the vapour-ware stagey.

Unknown said...

To compliment this discussion that has referred to patient engagement (Thanks Anonymous) this came from the NEJM this week. I have full text access.

Bernard Robertson-Dunn said...

and to give you an idea of the craziness of this "initiative":

re “support me in making the right healthcare choices, and provide me with options”

So I want to make a choice about the best doctor to see.

What data would I need on doctors to base a choice? Where would it come from? How reliable is it? Will doctors support such a scheme?

There's a myriad of other questions about just this one issue. It's already been thought about and has enormous difficulties and complexities.

And I wonder what the AMA would say about such a thing. I'm sure we'll find out if it is ever seriously suggested.

Anonymous said...

Interoperability is not something you can enforce as you point out Bernard. A CIO might be able to in an intranet environment however the art of interoperability is about negotiating layers of agreements and a willingness to share information. Government can assist by ensuring policy, legislation and standards are amicable towards enabling interoperability.

Interesting they seem to not consider the consequences of interoperability and all the innefiencies it exposes. I wonder how they will review responses as they seem rather lacking in foundational understanding. Maybe they let go of the wrong contributors. Trust is a key enabler, not sure I would trust these people.

Anonymous said...

Trust is a key enabler, not sure I would trust these people.

Could not agree more, there seems to many half truths, misleading statements and claims and an emerging culture of domanace and tyranny. I hope this ends well for all those throwing their business and customers in with this mob.

Anonymous said...

support me in making the right healthcare choices, and provide me with options

Does anyone else find these 'me' lines a little disturbing, seems very selfish and divisionalised. Seperate them and let them turn on each other while we pick of the weak.

Maybe I am to reliant of my GP and community focused.

Anonymous said...

The last time the government did this - maybe 15 years ago - the recommendation was 'just use XML, it's self-describing'. We can probably look forward to another useful contribution of this nature again....

Anonymous said...

4:24pm. Yes this is a worry and a commonly research topic. The phases used are very reflective of a UK phenomenon in the U.K. During the 2000's and is yet another example of the regurgitating narcissistic theme will have ended up with in this iteration of eHealth. Unfortunately David you will not be able to retire your blog for many more years to come.

Anonymous said...

All you negative fear mongering My Health Record sceptics need to take note that there is another view of the world thanks to Jeremy Knibb at The Medical Republic.

That’s not a compact: THIS is a compact

" ..... if those in the ADHA and DoH can swing this project, as they imply they can, why wouldn’t we try to help them get there?

I’m going to make a long-odds bet on the mark being even higher than 50%. The reason being, we all need to be positive during this period and do all we can to give this thing it a big fat shove.

There are allegedly some idealogues out there who still will say the project has no hope, that it is and always was fundamentally flawed. There is a well known group of what we could term “fundamentalist opt-inners” who say that by going to “opt out” the MyHR is already doomed.

I don’t think so. But that is a complex argument which we won’t examine in this piece.

I think that with enough commitment, energy and smarts, it is just possible to tip this project into something that pays respect to its original vision."

Anonymous said...

Just stay focused on the dynamic dou and their mission statement 'no fax please we're British

Anonymous said...

We have now made 8 attempts to register with the ADHA for Q&A Clarifications and Amendments on this RFT by sending an email to the address below. Unfortunately our emails keep bouncing back so we have to assume the email address provided by the ADHA in the RFT is not active !!!!!

If anyone has any luck using:
please let us know.

John Scott said...


Jeremy Knibb's article in the MedicalRepublic is an interesting contribution and possible circuit breaker. It is however, dependent upon the ADHA's willingness to move toward finding our deep mutual interest.

I, for one, will be very interested to see if Jeremy's article is able to solicit a positive response from the ADHA.

Anonymous said...

11:10 pm. Email bounce back? I also note that unlike every other Tender there is no webinar briefing? Without clarification I causes me to make the following assumptions
1. The reason ADHA operations seems from the outside and hinted in the blog to be such a mess if the GM for operations cannot get an RFT out properly
2. An email and webinar are not required as EY or similar already have been given the nod
3. It only requires six weeks to develop because the work has been previously undertaken (probably by the now redundant Interoperability team).
4. ADHA cannot explain either interoperability or what they actually want to a potential audience who can.

Either way it certainly indicates they have work to do before Opt-out if we cannot even communicate with them on this important subject.

Good job it's only tax payer money.

And yes can now confirm a bounce back on the email

Anonymous said...

John Scott, agree an interesting article and a great challenge to put in the table. I have been advocate for greater access to health information for all consented to parties and at a time I favoured the PCEHR. I still champion the former but believe the latter has had its day much like the fax machine. Technology and the understanding of technology in healthcare has moved forward, the PCEHR may have contributed to enabling a better understanding and familiarisation of HIT but I fear to continue with the MyHR at the cost of taking us to a more atomic data state will hold us back for decades.

Back to the article I will be interested to see if the ADHA CEO has the muscle or authority to enter into such a compact. As for smarts, I agree but that capability is fast diminishing at the ADHA from what I have observed.

Bernard Robertson-Dunn said...

I get the impression that ADHA doesn't have the foggiest idea what to do in or with Digital Health. Which isn't really surprising considering Digital Health is only a buzzword and means different things to different people.

To many vendors it's a term they can use to sell their wares.

To others it's simply applying the solution to old problems (IT) to the problem of healthcare (HIT) - a dangerous thing to do when the problems are very, very different.

ADHA has been going around asking people what they want from eHealth/Digital Health which IMHO is a dead giveaway that they don't know what Digital Health is, or could be, and have no vision or sense of leadership of their own.

They have been told to run MyHR which is something of a poisoned chalice, especially for Tim, but as for anything innovative - I've seen no indication they have any ideas. All we get is a regurgitation of the party line from people like Meredith Makeham, which is so at odds with what the myhealthrecord.gov.au website says that it borders on the fraudulent.

ADHA seems to want to be told what to do, but, ironically, are not disposed to listen to people who have far more experience than anyone at ADHA has and who have some good ideas about what can be done and what should be avoided - i.e. David and those who comment on this blog.

We are in a leadership free zone.


Anonymous said...

Bernard you may see this as sad, I would suggest it is more than that, collectively just the EGM layer and CEO would account for some $ 2 million a year, the quality or very apparent lack of quality and process as apparent from the Interoperability work is a major concern. In iscolation it could be passed of as an inexperience indervidual in the wrong role. However, it is yet another contribution to an ever increasing mountain of substandard output from the Department and its Agency.

This is a national body and should present the highest standards, it is not a couple of kids running a YouTube gaming channel.

Anonymous said...

Anon 2:33pm I agree with your sentiment and it would on the surface appear that the need to get something, anything out the door over ride basic editorial and publication processes. What happened to no longer over promising and under delivering? We are as a nation about to embark on a massive information and technology change that will directly impact every Australian, this seemingly apparent future of 'she'll be right' is one that indicates a very high risk with potential catastrophic results.

Anonymous said...

Hate to break it to you all but this will be water off the digital ducks back, in a week at the most it will be a distant memorary soon forgotten. The decline will continue much the same as before.

Anonymous said...

You may well be right, however the quality of some will remain known and some insight into events of late are just a little clearer.