I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in February 2006.

Joe Sixpack’s Concerns About Privacy and Security Need to be Taken Seriously
By Mr. HIStalk

Is it just me, or are we having a sudden epidemic of privacy and security breaches in health care organizations?

Quite a few examples have been reported in newspapers and on TV lately, including the embarrassing “backup left in the back seat” exposure at Providence Health System. Patients are angry, lawyers are salivating, and those organizations involved in such breaches are fixing the gate as the horse gallops away.

Consumer Reports joined the fray this week, expressing concern that our electronic systems may not protect personal health information. Not just from thieves, but from drug marketers and fundraisers as well (odd, I know, but that’s what they said).

Hospitals used to feel safe, rationalizing that much more attractive targets such as banks would receive hacker priority. Indeed, hacker-type security breaches that expose patient data are fortunately rare (medical information has little cash value and few willing customers, so we can’t take all the credit).

We in health care IT may believe that the biggest barrier to our obviously beneficial migration to electronic medical records is money. Outside our world, however, Joe Sixpack doesn’t give that a thought (he’s seen all those construction cranes darkening our hospital skies, so he knows we’re doing OK). He’s worried that his neighbors will learn his medical history, that his employer may fire him for poor health, or that his insurance will find a reason to deny him care because he is predisposed to need it.

Joe Sixpack understands stolen paper charts, but he doesn’t worry much about that. He knows thieves seldom bother, for the same reason they’d rather not steal pennies from a wishing well: it’s too much work and risk for too little gain. Electronic records are obviously more attractive. A single computer, backup disk, or unprotected server can hold thousands or even millions of medical records that are easy to carry and hide, attracting a thief who’s more interested in showing how smart he or she is instead of robbing a convenience store.

(And of course, there’s a good chance that the prospective thief is your own employee, as I’m sure you already know.)

Joe Sixpack might view your EMR project as unusually risky, despite liking the concept. He doesn’t know what precautions you should take, but he’ll hold you accountable if you are breached. Odd, isn’t it, that a physical break-in seldom reflects poorly on the company being victimized, but an electronic one immediately triggers outrage and disbelief?

Other industries already have electronic records, so their risk is lawsuits. Healthcare is just moving to electronic data storage, so our risk is greater. The implied threats could stall our efforts to get there.

I think we need to take quite seriously those concerns about privacy and security as we solve connectivity problems to support RHIOs and integration. That means money diverted away from much-needed functionality to hopefully never-needed security. The people sitting around the table need to come from all industries, not just healthcare. We’re fairly new at this security thing, after all.

Most of all, we need to pay new attention. When Consumer Reports is worried about health care security and privacy, that means a lot of Americans are worried. We need to reassure them that we know what we’re doing.

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An HIT Moment with ... is a quick interview with someone we find interesting. Daniela Mahoney, RN is president and CEO of Healthcare Innovative Solutions of Seville, OH.

Hospitals are still struggling with implementation of CPOE. What are some lessons learned about how to do it right?

There are a few major areas in which hospitals typically fall short. These are the items that often do not make it into the vendor’s work plan.

1. Understanding the true effort that will be necessary to successfully implement such transformation.
2. The impact organizational culture has on the planning process and how the project will be operationalized.
3. The focus is concentrated on physicians, and rightly so. However, a team of clinical resources is responsible for the execution of the orders. This clinical transformation is often not understood until after the implementation. Then the organization’s response becomes very reactive. You see a high number of unintended consequences that could have been easily prevented had the organization fully understood the impact CPOE has on the clinical teams.
4. And, as surprising as it may sound, many vendors are still very young at implementing CPOE. It seems they are learning as they go.

These items are equally important. I go to any hospital assuming that the vendor understands their platform and knows how to configure their software and upload their master profiles with the necessary parameters. Most of the time this is true, especially with some of the big players (but not always with some of the other vendors).

However, if you are lucky enough to get a work plan from the vendor, you realize that it is all about the technical steps that must be executed. CPOE is about 15% technology (the easy part) and the rest is all about process, yet 100% of the tasks are typically technical or software related. There may be references regarding “analyze current workflows,” but if you have never done this, one is asking, “What exactly are we analyzing and from what perspective?”

Workflow analysis is not a new concept for us in healthcare because we seem to always try to improve, become more efficient, and provide safer care for patients. The larger the organization is, the more initiatives or “lean” teams they may have. However, most of the smaller, community-based hospitals have a steeper hill to climb.

How do we go about addressing some of these challenges? Remember that culture eats strategy every day. When we look at culture, we should think about it holistically as an organization. Then we should focus on the medical staff to truly understand what can be accepted, how we should present the value proposition to clinicians and physicians, and how to sometimes compromise since everyone has to give up something. I try to create value propositions around the patient. Placing the patient at the epicenter of the transformation puts a different light on the whys and hows.

Some vendors offer packaged / fixed fees implementations. Budgets are estimated, approved, and the implementation begins. All is good, but we learn that there were no allocations for contingencies or considerations for what else is going on when the planned live event is scheduled (as simple as Halloween and they cannot get the appropriate staff for support — it sounds funny, but it is true). If we pull nursing for support, who will bridge the gap for patient care? Should you plan for external agency staff for patient care? Do you trust that they will do a job that you will be satisfied with? After all, these are your patients and their satisfaction is very important.

Should you outsource the support instead? If you do so, will your staff be less proficient? In what budget are these hours accounted for? Have you budgeted for training? How about retraining? These packaged deals often offer a false sense of security that the vendor will take care of it. Well, let me be candid and say, “They will not.” You cannot go to sleep at night thinking that you have nothing to worry about. The vendor has their responsibilities, but you have yours. Be sure you understand what they are. It takes two to tango, and if you are not careful, toes will be stepped on.

We need to understand that the true effort is not just on the IT side. That part is the most predictable, but understanding the effort required for clinical transformation can be overwhelming, almost daunting, when we realize what it is. At that point, timelines are typically slipping (and some vendors have financial penalties if you not meet them). These days, you have to meet the political timelines set by CMS so the organization does not lose its opportunity to get the incentive dollars. Because of this, there is a fine balance on how much transformation can take place, so the implementation moves along, remains on track, and the appropriate redesign processes occur, making good clinical sense.

Sometimes this balance comes with experience, but perhaps following some general concepts, such as not letting perfection getting in the way of good, may still accomplish the goals. Avoid paralysis by analysis. Realize that the CPOE implementation has a clear beginning, but not an end. It is a continuous journey that will give you the opportunity to improve as long as you recognize this upfront and create a governance structure to allow for constant process improvement. These structures and efforts are typically not budgeted or accounted for upfront. Knowing that it will not be perfect on Day One, don’t cut this piece of the budget just because it may seem the most expendable at the time. It has to be, however, safe for the patient. There should be no compromise for this, but if we do not measure, it will be hard to know.

What are some of the best practices involved with supporting physicians using IT systems?

The best practices I have seen for supporting physicians are not all the same. The organizations that provide support to most adequately match the culture of their physicians and organization are the most successful. To think that cookie cutter methods will work best is simply naive. Managers and administrators know their physicians and culture better than outsiders and should provide support based on what is best for their organization.

It is important to gauge the perceptions of your physicians in order to hear them out prior to designing a support system. It is very likely that your interpretation of what it means to implement CPOE is totally different than a physician’s interpretation. Setting expectations and defining what is expected of everyone will most likely lead you to providing support that the physicians feel is adequate.

At the end of the day, however, I have not seen anything more effective than one-on-one support among a blend of other options such as peer to peer or using residents when possible. Physicians respond well to nurses and they are instrumental in propagation of physician adoption. It is essential to understand how physicians process data when they make decisions. Understanding their rounding process and patterns and the data they need will offer valuable insight into how much support is needed, where the support should be placed, and how to deal with less-frequent users.

As a nurse, do you think hospitals are placing the right emphasis on clinical IT to help nurses?

I am seeing variations on this front. The average age for a nurse is somewhere around 48 years young. Many hospitals, especially more rural community hospitals, are still intimidated by technology. I also think we deal with a generation that it is not always very receptive to change and CPOE is all about change. In the larger facilities, I do see more opportunities for the nurses to choose a clinical informatics ladder, and there are provisions to support training in this field.

My main concern, however, is that the industry is telling IT that CPOE is a clinical project and that it should be led by clinicians. We do form clinical teams and have nurses and sometimes physicians leading the implementations. Now what does a nurse know about project management? About meeting milestones, lead and lag time? The tools that we give them to execute the projects are not designed to be used by clinicians, so there is a lot of struggling. The new tools that support the implementation of CPOE need to support the thought process of clinicians, not of a PMI-certified IT project manager.

What privacy problems and solutions are you seeing?

The most common ones are related to users not logging off their devices and sharing of the passwords from physicians to their staff, especially since some are still struggling with entering their orders into a CPOE system. We do not have to deal with many security breaches outside of the basic incidents, where sometimes people may get access inadvertently to units they should not, or access is too restrictive.

We see more and more need to allow physicians access to the clinical systems using their own devices, especially the iPad. One of the most interesting solutions to privacy I have seen lately has been the option of using virtual desktops for physicians for remote access. The hospital still has to implement the VDI (Virtual Desktop Infrastructure) so I would definitely look at this solution closer from a cost and performance standpoint. This would give users essentially the same interface to the hospital regardless of what device they are accessing it from, including iPads. It also prevents users from saving data onto the local devices. Overall, in my experience, I think hospitals are doing a reasonable job around security.

What would you change about Meaningful Use to emphasize patient safety and benefits?

If I could change anything about the Meaningful Use criteria to emphasize patient safety and benefits, it would be to change the order and percentage in which some of the requirements have been placed relative to Stages 1-3. Implementing CPOE, along with the other main components like medication reconciliation and discharge instructions, requires a substantial transformation of clinicians’ workflows. The MU criteria, in their current state, do not promote a logical transformation of this workflow, thus negatively impacting patient safety and benefits.

Without going off on a tangent and getting too deep into the logic of the MU criteria, some of the simple changes I would make to the MU criteria would be to align the goals of the objectives so they make sense from a clinical perspective. How can you have CPOE where only medication orders are entered, and only on 30% of unique patients? From a technology perspective it may make sense, but from a physician workflow perspective, it will be chaotic. How will this be safer for the patients? Also, how can I build order sets if we do not entirely address what patients need? It is unfortunate that some organizations look at this and plan around it without thinking that CPOE will require a holistic approach. CPOE should be done for the right reasons, not just for meeting the CMS timeline.

Here is another interesting objective. “More than 50 percent of all patients who are discharged from an eligible hospital or CAH’s inpatient or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it.” This is all great, but to do this, you need to have discharge instructions implemented on 100% of your patients. If you have not yet implemented this component, it will be challenging. This particular module cannot be phased in too easily and it is often underestimated what it would take to deploy.

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Top News

CPSI reports Q1 net income of $5.37 million ($0.49/share) compared to $2.92 million in the prior-year period. Analysts were expecting $0.46. Sales revenue grew from $31.54 million to $40.38 million.

GE’s Q1 numbers: revenue up 6%, EPS $0.31 vs. $0.17, with $1.8 billion in profit from GE Capital. GE Healthcare put up good numbers.

From Ishmael: “Re: Meditech. I am just loving being a Meditech beta tester for CHW’s rollout. It’s great when my livelihood and patients’ lives are on the line, especially when I’m not getting paid for it! I actually don’t mind the software as much as my median doc or nurse colleague, which are about an 80-20 split on hate/don’t mind. No one loves it.” I guess to be fair users almost never love enterprise software like they might Facebook or something. My armchair psychologist theory is that having software imposed on you with mandatory use is a reminder that you are subservient to management, and no matter how benevolent, nobody likes to give up control (and that’s what work software is – a package of rules, controls, and monitoring tools). Another problem I can cite from experience is that Meditech is the hardest system I’ve ever had to replace, and we’re talking the old Magic product – users hated anything that wasn’t Meditech. We took an IT black eye for replacing it in the hospital we acquired.

From St. Pauli: “Re: kudos. When I moved from medical practice to an informatics role, I researched any and all sources of information. HIStalk was one of the first I found and continue to read regularly. I admire anyone’s ability to write well and regularly and the expansion of HIStalk to include Inga, the reader polls, Dr. Jayne, Readers Write, and Ed Marx have increased HIStalk’s value logarithmically. I was recently promoted and would like to thank those responsible – my family, bosses, and employees. HIStalk is included in that list. This is not a lame attempt to get mentioned – I just want you and others that contribute to HIStalk to know the benefits you have given one of your readers.” Thanks – that made my day.

From Rango: “Re: HCRAP. Inga mentioned it, now I have to know what it means.” A couple of huge companies e-mailed to say, “We want to spend a ton of money and sponsor your site at a higher level than anyone else” (I’m paraphrasing slightly). I don’t do that – sponsorships are relatively inexpensive and everybody gets the same treatment – but I wanted to yank Inga’s chain. I first told her I was studying the Periodic Table of the Elements to find metals higher than Gold and Platinum and was feeling good about the Roentgenium Level and would calculate the price of that sponsorship based on its atomic number relative to those of the other metals. I then told her about the brainstorm I’d just had about two new sponsorship programs. The HS program (Hollywood Squares) allows a sponsor to not only run their own ad, but to buy the spots of their competitors (at a 50% premium) to block them from doing the same. The second option carries a 100% surcharge, for which we will send every news and rumor item about a company for their approval before we run it, which I dubbed the HIStalk Company Reputation Assurance Program (HCRAP). She was suitably amused, or at least pretended to be.

From iFad:”Re: iPad. It’s cool, but does anybody really think it’s revolutionary? We’ve had PCs for going on three decades and are still trying to figure out how to use them in healthcare. Call me a cynic, but there aren’t many paperless healthcare organizations and pie-in-the-sky simplicity and streamlined workflows remain just that. Reality check poll: if you own an iPad, do you really expect improved outcomes or productivity that you couldn’t get from a PC?”

HIStalk Announcements and Requests

  Several dozen companies have asked to be featured in the innovation showcase I’m starting up. As usual, my reach exceeded my grasp given that my time is almost non-existent between my hospital job and HIStalk job. Despite my being the rate-limiting step, it’s underway, albeit in a more controlled manner than I’d like. Stay tuned. I hadn’t heard of several of the companies that are interested, which I think is great since I’ll learn about them along with everyone else.

Welcome to new HIStalk Platinum Sponsor HMS of Nashville, TN. HMS provides Meaningful Use-ready enterprise solutions for 680 hospitals, focusing on the often-forgotten community and specialty hospitals that deliver much of the care out there in the real world. They’ve been around since 1984 and offer a broad line of products: EDIS, LIS, PACS, pharmacy, radiology, surgery, AP/GL/MM, payroll/T&A, HIM, quality management, transcription, CPOE, eMAR, device integration, clin doc, patient accounting, claims, document management, and a bunch more I left off since the list is obviously comprehensive. The company’s inpatient EHR, EDIS, and ambulatory EHR all earned ONC-ATCB certification in 2011 and HMS clients are already receiving inventive payments for using them, which can be run locally or hosted by the company. Thanks to HMS for its support of HIStalk.

Jobs on the job board, where sponsors post free: RVP Sales. On Healthcare IT Jobs: IS Clinical Systems Analyst II Nursing, SAN Administrator / Engineer, Epic Ambulatory Specialist.

Acquisitions, Funding, Business, and Stock

The State of Wisconsin awards Merge Healthcare $500,000 in JOBS Tax Credits and a $500,000 loan from the department of commerce to consolidate operations at its Hartland, WI facility. The project is expected to create 100 jobs and represents a $2 million investment.

Quest Diagnostics reports a 13.3% drop in net income compared to last year, falling from $162.4 million to $140.8 million ($0.86/share). Analysts expected $0.99 to $1.05. Revenue was up 1%.

Here’s the Cerner video presented by the ADP and the Small Business Administration, featuring co-founder Cliff Illig. It’s good.

Israel-based EarlySense, which sells a continuous patient monitoring system whose sensor resides under a bed mattress with no direct patient contact, announces that it will locate its US headquarters in Massachusetts. MetroWest Medical Center was also announced as the company’s first Massachusetts hospital customer.

Canadian vendor PatientOrderSets.com, which I mentioned last time, gets $750K in funding from a government-funded accelerator.

Sales

Emerus Hospital Partners (TX) selects InsightCS patient access, patient accounting, and revenue cycle information solutions from Stockell Healthcare Systems.

Allina Health System chooses Micromedex from Thomson Reuters as its drug information vendor after a month-long bake-off.

In Canada, Ottawa Hospital orders 1,800 iPad 2s for its physicians, saying they will pay for themselves through increased productivity and reduced errors.

NextGen gets a $6.7 million contract extension to provide an EMR to Maryland’s prison system.

People

Sad news: Craig Maszer died on April 11, 2011 at Brigham and Women’s Hospital after a long battle with multiple myeloma. He was a resident of Andover, MA and a principal at Champions in Healthcare, where he worked alongside his mother, industry long-timer Stephanie Massengill. Others may remember him from his time with Sentillion and Eclipsys. Craig Maszer was 46 years old. Condolences.

Omnicare names Randy Carpenter to SVP/CIO. He was previously CIO of HealthSouth and had hospital CIO experience before that.

University of Arkansas for Medical Sciences (UAMS) names David Miller as vice chancellor and CIO. He was formerly with University of Chicago Medical Center. I think I probably mentioned that awhile back — he and I swap e-mails occasionally and he let me know as soon as it was official.

OB-GYN PM/EHR vendor digiChart names Phil Suiter as president and CEO. The former president and CEO, founder and Vanderbilt professor G. William Bates MD, will remain with the company as board chair.

Former HealthPoint Medical Group CIO Steve Fisher joins MD Solutions as SVP of advisory services.

Announcements and Implementations

 

McKesson Horizon Enterprise Visibility earns top marks in KLAS’s new report on patient flow solution. TeleTracking and Allscripts Sunrise Patient Flow earned the next highest ratings. Only 20% of hospitals are using a patient flow system, but 85% of those say they provide benefits, especially in terms of resource collaboration and communication.

Denver Health (CO) implements Microsoft’s Chronic Condition Management platform to facilitate communication between providers and diabetic patients and promote better self-management of chronic conditions.

Wayne Memorial Hospital (NC) goes live on EXTENSION’s HealthAlert for Nurses for nurse call messaging.

The Methodist Hospital System (TX) will use the Rothman Index for scoring patient condition from EMR information into a dashboard.

Two Siemens Soarian customers successfully attest for Meaningful Use Stage 1: MedCentral (OH) and Riverside (VA).

Government and Politics

Indian Health Service becomes the first federal agency to have its EHR (the IHS Resource and Patient Management System, or RPMS, based on the VA’s VistA) certified as a complete EHR.

Other

A Sage Health survey finds that patients believe EHR use increases care quality and results in a more accurate health record. Eighty percent of patients have a positive perception of EHRs, compared to only 62% of physicians; privacy and security is a concern for 81% of patients but only 62% of  doctors. Both groups agree that the biggest benefits of EHRS are real-time access to records and  the ability to share information among providers.

A Texas hospital tries to convince county voters to create a hospital tax district after it experiences financial losses, layoffs, and wage freezes. The new tax dollars will pay for a  new EMR, which will cost $1.2 million plus $18,000 per month maintenance.

Strange: the family of a patient who died after heart surgery is suing the surgeon and hospital after an anonymous caller told them that the surgeon’s 7-year-old daughter was showing a video of the surgery to her friends. The family claims the surgeon was so interested in making the movie for his daughter that he left the OR before the revascularization procedure was complete, allowing a non-physician to close and monitor the patient. The family also claims they found out only after the surgery that the surgeon has the worst outcomes of any surgeon in the state for the procedures he performed.

Sponsor Updates

• Healthcare Growth Partners releases its Q1 2011 market and M&A report, which summarizes the capital market, M&A, and capital raising activity for the HIT and services sector.
• Salar’s TeamNotes and Charge Capture software products earn ONC-ACTB EHR modular certification from Drummond Group. 
• Central Illinois HIE picks ICA as its vendor of choice to provide the HIE’s technology and infrastructure.
• ZirMed and e-MDs partner to offer eMD clients ZirMed’s RCM services.
• MEDSEEK obtains CCHIT ONC-ACTB EHR module certification for its eHealth ecoSystem, Version 3.4.
• The Huntzinger Management Group posts a video of its HIMSS presentation Discussing the Future Viability of Hospitals.
• Hartford Hospital (CT) reports it has increased its early discharge rate nearly threefold by offering its clinicians access to Carefx’s business intelligence dashboard.
• Harrison Medical Center (WA) is live on GE Healthcare’s eHealth Information Exchange.
• EMRConsultant.com adds more than 100 EMR products to its database, a free service used by over 12,000 practices.
• Mission Hospital (CA) has implemented Meditech C/S 5.64 CPOE at both its Mission Viejo and Laguna Beach campuses, assisted by H/P Technologies, which has been involved with Meditech and Epic go-lives at Cedars-Sinai, Mission Hospital, and University of Chicago.

Earlier this week, the College of Healthcare Information Management Executives (CHIME) addressed a letter to new National Coordinator for Health Information Technology, Dr. Farzad Mostashari. It summarizes CHIME’s comments on ONC’s Federal Health IT Strategic Plan.

After the introductory pleasantries, CHIME delves into key areas close to many of us:

• Consent issues for health information exchange, not only clarifying how consent will be stored / transmitted, but how it will integrate with personal health records; unifying the patchwork of laws across various states; and national standards to pull it all together and fix the problem created when HIPAA allowed states to preempt federal regulations.
• Making movement to Stage 2 Meaningful Use requirements contingent on having a certain percentage of providers and hospitals compliant with Stage 1.
• Clarifying disagreement between HIPAA and HHS (Department of Health and Human Services) regulations on timely release of information and making sure that granting patients instant access to health information will not be harmful.
• Greater focus on the usability of technology.

As a practicing physician, the last one has the greatest impact in my day-to-day practice. There have been some unfortunate downsides to the speed of the Meaningful Use timelines. The relatively short time between the publication of the final rule and implementation has stressed vendors intent on incorporating items that may or may not be clinically helpful, yet cannot be ignored if they are seeking certification.

Let’s just look at a simple measure, documentation of tobacco use. Prior to the Meaningful Use hubbub, many EHRs did a perfectly fine job of collecting the information physicians needed to do appropriate health interventions. Physicians saw patients, counseled them, documented their findings, etc. However, MU required the documentation to meet certain standards of compliance. Was there any randomized, controlled study that showed that documenting tobacco use in a certain way changes patient outcomes? Or was it just nebulously decided that it should be “this way” going forward?

I’m certainly not privy to how it was all worked out, but vendors did a fair amount of retooling to make sure all the MU items were documented in the prescribed fashion. Don’t get me wrong, I support uniformity, the ability to report data across disparate systems, etc. But I also can’t help but think that the amount of development, testing, and implementation resources that were focused on making software changes that don’t materially benefit physicians (or patients) could have been better spent on making systems more usable.

This doesn’t even take into account the amount of time and resources spent by EHR customers to upgrade perfectly functional/serviceable systems to “certified” versions, regardless of pre-existing organizational priorities. A CMIO friend of mine laments the sheer number of projects (many of which would really have provided benefit to his physicians and their patients) that have been placed on hold so that all resources can focus on achieving Meaningful Use. The pursuit of MU has put his organization back a year or more on its five-year strategic plan.

I hope that ONC gives some thought to these comments as well as the thoughts of many others in the trenches who have submitted their thoughts. Do you have an interesting comment submitted to ONC? E-mail me.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

This is the second in a short series of posts on “The CIOs Best Friends,” BFFs who are critical in ensuring CIO effectiveness. This time we cover the CFO – CIO relationship.

The CFO – CIO Relationship

When asked to take on additional responsibilities, I inherited our financial applications team. This scared me. Not because of the expanded scope, but because I’d have to deal with our CFO, a person feared in the halls of IT.

During the first week in my new role as corporate director, the CFO demanded an update on the troubled decision support project for which my team was responsible. I gathered players and facts and cautiously took my seat in the arena … I mean, in his conference room. He was not happy about the multiple delays and lack of concrete plans for resolution.

My project manager struggled in her responses. The CFO’s gaze then landed on me.

I don’t recall if my summation came across as eloquent or suspect, but my speech carried a mix of service compassion and urgency. I ended with, balls to the wall. The CFO smiled. I made a connection — one free pass for the new guy to facilitate resolution.

No C-suite relationship has changed more this past decade than that of the CIO – CFO. As technology influence becomes increasingly strategic to success, wise organizations are evolving. CIOs are crawling out from under the CFO’s shadow and taking their rightful seats at the executive table.

Regardless of whom the CIO reports to, the relationship with the CFO remains essential. I have worked with several over the years, a mix of old school and new school. Here is what I discovered as keys to both personal and organizational success.

Connection. You have to establish a relationship that transcends organization boundaries. Something unique happens when you break bread together. Get out of the office with your CFO at least monthly for breakfast or lunch. Or, if you both enjoy working out, then a few-mile run or a one-on-one basketball game may be the answer. The point is to get out of the office and get acquainted on a personal level. A healthy foundation sets the tone for a thriving work relationship.

Collaboration. One way to supercharge the relationship is to join forces on an initiative or project, ideally one that benefits the organization and is important to the CFO. Welcome proactive ideas on taking costs out or leveraging technology to increase revenue. i.e. redesign processes to enable a faster month-end close or any technology to accelerate cash collection. Suggest working together to ensure Meaningful Use achievement. Don’t wait to be asked. Be the first to anticipate and reach out.

Knowledge. Learn everything you can about finance. Take courses and read what the CFO reads. I attend HFMA conferences and read their periodicals. Participate in finance webinars. Speak their language and understand what is important to them. How do they measure their success? What are the key benchmarks, and are they up or down?

Execute. Do it well. Never undertake anything halfway. With finance, precision is the standard, and you cannot afford to miss a commitment. If you cite a number or percentage, hit the mark exactly.

Trust. Be good stewards of your finite resources. Be transparent and accountable. Have a finance person on your team to assist with budget oversight. Ensure that your governance process has a closed loop process where you measure baseline and ROI achievement, and then report on it. If you say a new application will reduce costs or increase revenue, then ensure the specific budget is updated to reflect this. Conduct a zero-based budgeting exercise and review every budget line item with your managers and finance. Trust takes time and relationship.

Shared Vision. Once you establish the relationship and build trust through collaboration and execution, you can then arrive at a shared vision for the role of technology in your enterprise. You need the CFO’s support to be successful, and he or she needs yours. Give the CFO every reason to be enthusiastic about endorsing the direction of IT to ensure a commitment of resources available over multiple years.

The benefits of a strong CIO – CFO relationship are many and lead to a stellar organizational ROI. I have multiple examples of how the support of the CFO helped me fulfill the shared vision and positively impact the organization’s quality of care, patient safety, and business growth. Everything from financing critical infrastructure, implementing EHRs, obtaining Meaningful Use, or starting new businesses.

Some of you may be saying, “But you don’t know my CFO. He starves me deliberately.” Actually, I’ve worked with both types, the backward-thinking and the progressive. I feel your pain. But don’t let the die-hard keep you from making your best effort. If nothing else, your character and strength will improve. Be proactive for the sake of organizational success. Be relentless and keep developing the relationship.

That intimidating CFO? He turned out to be quite personable and of excellent character. I was so impressed that I asked him to be my formal mentor. He accelerated my growth. He pushed me to new heights personally and professionally. I moved from corporate director to CIO because of his influence.

Leverage these ideas and ensure your relationship is not sub-optimized. Accelerate quickly at full throttle. Balls to the wall!

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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Top News

CMS’s EHR Incentive Program attestation process is live.

Sad news: industry longtimer Marc Holland died suddenly on Saturday, April 16, 2011. He joined HIMSS as VP of market research four months ago following positions with System Research Services, several market research firms, and Montefiore Medical Center. He wrote a nostalgic reflection of his 30+ years as a HIMSS member in January, including his optimism that healthcare IT’s future is bright. Marc Holland was 62.

Reader Comments

From Petra: “Re: first-day Meaningful Use attesters. Why aren’t more vendors promoting customers who have successfully registered? They’ve hyped this for a year, so I would expect a flood of news. Where’s the beef?” I haven’t seen anything mentioned. It may not be all that newsworthy, but you know at least some of the rags would run the story anyway and vendors don’t usually turn down free PR.

From HIS Fan: “Re: UW Health (University of Wisconsin health). Announced yesterday that CMS has accepted its Meaningful Use data for Stage 1 as submitted. They are an Epic shop and achieved Stage 7 last year.”

 From Dr. Victor EHRlich: “Re: Epic’s mammography module. Two customers are planning to de-install in favor of niche vendors.” Unverified.

From WildcatWell: “Re: Dell’s aggressive EMR marketing efforts. I called and the phone kept ringing and ringing, redirecting a caller to sales and then ringing … well, I stopped after five minutes. How do you think support calls will be handled?” I tried the number and it was not necessarily a pleasant PBX experience, but someone did pick up after six rings or so. I’m not listing the number since someone will surely shriek that I’m pandering to a sponsor (via Dell’s acquisition of InSite One), but it’s easy to find. I would try again since maybe you just caught them at a bad time.

From Kerplunk: “Re: Zite for the iPad. It’s a content discovery app that I’m in love with and it’s free.” It’s a personalized magazine that gets smarter as you use it, the developer says (and the 4+ rating seems to indicate that users agree). One of my first and favorite iPad apps was Flip, so I’ll try Zite to see if it’s similar.

From Susan: “Re: Concerro. They released a video at AONE that is racist, a takeoff of the Apple vs. IBM commercial in which a disheveled black woman represents paper scheduling and a well put together represents electronic scheduling. As a black nurse, I find this reprehensible.” I watched the video and didn’t have that reaction since companies can never seem to please everyone with their well-intended attempts at representing diversity or by just treating everyone (like actors) equally. However, since I’m seeing it through white male eyes, I invited Concerro to respond.

Thank you for taking the time to express your concern about our new video. The Concerro marketing team went to great lengths to find the best actors for each of the roles in all of our videos. Our “paper” actor was selected because she played an excellent frazzled nurse and a younger person was needed to play the role of a “less experienced” nurse. It’s unfortunate that this has been taken out of context and we sincerely apologize for offending anyone. Concerro stands by these videos and we are proud of our actors.

 From NonCredentialedTechie: “Re: from Slashdot. The head of a clinical division at an academic hospital sets up his own server at work, asks IT to allow people to access it through the hospital network, and is ‘taken aback’ when they say they’ll need an account on his server. The best part are the comments.” I love this, even though it may be a troll and not a real clinician writing it. The author claims he’s miffed that IT isn’t thrilled about his server and says he’s considering “taking this up the chain” and asks readers if they think he should give IT an account. Here’s the best response from the many hundreds posted:

What you’ve done would cause any professional IT group to get out the hot tar, feathers, and rail. Or at least come into your office and ask you politely to remove the damn server from their facility. And never do this again. You must have missed all the security briefings, the issues with HIPAA, and whatnot when you were looking at systems. What you’ve done is to create a ‘rogue system’. Imagine one of your kids sets up a server in your house. You don’t understand it, you don’t know if it’s happily sniffing network traffic to steal passwords so pizza can be ordered using your credit cards, serving up pr0n, or just running minecraft. Would you willy nilly allow the kids to open a port on your firewall without the ability to audit what they’re doing ? Of course not. Personally I’m amazed that they only asked for an account on your little server. I would have gone over and watched while you removed it from the facility and put in in your car.

HIStalk Announcements and Requests

  Listening: new Foo Fighters. I never paid them much attention, but I should have … Wasting Light sounds great first time through. It was recorded directly to analog tape in Dave Grohl’s garage, yielding a sound that I nostalgically remember as “music” before lesser talents hijacked the term sometime in the late 90s to define computer-created dance tracks. This is amazingly good and gets a rare highest recommendation from me.

Acquisitions, Funding, Business, and Stock

Cerner is one of six companies profiled in a new video series by the Small Business Administration. Cerner vice chairman and co-founder Cliff Illig shares details of how he and fellow entrepreneurs Neal Patterson and Paul Gorup created the company in 1979 and how Cerner has evolved over the last 32 years.

Healthcare disclosure management provider MRO Corp. acquires the assets of Keystone Management Solutions, a provider of release of information services.

Community Health Systems files a motion to dismiss the lawsuit filed against it by Tenet Healthcare, which claims CHS admits ED patients for purely financial reasons. CHS, whose December bid to buy Tenet for $5 per share in cash and $1 in stock was rejected as insufficient, changed its offer to a $3.3 billion all-cash offer, saying that move eliminates the basic for Tenet’s lawsuit against CHS, which alleged securities fraud. This pair is like hot-blooded lovers who can’t decide whether to kill each other or to make passionate love (or maybe both simultaneously). I think I’d be cautious about waving $3.3 billion in cash around right as the public tries to figure out where to cut healthcare costs.

Sales

HealthInsight selects Axolotl’s Elysium Exchange infrastructure for the Nevada HIE.

Physician management services organization TeamPraxis (HI) chooses Microsoft Amalga to facilitate the sharing of patient information.

Presbyterian Intercommunity Hospital and Bright Health Physicians (CA) will implement the Shareable Ink documentation system as part of its rollout of Allscripts Enterprise PM/EHR.

Five hospitals in Canada will implement order set management tools from PatientOrderSets.com, increasing the Canadian vendor’s client list to 140 hospitals. The company changed its name from Open Source Order Sets in January, explaining that its collaborative network is cloud-based, but not open source in the software development context.

Lutheran Medical Center (NY) contracts for Service Desk healthcare-specific IT help desk services from CareTech Solutions. The company started up 24×7 services within three weeks to support Lutheran’s EMR rollout.

People 

University HealthSystem Consortium (IL) hires Mike Hebrank as VP and CIO. His previous employers include Helix Health and Greater Baltimore Medical Center.

Announcements and Implementations

  Seventy Hawaii physicians on the island of Oahu form Health Information Helping Others (HIHO) as a pilot project for the Hawaii HIE. HIHO will use Wellogic’s Direct Project technology for data exchange and secure messaging. Got to love the happy acronym, which is far less cynical than some of the ones that recently concocted by Mr. H (HCRAP comes to mind).

Roche introduces a new EMR interface for the VA that transmits patient diabetes data into the VistA computerized patient record system. JResultNet allows providers to automatically transfer patient blood glucose test results from the ACCU-CHEK 360 Diabetes Management system to VistA.

Thomson Reuters announces Micromedex Drug Interactions for the iPhone. It’s free to Micromedex customers, $50 per year otherwise.

PenRad announces plans to develop the next generation of its PenVasc Vascular Data Management System for vascular labs.

General Dynamics becomes the first healthcare application service provider host to earn HITRUST certification, which documents that its hosting service meets HIPAA and HITECH security requirements.

Government and Politics

Lawmakers in Maine are considering legislation that would give patients the ability to control what portions of their medical record could be included in the state’s HIE.

Without any clear explanation, ONC extends the comment period for the Federal Health IT Strategic Plan: 2011 – 2015 from April 22 to May 6. Comments can be made or reviewed here.

The Kansas Board of Pharmacy will require pharmacies to use the NPLEx system, which alerts store personnel when customers try to buy products like Sudafed from multiple locations to skirt sales limits imposed to thwart methamphetamine production. The system is provided nationally by the National Association of Drug Diversion Investigators and paid for by the drug companies whose products are involved.

Innovation and Research

A BBC article says that governments like Britain’s spend billions on ambitious electronic medical records projects, but small upstarts are tackling much smaller problems with greater success. The CEO of a company that offers a smart phone-based communication system says that hospitals have spent a fortune on IT, but caregivers still can’t monitor patients with it. “Cans of tomatoes are being treated better than patients,” he says, referring to the more advanced technologies used by the average grocery store. Another company is piloting a cloud-based hospital management system in a 2,000 bed hospital in India, saying that it’s a poor part of a world, but patients there get “more efficient, more high-tech service than patients in the UK” because they didn’t have to work around legacy systems or government policies.

Do you run a small and innovative healthcare IT company? Does it offer a product (not a service) and have at least five employees and one referenceable site? If so, a team of volunteer HIStalk readers and I will consider giving you a national audience right here on HIStalk. This isn’t like a venture fair, where you have to fly somewhere, pitch to an indifferent audience of allegedly interested investors, and then go home with nothing to show for it. We’re offering you the chance to reach HIStalk’s readers directly and at no cost, just because I like to shake things up a little by giving the little guy a chance to earn customers and investors (and because readers keep asking me to showcase those little guys). If your company would like to be the guinea pig, e-mail me and we’ll work through some simple details. I’ll post your story, an interview with you and your referenceable site, and your video pitch.

Old news that I just ran across: MediAngels says it has launched the first 24×7 Global eHospital to serve patients anywhere in India and elsewhere over the Internet. It has 300 physicians, including those from 85 super-specialties, who will render consultations and second opinions. The maximum fee, which is charged only if an international panel of physicians is involved, is $100 US. It claims to meet HIPAA standards (which is says were “enacted by the USA FDA”) and can also arrange medical tourism.

Here’s a fun and interesting video featuring Halle Tecco, a new Harvard Business School grad who founded non-profit HIT accelerator RockHealth (mentioned here last week) with medical partners Mayo Clinic and Cincinnati Children’s Hospital. “I didn’t even go to Recruitment Week or apply for any of the big jobs because I knew it could be really tempting because they pay probably like five times as much as I’m going to make, but at the end of the day, I’m more concerned about doing something interesting and meaningful with my time on this earth, whether that’s right out of business school or ten years down the road.”

Ten percent of ambulatory providers are switching PACS or RIS vendors due to market consolidation or poor vendor performance, according to a new KLAS report. KLAS also noted that providers will generally forego some functionality for solid PACS/RIS integration, though single-side vendors do well in their respective markets. Intelerad IntelePACS was the highest rated PACS and MedInformatix the top RIS.

The Rhode Island Board of Medical Licensure and Discipline reprimands a physician who posted details of her ER experiences on Facebook. The postings did not include any patient names, but the nature of the injuries described allowed at least one person to identify a patient. Alexandra Thran was found guilty of unprofessional conduct and ordered to pay a $500 administrative fee.

American Medical News runs an interesting question on its Ethics Forum: is it ethical for doctors to use their IT systems to “cherry pick” or “lemon drop,” meaning choosing only the healthiest patients to maximize pay-for-performance money while increasing costs overall? It gives interesting examples of Medicare HMOs, which have been caught recruiting only patients from affluent areas and discouraging sick patients from re-enrolling by charging high co-pays for dialysis and cancer treatments. It theorizes that the EMR could be a powerful profit-making machine since doctors could theoretically just drop patients whose performance targets would be difficult to meet. It’s an interesting article — if a system can be gamed, you can bet it will be, both legally and illegally (see: tax laws).

 Sponsor Updates by DigitalBeanCounter

• Vitalize Consulting Solutions held its all-company meeting at Hyatt Lost Pines Resort in Austin, TX earlier this month, including a build-a-bike team exercise that surprised 34 children of the local Boys and Girls Club with brand new bicycles, hlemets, and locks.
• Nathan Littauer Hospital (NY) selects ProVation Order Sets as its electronic order set solution.
• Cumberland Consulting Group promotes Amy Meiners to principal.
• Presbyterian Intercommunity Hospital and Bright Health Physicians (CA) sign an agreement to deploy Allscripts Enterprise EHR and PM solutions. The ambulatory systems will integrate with the hospital’s existing Sunrise inpatient EHR/RCM system.
• St. Joseph Health System (CA)  will implement MedPlus’s ChartMaxx electronic document management product.
• Cognify, Inc. selects Greenway’s PrimeSUITE to further integrate and advance its Web-based participant tracking system that monitors care plan continuums.
• The Rules-Based Charging solution of Surgical Information Systems earns the “Peer Reviewed by HFMA” standard for the fourth consecutive year.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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