Top News

HIMSS announces its acquisition of for-profit so2say communications, a German healthcare IT news distribution company whose European publications include HealthTech Wire and the recently acquired British Journal of Healthcare Computing.

Reader Comments

From No Surprise: “Re: Presbyterian, NM. Epic is in, McKesson loses another account. E-mail went out to employees Wednesday. Also, Lee Marley started as CIO in August, coming from Stanford.” Posted here as a rumor on August 15, but a solid one since I noticed that Presbyterian had Epic inpatient jobs posted on its site. Lee Marley’s LinkedIn profile verifies that she became SVP/CIO at Presbyterian in August after a couple of years as associate CIO at Stanford.  

From Redial: “Re: [company name omitted]. Another shakeup: just days ago, [name omitted] has suddenly left as VP of business development following the sudden departure of [name omitted] in August. Senior VP [name omitted] has been moved to the side following the discovery of his romantic relationship with a subordinate. There have been other significant departments of key management personnel over the past 12 months. Something is definitely wrong at the top.” Interesting, although I’m sure the company won’t confirm most of that except by catapulting litigious lawyers in my direction if I name names. At least I can feel smug knowing who it is.

From Ask Sam: “Re: HIPAA. Obviously they don’t know how to spell it.” They clearly need a new headline writer considering that healthcare is also spelled incorrectly (the article itself spells both words right, so there’s little excuse).

From WhoBuyz: “Re: acquisition. Who could this be? The $300-500 million range sounds very large to go unnoticed.” Sources say huge India-based software and consulting firm Infosys is in discussions about buying a US “public services and healthcare space” firm for $450-500 million, with the unnamed company booking annual revenue of $300-500 million. Infosys has extensive healthcare offerings that include payor analytics, disease management, supply chain, wellness management, Meaningful Use optimization, data warehousing, and infrastructure services. UPDATE: according to several sources, the acquisition will be the healthcare business of Thomson Reuters,  at a price of up to $750 million.

Recent tidbits from HIStalk Practice: the 2008 HISsie cartoon revisited. Telehealth saves money  in the treatment of chronically ill patients. US doctors earn more than physicians abroad. Dr. Gregg claims he is a Luddite and embraces his “onesy” status. Jonathan Bush rants about Meaningful Use attestation and his wish for his competitors’ “ethically-based suicide.” Doctors are down on AMA. World peace, a balanced budget, or better knowledge of the ambulatory HIT world are possible if you take 10 seconds to subscribe to HIStalk Practice’s e-mail updates.

Listening: brand new from Wild Flag, all-female low-fi rockers from Portland, OR.

Latest pet peeves: simplistic does not mean the same thing as simple (the former means recklessly oversimplifying complex concepts), nor does opportunistic mean taking advantage of opportunities (it means taking quick action that may be ethically questionable). Vendor CEOs misused both words recently in the national press, which would have cast a negative light on their companies except for the fact that their gaffe sailed right over the heads of the majority of people who didn’t know the difference.

Jobs on Healthcare IT Jobs: Expert MUMPS Developer, Epic MyChart Builder/Analyst, Senior Systems Analyst – Interfacing, Implementation and Account Manager.

Medical billing and RIS software provider Zotec Partners merges with Medical Business Service, a provider of billing services for hospital-based practices.

Allscripts CEO Glen Tullman, commenting on a share price that is virtually unchanged from a year ago, says integration concerns with the former Eclipsys put MDRX in “the penalty box,” but growth is coming since the acquisition positioned the company well for the changes spurred by healthcare reform.

Shares in Merge Healthcare hit a 52-week high on Wednesday. Above is the one-year share price of MRGE (blue), the S&P 500 (green), and the Nasdaq (red). A year-ago investment would have earned a 151% profit ($2.77 vs. $6.95) if you sold Thursday.

HIT services firm Gestalt Health appoints Charles Fazio, MD as CMIO. He was previously CMIO of Medica Health Plans.

Availity names Kelly Heape Parsons CFO, SVP, and corporate secretary to replace retiring Margaret Gomez.

Billing service provider AdvantEdge Healthcare Solutions hires John A. Roberts (InfoLogix) as chief financial and administrative officer and Michael Youmans (Concerro, McKesson) as SVP of sales and marketing.

Announcements and Implementations

Medsphere announces general availability of its latest version of OpenVista EHR, which includes an option for users to customize their views, dashboards, and workflows.

In Maine, Time Warner Cable launches Healthcare Solutions to connect providers and support home health monitoring by offering VPN service, managed security, and web conferencing.

The AMIA 2011 Annual Symposium will be held October 22-26 at the Washington Hilton in Washington, DC. Keynotes include the director of NIH and Farzad Mostashari from ONC. AMIA is a lot more science-oriented than the HIMSS boat show – I looked through the list of sessions and didn’t see any duds, provided you’re of the informatics persuasion, anyway. Full registration is $835 for non-members if you sign up by October 6. Reports from there are welcome.

McKesson integrates its iKnowMed oncology EHR with its Lynx Mobile drug inventory management system, allowing meds to be prepared in advance of the patient’s visit.

Patient check-in company Phreesia announces an electronic Medicare Annual Wellness Visit Form that it claims saves providers 15 minutes per patient in complying with the new Medicare Part B entitlement.

West Texas RHIO wins an Outstanding Program Award from the Texas Rural Health Association. The four founding hospitals, all of them competitors, use the remotely hosted ChartAccess Comprehensive EHR from Prognosis Health Information Systems.

Dell Services Healthcare and Life Sciences wins a Project Management Office of the Year award for its 96% project success rate.

Smiths Medical announces its PharmGuard Anesthesia Software Service, which providers hospitals with a customized anesthesia drug library for their Medfusion 3500 syringe pumps.

Anthelio launches a 24×7 physician-staffed help desk to support hospital clinical systems rollouts. Other types of clinicians are also available to callers.

A CliniComp press release says that on September 11, 2001, its Essentris EMR used by Bellevue Hospital was the only inpatient one that kept running through the events of that day. I’m not sure: (a) if they’re talking about Bellevue only or all hospitals in Manhattan or New York; (b) how they know that; and (c) if using September 11 as a product pitch is in good taste. If you can get past those issues, the press release is a good read.

Athenahealth’s co-founders are mentioned as backers of startup Healthpoint Services, which offers “e-doctor clinics” in rural India. Athena COO Ed Park is a director. Villagers can get a telehealth consult in the office for 80 cents and diagnostic tests for $1, which the company says is affordable to the patients and break-even for it. Vital signs are taken in the office and sent to the physician and to the EMR. The company also offers a water service that gives families the ability to fill their jugs with clean water for $1.50 per month.

Hospital employees and their family members incur healthcare costs that are 13% higher than that of the general population; are 22% more likely to visit the ER; and are more often  diagnosed with chronic medical conditions. Any theories why?

Cook Children’s Medical Center (TX) opens a 106-bed, $51 million NICU with all private rooms, the largest in the country. They cite research showing that babies do better when light and temperature can be individually controlled and when family members don’t have to leave.

SAP will release a tablet-based EMR front end app by the end of October, according to this article.

Sponsor Updates

• Software Testing Solutions shared its booth with an animal rescue organization at the Sunquest Users Group meeting this summer, giving attendees a chance to pet three rescued puppies. All were adopted during the conference and STS matched attendee donations made to the rescue organization. This is the second year STS has promoted the organization in its booth, raising over $4,000 and placing 10 dogs in homes.
• The Axolotl-powered Idaho Health Data Exchange adds St. Joseph Regional Medical Center and Pathologists’ Regional Laboratory to its network.
• Practice Management Associates (VA) selects the ADP AdvancedMD PM for RCM services.
• Citrus Valley Health Partners (CA) and MidMichigan Health (MI) select Allscripts Community Record, powered by dbMotion, and will underwrite and host Allscripts EHR for their affiliated physicians.
• OptumInsight names Ray Ambay, MD (Tampa Institute for Plastic Surgery), James A. Haley, MD (Veterans Hospital, Tampa), David Rossman, MD (Mass General Imaging), and Susan Strate, MD (clinical and anatomic pathologist) to its physician advisory board.
• DIVURGENT is participating in next week’s Epic UGM 2011 and is sponsoring a presentation by Bert Reese, CIO of Sentara Healthcare.
• e-MDs and Delmarva Foundation of the District of Columbia offer free assistance to DC-area e-MDs users wanting to take advantage of PQRS incentives.
• Allscripts, HP, Keane, and NCR are recognized by the InformationWeek 500 2011 list of top technology innovators.
• Kony Solutions shares findings from its Mobile Marketing and Commerce Study, including the observation that 40% of organizations believe the biggest challenge to their mobile strategy is developing applications across multiple operating systems and devices.
• Jersey Health Connect selects RelayHealth to provide HIE technology.
• Imprivata and PhoneFactor announce a partnership to provide phone-based authentication services to caregivers.
• GetWellNetwork’s Team in Training completed in the Nation’s Triathlon to Benefit the Leukemia & Lymphoma Society and raised $36,000.
• CareTech Solutions is promoting its CareWorks CMS Plug-In modules at this week’s SHSMD in Phoenix.
• MyHealthDIRECT CEO Jay Mason will speak at the Health IT Summit in New York September 20-21.
• CynergisTek CEO Mac McMillan expresses criticism of the Federal Health IT Strategic Plan for 2011-2015 in an information security article.
• MobileMD will participate in next week’s joint New Jersey and Delaware HIMSS Conference and Interoperability Demonstration in Atlantic City.

EPtalk by Dr. Jayne

I always enjoy hearing what readers have to say. I was double delighted to find that Daniela Mahoney’s piece on CPOE also included a recipe for profiteroles with coffee ice cream. Sounds like a good project for a quiet fall night (if fall ever arrives). She mentioned upcoming thoughts on adoption and organizational culture – I hope there are recipes included.

The Healthcare Billing and Management Association began its Fall Annual Conference yesterday. Due to horribly slashed budgets in clinical IT areas, which pretty much canceled my ability to attend any meetings this year, I have to live vicariously through colleagues and friends. In the first of these reports from the field, Bianca Biller reports:

HBMA Fall Conference in Vegas, baby. Held at the Bellagio, but actually the overflow accommodations are quite fine. Staying at your fave haunt Vdara Hotel & Spa, right in the midst of CItyCenter. Over 50 new members/attendees to the Fall Conference. Played Vendor Bingo for a chance at $1,425 jackpot tomorrow evening. Best giveaway was from Gateway EDI — decks of cards and gaming instructions. Quite creative for the Vegas venue.

Started the meeting with “Hot Topics in Compliance,” but only billing geeks/nerds would be excited about this session. Good reality check reviewing HIPAA + HITECH, 5010, ICD-10, 2012 Proposed Physician Fee Schedule cuts – all specialties. And let’s not forget the proposed SGR of 29.5% cuts for 2012 along with Medicare revalidation! Is anyone thinking about our patients in all of this? It’s a great day to be in the billing business!

P. S. Only 72 days until 5010!

Despite her feelings on compliance, I’m glad Bianca is my billing geek because she definitely gets the job done. And somehow, she succeeded in NOT getting her conference budget slashed. Maybe I need her to teach me the wicked ways.

MGMA reports that 70% of practices are looking into becoming Patient Centered Medical Homes and more than 20% are already accredited by a national organization. The top five challenges:

• Care coordination agreements with referral physicians
• Financing the transition
• Care coordination for high-risk patients
• Modifying or adopting an EHR to support PCMH
• Projecting financial impact of transition to PCMH

Clinical note of the week: several studies, one of which was published in May’s Journal of Strength Conditioning Research, show that low-fat chocolate milk helps athletes recover from training, especially if you add an Oreo cookie (a favorite of billing software developers, from what I understand.) That’s data I can work with.

MSN has recommendations that should be required reading for many an e-mail user. I’ve seen some e-mail signatures lately that are doozies. For most tech industry players (Voalte excepted), hot pink isn’t a strong corporate branding strategy. Political quotes are definitely a no-no, as are annoying or flashing fonts. The next-to-last paragraph had me laughing:

At public relations group Outside media, Sammi Johnson says she and her colleagues put quotes from fictitious “Saturday Night Live” inspirational writer Jack Handy in their quotes. One employee’s signature is, “Contrary to what most people say the most dangerous animal in the world is not the lion or the tiger or even elephant. It’s a shark riding on an elephant’s back, just trampling and eating everything they see.”

At this point, I’m going to take my Oreo cookies and my glass of milk (alas, not chocolate) and run.

Jayne

“To me, clowns aren’t funny. In fact, they’re kind of scary. I’ve wondered where this started and I think it goes back to the time I went to the circus, and a clown killed my dad.”

Contacts

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

 View/Print Text Only

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Is Healthcare Interoperability Possible With a Conflicted Federal Committee?
By Rusty Weiss

Interoperability – the ability of health information systems in different organizations to “talk” with each other – is crucial to the future of healthcare. By tapping into “big data” to learn more from existing information, we will make healthcare more effective and less expensive. By allowing patients to carry their health information across provider lines as easily as we want them to carry their health insurance across state lines, we will empower patients. In fact, one of the stated goals written into the Recovery Act was the development of “software that improves interoperability and connectivity among health information systems.”

But one politically connected left-wing company, Epic Systems, could destroy this healthcare progress.

With over $19 billion in stimulus money being dedicated to health IT, the selection of members to occupy the Health Information Technology Policy Committee was a crucial one for the Obama administration. And a platform of interoperability isn’t exclusive to the Obama camp. Democrats, Republicans, and industry experts alike recognize the importance of interoperability.

So why, despite their public support for interoperability, did the administration appoint to the HHS board Epic Systems CEO Judy Faulkner, who opposes the broad consensus position on interoperability?

As Lachlan Markey pointed out in the Washington Examiner, “Epic employees are massive Democratic donors.”

Unfortunately, those political donations may have caused the administration to overlook things like Faulkner’s 2009 comments to Bloomberg News claiming that sharing electronic health records (EHR) “doesn’t work when you mix and match vendors.” She added, “It has to be one system, or it can be dangerous for patients.”

Tariq Chaudhry, a consultant for American Soft Solutions Corp. says, “Judith Faulkner’s version of interoperability reveals a clear effort to establish (a) monopoly for Epic.”

He also believes that after working with Epic for a couple of years, there is little to indicate that their software is unique in the industry.

“I have not seen anything specific to Epic, not found elsewhere that could set (them) apart from other competing EHR/EMR systems,” Chaudhry explains.

In fairness, the entire industry is, according to Otech President Herman Oosterwijk, “15 years behind in interoperability compared with PACS systems”. PACS (Picture Archiving and Communication System) is a technology that allows medical images and reports to be stored and transferred electronically.

Oosterwijk, who has worked with the US Department of Veterans Affairs and the US Department of Defense, believes that “none of the EHR systems are truly open.” He adds, “I can connect a PACS workstation to pretty much any PACS system and query and retrieve images. Compare this with an EMR where we, at best, can get a HL7 feed and/or CDA summary documents out.”

Andrew Needleman, president of Claricode Inc., acknowledges difficulty with the implementation of interoperable EHR systems.

“Due to the amount and complexity of data being transmitted between systems, even systems that attempt to be interoperable run into issues when they send data to other systems.”

Expanding on the complexity problem, Needleman says:

“For healthcare data, even the demographic data to determine if you are talking about the same patient is complex. Then, you add things like medications with dosages, different forms, such as capsules, liquid suspensions for injections, tablets, inhalers, etc. And then you need to include observations, doctor’s orders, lab requests and results, admissions and discharges, billing information, vital signs, etc.”

“Despite the existing standards,” he says, “It’s not an easy task.”

Rob Quinn, a partner at APP Design, a software development company, says the office of Health and Human Services “is trying hard to get vendors to communicate via standards,” though he doubts many health IT companies like Epic will comply.

“There’s simply too much money to be made in locking in their clients,” Quinn admits.

In the end, Needleman isn’t sure if the appointment of Faulkner crosses ethics boundaries, but says a conflict of interest may be unavoidable.

“I think that it would be extremely difficult to appoint someone who was knowledgeable enough about the industry, was willing to serve, and didn’t have an interest in the outcome of the regulations.”

Needleman has a point about the difficulty of finding somebody without any conflict of interest. But it seems like the administration, at a minimum, should have appointed somebody whose business was not antithetical to an interoperable future. Unfortunately, as an iWatchNews investigation pointed out in Politico, the administration has appointed hundreds of big donors to “plum government jobs and advisory posts …”

The appointment of Faulkner poses a significant challenge for the Obama administration. Her opposition to interoperability creates difficulty for the advancement of the health IT industry. The market should decide whether the Epic Systems approach to health IT should be rewarded or deprecated, but – in the interests of interoperability and political integrity – HHS should immediately ask Judy Faulkner to step down from her role on the HHS Health IT Policy Committee.

Rusty Weiss is a freelance journalist focusing on the conservative movement and its political agenda.

Is Meaningful Use Enough When Disaster Strikes?
By Eric Mueller

Within the last 12 months, natural disasters have taught the health IT community the necessity of preparation. We’ve seen tsunamis threaten nuclear disaster; tornados wipe out entire communities and hospitals; earthquakes damage national monuments; and hurricanes effect remote coastal towns. In the wake of Hurricane Irene’s flooding and billions in damage, I truly wonder what we can learn from this experience in an effort to make the next disaster … less of a disaster.

When I think of disasters, I think of recovery. In health IT, how do we clean up and recover from the unexpected? How do we recoup data, tests, records, history, systems, schedules, hardware, software, and all the technical things that make our facilities run? Katrina occurred six years ago, yet some areas of New Orleans are still cleaning up. Virginians can tell you all about the unexpected now that they’ve experienced an earthquake in their back yard.

And who can forget the tragic images of Joplin, Missouri, where St. John’s Regional Medical Center stood directly in the path of the monster EF-5 tornado? Thankfully, St. John’s had just switched to an electronic medical record system, though it reportedly sustained some permanent paper record loss. We’ve already heard reports of IT-related problems stemming from Irene with offsite centers and backup generators failing along with general logistical and access issues. Unfortunately, after the dust settles, we’ll likely hear of communication outages, lost patient records, and failed technology – a story that is become a bit too familiar.

Having learned from past disasters, many large facilities have business continuity plans in place to restore their operations quickly. They have online data storage backups and cloud-based hosting facilities to mitigate minimal interruption and risk. But what about those that don’t? Many physicians and hospitals across the country continue to lack capital and access to advance to technology typically afforded to large hospitals. Many find it challenging to meet the noble intentions of Meaningful Use, which is designed to do just that. Reach the communities that don’t have the funds or access.

Long-timers in health IT know that implementation and adoption of new technology can be S-L-O-W. So when exactly is the appropriate time to hold ourselves and our vendors to a higher standard of safety, data recovery, and connectivity over finances? What measures do we enact to safeguard our IT investment before a catastrophic event strikes? Moreover and most importantly, how do we help those caregivers in need RIGHT NOW of information technology?

For example, cloud technologies are words that scare us. We think liability and compliance obstacles instead of opportunity and solutions. Flexibility is paramount. Many organizations are in critical risk positions because archaic and poorly funded IT processes and architecture are wrapped around one very inflexible platform. In allowing the unknown to stop us from proactively seeking out sustainable solutions, will we allow history to repeat itself the next time a natural disaster crosses our path?

Creating flexible and efficient solutions provides the foundation for innovation and problem solving. Remember, if your vendor doesn’t play well with others, Mother Nature will force you to figure this out. Patients rely on the entire continuum of healthcare to do one thing – deliver great care. Doctors, nurses, and administrators can’t deliver great care without depending on their arsenal of tools and technology in their greatest time of need. Let’s challenge ourselves to be innovative and redefine Meaningful Use in ways to help all providers regardless of size and limits, both at work and in our communities. I believe it’s worth the effort.

Eric Mueller is president of WPC Services of Seattle, WA.

Is It Only CPOE, or Is There More?
By Daniela Mahoney, RN

We’ve got to think about what is ahead of us more holistically. CPOE is no longer a standalone project. If there is one common denominator amongst any size hospital that is embarking on this journey, it is the fact that the effort is considerably underestimated. Unless you have directly experienced projects of such magnitude, it is natural to treat and plan for this project as you would for any other.

What makes CPOE so different? It is often a multi-year process, especially for larger organizations. It has clear beginning, but not an end. It impacts every operational aspect of a hospital’s business. Above all, it leads to significant clinical transformation efforts that are not welcomed by providers and clinical staff.

Adding to the complexity of delivering CPOE within the Meaningful Use timeline is that all of the clinical components targeted for Stage 1 interrelate. We have two significant integration points: (a) the integration of the CPOE application with the appropriate modules and technologies (lab, radiology, pharmacy, documentation, ED, medication reconciliation, discharge instructions, etc.) and, (b) integration of clinical workflows. The latter is more challenging.

The easier question that organizations should ask is not what CPOE impacts in a hospital, but what it does not impact. That answer is by far shorter. To drive successful CPOE implementation, we know that the leaders have to be involved to “pave” the road and set direction.

To achieve Meaningful Use Stage 1, a cadre of leaders — including the CEO — need a working knowledge of the requirements and organizational changes necessary to succeed. An IT strategic plan aligned with the vision of the organization should be in place at the time Meaningful Use projects are executed. For successful organizations, their strategic plan is centered on the patient and how to maximize clinical performance, the need for increased transparency, pay for performance, provider engagement, and building and expanding business intelligence capabilities, to name a few. This calls for resources, innovative technologies, and infrastructure, as well as a strong leadership team that is able to drive such a vision.

The CIO’s role in the execution of the vision is essential. To successfully attain these goals, the infrastructure must support all these clinical and revenue-generating applications and the new tools that optimize the care delivery process. Someone made the analogy that the infrastructure is like a garden — cultivate it and it will produce expected results, but ignore it and the weeds will take over. As we plan the budgets for these initiatives, although we lead with saying that these are clinical applications and we need to focus on clinicians, we cannot minimize the importance of reliable infrastructure.

In the big scheme of things, what does CPOE impact? Putting it simply, it will impact everything that a provider order does today. Moreover, if what happens today is not functioning at the most optimum levels, then CPOE will accentuate all inefficiencies, resulting in potential barriers towards its adoption. Even processes such as the timely assignment of the appropriate provider to a case will impact CPOE, as any delays or inaccurate information will cause disruptions in communication, delays in care, inaccurate physician performance reporting, billing, etc.

Another critical factor is the fluency of clinical processes related to patient flow, especially at the points of entry through ED or PAT/surgery. As an example, take the efforts of trying to integrate CPOE with a disparate ED system while fine-tuning the medication reconciliation processes. In most cases, the result is a mixture of new processes that could still place patients at risks, unhappy providers if they have to use multiple systems, and budget overruns. Time is a precious commodity – neither the patients nor providers want to waste it.

How do we plan for CPOE? It is by beginning with the end in mind and creating a patient-centric implementation. CPOE has to be safe, should optimize our clinical performance, and improve organizational efficiency. It is complex, but we can simplify it by always asking the question: will the patient and provider/clinicians benefit from it? If the answer is yes, then we are on the right track.

I mapped a visual diagram on how to think about the Meaningful Use components in parallel with what is happening to a patient when admitted to the hospital. This will provide a reference of thinking about what we do in a different way.

And of course, I did not forget about another delicious recipe you could try as we are approaching the end of the summer. I know this has nothing to do with CPOE other than finding a way to relax after a long day at work. And next time, we will talk more about provider adoption, organizational culture, and how to look for that value proposition.

Daniela Mahoney RN is vice president of Healthcare Innovative Solutions of Seville, OH, A Beacon Partners Company.

PHR: the Unicorn of HIT
By Ryan Parker

The Personal Health Record (PHR), in theory, is one of the best ideas in healthcare. Not only in terms of value (think of Facebook and Twitter’s skyrocketing valuations), but also in terms of patient care. As a depository of information, medical records would be easily accessible by patient and provider alike, with medications, procedures, and diagnoses always being accurate and up to date.

Unfortunately, the PHR is the unicorn of healthcare IT.

There have been some valiant efforts, but everyone seems to miss the key reasons why this fantastical PHR will remain just that, a fantasy.

1. PHR interoperability would be an issue. For a viable PHR, it would need to link with every practice and hospital, not only to ensure that providers can view information, but to also make sure that patient data is recorded properly. However, a direct EMR/PHR link would be costly and resource heavy. It would essentially be more effective to create a national HIE (which I won’t get started on why that will never happen). Since we all know that is not an option for the near future, the best option would be to give patients the responsibility of filling out the information themselves. This brings me to my next point …
2. People don’t want to take the time to fill out a PHR. Unless they are made to, most people won’t take the time to find a PHR online and then take the necessary time to fill out all of the information accurately to really make it a worthwhile source of information. In order for this to work, you would need almost a social networking/PHR option that draws people in and then allows them to fill out their medical information, essentially a “Facebook for your health.” However …
3. There will never be a “Facebook for your health.” I’ve heard this idea thrown around quite a bit, and again, it would only work in theory. Most people only use one social networking site. Although Google+ has seen some initial success, I think it will soon bow down to the Facebook beast. The only way we can guarantee a majority of the population has access and comes into daily contact with a PHR would be for Facebook to add a PHR section, which leads to my final point …
4. Facebook will never step into the healthcare arena. Sorry, folks, it is just not going to happen. Facebook is fun, exciting, and laid back. Unless you feel reviewing friends’ home medication list and procedure history is really something that most people would enjoy doing (and if you do, I think you might be in the minority on that one) venturing into healthcare IT would be an extreme departure from Facebook’s prior success strategy.

I, for one, am interested in seeing what the next few years bring in terms of PHR strategy. I think there is an option out there that will work, but it definitely has not been created yet.

Ryan Parker is implementation practice director of Preceptor Consulting Corporation of Fort Myers, FL.

 View/Print Text Only

Top News

President Obama declares this week to be National Health Information Technology Week.

From MT Hammer: “Re: All Type acquisition. As you reported earlier, MedQuist makes it official.” Sort of, anyway – the financial advisor  to All Type Medical Transcription Services issues a press release about its role in the transaction. Reported here on August 25 by Hammer, who didn’t hurt ‘em.

From Proud athenista: “Re: athenahealth’s MU dashboards. The other day I was surprised to learn my very own company was going public with our MU transparency and just read the great interview with Jonathan Bush. Whodda thunk it would ever happen? I suggest that all vendors share their numbers.” PA is referring to last week’s HIStalk Practice  interview with athenahealth CEO Jonathan Bush, who discussed the company’s decision to publish the performance of its athenaclinical clients against Meaningful Use metrics. We are happy to share similar information from other vendors, though I can only think of a couple of others that are offering those details.

From Funky Bunch: “Re: Medicare attestation numbers. Here is some information from CMS that you may have seen.” CMS says $149 million has been paid as of July 31, but it doesn’t give a provider count or breakout of hospitals vs. eligible professionals. Medicaid incentive payments total $248 million and registrants for both programs total 77,549. Hospitals would get pretty big checks for their Medicare attestation, so that number might represent a fairly low number of EPs. On a related page, CMS answers the question of whether audits will be performed: maybe, so keep your documentation for at least six years, it says, else the payment “will be recouped.”

From Just Askin’: “Re: Innovator Showcase. Is that paid promotion?” I’m kind of insulted that you would ask that, but no. Interested companies applied and my volunteer review team (investment guys and a hospital person) choose a handful from the several dozen that they felt were truly innovative based on some rather probing application questions. One of those companies happened to be a current HIStalk sponsor by coincidence and all of them earned their spot strictly on merit.

From Farmer Joe: “Re: Meaningful Use incentives. You seem to make a lot of implied negative statements about spending taxpayer dollars on these. Farm belt clinics are faced with closing due to low patient volume and MDs looking to retire, but with no residents who want to join them due to low pay and practices still on paper. These rural communities provide 80% of the food in this country. Every American who eats anything they don’t grow or hunt themselves should be glad to pay money to keep these practices in business to keep young farmers from quitting and moving to cities.” Sounds like a bit of a stretch that farmers will stop farming if the rest of us don’t buy EMRs for their doctors. If we have to subsidize money-losing medical practices, then I’d rather do it directly instead of paying them to adopt a particular technology that isn’t guaranteed to improve either their medical capabilities or their profitability. And I’m nearly always going to be against new government spending like HITECH, stimulus, TARP, artificial jobs creation, or whatever other cause du jour has aroused our debt-happy and votes-desperate Congress. As someone once said, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”

Streamline Health reports Q2 results: a net loss of $7,000 vs. a loss of $76,000 last year; revenue $4.1 million vs. $4.7 million.

Telehealth provider Teladoc secures $18.6 million in funding
.

EDI provider MD On-Line acquires healthcare communications company Strategic EDGE Communications.

Sales

Via Christi Health (KS) purchases QuadraMed’s Identity Management solutions.

Newberry County Memorial Hospital (SC) selects Summit Healthcare to provide interface engine technology for its Meditech system.

Wilmington Health (NC) chooses Humedica MinedShare as its clinical data warehouse.

HHS Secretary Kathleen Sebelius announces the appointment of Leon Rodriguez as director of the Office for Civil Rights, replacing Georgina Verdugo. He was chief of staff and deputy assistant attorney general in the Justice Department’s Civil Rights Division. He was nominated by the President last December to be Administrator of the Department of Labor’s Wage and Hour Division, but that nomination was withdrawn last week.

vRad names Sandy Schmitt SVP of Strategy and Development. She was previously with Allina and VHA.

 
AT&T names its first CMIO, rheumatologist Geeta Nayyar MD, MBA. She was previously with Vangent.

MediClick promotes President Mike Merwarth (above) to CEO, taking over for Ron Kupferman, who remains chairman of the board.

Hon S. Pak, MD joins AirStrip Technologies as a senior advisor. He was previously CMIO for the Army Surgeon General and is an innovator in telemedicine, particularly teledermatology, and is a graduate of the United States Military Academy and a former combat medic.

Announcements and Implementations

HIMSS names four additional winners of its 2011 Davies Awards of Excellence: Kaiser Permanente (Organizational / Epic); Fallon Clinic (Ambulatory / Epic); James F. Holsinger, MD (Ambulatory / e-MDs); and Hudson River Healthcare (Community Health Organization / eClinicalWorks).

McKesson introduces McKesson Practice Choice, a Meaningful Use certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Zynx Health will hire 40 new employees, including those with technical and sales experience.

Anvita Health is awarded a patent for a decision support system that can apply a variable medication patient co-pay, which it calls “dynamic, context-specific pricing.” Its intended use is to encourage optimal prescribing by charging the patient extra if he or she insists on getting prescriptions for drugs known to lack efficacy or safety. Co-pays can be reduced if a patient accepts a less-expensive cancer drug that matches responsiveness markers, or if patients are compliant with their prescribed meds.

A group of University of Alabama in Huntsville professors launches Decision Innovations, whose first product is a nurse staffing dashboard started as a 2008 pilot project with Catholic Health Initiatives. The company won the $100,000 Alabama Launchpad 2011 Business Plan competition and is setting up shop now.

Health benefits provider WellPoint signs a deal to develop commercial healthcare applications using IBM Watson technology. Few specifics were given, but the press release suggests that the applications could help physicians choose treatment options and direct patients to providers who have the best track record in treating their condition. WellPoint says it will start pilot projects early in 2012.

Government and Politics

HHS awards $8.5 million to 85 community health centers in Beacon Communities for the adoption of HIT.

HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied to received Meaningful Use incentive payments and 70% of primary care physicians in rural communities have signed agreements with RECs.

A proposed HHS rule would give patients direct access to their own lab test results.

Technology

Microsoft previews Windows 8 (that’s the working name, anyway). This SlashGear hands-on review shows it running on a tablet (assuming someone other than Apple is making them by the time Win 8 hits the streets). The big question for me: how well does a design that looks like it was borrowed from the iPad work on a desktop using a keyboard and mouse? Microsoft is betting the cash cow that consumers and businesses want their desktop and laptop PCs to have a radically different user interface.  

Software that creates natural-sounding news articles from a set of facts could write medical journal articles, the company that developed it says. They claim it can compose a unique, smooth-reading article in about one minute that even experts can’t tell wasn’t written by a human.

Other

The Canadian hospital that refused to name the nurse who breached the electronic records of 5,800 patients, citing her right to privacy, changes its mind after the province’s privacy officer declares there is no such law in a newspaper’s letter to the editor. The hospital now says it will give the nurse’s name, but only to patients who state by letter that she accessed their files.

An interesting article in the Charleston, WV newspaper covers Charleston Area Medical Center’s patient transfer center, an air traffic control-like room with a huge electronic status board showing bed status in its three hospitals.

I awoke this morning realizing I had been dreaming that a network technician was working to maximize the speed of my home network. I gloated when he told me how impressed he was with the labeling of all the devices, and I was school girl giddy when he complimented me on the strength of my passwords. We then discussed the merits of various printers. I am clearly overdue for a vacation.

A former pediatric nurse at NYU Langone Medical Center says hospital employees snooped in her medical records and, from her history and diagnosis of endometriosis, assumed she was a virgin. Her co-workers then kept trying to convince the 41-year-old woman to have sex, she says, with a neurosurgeon making references to “The 40-Year-Old Virgin” movie. She’s suing the hospital for $45 million, claiming it didn’t protect her medical records.

Wake Forest Baptist Medical Center (NC) fires and sues a former administrative director for “unjustified, vindictive, malicious, and gratuitous actions.” His transgression: he alerted the state that it was overpaying his employer under the terms of its health plan. The state auditor agrees, saying sloppy state contracting and oversight allowed the hospital to overbill by $1.34 million. The hospital says it was none of the former employee’s business and its contract allows it to raise prices without notifying the state.

The Wall Street Journal highlights the industry’s transition from ICD-9 to ICD-10 and mentions several of the wackier codes. One of my personal favorites: V91.07XA (burn due to water skis on fire.) athenahealth’s CTO Jeremy Delinsky correctly notes that, “You have millions of transactions flowing in the healthcare system and this is an opportunity to mess them all up.”

  Even Weird News Andy finds this cringe-worthy news item from China “too weird for words.” A man bathing with live eels as part of a spa’s exfoliation treatment is startled when he looks down at his private area and sees a six-inch-long eel disappearing by the obvious method of ingress. The eel found its way to his bladder on its own, but removing it required a three-hour surgical procedure.

• Sandhills Pediatrics (SC) receives $184,000 in ARRA incentives from its use of SRS.
• MEDSEEK announces the availability of ecoSmart Patient Precision predictive analytics technology.
• Practice Fusion forecasts that 5,000 of its eligible provider clients will receive $18,000 in Meaningful Use incentives in 2011.
• Two T-System employees, CMIO Robert Hitchcock, MD and Center for Performance Excellence Manager Janie Schumaker, RN, are elected to the board of the Emergency Department Practice Management Association.
• Aspen Advisors releases a case study on the Epic implementation of St. Anthony’s Medical Center’s (MO). 
• BridgeHead Software announces the successful integration of its MediStore archive technology with  three leading PACS products.
• Ben Michelson of Hayes Management Consulting discusses lessons learned from ICD-9 implementations in a guest article.
• Wolters Kluwer Health releases a ProVation MD module to support participation in the ACC National Cardiovascular Data Registry CathPCI Registry.
• Thomson Reuters introduces MarketScan Treatment Pathways to analyze medical care, outcomes, and costs.
• TeleTracking Technologies announces the availability of its RTLS to the UK healthcare market.
• Cumberland Consulting Group provides a checklist of 10 things hospitals should consider as they undergo EHR implementation.
• MidMichigan Health uses Concerro’s ShiftSelect in its retiree return-to-work program.
• The AHA Center for Healthcare Governance selects CareTech Solutions and its customer San Luis Valley Regional Medical Center as presenters for its Fall Symposium.
• The Massachusetts Department of Public Health replaces its e-Forms system with Access’s electronic forms on demand solution.
• AT&T contributes $100,000 to support a mobile health initiative to use smartphones in diabetes education.
• Elsevier / CPM Resource Center will integrate its evidence-based clinical practice guidelines and documentation solution into the McKesson EMR of Medcenter One(ND).
• Iatric Systems adds the federal government’s Blue Button capability to its PtAccess patient portal, which allows patients to download their health information as a text or PDF file.

Contacts

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

 View/Print Text Only

Company name: Health Care DataWorks, Inc.
Address: 1801 Watermark Drive, Suite 250, Columbus, OH 43215
Web address: www.hcdataworks.com
Telephone: 614.255.5400
Year founded: 2008
FTEs: 20

HCD provides business intelligence solutions that enable healthcare organizations to improve quality and reduce costs.

Business and product summary

Our products are innovative in that they are an accelerator for organizations that recognize the need to leverage their siloed data to improve their performance, but don’t want to spend years building an enterprise data warehouse (EDW) from scratch. Health Care DataWorks (HCD) brings a pre-built, packaged EDW that is immediately ready to feed data. Our clients are able to see value within months rather than years.

HCD’s EDW Appliance bundles robust hardware, AIX operating system, Oracle 11g database, HCD’s own comprehensive enterprise data model, plus hundreds of pre-built standard reports and a dozen pre-built dashboards with hundreds of key performance indicators with drill-down capability covering quality, Meaningful Use readiness, revenue cycle, operating room, nursing scorecard, to name just a few. 

Our company is innovative in that it was founded and is managed by people that grew up in hospitals and health systems, as opposed to within a vendor organization. Our CEO has been a healthcare CIO for most of the past 20 years at various-sized organizations. Our COO led business intelligence development efforts at a major academic medical center for over eight years. As such, HCD has “walked a mile” in the shoes of its clients and has a unique, first-person understanding of the problems that healthcare executives are trying to solve with integrated data.

Finally, HCD is innovative because — unlike the Goliaths in the industry that it typically competes with, such as Oracle, IBM, and SAP, which have many product lines and foci — HCD has a laser focus on delivering innovative, value-added business intelligence solutions to hospitals and health systems, and as such, can be much more nimble and responsive to its customers.

Strategic Roadmap — for organizations very early in thinking about how they will use BI / analytics / EDW. This process will ensure you have buy-in for whatever decisions you make in this area and takes approximately five months.

Dashboard Appliance — for organizations that want to do a proof of concept for an EDW or to meet a specific need that requires a dashboard solution. Low price allows starting on the path towards an EDW without losing any of work done in populating the dashboards.

EDW Appliance — for organizations that are ready to build an Enterprise Data Warehouse and want tools and technology to accelerate that process.  

Target customer

Large and mid-market hospitals and hospital systems.

HCD’s products allow the users to pull data from multiple source systems making the data accessible in one location. The ability to run reports and drill down using friendly dashboard interfaces gives decision makers the information required to make knowledge-based action plans.

Competitors

Microsoft, Oracle, and IBM are a few of the better-known competitors in the industry.

Advantages over competitors

As a spin-off from the Ohio State University Medical Center, the founders of Health Care DataWorks have developed and worked the product from the ground up.

List five fast facts about the company or product.

1. Ohio State University Medical Center spin-off.
2. All five founders have worked or still work with the EDW at OSU.
3. Won TechGenesis Grant of $50,000 after to a market analysis that determined a large unmet need for the product.
4. Named Gartner “Cool Vendor” 2011.
5. The EDW Appliance was one of the first data warehouse solutions to achieve Stage 1 Meaningful Use certification.

Pitch video created specifically for this Showcase

What problems have you solved using HCD’s product and what has been the overall impact on your organization?

We are in the very early stages of implementation, having just signed a contract. Our vision project vision statement is:

To support our mission and vision, we will implement a set of business intelligence tools and a data warehouse, starting in 2011, that will transform integrated clinical, financial, and operational data from the disparate systems throughout the organization to information that is aligned and driven from the strategy and will support real-time decision-making to enhance clinical care, support research, and facilitate economic and financial forecasting

The impact to the organization has not been profound as of yet, but we are looking for some innovative solutions which will empower our decision-makers with data to make good business and clinical decisions. Having the data at their fingertips vs. having to contact IS for the data or to run a report; providing dashboard capabilities related to their KPIs and quality indicators; looking at predictive analytics to utilize the value of the data as we look at risk-based contracts, etc.

If you were talking to a peer from another organization, how would you describe your experience with HCD?

The experience has been very positive. HCD has been very responsive and knowledgeable about healthcare data warehouse and business intelligence. They have also been very flexible in terms of contracting and even providing a proof of concept phase of the project / contract. It has been a much different experience working with a smaller, more nimble company than some of the bigger players who may dictate how the process will work.

How would you complete this sentence if again speaking to a peer? "I would recommend that you take a look at HCD under these circumstances:"

HCD is a startup company, and as such, you will be taking on more risk than a mature vendor, but the risk may well be worth the reward given their current products, future offerings, and expansive healthcare knowledge.

An interview with Herb Smaltz, CEO of Health Care DataWorks

A lot of big companies sell dashboards and data warehouses. Why would customers choose to buy from a small, healthcare-only vendor?

We are laser focused on healthcare. Competitors obviously have lots of different product lines, lots of different vertical markets.

The other thing that resonates with our customers is that we all came from the health system. I’ve been CIO pretty much my whole career, dating back to even before you could call it a CIO job. I’ve been doing this for a long time, sitting in that chair trying to solve these kind of problems. Our COO, Jason Buskirk has been working in the BI department building BI apps and solving those problems from a development standpoint inside the health system for eight years. All of us on the senior team that spun this technology out of Ohio State have been doing this for a long time.

We’re a young company. We’re three years old now, but we’ve been harboring this technology over 13-14 years now in a major academic medical center with built-in health system. Again, trying to solve these kinds of problems of data integration and really making sense of really heterogeneous, really potentially dirty data to solve business problems. 

I think those things resonate with our customers. That we walked a mile in their shoes and were one of them, if you will. Even though we are clearly a vendor company, well grew up in health systems and the technology has really been hardened in that kind of an environment.

We went through those years of at OSU where we were stubbing our toes on the best way to build a data model; the best way to build performance; the best way to build query capabilities. For most startups, they’re stubbing their toes with their customers as they build their product.

I think all those things make it a little more comfortable for folks to go with Health Care DataWorks.

You offer your product as an appliance in one configuration. Realistically, what kind of time, effort, and skill set would a client need to connect everything and go live?

That’s one of the things that we offer as a value proposition. We’re really an accelerator for organizations that are right at that precipice of trying to figure out how to get all their data to work together.

If you talk to people like Gartner and others, for the folks who try to build it themselves, it’s a good three-year prospect to build it from scratch. We’ve packaged everything: the hardware, operating system, Oracle 11g database licenses, our own very comprehensive data model, and tons of content. Lots of pre-built dashboards with scorecards and hundreds of reports. 

Essentially, we can just drop that in to an organization’s data center or just use our hosted data center, whichever they prefer. Instead of sitting around a table having discussions about how these tables should be built and what these data elements ought to be called and how the table joins ought to work, they’re immediately just working on populating this packaged data warehouse appliance that we bring to them. Within four to six months, they’re typically using one of the dashboards. They’re using a bunch of standard reports in whatever area they’re focused on.

But one caveat. Source data that comes from those various EMR systems, ERP systems, scheduling systems — you name it, there’s tons of systems in a hospital and health system — they’re notoriously dirty. When you bring that heterogeneous data into an appliance, what it exposes is some of that dirty data. 

One of the things that can cause delays is data governance. Seeing that the data is not good, having to go back to the source systems and the owners of those source systems — whether that be the chief medical officer or nursing or wherever the data was pulled from — and work with them on how to best move forward. Do you want to expose the data as it is, with some asterisks and caveats? Such as, “There are number of blank fields, but from this day forward, we’ve asked our registration folks to fill those fields in.”

That whole data quality, data governance within each hospital is a new core capability that they really need to develop. The ability to take their data from their various systems and help to make that cleaner and cleaner and cleaner over time.

But typically, it’s four to six months from the time that we sign a contract to the time that they can get use of a set of reports or a dashboard or a scorecard.

It’s been a year since you signed Orlando Health. What results have they seen?

Orlando Health is one of those organizations that this issue of data quality and data governance has come up. Very quickly, we were able to get their quality dashboard in place. One of the things they wanted to do to before they exposed it to their users was to clean up all their data.

I’m a fan of, you know, “data gets better with use.” Now to be sure, at a physician level or a patient level, you want to make sure that data is right. There’s that tradeoff. Orlando Health has really focused a lot on their data quality. They’ve been busy for a number of months working on data quality, getting the data quality up to speed. But their dashboard was ready and loaded with data within months of getting the appliance in place. 

With another customer, Essentia Health, we did a proof of concept with them. Just three months later, they got a Top of the Hospital dashboard up. They put in place a data governance group, which has been meeting and working on those sorts of things. 

It’s one of those things where the technology really isn’t the thing that holds people back. It’s the ability to make decisions about the data that it exposes and how they want to deal with that and handle it. In some cases their source system data is very clean and they can very quickly move on and deploy that to users. In Essentia’s case, that’s what happened.

In Orlando Health’s case, they had a number of fields that were blank in their source systems. For example, a referring physician is one of those that was blank. They had 160,000 instances of a blank referring physician. If you want to do analysis on where your patients are coming from, it’s important to fill that in. They had to go back to their registration department and essentially say, “We really need this field filled in.”

Anybody you talk to in the marketplace will tell you there’s no silver bullet technology that can overcome poor source system data quality issues. With all of our customers, we absolutely offer that acceleratory capability, to immediately let them start using the data. The question really becomes is whether the data coming from their source systems is of a high enough quality that they want to expose that to end users to make business decisions on. We very much work with them on that data governance process in making decisions around that and helping them to the point they’re exposing that data to make business decisions.

What do you hope to gain from the exposure?

As you mentioned, we are a small company. We don’t want to take anything for granted. We want folks to get an understanding of the company, the fact we’re laser focused on healthcare providers in particular. We very much appreciate it. Any small company can benefit from people knowing about you. We hope to be included in more RFPs, and we’re getting more and more. We just closed Presbyterian Health System  in Albuquerque, New Mexico and Children’s Medical Center Dallas. Because we’re competing against folks like Oracle, IBM, and Microsoft and the exposure really does help.

 View/Print Text Only

Mr. H’s recent Time Capsule on hospitals wanting software to do the dirty work of changing physician behavior is as true today as it was five years ago. All too often, we see the fallout of this strategy – poor adoption, user dissatisfaction, and worse.

The editorial mostly discusses CPOE, which was the hot ticket item at the time. Back then, there wasn’t a lot of attention to the ambulatory space, although Meaningful Use has certainly brought that to the forefront for many organizations.

Changing physician behavior on the ambulatory side, whether in an integrated delivery system or in a private practice, brings different challenges than on the inpatient side. Hospital have well-defined governance rules and entities to deal with problems when they arise. (note that I said ‘when’ – this is not an ‘if’ situation. There will be problem providers.)

Typically, you have a medical executive committee of some kind, made up of department chairs, service line directors, administrators, etc. Each specialty department typically has a chair who can address behavior issues with providers. Providers (both compliant and difficult) are used to these enforcement structures as they pertain to delinquent medical records, unsigned verbal orders, and the like.

Providers are used to JCAHO-dictated processes and procedures, care plans, and lots of administrative involvement and oversight. They are typically subject to medical staff bylaws of some kind and can lose their hospital privileges for misbehavior.

The ambulatory space in many organizations, however, is like the Wild West. Physicians are used to a high degree of autonomy. Even in hospital-owned provider organizations, leadership is often unwilling to be the ‘stick’ needed to change behavior. The average primary care physician generates roughly $1.5 million in downstream revenue and organizations are afraid of disruptions to referral and test ordering patterns. Unless there are legal or regulatory issues at stake (and sometimes even in those cases), physician non-compliance is often overlooked.

Implementing an ambulatory EHR is seen by some as a relatively easy way to address these behaviors. Rather than deal with true process and workflow issues, the thought is to just mandate the behaviors through system configuration. The software becomes the third-party “bad guy” to force change.

This rarely ever goes well. Users placed in these situations (both provider and other) immediately demonize the software, the implementation team, the selection team, and the vendor. This negative response isn’t very helpful or productive for anyone.

I’ve been involved in implementations where physicians were told that something is required by JCAHO or Meaningful Use when it frankly had nothing to do with either. It was just used as an excuse to try to make physicians behave one way or another. That puts implementation staffers in the middle of this fight. I’ve seen savvy physicians who know their facts completely derail training and implementation efforts as they argue with training staff who may or may not know they’re part of a manipulation effort, but either way, are not decision-makers.

Independently owned or smaller practices are also subject to manipulation efforts, but usually from within (unless there’s a Stark-related subsidy involved – that adds an additional level of potential control.) Typically, a subset of partners or a lead partner will try to leverage the EHR to change colleague behavior or practice patterns rather than addressing them head on.

We all know the old adage that putting automation on a dysfunctional process will only serve to make it more dysfunctional at a faster rate. Practices who try to implement EHR without cleaning up internal issues first place themselves at significant risk. Much like a driver’s license exam, there ought to be a test before practices are allowed to implement. I know some vendors who do readiness assessments and will reschedule practices who don’t have their acts together, but most seem to allow them to forge ahead regardless of the risk.

Some key advice for ambulatory organizations ready to implement EHR:

• Decide on what level of customization will be allowed. Will it be at the practice, specialty, or provider level? If you’re really willing to support provider-level customization regardless of outcomes, cost, or impact, then you don’t have much to worry about as far as changing physician behavior.
• For practice- or specialty-level decision-making, start the change management process prior to implementation. Standardize order sets and get agreement in the paper world. Make sure new protocols and initiatives actually work in your culture before adding an EHR to the mix.
• Revisit state and federal laws and regulations. Ensure compliance before implementation so that providers clearly understand the origin of the mandate.
• Revisit standing orders and care protocols. Make sure they are up to date. Build them accurately into the EHR and work with your vendor to ensure effectiveness.
• Analyze staff roles and responsibilities. Optimize performance and clarify expectations. If staff isn’t up to par, start remediation now. Help staff understand that EHR will change their jobs regardless of their role, and if they can’t live with that, they need to adjust or start looking elsewhere.

These items seem deceptively simple, but in fact are the hardest things a practice needs to do to be successful and are often the ones that are ignored. Implementing an EHR is not going to accomplish this for you. There are no magical lines of code to deliver a keyboard-induced shock to their sneaky little fingers. Non-compliant physicians will simple use the EHR as an excuse for their behavior rather than change.

Organizations with large numbers of “outliers” may need a formal change management initiative in addition to EHR implementation efforts. The benefit is well worth the cost.

E-mail Dr. Jayne.

 View/Print Text Only