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I Am the BOSS!
By Bill Rieger
There is no question who the boss is around here. I earned the office with two — count ’em, two — windows. My paycheck is at the top of the pile and serves as a paperweight for the rest of them. The CEO and I swap stories about how great we are. I am the one in front of the board every month reviewing IT strategy and direction. Make no mistake about it, I am the man!
Ever work for anyone like this? Maybe you still do, although it may not be this obvious. Or, are you yourself like this?
WAKE UP! The time for career oppression is over.
Change is happening faster than ever. We no longer have the luxury of centuries, decades, months, weeks, days, or even hours to adapt. While back in the day it took just about 2,000 years to invent the stethoscope after discovering that heartbeats do actually have clinical meaning, today a discovery can reach millions of scientists around the globe in seconds.
Have you seen some of the "Did you know" videos that illustrate the rapid pace of change today? Certainly not all of them are validated, but it makes you think, doesn’t it? One of the statistics I like is about text messages. The first commercial text message was sent in December 1992. Today the number of text messages sent and received every day exceeds the total population of the planet.
The point? As stated before, change is here and it is coming faster every day. If you think you can manage the change of this generation alone, you will cut short yourself, your organization, your community, and all of those you influence.
At our hospital, a member of the IS leadership team had previously been exposed to the Clifton Strength Finders book. Their idea was to purchase it for all IS staff members to help them find their strengths. This led to a whole mindset shift of the IS leadership team, including me. Instead of focusing on what we don’t have, let’s determine what we do have and capitalize on it.
What a difference it has made. All staff members who participated have proudly tacked their list of strengths to their cubicle or office. The entire IS leadership team from supervisors on up have gone on to read Go Put Your Strengths To Work to help align staff member roles with their strengths.
From here, it is a work in progress. I am fully confident that many more ideas will come from this and we will continue to focus on and better use the strengths of the team. What if I would have said, "Great, Chris, now go back to your office and get me the budget report?" or something else insignificant in comparison? Where would the department be? Where would the organization be, as this concept is certainly leaking out of the IS department?
Healthcare is in the beginning of great change and healthcare IT is in the middle of frantic change. As the stethoscope example indicated, healthcare changes slowly. After all, change in healthcare is risky. My response to that is that indeed change can be risky. In order to mitigate that risk, you cannot — I cannot — be the big shot in the corner office.
You have to — I have to — seek out who can best help manage the seemingly unmanageable change that is coming. The talent exists. It is up to leadership to draw out those strengths that will be needed. Leadership should be seen as a springboard, not as a ceiling.
When Abraham Lincoln worked hard to free the slaves, his original idea was to "free" them from their oppressors and then send them to Jamaica or Cuba where they could be "free." When some of the slaves were freed, they asked to be able to fight for and with the Union. That was great, and in response, they were given shovels and uniforms. When they asked for weapons, they were originally told that they could not have them. It literally took an act of Congress to get weapons in the hands of the newly freed slaves. The fear was that they would turn on their oppressors. What actually happened is that they fought with honor and courage and played a vital role in the final defeat of the Confederate army.
That is exactly what I believe some leaders are like: afraid to empower their teams, afraid they will turn on them when they lose control of them. If you want to see an empowered employee, bring them to the CEO’s office, the next board meeting, or the next department meeting and give them credit for a great idea. Watch their world change as they grow in front of your eyes.
How many more ideas will be born of that one? How many light bulbs and stethoscopes will be created from simply giving credit where it is due? As a result of our Strength Finders journey, the IS org chart changed. The CIO and the directors are at the bottom, supporting those who are above. The ceilings are gone. Fly, people, fly!
Bill Rieger is CIO of Flagler Hospital of St. Augustine, FL.
Moving from Care Following Technology to Technology Following Care
By John Haughton MD, MS
How is it the feds have paid out $5.7 billion for Meaningful Use Stage 1 incentives and we are still missing community-wide patient views and shared care plans accessible across EHRs and mobile devices for acute providers or across providers and payers working to enhance coordination of care or across acute and post-acute providers engaged in streamlining health delivery effectiveness?
The answer is threefold, but simple. Standards-based interoperability using discrete data is hard. Available EMRs, at their core, were designed with an encounter and billing perspective rather than a discrete patient level portable data and shared care focus due to business and legal needs. Technology in the standalone, client-server / web screen-sharing world is not designed for moving data across systems.
Integration and processing of discrete data across populations requires dynamic community views of information coming from multiple sources to realize the true value of shared care – better coordination, pre-crisis intervention, and decreased redundant care delivery. To date, incentives and needs haven’t requested the collaborative care technology infrastructure. That’s changing.
Enter the cloud and native Internet applications integrated with secure cloud information brokers, cloud consumers, and cloud providers. Cloud coordination is front and center in general federal IT acquisition activities. These systems are designed for collaboration and to share information across organizations, systems, and technologies from different vendors in different formats.
True and complete interoperability requires standards that are useful and usable, which are still hard to come by in general and certainly in healthcare. Heck, even a simple one – Medications and RxNorm didn’t allow for the prescription of birth control pills (two in one box) or prenatal vitamins (more than three ingredients in one) until recently. Fortunately, there are ways to use modern security, data, and analytic processes to move information now. Methods that are proven from other industries to work in environments without perfect standards are available to healthcare.
MU 1.0 was a good first step: $2 million or more for hospitals and $18K to start for providers. Money flowed into the system to purchase IT. Even so, the electronic health records purchased by and large don’t talk to each other yet. Even the Beacon Communities are into their third year without real interoperable clinical data from various EMRs (fingers crossed — we should see data movement starting this fall. Lots of folks have been working hard to make it happen.)
Now with MU 2.0 out, the money for change won’t come so much from the same ONC carrot. The majority of incentive dollars will have been earned during MU 1.0. Instead, there’s a new carrot — shared savings rewards in ACOs and other value purchasing — and now a stick in penalties for fee-for-service Medicare payments for a lack of reporting and performing on various quality of care metrics. Additionally, rewards and penalties from commercial insurers are creating narrow networks with less revenue and access for providers at the lower end of the cost-quality matrix.
What is the right design for EHR and community care systems in the evolving world? At a minimum, systems must make sure the data collected is secure, accessible, portable, and interoperable. To make this happen, EHR systems must include the perspective of being part of a network — part of a data fabric — at their core.
Newly emphasized functions from MU 2 for collaborative care include: data formatting; content normalization; patient-level information aggregation – in discrete, standardized elements – attributable to sources; population analytics for opportunity identification and effectiveness measurement; workflow that includes access to information at a place where it can be used; and collaborative communication across teams. Expanded decision support rules are useful for clinical care, financial management, and measurement and reporting for payment based on value.
As we move forward, the biggest change will be a change in design mindset for electronic health records, from one of monolithic, vendor-specific islands of technology to a connected ecosystem of secure data collection, portability, display, aggregation, and access across the community, across payers and providers, across patients and their caregivers , across healthcare and the general community.
Change is unstoppable as we move to networked healthcare. That’s good, but it’s tiring. In the new world, providers will no longer be dependent on singular big IT infrastructure as secure, clean, portable data and identity coupled with lighter-weight modules, interoperable widgets and applets solve real problems. Vendors will open communication channels as a strategic asset rather than “wall the garden.” Monolithic HIE umbrellas will fade as government initiatives — such as Direct for the patient and Query Health for the population — continue to gain traction as front and center techniques for simplifying interoperability and shared care tasks.
What will be needed? Outside of healthcare, the federal government has a framework. It’s moving into the cloud – a framework that includes cloud suppliers and cloud brokers – to ensure a secure, reliable interoperability experience. In fact, it is the cornerstone of the federal strategic plan for technology and information management: increasing usability and access to information while decreasing the complexity and cost of information technology. Why should healthcare be any different?
John Haughton MD, MS is CMIO of Covisint of Detroit, MI.
By Kim South, RN
With the new Stage 2 Meaningful Use rules finalized and released, patient engagement is becoming a major focus. Can providers control that their patients are logging in online to view their medical information? Can providers control their patients to the point of sending secure messages? Everywhere I turn, these are the questions I am hearing.
The short, quick answer is, “Of course we can’t control them.” That’s also the answer the people who are asking the questions are searching for.
On the surface, it’s an accurate answer. We can’t control our patients. We can’t make them engage in their care. We can’t make them be interested in losing weight or quitting smoking. But we do have the potential to influence their behaviors and encourage them to be our partners in their health.
As an oncology nurse, I spent hours every day talking with my patients and their family members about what was discussed in the recent office visit. It’s so much foreign information to take in, remember, and explain to others. Online access to this information has the potential to seriously reduce office time spent in this role, which translates directly into the nurse’s ability to focus on other tasks.
I’m no longer a practicing oncology nurse, but it’s where my heart lives. Being on the vendor side now, my patients are always in the back of mind: what would benefit them, what would make their burden less, what would make them feel more in control of this disease process? Patients with chronic diseases are hungry for information. What better information to supply them with than their own? It makes perfect sense to me.
I’m sure I’m in the minority, but I actually see this transparency with medical records as a benefit to both the patients and the medical personnel who care for them. Fewer phone calls about what was said, secure messaging to answer questions that would be a phone call interrupting a clinic, the ability for patients to visually see their health. It’s very powerful stuff and why I stay in the healthcare field — to make a difference for the patients.
Can we control patients? No, but we sure can influence them. I could sell online access to my cancer patients in a heartbeat. Online access to their office visit information, online access to their lab results, online access to send me a question as they think of it regardless of the time.
The 5% threshold to meet these measures is very attainable. Having the right tool to enable your patients to participate in their health is core, but those tools already exist. As a medical community we need to embrace patient engagement and give our patients the tools to be intelligent about their health.
Kim South, RN is product manager of Jardogs, LLC of Springfield, IL.