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Curbside Consult with Dr. Jayne 1/20/14

January 20, 2014 Dr. Jayne 2 Comments

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Last week, Mr. H polled his HIStalk Advisory Panel regarding their top priorities and concerns for 2014. I laughed out loud at the response above. Not only is it extremely direct, but in the case of my hospital, it’s entirely true.

Like many facilities, we spend a lot of time going through various exercises to define the various projects we need to work on during the year. We also expend a great deal of effort reviewing our personnel and their capabilities while we determine the overall capacity for work.

I looked back at our timekeeping system, and during 2013, I spent nearly 100 hours in various project evaluation and prioritization efforts. That doesn’t include the time spent looking at team members and whether or not they can take on additional projects. At most of those meetings, there were between six and 12 attendees, so that means we spent close to half a person-year trying to figure out what we need to work on and in what order.

We have over 100 prioritized projects on our ‘to do’ list. Being “prioritized” means that a project fits certain business criteria. For example, it might be in support of our Accountable Care or patient outreach efforts. It might be a process improvement project which requires modification of existing systems or addition of a new system. It might even be something that enhances the user experience or the overall usability of an application. Bring prioritized, however, does not mean that a project is funded.

There are a lot of things on the list that the requestors believe we need to do, but are not willing to commit funds to actually accomplishing. They want us to find funding out of some nebulous IT pot of gold which simply doesn’t exist. Because these projects aren’t funded it means they languish on the prioritization list, which adds to everyone’s frustration. The IT department feels like it can’t ever move things off the list and our departmental customers feel like the IT department doesn’t do anything.

When a project is actually funded, we can knock them out pretty quickly. For example, one of our outreach clinics recently applied for and received grant money for a very specific clinical reporting project. The requested a suite of reports and a dashboard for monitoring. We created a proposal and they approved it. The IT chargeback item was opened and the scope document created and finalized. We had their dashboard live in beta in under 30 days and in production a week or two after that. We probably could have done it faster, but there were some delays with accounting and paperwork and we’ve learned the hard way not to start anything until all the paperwork is in place.

Looking at the actual IT discretionary budget that we have to work with, it’s going to be nearly impossible for us to do anything that isn’t MU-2 or ICD-10 related. If it’s not regulatory, it’s not going to happen unless D.B. Cooper drops a mysterious bag of cash from the sky. We have enough in the budget to handle various hardware and infrastructure upgrades so we can stay ahead of the vendor requirements game.

Like many other hospitals, we’re struggling with the fact that our vendors aren’t delivering the MU-2 and ICD-10 software as quickly as we want it. I hope what we ultimately receive is high quality because we can’t afford endless rounds of testing or delays when what we receive requires patch upon patch. We need to get the MU software in so we can free up the environments for ICD-10 testing. If there are delays, we can’t afford to stand up extra testing environments to handle what the vendors should have taken care of during beta testing.

At least our ambulatory vendor has delivered its software package, which includes both MU-2 and ICD-10. We’ve got it in testing and it looks pretty solid, but there are a couple of fixes we’re waiting for that are fairly specific to our environment. We should have them in the next week and then the real fun will begin. Our physicians are very nervous about the ICD-10 transition and we’re using a third-party vendor to augment the mapping provided by our vendor, but that’s one more thing we’ll have to test.

We’re only a couple of weeks into the year, but I already need a vacation. We plan to attest for MU-2 in the third quarter so we can coast towards ICD-10, but I doubt it will be a smooth ride. In the mean time, we’ll be on-boarding new practices and adding several dozen physicians to existing practices. I think I’m going to need roller skates. If you’re a CMIO what are your priorities for the year? Email me.

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