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Advisory Panel: Your Personal Mobile Device

April 18, 2014 Advisory Panel No Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What brand/model of mobile device do you use most often and what do you like most and least about it?


I use an iPhone and an iPad and I am happy with the fact that I can access my email from anywhere and can respond on the fly, but for the business of medicine it is cumbersome, difficult to type, not secure, and the constant need for iOS updates makes it difficult to use and upgrade apps. I do not like the "Walled Garden" approach from Apple that does not allow certain applications on their platform like Adobe Flash and it is also very expensive. I read somewhere  — on LinkedIn, I believe — that it seems only wealthy people use iPhones and it is almost like a statement of status, sort of the same stereotype that wealthy folks drink wine and the not-so-wealthy drink beer…just saying.

Interestingly enough, I did not end up with an iPhone by my sheer choice, but it was rather imposed on me by Allscripts of all people. They bought my initial e-prescribing "I scribe" which I had on a Palm for free and when Allscripts bought them they, did away with the Palm. In order to preserve my data, I had no choice but to get an iPhone and there you have it: there is no such thing as "free" and consumer choice, is it really? Mr H touched on this on one of his posts: the fact that it looks unprofessional to respond to emails from the iPhone (folks do not correct spelling, grammar, and at times it looks like mutilating the English language) but I admit I am guilty of doing it myself because on the other hand, what is the sense of the whole mobility trend? I cannot always wait for access to a desktop to respond to my emails, but I promise to correct the spelling.


Apple iStuff. They work as a consumer device (for which they are designed). I just wish they had enterprise devices.


HP laptops >> iPhones>> iPads


Personally I use an iPhone >iPad>>MacBook Air


I have used an iPad for a few years but switched to a small Dell Iconia W5 last year. I thought the Microsoft OS would make life easier working with my corporate applications. The Iconia certainly beats lugging a laptop on and off aircraft as I travel but it still isn’t as easy as the iPad. Last month I picked up an iPad Air. The smaller size is great. I think the Iconia is going back on the shelf and the Air will be my travel companion going forward. Now if only I could find something the size and ease of the Air combined with the MS OS….


Can’t live without my iPhone 5 and my iPad 2 (with a keyboard/case combo). Allows me to stay easily reachable and to work at home without lugging a laptop every night. What I like most about the iPad – Microsoft OneNote and the ability to keep all my data and projects current across devices and operating systems. This has been a huge help in organizing an extremely busy life. I literally walk into a meeting, pop open the iPad, and jump right in. I have all the meeting notes organized, all the action items up front, and I can take notes at the same speed as if I had a full keyboard. The search feature helps me quickly find pages by keyword. I share Notebooks with my team and that is working well, too. Note: I’m ordering some Microsoft Surface Pro 2s this week to trial for potential laptop/tablet replacement.


Personally I use a HTC smart phone and an iPad. I’m not crazy about the phone mostly because of the battery life (or lack thereof). My contract is up so I need to make a decision on a new device, but I’m not sure at this point what I will choose. I am very fond of my iPad. I use it primarily for reading and distractions and very little for work. I know that Ed Marx said in one of his blog posts that he doesn’t trust anyone that uses paper, but I went back to a paper notebook for meetings. When I take my iPad, I don’t generally take a pen to the meeting. The majority of the time someone passes out paper and I need to make note on a section so that I can follow up later. If I could get the groups to move to a paperless culture I would use the iPad exclusively.  


iPhone. I love the consistency between my Mac, iPad and iPhone. Battery life and the lack of a SD slot are the downside. I also never use Siri.


Samsung Galaxy S3 and Nexus 7 tablet. The Samsung battery is dreadful, but other than that, both devices are excellent. Google’s services and products are nicely integrated. The processors are fast, multitasking works great, and the Android OS is very reliable. And I can’t live without Swype and Dragon.


Apple iPhone 4S. I use maps, social media, email, calendaring, travel (airlines), weather, stocks, search, music, text, sports updates, news (around the world to help reduce spin), shopping (Amazon), restaurant ordering, restaurant reservations, and so on. There is not much I don’t like about it except for Siri. She is not very smart and does not take a clue when I am upset with her ;-). I find it works better without the protective film on the glass, to be sure.


My iPhone 5 is my most used mobile device. I find it great for email use and I have several apps that I use for business and personal needs. My AT&T service is great for talking and browsing. With the latest iOS upgrade my battery life is terrible. 


iPhone5. I love the iPhone. I will happily pay for something that is intuitive, quick, consistent, and has a lot of people writing for it. With that said, I am starting to see the Samsung users smirk as their product may take pictures better, get better Wi-Fi access, doesn’t charge extra for some little things. I am hoping the iPhone6 has some nice breakthroughs. But I will likely stick with Apple as the service has been phenomenal if I have any problems on any device and that is worth A LOT in  my book.


I’m not a Mac person, but my iPhone is my most favored and trusted sidekick (iPad comes in a close second.) Portability is the best feature. Clearing out my email inbox while waiting for elevators, looking up info on Google on the fly, quickly populating and reviewing my ToDo list, and other mundane tasks are much faster and more fun. With aging eyes, the screen size on the iPhone is the biggest impediment, but any increase in size would make it harder to stash on my belt and therefore easier to lose.


Apple iPhone4s. I like the Apple devices because most physicians use them and I can have an intelligent conversation with them about the pros and cons. I haven’t upgraded to the 5 series because my really cool case that looks like a cassette tape won’t fit the bigger phone. 


Personally, I use Droid devices. I think the capabilities are superior to iPhones (at least at this minute)  I think the openness and “less control” that has been placed on the Droid market have created these newer capabilities.


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April 18, 2014 Advisory Panel No Comments

HIStalk Advisory Panel: IT Service Management

April 14, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Does your organization use a formal IT service management program such as ITIL, and if so, what results have you seen?


Responses indicating no: 4.


[from a practicing physician] No , I am not aware of any formal IT management program used by my now very large company, but that is not to say that they do not need one.


We started with one, but we didn’t have the institutional memory to keep it alive. As new people came, it became increasingly difficult. Some good remnants remain, but only if somebody remembers to enforce them.


Yes and no. We’re a small shop, so we use ITIL and other models as a source of best practices and implement what makes sense for us. We don’t want to reinvent the wheel, but a full-scale implementation in a small organization is not cost-effective. The processes, templates, etc., that we have pulled in are extremely useful and allow us to more efficiently manage a large workload with a small team.


Not at this time. We have evaluated the use of ITIL and COBIT, but our plates are too full at this time to put any formal processes in place. Luckily the management team has experience with ITIL, so we apply the concepts to change management and service delivery as much as possible.


We have begun to install ITIL. It has been challenging given we are short on resources and when busy, people tend to fall back into the old way of doing things. We have had success with incident management, which is a good thing.


I was one of the first to enthusiastically jump on the ITIL bandwagon, many years ago, then I saw firsthand how the ITIL process became the goal, not a means to a goal. After two ITIL implementation attempts with two different teams, in which internal client satisfaction with IS declined and my employees became demoralized drones, I threw away any philosophy to implement the details of ITIL and instead focused on the concepts and the end goals. Those end goals are (1) internal customer satisfaction with IS; (2) IS employee satisfaction; and (3) achievement of both #1 and #2 at the lowest possible IS budget.  Since then, I’ve watched ITIL spread to other organizations and watched the same pattern that I experienced. There seems to be an inverse relationship, or at least a tipping point of inflection, between dogmatic adherence to ITIL and IS success and creativity.


At this time we don’t have a formal service structure methodology. We are beginning to look at this due to our organization growing and that all areas now have a major IT component. We most likely would lean towards ITIL.


Yes, we do. If you agree that using ITIL can be helpful and that every part of ITIL may not apply to your operations, it can provide consistency in support that many organizations need. We have found that it is helpful in many aspects of providing end-user services more consistently and more timely with much fewer variations.


We do not use ITIL formally. We will soon be joining a larger system and they have adopted ITIL and we are comparing our current practices to this framework.


We have been trained in the basics of ITIL and have incorporated several concepts and processes. We have not gone full out at this point.


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April 14, 2014 Advisory Panel 1 Comment

HIStalk Advisory Panel: IT Department Layoffs

February 19, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Has the IT department laid anyone off in the past year?


Our local IT department had to let go of people, but the biggest loss we witnessed was the whole CIO’s team as well as the CMO being gone as the hospital chain got bought by a larger organization. Many of us are very apprehensive as "bigger does not mean better" always and the vacuum created may be filled in a hurry by hubris. The jury is still out on that one and  I will be happy to share any happy endings if we should have any.


No.


No layoffs. We have implemented approximately 20 applications the past 18 months and assumed responsibility for another six systems that had been managed by other departments. We added four FTEs to our staff the previous year and have 4-5 contractors at any given time.   


We are still hiring, but have laid off a number of consultants.  


No layoffs. We need all the people we have. 


Are you kidding me? Our problem is not being able to keep good staff. But who can blame them? We underpay them compared to vendors, we overwork them, and we don’t let them be innovative. No wonder they are jumping to startups and vendors so quickly. We are learning and trying to improve on each of those issues, but it’s still new stuff for large healthcare organizations.


Yes. Consequent to budget cutting. 


No. We added staff.


No layoffs this year, thank God.


No, but some have left due to burnout and boredom and stress.


No. There have been some reductions in other areas of the health system, However, they have not impacted IT. Justification for open and new positions is much more highly scrutinized, though.


No layoffs so far.


Not in the last year, fortunately.


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February 19, 2014 Advisory Panel 1 Comment

HIStalk Advisory Panel: IT Issues Physicians are Worried or Angry About

February 14, 2014 Advisory Panel No Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What are the biggest IT-related issues your doctors are worried or angry about?


The lack of basic IT support at the hospital level, the doctors complaining all the time about not having anybody on staff to help them when the system goes down, them needing to send an email to the "headquarters" and virtually having to wait for days when they may need to put an order right then and there in ICU. Our hospital IT department is almost nonexistent and consists of a clinical analyst and few hardware guys and it is basically rudimentary. As one doctor put it, "We need speed, speed, speed!”


The increased documentation requirements of ICD-10. The increased direct interaction with the EMR for MU. The changes in their workflow necessitated by our EMR implementation.


The biggest issues are around being forced to use the systems. There is nothing wrong with any of the electronic systems that we use. Our employed physicians aren’t unhappy as they understand the trade-off for their paycheck. The pushback is with the independent physicians.


Biggest IT issue for doctors is lowered productivity. Since this is the new reality, most are resigned to it. At least for those who can successfully mentally separate IT from ICD-10, Meaningful Use, hospital and insurer intrusions into their practices, and Peyton Manning’s deer in the headlight performance.


The two most common conversations I have with physicians are problems with their access to the hospital systems and concern about their EMR and whether or not it will interface with the hospital HIE or CIN (clinically integrated network). Access and usability issues are a huge headache for physicians in my current health system (and previous). It has to be reliable and fast. We can’t seem to get either right consistently. For the physician that drops in to round on patients, we have very little time with them. Depending on the call schedule of the practice, we may see them once a month or less often. An expired password can require a call to the Help Desk because they haven’t logged in during the time allowed to change the password. The physician planned to spend 30 minutes in the hospital seeing patients and instead they spent 30 minutes trying to resolve their access issue followed by another 30 minutes to see patients and now they are late for the office appointments. The other common access complaint I get is the fact that we require two-factor authentication and do not have true single sign-on. I have had two calls just this week from practices that are ready to sign a contract and they want to know if the software will be able to connect to our CIN. I usually have to call the vendor as I have never heard of many of the small ones.


Too many clicks. Citrix. Texting PHI. Cost of IT.


It seems as though it’s increasingly difficult to sort out direct IT issues from indirect ones. For example, many problems that are worrying or angering doctors are blamed on IT but really result from regulatory agencies and others who are using the advent of electronic records to impose an increasing number of inane demands on clinicians for data entry and documentation. Examples include Meaningful Use, ICD-10, and requirements of CMS and the Joint Commission, for those of us who work in hospitals. Billing related documentation is another big source of consternation. In the pre-EMR era, it was clear that no one could humanly keep all of the E&M coding requirements straight. Now with the ability to have EMR templates and the increased emphasis on "optimizing clinician productivity", we are encouraged to code what we’re actually doing rather than chronically under-documenting and under-coding. Meaningful Use and billing compliance also erect roadblocks for using other professionals to help optimize workflow. Many elements could realistically be obtained or entered by someone else (e.g., NP, PA, med student) but the attending has to do the documentation anyway rather than just confirm the information. In many EMR systems, this is less flexible and more time consuming than it was on paper, so the EMR is blamed. As physicians are staying later and later to finish their notes or signing them from home after dinner, the EMR is blamed. But it is the perfect storm of bureaucratic requirements that’s really at fault and ICD-10 hasn’t even hit yet!


We are doing an EMR conversion this year, so that is their main worry. They don’t know enough about ICD-10 to be worried or angry about it yet … but the more we learn, the more we realize how asinine it is for primary care!


Too many clicks. Workflow processes that put the physician’s work at risk: residents and mid-level providers who start a note which the attending physician later amends and extends (this much OK and was consensus workflow). Document is then altered by resident or mid-level provider subsequent to the attending’s note. “Locking” or “finalizing” note not available because of vendor’s implementation requires these functions apply generally and that breaks other workflows.


Cumbersome medication reconciliation process. Workflows in ED and Surgery slow them down. These areas need optimization.


The biggest thing I hear about is usability issues. Providers worries and anger won’t get any better until that is resolved.


We are going Live with CPOM later this year and the majority of physicians that have approached me are worried, angry, or upset about the impact to the workflows they use every day. It has been a real eye-opener for some as they are brought to the table and see what the nurses and unit secretaries do with the paper-based orders they write. We also have a fair number of docs that can’t wait to do CPOM and are excited to be able to do this electronically from their home and office. They see it as a big quality of life win by not having to drive into the hospital and a big patient safety win by having all the relevant information in front of them when ordering medications, not to mention eliminating undecipherable handwriting . Not surprising is the latter group tend to be younger and more comfortable with technology than some of their counterparts.


EHRs from different sites still can’t talk to each other without effort from the clinician changing screens. Frustrated and also workarounds continue to be major things so as to get to the necessary data with the patient sitting in front of them.


Change management — MU2, ICD-10, and lower reimbursement with higher administrative overhead. None of our providers believe that there will be any demonstrable improvements in patient care as a result of ICD-10, and with the continued increase in non-patient care "bookkeeping," they’re questioning the value of remaining in this industry.


Bad, buggy software that is difficult to use, not accurate or timely, and not improving over time.


The rate of changes and workflows with EHR related to MU.


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February 14, 2014 Advisory Panel No Comments

HIStalk Advisory Panel: Analytics Success

February 11, 2014 Advisory Panel 3 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What are examples of major operational or clinical successes your organization has experienced in the past year from using analytics or data reporting tools?


No operational successes of any kind as our medical staff as well as administration does not even know the meaning of analytics nor what to do with it. We lack even the basic reporting capabilities needed to know our observation and LOS. We did well with core measures and scored high and used that as a marketing tip, however we did not use any sophisticated tools to get there. The physicians do not get any personal performance data to look at to compare with their peers and are not used to looking at their own data at all. It is part of the reason why I believe the institution failed so miserably and ended up being acquired by a lager hospital chain.


Improved GI lab throughput. Reduction in the use of blood products. Improvements in GI Billing process. Improvements in GI DNKA.


None.


Hard to know what success we have had from using analytics. If we decide, based on environmental scans and analytics to to focus on, say, total joint replacement, there will never be a time when we can say, "Ah, that was the right decision", even if your hospital is still afloat, or doing well. It may be that another service line or focus or workflow or supplier would have been better. Analytics comforts us into thinking we aren’t making a WAG, but there aren’t answers in the back of the book. On the more micro level, cost-benefit does help balance the budget.


Over the past year we deployed reporting tools to our front-line providers, departments, sites, divisions and company-wide providing actual results compared to our goals for people, service, cost, quality, access, and primary care flow. Particularly in service and access we improved performance compared to baseline and moved closer to (and in some cases exceeded) goals. Patients report improved experiences and appointing wait times have come down. There’s probably a link between the two improvements. 


We used some basic reporting tools to identify high risk patients who are overdue (e.g. diabetic with A1C over 8 not seen in six months). We then tried multiple methods of outreach and found email, letters and robocalls had minimal impact on this group. We finally found  success with having our call center staff call them during the late afternoon when there was low incoming call volume. Turns out they responded very well to real people calling them who could make their appointments right then!


No use of data beyond mandated reporting: MU, Core Measures, etc.


Using a SaaS population health data analytics tool, which blends CMS claims and EMR clinical data, to identify leakage of ACO patients outside our Network, which identifies opportunities for providing services not currently offered by our network in order to capture the lost revenue and reduce the expense to the CMS Medicare program.


We’ve been able to push an Analytics Dashboard to each member of our clinical leadership team that allows them to have real-time data as to the patients on their units, the patients that were discharged yesterday, and so on. Dramatically reducing the turn-around time for actionable data and ‘teaching them how to fish” has resulted in greater satisfaction amongst them and allowed my folks to focus on other projects instead of grinding out repetitive reports.


Minimizing the readmission rates in our high risk population such as those who had an MI or uncontrolled diabetic states  – two major clinical categories. Minimizing ER visits of high risk patients


We have set up a few transitional care clinics where we try to work with patients, post discharge, to ensure that they get/take their meds, get in to their PCP’s office as ordered, and generally try to get them compliant with their treatment plan in order to keep them out of the hospital again. (Basically, trying to prevent re-admits). We are using a number of tools and reports to generate data to assist with this process, but we are investigating new ones (e.g., PHM systems) that are specifically designed to do this.


Data on our clinical initiatives to improve clinical performance on readmissions, VTE prevention and early recognition of clinical deterioration have been very helpful in terms of showing benefits of these projects.


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February 11, 2014 Advisory Panel 3 Comments

Advisory Panel: Recent Vendor Experiences

January 17, 2014 Advisory Panel No Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Can you describe a particularly good or bad experience you’ve with an IT-related vendor lately?


Explorys has been great to work with as we focus on connecting our community physicians


I have been very pleased with the responsiveness of our consultants and vendors to lower their fees in order to help us meet our budgetary needs around our $100 million plus implementation. It has become clear to me which vendors can be relied upon to become true partners in which are only in it for themselves.


We’ve had a very tough time with Voalte. Call quality has been pretty awful and Voalte hasn’t been able to delve an app that addresses the problem. They keep telling us that the iOS7 version of their app will correct the problems, but they do not recommend that we deploy that version. Hmmm. 


I’ve actually mentioned this vendor before, but they continue to provide major benefit to me. Virtual Procurement Services.  (VPS). They have saved our organization millions of dollars in capital and operating expenditures. It’s an interesting model, actually, probably worth one of your interviews.


I continue to me amazed at the poor state our vendors are in as we prepare for MU Stage 2. They blame CMS and ONC and say the certification process is broken and that the regulations come out too late and are not fully baked, but the fact is they are sending us code that doesn’t work and isn’t ready for testing. Many of us are in jeopardy of not meeting MU S2 since we will have to wait until Q4 leaving no room for error. The vendors must do a better job getting us a product we can use as we face the challenges of implementing the processes and workflow changes that are required once the software works.


A CDS vendor with a good presentation of a great product, concentrating on our EHR and our issues. They are Dutch, so they already know about ICD-10. I guess that identifies the company.


Predixion Software, good experience related to analytics, supporting our clinical staff in better management of readmission rates.


None of late. Still ramping up in the new gig and the only net new I have hired is the Advisory Board for ICD-10 help. We just started (I know, I know – this is way late but clearly one of the reasons I got hired!)


On the good side, a vendor sent me a holiday gift card that could only be used for donation to a provided list of charities. You could donate on behalf of yourself, your organization, or anyone else. On the bad side, any and all vendors that send you half of something expecting that you will meet with them to get the other half of something that as a whole you couldn’t and wouldn’t accept in the first place.


I was just discussing a system upgrade with a manager. The upgrade turns out to be a reimplementation. The ballpark cost provided by the sales guy/gal, that we budgeted, has now tripled. While I’m obviously not opposed to a vendor improving their product, I think they should be assuming some of the additional expense. While they are changing the system’s infrastructure to something “better” there is no acknowledgement that their previous infrastructure may have been somewhat lacking.


Unfortunately all seemingly middle of the road/mediocre.


I work for a vendor now, but when I worked in a hospital, I found Iatric to be the most responsive vendor we dealt with. They were professional and very quick in all responses. If we had a problem they would have their people work through the night to fix it. Literally every dealing I have ever had with anyone in that company has been positive.


A general experience growing with vendors who really do not take time to know or understand customer needs. Let’s stop cold calling and cold emailing in health IT.


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January 17, 2014 Advisory Panel No Comments

Advisory Panel: 2014 Will Be the “Year of the …”

January 17, 2014 Advisory Panel 2 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: In your opinion, 2014 will be the "Year of …"


2014 will be the year of population management. Not really, but those two words will be used a lot.


Informaticist. I think all healthcare organizations will be focused on how to turn data into information, whether through business intelligence, clinical or biomedical informatics, retrospective / real-time / predictive analytics. These efforts will take on new meaning as we continue to build accountable care organizations and networks


Cuts to the budget.


The year the Federal Government went too far trying to ‘fix’ healthcare.


2014 will be the year of the HIE. Many words will be sprayed onto computer screens and into throw-away journals regarding connectivity and data availability, but there will be few objective studies, and I still will not be able to see the actual Xrays of the patient that was just transferred from another downtown hospital.


Data analytics.


I hope it will be the year of the non-buzzword, meaning that if one has not figured it out by now, whatever the buzz is about, rarely helps you in accomplishing the tasks at hand for your organization. Of course, we will hear ICD-10 and MU, but I would not call that buzz, it is just work that has to be done.


"Year of the Hospital Financial Losses." I think there will be more hospitals showing financial deficits than at any other time in history.


2014 will be the Year of the EMR App. We will see more and more apps which integrate nicely with EMRs and fill a special niche via content and/or workflow, which the giant and slow moving EMR vendors can’t do themselves. 


EHR Equivocation. Until the vendors solve or at least do a better job on usability, understand their OWN product completely, and enlist the help of clinicians in design, we will see significant slowing in EHR adoption. We’ve seen most of the adopters that were able to provide the resources required for an enterprise wide EHR implementation already take the leap… in the end, the cost of an EHR still significantly outweighs the penalties for the foreseeable future.


Year of patient engagement and ICD-10 chaos.


For healthcare in general, Year of the Merger & Acquisition. For Healthcare IT, Year of the CIO turnover.

I think it will be the year when interoperability and big data will continue to be little more than buzzwords. The difference between the two is that one day, in a somewhat distant future, interoperability will actually come to pass and make a difference. Big Data will never be more than a buzzword. Like smart watches, Google Glass will prove to be useful in some applications in healthcare, but will not be a game changer. The leadership of a few HIT companies will continue to watch with glass-eyed wonder at how the American taxpayer continues to fund the exponential growth of their personal bank accounts while the products they provide in exchange for those funds reach new heights of mediocrity. And those whose mortgages are paid by selling these mediocre systems will continue to defend to the last breath the promise that these systems will one day deliver on if we only give them another decade or two to work their magic because the years and years they have been given to prove their value so far just aren’t enough. At the same time, any impartial studies done on the ROI of these systems that cost the taxpayers billions will show little to no benefit to that oft intentionally forgotten constituent of the healthcare system- the patient. (Man, am I a cynic or what?) On a more optimistic note, I think the health insurance exchanges will actually start to show some positive ROI for the oft forgotten constituent.


2014 will be the Year of EMR Optimization. Now that most IDNs are finished or far along with EMR implementation, they will turn increased attention and resources to making EMRs work more effectively to support critical business imperatives related to healthcare reform and the numerous changes we’re undergoing in response to industry pressures.


2014 will be the year of a major data breach (hopefully not here). Most of the breaches I’ve heard about have been from lost/stolen computers or an organization doing something stupid, not an intentional penetration. Perhaps I’m just overreacting to the Target hack and in reality there is no interest in healthcare data. On the other hand, nobody that I’m aware of in health care has NSA-quality protection and I think it would be pretty easy.


Regulatory mandate dictating the IT vision/budget


Year of the “search for value in analytics.”


Wearable.


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January 17, 2014 Advisory Panel 2 Comments

Advisory Panel: Top 2014 Priorities and Concerns

January 16, 2014 Advisory Panel 2 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What are your organization’s top three IT priorities for 2014 and the concerns you have about executing them?


(1) ICD-10.
(2) Data center relocation to a CoLo.
(3) Complete enterprise EHR rollout.

The only one I’m really concerned about is ICD-10. There are just so many uncertainties around how the providers and the payers will make the transition.


Our top three IT priorities for 2014 all revolve around our Epic platform.

(1) We need to finish our enterprise-wide Epic implementation.
(2) Once we survive our go-live, we will enter into an extended period of optimization of the system, which I anticipate will take at least three to four months.
(3) Subsequent to that, we will begin to develop the capabilities within IT to begin to extend our Epic platform to other entities across our state.

My biggest concern for all of these is the ability to maintain my current resource levels as well as adding new resources in order to address the organizational strategic outreach initiatives.


(1) We are determining whether to stay on our current EMR platform or to switch.
(2) ICD-10 is looming.
(3) We are also focused on getting our remaining hospitals to Stage 7.


(1) ICD-10. Significant work needs to be completed on all facets of this mandate. Vendor testing and validation, staff education (HIM, physicians, and billing), reporting requirements, and many more. Payors are not ready, IS vendors are not ready, and our staffs are stretched thin, so it remains my greatest concern in 2014.
(2) MU Stage 2. So much is still not known. How will we meet the patient engagement goals (absurd for a community hospital with independent medical staff that also must meet the portal goal)? What will the CQMs require for new data collection? How will the medical staff deal with electronic medication reconciliation and the requirements of the Transitions in Care electronic documentation at the hospital while also dealing with a different system and set of requirements in their office? These questions remain and the vendors will not be ready until the last quarter leaving no room for error.
(3) Pending affiliation. During all of this, we are entering into an affiliation that will dramatically change our organization and will, at some point in the near future, require a conversion to a new ERP system and EHR.


After the massive expense of our EHR and in the face of ongoing financial financial struggles (real or perceived), there will be great pressure to hold down costs, perhaps even to find a revenue-generating activity for IT. The concern is that needed education and training will be shortchanged and clinician workflows that should be corrected promptly will be allowed to calcify, requiring even more resources in the future. Many of these workarounds reflect inadequate technical support (I never knew it could do that!) or training (I never knew it could do that!)


(1) Ensuring readiness for regulatory items like ICD-10 and Stage 2 Meaningful Use).
(2) Continuing to optimize our EMR investment via new high-value clinical decision support projects. 
(3) Implementing new enterprise-wide revenue cycle solution.


(1) ICD-10. 
(2) Operational cost reductions (both IT and non-IT).
(3) Growth through acquisition.


(1) ICD-10.
(2) MU Stage 2.
(3) Financial resource management (conservation).

The three are not compatible. I’ll need resources for both of the first two while being asked to use less at the same time. 


(1) Our top IT priority is moving from Cerner to Epic, with the obvious concerns about data migration and workflow changes slowing us down initially.
(2) Appropriately using analytics (from identifying high-risk patients for outreach, to looking for otherwise hard to find adverse events), with the dual concerns of (a) not having enough report writers, and (b) not having enough people to execute on what we find. 
(3) Figuring out telehealth at our organization, with the concerns of (a) finding a technical model that works efficiently, and (2) finding a business model that makes sense (who will pay for it!)


(1) Epic optimization. Hiring and retaining qualified Epic analysts is becoming very challenging in our region. Standard now is  work from home and significant yearly salary increases due to the local competition from institutions out of build phase so analysts are free to jump ship.
(2) Windows XP support (lack thereof). The March 2014 move to Windows 7 has us very nervous – Epic and scores of integrated applications cannot be tested enough to quell the unease.
(3) ICD-10. Ouch… how am I going to get providers that don’t document well to do an even better job next October? We discovered quite quickly that Epic support is still just nudging up their own learning curve.


(1) MU Stage 2. 
(2) ICD-10. 
(3) Integrated financial and clinical systems.


(1) ICD-10. Since ICD-10 success is based on physician documentation, it’s a wildcard as to how well you will do regardless of the education effort. 
(2) MU Stage 2. MU Stage 2 criteria related to transitions of care will be particularly difficult since there are three components (i.e. 50 percent of discharges, 10 percent using CDA format, and a transaction to a different EHR.) Items 1 and 3 are easily achievable but 10 percent using CDA format could be difficult depending on where your patients transition (both inpatients and ambulatory). Many post-acute settings, for example, do not have an EHR capable of receiving this format.
(3) Privacy and security. Privacy and security is just a matter of keeping up with the regulations. Competing for resources is difficult since this area doesn’t  get enough attention until you have a problem. With the final Omnibus rule in place, fines have increased, as will audits. Business associates will be particularly vulnerable, as well they should be. There are a considerable amount of other priorities for 2014 (e.g. ACO IT, EHR optimization) but these may have to wait.


(1) Government regulations compliance.
(2) M&A integration.
(3) Growth initiatives.

My main concern is having too many top priorities competing for finite resources, both in IT and operations.


I’d be very surprised if anybody answers anything but:

(1) MU2.
(2) ICD-10.
(3) Keeping the place running.


(1) MU Stage 2. Vendor delays, expectation of patient engagement.
(2) ICD-10. Inability of vendors to deliver on time; excessive fees (CAC).
(3) Volume to value mandates (reporting, data exchange, etc.), a market mess.


(1) Meaningful Use Stage 2 and 3. Concern about areas where we don’t have full control.
(2) Expanding use of mobile and connected care connecting our enterprise and our community through mobile devices.
(3) Maintaining security in a rapidly changing environment. Expecting more and more security breaches.


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January 16, 2014 Advisory Panel 2 Comments

Advisory Panel: Alarm Fatigue

January 1, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Is your organization using or considering IT solutions to the challenge of alarm fatigue?

Note that while I was thinking specifically of physiologic alarms at the bedside, I didn’t state that explicitly, so some answers reflect clinical alerts in traditional IT systems. Seven responses indicated a “no” answer with no IT solutions being considered.


We struggle to balance harm prevention and user design.  We are biased toward harm prevention.


We haven’t found a good solution yet. We’re looked at things like alarms that start out low and increase in volume if not addressed, but many/most vendors haven’t embraced that idea yet. We’re looking at routing alarms to phones, but that also has challenges. If you find a good solution, let me know.


We are currently considering a few IT solutions to address this, but no decision has been made to move forward.


We are currently investigating tools to consolidate alarm management but we have not yet developed an RFP or even a vision for the future.


We are currently investigating and likely to pilot a solution to integrate nurse call bells into nursing phones to improve the alarm fatigue of the ears. In the EHR environment, we are continually analyzing the alerts that fire for their utility, appropriateness, and actionability and working to reduce those that are more "noise" than "signal".


Alarm fatigue happens when the technology was not supportive of the end user – it should not exist if each vendor really knew the topic and client being served.


We have explored alarm management systems, but I was left with the realization that the devices can alarm on anything and it’s up to each organization to determine what’s important. I am not aware of any national standards.


We learned early on to be very judicious with alarms and try and keep them to a minimum. As we’ve merged in some additional physician groups, the governance of managing alerts will get increasingly interesting however. I’d be curious what type of IT helps with alarm fatigue (i.e. do they make alarms more sensitive/specific somehow?)


I wish !!! Turning off the drug duplicate alerts would be like manna from heaven as they are invariably uninformative and annoying. For example, renewing a drug always gives a duplicate alert even though the system obviously knows that if you click "Renew" it will automatically stop the current order and start the new one. But the current order is still active when the system compares the new order to the med list. Ergo, duplicate alerts gone wild. One of my other favorite alerts tells me that the patient is taking two non-phenothiazine antipsychotics.  If I was really concerned about duplication, I would want to know if they were taking two antipsychotics period. Whether it’s a non-phenothiazine makes no difference whatsoever.


Primarily focused on refining medication alert rules to reduce unnecessary noise.


I assume you are talking about actual alarms, vents and IVs and tube feeding pumps and such, not EMR alerts. Since noise levels can exceed OSHA standards 80 percent of the time in an ICU, we are keenly interested in the twin problems of noise from alerts and the false positive / false negative rates of the alerts. We do not have a good answer, but I would be happy to buy one that worked.


We’re still trying to reliably deliver secondary alerting. Alarm fatigue getting some notice, but no definite intervention as of yet.


Yes, considering FDB AlertSpace to achieve what should be included in their product in the first place (we’re on Epic/FDB).


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January 1, 2014 Advisory Panel 1 Comment

Advisory Panel: Telehealth Projects

December 30, 2013 Advisory Panel No Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Is your organization running or planning telehealth projects?


Assuming the term telehealth includes scope of technologies included in the HRSA definition, we run remote ICU monitoring across our WAN. In addition, we continue to expand the use of mobile clinics that roam around our geography. These clinics include videoconferencing between clinic providers, patients, and remote specialists. We are planning additional work with a national telehealth provider.


No, my organization is still struggling to implement CPOE, keep the beds full, reduce readmissions, etc., etc., and we have not got that far yet.


This shows up in our annual strategic plan every year and it’s there this year too. But I haven’t been able to generate much interest among my medical staff, even the members who travel hundreds of miles for outreach clinics. We run a telemedicine epilepsy clinic and we have the usual teleconferences, but that’s about it. So I’ve retained some consultants to explore options like e-visits, home monitoring, and video visits using webcams with the med staff.


We have a few telehealth services we consume for a couple of specialties. For example, we have a small pediatric hospital and will perform remote echoes with specialists at a leading children’s facility for special patient cases. We do not have any plans to provide any additional telehealth services within our organization or service areas at this time.  


Multiple coordinated efforts related to telehealth as we are approaching from a number of perspectives. More traditional eICU, using remote monitoring of multiple ICUs from a centralized location where critical care physicians and other clinicians are monitoring beds across multiple hospitals. Tele-psych consults in our emergency departments. Developing newer capabilities for virtual ambulatory visits, more acute or urgent care conditions where audio/video is effective in connecting a patient and a provider. Our EMR is really helping with efficiency in this service area and also with tele-psych and ICU areas. The key being that tele-X software, hardware can help best facilitate the patient encounter but it’s important to realize our EMR is needed for order entry, documentation, communication with the local hospital pharmacy, etc.


We currently have a monitoring station set up in our ICU for pediatrics so that our patients can be “seen” by a specialist at a large teaching hospital in the state.  We are currently proposing to provide healthcare services to our local detention centers. If accepted, we’ll go the telehealth route.


ANGELS – Antenatal & Neonatal Guidelines, Education, and Learning System – consists of 23 hospitals and clinics who receive clinical services from us, as well as 18 hospitals who participate in a tele-nursery with us as the hub. Neonatal mortality rates for Medicaid declined from 4.5 per thousand to 3.3 per thousand. ANGEL EYE – one-way video from NICU to authorized family members. AR SAVES – Stroke Assistance Through Virtual Emergency Support – consists of emergency support for 42 hospitals across the state. Increase delivery of TPA from <1 percent to 29 percent in participating hospitals. Other telemedicine services – psychiatry, pediatrics, geriatrics, rehab medicine, cardiology, internal medicine, burn, trauma, genetic counseling.


We’re doing projects with telehealth, telepsych, home health monitoring, remote hospitalist consulting, and have others we’re thinking about. While telemedicine has been around for decades now, it seems to be really heating up lately.


[from a vendor member] We are working with several organizations who are planning telehealth projects. However, it is like NLP at this point – all talk, no action.


We are on the receiving end in that we use a telehealth service (neurology consults) in our ED. It works well, although the service and support has proved problematic. The cart contains all the video components, but when there was a problem, they had no local service techs. This left it to our staff to troubleshoot – if we were a smaller very rural hospital we may not have had the expertise to troubleshoot their equipment on our end. Overall the service has been a benefit to the hospital in that we have a shortage of these specialists to take call.


We actually do a lot of telemedicine, both inside our health system and with external partners and that program is continually expanding. Our main service lines at this point are Neuro, Pediatrics, and Psychiatry. The primary locations served tend to be emergency departments in order to deliver otherwise unavailable specialty care to patients.


Yes, for various disease states and ethnically diverse populations.


A year and a half ago, we agreed to work with a vendor on a case study to determine if telehealth would positively impact outcomes. Telehealth was new to them and they struggled to develop a website for data collection and patient interaction. For the research study we needed IRB approval and a contract with us. Once the attorneys got involved, everything came to screeching halt. A year later, we have a contract and pending IRB approval. Perhaps in the near future we can begin the study with our diabetes and CHF patients.


We have long offered telehealth via phone and web visits for mild, acute problems (e.g. URI, UTI), and we charge a separate fee for those. We are also now looking at using telehealth technology to do remote care at corporate clients.


Vague talk only about telepsychiatry to local ERs and jails.


Telehealth in use for burn, stroke, and psych consults. All working very well with different technology solutions including iPad and a mobile robot looking device.


To meet requirements for Level 1 nursery, we have neonatology sub-specialists on tap, credentialed and available. This is a great solution to consultations that would otherwise require transfers. It is another question entirely whether early transfers are in the baby’s best interest; it may be that telehealth consultations get an actual consultation in the odd hours, where if the baby were in the actual institution providing the consultants, there would be more of the "I’ll see them in the morning" mentality. Of course, in that setting, the consultant is probably more comfortable with the nursing and ancillary staff, so it may be about the same outcome. Still, it feels good to have an actual clinician to clinician discussion about a specific case.


We’re doing a lot of tele-stroke work. A real smart stroke neurologist with an interest in the technology. He’s serving other organizations and when not on site, he starts care using his tablet and the stroke robot in the ED supported by a stroke nurse-practitioner or neurosurgery PA.


Virtual visits are part of our future plans, none running yet.


We are rolling out telemedicine to support our network of six rural health clinics. This will be essentially to push the access to our specialists. Rollout is over next three months.


Radiology uses NightHawk services from the other side of the globe for night preliminary reads, but that’s it.


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December 30, 2013 Advisory Panel No Comments

Advisory Panel: HIMSS Booth Reps

December 18, 2013 Advisory Panel 6 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: When you are approached by a rep at a vendor’s booth at the HIMSS conference, what factors (their mannerisms, appearance, actions, handouts, etc.) make you most likely to pay attention?


He or she needs to be very outgoing and engage me. I’m generally exhausted and numb from all the activity on that floor. I have trouble sorting the wheat from the chaff.


It’s important that the booth signage and setup communicate something about the products or services the company offers. Weird, techy names and generic descriptions like, "Biodynametric. We enhance interoperability and efficiency across the continuum," and I pass on by. Second, the guy who lunges at me from the booth is another non-starter. Professional dress and demeanor combined with a pleasant introductory line usually works. "Are you having a good show?" Or, "Good afternoon. Are you interested in learning about our new line mobile device integration software?" Something like that.


A drug rep once told me, when I asked her to not waste my time and to tell me something that I did not know already, that in sales training they are told that it takes a doctor eight times to hear a message before they start registering and remembering to write their drug. Needless to say she never set foot in my office again, but later I learned  that Big Pharma  calls this "the rule of seven touches.” It is indeed believed that it takes that long to build a relationship based on trust. Having said that, I like to see a vendor who does not ask for my email after we just got introduced, only to bombard me with their white papers. Who does not act as if they would rather be somewhere else, but who also makes me want to see or speak to again. Who understands that I will not sign a contract at their booth and that I will not be impressed by the size of their booth or the amount of useless goodies but by their humility and knowledge. Also, since the number of doctors walking the hallways at HIMSS is dwindling and the decision and buying power is being stripped away from them, if the vendor sees an MD who is still practicing and  took the time to be there, maybe he or she should listen to him before throwing a sales pitch as it may teach a thing or two about how doctors think and operate. It is ultimately the doctor who is the end user of IT and unless we talk about patients treating themselves( there seems to be no shortage of solutions for "do it yourself" under the disguise of "patient engagement") we cannot take our eyes off that ball or soon the HIT vendors will sell to …each other. And in my exam room it is getting pretty crowded.


A non-salesy and personally engaging approach works well for me, particularly ones that don’t make me feel like I’m trying to be picked up in a bar. Don’t glance at my badge before you look me in the eyes. And I particularly dislike the sales pickup lines like, “Do you have any concerns or issues about or around [fill in your self-serving topic]…” They are quite the turn-off and I will say no even if I do. Engage me and let the conversation go where it may. If there is an opportunity for a fit, things will take care of themselves.


To be honest, I generally avoid the stalkers. I put on my “don’t talk to me” face and it’s been pretty successful to date. Also, I don’t generally use HIMSS to research new products. I use it as an opportunity for face time with my current vendors.


If it actually starts with a conversation rather than a sales pitch. (How are you enjoying the show? What have you found interesting so far?)


Personally, I rarely react well to being approached by a vendor rep. My preference is to walk through their booth to get a feel for what I’m seeing on their screens or promotional details, and if I find something I find interesting, I’ll ask a rep to explain it to me then. And when they do, my preference is that they skip all the BS and just hit me with the major points, key facts, concepts etc. of their solutions. I don’t need to spend time hearing how we all understand XYZ (e.g, reimbursement, big data, ACOs, HIEs, whatever). I don’t want to spend any time chatting or building a relationship with them. Suggestion to vendor reps:  think "speed dating," but focusing on your solution, not each other. You don’t really need to know what issues and challenges we’re facing — we’re all facing the same ones. I have 1,000 vendors to see today — make your few minutes count and maybe I’ll come back for more.


I know it sounds superficial, but the first impression is very important. If the person looks dirty or sloppy, I will not take time to talk to them. I feel that if they cannot put their best foot forward when representing the company, then they will not put their best foot forward with me as a customer. I also want someone who is friendly and makes eye contact. My biggest complaint at HIMSS or any show is that a lot of booth reps act like they don’t want to be there or want to be bothered talking to anyone. Friendly, energetic, and knowledgeable wins every time in my book.


Unfortunately, appearance matters. The best sales pitch is lost if  you don’t look like you represent a vendor with its stuff together. I seldom visit booths at which I have not made an appointment, but taking that walk around and getting inundated with pitch after pitch can be fun sometimes. When I do,  I first look to someone who appears like a professional (neat in whatever booth attire they have chosen – but I prefer business attire to the casual polo shirt.) Second, they have to be able to give me the “what we sell” pitch in two minutes or less. If they can accomplish this, the chance of me stepping into the booth to look at the product is greatly increased.


I tend to be uninterested in or entirely put off by being approached at all. The most annoying vendor hall experience I had was a vendor rep that caught sight of my badge and followed me for a while and then approached me by name as if he were another attendee. Very off-putting. I go to the vendors that I want to talk to on my own — don’t approach me. I do my homework ahead of time to determine who will have something I want to learn more about or a possible solution to a problem we have, but I will also skip them and mark them off the list of potential partners if I cannot quickly get a friendly and informed representative to pay attention.


I avoid anyone in stilettos or sexy outfits. I’m not there for sex – I’m there to learn. Someone who looks genuine and actually has a pedigree is someone I walk towards. Sex does not sell in HIT, only when trying to sell Viagra or something. Get rid of the sexy pots at HIMSS booths.


If I don’t know anything about the vendor, I need to hear a compelling elevator speech about what they do. During that speech, if they are articulate and passionate, I may stay longer. If I do, then appearance and mannerisms help keep my attention. If all they know is the elevator speech, I move on. A stunning blonde with nice legs overrides all these professional considerations. If I do know something about the vendor, I would probably just move on.


This falls into two categories. (1) I already know I want to see the vendor, in which case I will look for someone who is experience and can give me the real details. Or said another way, I avoid the young kids who look like it’s their first conference as well as the high-level VPs who can only give me high-level answers. (2) An unexpected surprise… maybe it’s a vendor I had heard about somewhere, or maybe they have a slogan that is intriguing or better some stats that stand out (e.g. "We save our practice 10 percent of costs a year!") Usually these are the smaller booths and there are only 2-3 people there, and they are always very helpful and grateful and give a good talk.  


I’ve never been to HIMSS but I’ve been to plenty of other professional conferences where pharmaceutical reps were trying to lure me into their booths and I’ve been to the user conference of my hospital’s EHR software vendor which has their own reps and those for affiliated products lying in wait. Thus, I’m fairly confident that HIMSS would be similar. In general, I walk up the middle of the aisle slowly, feigning disinterest to get a sense of whether I have any interest at all in the products being offered. Part of my reconnaissance involves watching the interactions of the booth reps with unsuspecting passersby. Then I go back up the aisle and stop at key booths of interest. If the reps do not look professional or are cloying or annoyingly pushy, their product is crossed off my list of stops unless it’s REALLY amazing. When I stop at a booth of interest, I’ll glance at their materials if they’re with someone else (and sometimes move on if it’s not of interest). If they’re available, I’ll ask them to tell me a bit about their product. If they are straightforward, answer questions reasonably, and let their product sell itself, that’s a big plus. If they come on too strong with buzzwords and marketing hype or start asking too many "friendly" personal details (e.g., "Oh, I see from your badge you’re from Badger Falls — my Aunt Bessie’s ex-husband grew up there") I’ll say that I just wanted to get their materials and that I’m not in the market right now. Then I hightail it off to the next booth. This dramatically improves my efficiency and lets me spend quality time at the booths that are of greatest help. Even if I’m really interested in a product, it’s not efficient to deal with a rep who’s not knowledgeable or just trying to sell me a bill of goods (sometimes I’ll go back to such a booth later when a different rep is there.) When I do get a handout, if it’s pure marketing pablum, it goes straight to the circular file. I want to see details that will help me make a decision. With software-related products, a key to try to product for 10 days or a sample CD to get an actual feel for the program gives multiple bonus points in my eyes. Again, the booth is confident enough in its product that it knows it can sell itself.


I try to ignore all sales people as much as possible while waking the halls.


I am rarely approached by vendors, and when I am, I feel I am being treated like the the last girl in the bar at closing time. When I seek out a vendor (I do my homework) or I am attracted by a display, I want the elevator pitch, some literature, and contact information. I pick the person that seems most likely to give me what I am looking for without being clingy. Mannerisms? Professional. OMG, no flirting. Appearance? Sorry, but the middle-aged white guys or the person that the other boothies defer to  is the person with the most efficient pitch. If it helps, it is harder to pick out who is in charge than it used to be.


When I’m asked a question. “Are you interested in learning more about _____ ?” Not a brand name, but rather a function or feature –I can see the brand name since I’m right at the booth. Pitch your product with a question, and I don’t mean of the form, “What are you currently using for _____?” In short, don’t sell—teach.


Mannerisms, appearance, first sentence.


I have found that the art of navigating the HIMSS hall is to have a plan. Know what you are looking for, perhaps even the vendors you are interested in, and so forth. I have found the hall to be more beneficial if you add intentionality to your visits. I do not like gimmicks, but a free beer, water, snack, or other food item helps. I also like vendors that provide trash bags (oh, I mean, brochure bags,)  I do not like vendors that “attack” a passerby.


If I’m in their booth because I haven’t heard of their product or don’t know much about it, then I’m focused on how quickly and clearly they can explain their product’s practical application and how it can provide value to my organization. If I’m there because I have decent knowledge of their product, then my goal is most likely to get specific questions about how their product works answered. In this case, the last thing I want to hear is them talk about the practical application and value proposition of their product. I’m focused on the knowledge of the person I’m speaking to. If they quickly say that they cannot answer my question, kudos. I’ll give you a second chance. If they blow smoke, then I may blackball them when I get home. In either case, if the sales person talks about a partnership or attempts to get to know my personal interests, then they immediately lose points in my book. Their job is to take as much of my health system’s money as they can while ensuring that they provide good enough service for us to perpetually pay upgrade and maintenance fees, not buy me tickets to the World Cup (which would be the right way to bribe me). My advice to the sales folks — open our conversation by asking me why I’m there, what I know about their product, and if I have any specific questions for them. As I answer those questions, ask clarifying questions about my business situation (facility size, location, etc.), and then tackle the problem at hand. It will work way better than the gibberish your marketing person wrote.


A mild manner is preferable (Jimmy Stewart over John Wayne). A working demo of their product and the knowledge to use it – amazing how often this is not available (Alfred Turing over Don Knotts). I am a fan of understanding the challenges of a community hospital and not quoting how they solved a problem at Johns Hopkins or UCLA (i.e. Fred MacMurray over Roseanne Barr).


Appearance and mannerisms. Down to earth “real” people versus salesy used car salesman type folks make me want to stop and talk. The booth babe costumes really turn me off. Because there are so many booths at HIMSS, the signage is also one of the things that gets me to stop for a look.


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December 18, 2013 Advisory Panel 6 Comments

Advisory Panel: Keeping Peers Informed About IT

October 16, 2013 Advisory Panel No Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What methods do you employ to keep your executive peers informed about IT initiatives, spending, and plans?


Regular face to face meetings (or a call) are always the best. 


Annual work plan development. Capital budgeting, especially the part of the process where business execs say yes/no to requests and as a result prioritize investments. Monthly leadership report of IS accomplishments to plan.


It’s all about governance. You have to have the structures in place to meet with your peers and have the decision making process completely transparent. I also use our executive meetings as opportunities to get on the agenda on a quarterly basis to give updates regarding IT activities.


Routine updates at Exec Team meetings. Lots of meetings. Annual report.


Multi-year IT roadmap, status reports, status meetings.


Our admin team is right down in the weeds with us since HIT is such a big expense. They have been reasonably agile and able to understand what we are doing, and actually ask good questions. Sorry, not a very Dilbert response.


Historically, there has been a disconnect between what IT sends out the end-user leadership and what actually gets communicated down to the folks in the trenches. If I had a dollar for each time I’ve rounded on floors during downtimes on the weekends and heard, “No one told us the system was going to be down”, I’d be typing this from a warm sunny beach somewhere. To bridge the gap, we have started publishing, at a minimum once a month) a newsletter focused on the team members and what they need to know about  IT initiatives. The plea I have made is for each department leader to discuss the contents at their respective huddles and to place it on the communication boards each department maintains. Thus, any team member who works has an opportunity to review it. (Are they up on all the boards in the hospital? What do you think? ) IT Updates are now a standing agenda item at the Friday weekly leadership huddle attended by senior leaders and department heads. I have two agenda items with the hope that repetition will help them connect the dots: (a) Here is what is happening one to two months out, and (b) here is what is going on next week. Beginning this budgetary cycle, I’m meeting with each department head (instead of their vice presidents) to discuss their goals / dreams / hopes for 2014. Many times IT has been backed into a corner by surprise requests coming from senior leaders that were unaware for whatever reason what their reports were considering. The hope here is if we can deal directly with the department head, we can set up a win/win experience for them and for us in terms of managing expectations.


Monthly updates in executive meetings if within organization – outside organization at regional and national meetings. Email within organization when appropriate. Newsletters to executives when appropriate.


IT leadership directly involved in system leadership councils and directly report to most senior leadership to be sure efforts are aligned with strategy. Involvement of clinical leadership in IT prioritization, governance bodies.


Monthly meetings, inclusion in the distribution announcements, phone calls on surprises, etc. This is most effective if the executive understands the importance of IT and informatics. When they don’t, it’s pretty useless.


IT participates in strategic planning sessions with health system executives. This was not true a few years ago, but is now. IT produces and sends out a monthly dashboard to executives of all key projects, which includes project status and barriers to completion. Each project has a health system executive as the key sponsor.


Lots of financial reports, for one. Those are what matter really, cost projections and cost actual. Outside of that we have a very simply way of showing project statuses. The classic green, yellow, red with only 5-10 lines of detail. There are also numerous meetings with different members of the executive suite on any given week as well. 


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October 16, 2013 Advisory Panel No Comments

Advisory Panel: Three Hospital Improvement Actions

October 14, 2013 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What three actions would most improve your hospital overall and how could IT contribute to those changes?


Better understand our variances in high cost procedures. Analytics can help in finding variances and understanding why they happen and then we can work on fixing those problems. Manage high-risk patients better. IT can be used to identify (predictive modeling) and track (registry) these patients, but people will make the difference in helping them. Understand our patients better. IT could be used for better surveying of patients both in real time and retrospectively


Hospitals need to start by realizing that their days of glory are gone and that healthcare is no longer hospital centric and need to regroup. Need to start applying "lean" principles and look for ways to cut cost but not compromise care, which is indeed a balancing act. Invite and involve all the stakeholders in and have a mission statement. Admit that "all healthcare is local" and that certain rules apply in certain markets but are not valid in others where the consolidation is not so pervasive.  Realize once and for all the role of clinicians whose decisions and behavior we are trying to influence and change and  groom real leaders who are in it for the good of the community and not merely to embellish their resumes. Improve communication all the way from the CIO and C-suite to the practicing MD and nurse who are " where the rubber meets the road". It has been my experience that the larger the organization, the more broken the communication and the more bureaucratic the process. IT can do exactly that — improve communication and transitions of care.


Enhance value (improving quality and reducing cost) – IT focused on data analytics to produce actionable descriptions of current conditions and to support experiments planned to move us toward our targets. Wow our patients and families (great service experiences) – right now we’re focused on providing patient portal access. Innovation and partnerships (new models of caring) – deploying and operationalizing health info exchange.


There are three major factors that will determine the viability of hospitals over the next five years that IT has the capability to improve. First and foremost, we absolutely have to reduce the cost of care. Clearly, one of the main ways to accomplish this is through better coordination among providers as well as better clinical decision support mechanisms to reduce unnecessary tests. This is more than just duplicate checking — it is now quickly moving to personalized medicine using the more rapidly available genomic and proteomic information available for patients. Secondly, we must provide better interoperability and analytics for population health between multiple disparate providers of care. We are moving to a model of care where the primary care physician becomes the gatekeeper and we have to be able to communicate in real time the status of every patient and their disease states. This high level of coordination will only be possible with a significant IT support model. Thirdly, we have to optimize our ability to capture charges with payers who still pay in that manner. The list of those payers will continue to shrink, but we need to take advantage while we can. That also includes the ability to capture activity, especially on those newly insured patients that will be creates as a result of the Accountable Care Act.


A few more hours in a day, and a week would be great! Improved collaboration around significant challenges is adversely affected by a lack of time and ability to focus on priorities. Effective use of video technologies might help, but folks are so busy it’s hard to know what can help. Creating a culture of appreciation and not just recognition. Hard to do – perhaps better use of social networking tools? Better financial performance….. if we could drive value from all of our technology investments and truly ensure that we are using 100 percent of everything we deploy and get value from all of it.


Patient safety: better clinical decision support. Patient care: better order sets and workflows. Patient engagement: in-house use of Epic Bedside.


If you are looking for the most bang for your buck in changing the hospital, it would start with the most important determinants of hospital outcome (RNs) and patient satisfaction (CNAs). It is clear to me  but hard to prove that a well-trained RN staff improves outcomes, but a good outcome, at least in the sense of following guidelines and providing consistent, checklist driven care, is now the expectation. Patient satisfaction is proportional to the number and the friendliness of the staff that deals with the personal needs of patients (toiletting, call lights). IT can help with efficient one-click charting, and clinical decision support for the RNs. We should spend a lot of our optimization time on the RN workflow. On the CNA side, a Vocera type solution that allows direct communication to a CNA as well as combining a group into a lift team will speed up response. Oh, and relax the "no personal calls" rule on your devices. These folks, typically ladies, will check on their kids. Let ‘em do it quickly, openly, without apology, and back to work.


The government dropping ICD-10 and waiting for ICD-11. The costs of systems, implementations, and training, especially for physicians, is clearly not worth the benefit to a handful of researchers and will do absolutely nothing to directly improve patient care. To complain about the cost of healthcare while spending money that doesn’t directly improve care is ludicrous. The government slowing down the pace of MU and only focusing on those aspects that directly improve patient care. (Seeing a trend here?) The government stopping changes that only impact billing. Let’s put our focus and money to better use improving patient care, not worrying about how to pay less for it or spending more time on record keeping.


A  major issue with us is lack of resources across many of the departments. The Catch-22 is that IT could help by automating some of the workflows, but we do not have the money or the human capital to assist given our EHR implementation. IT is working to generate as many initiatives as possible that would allow team members to better document what we actually did to the patient through documentation and capture applicable charges. The thought here is that we could achieve better reimbursement through increased documentation of what we actually did for the patient. “You can’t manage what you can’t measure”….we are pushing out analytics and other business intelligence deliverables to leaders such that they can have information in a more timely and readable fashion. These deliverables are done real time on a proactive basis and provided at least weekly. In their office, leaders can look at throughput, length of stay, payer mix, etc. without having to call down to have one of my team members run a report and then interoffice or email the output.


Create processes for improved communication between departments – streamline tech services; increased qualified staff – mentoring programs on line; identify marketing opportunities to show case hospital success – social media support.


Reduction of regulatory burdens which consume lets and lots of resources including IT to "remediate" and impedes innovation. Support the digitization of all business processes to align with MU and transition to EMR, etc. Drive true patient engagement very openly and aggressively. IT would benefit from these changes and could work to facilitate patient engagement.


Improved integration of IT and Informatics into Strategic Planning and Business Development. Improved adherence to strategic planning (we spend too much time chasing shiny objects that don’t contribute to strategic gains). Improved measurement and learning from strategic actions taken (i.e., measuring how well we actually did).


Robust report writing capabilities with a clear roadmap of standardized reports across the organization. We have lots of data, but much is not useful. Also have people running reports from various systems that don’t match—lots of confusion! Standardized processes for onboarding employed physicians.  We have chaos that includes HR, Finance, Physician Enterprise, Property Management, Credentialing, and IT, due to a non standardized approach. Better integration between hospital operations and ambulatory operations. With the rapid growth of the ambulatory world over the last few years, these two entities have been separately managed and poorly integrated. IT can and should be a strategic partner for the planning and execution of all three of these actions, providing technology solutions and  facilitating standardization.


A shift of focus back on to patient care and not reimbursements/cost only. In our situation, we are a single-entity, regional non-profit. We have many hospital-owned clinics, of course. The past few years with all the cuts to reimbursements the organization has moved on all types of budget and process improvements. I’m all for process improvements, but the other side of budget cuts if not done well can be damaging. The organization’s competitive advantage was always patient care. The patient came to us because they didn’t want to travel to a larger city and a larger care environment. Now that we’ve eliminated whole scores of patient transport people, floor secretaries, and even furloughed some nursing staff, that advantage is gone. We run positive margins is the crazy part. I fear in time those margins will shrink and it’s not going to be because of costs. It’s going to be because we lost our best patients to other competitors. Even if your payer mix is only 10-12 percent insurance, those are the people getting the cancer/spine/heart treatments that keep a unit/hospital in the black. How can IT help that? That’s hard as that is a human element. We can support the frontline with streamlined systems but IT can’t be there caring for the patient. IT is a force multiplier on many things but not patient-focused staffing. Those patient transport staff who used to move patients out of the ER but now there is backlog getting patients to the floor from the ER.  I suppose IT could find a robotic system from and industrial plant and put that to use to automatically transport a patient to their waiting room! That will really help with patient satisfaction scores!


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October 14, 2013 Advisory Panel 1 Comment

Advisory Panel: Decisions Regretted

September 25, 2013 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What decision did you or your department make recently that you regret the most?


Actually all recent decisions have been good ones.  It’s the sins of the distant past that are still haunting us.


Letting the hospital put "web filters" to reduce inappropriate web surfing… it has slowed normal internet use to a crawl at times!


We decided to wait until this week to hold an all-IT-employee appreciation event. In retrospect, I wish we had held the event sooner. My team has been working incredibly hard, long hours for quite some time. We need to celebrate, relax, and break bread more often!


There are so many in hindsight of course. Anything with McKesson Horizon. HIStalk ran the rumors for at least a year before the 20/20 announcement. Anyone with experience in vendor mgmt or software development in general would say the Horizon 20/20 announcement was a sign of problems. It was the start of the best and brightest leaving the Horizon project team. It was a declaration that much if not all of your software licensing money spent was wasted, if you move to Paragon you can recoup, but all that time building a solution. All those hours spent and knowledge built will have to be repeated inside of 24-36 months.  It’s a demoralizing thing, in my opinion, when you could see/feel the winds of change but couldn’t get the ship turned. 


I regret holding on to one of my managers for too long.  I tried for three years to get him where he needed to be, including a management geared towards his weaknesses. I found it difficult to provide tangible measurable criteria with which to push him. Regular staff is much easier to measure/document against, but they are more task based. The role of management really has to do with decision making and overall philosophy ,which is difficult to make tangible. I finally replaced him and can’t be happier. The new manager has the same management style/philosophy and has made significant changes since his arrival seven business days ago!


Hiring someone we thought would want to get EpicCare Certification and then be hired somewhere else and did. Jerk.


Not my decision, but I’d say the state’s decision to try to dictate HIE (without understanding it) after everyone had already made plans.


Picking a vendor for an automated claims processing system that had very little experience with the types of claims adjudication rules that we follow. But, our department really didn’t make the decision. The decision to choose the vendor was made by members of the Board of Directors, overruling the recommendation of the CIO and selection committee. True to form, the decision has been a disaster and we are going to throw the vendor out and re-compete the contract.


A trusted current vendor acquired a new system through acquisition. Because we needed what it did, I jumped on it right away. Only later did I come to realize the trusted vendor didn’t have a clue how to integrate it with what they/we had. By itself it works great – a year later they/we are still trying to figure it out.


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September 25, 2013 Advisory Panel 1 Comment

Crowdsourcing Results: User Group Meetings

September 20, 2013 Advisory Panel No Comments

A growing vendor asked me about when and how it should consider hosting its first user group meeting. I surveyed readers for their opinions and received 44 responses. Thanks to all who responded – I’ve read every word carefully and summarized below. I think it’s fascinating.


Reasons for Attending

9-20-2013 9-48-30 AM

Attendees attend UGMs to get education and to network with peers. Company interaction isn’t nearly as important.


Meeting Sponsor

9-20-2013 9-51-07 AM

Most respondents preferred an event produced by the company itself rather than by a user group.


Most Valuable Education Sessions

These were freeform responses, but the majority of respondents expressed a strong preference for allowing customers to present rather than the vendor. Some ideas:

  • Big picture company strategy
  • If I had to do it over again ….
  • Customer roundtables
  • Regulatory compliance training
  • Tools and tricks
  • Workgroup sessions for customers with a shared market challenge
  • Hands-on customer sessions, such as best practices
  • Customers describing how they use and derive value rom a product – are they using it in a way I’m not?
  • “Did you know” sessions from the vendor
  • Training sessions delivered by customers, but with vendor assistance to make sure the information is correct
  • Information about upgrades and how to use new functionality
  • Product road map sessions from the vendor
  • Implementation lessons learned
  • Integrating the product with other solutions

Fun Session or Event

  • Customer panel
  • A concert
  • Beach party
  • Sailing
  • A casual wine tasting the night before the main session
  • Closing down an attraction just for attendees
  • A session just for newbies who need tips on how to network, how to join a conversation, what  not to say
  • CEO new feature rollout
  • Dinner out with groups by individual signup – large enough to provide networking, but small enough to force interaction
  • A general session with a hired speaker to motivate the audience
  • An evening at a local farm with homegrown local foods and wines
  • Sporting event
  • Competitive events
  • Team building exercise, such as group drumming
  • Breaking out into groups and being asked to design new functionality
  • Company party
  • Attendees brainstorm new features and “sell” the idea to the vendor
  • Panel session where the company was “roasted” in a professional and non-personal manner
  • Theme night dinner
  • Surprise slumber party – guests received a tee shirt and slippers, just a few tables, a room full of games like Twister, and finger food — the common dress and surprise nature made networking comfortable
  • Group activity to support local charities – build bikes, create care packages for troops overseas, work in the local food bank
  • Square dancing and dinner on a farm

Best Experience

  • Learn more about product capabilities
  • Specific product workshops by users
  • Customers create the agenda and run most of the presentations
  • Focused networking, like tables by topic
  • User case studies about problems solved
  • Every best experience involved networking
  • Being invited to present about lessons learned and having prospective customers asking questions afterward
  • Getting confirmation from other users and presentations that we’re on the right track with our use of the system
  • A good keynote speaker from outside the company who presents a motivational message always sets the tone for everything else
  • An EDIS competition among top competitor products
  • Hearing gotchas from customers so I could avoid them
  • “Seeing 30 kids being told they were to become ‘bike testers’ – after ‘testing’ the bikes they were told they could keep them. The squeals of joy, kids tears of happiness, parents of the kids with tears of gratitude, attendees with a lump in their throats seeing what they could do working together to bring happiness to someone else.”

Worst Experience

  • Vendor taking control of the meeting
  • Standardized lecturing by company employees, more like a trainer session for “one size fits all”
  • Company rah-rah at every session – get on with your discussion
  • Boring speeches by executives telling me how great their product is
  • Company-run presentations that turned it into a two-day sales pitch
  • Go easy on trying to sell me something
  • Rooms that were too small to hold everyone
  • Execs talking about how great the company is and how lucky we are to have them as a vendor
  • A pompous executive telling us the same thing every year – if you’re going to share your roadmap, make sure it’s paved
  • Hard sell by the vendor of vaporware
  • Bad presentations or poorly prepared presenters
  • We present real-time issues and company leaders dismiss their significance to healthcare
  • Vendor using their “top” customer as a mouthpiece – you attend a session thinking it’s a customer speaking and then learn they’re in bed with the vendor
  • Networking events with music that’s too loud and everyone (especially the company’s employees) drinking too much free alcohol
  • Sessions that weren’t as advertised
  • Condescending speakers
  • Lack of signs to get to rooms on time

Ideal Location

9-20-2013 12-27-19 PM

Any city that’s easy to get to an inexpensive was the clear choice.


Preferred Type of Educational Sessions

9-20-2013 12-28-34 PM

Case studies win, followed by informal chats and roundtables.


Importance of Offering CE Credits

9-20-2013 12-29-24 PM

Offering CE credits isn’t essential.


When is it Time to Have the First User group Meeting?

  • Size of install base and maturity of product
  • Vendors need to lead their customers to what the marketing is doing – if you have multiple products and services, then get your act together and design the meeting
  • Sufficient user size where the cost will benefit an expected number and quality of attendees
  • User requests
  • Number of users, demand for training, frequency of new products that require training, established groups at beginner, intermediate, and advanced levels
  • When customers ask for peer references for best practices and when product complexity and changes can’t be explained in an email blast
  • If your customers aren’t involved, don’t start one
  • Multiple users that are geographically disparate
  • At least 20 installs
  • Clients are meeting informally on their own
  • If at least a third of the user base is asking for it
  • If the company doesn’t have a formal process to gather and respond to customer enhancement requests
  • Size of the customer base – maybe 30-40 percent will attend
  • In the first year, do it close to home so you can learn and get back to the office quickly to make changes
  • When there are enough successful to-lives to make sure it doesn’t turn into a giant gripe session – there must be enough true believers for critical mass
  • After 2-3 major updates or the first all-new release of the software, especially if the updates coincide with government, payor, or industry changes
  • The vendor has at least 20 customers and actually cares about them
  • When it seems customers are asking the same question over and over

Should The Meeting Have an Exhibit Hall?

9-20-2013 12-38-05 PM

Yes, it should.


What Can a Company Do to Create a Great User Group Experience?

  • Keep it orderly, timely, and on track
  • Keep the meeting to 1-2 days
  • Make it easy to register and attend
  • Have a customer panel for Q&A
  • Make sure the company staff interacts with customers
  • Have engineers attend – they will learn a lot about customer use
  • Get topic ideas from customers
  • Offer varied events, not just lunches and educational sessions, and include after-hours events
  • Crowd source the venue and sessions from active users
  • Make sure space is big enough for all attendees
  • Repeat popular sessions
  • Always offer vegetarian options
  • Offer CEUs if possible
  • Make it about edification of the current customer base, not a sales pitch
  • Choose a location that’s travel friendly and inexpensive
  • Make staff available, which is why you have it near your headquarters
  • Advertise well in advance so customers can budget travel
  • Provide hands on experiences
  • Give customers something they can use to make their organization better
  • Have good food!
  • The company should provide support resources but not control the group
  • Fewer sales staff at the meeting and more support and technical staff
  • Less pitching of new stuff
  • Use an advisory board to set the agenda
  • Make sure the people behind the scenes who customers talk with but never in person are there
  • Arrange good, clean, and safe accommodations
  • Include a lot of case studies
  • Allow customers to interact with each other and the real developers in the company

Advice For a Company About to Launch Its First User Group Meeting

  • Designate resources to ensure smooth delivery–1 person can’t do it all re strategy, planning, communications, positioning, event aspects, as well as internal communication to staff involved. And don’t assume because the company launches with an email communication that customers will read it and understand what’s in it for them. Customer’s are spending money to attend and time out of their medical practice. Make sure there’s plenty and frequent advance notice and easy registration and staff available to answer my questions–pre and during the group meeting. Seek continual improvement–do a electronic post event survey–both to customers and internal staff.
  • Make it as central to your user community as you can to reduce expenses for attending and announce it in enough time for me to get it funded to go.
  • If you are going to hand out free swag, don’t make it too cheap. Better to not give anything at all. Also consider location carefully. A mix of a tourist area, easier to get to gives folks a nice excuse to attend. Forget Fargo in winter or any combo of Verona and cheese curds.
  • Invite small group of active users (each should represent all regions of the country) to act as ambassadors/advisors to provide recommendations on sessions, venue, fees, etc. This group should also be encouraged to promote event to colleagues via social media channels.
  • Try to imagine yourself as an attendee and what kind of service you would expect, and then go beyond that to knock their socks off…in other words, treat your customers like royalty and they’ll respond with loyalty.
  • If you don’t already have an enthusiastic group of users who are willing to share ideas – don’t expect it to magically happen at your first event.
  • no hard sales pitched. sell via education and solving client problems
  • Start planning & advertising to base early. Make sure the location is experienced with handling such events.
  • Be a facilitator, not just a presenter. Remember this meeting to to let clients learn from one another, not just from you. Manage the process to insure constructive feedback, not just bitch sessions. Have fun.
  • Ask for your users to be active partners in the process. They know & use the product in ways you won’t expect.
  • Get at least some of your frontline staff to the meeting, not just marketing. They are your day-to-day contacts with your customers, and they probably want to actually meet the people they spend a lot of time on the phone with. Your customers also want to put faces to names when they can.
  • The lower the cost, the more users they will attract. Don’t make it free, because "you will get what you pay for".
  • Select users to help set the agenda and overall experience goals of the conference. Select a mix of; great and not so great users; large medium and smaller organizations; encourage networking opportunities; Keep the message clear, simple and honest.
  • Plan, plan, plan. Don’t expect to make money – it is an investment and will take several years to break-even.
  • Pretty simple. If you make it a big company sales pitch, it will be the last UG meeting I attend. Your goal should be to increase customer loyalty by showing off a community and ideas. Your goal should not be to upsell.
  • Re-evaluate if you really should. Make sure you have enough client support.
  • Keep costs in line with expectations created, follow the old adage to deliver more than promised.
  • Get a major client to host the first few meetings at their location.
  • Get input from your customers using a survey or direct calling to gauge interest and get input on the agenda.
  • Do It!

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September 20, 2013 Advisory Panel No Comments

Advisory Panel: Patient Portals

September 16, 2013 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Do you have a patient portal, and if so, what can patients do on it?


We have a new patient portal from Epic that was implemented as of August 1. Currently, you can view results, appointments and prescriptions on-line or on your mobile device, send messages to your provider, and pay your bill. It also has health maintenance alerts. Future functionality will include self-scheduling of appointments.


We’re working on the policy & procedure of what we want patients to do in the portal before we start actually implementing.


We currently have a patient portal from our outpatient EHR vendor. Over the next year we anticipate migrating to an enterprise patient portal that will cover both our hospital and physician practice arenas. Currently patients can: see basics of their medical information, request appointments, request medication refills, send a medical question, receive documents, pay their bill, and research health information using a provided library.


Yes – custom built. Patients can see lab results, see their meds and allergies, request changes to these, request appointments, pay bills, send a message to their PCP. 


We have been live for many years and focus on what we think patients want to do most: Communicate with their doctors, Communicate with admin staff (e.g. billing, referrals), and request appointments. We will eventually add in the ability to view their EMR data, but it has not actually been a big request from most patients. The key has always been around communication. 


We use Epic’s MyChart. It went live last September. In the first release, patients have access to refill requests, appointment requests, and portions of their medical record, visit history, and upcoming appointments. Future releases will increase functionality and data access.


We do but for Allscripts/Clinic services only. Not much right now, scheduling details, and that’s about it. Not all offices have the feature enabled.


Yes but it is not yet live. Includes: access their billing statements; pay bills online; request and manage appointments; view, print, and securely email their medical information; access discharge instructions to improve patient care;  update their information and manage their medical history.


MyChart of course. Pts can: request appts, send messages, view all sorts of stuff (visit summaries, letters, etc.). We are just now going live with questionnaires (health summaries) and health maintenance reminders.


We have a patient portal for the hospitals but due to having disparate systems (hospitals vs ambulatory clinics) will require multiple portals or will use our HIE.


Yes. View lab results, delayed until released by the physician, and browse patient education material, tailored to their age, gender, ICDs and CPTs. Editorial: our patients should be able to see their entire record, and lab results as soon as they are available, not pending review by the physician.


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September 16, 2013 Advisory Panel 1 Comment

Advisory Panel: PHI on Mobile Devices

September 12, 2013 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What policies, practices, and tools are you using to control the use of PHI on mobile devices and apps?


Policies titled “Data Encryption” and “Mobile Device Safeguards” provide the basis for protection regarding mobile devices, emphasizing the requirements for encryption (storage and transmission), not saving PHI to mobile devices unless necessary, deleting the PHI when finished, and basic physical protections. Tools utilized are various methods of VPN, McAfee EMM and ActiveSync, native and container encryption methods, whole disk encryption, complex passwords, training and publications, Citrix, VM View, and custom applications that provide connectivity without storage or print.


We require any device that connects to our mail server to be encrypted.  If the device isn’t encrypted, the server won’t allow a connection.  We’re still working on a secure communication system with our non-employed providers, since they want us to send SMS messages rather than emails. 


We use Good Technology to provide secured access to our corporate email, contacts, and calendar on mobile devices.  Our policies limit the users who can have access by role. My perspective is that we use Good to mitigate our risks, but it has not increased satisfaction among our users.


We force a password protection on mobile devices and enforce a "10 attempts" wipe policy.


The health system adopted an encryption policy as a  CYA effort. We officially prohibit the use of personal computers for health system business, but I can’t see any way that we can control or even police this activity. Employees have external hard drives at home that they use to backup their laptops, at least they should have some backup mechanism. Therefore, when any of these home-based devices is stolen, the health system does not have to report the event, but the patients’ data are still compromised.


Likely not a surprise with all the recent news around this subject, we recently are about to launch the following: (1) Automatically encrypting all outgoing emails which contain PHI (based on whatever detection system the IT team is using). I hope ours is accurate and does not create a painful process in non-PHI circumstances;  (2) Automatically enforcing that any smart phones syncing to the system for emails/calendar have a four-digit device PIN, an inactivity timeout under 15 minutes, and remote wipe ability if device lost or stolen – I did not realize they could do all this automatically (but hopefully most of us do all this already!)


We have a policy that prohibits storage of PHI on mobile devices. We use a mobile device management software tool (MDM) that enables us to securely deliver e-mail, calendar, and contacts from our Exchange environment to iPhones and Android smart phones.


Must enforce passcodes, that is blocking and tackling/101 stuff. All too often you’ll see misconfigured policies for iOS / Android / BlackBerry that are missing that simple setting. Then you must encrypt. We are using a cloud service MaaS360 that segments the device into a personal and a business side. The solution has device encryption and very nice GUIs for policy management. You can deploy your own applications through the solution and it’s been stable. Cheaper solution compared to other MDMs.


DLP for flash drives and any data moved to a mobile device or external drive. The use of computers as kiosks in all patient care areas. These are locked down so that no data can be downloaded. Encryption on phones though this is a self-reporting/self-enrollment process at the present. By policy we require all portable devices to be encrypted. This is difficult to enforce on non-organizationally owned devices.


Currently only supporting Epic apps (Haiku) and don’t require UDID management. Rather we control by security (if you’re a provider, you can use). We just force 5 minute logouts and logout immediately upon exit. We are looking at bringing up policies for mobile management of any device that wants to connect to our Exchange as well. Should be live by end of year. BlackBerry Enterprise server offers these controls.


In the process of implementing an MDM solution, and evaluating DLP solutions.


If employees choose to store PHI on their mobile devices, the device must be protected by encryption and strong passwords; they must fall under central device management, which means we can erase the device, remotely and enforce password policies; and they must agree to declare a "lost PHI device" incident within 1 hour of first realizing the device was lost. Interestingly, we experienced one of these incidents recently. A physician reported his device lost, as required, and we erased it– everything on it. Later, he found it and was angry that we had erased his personal pictures and address book.


We are in process of rolling out a mobile device management strategy utilizing Airwatch. In addition, we limit the individuals and roles that can access particular information already (even a bit more granular/more tightly controlled than the typical role based access) with regard to mobile devices/apps.


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September 12, 2013 Advisory Panel 1 Comment

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