Curbside Consult with Dr. Jayne 3/14/16

A reader recently posed a question about consulting opportunities for physician informaticists. He was interested in exploring whether consulting is right for him. Specifically, he was asking: what are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems? Mr. H asked consultants to weigh in, especially physicians. I haven’t seen anyone weigh in yet, so I’ll at least give my own thoughts.

First off, I don’t think my journey to being a consultant has been typical. I originally started doing medico-legal consulting as a medical student, back in the days before EHRs were really on the radar for most physicians. Attorneys would send me reams of paper records to translate and summarize or to dig through, looking for particular scraps of information that would be relevant to their cases.

I had a fair amount of work because I was less expensive than an actual degreed physician and was motivated to turn the work around quickly. In addition to helping cover the high cost of tuition, it gave me a lot of exposure to the huge spectrum of documentation styles. It also helped me see a variety of errors and omissions that were common in various situations.

I originally ran that business under my own name and filed as a sole proprietor for tax purposes. I continued to do that kind of work during my residency training, and as more hospitals started using electronic charting, I started to see less work that involved reading cryptic notes and illegible writing and more that involved sifting through pages and pages of redundant information.

Most of my clients found me through word of mouth. Most of them were from smaller cities or rural areas. That made it easier, as far as not being pulled into cases that might involve faculty or colleagues or that otherwise might pose a conflict of interest.

I maintained that client base until I left training, and then ended up getting into the world of pharmaceutical consulting. I had done some research and co-authored a paper on a particular disease process, which apparently made me an expert in the eyes of a particular manufacturer. They asked me to attend a focus group. Since it was being held at a lovely resort and I hadn’t had a vacation in seven years, I agreed.

Once there, I realized I was totally out-gunned by the other attendees, who had serious reputations in the field. However, the discussions were stimulating and they must have felt my contributions were valuable because they added me to their advisory board. We could see our recommended changes actually come to fruition in how they marketed their products. I felt I was doing good work.

It certainly wasn’t what you sometimes hear about with pharma companies flying physicians to sit on the beach and paying them enormous honoraria. Although we would generally meet in a nice location, they would keep us locked up in working groups eight hours a day. That work continued for a couple of years, and then as their two flagship products came closer to rolling off patent, they disbanded the advisory board.

I didn’t get into formal informatics consulting until a couple of years after that, while working as a physician informaticist for a health system. I had done a couple of side jobs for small practices – basically physicians who knew about the work I was doing for the hospitals and wondered if I could help them out with issues they were having with their EHR systems or other practice issues.

I would do an hour here and an hour there, mostly in the evenings and on weekends. Physicians were happy to do it on that schedule because it didn’t interfere with patient hours. A friend of mine was doing practice operations consulting independently and had a client who needed a great deal of assistance regarding use of their electronic health record, so he reached out.

Since his client was located in one of my favorite cities, how could I resist? We came up with a proposal for the client. Although they were larger than any of my previous consulting clients, they were smaller than the medical group operation I was leading at the time. I was honest with them, going onsite to deliver my proposal and explaining my experience and what I could and could not do for them. They wanted periodic on-site work as well as remote work, and my then-employer was agreeable to having me take vacation time for the periods when I needed to do work during the day.

When I started working with that client, I realized that I was actually bored with my day job. I didn’t have a lot of growth opportunity there and was tired of some of the politics. In addition to the client work, I started doing some work with vendors. Mostly just focus groups and the occasional paid demo, but also did some co-development work with a start-up.

I realized during that time that I should get serious about being an actual consulting firm and filed for my first LLC. I also had some connections at some of the larger consulting firms and started looking at those possibilities. Generally, though, they would require more travel than I was willing to agree to, so I didn’t pursue them despite the significant potential for earnings.

Looking at some of my colleagues that did end up working for the larger firms, they seem to fall into a couple of different models. Some are actual employees of a single consulting firm, and when they’re not on client engagements, they perform work on standardized methodologies and materials that will be used for future engagements.

Others are independent contractors, and when they’re not engaged, they don’t get paid. Those folks have to do a fair amount of self-promotion and marketing. I have one friend who “works” for three major consulting companies and has actually found himself onsite with a single client as an agent of both companies.

Once I got serious about having a business plan and operating as a real company, I also got serious about my credentials. I didn’t want to have to market myself as “homegrown informaticist seeking bigger gigs” and the board certification for Clinical Informatics was about to become a reality. I looked at masters programs and decided to just go after the board certification, figuring that plus 10 years in the field with a large health system was probably enough to take me to the next level. The rest is history and I’ve been an independent consultant for some time now.

To the reader’s question, though, some of us do consult directly with health systems. Depending on the size of the hospital or health system, it can be straightforward or complicated. Sometimes I can get away with just writing a proposal. Other times I am participating in a formal RFP process that can take weeks to put my bid together. It can be frustrating at times.

It can also be very rewarding, since I control my own calendar for the most part. If I don’t want to work for a while, I can. I still continue my clinical work, not only because I enjoy seeing patients and love my current employer, but because it’s easier to get benefits that way than dealing with it on your own. Being on your own also means being your own IT department, your own accountant (sometimes), and your own secretary. Although I now have a partner, we’re still doing most things on our own.

People often ask me for advice on hanging out their consulting shingle. My first recommendation is that if you haven’t completed a formal training program, consider board certification through the practice pathway if you are eligible. Preparing for the certification exam forced me to learn areas that I hadn’t really been exposed to as a practicing informaticist. I feel that having the certification shows you’re willing to go the extra mile even though it may just be another piece of paper to some.

AMIA is hosting a free webinar this week on this topic: “Clinical Informatics: Board Certification through the Practice Pathway – and Beyond” will be held on March 18 from 1-2 p.m. ET. William Hersh, MD, FACP, FACMI is the presenter. For those of you not familiar with Bill, he is also professor and chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU. He also serves as chair of AMIA’s clinical informatics board review course, which I’d highly recommend. Topics for this week will include:

• Physician informatician roles and responsibilities
• Requirements for the “practice pathway” for board certification in clinical informatics
• Value of becoming board certified during the “practice pathway” period (which will be ending)
• Fellowship training required for certification after the “practice pathway” ends

Registration is available here and will also be archived at knowledge.amia.org for members.

What are your thoughts about being a consultant? What are the qualities of a great consulting company employer? Leave a comment or email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 3/10/16

Good news from the people at Microsoft, who are listening to the user community’s pleas to return critical functionality for those using Office 365 on tablets. They’ll be adding back the ability to use the pen/stylus as a mouse. That makes me happy on multiple fronts, since not only will I be able to go back to previous workflows, but I won’t have to spend hours stripping my Surface Pro to return it to the store. There’s no ETA on the fix yet, but other than that recent failure, I really have been satisfied with my purchase.

Friday is the last day for providers and hospitals to attest for 2015 Medicare EHR Incentive Programs. If you’re on the provider side, I hope your attestation is long complete. I’ve been helping a client with a last-minute effort and we ran into a lot of issues, mostly on their side, but some with website slowness which I can only assume is due to volume. Fortunately, we finished their attestations last night and I can breathe easier going into the weekend.

Last-minute projects always make me cringe, but as a small business person, they are valuable. It’s a way to help clients in a pinch, which can bring considerable work in the future when they’re happy with your services and realize you saved their backsides. Several of my steady clients have met me while in dire straits and I’m happy to continue working with them. It can make the work unpredictable, though. I’ve been fortunate to have a couple of clinical informaticist friends that I can ask to help out when one of those situations hits or when I need coverage to take some real time off. It’s been an informal arrangement, though, and I’ve been on the fence about whether I should engage someone to work with me on a more dedicated basis.

Finding someone who knows the space in the same way I do but who isn’t already crazy busy or who doesn’t have a full-time job has been a challenge. There are a lot of inpatient CMIOs that are interested in branching out, but in order to service my clients, I needed someone with solid ambulatory experience who can also cover the softer disciplines like change leadership and team development.

After talking with multiple candidates and conducting a trial run, I’m happy to say that I officially have a partner. He’s one of my long-time mentors and I suspected that his recent retirement wouldn’t last long, so was glad to hear of his interest. It has been fun working together on projects. I’m sure that due to the difference in our ages and his more prominent career, some people might assume that I’m working for him. It’s a risk I’m willing to accept. However, my company logo (which involves a figure in a dress and stilettos with a briefcase) should make for a good icebreaker when he hands out business cards.

I’ve had quite a few emails from readers this week, which always makes me smile.

From Think Twice: “Re: MU. Your recent Curbside Consult describes all that is/was wrong with MU. Instead of ‘certifying’ systems, MU should have defined a data ontological framework, a file standard (standard XML/CCDA), and an information bus that all systems that handle PHI must comply with. In that world, we wouldn’t be certifying vendors, but rather required capabilities. It would have opened the door to innovation. I’m not sure how we would handle, app-app communication across the workflow (like SMART is supposed to address), but we’d still be much better off.  More importantly, this wouldn’t have dealt with how providers protect their data (just to keep patients inside), while using HIPAA to hide behind (another story!) Although Meaningful Use as we knew it is on the way out, there are plenty of regulatory and quasi-regulatory bodies waiting to take us to the next level as they drive towards value-based care and other buzzword-worthy initiatives. I hope they’re listening, and look at how much money has been spent vs. how many provider hours as being wasted. The recent piece on providers spending hundreds of hours keeping up with quality measures was telling (especially since we haven’t seen a commensurate uptick in patient outcomes). It may be too early to tell, but my sense from the trenches is that it hasn’t been worth it.”

From Keeping Up: “Re: HITECH. I read most of the HHS report. It’s the same garbage we hear every month about the ‘numbers’ of EPs and EHs that used a certified EHR. They may ‘use’ them, but do not attest to MU or any of the other BS. It’s the same stuff — we gave out $30 billion in incentives, EPs and EHs took that and paid it all and more to EHR vendors (they don’t say that), and it’s still a mess. The lack of vision of ONC and HHS about this is amazing to me. EPs and EHs were moving towards EHRs prior to HITECH, but instead, HHS and ONC made this artificial market. Sure, it moved the adoption needle, but to what effect? Now you have the same problems as before, but EHR vendors made a ton of money. That bubble is about to burst and it will be ugly.” He goes on to mention the lack of improved patient care, safety, security, efficiency, and costs worrying that providers will bear the blame. I don’t disagree – we’re already seeing practices who have more staff than they did five years ago but are less productive and feel like they are providing a lower quality of care. Certainly there are people who have been able to make it work, but not without a considerable amount of resources or without sacrifices at the financial or personal levels. He mentioned watching his peers leave practice due to the pressures and I’m seeing that in my community as well. Given the costs of training, the risk of burnout, and the constant external pressures, I don’t think I would recommend a career in medicine unless someone felt a true vocational calling.

From St. Elmo’s FHIR: “Re: LOINC. Regarding your comments on regulations requiring customers to use LOINC for reporting laboratory measures but not requiring lab vendors actually send the codes with the results, amen. This is one of the stupidest things that’s been done. Although you mentioned that interoperability isn’t going to change the culture of competitive advantage, eventually companies learn that interoperability isn’t in competition with this. My view is that the vendors have learned this – based on working with development teams – but it’s a time-to-market problem. The solutions they are working on today haven’t hit the market, but when they do, it will be clear that competitive advantage is built on interoperability.” As much as I’m a bit pessimistic about the future of medicine, I do want to have hope. The old adage of “knowledge is power” would seem to lead organizations to want to share as much as possible. There is a leadership training game I use called “Win All You Can,” which ultimately shows that the only way for everyone to prosper is for everyone to work together for the common good. I first ran into it during an outdoor leadership course and have used a variation of it ever since. Maybe we can get ONC to require knowledge of it (or something similar) in the next round of incentive or penalty programs.

Is interoperability really the answer? Will knowledge set us free? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 3/7/16

I’m still recovering from HIMSS, which really gave me a beat-down this year. What started as the usual sore throat and froggy voice from yelling over loud music and being exposed to smoke seems to be turning into something more. On top of that, my self-diagnosed broken toe is actually a pair of fractures.

Fortunately, I scheduled a fairly low-key week, so I am working from the sofa with my foot propped. I’m wading through quite a few press releases that were lost in the HIMSS shuffle. I know vendors like to save them up for the week, but then there is so much noise that they’re easily missed.

I’m also following up on some consulting leads. Although a couple of them are from actual healthcare delivery organizations, most of them are from vendors who like the idea of having a physician informaticist on call, but not necessarily having to keep them on the payroll.

I’ve enjoyed the flexibility of consulting as well as the variety. There are a lot of organizations that have problems they’re trying to solve or could benefit from some outside opinions. It’s actually a lot like being a family physician. Sometimes the problems are straightforward with obvious solutions like cold and flu symptoms. Other times the issues require a lot of analysis and diagnostic maneuvers as well as the possible intervention of other specialists. The “detective work” aspect of medicine is what attracted me to the field in the first place, so I’m glad to be able to put those skills to work in other arenas.

Having worked in the large health system space, I’ve also developed some pretty solid firefighting skills that I’m putting to use assisting a client with their 2015 Meaningful Use attestation. The deadline is Friday, and although they thought they were prepared, it turns out that their internal MU resource hadn’t really been doing much in regards to documentation. Unfortunately, this was only discovered after she left the practice. I’m helping one of their senior clinical leads understand what documentation they have, what they’re missing, and how to go about creating an attestation binder for each eligible provider. It’s not glamorous, but they’re very appreciative, so I’m enjoying the work.

ONC announced three challenges in conjunction with HIMSS. The first is for $175,000 and seeks consumer apps that use open APIs to help patients aggregate their information under their control. I saw the Humetrix iBlue Button app at last year’s HIMSS and gave it a test drive. It was straightforward and easy to use. I know there are other vendors as well, so I will be interested to see what this challenge yields.

The second challenge is for the same amount, but this time for improved user experience for providers. Eligible apps will use open APIs the improve clinical workflow.

I had worked with a vendor last year who had designed a slick-looking bolt-on documentation solution for providers. They were looking for vendor partners. I had to advise them that they’d be hard pressed to get vendors to play along with them since essentially the purpose of their product was to correct clunky and ugly workflows.

They were reluctant to admit that calling someone’s baby ugly isn’t the best way to build relationships. Instead, I advised them towards a more grassroots effort with either provider organizations or specialty societies. They’re still working on their approach. I hope to hear from them again soon, but maybe this challenge will spur even more innovation.

The third challenge is for $275,000 and supports the development of an “app discovery site” to help developers distribute their apps for providers to evaluate. The overall goal of the challenges is to leverage FHIR to build interest in open APIs while advocating user-focused innovation. I agree with them that improving in these areas is important, but don’t think we have enough money on the table yet to really move the needle.

My former health system employer decided to consolidate its clinical platforms primarily because it was tired of supporting 1,000+ applications. It feels a bit like we’re headed back in that direction — having to add on multiple third-party solutions to get the work given the increasing complexity of healthcare delivery. Not to mention that just having interoperable solutions isn’t going to motivate people to send data in a codified way that would make it truly useful.

We’re seeing issues with regulations that require customers to use LOINC for reporting laboratory measures, yet there is no requirement that lab vendors actually send LOINC codes with the results. This has put provider organizations in a bind. Although I’m grateful for the work that problem has provided my consultancy, we’d be better off if the codes were required as so many other things are.

Interoperability also isn’t going to change the culture of companies wanting to maintain competitive advantage. There’s too much at stake from a market share and financial perspective for most organizations to truly cooperate, whether they are on the vendor or provider side.

Like most patients, I’m still having to log into three or four different patient portals to track down my information. There is no incentive for the systems to share, and in some cases, the focus on accountable care organizations is making patient care less accessible as groups vie to maintain control over patients in an effort to control costs.

The Department of Health & Human Services recently released its annual Report to Congress, providing an update on the adoption of health information technology and the exchange of health information. Although it documents the progress that has been made, it also describes some key barriers, including:

• Lagging adoption by providers who were not eligible for incentives.
• Insufficient specificity of standards.
• Varying interpretation and implementation of government policies and legal requirements.
• Safety and usability issues.
• So-called “information blocking”

So far, the only real instances of information blocking I’ve seen are in the provider community, and range from lack of education in some smaller practices to activities that cry out for antitrust scrutiny. I haven’t seen much of a response to the Report, which was issued right before HIMSS. I’d be interested to hear what readers think about it.

Have you read the HHS Report to Congress? Email me.

Email Dr. Jayne.

Dr. Jayne’s HIMSS16–Wednesday

If I thought yesterday was an overwhelming 16 hours of HIMSS-related events, today was even more packed. I started the day with a couple of standing client calls. It’s important for those of us that are here to remember that for the rest of the health IT community, time marches on and no one really cares whether we’re at HIMSS or not.

Fortunately, both of my clients are doing well and the calls were brief, allowing me to use the time zone change to my advantage and still make it to the exhibit hall close to opening. Crowds seemed lighter today and I felt much less like I was trapped in a salmon run.

I had the opportunity to check out Aprima’s new patient portal, which was aesthetically pleasing with very little clutter. They have solid features and are planning to add more during upcoming releases. We had a good discussion about the difficulties of developing a patient portal, including the requirements for proxy users and the difficulty of handling data for pediatric patients. They definitely understand the challenges and I’m looking forward to seeing how their product evolves over the next year.

One of the other areas I focused on today was Chronic Care Management documentation for ambulatory EHRs. For those of you not in that space, Medicare came out with a new billing code last year that allows providers to bill an additional $42 per month for care management services for patients meeting certain criteria involving chronic diseases. Each vendor seems to have its own spin on how to handle the documentation (there are time thresholds that must be met) as well as how to identify patients for the service in the first place.

I didn’t see any vendor with as robust documentation as I would have liked to, but that reflects the slow uptake in the market for the new code. Patients have to consent to enrollment and usually end up paying around $8/month in coinsurance, so adoption has been slow in some markets.

I met up for lunch with a handful of my favorite women and one of them was packing these fetching flats for later in the day. Due to my broken toe from earlier in the week, I’ve had to resort to some less-fashionable shoe choices, but it was nice to live vicariously through her.

I was also busy today attending sessions. Most of them were sparsely attended and it didn’t seem like the rooms were particularly well matched to the number of attendees. I’ve been to several other conferences where attendees are asked to register their session preferences in advance to the planners can right-size the rooms for the expected audience. One presenter commented that this was the largest room he’s ever spoken in especially given the number of people present. I think there were about 20 people in a ballroom that would seat several hundred. He did a great job with his material, but included a couple of off-color jokes, which would have been better left unsaid.

I haven’t been able to hit nearly the number of sessions I had planned. Rumor has it that HIMSS will be posting the sessions to their website so we can complete the continuing education requirements after the fact. Hopefully they’ll be posted soon because I’d like to cross Maintenance of Certification off my list for the rest of the year. I had the chance to connect with a couple of fellow clinical informaticists and swap war stories, which is one of the main reasons I like to come to meetings like this.

I always love Epic’s artwork, including this bottle-cap wearing unicorn and a musical cow. I overheard a couple of attendees commenting about the adult coloring books at Aventura. Kudos to them for tapping into a current trend and having a give-away that was definitely out of the box.

I’ve been plagued by dry skin on this trip, requiring a trip to the store for better moisturizer. I forgot my lip balm at the hotel so spent a bit of the afternoon scouring the hall for another tube. NextGen didn’t disappoint with their high-end giveaway and the mesh bag will be perfect for corralling cords in my bag. I know Mr. H mentioned the apparent lack of recycling and I’m always happy to see something I can reuse. I know some hotels do recycle and do the sorting for you, but I haven’t seen anything about that practice on the signage at the expo center or at my hotel.

IMO had some technical tee shirts at their booth. I’ll be enjoying mine as I continue to hit the treadmill during the rest of the winter. They also hosted a reception tonight at Hyde, located right on Lake Bellagio. The views of the fountains were stunning and I was impressed by the understated elegance of the event.

Tonight seemed like the busiest night for vendor events, with offerings from Nordic, Athena, NextGen, Greenway, and a host of others. It seemed like the events were shorter this year than in the past, with many of them only scheduled for two hours. The tight timeline and spread-out nature of the venues made it difficult to get to all of them although I did give it a fighting try.

I’ve never been able to make it to a Greenway event because it usually conflicts with HIStalkapalooza, but due to the date shift this year I finally made it happen. I’m glad I did because it was the best party of the night. Held at the OMNIA nightclub at Caesar’s, it featured a good selection of food and some sassy bling-handled cake pops. The DJ had the party hopping and it continued well past the published end time, with wait staff continuing to circulate for drink orders and offering water to those of us that were starting to wind down. Their photo booth was busy all night, and since it was open and in the middle of the action, we got quite a few laughs.

I met up with a good friend for a nightcap, although I didn’t get to stay as long as I wanted. Luckily he understood my need to go back and finish writing as well as to try to catch up on the hundreds of emails I haven’t been fielding for the last few days. Jet lag has definitely set in but I hope to sleep in a little tomorrow.

Dr. Jayne’s HIMSS16 Tuesday

Today provided a full 16 hours of HIMSS-related fun, starting with a questionably planned breakfast meeting that was way too early for a post-HIStalkapalooza morning. As usual the party was tons of fun, with lots of celebrity sightings and more than my fair share of time on the dance floor. Party on the Moon never disappoints, and I was glad to share the night with some good friends, connect with last year’s Secret Crush, and meet some new people.

Props to Dr. Eric Rose of IMO for his blue suede shoes.

These boots were also fetching. After catching a late night snack and some must-needed rest, I hit the exhibit hall along with apparently everyone else. The crush of people moving through the expo center was unreal, with long lines for breakfast and coffee.

I started my day with a Greenway demo. I’m focusing on population health during this visit and give full credit to the product specialist, who asked a lot of good questions about what I was looking for and immediately recognized that I was more knowledgeable than the average bear, jettisoning her standard presentation to tailor it to my needs.

After hitting a few more booths, I headed over to Medicomp to play the new improved version of Quipstar. This year they are featuring their Quippe Clinical Lens product, which was easy to use. The Green Team was victorious, making this my first win at Quipstar. The team was made of audience members as well as the core group of Evan Frankel (4ealth Consulting Group), Maria Luoni (NextGen Healthcare), Bonny Roberts (Aventura), and Debbi Gillotti (nVoq) as well as several audience members. I was pleased to see quite a few HIStalk readers in attendance as well.

I was able to get a quick behind-the-scenes tour of the operation behind the Quipstar show and learned the answer to one of the biggest mysteries of our time.

Sunquest had the first sponsor sign I spotted.

Orchard had some cute stress-ball giveaways. I plan to surf the hall tomorrow with one of my favorite people, who has gathered up some of last year’s giveaways and plans to return them to their vendors. We’ll see how that goes.

I spotted my secret crush in the exhibit hall sporting his sash with his bright orange Aventura shoes. I’m just glad he got the sash back at the end of the night, since there were multiple people wearing it at different points at HIStalkapalooza.

I spent lunch catching up with a start-up vendor, who is not exhibiting but who is conducting meetings at HIMSS. Given the cost of booth space and other amenities, I’m not surprised by this approach. The hall hosted several happy hours this afternoon – Webair with their “Doctors, DR, and Drinks” event as well as Orion and Greenway. I participated in a vendor focus group which was very interesting, then headed for a quick shoe change and purse swap before the second night of events.

In the afternoon I hit the Intelligent Health Pavilion, located in the subterranean exhibit hall. I was surprised by how much buzz was going on there, and ran into a friend that I hadn’t seen since 2009. It was good to catch up in person. I also spotted these snazzy wing tips.

Dell hosted a client event at Bellagio’s Bank nightclub, which was hopping. Practice Insight had a subdued but classy event at the Platinum Hotel. We also hit the Imprivata event at Beer Park at Paris. The band was great and they had not only a photo booth, but someone hand-rolling cigars. Next it was off to the Bourbon Room at the Venetian to connect with friends old and new. Renewing relationships is the best part of HIMSS and I hope to connect Wednesday with someone I haven’t seen in almost six years. It’s been too long.

Dr. Jayne from HIMSS 2/29/16

Usually the travel day to HIMSS is uneventful and this year didn’t start any different. I boarded my flight at O Dark Thirty and settled in to watch some software training videos that my client had created, since I knew there was a good chance they’d put me right to sleep. After a nice nap, it was time for email clean up.

I must have missed this before, but CMS has extended the Medicare EHR Incentive Program hardship deadline until July 1, 2016. If you haven’t submitted your application yet and want to avoid adjustments to your 2017 Medicare payments, you have plenty of time.

I touched down in Las Vegas right around the start time of the Hot Chocolate 15k run, which had multiple roads closed. Fortunately I had a taxi driver with a great personality, which made the delay tolerable. Although the roads were closed, I never saw any actual runners.

Speaking of runners, I mentioned previously that Edifecs has their #WhatIRun campaign live. I’m flattered to have my profile posted under the healthcare leaders section and appreciate their willingness to keep me anonymous.

For those of you who pop over to take a peek, yes, the comment about the refrigerator is true. Once I arrived at my hotel, I found out that my promised (and paid for) early check-in had been pushed back an hour. It was difficult to find somewhere to hang out that wasn’t completely smoke filled, which reminded me why I am not a huge fan of Las Vegas.

Once I finally received my room keys, I was quite surprised (as was he!) to find a naked guy who had apparently just stepped out of the shower. The front desk was apologetic and reversed my early check-in fee and also upgraded my room. It wasn’t their fault, though – the guest had checked out before he was actually ready to depart, so let that be a good lesson to only check out when you’re ready and also to use the privacy lock.

Once I was settled, I enjoyed the opportunity to get outside and actually see the sun since there is still snow on the ground in my world. I’m always saddened to see the panhandlers on the elevated walkways. Although it’s a complex problem, one man today was clearly having a psychotic episode outside the Palazzo. Hotel security were keeping an eye on things since he was accosting pedestrians. I hope he gets the help he needs.

The fountain at the Wynn was getting some maintenance and I imagine electricians who own dry suits are in demand across down. Registration was smooth, although there was a snafu with picking up bags and materials. At the registration area, they were telling people to come back in three hours to get everything. I decided to wander around the meeting areas and found the bag desk a few dozen yards away, fully stocked and ready to distribute. There were several people headed to the CHIME golf outing toting their clubs.

I stumbled across this Sunday session, featuring AMA president Steven Stack as well as Nancy Gagliano from CVS Minute Clinic and some others. From the time I saw it to when I returned to snap a photo, they had added the “free” to the signage. I registered and chatted with some of the staffers, who were very enthusiastic about their mission. I popped in for a bit and didn’t learn anything new, so headed back out for some more sun.

I connected later in the day with Dr. Lyle and some of his Healthfinch colleagues, who were on their way to a get-together at the Palazzo. My favorite part of HIMSS is catching up with people that I may only see once or twice a year. The rest of the evening was spent with friends old and new, as we christened the Southbound Greyhound as Dr. Jayne’s Official Drink of HIMSS16. (I personally like to muddle in a few blueberries, but there were none to be had.) Note to the bartenders at Treasure Island: you might want to stock in a few more bottles of Deep Eddy Ruby Red. You’re going to need them.

I was trying to unwind this morning in preparation for this evening’s big events, but despite the privacy sign on the door, the housekeeper opened the door without knocking. I always use the privacy lock, so she wasn’t able to get in, but it was annoying, especially since it was barely past 8 a.m. I know they’re in a hurry to turn over rooms, but I’m not checking out today and I did have the sign on the door.

I’m going to meet up with a good friend for lunch and lay out the battle plan for the week. Unfortunately I’ll miss the opening keynotes due to HIStalkapalooza prep, but I don’t think I’ll be missing anything earth-shaking.

For the rest of you prepping for the big night, may I suggest the liquor section at Walgreens, which has the Pedialyte thoughtfully displayed with the Ketel and Tito’s. I’m looking forward to the dance-floor stylings of Matthew Holt as we Party on the Moon. See you there!

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/25/16

This week has been completely off the rails, with all my best-laid HIMSS preparation plans left undone. There’s nothing like five inches of mucky wet snow, flight delays, and a case of pinkeye to throw a girl off her game. Luckily I made it home, saw one of my partners for some eye drops, and am now playing a frantic game of catch up.

The pre-HIMSS news cycle is pretty slow. There was a flurry of mailings earlier in the week, most of which were nondescript post cards that wouldn’t lure me to a booth. Today there was nothing, but there will always be those post-HIMSS straggler mailings to look forward to.

Several readers have been sending me their shoe pics, wondering if they’ll give them a proverbial leg-up on the competition. There’s even a HIMSS Style 2016 board  on Pinterest, with suggestions for both ladies and gents. I do like the pink socks and fetching wing tips pinned from www.dapperclassics.com.

Another sent me a pic of this two-heeled number from Christopher Dixon, which are supposed to be extremely comfortable. They’re also tech savvy, using Silicon Valley partner Chronicled to ensure authenticity. Shoes are tagged using a microchip and registered from a mobile app, allowing a future secondary market for non-knockoffs. Accessing the shoe’s chip via the app also displays a story about the inspiration behind the shoe and the sourcing of its materials. I doubt we’ll see any on the show floor, but a girl can dream.

I’m putting together my final social schedule for next week. Unfortunately, there are way too many events on Wednesday night and too few on Tuesday night. Most of the vendors who are hosting events are either gracious enough to allow public registration or are swayed by the MD accompanying my generic-sounding practice name.

I did have one of them question exactly how I received their invitation since it didn’t match their list. I had to just ignore it because I couldn’t exactly say, “Well, someone on your marketing team thought it was worth inviting Dr. Jayne.” One vendor offered to add me to its attendee list if I would send my real name – nope, not happening.

If you have an event on Tuesday that’s open to all readers, let us know. We’d be happy to have a member of the HIStalk team cruise by if time permits.

I tried to attend a Google Hangout this week, where NCQA was going to talk about the pilots for their redesigned Patient-Centered Medical Home program. The audio from the moderator’s PC was so bad that people couldn’t hear, which turned some attendees away. There were also a lot of people who weren’t muting their own microphones, adding to the problem.

Once the featured speakers started their talks, things got better, but it goes to show that Web conferences still can be tricky for a lot of people. At least the comments were fun to read.

I followed up after with one of my friends who does a lot of PCMH consulting work. She’s personally steering people away from NCQA, not only due to the complexity of their process, but also the growing fees. I haven’t had a chance to look at their new measures in depth, but she has seen them and thinks there are a few in there that are nonsensical. Looks like I have some reading to do.

CMS shut down the Medicare/Medicaid EHR Incentive Program attestation website over the weekend to correct an error preventing Eligible Professionals from claiming an exclusion for one of the measures in the Patient Electronic Access Objective. Those whose attestations were rejected previously must resubmit their information.

ONC has released a new Health IT Buzz post about “The Real HIPAA,” giving examples from care coordination and case management. This should be required reading for all the people who continually try to use HIPAA as an excuse not to share patient information when it is clearly permissible. The next installment is slated to cover Quality and Population-Based Activities and I’m looking forward to seeing what they have to say.

If you’ll be in Las Vegas next week and are interested in giving feedback to CMS, they will be hosting three Design Lean Planning Sessions during HIMSS. The goal is to receive feedback on the Merit-Based Incentive Payment System (MIPS). Sessions are one hour long and will be held March 1 at 2:30, March 2 at 2:30, and March 3 at 11:30 in the CMS Meeting Room, Venetian Level 4, Zeno 4603. Space is limited and you must email  with your session choice, name, title, role, and organization to register.

Another reader recommended I not spend too much time at HIMSS job hunting, suggesting that I consider a position in New Zealand. They’ve been trying to recruit a primary care physician for more than two years with no takers. The position has good compensation, no nights or weekends, and 12 weeks of holidays. I’m not ready to live in the southern hemisphere, but a nice locum tenens gig might hit the spot. Unfortunately, he’s been inundated with applications of dubious merit, so he probably won’t see mine.

My week also went askew thanks to the usability efforts (or non-efforts) of Microsoft, who decided in their infinite wisdom to “update” Office 365 with a feature that completely broke my workflow. I have been enjoying my Surface tablet, especially the Surface Pen, which I use in lieu of a mouse or the touchpad on the keyboard. I have been working on a huge editing project (textbook chapter, anyone?) and two days ago the pen stopped working as a selection device and only worked for annotation. Using classic user psychology, I assumed I had done something wrong or activated something unknowingly. I immediately knew better when I did a Google search and typed “Microsoft Surface Pen” and it automatically suggested adding “stopped working” to the search.

Apparently Microsoft engineers decided we no longer want to use a pen or stylus for anything but annotation — the pen is now locked in Ink mode while using Office products. Although there appears to be a button to return it to selection mode, it doesn’t work. Multiple users have already weighed in on a Word suggestion forum that there needs to be an option to go back, with several comments from people who used the pen as an accessibility and adaptation tool to help with physical limitations. I use mine with the keyboard, so I can use the touchpad even though I don’t like it, but I truly feel for those actually using it as a tablet. Having to use the touchpad reduced my editing productivity by more than 50 percent.

Even worse, the on-board Microsoft Help seems to brag that the “select objects” button (which should turn inking off) no longer works. The Microsoft Answer Tech gave me an escalation link that wasn’t customer facing and the escalation site shows they don’t know the difference between a country and a language (featured above).

Help a girl out by sharing the link and helping us tell Microsoft they’re offending their users. If I scurry home from HIMSS, I’ll still have two days left in my return window to offload it.

I won’t post again until I get to HIMSS, If I have to ditch the Surface, what’s your advice on a tablet? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/22/15

I’ve mentioned a couple of times about having issues in the office recently, where our cloud-based EHR is down. A reader asks: “Please explain to me as an IT physician expert why your cloud EMR was ‘down again.’ Mission-critical systems should have backups. I also believed that bigger organizations should have more resources (like you) to prevent/remediate these events. Please tell your readers why this is happening and what procedures your organization has in place to prevent this?”

We actually went down again while I was seeing patients last week, although it only lasted for a few minutes. I’m happy to tell my story.

In my current clinical situation, I’m more representative of the “average Joe” (or Jayne) physician than an IT physician expert. Like many other physicians in practice, I am employed. Although I used to own my own practice, that was more than a decade ago and the demands of running the business took all the joy out of medicine, sending me into employed practice in the first place.

That was the position I was in when I became a CMIO – homegrown by my hospital/health system to take the reins as we moved into the EHR world, long before Meaningful Use was even thought of.

From a physician informatics consultant perspective, I live and breathe downtime strategy. Clients hire me to engineer their downtime strategies and ensure that being down is something they never have to encounter. Whether it’s the threat of utility providers with backhoes or a natural disaster, I’m all over it.

The downtime solutions I helped engineer when I was a CMIO were initially ridiculed by the IT department as overkill, but they proved themselves time and again as we encountered a variety of unstable situations. Car crash into the data center, knocking out power? Check. Flood in the backup data center? Check. IT guy pulls the Halon fire suppression system on accident, shutting down the building for half a day? Check. Network switch down? Check. Vendor fries your database with a bad upgrade? Check. We had it covered and I learned a great deal along the way.

However, when I go into the office now, I put on my physician hat. My employer knows full well what I do the rest of the time, and although we are a good-sized independent physician group, we don’t have the level of dedicated informatics or IT resources that a hospital-owned group or academic medical center might have. We sometimes run on paper-thin margins as we deal with shifting reimbursement schemes and a rising balance of patient pay accounts.

The bottom line is that that our management (like many other private practices) are not able (or perhaps willing) to pony up to have a full-time or even part-time expert deal with the situation.

That scenario is exactly why I went into consulting in the first place. I started my consulting practice on the side while I was still a CMIO, working with practices that might be on the smallish (or cheapish) side but that still wanted expert advice. Practices who may not feel like they can afford ongoing expert assistance, but might be willing to hire someone to come in, do an evaluation, and give them advice. But despite dire warnings and imperatives, clients don’t always take my advice and sometimes simply cannot afford to do so.

Eventually my consulting practice grew to where I also handle large hospitals and health systems, especially ones with more than their share of challenges. I left the hospital-based world some time ago and hung out my consulting shingle full time.

I had several locum tenens and urgent care-type assignments before settling in at my current practice. In my employment as “staff physician,” I am somewhat blinded to what our owners are doing with regard to the EHR vendor and the ongoing issues. I do receive direct emails from the vendor when the system goes down, and they’re “all customer” type bulletins, so I know that our outages aren’t due to local connectivity issues.

The level of redundancy our vendor may have is a black box to me as an end user. Although I have made suggestions about improving the downtime documentation tools and having regular drills, as an end user employee, dealing with the vendor is not my responsibility. (As a CMIO, I’d have had a vendor exec on a plane and hundreds of thousands of dollars of maintenance credits by now, had we had these issues.)

I’m not excusing the actions of my employer, but just sharing how it is in my world as an employed physician. They know what I do. They know I’m available if they want my opinion. Otherwise, my role is to care for patients and let management do the managing.

I will be visiting the vendor’s booth at HIMSS and asking a lot of pointed questions, but I won’t be doing anything to jeopardize my employment. A practice that lets me work a relatively limited schedule and is flexible with the demands of my consulting practice is rare. One that actually performs (from a clinical standpoint) at the level of my current employer is even more so. Despite the recent failures of our EHR, it does generate mounds of quality data that put us in the top decile for many benchmarks. Patients are voting with their feet as well, allowing the group to continue to grow.

You can bet that things would be different if I held a leadership or ownership position. But much like many other physicians across the country, I don’t. I am subject to the decisions of my employer. Maybe someday they’ll reach a place where they have dedicated informatics resources, but until then, I’m going to put my stethoscope around my neck and see patients.

How do you feel about being an employed physician? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/18/16

Although health IT news is a bit slow in the run-up to HIMSS, I’m pleased to see that things are starting to pick up. I’m back on Twitter after a long hiatus and enjoying some of the conversations around HIMSS shoes. In looking for comfortable yet fun alternatives, I realized there is an entire market dedicated to alternative prom footwear of the sneaker variety. Although I’ve been to a wedding where the bride wore vintage Chuck Taylors, she was a PE teacher and it was part of a running joke. I’m going to have to completely rethink my plans for HIStalkapalooza.

I’m putting together my list of vendors to visit as well as my list of spectacles to try to photograph. As usual, several booths are planning a Las Vegas theme with blackjack or games of chance. Others such as FormFast are bringing exotic supercars or other “cool factor” displays. I always enjoyed the Indiana Jones-style guy they had in their booth that would throw hats to the audience. At least they’re tying in the car with their name and their business line through their “Fast Matters” campaign.

I’m also seeing an uptick in pre-HIMSS webinars as well as a couple of vendor campaigns encouraging practices to seek out replacement systems. I don’t know if it’s tied to HIMSS or not, but it was noticeable. My favorite communication from an EHR vendor this week was from Kareo, who asked me to take a survey about my practice’s success with their system. They should know that I haven’t logged on to their system in more than six months, which should be telling enough.

Edifecs has launched the #WhatIRun campaign supporting women in technology. They are donating a dollar to brightpink.org for every share or tweet of the #WhatIRun hashtag. Visit them at booth #8107 and they will also donate $5 to Miracle Flights for Kids.

NCQA has proposed an “ambitious redesign” of their Patient-Centered Medical Home recognition program. They’ll be hosting a Google Hangout on February 24 where practices can get an update on the redesign progress and hear from practices that participated in a redesign pilot program. I’m interested to hear about the changes, which will not only impact practices but also EHR vendors who support clients in achieving recognition. The Patient-Centered Medical Home movement is turning nine this month and the American Academy of Family Physicians put together a nice blog post summarizing a recent review of studies around the impact of PCMH on cost and quality.

Telemedicine is a hot topic and I was intrigued to hear about Nurx, which allows women in California and New York to receive prescription and delivery of FDA-approved contraceptives within 48 hours of accessing the app. They have plans to expand to HIV PrEP (pre-exposure prophylaxis) as well. Some are referring to Nurx as “the Uber of birth control” and I’ll be interested to see how it goes. I recently had the opportunity to speak at my local school board about proposed changes to their human sexuality curriculum, so I can imagine feelings about such a service will run the spectrum. Nurx waives its consultation fee for uninsured patients and in some markets patients can receive their medications the same day. Plans for expansion into markets in Illinois, Washington, and the District of Columbia are in progress.

For those of you who have been following my ongoing saga about Maintenance of Certification requirements for the Clinical Informatics subspecialty, I have some good news to report. Several Institute for Health Improvement Open School courses have been approved for ABPM LLSA credit. If you’re a member of an ABMS specialty board, you are eligible for a 10 percent discount by entering the code MOCABMS at check-out. Approved courses cover quality improvement, graduate medical education, and patient safety.

Packing for HIMSS is always a challenge and a reader shared a link to Heelusions as a way to make things easier. Invented by the reader’s wife and her mother, it allows you to accessorize a single pair of shoes for multiple looks. I’m all about supporting small businesses, so I’m happy to share. It’s a cool idea, but sadly my stiletto days are numbered.

Seeing patients this week has been a bit bumpy, with our cloud-based EHR being down intermittently for the last few days. Luckily our downtime procedures went more smoothly than the last time we had an outage, but it’s never fun when you don’t have all the regular tools at your disposal. I’m back in the office tomorrow so cross your fingers for me.

What’s the most annoying thing about the EHR being down? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/15/16

Although I do the majority of my work independently, I have other resources that I lean on from time to time. This weekend, I had the rare pleasure of traveling with one of them as we headed to a job. I enjoyed having another person to talk to while we traveled as well as being able to use the time to plan some upcoming work.

Although he’s more of an infrastructure expert, we share a lot of the same battles: dealing with corporate doublespeak, figuring out how to deal with other people’s emergencies, and having to explain to people why we can’t deliver solutions until we know what the business requirements are.

Both of us have recently had some interesting experiences with collaboration. A recent article in The Economist covers some of the ways in which collaboration goes too far.

I’ve experienced the collaboration curse several times. The IT department at my hospital was notorious for embracing collaboration tools at the expense of actually getting work done. We were so busy with Google Hangouts and HipChat and being collaborative that no one bothered to document requirements, decisions, and outcomes. We had a mix of workers at various career stages, some of whom weren’t terribly skilled with collaboration tools.

Our leadership didn’t want us to spend the time getting everyone on the same page. Add to that an inability to manage logins and permissions adequately (it’s hard to collaborate on documents you can’t edit) and it nearly destroyed some of the teams.

My travel partner experienced it on one of his contract assignments, where management responded to a lack of in-person meeting attendance by instituting compulsory collaboration. Teams of largely remote workers were forced to come into the office one day a week, where they sat on conference calls with other teammates that were working from home on those days. After that, management forced everyone to come in on a single day of the week, where many of the workers ended up sitting in cubicles all day and talking to no one.

I don’t disagree that collaboration can be a good thing. There’s no substitute for being able to work as a team and use diverse skill sets to move a project forward. Nor is there a substitute for getting to know one another as more than just a disembodied voice on the phone or a choppy image on a video conference.

But simply putting people in physical proximity isn’t necessarily going to achieve that outcome. Teams have to be able to work together productively and have to be freed to focus their efforts in the right direction in order to be most effective.

I once worked with an IT support team that estimated their non-productive overhead at 40 percent. That seemed high until I took them through the exercise of documenting all the non-value-added work they were performing on a daily basis. Inefficient corporate requirements sucked away valuable time. Just looking at the cost of highly-paid engineers who had to battle inefficient timekeeping and project tracking systems, we could have paid for a part-time administrative assistant and allowed the team to focus on their work.

When I perform consulting engagements where I look at IT team processes, I usually see at least 20 percent of the time spent on non-productive activities – scheduling, timekeeping, logistics, waiting for people to arrive at meetings, and rescheduling due to lack of key participants. That doesn’t take into account the productivity loss when people have constant interruptions due to misused collaboration tools – the productivity cost of instant messenger and email notifications has been significant for many of my clients.

Some of my favorite consulting work is helping clients fix this problem – developing communication plans, helping teams set boundaries, and assisting them in figuring out how to collaborate but still allow time for productive individual work.

I’ve written previously about the challenges of open office design, and have seen a couple of companies that are moving back towards more traditional workplace arrangements. Others are allowing employees to work at home more regularly in order to increase individual productive time.

One of my clients recently hired scheduling assistants to deal with competing meeting requests. The effort is part of a larger initiative to increase meeting productivity and it seems to be working. Rather than having dozens of workers trying to schedule around conflicts, time off, and available rooms, team members have to send a meeting request to the central scheduler. In addition to the participants and desired time frame, the request has to include an agenda with the purpose of the meeting and expected outcomes. They’ve actually seen the number of meetings start to decline.

It’s hard to sort out all the causative factors, but staffers cite fewer meetings where key people are double booked or unavailable, which lets them actually get decisions made the first time so they can move forward. The need to have an agenda and outcomes formulated before requesting the meetings has also reduced the number of meetings that didn’t need to happen in the first place.

It was a difficult transition, though, as people had to give up a little bit of calendar autonomy while adding scheduling discipline. Individuals had to clearly identify which appointments on their calendar could not be moved or modified while trusting the schedulers to make things happen for the greater good.

The concept isn’t that different than that of using centralized scheduling for radiology, diagnostic testing, or medical consultations. The schedulers can see all the available resources as well as the queue of requests and look for creative ways to work through constraints. It’s not something I’ve seen in the corporate environment though more than a handful of times. There has to be a balance between collaboration and focused work time as well as between tasks that have to be done personally vs. those that can be centralized.

How does your employer make the most of collaboration? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/11/16

It’s been a great week here. First, my trusty IT guy was able to resurrect my PC and we bartered for its safe return. I got off fairly cheap, but I’m sure he’ll need a supplemental favor down the line. I was also able to catch up with a good friend of mine, although I was sad that he was lounging at Pebble Beach while I was watching the snow fall. And finally, I finished an enormous consulting engagement, so it’s officially time to celebrate with a glass of wine and some invoice generation.

Now that the big project is off my plate, my HIMSS planning is officially in high gear. I looked at the options for focus groups and can validate what Mr. H said previously about the HIMSS websites still displaying HIMSS14 or HIMSS15 labels. Certainly there is an intern who can take care of that for you? I declared my interest in several different options and hope I’ll get to attend at least one of them.

Some of the options were thinly-veiled marketing opportunities, but several looked to be educational as well as a way to share experiences with other CMIOs. Although some focus group sponsors are transparent, others aren’t quite so obvious and it was fun trying to read between the lines and figure out who was paying for breakfast.

I’ve also started receiving an uptick in HIMSS-related mailings. Some are engaging and others are pretty dry. My favorite this week is from PC Connection. They’re mailing playing cards for you to bring to their booth and use to play blackjack. Mine was an ace, so we’ll have to see how it goes.

HIStalk sponsor Imprivata is encouraging attendees to “Get Charged Up for HIMSS” by sending Starbucks gift cards along with an offer to receive an engraved portable charger by scheduling a meeting in the booth. Too bad I’m registered for HIMSS as my real self, because having one that says “Dr. Jayne” would be too funny. One of my dear friends, Bianca Biller, gave me an engraved box for storing my pearls. Fortunately, she warned me to open it under the table at my hospital “send-off” party.

I’m also happy to announce that I’ve selected my first two “Team HIMSS” contestants to play with me on Tuesday at 11 in the Medicomp Quipstar game show. One is a true competitor whose leadership mantra of “get on board or get out of my way” inspired me. If nothing else, she’ll be able to wrangle the rest of the team while I’m donning my disguise. The other won me over by not only supplying me with a brilliant “Top Ten Reasons to Pick Me” list that included a full 37 reasons. Many of them mentioned various HIStalk moments over the last five years, confirming he is a true reader and fan. Some highlights:

• I have a photo of Jonathan Bush and Judy Faulkner talking to John Glaser at HIStalkapalooza.
• I won a giant three-foot-tall chocolate bunny from Medicomp, and yes, even though we needed to freeze a majority of it, had an unsuccessful fondue night with some of it, and tried to give it away, we finished the giant bunny.
• I once conspired to take over an empty HIMSS booth and re-brand the company when their booth sat empty.
• Matt Holt doesn’t know if I am friend or foe. I like it that way. I think he does, too.

Incidentally, the reader sent me real-time photos of the giant bunny when he decapitated it with a large kitchen knife, so I know he’s a contender.

I’m not sure who we’ll be competing against yet. We still need two more team members. A couple of potential candidates weren’t willing to commit to the time slot (Tuesday at 11), so I’ll have to put them in alternate status. You still have time to send me your top reasons for why you want to be on Team HIStalk.

Several readers have already started sending me pictures of their #HIMSShoes and this will be a great opportunity to show them off. If you can’t make that time slot but want to play Quipstar, you can register for other show times.

In other news, CMS is extending the submission window for 2015 QRDA data submission for the EHR reporting mechanism. Eligible professionals, PQRS group practices, qualified data registries, and data submission vendors now have until March 11, 2016 to submit 2015 EHR data. A complete list of time frames is below and all times end at 8 p.m. ET, so mark your calendars now:

• EHR Direct or Data Submission Vendor (QRDA I or III) – 1/1/16 – 3/11/16
• Qualified Clinical Data Registries (QRDA III) – 1/1/16 – 3/11/16
• Group Practice Reporting Option (GPRO) Web Interface – 1/18/16 – 3/11/16
• Qualified Registries (Registry XML)  – 1/1/16 – 3/31/16
• QCDRs (QCDR XML) – 1/1/16 – 3/31/16

ONC launched a new blog series about permitted uses of Health Information under HIPAA. The first one is titled “The Real HIPAA Supports Interoperability” and should be required reading for all the hospitals blocking release of information where it is clearly permitted. The series runs every Thursday through February 25.

Are you getting ready for HIMSS? What are you most looking forward to? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/8/16

Last week I talked about physician understanding of the economics involved with a transition to value-based care. This week I’d like to entertain the idea of opportunity cost, which is the loss of potential benefit from alternatives not selected when a choice is made. In explaining it to my niece, it’s missing out on buying a cool pair of boots in three months because you’re buying too many lattes and not saving anything from your part-time job.

I’ve had a series of events lately that make me think that healthcare leaders don’t understand the concept of opportunity cost. I know I have a penchant for working with organizations that tend to be fairly troubled, but this is a pretty basic concept. Let’s take a look at a few of those scenarios:

Hospital A had a very strong IT analyst who had been working in a physician liaison role, meeting with new hires and personally setting them up with various credentials, their VPN tokens, etc. She would meet them either at their offices or in the physician lounge and do whatever it took to get them activated and make sure they felt supported for the first few months of employment. She was dearly loved by everyone. 

When her husband developed an ongoing medical issue and she asked to reduce her hours, it seemed like a done deal. Instead, the IT department informed her that they had no part-time positions available. She was forced to take early retirement in order to care for her family.

Subsequently, they contracted out the position to a third-party desktop support group, who immediately hired the staffer part time. She earned close to her previous full-time salary as a part-time contractor while the hospital ended up paying more than her full-time salary.

It’s bad enough to not do the right thing for an employee who has been with you for 30 years, which is unheard of in the working world today. To make such a poor business decision on top of it, though, is just mind-boggling. They’re now essentially paying twice as much for her services. Making it even more bittersweet, her husband’s condition turned out to be not as dire as predicted. She’s now back in a full-time position, performing project management services in addition to the desktop support.

Hospital B had been trying to hire a CMIO for some time. They engaged me to help put together the job description and evaluate candidates since they had never had a CMIO and wanted someone to help sort the wheat from the chaff.

We first ran into trouble when they created the job posting and its accompanying salary range, which was less than what most physicians make fresh out of training. Yet they expected to hire a board-certified clinical informaticist who had been working in the field at least five years with their specific platform.

They were surprised that no one was interested in the job. Only a handful of folks who had lost their licenses or had other suspicious gaps in their employment history had applied in several months. None of them were board certified. They changed the salary range, but by then the organization had lost momentum. After engaging an external recruiter, they were able to finally get some good candidates. 

The human resources department processes of running the background checks and making the offer sent the first-choice candidate running for the hills. Why would someone want to work for an organization who can’t even get the hiring process right? I’m not sure, and neither was he, apparently.

As time elapsed, their second-choice candidate had already accepted another position. Their third choice turned them down with inadequate compensation as the reason. They were unwilling to respond to a counter-offer. 

The newly-created position has now been vacant for six months. Had they been able to get themselves in order, how much could a new CMIO have accomplished over the last several months? How many opportunities for improvement were missed? How much money have they lost in recruiting after trying to “save” it on salary?

They’re now back at square one, cobbling the role together with a host of physician champions who are trying to fill in on top of their regular jobs and hiring me to do tasks that are beyond their capacity or skills.

Hospital C had an employed physician group that was preparing to change EHRs. They hired me to shepherd their data migration. After looking at the quality and quantity of the data (which was really pretty appalling), I recommended against trying to extract the data to to seed their new system.

As an example, most of their blood pressure values were unusable since their previous vendor didn’t have adequate control of data fields. Nonsense characters and inappropriate abbreviations filled tables where only numbers should have been.

In looking at the overall poor quality of the data, the specialty mix, the volume of truly “repeat” patients vs. those that were episodic, I recommended they use a third party to abstract and load the data so they could have a clean start. It looked costly on paper, but I thought I made an adequate argument for the return on investment given the risk to patient safety of poor data quality.

The IT team felt my concerns were “ridiculous” despite my experience and decided to go it on their own. They now have spent nearly a quarter of a million dollars trying to get the data to a point where the incoming vendor will accept it. They’re paying their own physicians (who aren’t informatics trained) to work on the data. They have done so much manipulation that now they’re questioning the data integrity themselves.

I was asked if I am willing to come back and help. Of course there is no way I’m touching it at this point. I referred them to the abstraction firm and hope they can take a rush job. Their go-live is in a few weeks and the physicians are at risk of starting on the new system with nothing.

Figuring out the money wasted is easy. But how do you put a value on all the stress that has been generated and the growing negative feelings about the transition?

I have friends that work in all kinds of industries and we always swap war stories. It seems like mine are always the most outrageous as well as being most plentiful. It’s like no one is watching the store. Healthcare organizations hire someone to give them advice, then ignore it, then act surprised when things turn out badly. I’m very much concerned that the move to value-based care will only make a broken system more dysfunctional.

Where do we go from here? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 2/4/16

This week we celebrated the creation of National Women Physicians Day on the birthday of Dr. Elizabeth Blackwell. As the first woman to receive a medical degree in the United States, she helped pave the way for many of our careers.

There has been some backlash about adding another recognition “day” and jokes about whether we’re going to also have National Men Physicians Day. For those of us who trained and continue to work in environments that can range from covertly sexist to outright discriminatory, it’s nice to be recognized. In some areas, girls are still discouraged from pursuing science and technical careers.

I vividly remember my oh-so-Southern college roommate being told by her parents to just “paint your nails and do your hair and find a good husband and let daddy and me worry about the rest.” She was shocked to have been paired with a roommate who actually planned to be “pre-med” and not just use biology 101 to be “pre-wed.”

My medical school class at Prestigious University was the first to be more than half women. We crammed more than 60 women into a locker room designed for 20 as we changed for gross anatomy. The school refused to provide any other accommodation. Some of my gutsier classmates protested by changing in the hallway. You’d have thought they’d seen the admissions trends and made some preparations, but apparently it didn’t occur to the administration.

Despite having trained in the last two decades (when we should have known better), I’ve been sexually harassed more times than I can remember and have had to watch male residents harass a female faculty surgeon without repercussions. The joke was on them, however, because in their refusal to staff her cases they left the door open for the rest of us to actually perform procedures while they were three-deep holding retractors for a male surgeon.

Although we’ve come a long way, subtle sexism still exists. I look forward to the day where our children and grandchildren can choose whatever career suits them without sex- or gender-based comments. I’ve never heard anyone ask a male executive how he balances his family and career, but I hear it asked of women all the time.

It goes both ways, though, and I sympathize with men who have chosen careers that have been historically “female.” No one should ever have to justify their vocation based on chromosomes. If people take issue with that, I have a Marine Corps pastry chef I’d be delighted to introduce.

In other news, this week has been chock-full of things that are almost too ridiculous to put into words. Unfortunately, most of them involved fairly specific situations with vendors and hospital executives that I can’t write about without risking my anonymity.

That’s one of the hardest things about being on the HIStalk team – not being able to share the best stories because they would out us. Often I go ahead and write things up but let them sit for a couple of months until memories fade, but several of these were so over the top I don’t think I’ll ever be able to use them. A couple of them though were general enough to have occurred anywhere, so I’ll offer some pro tips.

If you are creating recorded training materials that are going to be viewed by not only your internal staff but also by your strategic partners, you might want to have some “webinar hygiene” requirements for the staff conducting the sessions. First, address the barking dogs before they bark or figure out how to pause the recording while you do it. I now know the names of your dogs and the fact that they don’t listen to you at all. BTW, the kissing noises were cute.

Second (and I thought this went without saying), use a headset and not your speakerphone. Make sure your microphone gain is adjusted properly. Otherwise, you end up yelling at your audience or being nearly inaudible.

Third, close your Outlook or hide your alerts.

Finally, for the love of all things, please turn off your instant messenger. I saw some things pop up during one session that were completely NSFW. Since it was a recording, they’re preserved for posterity.

Whether you’re recording content or just presenting, it might be a good idea to ask someone to peer-review your slide deck. Typos are embarrassing in front of hundreds of people. Also, when introducing a guest speaker or secondary presenter, make sure you’ve vetted the introduction with them first. I was completely embarrassed when I was recently introduced as “the CMIO of Big Medical Center” when in fact I haven’t been there for months.

I’m not ashamed of being without a title other than “independent consultant” and provided a bio prior to the session that was essentially a three-line introduction suitable for the call and edited for the audience. Apparently the moderator missed it, however.

Adding to the ridiculousness of the week was the arrival of some malware on my laptop. Thank goodness it was my older one that I’m only using for music, movies, and browsing. Its arrival was suspiciously timed with a visit from my nephew who spent quite a bit of time on it, showing off his skills with Scratch and Python. I fought with it for several hours and finally gave up, having tried most of my own tricks and several from friends. I’m taking it tomorrow to my favorite “will trade Jameson for IT support” guy and hopefully we’ll get it back on its feet.

Regardless of his contribution to my stress level, my nephew is a great kid and I’m impressed by his technology skills. In his school district, they offer a program where students can sign up to spend a day at work with alumni in various fields. He was disappointed that they don’t have anyone who writes code for a living, but his eyes lit up when I suggested that I might just know some people who build EHRs every day. Looks like we’ll be cashing in some frequent flyer points for a spring break adventure of the health IT kind.

I spent some time away from the craziness working on my HIMSS schedule. I already have lunch scheduled with one of my favorite start-ups and am eager to hear about what they’ve been doing. We spend some time catching up at Midway after HIMSS last year and have checked in once since then, but I’m sure their product has grown in leaps and bounds. I also tracked down the truth behind the rumor that Medicomp was planning something different for their Quipstar game show this year. Indeed they are!

This year will feature teams (!) competing using their new Quippe Clinical Lens product. I’m pleased to announce that I’ll be captaining “Team HIStalk” on March 1 (Tuesday) at 11 a.m. We need four readers to join me in kicking off the week’s game show play at booth 1354. If you’re interested, email me with your credentials, witty comments, outright bribery, or a photo of your favorite shoes and tell me why you want to play on Team HIStalk. I can’t promise much more than the opportunity to meet me and have some fun, but you never know what you’ll see at their booth.

Last year’s appearance by Jonathan Bush was one for the highlight reel. I’m looking forward to having some team backup to make up for my appearance a few years ago when I blanked on David Brailer’s name even though I could see his picture in my head.

I don’t know who we will be competing against, but I hope it’s someone fun. Could it be Karen DeSalvo? Perennial contestant Jacob Reider? John Halamka? My not-so-secret crush Farzad Mostashari? Or the dashingly hilarious Matthew Holt?

Are you ready to get your game show on? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 2/1/16

A wise man once told me to take as many business and finance classes as I could, even though I planned to go to medical school. That advice has served me well over the years, particularly as medicine has become more of a business and less of a calling.

Although my residency program provided solid education in practice management, it still didn’t fully prepare me to run my own solo practice. I was lucky to have some good advisors who could point me in the right direction and were willing to mentor me in learning more about healthcare economics.

As we move into the realm of value-based care, the ability to understand economics and finance will be critical for physicians and other care providers if they want to remain solvent. There has to be a return on investment — not only on technology and infrastructure expenditures, but also on staff.

The latter seems to be the hardest for some organizations to understand. I have worked with quite a few employers over the last several years that don’t have a working knowledge of productivity benchmarks. I’m not saying that everyone needs to go out to national sites and compare their staff right off the bat, but at a minimum, organizations should understand productivity within their own site, practice, or location. If they’re serious about operating in the value space, they’re going to have to get very cozy with benchmarking and determining the total cost of various episodes of care.

It’s hard to reconcile complaints about the EHR being too clicky or too cumbersome when you have physicians seeing dramatically different numbers of patients. I was recently at a site where providers were seeing 16 patients a day in the primary care setting. Personally, I haven’t seen that few patients since I was a first-year resident and still had to review every patient visit with a supervising physician. After getting them past their initial arguments about how their patients were sicker or more complex than anyone else’s, the physicians in question were eager to blame everything on the technology, when a careful review of their office process revealed otherwise.

I spent several days in the office observing workflows and what I saw was shocking. Staff were blatantly surfing the Internet on their phones and ignoring patient-related tasks that were waiting for their attention. The amount of gossip and chatter reminded me of a middle school lunch room.

The Hawthorne Effect poses that when people are observed, they change their behavior simply because they are being studied. I couldn’t help but think that if this is what they were doing in front of someone observing them, the amount of waste when they weren’t being observed might be staggering. And yet the physicians felt that they couldn’t give the staff any more work because they were “too busy” and therefore were taking on more non-value-added work for themselves, such as filling out forms and looking for missing lab results.

After documenting the current state thoroughly with not only summary statements but actual time studies, I presented my case to the physicians and practice managers. Generally, I expect a little push back, including concerns about being able to hire better staff or that staff will leave if they are confronted with a lack of productivity or with rising expectations.

This organization, however, had worked its way into a seriously co-dependent state, with the physicians mounting a strong defense of the status quo even though it was adding to their misery. They continued to blame the EHR and government mandates even when presented with data from high-functioning practices using the same EHR under the same government mandates. The practice’s leadership was unwilling to accept the possibility that the staff (and lack of management thereof) was a significant part of their problem even though it was directly impacting physician satisfaction and the bottom line.

After presentation of a proposed set of future state workflows, we had several hours of discussion. I used all my Jedi mind tricks, but was unable to get them to consensus around what needed to be done to take their practice to the next level. They have it in their minds that they want to achieve Level 3 Patient-Centered Medical Home recognition. How are they going to create a highly functional team care structure when they are unwilling to take the time to even discipline a staff that is obviously goofing off?

They also want to join an Accountable Care Organization because they’ve heard it’s the way of the future. Don’t get me started on changing your model of care just because you read somewhere that you should. Furthermore, if they’re not willing to address both staff and provider performance issues, how do they think they are going to use data to address patient compliance issues and drive outcomes?

Knowing that I was getting nowhere fast with the idea of practice accountability, I tried to appeal to their understanding of economics. We discussed the money they are losing by not making the most of their existing resources as well as the potential cost of hiring incremental resources to accomplish their goals. Again, they tried to throw the technology out as a cause, citing what they perceive as a high cost of ownership of their current client-server EHR.

One of the doctors mentioned that they were considering chucking the system in favor of the free online EHR that he saw an ad for in one of his journals. I asked how much they thought it would cost to migrate 10 years of data from their existing system to a new one and how much they might lose in the transition. It was clear that those thoughts had never crossed their mind.

I know they have at least a minimum desire to move to a better place. Otherwise, they would not have hired me to come in and do an assessment. I have to say, though, that I was grateful that my engagement with them only included the assessment and the creation of a report with basic findings, and not the actual optimization effort. Without committed leadership that “gets it,” they are doomed to stay right where they are.

Frankly, I don’t think I can handle another train wreck client right now. I know they’re going to push me to provide a proposal for the next phase, but I think I’m going to have to respectfully decline for my own sanity.

There is at least one health system in the area that is in acquisition mode. I wonder if this practice will become a potential target. Despite the mess they’re in, they have a fairly large patient base and a decent location. Stronger leadership with a better understanding of the big picture and a willingness to ruffle some feathers (if not getting rid of the chickens all together) could turn this into a much more successful situation.

Although some of the practice’s leadership thought I would be able to force change from the outside, I had told them that it rarely works that way and played out exactly as I had predicted. Unless they’re willing to give an outsider control of their staffing or are willing to take charge themselves, they’ll likely just keep running in circles. Worst case, they’ll run themselves into the ground if they attempt to do an EHR replacement no matter how “free” they think it is. I’ve never seen that turn out well despite the claims of the vendors.

What do you think about free EHRs? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 1/28/16

One of my clients reached out to me today to discuss a potential safety issue with one of the network-enabled devices they use for patient care. Although there hasn’t been an official recall by the manufacturer, there have been enough concerns for my client to want to remove the devices from use while they perform an evaluation.

The new devices had only been in service for a couple of months. Luckily they still have the previous devices in storage and can redeploy them for patient care. They were looking for guidance on how to communicate the issue without alarming physicians who had come to rely on the data points from the machines. They haven’t had to do anything like this before and didn’t have a policy or procedure in place.

I recommended that they use the procedure they follow for pharmaceutical recalls as a potential template. It hadn’t occurred to them to think about it that way – I think they were mostly still getting over the idea that they had to deal with a situation with a number of unknowns. I was able to talk them through a step-wise plan for addressing it, and by the end of the call, I could tell their stress level was substantially lower.

It reminded me of some of the disasters I encountered during my first couple of years in the CMIO trenches, when it felt like every day brought a giant pile of unknowns that I had to deal with. It was a good reminder of the ways in which being a consultant can be rewarding as well as the fact that the role of CMIO is a relatively new one and there are plenty of us still learning as we go.

Many of us are homegrown clinical informatics professionals who got into it either because we enjoyed technology or we were “voluntold” by our employers that we would be wearing a new hat. I like to think that makes us very skilled at thinking on our feet and being creative with problem solving. Still, I sometimes envy people who completed formal informatics studies and had easy access to mentors at critical points in their careers.

One of my former colleagues who accepted an informatics role much in the same way that I did (come on, it’s only four hours a week!) is planning to take the Clinical Informatics board exam this year before the “grandfather” period expires. When you’re already in the trenches, the idea of trying to find the time and money to enroll in a formal program can be daunting.

On January 26, the US Preventive Services Task Force issued a final recommendation that all adult patients be screened for depression. Changes in recommendations usually lead to a flurry of IT activity as preventive services tracking and reminder software requires updating to accommodate the changes. The most nimble vendors will have the new guidelines embedded within a few weeks, but others may take significantly longer.

The HIMSS16 invitation cycle is finally upon us. I always get a kick out of the different event invitations. Some of the best parties I’ve been to are at HIMSS and putting together the social schedule is always a bit of a challenge. I’m hoping the Monday start will shake things up a little and allow me to attend parties I’ve previously missed due to conflicts. If you have an event (whether after hours or on the show floor) and you’re interested in coverage from the HIStalk team, let me know. We try to make as many events as possible as long as schedules (and our tired feet) allow.

ONC shared a list of its activities at HIMSS. The Tuesday session with Karen DeSalvo and Andy Slavitt might be a “must see,” especially if Mr. Slavitt goes off script again and starts lauding the demise of federal programs. If nothing else, the session should be Tweet-worthy. I’ll also be keeping my out for my favorite former ONC staffers, including Jacob Reider and of course Farzad Mostashari.

I heard a rumor that Medicomp Systems has something new in store for its Quipstar game show booth. I always enjoy seeing the game and catching up with the team, as well as taking advantage of their seating when I’m running out of energy. I had the opportunity to hang out with CEO Dave Lareau at HIStalkapalooza last year – I wonder if he’s eager to pinch hit for pie-throwing duties again?

A reader shared this piece on physician burnout. My initial read of the data focused on the specialty distribution, but that approach masks a larger problem. Burnout rates increased across all specialties from 2011 to 2014. Even more significant, only one specialty reported a burnout rate of less than 40 percent. The comments section is worth a read for those looking to understand why physicians are angry, stressed, and looking to do something else.

What are your strategies for dealing with burned-out physicians? Email me.

Email Dr. Jayne.

Curbside Consult with Dr. Jayne 1/25/16

Although I’m still thinking pretty seriously about hanging up my consulting shoes, I decided to accept an EHR vendor’s offer to become a potential subcontractor. Apparently they’ve heard about my work with some of their clients and would like to able to book my services on their paper.

I thought about it for quite some time before accepting. Although financially it’s a wash for me, it has the potential to increase my pool of potential clients. It might also lead to a bit of accounting efficiency, as I will bill the vendor for my time and expenses rather than having to deal with the accounts payable departments of multiple practices, hospitals, and health systems. That can be a blessing and a curse, though, if their accounting department turns out to be chaotic or they’re a slow payer.

Any of their clients that I’m already working with will remain my direct customers. The agreement is year-to-year and I have a 90-day out clause if it doesn’t work out, so I thought I would give it a shot.

One of the benefits of being an official subcontractor is gaining expanded access to their client support site and their online training and education materials, so that’s a plus. I can also attend formal training at the corporate office if I choose. Prior to this, I’ve had to rely on the kindness of my clients in obtaining access to the vendor’s support system and documentation.

Although I had taken a bit of a break from travel at the end of 2015, I’m now back in the air and watching some of their client-facing training sessions from 38,000 feet. What did we ever do before in-flight Internet?

I’m pleased to see that the vendor has made some significant improvements to the application from a user workflow standpoint. They’ve added quite a few “nice to have” items that I’m guessing have been in their development backlog from some time. For many of the products I work with, vendors were forced to push pure usability enhancements to the side while they pressed forward with a seemingly endless list of Meaningful Use and regulatory enhancements. Although MU3 continues to lurk, it feels like there may be some breathing room and ability to go back and give users things they actually want and need.

I’m grateful that my travel this week takes me away from the Blizzard of 2016. I’m going to meet with a potential new client who heard about my work after I met one of their physicians at the AMIA meeting. Apparently they’ve been through multiple physician and operational leadership changes in the last few years and the organization has finally hit rock bottom, or at least that’s what it feels like to the physician I met who is stuck trying to get value out of the EHR with little support.

From the information I have so far, it looks like they may have been a victim of trying to follow the “flavor of the month” in healthcare without any semblance of strategic planning. The group dabbled in Patient-Centered Medical Home, followed by an Accountable Care initiative, then acquired several independent physician groups and tried to do some work with procedural subspecialties including an Ambulatory Surgery Center. They applied for numerous grants and agreed to participate in multiple incentive programs without a clear plan or strategy.

Based on those goals, they went on to build custom reminders into the EHR for all of them, which has largely driven the end users to their wits’ end. They also mysteriously spun up a practice that operates on the concierge model, yet has to document using the same templates and content used by everyone else even though some of them are not relevant. The physicians feel bombarded by an alphabet soup of initiatives that lack coordination or staff support.

They’re also suffering from staffing issues, including high turnover, lack of coverage in certain skill sets, and perceived budget constraints that have led to the departure of seasoned clinical managers. They allowed several payers to embed care management staff in the practices, but didn’t have a plan for how they would document in EHR or how they would truly coordinate care. In many instances, care has actually become more fragmented as some of the care managers are documenting in systems hosted by their employers rather than in the practice’s EHR.

It’s not just their clinical house that’s in chaos. Their revenue cycle management has also taken some hits. He’s had patients complain that they’re receiving bills for visits that were never sent out to insurance. After investigation, it appears that timely filing deadlines were missed, so the billing office just moved those balances to patient responsibility.

Needless to say, the patients are irate. Co-pays aren’t being collected at the time of service, so even for those visits that did get sent to insurance, they’re spending an inordinate amount of money sending statements to chase the co-pays. Physicians aren’t seeing regular performance metrics and have been told that there are problems with the EHR that prevent accurate reporting.

Sometimes when I meet with groups like this, they want to dwell on the aspects of what went wrong and how they got to this place rather than putting their resources into moving forward. Although some root cause analysis and probing of organizational psychology is a good thing, pointing fingers or trying to pin the blame on people who have left is not.

Even if the organization is ready to move in a new direction, change leadership is difficult. If they don’t have the collective will to devote long-term support to new processes, they might find themselves back where they started or potentially in a worse position. The outgoing CIO had tried to bring in some assistance previously, but was stymied by budget issues.

The physician who recruited me for this adventure isn’t sure whether they’re truly ready to accept outside help, but I am certainly willing to pitch to them. In reality, he didn’t have to do much arm-twisting since the client is located in one of my favorite cities.

As a bonus, I get to visit with one of my health IT mentors while I’m in town. He recently retired to the area and I’m hoping he has some sage wisdom to offer. I won’t just be pitching to a potential client on this trip, but also to him, in hopes that if I’m successful, he’ll agree to help with the onsite work. There’s just something about the lure of putting the band back together that I don’t think he’ll be able to resist.

Are you a sucker for hopeless causes? Email me.

Email Dr. Jayne.

EPtalk by Dr. Jayne 1/21/16

I’m not always able to practice what I preach. Last week was one of those weeks. Our practice is experiencing a wild growth spurt and my last patient care day was one for the record books. Not only did we see more patients than we’ve ever seen in a single day, but we had several ambulance transfers and other critical situations.

I admit that my charts got out of hand, even with a scribe joining me partway through the day. At least 90 percent of the notes were done before the end of the day and all of them were done within 24 hours, but I had to spend some evening time going through and doing a final review and locking them.

Normally our “default” settings are great, but as I was reviewing, I discovered that partway through the day that my “award-winning, cloud-based EHR” began documenting a negative male genitourinary Review of Systems on all patients, even if they were female. Of course they’re not having any problems in their male organs, because they don’t have any.

I’m not sure what went haywire, but I had to stop my review process and call in the experts. Our practice’s staff tinkered with it for a while and then contacted the vendor. We still don’t have an answer. Although I can manually correct them, I’d rather not have to go through scores of charts if there’s a quick fix. In my consulting practice, I see a lot of physicians that quickly click through their documents without reviewing them, so this is a great cautionary tale for me to use in the future.

In the meantime, I’ve had plenty of diversion with dozens of people emailing me the CMS blog backpedaling on comments about the end of Meaningful Use. At least they made it crystal clear that they’re not eliminating MU and that we’re still stuck with it for the near term.

Although it was about as nice of an “oops, we take that back” post as I’ve seen, I take issue with their comments on offices being “wired.” As we all know and as I’ve said time and again, just because technology is present doesn’t mean anyone is using it or that it is useful at all. Most of us in the clinical trenches have used EHRs that have been decent and those that have been soul-suckingly bad. The fact that they’re “wired” has nothing to do with our outcomes.

I have several close friends that ran Level 3 Patient-Centered Medical Home practices using only pen, paper, and Excel – and with a level of efficiency and improved outcomes that would put many EHR-based practices to shame. Of course, that level of performance requires not only skilled staff, but individuals who are dedicated, compassionate, and believe in the practices and their missions.

It becomes harder to retain that level of staff when they become demoralized by a poor product or a good product with a poor implementation. I’d like to see people who should know better stop using computers as a proxy indicator of whether a practice is moving in the right direction or not.

I didn’t make the list for the HIMSS16 Social Media Ambassadors. I shouldn’t be surprised because my use of Twitter and Facebook has been at low tide for months. But I found coverage of the announcement rather funny, in that it says that they are “credentialed by HIMSS to cover the conference.” I didn’t know you could be credentialed for social media – perhaps a license to Tweet?

Regardless, I’ll be covering the conference in my usual style, with scheduled strolls through the exhibit hall accompanied by real, live providers and in-the-trenches users of healthcare IT. The reasons I’m not all over social media became clear in another piece, this one featuring tips from the Ambassadors. Medicity’s Brian Ahier @ahier talked about only following “five or six hundred folks” but that he tries to read “every tweet of the people I follow.” There aren’t enough hours in the day for me to be that active in the Twitterverse, even when I multitask while hitting the treadmill.

Lately on the treadmill I’ve been working on some required Continuing Medical Education content for my primary specialty certification. I’m six years into a 10-year Maintenance of Certification cycle. Although at least one Board has somewhat put MOC on hold, mine hasn’t. I like to try to get the arduous (and wholly irrelevant) required module out of the way early in the year so I don’t have to sweat it later. In response to my comments last week about there being Clinical Informatics “LLSA” CME hours offered at HIMSS16 (my that was a lot of acronyms in one sentence!) I heard from a couple of readers.

One lamented the fact that there are virtually no approved LLSA hours relevant to clinical informatics unless you can attend one of the AMIA conference or HIMSS. It costs thousands of dollars to attend these conferences (most of the registrations are pushing $1,000 on their own) and they’re not always ideal venues for learning. Although I learned a great deal at the AMIA symposium, many of the non-LLSA sessions were more valuable to me as an informaticist than the approved courses. I also learn better when I can focus at home rather than being in a hotel meeting room with hundreds of other people some of whom are having sidebar conversations or moving around and being distractions.

Another reader complained about the costs of HIMSS in general and shared his hope that perhaps in the future the conference will become the irrelevant part of the week since there are so many events outside of the actual proceedings (did someone say HIStalkapalooza?)

Another reader shared some of his correspondence with the American Board of Preventive Medicine, who certifies a good chunk of the Clinical Informatics diplomates. The Board staffer commented that they had planned for AMIA to provide more LLSA-approved CME by this point. My response to that is that it’s irresponsible for a certifying board to rely on a third party to provide credits unless there is a contractual obligation to do so. At least my primary certifying board has its act together and provides adequate content (volume wise – some of it may be irrelevant depending on your practice) on its own.

HIMSS also responded to my difficulty in being able to find information on the LLSA sessions. Unfortunately, three staffers sent me a link that didn’t take me anywhere helpful. One did send a PDF with the schedule and instructions which was very helpful. Although many of them overlap, they also mentioned that after the meeting they will be posting the sessions online so that we can access them as “enduring materials.” That will help for those of us who wanted to attend multiple sessions at the same time.

There are now over 1,000 of us who are certified in clinical informatics, so for those of you in the latest class of Diplomates, welcome to the CME/LLSA party.

A reader who knows my fondness for shoes shared a link to this church recently completed in Taiwan. It’s supposed to draw more women to attend, but I’d also be on the lookout for fetishists.

Do you have your shoes picked out for HIStalkapalooza? Email me.

Email Dr. Jayne.