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Readers Write: Help on the Way for Clinician Work Fatigue with Drug Interactions?

June 19, 2013 Readers Write 3 Comments

Help on the Way for Clinician Work Fatigue with Drug Interactions?
By Helen Figge, RPh, PharmD

Clinicians are increasingly using an electronic health record (EHR) to enter prescriptions via a computer. Increased utilization of computerized medication order entry is being driven in part by the Meaningful Use program, which includes incentives for the adoption and meaningful use of certified electronic health records for eligible clinicians in both the Medicare and Medicaid programs.

Electronic prescribing is an integral component of the Meaningful Use program. Regardless of whether the prescriber elects to print or electronically transmit the prescription, the prescriber’s EHR can apply a series of edits to check for potential errors that could be harmful to the patient.

Some EHRs display all edits with equal significance. Hence, clinicians are presented with a stream of low-priority or irrelevant edits mixed in with occasional high-value edits. The consequences of this type of presentation are very serious because clinicians become overwhelmed and frustrated with the continuous presentation of low-priority nuisance alerts – hence clinician “alert fatigue.”

Because alert fatigue threatens to potentially jeopardize the entire concept of improving patient safety, the Office of the National Coordinator for Health Information Technology (ONCHIT) awarded a grant to the RAND Corporation and Harvard/Partners HealthCare in collaboration with UCLA to study the problem and develop a solution. The approach taken by the study group was to identify a critical set of interactions that should be implemented universally.

Thirty-one high risk drug-drug interactions were reviewed and a final list of 15 interactions was adopted. The study group considered the final set of 15 interaction pairs to be a starter set that should be identified in all commercial products as high severity because they have high potential for patient harm and are contraindicated for co-administration. The list might not represent all high-severity interactions, so additional research will be needed in this area, but it’s a proactive start.

Deployment of these 15 interaction sets in EHRs as high risk, along with the elimination of clinically irrelevant edits, could greatly reduce the burden of alert fatigue that clinicians overwhelmingly feel in their day-to-day encounters with the technologies. However, the actual commercial implementation of this approach has not been successfully accomplished due to legal issues, particularly due to concerns among database and EHR vendors about liability.

The overarching question to be answered is funding and exact methodology for moving this effort forward at the national level, which has not been identified. Furthermore, it has not been determined whether the database should be maintained by a private entity or by a public agency such as FDA.

But it is progress in the war against what really true drug integration is and what is just a cautionary listing for liability’s sake.

Helen Figge is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: Have a Seat

June 19, 2013 Readers Write No Comments

Have a Seat
By Ryan Secan, MD, MPH

6-19-2013 4-12-41 PM

Customer service is important. This is not a revelation. We’ve all had our terrible customer service experiences (airlines, banks, utilities, cable companies, and social media, I’m looking at you), but today I’d like to focus on good customer service. There are lots of examples of excellent customer service which don’t cost that much money (like this, or this), mostly just time, effort, and actually caring about providing a high level of service. 

While everyone pays lip service to the notion that customer service is important, somehow there never seems to be money in the budget for it. While some customer service efforts require investment, many can be done at low or no cost. This is a win-win we all hope for – a better experience for our customer that is cost neutral.

I used to own a high-mileage luxury brand car. When it needed service, my wife liked to take it to the dealer for repairs. It cost more money for the service, but to her it was worth it. The drop-off area was clean. There was a place to sit down and talk to a professionally dressed person regarding what was wrong with the car. While the car was being fixed, she always got a nice, new car as a loaner free of charge. The dealer was flexible about when she could pick up the car and bring back the loaner, and her car was always washed and vacuumed when it was done. 

This was high level customer service that was worth paying for. It likely didn’t cost the car dealer much, as any costs were likely covered by the higher prices for service. It may have actually been a source of profit if the cost of providing this level of service was less than the extra money made from the service. 

One of the best examples I’ve read is described in this post by Joe Posnanski about an experience he had at Harry Potter World at Universal Studios. He’s a sportswriter, but writes on a range of topics, and if you aren’t reading him, you’re really missing out even if you aren’t into sports. 

The column is a bit of a long read, but definitely worth it, and if you’re a parent like me, it might make you a little misty at the end. Go ahead and click through and read it right now – you’ll be happy you did.  It wasn’t the $250 million theme park that this little girl (and her dad) is going to remember. It’s the brief, meaningful interaction with a staff member who put forth just a little bit more effort than expected that made all of the difference.

In the clinical world, sometimes even the smallest things can improve a patient’s satisfaction with their healthcare encounter. A study out of the University of Kansas Hospital demonstrated than when physicians sit down during a bedside encounter rather than stand up, despite spending less time with the patient, they were perceived as having spent 40 percent more time in the room. The patients reported that they were more satisfied with the encounter and had a better understanding of their condition. 

High levels of customer service don’t have to cost a significant amount of money, just an understanding of what your customers want and are willing to pay for and a culture that empowers your team members to go the extra mile to meet the customer’s needs. We can provide this high level of service to our provider clients by actively listening to them and selling them what they want or need to do their job effectively (e.g., single sign on, interface between an application and their EHR, automation of a manual process, etc.)

In the health IT world, where technology road blocks can interfere with patient safety, it is critical that we play our part – and play it well.  

Ryan Secan, MD, MPH is chief medical officer of MedAptus.

Readers Write: Time Out for Pre‐Implementation Training

June 16, 2013 Readers Write 1 Comment

Time Out for Pre-Implementation Training 
By Tiffany Crenshaw 

6-16-2013 5-31-27 PM

I’d like everyone to join me in giving a hand to the nurses at Marin General Hospital for bringing a bright spotlight to the specific issue of healthcare IT implementations and patient safety, and  the broader issue of the enormous pressure hospitals are under today.

As recently reported in HIStalk, a group of nurses from Marin General voiced their concerns at a recent board meeting with the hospital’s new CPOE system, citing threats to patient safety as a result of inadequate training and other unspecified problems with the software. Unlike those EMR detractors we’ve read about in the last few months, this group doesn’t want to kick the new technology to the curb. They simply want a “time out” for additional training so they can use it in the most effective way possible to provide the safest care possible. 

This particular hospital’s struggle with new technology highlights the many pressures providers  across the country are facing when it comes to implementing new healthcare IT systems. Many hospitals are enticed by Meaningful Use incentives. Some sign on the vendor’s dotted line, not realizing implementation timelines suggested by vendors are at times too aggressive and don’t typically allow for proper end-user training. But since hospital XYZ down the street is doing it and Meaningful Use deadlines are looming, new systems are being installed rapidly across the US. I’ve heard more than one hospital executive say meaningful utilization is becoming an afterthought. 

In my 15 years in this industry, I’ve learned – and I’ve seen my clients learn – that implementing EMRs isn’t a project that affects just one department for a few months. It’s an initiative that touches every facet of a hospital – from IT to operations, from clinical to financial. It can’t be stated enough how big of an initiative the transition to an EMR is. Its size necessitates careful, methodical planning – not only for implementation, but for training; go-live support; and post-implementation optimization, support, and continued education.  

Perhaps it is because of this “project” mindset that healthcare associations have become vocal in their cries to delay the transition to ICD‐10 and the deadline for Stage 2. Providers are realizing these initiatives and the funds they’ve spent on them will be compromised without a proper strategy in place for training, implementation, post go‐live, and continued education around upgrades.

Is there a disconnect when end users such as the nurses at Marin General are filing “assignment despite objection” forms while upper management attributes nurses’ uneasiness as “just to be expected” during times of change, or are both opinions valid?

Human beings by nature are resistant to change. Those in healthcare are doggedly so, and  with good reason. But it’s important to remember that most people are not totally averse to change. Some providers have embraced technology. Many attribute their adoption to being  involved in the decision-making process and/or being well trained in preparation. It’s a debate that will likely go on as more surveys come out around EMR dissatisfaction and HIT/ROI conversations play out.  
Tiffany Crenshaw is president and CEO of Intellect Resources of Greensboro, NC.

Readers Write: Shame on Health IT

June 16, 2013 Readers Write 9 Comments

Shame on Health IT
By Tom Furr

I’m willing to bet were I to ask anyone even remotely associated with healthcare IT, that person would wax poetically about how collective efforts are helping to advance the speed and quality of healthcare. I’d hear boasts of breakthroughs in all areas of medicine, drug discovery, imaging, lab procedures, and surgery as well as recovery and rehabilitation methods.

Be it ambulatory- or hospital-based care, all those advancements have made a big impact on the care and treatment of the patient. I can find nothing wrong with initiatives that yield a faster, better end result for any man, woman, or child who requires medical treatment.

Why, then, after having benefitted from 21st century state-of-the-art healthcare, does the patient get time-warped back to the 1950s when it comes to providing the bill? If the last impression left with a patient after receiving state-of-the-art care is an antiquated management and billing process, could s/he not question everything that’s happened in the examining room?

My point is simple: shame on the health IT industry as the advancements made on the clinical side of patient care have far outpaced the comparably meager improvements that have been made on the financial side. Don’t deny it, especially when you know that healthcare providers have played a major role in maintaining the existence of the US Postal Service, printer companies, toner suppliers, envelope makers, and a bunch of related entities.

Yes, shame for not embracing technology on the business side with the same determination so dramatically shown on the clinical side. What’s worse, the underpinnings for an automated patient bill and balance management system has been in place almost as long as practice management software has helped run practices, from the individual doctor to multi-office physician groups and multi-state hospital networks.

The need for every software vendor and billing company to get to the point where they are actually helping the patient manage and meet her/his financial obligations is very great and very much of the here and now. Not to mention the disservice that they are doing to the very clients who they claim to help … by not providing a tool to help medical practices keep their accounts receivable in check and drive them towards profitability instead of languishing with large back office overhead.

The high deductible health plan (HDHP) isn’t going away. Rather it is only going to grow, bringing with it change that must be dealt with in the business offices of healthcare providers and the homes of all their patients. The shift of the primary payment responsibility coming from the health insurer to an even split with that organization and the patient is here now and not helping practices collect those balances is negligent on health IT’s part.

As a practice’s A/R gets out of hand, one of two things will happen: the practice will be sold, either to a large physicians’ group or a hospital, or the doctor takes down her/his shingle and ends a career. Either way, the practice management software vendor and/or the billing company lose a customer.

But it doesn’t have to be that way.  Unless, of course, you want to continue to keep medical business offices operating like it’s still “Happy Days.”  Keep that attitude and there’s a good chance your company won’t be happy or healthy, especially if it makes practice management software.

Tom Furr is founder and CEO of PatientPay of Durham, NC.

Readers Write: Accent on Objects

June 12, 2013 Readers Write 1 Comment

Accent on Objects
By Woodstock

It has been many years since I acknowledged patient record subpoenas for medical malpractice lawsuits and other legal actions as an HIM professional and designated custodian of records (COR). But the process was memorable.

During the 1970s, one was not able to reproduce analog paper and photographic film or send records by postal mail or courier to the courts. Rudimentary paper and film photocopy machines only recently were introduced into healthcare organizations, and the courts required the personal delivery of “original” source documents and records by a COR.

Consequently, upon receiving patient record subpoenas, I took a large cardboard box and collected from each department the “original” source documents required by the subpoenas. The contents included the patient’s paper financial and medical records. The medical records also included all film-based diagnostic images, tape-based medical dictation, cine-based ECGs, and pathology slides.

During the 1980s, when I established my related career in HIT and because of my COR experiences during the “analog” years, I knew well that electronic patient records consisted of more than just the structured data typically found in electronic patient financial and medical records. Structured data are the record’s binary, discrete, and computer-readable data elements that, typically, are stored in relational databases with predefined fields. Electronic medical records (EMRs) also consisted of digital diagnostic images, audio file-based dictation, and ECG waveforms.

In fact, such unstructured data make up at least 75 percent of all the data in a typical patient’s EMR. Unstructured data are the record’s non-binary, non-discrete, and often human-readable data elements that, typically, are contained in text-based reports, e-mails, and Web pages and include symbols, images, video clips, and audio clips. In some vertical markets, unstructured data are referred to as a record’s intellectual substance or content. In technical arenas, unstructured data are referred to as objects.

My 1990s published chart below (note: not to scale) depicts a typical EMR’s structured and unstructured data. Thus began my affinity for marrying the two data types in healthcare provider organizations.

Frequently Mr. HIStalk receives comments and questions relating to an EMR’s unstructured data, particularly digital diagnostic image data around the time of the annual RSNA or SIIM conventions. Since The PACS Designer has been busy developing a growing list of mobile apps, I plan to contribute a Mr. HIStalk column relating only to patient record unstructured data or “objects.” I plan to focus on news, acquisitions, sales, people, implementations, and government, just like you are accustomed to reading in other HIStalk venues. I hope you will find this column important to your work and will reply with many comments and questions.


I’ll begin with a brief opinion piece, which is related to my above comments and subtitled:

When the Writ Hits the Fan

Just like healthcare organizations, the courts finally have entered the digital age. Today, secured electronic files of “original,” electronic source documents and records as well as “copies” of original, electronic source documents and records are admissible in courts as long as the healthcare organization can substantiate (1) the trustworthiness of the system(s) used to store and retrieve the documents and records; (2) the accuracy of the organization’s records management policies and procedures; and (3) the documents and records were not created (or altered!) just for a court case. (NOTE: Always one must verify the courts’ acceptance of digital records on a state-by-state basis.)

Large cardboard boxes have been replaced by EMR (or other system) features that promote single points of personalized access through which to find and deliver electronic information, applications, and services. As such, in either hybrid or full EMR environments, designated CORs, Release of Information professionals, and even patients—after rigorous authorization and authentication processes—merely click on hyperlinks and instantaneously retrieve “original” electronic source documents and records required by subpoenas or other requesters.

While our industry continues to pursue the best “highways” to securely transmit the documents to and acknowledge receipt from requesters, today’s day-to-day challenges involve the current mechanisms used to transmit unstructured data and the shameful output of structured data generated by most EMR systems.

For example, the transmission of the large and ever-growing number of patient diagnostic images (primarily radiology images), which remain hand-carried or sent by postal mail or courier from hospitals, physicians / groups, specialty (e.g., cancer) centers, etc., to other hospitals, physicians / groups, and specialty centers on CD storage media, is completely unmanageable. Many of the CDs containing (e.g., radiology) diagnostic images cannot be imported into the receiving radiology PACS due to the way the images were burned into the CDs. Although most of the CDs include the senders’ viewers for measuring, window / leveling, etc., often the CD files arrive corrupted. Frequently the CDs are misfiled and / or lost.

Consequently, transmitting diagnostic images on CDs has lead to duplicate testing with more patient exposure to radiation. In addition, when the CDs contain diagnostic images other than radiology images, often the receivers have no corresponding PACS for these other, “ology” images.

Thankfully, popular, standard, inbound (i.e., CD ingestion and electronic receipt of diagnostic images) and outbound (i.e., report and image distribution to referring physicians, referral centers, etc.) image sharing solutions exist. However, most are too expensive for the healthcare provider masses. In addition, few, if any, non-standard image sharing solutions exist, whereby direct connections are established between two or more organizations for readings, consultations, and second opinions and inbound and outbound electronic reports accompany the images.

Also, there is not a healthcare professional that has not experienced the reams of paper output generated by EMR systems because the systems’ structured data are not report-formatted for output. This is one reason why a patient still cannot receive his or her entire patient record from a portal. Not that I promote hard copy printing; however, healthcare providers still must maintain a legal archive from which to generate the electronic document presentation as proof for exception and dispute handling. In other words, providers must have the document presentation for legal purposes and not an informational statement or data representation of the document, which, unfortunately, remains common in today’s electronic patient record system output.

Yours truly,


Readers Write: What’s More Useful Than Hospital Pricing Data?

June 12, 2013 Readers Write 8 Comments

What’s More Useful Than Hospital Pricing Data?
By Data Nerd

An HIStalk reader challenged my recent post, “Hospital Pricing Data: Another Step Down the Rabbit Hole” by asking what healthcare data should be publicly available to help consumers make better choices, not just from CMS, but from providers and private insurers.

I cannot fault anyone for their enthusiasm. Trust me when I say I know how demoralizing it is to come up with a data solution that just doesn’t fit the need. That’s precisely why I felt compelled to speak out on the subject. After setting high hopes and expectations of the analytical possibilities from data in CMS’s pipeline, the solution fell drastically short of what I had hoped it would accomplish when it was finally released.

Having said that, the ideal data solution for me as a consumer would use the same or similar claims data sources, but aggregate the data two different ways to come up with a predictive solution that can be tweaked to assist the patient in their own cost containment efforts. This type of solution would involve:

  • Risk-adjusted cohorts. Grouping the data not just by DRG, but by patients with similar risks (age, co-morbidities, etc.) to chart out the most likely course of treatment for someone of my age and health facing the same diagnosis. Ideally, this dataset would include all payer types, but the next-best offering that is within CMS’s reach is to combine Medicare and Medicaid datasets to account for a broader age distribution. Data would not be aggregated by hospital, simply by patient characteristics across the country.
  • Once we have an idea of possible treatment routes, we can then couple that with charge data. And, yes, I want that broken down by procedure at each hospital. Like there is no such thing as bad data, there is no such thing as too much data. I’ve never seen OSCAR’s backend, so I’m not sure if it’s possible to break apart every claim and get a procedure-level charge, but I do know with the data as it is today, claims with only one procedure can be isolated and charges or reimbursements tend to have low standard deviations. Since I am not insured by Medicare or Medicaid, knowing what hospitals charge or are reimbursed by CMS does me very little good, though. I would need my own insurance company’s network rates with the hospital to analyze how soon I’ll meet my annual deductible, etc. Or, if I have the luxury of time to make a decision, evaluate if I’d be better served investing in an HSA and initializing treatment in the next fiscal year. But, for the millions covered under Medicare and Medicaid, such an analysis based on the data today would assist in forecasting when deductibles will be met and/or what other amounts will not be covered during the course of treatment.
  • In the event that I have a long-term illness or a more drawn-out treatment plan, I would want an analysis of whether or not it would behoove me financially to have different procedures performed at different facilities. Outcomes data would be useful here as well.

All of these data components would need to be dynamically updated and processed, probably using software to evaluate each step of the way, much like the way a simple tax form is completed online. Play with one number and see how it affects the final bill, and in this case assess the risk factor involved in hospitals with poorer outcomes. Ideally, the solution would also interject preventative challenges over time to help the patient meet their health goals in a way that saves the health system money as well, but that is more the quantified-self realm than the (current) data realm.

So, to recap the data offerings that would satiate my current appetite for price transparency:

  • Claims data, aggregated by DRG and patient characteristics to obtain expected procedures
  • Claims data, aggregated by hospital and procedure charge
  • Combine these two alongside insurance reimbursement rates to give a patient’s total estimated personal expense at every hospital
  • Hospital procedural outcomes data to evaluate cost savings and determine at which hospital(s) to have the necessary procedures performed

This is the type of data that would be useful to me as a consumer.

Readers Write: EMR Installed and Meaningful Attested — Now What?

June 5, 2013 Readers Write No Comments

EMR Installed and Meaningful Attested — Now What?
By Don Sonck

6-5-2013 9-53-58 PM

If it’s the spring of an odd-numbered year, then I know it’s time for me to pay a visit to my primary care physician for a biennial physical examination. So a couple of weeks ago, off I went!

As my doctor and I reviewed my medical history from the past seven years, all of which has been well-chronicled in an EMR, he asked me a series of diet- and exercise-related questions. At the conclusion of this exchange, he complimented me on my diligence in maintaining a diet and fitness regimen that promotes good health.

I’m no longer a spring chicken in biological years. Like many Americans my age, I’d like to extend my quality of life and attempt to do so by adhering to the recommendation of an expert in the field who in turn preaches evidenced-based best practices. My wife and two sons are on the same sheet of music. Whether it’s the preventative maintenance of our car, home, or any other major asset, the same discipline is implemented, and again based upon historical and empirical data.

Like anything in life, there are always accidents and anomalies that run counter-intuitive to the expected outcome, but common evidenced, majority outcomes cannot be refuted. To borrow a line from Sergeant Joe Friday of “Dragnet” fame: “Just the facts, ma’am” are words to live by.

This latest encounter with my physician got me thinking about the HIMSS EMR Adoption Model, particularly Level 4. Evidence-based population management is going to be critical if this country is ever to reach Level 7.

For the sake of full disclosure, I am a disciple of Dale Sanders in his conviction that the United States must become “a data-driven culture, incented economically to support optimum health at the lowest cost.” How long will it take for healthcare organizations to even assemble registries for their top 10 patient conditions; let alone share them? The life expectancy of HIEs is unknown, as the migration from public to private funding has yet to be determined.

The cornucopia of complaints spewing forth from health systems and physician practices on the subject of EMR (too expensive, no ROI, minimal patient-physician interaction, etc.), coupled with confusing government mandates, leads this writer to wonder if I’ll live to see the day that EMRAM is fully achieved. If I do, the likelihood is great that Mr. Sanders’ vision came to fruition.

Let’s hope for the sake (and health) of our country that the EMRAM progression marches onward expediently.

Don Sonck is director of EMR staffing solutions for AMN Healthcare of San Diego, CA.

Readers Write: The Year is 2025…

June 5, 2013 Readers Write 4 Comments

The Year is 2025…
By Nick van Terheyden, MBBS 

6-5-2013 9-45-36 PM

In 1963, Spock uttered the words: “Computer, compute to the last digit the value of Pi," and with that launched us into a world of human to computer interaction. Reaching that vision took many more years and it was not until the 1990s that the first realistic tools emerged onto the market.

By 2001, it was clear that speech recognition technology was set to revolutionize healthcare’s clinical documentation industry, but there were many naysayers stuck in the paradigm of dictation and transcription who were unconvinced that the technology could ever be better than a human at transcribing doctors notes from audio into text. Acceptance of speech recognition took longer than many had hoped, but innovation helped accelerate adoption.

Still, delivering on the vision laid out in the Star Trek episode mentioned above would require a little longer since that vision included not just speech recognition, but also intelligent understanding.

I recently had a conversation with an analyst about how healthcare technology would evolve by 2025. Today, the pace of change in speech recognition is incredible, and I’m seeing something similar in the field of natural language understanding (NLU). As such, it is clear to me that we will see a similar explosion of NLU, making it pervasive in every aspect of our interaction with technology.

NLU will in time make technology fluent in human communication. The days of learning a system are numbered as we move away from requiring humans to learn a “language” to communicate with technology. NLU is poised to reinvent the relationship between people and technology, and nowhere is the potential of this innovation more pervasive than healthcare.

To get a sense of how deeply natural language technology has already entered our lives, you need only to sit in your car, pick up the phone, or even start talking to your television. In healthcare, these intelligent systems equate to allowing clinicians to spend more time practicing medicine vs. filling in forms and entering data.

A recent study found that medical interns spend 12 percent of their time examining and talking to patients, but more than 40 percent of their time behind a computer. And it’s not just clinicians who want to change this statistic – it’s patients who are frustrated with focus being placed on the technology instead of the patient-doctor interaction.

My daughter remarked on this lack of human-to-human connection after a recent doctor’s visit, which opened my own eyes even more so to both the benefits and downfall of technology in healthcare. Luckily, tools like speech recognition and natural language understanding can help streamline the transition to digital care and enable the physician to focus their efforts on the patient instead of the extensive documentation process and check boxes associated with the visit.

As I look ahead, by 2025 I think NLU will be readily available for physicians and patients alike and will have a profound impact on healthcare as such. Here’s an example of a patient interaction I imagine taking place in the not too distant future:

“Please book the next available appointment with Dr. Jones for my annual checkup.”

The system knows my calendar and Dr. Jones’ calendar and my health coverage. As a result, it is able to compare the two schedules to find the next convenient slot for a 30-minute appointment. It would also know that the standard 10-minute appointment would be insufficient. It offers me the options, I confirm, and the appointment is set in both calendars.

If we add this type of medical intelligence to the world of the physician, the interaction would look something like Project “Florence.” Today, the first virtual assistants for healthcare, like Florence, are just entering adolescence. As intelligence capabilities improve, we can expect to see NLU permeate throughout the patient-physician interaction, intelligently listening in to the exchange and extracting out clinically actionable data for summarization and presentation to the patient and clinician for review.

In essence, smart NLU will help drive complexity out of how physicians and patients engage with technology as part of the two-way care process. That’s something even Spock would be excited for.

Nick van Terheyden, MBBS is CMIO of Nuance.

Readers Write: High-Tech Patient Engagement Tools Empower Patients for Shared Decision Making

June 5, 2013 Readers Write No Comments

High-Tech Patient Engagement Tools Empower Patients for Shared Decision Making
By Corey Siegel, MD

6-5-2013 9-36-49 PM

Shared decision making (SDM) is one of few approaches proven to achieve the Institute for Healthcare Improvement’s Triple Aim of improving the patient experience, improving the health of populations, and reducing the per capita cost of healthcare.

The Patient Protection and Affordable Care Act (ACA), as well as organizations driving health policy such as the National Quality Forum, embrace SDM. Yet the roadblock to widespread implementation has been the lack of access to the technology and tools to make it a reality.

The process of SDM engages patients in treatment decisions to optimize the likelihood that a chosen therapy matches their personal preferences for care. Decision aids are standard SDM tools, which are used to present evidence-based data in a patient-friendly manner to help patients with preference-sensitive decisions.

Not all care decisions are preference sensitive, and not all patients are interested in being part of SDM. The responsibility of the provider is to identify how much of a role patients want, and then determine which decisions require their input to provide the best patient-centered care.

The overall goal is to involve patients in decisions so that they are educated about their options, confident in the plan, adherent to their therapy, and ultimately have a better quality of life.

One example is a new initiative by the Crohn’s & Colitis Foundation of America (CCFA) in collaboration with Dartmouth-Hitchcock Medical Center and Emmi Solutions to give its gastroenterologist members access to an interactive, Web-based patient education and engagement tool. The 25-minute decision aid combines voice, image, and on-screen text to explain Crohn’s disease and the potential natural progression and risks, as well as the benefits and tradeoffs of various treatment options.

Treatment options for patients with Crohn’s disease are improving. But because it’s a complex disease and some of the treatments have serious risks, too often, patients delay critical treatment until they are experiencing significant symptoms, and by then, it may be too late. The decision aid serves as an effective tool to engage the patient and open a dialogue with the physician, who can answer any of the patient’s questions or concerns.

Patients access the tool at their convenience from any computer using a unique access code provided by the physician in less than a minute. The technology enables providers to track compliance and measure outcomes. It can be used in a standalone mode or fully integrated into existing electronic health records or patient portals.

The goal is not to replace physician-patient conversations but to make these conversations more fruitful. The goal is to support physicians and empower patients so that SDM results in optimal treatment decisions for each patient.

SDM is a field that will continue to evolve, and hopefully the number of easily accessible patient tools will grow.

A simple approach to decide whether a SDM approach is right in certain circumstances is to consider these four questions:

  • Is there an established standard of care for the clinical scenario or is there equipoise?
  • What are the stakes? Is this a decision about which antibiotic to use, or do side effects such as death and cancer need to be discussed?
  • Does your patient want to be part of a shared medical decision?
  • What are the information needs of your patient?

Considering these questions and reviewing options with your patients will be a step forward in SDM and better-informed treatment decisions.

Corey Siegel, MD is director of the Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, recent co-chair of CCFA’s Professional Education Committee, and medical advisor to Emmi Solutions.

Readers Write: A Five- Step Approach for Collaborative ICD-10 Testing

May 24, 2013 Readers Write 2 Comments

A Five-Step Approach for Collaborative ICD-10 Testing
By Deepak Sadagopan

With the October 1, 2014 ICD-10 deadline rapidly approaching, payers and providers should be knee deep in their transition and testing efforts. According to CMS, there will be no more delays.

For many, especially healthcare provider organizations, ICD-10 is straining resources across all operational departments, including revenue cycle, coding/HIM, and IT. Providers are actively seeking ways to contain the cost of compliance and minimize revenue disruption post-transition. Many are mitigating ICD-10 risks by analyzing historical data and prioritizing high-risk areas based on impacted specialty or department.

As providers evaluate high-impact scenarios, they need to take a more strategic approach by allocating scarce, skilled resources to the evaluation of high-impact cases, natively coding those carefully selected scenarios, and then collaboratively testing these scenarios with their trading partners.

This last step is vital to avoiding revenue cycle disruption after the transition. While collaborative testing may require more testing time, the resulting ICD-10 readiness will give providers the ability to foresee potential coding problems and possibly avoid a negative impact on revenue flow.

Most importantly, with the rapid evolution of value-based reimbursement programs that would include direct trading transactions between providers and payers, collaborative ICD-10 testing will build confidence and pave the way for more intense collaboration that involve higher financial stakes for both parties.

But there’s a problem. Nearly two-thirds of respondents to a survey conducted at the February 2013 Healthcare Mandate Summit indicated they have used, or are planning to use, the additional year to conduct testing. However, two-thirds of respondents also said they do not have a specific strategy in place for collaborative testing. By not testing together, providers are missing out on a significant opportunity to share coding knowledge and outcomes with their trading partners.

Collaborative testing is a key component to overall mandate adherence and can be managed with a simple five-step approach. This approach enables providers to assess their readiness and achieve a less disruptive transition to ICD-10.

  1. Establish a baseline. Providers and their trading partners should evaluate at least 12-18 months of key performance indicators such as claims acceptance rates, electronic claim adjudication rates, and aggregate claim reimbursement amounts for high-impact medical services.
  2. Identify key partners. Healthcare providers should identify and connect with trading partners that want to achieve ICD-10 compliance with as little financial risk as possible. This approach brings both perspectives to the table to establish a balanced testing plan.
  3. Develop test scenarios. Both parties work together to establish testing goals and mutually beneficial testing scenarios. The choice of test scenarios should involve a mix of cases likely to increase or decrease reimbursement compared to historical claims data.
  4. Run tests. Both parties set up their test systems and infrastructure to test identified scenarios and run them through their processes. Providers should natively code scenarios in ICD-10 and send claims to the payers. The payers natively process the claims in ICD-10 through the complete life cycle and return the reimbursement advice to the provider.
  5. Assess results. Providers and payers compare results with the baseline to identify discrepancies. Providers can use the results to assess impacts to internal coding productivity, DNFB days and revenue disruptions that may occur post-transition.

With 85 percent of healthcare costs hanging in the balance, it is imperative that problems are solved before the 2014 deadline. Providers and their insurance plan partners hold the key to each other’s success, and by coming together early, everyone can better ensure business readiness and financial neutrality.

Deepak Sadagopan is general manager of Clinical Solutions & Provider Segment at Edifecs.

Readers Write: Pagers Cost Hospitals Billions Each Year

May 22, 2013 Readers Write 10 Comments

Pagers Cost Hospitals Billions Each Year
By Larry Ponemon, PhD

5-22-2013 8-12-29 PM

Earlier this month, the Ponemon Institute released a study titled “The Economic & Productivity Impact of IT Security on Healthcare” that aims to quantify the impact that the use of pagers and other outdated communication technologies has on healthcare. The research reveals that communication in healthcare lags behind other industries, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

As a result, outmoded communication systems waste clinicians’ time, limit patient interaction, lengthen discharge times, and lead to significant industry-wide economic loss.

The healthcare industry is facing some challenges in trying to balance the convenience benefit of new technologies with the need to keep patient health information protected at all times. While the implementation of electronic medical records and other new technologies is designed to improve efficiency and enhance patient care, it also has the potential to introduce risk, so IT departments must ensure that these new systems meet security and regulatory compliance requirements to keep private information protected.

As organizations struggle to strike this balance, the use of pagers and other outdated communications technologies continues as the status quo, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

To quantify the impact this has and try to understand the scope, we surveyed 577 doctors, nurses, hospital administrators, IT practitioners, and other healthcare professionals. Overwhelmingly, respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. They also recognized the value of implementing smartphones, text messaging, and other modern forms of communications, but cited restrictive security policies as a primary reason why these technologies are not in use.

This study revealed that the use of pagers and other outdated communication technologies decreases clinician productivity and increases patient discharge times, collectively costing U.S. hospitals more than $8.3 billion annually.

According to our findings, clinicians waste an average of about 46 minutes each day due to the use of outmoded communication technologies. The primary reasons cited are the inefficiency of pagers, the lack of Wi-Fi availability, the inadequacy of e-mail, and the inability to use text messaging. On average, we estimate that this waste of clinicians’ time costs each U.S. hospital more than $900,000 per year. Based on the number of registered hospitals in the US, this translates to an industry-wide loss of more than $5.1 billion annually.

We also found that similar deficiencies in communications lengthen patient discharge time, which currently averages about 101 minutes. The majority of respondents said about half of this time could be eliminated if modern communication technologies were allowed. Specifically, 65 percent of survey respondents believe that secure text messaging can cut discharge time by about 50 minutes. Again, based on the number of registered hospitals in the U.S., we estimate that this ‘idle time’ during the discharge process costs more than $3.1 billion in lost revenue per year across the healthcare industry.

One of the primary reasons why smartphones and other newer technologies have not yet been adopted on a broad scale is the perceived security and compliance risks this would create. As a matter of both best practices and complying with HIPAA regulations, healthcare IT administrators are charged with keeping clinical systems and private health information protected at all times. As with other industries, we see that the reduction of risk often comes at the sacrifice of the convenience and productivity benefits of newer technologies.

For example, native SMS text messaging is not encrypted and therefore cannot be used to transmit private health information. Many hospitals have a policy forbidding the use of texting despite the fact that research like ours clearly demonstrates the value it would have on both clinical workflows and patient care. In fact, the majority of respondents to our survey said HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically, HIPAA reduces time available for patient care, makes access to electronic patient information difficult, and restricts the use of electronic communications.

There is clearly a tension between giving caregivers access to the best possible technology to do their job effectively and ensuring that security and compliance requirements are met. Unfortunately we see that the pendulum seems to swing in favor of the latter, and while it is absolutely necessary to ensure security and patient privacy, clinician productivity and patient care suffer as a result.

One of the takeaways from our research is that healthcare professionals—both clinicians as well as IT staff—seem to understand these challenges and the benefits of deploying more modern communication technologies. For example, 74 percent of survey respondents said secure text messaging either has replaced pagers or will replace pagers within the next two years at their organization.

This is encouraging, and we think research like this will help the healthcare industry realize that the cost of implementing new, modern communication tools will be just a fraction of the economic and productivity costs of continuing to rely on pagers and other outdated technologies.

Larry Ponemon, PhD is chairman and founder of Ponemon Institute of North Traverse City, MI.

Readers Write: 256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS

May 17, 2013 Readers Write 5 Comments

256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS
By Brad Levin

5-17-2013 7-39-27 PM

There is widespread agreement that radiology has been the epitome of success spreading PACS far and wide over the last two decades. Thousands of organizations transformed from the dark ages of film to digital operations. Early activity started in the mid-1990s and peaked in the mid-2000s. Once the 2000s were in full swing, many groups moved to PACS for the first time, but it was relatively common for PACS early adopters to have implemented their second or in rare cases, their third PACS by then.

Along came the late 2000s, when industry analysts KLAS and Frost & Sullivan called for the next wave of PACS replacements. Many systems had aged well beyond the average 5-7 year lifespan of PACS, and it seemed like a solid market forecast. However, in reality the replacements never came in earnest. 

Fast forward to present day and the institutional use of PACS has stagnated. PACS continue to be used past their useful life, problems persist, and upgrades are delayed. The other contributing factor is a majority of institutions today are using PACS born in the late 1990s or early 2000s. Their vendors purchased PACS largely through acquisition, and while these systems have been upgraded periodically, most of the core architectures remain largely unchanged.

This would be fine if time stood still, but of course it hasn’t. Over the last two decades, modalities have advanced at breakneck speed, producing computed/digital radiography, multislice CT, PET/CT, digital mammography, and the newest modality, digital breast tomosynthesis (or 3D mammography).

Modern technology has also dramatically changed consumer and physician expectations. Everyone expects instant gratification. Pay phones are extinct and we all use smartphones. The world is app-driven and tablet accessible. LPs/CDs have been replaced with MP3s. Medicine is mobile, and we’ve ditched our VCRs/DVDs for streaming media.

Today’s challenging healthcare environment, supported by yesterday’s PACS technology, has led to widespread chronic problems and missed opportunities. When I was told recently that some of the most senior leaders in imaging informatics had convened and were discussing how "Radiology Has Solved The Problems of Going Digital", I was stunned. Based on what I see at community hospitals, academic medical centers, IDNs, imaging centers, radiology groups, and teleradiology vendors, I know that statement couldn’t be farther from the truth.  

The vast majority of practices are digital, but are their problems solved? In my view, absolutely not. Just this week I spoke with a PACS administrator from a 400-bed hospital in the Southwest. I was told that when their network access peaks, performance gets crushed on PACS, taking up to a minute to launch even a small CR study. Radiologists launch the study on PACS, grab a coffee, and hope that when they come back they can start reading the study. While this may or may not be just a PACS issue, it is a persistent, unacceptable problem nonetheless.

If you are unaware of the state of your imaging operations, I encourage you to speak to your radiologists, referring physicians, PACS administrators, and your IT staff. You may also consider meeting with your affiliates, and plan on attending the upcoming SIIM 2013. If you tackle today’s Imaging problems with the same vigor you used to transform from film to digital, your problems will quickly go into the rearview mirror.

Brad Levin is general manager, North America for Visage Imaging.

Readers Write: Trade Shows: How to Make Sure You’re Heard When Everyone’s Screaming

May 17, 2013 Readers Write 2 Comments

Trade Shows: How to Make Sure You’re Heard When Everyone’s Screaming
By Cindy Thomas Wright

5-17-2013 7-33-09 PM

More than 1,000 companies exhibited at this year’s HIMSS. Did you go? If you did, can you name 10 companies and describe their trade show exhibits?

If you’re like most attendees, you can’t. Because with 30,000-plus people there and row after row of exhibits, you were probably on trade show overload.

Now let’s put you on the other side of the exhibit table. Your business is there, in a giant room filled with the hottest prospects in the world. How are you going to get their attention when you’re one in a thousand?

Well, you can’t just hit play on a PowerPoint and toss some business cards on a table. You need to engage, quickly and with impact. Here are a few points that will help you do so and can apply to HIMSS or any other trade show, such as HFMA coming up in June and AHIMA following in October.


Point 1

You have a brand. Bring it to the trade show. What is your brand positioning? What is your brand personality? Have you done the hard work to define who you are? Without a clear positioning, marketing is futile. You can’t tell a story that you haven’t written yet.

But if you do have your brand strategy locked down, that’s what your exhibit needs to tell the world. Throughout your trade show exhibit’s development, keep asking yourself, “Does this align with our brand?”


Point 2

Make sure the best people are manning your exhibit – and be sure they know their goals. Most people that you meet on the floor aren’t professional trade show folks. At HIMSS, for example, you might see people at the exhibits who are CIOs, program managers, or system developers by day, and they come to this one trade show a year. They are then tasked with “booth duty”, shall we say. 

What you see when you walk the floor is often folks looking down at their phones or a laptop, sitting in chairs meant for would be prospects, or perhaps taking a break to eat their lunch. Let’s face it, are you really going to approach anyone whose obviously eating lunch? Or who has their hands in their pockets or are busy texting? These are all issues that need to be addressed prior to the show. Be sure your representatives are outgoing, have their messaging perfected, know how to “triage” exhibit visitors and how to get them to the right person, and most importantly, be sure they know how to make everyone feel welcome and engaged.


Point 3

Don’t forget that you’re all about technology. We’re in the tech business. So don’t fire up your seven- year-old MacBook at the exhibit. And don’t click through a PowerPoint that looks like it was designed in 1989.

Look at the people manning the booth – do they look “modern”? Are they wearing shoes and eyeglasses from this millennium? Remember, everything you put out there has to be clean, polished, high-tech, new and smart. Because that’s what your company is, right?


Point 4

This isn’t just about you. It’s about them. So many trade show exhibitors see this as their chance to tell everybody all about them. But remember, people are looking for solutions to their own situation. Find out what people need, and show them how you can fill that gap. Trumpet your solutions in a way that’s interesting, but tangible.

Cindy Thomas Wright is the owner of
Thomas Wright Partners.

Readers Write: Hospital Pricing Data: Another Step Down the Rabbit Hole

May 15, 2013 Readers Write 6 Comments

Another Step Down the Rabbit Hole
By Data Nerd

On Tuesday, May 7 at 9:53 p.m., the Center for Medicare and Medicaid Services released a new open dataset to shed light on hospital pricing variations. The Times and The Washington Post (among others) published lengthy online articles (presumably overnight), complete with data visualizations to assist consumers in understanding the vast differences between what hospitals charge Medicare for their services. CMS released state and national averages a week later after The Washington Post published an article aggregating the data for comparison on the state level.

On the first day of its release, the dataset was downloaded over 100,000 times, displaying the large appetite that the public has for open healthcare pricing data. What is unfortunate is that this data set is fundamentally flawed for the purpose for which it was made public.

In the age of high(er)-tech journalism, I was disappointed to read article after article that overlooked the data documentation and went straight to the numbers and visualizations that could be concocted. Even HHS’s own chief technology officer got it wrong when he referred to the data as, “The actual prices that hospitals charge Medicare for the top 100 procedures across the country.”

The data given are not the top 100 procedures. They are the top 100 DRGs, which means that in any given claim, there could have been anywhere between one and 25 procedures performed (and they do vary, wildly.)

If the goal is to compare hospital’s charge rates, you need a normalized cohort. Or in layman’s terms, you need to compare apples to apples instead of kumquats to grapefruits. People with the same DRG suffer from the same diagnosis and often share similar courses of treatment, but wouldn’t a better analysis look at patients that all had the same procedures?

A DRG is a diagnostic related group, a very broad categorization of the primary diagnosis that the hospital is treating. A claim only has one DRG, but can have anywhere between one and 25 procedure codes. The data as it is currently presented is inherently incapable of pointing to charging discrepancies because a claim could be charging for one procedure or 25.

Personally, I think the move was more of an administrative muscle flex going into the healthcare exchanges set to open in October — fueled by the threat of public perception rather than an attempt to shed (non-refracted) light on the subject. A more accurate approach would have been to isolate claims where only one procedure was performed and provide the average charge or reimbursement data for those. Unfortunately, CMS charges nearly $4,000 for the data in a format that would allow this type of analysis.

This open dataset is another unfortunate example about our exuberance for “big data” giving way to our human propensity to under-analyze and take misinformed baby steps toward a greater goal, however noble it may be. As more and more data is presented for public digestion, its dissemination must be properly documented and cited if it is to be used to drive analytical outcomes.

Readers Write: Managing Total Medical Expense While Improving Health Outcomes

May 10, 2013 Readers Write No Comments

Managing Total Medical Expense While Improving Health Outcomes
By Michael Gleeson

5-10-2013 8-53-34 PM

As our healthcare system evolves and payment reform expands, providers are forced to deliver higher quality care at a lower cost to curb explosive growth in national expenditures seen in past decades. As a result of this paradigm shift, the industry is responding.

In order to accommodate the incentives and priorities set forth by the Affordable Care Act (ACA), health systems must elevate the importance of primary care. This care model is shifting, with many adopting a patient-centric “Medical Home” approach to patient management. This new model emphasizes cross-provider care coordination, risk-stratified patient management, and proactive, preventative care.

Organizations are also using data more effectively. Increased adoption of electronic health records (EHRs), has led to valuable clinical data that can be mined and analyzed to inform health plans and providers on both their patient population as well as clinician behavior. However, the problem is that it isn’t being mined correctly. By integrating claims and clinical data, building trust and acceptance by care delivery professionals, and reorganizing care teams around actionable information, health systems will start demonstrating reductions in medical costs while improving patient outcomes.

So where should you start?

The four key pillars for success outlined below focus on improving health outcomes and managing total medical expense as critical elements in achieving lasting change within the practice.

Building Trust and Sharing Data

Despite significant investment in technology and data sharing by health systems, health plans and most primary care providers still have no visibility into their patients’ activity outside the four walls. And some health systems are hesitant to share data and/or performance with their counterparts, so as a result, it’s important to do the following when integrating with the network:

  • Create data governance policies. It is important to have a policy that dictates the use and exchange of shared data.
  • Establish role-based security and blinded data policies. This is a good rule for those who are apprehensive to share information. Not everything needs to be shared in order to drive change.
  • Data validation. Assessments to ensure that the data presented to the practice accurately reflects the activities at the point of care is critical to building trust.

Patient Attribution and Outreach

Quality improvement programs are often hindered by the challenge of accurate patient designation. If you can’t accurately identify who is responsible for a patient, you can’t improve the care rendered to them. Health plans often provide member rosters, but these can be large, burdensome to work with, and are often wrong.

It’s important to implement a system that will absorb the membership files from multiple plans, sync this data with the EHR and Practice Management data, and generate a list of members who are inaccurately attributed. The upkeep on this process, once it’s started, can be done monthly and will only take a couple of hours. With the attribution problem solved, the practice can reach out to the non-engaging patients it was responsible for and re-immerse them in primary care.

Fast, Accurate, and Actionable Data

In the whirlwind of external data feeds and complex EHR data structures, finding meaning can be a long process. Utilizing a flexible, transparent and vendor-agnostic data warehouse system allows information from multiple EHR feeds and claims files to aggregate on a nightly basis. This data is merged into a simple, patient-centered data model for reporting and analytics use. A focus on the EHR’s clinical data ensures near real-time analysis and greater relevance to the providers and care teams, resulting in more accurate and efficient patient results that can be monitored accordingly.

Transforming Clinical Care Teams

Even with access to timely and accurate data, practices can still struggle to improve outcomes because of inadequately aligned care teams. Providers are burdened with excessive documentation requirements in poorly optimized clinical systems. When a PCP is spending 10+ hours a day documenting in their EHR, they do not have the time and energy to consume the relevant information to drive proactive care management and move the needle on patient performance measures.

Arranging these roles appropriately within the care team maximizes resources and is critical to successful patient care. Medical Assistants should become the primary consumer of reports and act as a quarterback for the team, beyond their role of taking vitals. Using pre-visit planning reports, they should identify care gaps and coordinate with the RN and care manager to ensure the right actions are taken before the patient arrives. This will enhance the interaction and allows all current and potential problems to have the time to be addressed.

The inevitability of healthcare reform is forcing practices nationwide to shift how they view, plan and deliver care. While there is a renewed focus on managing quality and cost containment, this requires health systems of all sizes to master their data assets and align care team roles around the right tools and mandates.

As noted earlier, this charge is not easy. However, many organizations are currently rising to and conquering this challenge by utilizing these four pillars of success. By meticulously positioning themselves in line with this industry transformation, and keeping their goals and attention keenly on improving patient care and dissolving excessive costs, real improvements are being identified in the current health environment.

Michael Gleeson is senior vice president of product strategy for Arcadia Solutions.

Readers Write: Transitioning from Fee-for-Service to Fee-for-Value Requires Outcomes-Focused Patient Engagement

May 6, 2013 Readers Write 1 Comment

Transitioning from Fee-for-Service to Fee-for-Value Requires Outcomes-Focused Patient Engagement
By Richard Ferrans, MD, ScM

Critical to success under new care models is creating the right IT infrastructure to break down walls and foster better partnerships between hospitals, physicians, payers, and patients alike. We can no longer view inpatient and outpatient settings as different businesses. We must share complex clinical data between the “Care Layer” of physician and hospital EHRs and the “Value Layer” of HIT to integrate their disparate records and promote clinical analytics, value decision support (VDS), care coordination, and digital patient engagement.

Presence Health is the largest Catholic health system in Illinois with 12 integrated hospitals, 29 senior care locations, and more than 4,000 providers and 100 primary and specialty care medical practices. In January 2013, our Accountable Care Organization (ACO), Medicare Value Partners, joined the more than 250 other ACOs established through the Centers for Medicare and Medicaid Services’ Shared Savings Program.

A major part of our journey to becoming an ACO was the integration of employees, providers, and systems during the 2011 merger of Provena Health and Resurrection Health Care that created Presence Health. The combined experience and excellence of the two organizations is helping us succeed in the Shared Savings program. Specifically, both Resurrection and Provena, each with significant Medicare and Medicaid patient populations, had undertaken clinical integration and quality improvement pilot programs before the merger.

The proven patient outcome and financial improvement results of these efforts prepared us for the transition from a fee-for-service model to one based on value. Nevertheless, achieving the CMS’s required 33 quality of care measures while controlling costs will be a challenge.

An integral piece of our “Value Layer” is our patient engagement technology platform that allows us to provide patient-centric communication. We chose our partner, Emmi Solutions, because they have been focused on patient engagement for more than a decade. They have a complete solution proven to motivate patients to take preventive action, transition from one care setting to the next, and participate in shared decision making.

The technology supports web, mobile and interactive voice response (IVR) all in a single platform to deliver actionable information to patients. The platform uses language patients can understand and connects with them at their convenience and on devices they already own – both in and outside the hospital or healthcare setting.

Our patient engagement solution was first introduced to the Presence Health system at Presence Saint Joseph Hospital in Chicago. A survey of nearly 200 patients who had accessed the technology on the Web, conducted over a six-month time period, showed that 94 percent of patients said the engagement platform answered questions for which they normally would have called their doctor. In addition, 92 percent said it motivated them to change their lifestyle and all patients indicated it gave them a better understanding of their treatment options.

We do not passively “educate” patients, but rather use our interactive technology to engage patients in a two-way process where they become motivated participants in their care, exchanging information, validating understanding, and sharing concerns. This is more than a discreet intervention. It is a comprehensive set of reminders, calls to action, and tools needed throughout one’s entire healthcare journey.

We are in the process of expanding it across the Presence Health system and ACO to broaden our ability to cost effectively manage the health of populations and improve both clinical and financial outcomes.

Another reason we chose this technology is because its platform tracks the delivery and consumption of information, which enables us to measure the impact of patient engagement down to the individual patient level. With healthcare transitioning from a fee-for-service to a fee-for-value model, being able to quantify the return on IT investments is becoming a business imperative. Not only are we being held accountable, so is our vendor partner.

Richard Ferrans, MD, ScM is system vice president of Presence Health and CEO of Medicare Value Partners.

Readers Write: Healthcare IT vs. Corporate IT

Healthcare IT vs. Corporate IT
By Anonymous

This is in response to an April 29 reader comment suggesting that healthcare IT leaders are unable or unwilling to make decisive decisions that would improve the bottom line.

I don’t think it’s always not making a “responsible” decision on the part of the HIT leadership. There are different priorities in healthcare organizations versus us in the corporate world. 

In the corporate world, we in IT are well aligned to the profit motive of our company. Period. In healthcare IT, leadership is often not worried about that profit motive. They say they are, but the other departments we serve — they say they are worried about finances, but they really aren’t. HIT leadership doesn’t want to have a crucial conversation with the department heads in the healthcare system about their wasteful applications. 

The infrastructure is normally fully under the control of HIT leadership. There is a ton of cost cutting that happens there. Way too much in my opinion, causing unnecessary downtime that would never happen in a corporate IT shop. That’s due to the cost cutting to not have that switch stack be fully redundant or we don’t need to buy ALL that storage area network growth space now … and then you run out. I’m looking at you HIT shops in the North Carolina Tobacco Road region. 

The real HIT waste is in the applications. Nearly every health system I’m familiar with have some pretty serious application redundancies. What I mean is an HR department that runs both Kronos and Lawson and the payroll department is not part of HR and not outsourced to ADP or the like. That’s two very expensive systems that can do the same job if someone can tell or convince HR to just pick one. 

Or better yet, just let someone else run that whole part of your operation. Many of the corporate IT guys handled the payroll / processing / HR system cost issue a long time ago via outsourcing. Then HR can focus on, oh I don’t know, recruiting people and working on benefit plans. That doesn’t seem to be all that common in healthcare IT.  

Also, your hospital maintenance departments run very expensive name-brand systems meant to run whole manufacturing operations. To do what? Inventory objects and print out repair orders. I’m not talking about your medical device department here, just good old facilities and services. 

The list of applications that cost serious dollars and do only  small jobs inside the healthcare operation as a whole goes on and on.  Corporate-based IT shops would have had a programmer build a little Web application or SharePoint portal to eliminate a few hundred little apps inside a typical healthcare IT shop. 

There’s not a lot of movement in HIT shops to simplify. Simplicity equals cost savings in both break/fix and maintenance/purchase dollars. 

Why not focus on those applications particularly that need simplification and save costs? 

I believe it’s political costs mainly in the healthcare IT field. Those department heads often hold much power in an organization. Healthcare IT is not the sole owner or, at minimum, the first owner of the application. That department or unit is. They can claim patient benefit or employee benefit, or most often, that the redundant systems allow them to have their own inflated head counts. 

Will a healthcare IT leader have time to quantify those patient benefits into a dollar measurement to then justify the maintenance cost and support/time cost for that application? No. Who has that kind of time? 

There are often redundant departments in a healthcare operation. Health systems have DBAs/report writers creating reports for clinicians, but there is a whole other Decision Support Services department with their own specialized application. Nine times out of 10, it’s the same data being reported in almost the same way, and let’s not talk about that DSS app and how it gets the data every day or night and the integration and support work there. In some shops, those DSS people with limited SQL writing skills will even tug some of that DBA’s time to help with their work. 

In corporate IT, there is one measure — efficiency measured in real dollars. There are no patients, so the hard math is easier to quantify. How much does that application cost to have support, maintenance, and upgrades purchased? OK, that’s $100. What does it save us in time running the business vs. another application/process? We are in the positive side in $1,000s — it is justified. There isn’t a lot of worry about the business unit’s politics other than making sure their process is as lean and efficient as possible and that usability of the application is good so that the process time is as efficient as possible.

That’s not to say that a corporate business unit doesn’t have its own political pull, but often you can show the C-level the numbers and those numbers win the argument. Proof in the corporate world means something. I’ve been in many healthcare IT ROI discussions showing the cost savings that could happen. They are normally hundreds of thousands to millions when you take into account the database licenses at the infrastructure layer also. Healthcare IT leadership still passes. It’s not their priority to go against the department heads. 

Internal politics are everywhere. In healthcare, political might can win an argument when the proof in dollars are staggeringly in support of the other point.

I’d say this is changing in healthcare IT as many organizations are having their bottom line get worse and now some of those golden goose political situations are getting weaker.

The dollars of cost argument is winning the day here and there. It’s just the wins are only on small projects and applications to show the cost saving committee that we saved $50K. That’s for show. The real cost saving opportunities that exist are hundreds of thousands in savings.

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