Readers Write: Bridging the Divide: Can Clinicians and CFOs Speak the Same Language?

Bridging the Divide: Can Clinicians and CFOs Speak the Same Language?
By Nick van Terheyden, MBBS

Pity poor Henry the VIII. Historians still argue over his medical records. Though his was the most scrupulously documented medical history of his age, burning questions remain. Did he suffer from syphilis as believed for centuries? More likely he had familial diabetes, which better explains his symptoms – including his well-documented inability to heal from wounds.

Imagine if Henry’s physicians were also tasked with assigning codes and complying with the clinical documentation requirements of today. The Tudor dynasty might have had some reimbursement issues. Heads would have rolled.

Sure, bloodletting is no longer an accepted therapeutic modality. But have we really come that far in bridging the divide between the clinician’s responsibility for care and the CFO’s responsibility for financial performance? Or do finance and quality continue to be involved in a forced marriage of sorts?

Clinicians are focused on their patients. While they understand the importance of billing, they need to put their energies into diagnosing and treating patients to ensure positive outcomes. And they’re overwhelmed with data – patient test results, clinical studies, guidelines, protocols – much of which they have to sift through to find relevant, critical information. Add to that, they have the burden of learning the new coding requirements under ICD-10, with the deadline approaching around the corner.

CFOs, of course, are also focused on quality but, at the same time, must juggle that priority with issues related to reimbursement, their bottom-line and ever-changing and expanding compliance requirements. They’re continually seeking out and analyzing solutions that may be able to improve both patient health and revenue performance. At the same time, they also recognize that without physician buy-in, they cannot meet any of these goals; therefore, they are looking for meaningful ways to bring them along, without disrupting their workflows.

Information that’s deemed crucial for the clinician may not be deemed useful by the CFO, and vice-versa.

Yet finding ways to break through this language barrier between the clinical and financial perspectives will be a critical success factor for healthcare organizations in the years ahead. It’s more than just a communications issue. It’s a strategic imperative aimed at translating the narrative of care into an actionable piece of information that aids in care coordination, while also ensuring appropriate reimbursement and minimizing the potential revenue leakages that keep most hospital CFOs up at night.

Clinical documentation is at the heart of plugging these revenue leakages while also meeting quality standards. Instead of finding one-stop solutions to prevent leakages across the revenue cycle, it is much easier to build accuracy from the start rather than trying to fix the problem after the train has left the station and the process is in motion.

Regardless of the tools used, clinical documentation addresses the most important concern for both physicians and CFOs: ensuring that the most useful information is captured accurately and is made readily accessible to the decision makers (and systems) who need it. At the end of the day, we all know that quality leads to a win for all.

Nick van Terheyden, MBBS is CMIO of Nuance.

Readers Write: Fund Healthcare Modernization and Innovation – Retire Legacy Applications

Fund Healthcare Modernization and Innovation – Retire Legacy Applications
By Julie Lockner

The American Recovery and Reinvestment Act of 2009 (ARRA) provided the healthcare industry incentives for the adoption and modernization of point-of-care computing solutions including electronic medical and health records (EMRs/EHRs). Now that these funds have been allocated and invested in new information systems, hospital and patient care provider CFOs are checking in on the return on those investments. Many are coming up short.

These mega EMR/EHR applications are taking longer than planned to implement leaving a number of legacy applications running in parallel. In addition to hardware and software maintenance costs for both environments, costly resources with skills to maintain aging technology platforms drain IT budgets – funds needed to support new systems.

This challenge is not unique to the healthcare industry. A recent survey [1] of companies with over 50 IT staff shows that on average, 70 percent of the IT budget is spent on existing systems. If half of the applications are redundant, this represents a major opportunity for cost savings or reinvestment.

Why are so many legacy systems still running? An industry research report [2] indicates the #1 reason is that users still want to access data. As creatures of habit, many hospital staff continue to use familiar systems to look up patient information and records out of convenience. Unfortunately, this comes at a cost.

Another reason is because entire legacy data sets are not always migrated to new systems. Data with assigned records retention schedules require collaboration between stakeholders and compliance teams. Without a programmatic approach, application retirement projects can be significantly hampered.

Many providers have overcome these hurdles and successfully implemented an application retirement strategy while migrating to a new system saving millions.

For example, the nation’s largest children’s hospital expects to save $1.8 million annually from retiring legacy applications. Their IT modernization program replaced applications running on aging platforms such as HP Turbo Image, SQL Server, Oracle, and MUMPS with an EPIC implementation. Patient clinical data needed to be retained for compliance reasons, so they deployed an application retirement strategy that allowed them to keep that data and eliminate dependencies on legacy systems and applications. Hospital staff was given online, convenient access to data in a secure archive and compliance teams could track retention.

Key to success, they claim, includes a platform with the following capabilities:

• Archive support for a variety of data types, systems and platforms
• Automated validation to confirm data had been completely and correctly archived
• Ability to assign retention policies during or after the archive process
• Automate data purge workflow when retention periods expires with legal hold support
• Mask sensitive data in case a clinical trial is reopened

[1] NCC survey companies with over 50 IT staff

[2] Enterprise Strategy Group Research Report, Application Retirement Trends, October, 2011

Julie Lockner is vice president of product marketing for Informatica.

Readers Write: Good Product Design is Preventive Medicine for your Software

Good Product Design is Preventive Medicine for your Software
By Ryan Secan, MD, MPH

As a practicing hospitalist physician, I see many patients with untreatable or difficult-to-treat disease that could have been prevented with care before their illness took root. From the lifelong smoker with emphysema who might have quit smoking to the patient with end-stage colon cancer who should have had a screening colonoscopy, dealing with the issue before it started would have potentially prevented their problem.

As a practicing informaticist, I also see parallels between the preventive situations described above and common issues that I’ve faced in healthcare IT. When it comes to healthcare IT, it seems that like patients, too many companies are ignoring preventive care for their product.

As an employed physician, I have limited to no choice regarding what software I use for clinical care. Even as an informaticist, I have inherited my share of decisions regarding software that took place before I had a chance to offer input. Often these software choices that my colleagues and I are forced to use appear to be designed without ever considering the workflows of the clinicians who would use them. It just doesn’t seem possible that any physician involved in product development would allow something this difficult for a clinician to use to be rolled out.

One simple example involves ordering medications in an unnamed product. After typing in a medication name, clicking on it to select it, clicking on a prepopulated order string, and clicking OK (already too many clicks), the pop-up window cycle starts. A click to confirm that I understand that the medication requires dosing based on kidney function, a click to confirm that I know that the kidney function is X (or unable to be calculated), and another click to confirm that the appropriate dose for this level of kidney function is Y (it remains unclear why all of these notations couldn’t be in one window).

Worst of all, if the correct dose is different from what I’ve ordered, it doesn’t offer to change the order or allow me to cancel my already entered order. I need to cancel the old order and order the medication again, remembering the correct dose, and once again going through the multiple windows telling me that the medication must be dosed for kidney function, etc. This is a completely absurd process and a missed opportunity.

Instead of having unhappy customers and trying to repair the damage after the fact, HIT companies need to invest the time and effort in product design. Seek advice from experts (you know, the people who will be using your product) and make sure your product fits into your clients’ workflow. Build customization into your product so it can be adapted to the particular workflows of your individual clients, and make the customization more than just cosmetic. When you get feedback from one client regarding problems, make changes for all of your clients so your entire user base can benefit from each other’s experience.

This preventive medicine will prevent difficult (or impossible) to fix problems down the road.

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

Readers Write: Connecting the Industry: Behind the Scenes of the New Healthcare Triangle

Connecting the industry: Behind the Scenes of the New Healthcare Triangle
By Gary Palgon

The days of patients accepting the decisions and information provided by their physicians – no questions asked – are in the past. Today, patients are in the driver’s seat, participating in discussions about their care and making crucial decisions based on information from all members of their care teams. The movement from a linear form of communication between a single physician and a patient has changed into a multi-dimensional conversation that includes a variety of healthcare providers and patients.

Patients have always trusted physicians to provide the best care for them as individuals. Yet few realize until they become ill that historically there has been little exchange of information between all points of care. A patient who first visits an urgent care center, for example, then sees a primary care physician who refers him or her to a surgeon expects their health information to follow from place to place.

Fortunately, technology now supports the exchange of health information among disparate sources so that a patient’s longitudinal record is accessible. This not only prevents the need for the patient to repeat information at each point of care, it also ensures the accuracy of the information on which all of the providers base their treatment recommendations.

Better exchange of health information among providers and patients has led to a more collaborative approach to developing the best possible treatment plans. While providers and patients make up two important points in the communications continuum, however, there is a third important point in the healthcare communications triangle that must not be overlooked – pharmaceutical organizations.

Access to the most current medications and treatment protocols requires an exchange of information among patients, physicians, and pharmaceutical organizations. Searches for clinical trial information can be initiated by patients or physicians, as each seeks the best care for a specific condition.

Nevertheless, patients expect physicians to have greater access to clinical trial information, as well as the ability to qualify them for participation in trials. This increased awareness of the benefits of clinical trials brings the healthcare industry face to face with a longstanding challenge: how to give pharmaceutical companies access to patient information for research while still respecting patient privacy where desired.

Concern about patients’ privacy and the security of their data has for many years limited healthcare providers’ willingness to share information, resulting in limited access to it for researchers. Yet de-identified patient information can be tremendously beneficial, helping shorten research timeframes and speeding time-to-market for new treatments. Today, many patients not only understand the importance of their medical data to research, they also want to share it with the general population as a way to help improve care for others suffering with similar conditions. It is, after all, their information to be used as they wish, which includes individuals using such data for future treatment of diseases.

The technology to connect all points of the healthcare continuum is available today. Although not perfect – industry standards are still evolving and interoperability challenges do exist – successful connections being made every day prove that the challenges can be overcome.

Take lab and diagnostic results, for instance. With lab results comprising roughly 70 percent of an average patient record, the ability to see and share lab data electronically greatly improves communication across the continuum of care. Physicians rarely have a laboratory in their own offices, so they rely on technology to share data outside their four walls. The connections among physicians and multiple laboratories or diagnostic services provide a real-life example of the benefits and possibilities of secure data exchange.

A truly connected healthcare industry can be accomplished if the strategy to achieve it is simple, cost-effective and beneficial to everyone. Technology that incorporates use of the cloud to integrate disparate systems, aggregate and harmonize data, and provide access in usable formats addresses these requirements. Not only does this strategy overcome the financial and staffing challenges of industry integration, but it provides enhanced security for health information.

Even though patients are willing to share their health information for research purposes, protocols that authenticate user identities and provide secure access for specific research needs still must be put into place to protect it. Leveraging cloud-based solutions is one way to provide those securities while enabling access to data for multiple researchers working on different studies at the same time.

Easy access to information is part of day-to-day life in the 21st century. In years past, you might have to ask the advice of the local hardware store owner or look through a book if you wanted to fix a leaky sink. Today, a simple Internet search provides hundreds of suggestions and videos showing exactly what to do.

The same concept – easy access to data in a usable format for everyone – applies to the exchange of health information among patients, providers, and pharmaceutical organizations. The benefits include improved clinical trials, appropriate research, faster time to market for beneficial new drugs, and ultimately enhanced population health management.

Just as access to information improves our daily lives, so it does too for patients, researchers, and providers. It is a win-win-win situation for those who rely on shared information to develop new treatments, assess care options, and make the best care choices possible.

Gary Palgon is vice president of healthcare solutions for Liaison Healthcare Informatics.

Readers Write: A Meaningful View of Meaningful Use

A Meaningful View of Meaningful Use
By Helen Figge, PharmD, MBA, CPHIMS, FHIMSS

Meaningful Use has meaning to us all. While we struggle to decide timelines for milestones and determining measured success, we all experience Meaningful Use in our daily lives.

First and foremost, we are all consumers of healthcare living in a society that wants immediate gratification. As consumers, we are being granted instant healthcare gratification through the lens of Meaningful Use. We receive visit summaries, electronic copies of our medical records, and a detailed report of our current medications. Our providers have access to information such as our laboratory reports, X-ray reports, and notes from our specialists. We are encouraged to engage in our own care by having access to our data through patient portals.

We can ask our clinicians new questions based on previous test results, which is great for the patient, but perhaps less than ideal for the clinician (e.g. a TSH ranges from 0.3 to 5.0 – so what is normal for me or for you? Does a low value mean something versus a higher one?) We assume all are equally computer savvy, which in turn creates a potential digital divide. Some more tech-savvy patients “get it” with little prodding, while others finding this new Meaningful Use approach cumbersome, yielding potentially more work for the clinician. 

Maybe to counteract this one potential angst of patient computer illiteracy, should we offer patients a computer literacy course in order to take advantage of the opportunities presented to them by Meaningful Use?

There seems to be a learning curve for us as healthcare consumers. Not only learning the technologies given to us for data access, but also comprehension of the new rules of healthcare engagement. Given that we want it and want it now, Meaningful Use is the lightning bolt needed to energize the healthcare delivery system. Most noteworthy of all, Meaningful Use to a healthcare consumer is invisible, and translates to a meaningful interaction with our healthcare provider with the highest quality of care delivered to us that is coordinated, seamless, accessible, real-time, and complete.

Next comes the clinician, whose perspective is somewhat more sterile. Patient record transparency and best practices yielding to a more informed patient with data in real-time, workflow supportive and organized is the nirvana. But, in reality, the technologies do not always support clinician workflow, hence the angst felt today with the execution of Meaningful Use to some clinicians. Additionally, clinicians have an extra burden to exercise patience with their patients who might overuse or underuse these new approaches for data access.

But if patience is exercised, Meaningful Use will work to transform healthcare the way we all want it to be. It just might take a little more time for some to realize the benefits, lending fuel to the current discussions of some “catching up” with others in the various stages of Meaningful Use. And to compound our “want it and want it now” mentality, don’t forget the Direct Project that if exercised correctly could improve communication across many layers of clinician thought. The problem with that project, however, is the select few who enjoy its rewards as many haven’t caught up to the pack yet for this vehicle offered in healthcare today to work for optimal effect.

Now enter the poor vendor who finds Meaningful Use an opportunity, but also a challenge. The challenge comes not only from the institution that purchased the technology, but the various stakeholders that institution represents. Vendors who can’t keep pace with these demands will now become easily identified, and these vendors in turn will now more than ever experience negative selection because stakeholders will opt for software that supports healthcare delivery.

Vendors also need to contend with clinicians who have the extra burden of now hearing from patients that the technologies are not user-friendly, adding fuel to patient dissatisfaction. This is a double whammy of frustration. Complaints fielded by clinicians are in turn angsts for the CIOs, who then turn their aggressions on the vendor for immediate response and relief.

Rome wasn’t built in a day and neither were software platforms, yet our need for instant gratification overrides the ability to work through issues that otherwise without emotion would be handled quite effectively. Darwinian Theory of evolution plays well here: only the best adapted will survive (the vendor, I mean). The meaning of Meaningful Use to a vendor is twofold: to deliver high quality technology meeting acceptable government criteria and also technology that all stakeholders find acceptable, functional, and timely.

Finally the last group who should or could benefit from Meaningful Use if implemented, accepted, and seamlessly delivered involves insurers (third-party payers) that have been battling the cost containment of healthcare for quite some time. If insurers were really wanting to make a difference in healthcare costs, they would reward more for preventive care and support universally such processes as the Patient Centered Medical Home and also invest in the health of our bodies real time, not years later when we are ravaged by illnesses due to poor lifestyle, poor gene pool, or a combination of the two. In the end, if Meaningful Use is supported by these groups, the insurers will benefit from lower healthcare consumption, more efficiency, and better outcomes.

Meaningful Use has meaning to us all and worthy of support. It just needs to be appreciated and agile enough to survive the need for our society’s immediate need for gratification and be resilient enough to let some play catch up.

Helen Figge, PharmD, MBA, CPHIMS, FHIMSS  is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: Building an Accountable Care Organization? Consider Starting in Your Own Back Yard

Building an Accountable Care Organization? Consider Starting in Your Own Back Yard
By Claudia Blackburn

Explaining my healthcare IT profession to my parents and children has never been straightforward. Yet sometimes they are the ones who can boil it down to the essence of what we do, perhaps even better than we can.  Before I became a consultant, my mom once told a family friend that I, "paid people to be healthy so that the hospital I worked for didn’t have to pay as much for health insurance." The friend responded,"Where can I sign up?" They both clearly understood the value of population health management (PHM) programs.

With the CMS news released this month about those Pioneer Accountable Care Organizations (ACOs) that have demonstrated success and shared in the savings — and of those Pioneer ACOs that are not continuing the program — there’s healthy debate about the model and the key success factors.

For those organizations considering starting an ACO, consider test-driving the concept in your own back yard with your health plan member population.

The Opportunity: An Integrated Wellness Model

Several self-insured employers – both healthcare organizations and companies from other industries – have proven that an ROI is achievable through population health and wellness programs. A few shared their program experiences showing impressive return for their wellness dollars:

• In 2011, Mercy Clinics, Inc. reported a four-to-one return on investment of wellness dollars spent. Mercy uses coaches within its practices to assist with coordination of care.
• Franciscan Missionaries of Our Lady Health System decreased health plan expenses 13 percent, with a 21 percent decrease in medical claims alone in 2011. A four-to-one return over five years projected a savings of $37.3 million.
• John Hancock’s Healthy Returns program increased savings per participant from $111 in 2009 to $261 in 2010, and preventative care increased 1 percent to 4 percent per year with an overall 2.5 to one ROI.

Just as any other employer, hospitals face increasing healthcare costs for their employee and member population. However, hospitals can use their healthcare expertise to develop practice protocols that change habits and ultimately improve the health of their self-insured member population and decrease employee benefit costs.

Strategic Elements of a Successful Population Health Management Program

Screening, prevention, and care management are all involved in population health improvement, but by far, changing the habits of individuals is the most challenging. Smart phone applications and portals, in addition to payers and providers pushing information, have not engaged members.

To engage members for best outcomes with accountability and oversight, the health management program must be a combination of people, new processes, new technology, and much better use of the collective data. There are several essential elements of an integrated PHM model:

• Claims data. Claims data define healthcare services received across the continuum of care and risk in order to target program benefits and measure improvements in utilization and cost.
• Health risk assessment (HRA). A HRA captures basic information to determine the consumer population health status and risk stratification, especially important for those with no claims.
• Electronic medical record (EMR) / biometric screening. It’s important not to allow the member to self-report on weight, cholesterol, blood pressure, and glucose. Instead, a coach or nurse should measure other biometrics charted in the EMR. Patient data from a personal health record (PHR) can be useful and selectively imported into the EMR.
• Aligned incentives. Incentives are important to move members towards participation and keep them active and accountable. Incentives such as reduced premiums, door prizes, or gift cards are helpful to encourage enrollment. Once enrolled, outcomes-based incentives can be used to keep the member working towards health goals.
• Coaching. Successful PHM programs have coaches armed with full information from claims, HRA, and EMR to motivate members to change behaviors.
• Consumer portal. The portal allows for better engagement between provider and consumer and monitoring of healthy habits, such as exercise.
• Data warehouse /analytics. Armed with holistic information about the consumer, high-risk root causes can be identified, targeted with strategic program initiatives, and measured for success or rework as part of a feedback loop to assure data-driven increased quality and decreased cost.

From the above list, clearly the “glue”for connecting the PHM program elements is a solid technology foundation. It provides a concise picture of population and individual holistic health. When combined with coaching, health systems are able to not only monitor but also influence change. Additionally, the closed-loop feedback mechanism enables measurement of the success of strategies at an enterprise level and a member level to allow for continuous improvement.

Just as my mom and her friend understood, the value of population health and wellness programs can be substantial. Keeping members accountable through incentives increases healthy behaviors and reduces the self-insured health insurance cost of the employer.

Hospitals can take a leadership position in the move toward the IHI’s Triple Aim both as an employer and a healthcare provider via PHM programs for its own self-insured member population. The individual wins, the employer wins, the hospital wins, and the community wins.

Claudia Blackburn is a consultant with Aspen Advisors of Pittsburgh, PA.

Readers Write: Think Beyond the Text: Understanding HIPAA and Its Revisions

Think Beyond the Text: Understanding HIPAA and Its Revisions
By Terry Edwards

Every day, an increasing number of physicians and other health care providers are exchanging clinical information through a wide range of modes, including smart phones, pagers, CPOE, e-mails, texts and messaging features in an EMR. It’s no surprise that hospital and health system leaders are increasingly focused on securing protected health information in electronic form (ePHI)—a trend that has certainly invoked some confusion across the industry.

As PHI data breaches increase in frequency, hospital executives must strategize ways to eliminate security threats and remain HIPAA compliant. Especially since HIPAA violations can be extremely expensive, leaving these already-strapped organizations in an even more stressful financial situation.

In order to prioritize tangibles such as patient safety, physician satisfaction and overall efficiency across processes and hospitals, health care leadership must consider ways to tackle this confusion and maximize the benefits enabled by modern technology and electronic communications.

PHI can take a variety of paths in today’s complex healthcare environment and expose a health system to risk. But time and time again I see health systems looking to implement stop-gap measures and point solutions that address part—and not all—of the problem.

While texts are commonly sent between two individuals via their mobile phones, the communication “universe” into which a text enters is actually much bigger. It also includes creating ePHI and sending messages—in text and voice modalities—from mobile carrier web sites, paging applications, call centers, answering services and hospital switchboards.

For example, a 400+ bed hospital generates more than 50,000 communication transactions to physicians each and every month. Many of these communications contain ePHI. And if they were transmitted through unsecure networks and stored in unencrypted formats, they would represent a meaningful potential security risk to both the hospital and its medical staff.

In order to identify all potential areas of vulnerability, health care leaders need to consider all mechanisms by which ePHI is transmitted and the security of those mechanisms and processes. No mode of communication can be viewed in isolation. By failing to address all transmitted ePHI, organizations become vulnerable to security breaches with adverse legal and financial consequences, as well as loss of patient trust and reputation in marketplace.

In addition, contrary to what many health leaders have been led to believe, HIPAA provisions do not call out any specific modes of communication. Text messaging is permissible under HIPAA. The law simply stipulates that a covered entity (CE) must perform a formal risk assessment; develop and implement and effective risk management strategy based upon sound policies and procedures; and monitor its risk on an ongoing basis. These regulations apply to providers communicating PHI in any electronic form.

As a result, there is no such thing as a “HIPAA-compliant app.”

HIPAA provisions emphasize the risk management process rather than the technologies used to manage risk. For hospitals and health systems, the pathway to safeguarding electronic communication of PHI lies in the creation of an overall risk management strategy.

Ideally, leaders of the CE will form an information security committee to develop and execute the strategy, which includes representatives from IT, operations, the medical staff, and nursing, as well as legal counsel. Leaders should also consider including an external security firm in the group. Once the committee is formed, the organization should take these four essential steps for protecting the security of ePHI:

1. Organize and execute a formal risk analysis. A formal risk analysis should break down types of technology used for electronic communication as well as the transmission routes for all ePHI. To ensure HIPAA compliance, ePHI transmitted across all channels must be “minimally necessary,” which means it includes only the PHI needed for that clinical communication. This layer of complexity, which is common in clinical communication processes, underscores the need for a comprehensive security assessment and strategy appropriate for the organization, coupled with the resources necessary to implement that strategy.
2. Establish an appropriate risk management strategy. The committee should develop a risk management strategy that’s specific to the needs and vulnerabilities of the organization and is designed to manage the risk of an information breach to a reasonable level. HIPAA does not specifically define “reasonable,” but in general, the risk management strategy should include policies and procedures that ensure the security of message data during transmission, routing, and storage. The strategy should also include specific administrative, physical, and technical safeguards for ePHI.
3. Roll out these policies and procedures and train staff. Implementing new policies and procedures is the biggest challenge for organizational leaders, especially as a substantial proportion of reported security breaches are due in part to insufficient training of staff. As a result, appropriate individuals should be assigned specific implementation tasks for which they are held accountable, while leaders and committee members must carefully monitor the success of implementation. All staff with access to PHI must be educated about the specific policies and procedures, which will help ensure they are upheld across the organization.
4. Monitor risk on an ongoing basis. To ensure continued compliance with security standards, organizations must conduct ongoing monitoring of their information security risk. Leaders should receive regular trend reports from the information security committee based on their ongoing assessment of ePHI security at the organization. Those reports should support the ongoing assessment of security needs as technology and health care delivery change, and act as a catalyst for changes that may need to be made to the policies and procedures over time.

In today’s increasingly complex healthcare environment, analyzing and implementing a broader policy around security across all forms of electronic communications—rather than focusing on a single mode of communication in isolation—is critical to any health system’s ability to avoid and mitigate the adverse consequences of a breach. By clarifying the confusion around electronic communications now, hospitals and health systems will be better prepared to minimize risk and maximize best-practice communication process in the future.

Terry Edwards is president and CEO of PerfectServe of Knoxville, TN.

Readers Write: Seven Strategies for Optimizing the EHR

Seven Strategies for Optimizing the EHR
By Marcy Stoots MS, RN-BC

Healthcare organizations are making a mistake if they subscribe to the notion that once an EHR is successfully implemented, it no longer requires attention. Even the most carefully designed EHR will not work as intended in all situations, causing users to create workarounds that are counterproductive and inefficient. It’s important to develop and implement an ongoing strategy for fine-tuning the EHR so that users can input and access the data they need with fewer clicks and better outcomes, which will improve clinician satisfaction.

Besides moving toward usability and adoption, optimization will help with plans to achieve Meaningful Use Stage 2, which raises the bar significantly. Under the Stage 2 final rule, for example, hospitals must report on 16 of 29 clinical quality measures (CQMs) and Eligible Professionals must report on nine of 64 CQMs. Optimizing the EHR to properly capture this data and generate compliance reporting is crucial.

Finally, optimization is a key step to realizing the financial ROI of the EHR, in which a substantial investment has been made. In today’s landscape of cost containment and healthcare reform, an organization can ill afford to sacrifice financial ROI or be bogged down by inefficiencies.

Below are seven strategies for optimizing the EHR to increase efficiency, improve the ROI, drive adoption, and improve usability, with the ultimate goal of providing better outcomes.

1. Create a Governance Structure

Just as an organization needed a governance structure during planning and implementation of the EHR, it will need one for ongoing optimization. This will provide an avenue for making decisions and keeping the optimization plan moving forward. Problems will continue to arise and solid governance will ensure that they are dealt with effectively. A process should be in place to manage variances when clinicians do not want to adhere to a standardized documentation or workflows. When these crop up, the governance group will need to decide upon appropriate action.

2. Create a Solid Informatics Structure

Many healthcare organizations struggle with the size and organization of the informatics team. From an optimization standpoint, it’s important to get this right. There is no standard answer here; every organization is different. Detailed descriptions of job roles and responsibilities should be created and appropriate resources budgeted.

3. Assign Responsibility

An individual at the leadership level should be designated as the responsible party for optimization. This function should be incorporated into that person’s job description. This is typically an informatics director, but could also be a CMIO or IT director, depending on the organizational structure. Assigning this responsibility will help ensure that optimization is an ongoing process, since it requires continual evaluation and modification. Ideally, for larger health systems, there should also be an optimization team in place that could include clinical leadership, operational leadership, informatics analysts, and super users. For smaller health systems, the team would be much smaller, but informaticists should have optimization as a core job function.

4. Measure

The pain points of clinicians should be determined by interviewing stakeholders, examining service desk tickets, listening to input from IT and informatics staff, analyzing reports and metrics, and observing end-to-end workflows. The most important issues should be focused on with data collected at baseline and after 30, 60 and 90 days. Measuring is an ongoing process. It should be used to monitor progress and gauge success.

5. Create Scorecards

Scorecards are a powerful tool for demonstrating what has been achieved. They display the collected data and communicate improvements to the team and stakeholders. Managing workarounds starts with accountability; Scorecards lets users know where they stand and create a healthily competitive environment that encourages success. They can be used to compare units within a hospital or hospitals within a health system.

6. Provide a Quick Win

Clinicians can be easily frustrated by glitches in the EHR, so areas should be pinpointed that will quickly increase their satisfaction. These are issues that are important to them, yet easy to address, the low-hanging fruit that delivers the highest impact. Success breeds enthusiasm, setting the stage for better adoption.

7. Continue Refining

Optimization is never complete. It is an ongoing endeavor without an endpoint.

Workarounds are a reality. The organization should have an optimization plan to monitor and manage them, as well as establishing ownership of that plan. With proper planning and a roadmap in place, addressing problems and overcoming challenges will go smoothly. The end result will be satisfied users and healthier patients (and lower costs).

Marcy Stoots MS, RN-BC is a principal with CIC Advisory of Clearwater, FL.

Readers Write: How Many Licks to the Tootsie Pop Center Versus How Many Clicks to Relevant Clinical Data?

How Many Licks to the Tootsie Pop Center Versus How Many Clicks to Relevant Clinical Data?
By Helen Figge, PharmD, MBA, CPHIMS, FHIMSS

A group of engineering students once reported that it took an average of about 364 licks to get to the center of a Tootsie Pop. For some reason, this was a very important scientific query that needed an answer.

A current healthcare query many are pondering today is: how many clicks are needed to get to the relevant clinical data necessary to support patient care? Clinicians using the various technologies like EHRs and HIEs for data retrieval often times have the same number of steps as getting to the center of a Tootsie Pop. The more clicks it takes to get to the required clinical data, the more time spent away from the patient, and thus eventual loss of productivity, suboptimal patient care, and potentially total clinician frustration. If you speak to clinicians on the front line, many of the technologies are more of a hindrance than a help.

In reality, one wants the right data at the right time and in a comprehensible format without undue effort to retrieve it. Clinicians are yearning for “smart software” that knows what data to fetch and how to properly present it. Data needs to be automatically populated inside the clinician note. Additionally, more than ever clinicians need technology that supports workflow and provides the correct data with minimal effort on the clinician’s part. 

Bottom line, we need “smart software” that knows what data to present while simultaneously having other data immediately available with one click. As an example, if the software recognizes that the patient has diabetes, then certain labs — such as hemoglobin A1C, lipids, and renal function — should be automatically displayed in the note.

Ask clinicians and they will tell you that they are getting drowned in unnecessary data. Data needs to be presented in a way that is easily understood by clinicians. We know a lot about the technologies out there today compared to a few years ago, so clinicians more than ever should expect nothing less from their vendors today than data that is useful, timely, and in real-time.

Clinicians require from their technology enablers the ability to aggregate data from multiple sources and present it in a comprehensible format. For a diabetic patient, the software needs to aggregate kidney function from any laboratory source and plot and trend the data appropriately. Clinicians need to be more vocal in their desires for appropriate data and need to collaborate with the IT departments to get the desired outcomes from their technologies. Clinicians need to engage more than ever before to ensure the software chosen for their organizations delivers what is needed on the front lines.

Right now, clinicians need easily customizable data presentation formats, smart order templates and true data aggregators along with evidence-based algorithms from their vendors. Clinicians must have tools that actually work for them, not against them, and truly support patient care. True “smart software” should support what the clinician needs, not forcing the clinician to adapt to inept software to attempt data retrieval for patient care. IT experts need to continue engaging the clinician in collaborations because right now it’s all about the data and how it is presented.

Organized structured data is the paramount piece to the current healthcare puzzle. We have the answer to how many licks to the center of a Tootsie Pop. Now it’s time to get to the answer of how many clicks to the necessary data that truly supports patient care.

Helen Figge, PharmD, MBA, CPHIMS, FHIMSS  is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: The Sequester’s Impact on Healthcare: Dangerous Unintended Consequences

The Sequester’s Impact on Healthcare: Dangerous Unintended Consequences
By Rich Temple

It has been three months since the sequester hit the healthcare industry, and the effects are more profound than they might seem. What’s most troubling is that the budget cuts in many cases will wind up costing the government more money and will have a particularly negative impact on cancer patients and those living in rural areas.

Cost of Caring for Unemployed

Across the healthcare spectrum, providers can anticipate about $11 billion in cuts. A joint study by the American Medical Association and the American Hospital Association estimates the loss of 330,127 healthcare jobs and 496,000 indirect job losses by 2021. Victims of job losses tend to require extra care to sustain their health and well-being while out of work, and the cost of these interventions may wipe out the perceived benefits of the sequester’s capricious cost-cutting.

Another Hit for Providers: Cuts in Medicare Reimbursement

For individual healthcare providers, the 2 percent across-the-board Medicare reimbursement cut will exacerbate challenges for providers who are already struggling to adapt to value-based purchasing and other mandated reimbursement cuts. Mercifully, Medicaid was exempted from this cut, but even Medicare Meaningful Use incentives will sustain the 2 percent reduction.

Particularly hard-hit will be rural hospitals, which according to a study by iVantage Health Analytics are twice as likely to be thrown into the red as a result of these cuts. That’s because rural hospitals treat older, poorer, and less-insured patients and are thus directly dependent on Medicare for their economic sustainability. This financial damage will ripple down to the communities they serve since these organizations tend to be among the largest employers and are likely to be a key focal point of much of the activity in their local economies.

Cuts Disproportionately Affect Community-Based Cancer Clinics

Cancer care is the area most profoundly impacted by the sequester. Reimbursement cuts are making it financially untenable for community-based cancer clinics — one of the more cost-effective treatment sites — to continue to serve many patients, thereby forcing them to either seek care in a more expensive hospital setting or not seek care at all.

Historically, Medicare reimbursement for cancer drugs has been the average price of the drugs, plus a 6 percent administrative fee to cover the cost of providing care. The sequester reduces that fee to 4.3 percent for both drugs and services, which in essence translates to a 28 percent cut in actual reimbursement.

According to a study conducted by the actuarial firm Milliman, the sequester is already resulting in layoffs, closings, cutbacks, and is driving patients into hospital settings. The study also says that the government could pay an average of $6,500 more per year for cancer patients in a hospital versus a community clinic.

Cuts to Cancer Research Means Fewer Clinical Trials

Another area where cancer patients are hard hit involves cuts to research funding. Besides the estimated loss of 20,500 research jobs, NIH research indicates that every $1 invested in cancer research yields over $2 in incremental economic activity. This translates to a $3 billion direct negative hit on overall economic activity.

Significant cuts to cancer research mean that fewer clinical trials will be available to help identify better treatments and thus, more protracted, costly, and painful care for patients will continue.

Most Vulnerable are Hardest Hit

In summary, the sequester’s effects are causing great pain on many levels to some of the most vulnerable segments of our population. And the perceived cost-reduction benefits are actually not likely to be realized since the unintended consequences of the sequester look like they will cost even more than the mandated cuts. These consequences could take the form of:

• More expensive, less efficient care due to patients losing access to primary care physicians
• Incremental unemployment insurance for those who have lost their jobs
• Protracted inpatient stays due to less readily available preventative research
• Other forms of public assistance these individuals will require

The effects of the sequester on healthcare have not been discussed extensively of late in the media. However, it should be noted that there are unintended consequences that we will most likely pay for in the coming years ahead.

Rich Temple is national practice director for IT strategy at Beacon Partners.

Readers Write: The Enterprise Content Management Adoption Model

The Enterprise Content Management Adoption Model
By Eric Merchant

There have been numerous publications recently about the amount of unstructured content that exists (80 percent of all content) in a non-discrete format outside of the electronic medical record. This unstructured content exists as digital photos, scanned documents, clinical images, and faxes and e-mails.

The challenge of capturing this information as close to the source as possible — managing it effectively and ultimately delivering it to the necessary physician, nurse, or other provider in a timely manner at the point of need — is a continuous uphill battle. There are varying degrees of being able to manage unstructured content and make it available to decision makers in a meaningful way to improve patient care, drive operational efficiencies, and improve financial performance in the healthcare market.

In developing a content strategy, the challenge is greater than simply buying a software suite and thinking your problems are over. As content grows in volume and complexity, the strategic plan needs to be flexible to be able to grow and adapt accordingly.

To do this, a reference is needed to determine where we were, where we are now and where we want to be. I began creating an Enterprise Content Management (ECM) adoption model as an internal point of reference, but also as a strategic guide for the industry. In practice, it would function similarly to the seven stages of the EMR adoption created by HIMSS Analytics.

ECM Adoption Model

This adoption model can serve the healthcare industry well by allowing us to keep focused on the outcomes we want to achieve and the systems that would provide them. The adoption model also intertwines patient care initiatives (capture content and deliver within the EMR), operational efficiencies we need to achieve (federated search and analytics) and outcomes that will directly benefit healthcare organizations’ financial performance (intelligent capture, VNA and Image Lifecycle management).

In addition, this strategy also delivers on the commitment to support Meaningful Use and IHE data-sharing initiatives with the ability to share and publish unstructured content to information exchanges.

EMR systems have received the bulk of the attention the past few years due to the value they bring and the public policy and reimbursement implications of getting them successfully implemented. However, as the healthcare market becomes more electronically mature, we cannot lose focus on the larger picture and the bigger challenge and ultimately the patient. This picture is incomplete without bringing together both the unstructured content created outside the EMR and the discrete information within the EMR.

To do this, the ECM adoption model, in conjunction with the EMR adoption model, must both be used as a roadmap to reach that goal. ECM vendors must take the same approach that EMR vendors have taken and work hand in hand with healthcare organizations to provide the solutions to achieve Stage 10 of the ECM adoption model and ultimately move closer to a complete patient record, which subsequently creates better health outcomes delivered efficiently and in a financially solvent manner.

Eric Merchant is director of application services, health information technology, for NorthShore University HealthSystem of Skokie, IL.

Readers Write: Requirements Versus User Experience: The MU Design Impact on Today’s EHR Applications

Requirements Versus User Experience: The MU Design Impact on Today’s EHR Applications
By Tom Giannulli, MD, MS

Since the first electronic health record (EHR) applications, the federal government has been looking for ways to leverage EHR technology to improve the quality and cost of healthcare delivery. A decade ago, President George W. Bush declared that every American should have an electronic health record within 10 years. While we’ve come a long way, almost half of all medical providers are currently searching for an EHR, installing one now, or looking to switch out the one they have in place.

This is an eye-opening situation given the investment of billions of dollars in EHR technology by healthcare providers, technology suppliers, and the government via incentive programs. Why is this? One contributing factor is that the government incentive programs have excessively focused on features over user experience and outcomes.

When the current EHR incentive programs emerged in 2009, EHR suppliers with existing products were faced with the challenge of meeting Meaningful Use (MU) requirements. It’s not easy to retrofit new functional requirements into an existing product, and it’s commonly understood many suppliers had to focus on achieving functionality requirements however possible given the potential impact of government incentives. The time-bound goal was simply to get X feature programmed in Y weeks so that version update or hot fix could be applied to meet customer certification timelines.

Function ruled over form, often resulting in degraded user experience and sub-optimized workflows. In hindsight, it may have been better to have fewer incentive program requirements with broader definitions and simpler tests to validate compliance.

For example, assume a general requirement for physicians to be able to share standardized clinical documents with basic tests of compliance. With this more general goal, technology suppliers would have greater freedom around how to solve the requirement resulting in a greater range of solutions—some of which likely would have superior usability. The market would then reward the company that best met both the requirement and the associated usability and user satisfaction.

The overall goals of MU are sound; it’s simply that in practice the extent and specificity of the requirements often overemphasize feature content and prescribed usage at the expense of user experience and the innovation that comes with flexibility. A doctor on HIStalk a few weeks ago highlighted this reality:

“When you’re used to using very clean designs—a MacBook, an iPhone, Twitter, Facebook—and you sit down on an EMR (electronic medical record system), it’s like stepping back in time 15 or 20 years.”

I had the opportunity to build an EHR after MU Stage 1 had been established. This allowed us to take a more comprehensive approach in terms of meeting our overall design goals, including usability, as well as MU requirements. We wanted to make it possible for the physician to use the application to chart patient visits and the required data and reporting were generated as an by-product of normal use.

Now, we are facing changes for MU Stage 2, integrating those into an existing product, tying them to user needs in a way that makes sense. We have developed a process that uses a lot of user feedback and testing and we try to iterate quickly with releases at least monthly.

But the fact is that the specificity of MU and the rigorous testing don’t provide for the best user experience. Ironically, these really specific requirements—a number of which dictate the user experience to a large degree—are supposed to be creating improved usability when in fact they are detracting from user-friendless and improved workflow.

I believe that without MU, many EHR features would be similar, but there would be notable differences resulting from the focus on user feedback versus government direction. As a physician and an EHR designer, I would still want to track health maintenance and have tools to manage people’s care. The big change would be the ability to focus on some market-driven elements that we haven’t been able to spend as much time on because they aren’t MU requirements.

We would be spending more time looking at how we could use the practice data to highlight workflow problems or areas where the practice isn’t using best practices. By leveraging our large pool of operational and clinical data, we could generate more recommendations for practice optimization and patient care. These are very high level concepts that we are exploring, but are at a lower priority given the resources required to implement MU2 in a way that is well integrated and results in a positive user experience.

In a perfect world, current MU2 requirements would be replaced with just few high-impact goals related to interoperation and communication. Current MU2 requirements have added little new incremental value while creating a significant burden for vendors and end users. This situation is even more challenging in that the requirements are becoming more specific and dictate user interaction in some cases. The structure is in place to capture discrete data, measure quality, and communicate standardized data.

At this point, I believe the market should drive the process of advancing features and expand-on the valued features outlined by the MU requirements.

Tom Giannulli, MD, MS is chief medical information officer at Kareo.

Readers Write: All Vendors Exit Stage Left

All Vendors Exit Stage Left
By Frank Poggio

Stage 1 product certifications end this year — September 30 for Inpatient products and December 31 for Ambulatory. In many of my conversations with systems suppliers who are considering the next step in ONC Certification, they refer to it as “Stage 2 Certification.” I can’t blame them. I’ve done it myself.

Remember, it all started with Stage 1 two years ago, so naturally you would expect Stage 2 to follow Stage 1. But with the feds and ONC, it could never be that simple.

When ONC issued the final Stage 2 rules last year, they made a very purposeful and distinct break between Stage 2 Meaningful Use and the vendor test criteria. Instead of referring to “Stage 2 Test Criteria,” they labeled them the 2014 Edition Test Criteria. Providers are subject to Meaningful Use Stage 2 rules, while vendors seeking certification come under the 2014 Edition of Test Criteria. There are real differences  — some pretty big ones.

What I usually see is a software firm starts by carefully reviewing the provider MU Stage 2 attestation criteria since they are all over the Web. Next, they try to translate the MU list to product test criteria. Then confusion follows.

Although the MU attestation criteria for Stage 2 resembles the Certification test criteria, there are differences. For example, one big difference is a provider needs to attest to about 25 MU criteria and some Quality Measures to get the Stage 2 money. But you as a vendor need to pass on about 40 certification test criteria and nine QMS elements to become 2014 Edition Certified.

Another example: under Stage 2, a provider would attest to completing a HIPAA compliance risk analysis. That’s just one question (the answer is ‘yes’, subject to audit, of course). But for a vendor completing a certification test under the 2014 Edition, you address eight very specific tests for privacy and security.

ONC now refers to your Stage 1 certification as the “2011 Edition Test Criteria.” No more Stage 1.

A related question ties back to what I said at the top of this piece. Your current Stage 1 certification ends this year. Actually, ONC says your 2011 Edition certification ends and you must test out on the new 2014 Edition to continue to sell certified software.

As of this week, only four vendors have been successful in achieving 2014 Edition Full EHR Inpatient Certifications. Under Stage 1, there were dozens. The 2014 testing is turning out to be a real challenge for many vendors, far more difficult than I think ONC expected.
Some think ONC will extend the Stage 1 vendor certifications if they do not get enough vendors through 2104 Tests by September. That would seem a likely solution. But given Dr. M’s pointed comments about vendors “gaming the system,” I doubt it.

The reason they made the breaks between certification test criteria and MU attestation criteria is that when they decided to extend Stage 1 of provider attestation into 2014 (originally it was to die in 2013) they did not want to extent the vendor certifications as well. Why? I guess they just wanted to keep your feet to the fire.

Which raises the next question. How can a provider attest to Stage 1 in 2014 when all the vendor certifications for Stage 1 die in three or six months? Simple. ONC now allows the provider to MU attest under Stage1 using a 2014 Certified system. If you have clients or prospects that have not attested to Stage 1 and plan to do so in 2014, they must be running your 2014 Edition certified software for at least 90 days in 2014.

It seems that ONC has taken vendors off the Stage, and reduced them to simply an old Edition.

Frank Poggio is president of The Kelzon Group.

Readers Write: Asking the Right Questions: How to Find the Right Technology Development Partner

Asking the Right Questions: How to Find the Right Technology Development Partner
By Lee Farabaugh

We’ve all heard the stories. A hospital implements technology only to discover that it is so complex and confusing that it takes clinicians twice as long to get their work done as it did before, frustrating providers and patients. The hospital tries to work through the issues to no avail, and the organization ultimately abandons the software in pursuit of something else.

Money, time, and resources are wasted, and the organization is still no closer to effectively leveraging technology to improve patient care or streamline efficiencies. On the other hand, there are technology implementations that go smoothly, with providers fully embracing an application and using it appropriately.

What differentiates the good from the bad? User experience design, centered on end user input. Positive outcomes (increased user adoption, for example) occur when end users are actively involved in technology design, development and implementation.

To determine whether your technology partner incorporates user experience into its approach, there are some key questions you should ask. Getting answers to these questions can help you avoid disastrous technology roll-outs and ensure potential applications are a good fit for your organization.

Does your technology partner take a provider-centric approach by involving clinicians as key members of the development team?

These clinicians should be providers who have been actively involved in practicing medicine, so they are aware of the issues clinicians face in their day-to-day work. Getting direct input from providers who will use the system ensures that any potential roadblocks are addressed and resolved. Even if the technology you are considering is more patient-focused, clinicians should still be part of the development team. When people with medical expertise are involved in designing a patient-focused product, they can share the clinical perspective on what is possible and preferable for the technology.

How much of your technology partner’s research and development budget is devoted to garnering information about user experience?

This question can reveal the value your technology partner places on end user input. In other words, are they putting their money where their mouth is and dedicating resources to obtaining and leveraging user feedback?

Have you ever had a usability assessment on your application portfolio?

This puts hard data around your technology partner’s usability claims. By reviewing a usability assessment, you can clearly see whether providers or patients are actually using the software your partner developed on a long-term basis.

Does your technology partner have an end user group to provide ongoing feedback?

This type of forum can be a valuable source for transparent feedback about a solution. Not every software developer has the resources to sustain a user group for each of its clients, but those companies that do communicate their commitment to their customers and end user satisfaction. If your technology partner does have a user group, you may want to ask if you can attend a meeting. Although this may not be possible—some companies prefer to limit the number of attendees at a meeting—it would allow you to gain helpful information directly from other users.

Does your technology partner provide you with easy and intuitive training and support?

While some applications may be “plug and play,” most will require a certain level of training. Getting a sense of how user-friendly the training is can help provide insight around your technology partner’s commitment to user experience design across all of its materials. User-centered training may involve short videos, web-based modules or super-user mentoring. Ideally, you want to avoid day-long didactic training sessions that provide limited value and take providers away from patient care.

User experience design is the linchpin for technology adoption. Technology companies that don’t place value on user experience in the design and development process could offer products that aren’t fully usable and don’t meet the needs of your organization. As such, asking deliberate questions about your partner’s view on the value of user experience is time well spent.

Lee Farabaugh is the chief experience officer at PointClear Solutions.

Readers Write: What to Consider Before Accepting Your Next Healthcare IT Position

What to Consider Before Accepting Your Next Healthcare IT Position
By Frank Myeroff

In a competitive and growing job market like healthcare IT, it might be tempting to accept the next attractive job offer you receive. But before you do, take time to consider certain predictors that could determine whether you will be successful on the job or regretful that you took the job.

Is the organization in line with my values, attitudes, and goals?

You may have heard that people are hired for skill but fired for fit. It’s true. That’s why it’s so important to make sure you mesh with the culture of a healthcare organization. Their culture includes a combination of values, visions, attitudes, beliefs, and habits. These collective behaviors are taught to new organization members and affect the way people interact with each other and the way business is done.

What are the workload expectations?

Ask the hiring manager to address the workload expectations. There’s no doubt if you take the job that your boss will expect you to complete all your tasks on time and accurately. New hires usually want to meet and exceed organizational expectations by going over and above the job. But consider and evaluate if you have the staff support and resources you need to be successful.

Can I handle the commute to this job?

Always consider the commute to your job. Is it too far? How much will it cost? Gas? Parking? Will you need to be a “super commuter,” in other words, fly back and forth? The number of super commuters has increased sharply over the past few years. Be sure to determine your tolerance level and that of your family regarding the job commute.

What is the boss like?

Your career depends on understanding what makes the boss tick. Having a positive relationship with the boss is key to your success, but having a bad boss is the ultimate morale buster. Find out if the boss is a micro-manager or hands-off boss. Know if he or she has realistic or unrealistic expectations for employees. Find out if they foster innovation or discourage it. It’s important to work for a boss who values your efforts and makes it worthwhile to come to work every day.

What are the people like?

There may be a good reason why the job is open. Are the people the kind you want to work with, or are they the type to push buttons? For a workplace to be really great, it’s essential that you have a good relationship with your co-workers since you will see them so often, work with them on projects, or interact with them on a daily basis. For an office to be truly productive, there has to be some sort of harmony and cohesiveness.

What is the career progression?

This is an exciting time in healthcare IT. The demand for talented IT professionals continues to grow and the opportunities for advancement have never been better. The healthcare organization you join should be committed to meeting your current career aspirations as well as foster your future career path.

What is the training offered?

There is a clear, strategic value in continuously training and developing staff. Not only does it enable the healthcare organization to meet its mission, but allows their professional IT staff to stay current and ready for upcoming changes and trends. When considering your next IT position, make sure the organization places a strong emphasis on training and development for all IT levels. Training should focuses on individual needs such as job-related and specialized training and collective needs such as leadership and time management.

Before you jump to accept that job offer, remember that an offer is only half of the equation. The other part is performing your due diligence. Make sure the healthcare IT position and organization match your “must haves” both professionally and personally.

Frank Myeroff is managing partner and VP of business development and operations of Direct Consulting Associates of Solon, OH.

Readers Write: Uncovering the Unexplored Role and Benefits of Clinical Data Abstraction

Uncovering the Unexplored Role and Benefits of Clinical Data Abstraction
By George Abatjoglou

With the industry’s move to electronic health records (EHRs), healthcare information management (HIM) professionals as well as RNs must play a guiding role through implementation and beyond, seeking processes and solutions to manage the conversion of enormous amounts of historical health information into meaningful, structured data. One helpful and often underexplored strategy for getting organizations up and running smoothly on an EHR involves pre-go live clinical data abstraction.

Historically, clinical data abstraction has been used to retrieve meaningful information that exists in unstructured formats – paper or otherwise – to fill in the “holes” in the electronic chart. Typically, this occurs so an organization can perform better financial or quality reporting. However, with the current push to implement EHRs within the ambulatory setting under Meaningful Use, healthcare organizations often underutilize or completely overlook using clinical data abstraction as a strategy for jump starting the EHR rollout process. In short, by populating EHRs with these details from paper charts and unstructured legacy EHRs before organization-wide rollout, physician practices to health systems and ACOs can reap EHR benefits more quickly, while ensuring more optimal data quality and integrity.

Whether patient records are electronic or paper-based, most contain “legacy” health information that requires someone to pluck relevant data from unstructured content and incorporate it in a structured, representative history in the EHR. While you may think it sounds like copying and pasting, the medical and scientific nature of the information makes this more complicated than it seems. In other words, clinical abstraction, when done well, is best left to the experts, including trained and credentialed HIM professionals and RNs who are consistently focused on clinical data integrity in their day-to-day roles.

With practice makes perfect, and experts in this arena are skilled magicians at identifying and pulling nuggets of information that will provide practitioners with the most valuable details moving forward, especially from a continuity of care perspective. Moreover, these individuals understand data in a broader way than a coder might, and as a result, take into consideration different clinical components that shape the picture of a person’s whole health as they mine critical details for the new EHR.

Leveraging clinical data abstraction as a strategic step in EHR population can take two forms.

• Existing resources. Healthcare organizations can facilitate the effort themselves by using staff clinicians and/or hiring additional nurses, medical assistants or students to abstract clinical data.
• Outsourcing. Other healthcare organizations work with partners who embed clinical experts within the organization to facilitate the process.

Although it’s feasible for smaller healthcare organizations—community hospitals, critical access hospitals, and small practices, for example—to abstract and manage data internally, clinical data abstraction becomes increasingly complicated for larger physician groups and health systems that provide care to hundreds if not thousands of patients in a given day. When these large systems try to enlist internal staff to conduct data abstraction and enter historical data into EHRs, they are likely to run into roadblocks.

For example, relying on internal resources for data abstraction will further decrease the productivity of clinicians and HIM professionals already diminished by an EHR implementation and preparing for the ICD-10 deadline. Clinicians typically decrease the number of patients seen during the EHR implementation period in order to adjust to the new workflows demanded by the technology. A physician who normally sees 20 patients per day may need to decrease patient appointments to 12 per day and gradually work back to a normal activity level after several months. If paired with abstraction responsibilities as well, the productivity decline is often viewed as too steep.

Although it may seem counterintuitive, using internal resources also can lead to the generation of even more non-standard, unstructured data. With patient care being the top priority for clinicians, abstracting clinical data and entering historical information may not always be executed in the same way as a full-time abstractor whose sole focus is on that one task, guided by standardization across every record. While some data is better than none, the benefits of unstructured data within an EHR are not much different than working with paper-based records, which defeats the value of EHR implementation.

An EHR implementation can only be as successful as the quality of its data. As the saying goes, “garbage in, garbage out.” Regardless of an organization’s decision to use internal or external resources, clinical data abstraction overseen by seasoned HIM professionals and supplemented by knowledgeable RNs offers several benefits—some of which are more heavily weighted in the interest of utilizing outside consultants:

• Improved data integrity. As healthcare organizations go live with EHRs, data need to be organized in a structured and sustainable format to provide consistent core medical content for clinicians across all patient records.
• Increased patient safety. When data consistently and accurately reflect patient conditions in a streamlined, structured format, EHRs become easier to navigate from a decision-making and care management perspective, contributing to increased patient safety and care quality.
• Enhanced productivity and satisfaction. By relying on outside experts rather than tapping internal resources to abstract and enter historical data, clinicians’ time is maximized and remains focused on providing patient care, while internal HIM professionals are able to focus on other mission-critical tasks like ICD-10 training.
• Better patient experience. Tasking clinicians to enter data does not add value to the delivery of care, nor does it contribute to the clinician–patient interaction. Unfortunately, with the learning-curve that often accompanies EHR implementation, a patient appointment can become rather data-driven and impersonal if clinicians spend more time looking at the computer screen than their patients. Using data abstraction experts allows physicians to maintain a positive “human” interaction with the patient, a critical component to meeting patient expectations.
• Higher return on investment. No matter who facilitates it, there is an absolute cost associated with abstracting clinical data. Outsourcing the process does carry an initial expense, which may then be recouped by physicians’ sustaining their activity loads. On the other hand, revenue lost through decreased provider productivity when clinicians are tasked with performing data abstraction may not be regained. Cultivated by the improved patient experience, outsourcing the clinical data abstraction effort may also lead to additional gains such as practice expansion and patient retention.

The number of provider choices for patients is multiplying and steering healthcare into a more consumer-driven model. The healthcare organizations that thrive into the future will be the ones that safeguard data integrity and use it to streamline the physician/patient interaction. Tapping into the data management expertise of HIM professionals in particular and using clinical data abstraction to improve data quality, patient safety, and clinician productivity is one key to providing a positive experience for patients and clinicians alike – both throughout and beyond an EHR implementation.

George Abatjoglou is CEO of IOD.

Readers Write: My Tradeshow High Horse

My Tradeshow High Horse
By Annie Oakley

Perhaps you’ve read HIStalk posts in the past – particularly after HIMSS – lambasting the poor showmanship of exhibitors at tradeshows. Eyes down, phones on, beckoning smiles nonexistent.

You may also have read subsequent reader comments from said exhibitors attempting to explain away their need to ignore attendees for the sake of an incoming service call. I get it. Everyone has multiple jobs to do while at a conference. I’d be surprised to find a healthcare professional – provider or vendor – who doesn’t wear multiple hats these days and gets taken advantage of by 24/7 connectivity.

But, like many others out there in HIStalk land, I say turn your phones off when you’re in the booth. If you need to take or make a call, exit the exhibit hall.

I’ve been on both sides of the booth at tradeshows over the years, and so I feel qualified to get up on my high horse for just a few more paragraphs about my recent trip to the HFMA ANI show. It was an experience that left me optimistic about the tradeshow experience overall, but left me with a bitter taste in my mouth on more than one occasion.

The HFMA staff and volunteers were incredibly helpful, always had smiles on their faces and good attitudes to back them up. The majority of exhibitors that I had a chance to approach were pleasant to speak with. Some were downright engaging, leaving me with lasting positive impressions of their employees and brands. Most were extremely patient in explaining revenue cycle concepts and challenges – not easy completely absorb on first go round.

The “booth babe” phenomenon continues to die a slow death, unfortunately. I found out during an educational session that HFMA membership is 60 percent women. Do exhibitors really think they’ll attract female attendees with models dressed up in racing gear? I saw one male attendee look happy enough as he posed for pictures with them, and I shook my head in shame. Is that really how you want to get your leads? Is that really the impression you want to leave people – mostly female people – with?

Drew Brees was on the show floor for a time signing autographs, an attraction which drew a few dozen folks into a line that crisscrossed the exhibit floor. Now that’s a way to create buzz without alienating anyone.

One more comment, then I’ll get off my high horse. Exhibitors, please don’t be stingy with your giveaways. You and I both know that come the last day of the show, you’ll be moaning and groaning about having to ship them back. I approached one booth BECAUSE of their unique giveaway, but was immediately turned off when the rep, thinking I’d already been by, gave me the cold shoulder. I pleasantly explained to him that we had indeed conversed the day before, but I had not acquired any of his trinkets. He apologized – sort of – and actually said he hates having to talk to people twice! Buddy, if you don’t like talking to people twice, maybe you shouldn’t be in sales.

This particular conference was a great experience for me overall. The positives far outweighed the negatives. But, it’s true what they say: one bad apple can spoil the tradeshow bunch.