Readers Write: The Shady Side of Value-Based Purchasing

The Shady Side of Value-Based Purchasing
By Data Nerd

Beginning October 1, 2013, CMS is implementing what it is calling “Value-Based Purchasing.” As a lifelong policy student, I cannot help but admire the mathematical and administrative intellect behind the program.

Even politically speaking, it has a stroke of genius to it. The funds come from a pre-determined source (starting at 1 percent of reimbursement payments) and the payouts cannot exceed a set amount (said 1 percent of payments). This is achieved by several stages of normalization, where scores are weighted and examined as part of a ratio rather than on their own merit. Hospitals can earn in excess of their 1 percent withheld payments either by improving their own scores over time or scoring better than the other hospitals participating in the program. This differential is then weighted and reweighted to ensure that payouts never exceed the 1 percent amount withheld from all participating hospitals. Awards are all dependent on industry performance as a whole, since the same sum of money will be awarded overall even if every hospital had perfect scores.

CMS is to be commended on the clear and concise way they made the details of the program readily available, providing everything from a slide deck to a recorded provider call to walk through examples. But that is where the understanding (and compliments) end for this data nerd.

By sharing all of the plans for the program, it was easy to get the impression that numbers could easily be crunched from data that is already open. However, open data sources cover quality metrics that were taken over measurement periods that differ greatly from the measurement periods being used by CMS to calculate awards and penalties. Even though we’re talking about the same metrics, we have different reporting periods, so the data is not going to be the same.

One could argue it is another stroke of administrative genius to craft a program then ensure that no one has the data needed to either predict or verify financial outcomes. Based on the latest release of quality data, none of the open datasets are compatible with what CMS will be using to perform VBP calculations (in green and yellow). Some data have yet to be released, while other archived datasets use different timetables, making it impossible to determine hospital eligibility for the program. MedPAR data could theoretically be used to calculate reimbursement withholdings, but without knowing which hospitals are eligible, it makes it impossible to predict which will participate, much less any other aggregate observations (will more hospitals lose than gain, will losses or gains be great or small, etc.).

With all of the talk about transparency, this whole program looks shadier to me with each passing fiscal year.

Readers Write: Misconceptions About the Health IT Workforce

Misconceptions About the Health IT Workforce
By Helen Figge, R.Ph, Pharm.D.

There are many misconceptions out there about workforce development in healthcare IT today. As technologies become introduced into the various healthcare settings to support quality healthcare, it is always assumed that one needs an advanced certification, advanced degree, and advanced resources to implement and support these technologies.

Well, yes and no. For viability if nothing else, these added career efforts are valuable, but truly viable workforce development plans in healthcare IT need to evolve and grow from the bottom up. You don’t make a cake by starting to put the sprinkles together before baking a solid foundation – the cake. The same holds true in the workforce of healthcare IT today.

Many now understand that the backbone to the evolution of the demand for “skilled “workforce today is due in most part to the electronic health record (EHR). Thanks to visionaries like Glen Tullman who positioned the EHR front and center in healthcare discussions, the healthcare market now realizes that the real need in the workforce today involves an understanding of the implementing, programming, interconnecting, and relationship of the EHR to clinician workflow.

One of the backbones to any workforce development plan is continuing education in helping to shape and evolve the IT workforce. Continuing education programs commonly exist for physicians, nurses, and pharmacists. However, there is very little formal infrastructure in place to provide continuing education to the IT workforce. A true educational program for any workforce entity that is sustainable and viable long-term needs to understand the “how” and “why” of the tasks at hand and then educate from that vantage point. 

How would you measure true workforce healthcare IT success? That is yet to be determined, but for all practical purposes, if you don’t understand clinician and healthcare workflow from its various angles and nuances, then you won’t be able to create a viable and competent overall workforce to support the needs out there today. The future of the health IT workforce rests in the hands of those clinicians that adopt the technologies, and in turn, the measurement of success will depend on having critical knowledge about the exact needs of these end users. There is no substitute for knowledge past to bring in the future direction.

The most realistic approach for a viable workforce development program is for organizations to recruit to their organizations and then create loyalty factors for the employees. This in turn provides a base of employees that an organization can draw from for an expanded workforce need. No one really knows the future skills needed in the healthcare workforce, but if an employee can use an iPad or their Android, then they have the potential to learn healthcare IT.

The wave of the healthcare future is mobile applications. You would be surprised how many individuals out there use technologies for various purposes that are non health-related. To get a trained workforce in healthcare IT, maybe we train these individuals through “gaming” learning from such gaming wizards like John Gomez, former CTO for Eclipsys.

Organizations should consider grooming from within and cultivate the talents of motivated employees to fill the voids being felt in today’s healthcare IT marketplace to fill the immediate voids, but also helping to create loyalty programs and career transition pathways for employees. Also, you would be surprised how many prior work experiences are much underestimated in the workplace today. Consider engaging individuals who might have soft and transferable skill sets from other previous positions, encourage them to create new ideas for the healthcare workforce and develop opportunities for long term employment.

There is no nirvana in the formula for developing a healthcare workforce, because if there were one, we would not be hearing endless complaints about not finding “qualified staff” for vacant positions. Groom from within, because healthcare is a forever changing process. It has to be because medicine is an evolving entity, so the skills we are seeking out now may be obsolete in a few years, but if you invest in the person from the ground up, the cake is well baked, so when it’s time for the sprinkles, the final product will look just right.

Helen Figge, BS, PharmD, MBA, CPHIMS, FHIMSS is a principal with Figge Workforce Development.

Readers Write: Five Ways to Improve the Healthcare User Experience

Five Ways to Improve the Healthcare User Experience
By Dan West

Unstructured information — the content that resides outside your organization’s core systems and processes — plagues practically every healthcare organization. For patient care, it’s the 25 percent of patient information – paper or electronic – that exists outside your EMR. In patient finance, it’s the data outside your billing and financial systems. And in accounting, it lives beyond the reach of your ERP system.

But why is unstructured information an issue and how can effectively managing it improve the user experience? Here are five steps to improve user experience at healthcare facilities.

Step 1: Identify it

Before you think of ways to better manage your unstructured content, you first need to understand what it is. For each organization, this content can be a different assortment of documents and information collected from all departments.

For example, in care delivery, unstructured content can be everything from faxed orders and diagnostic images to the actual paper chart. In accounting departments, invoices and the information surrounding specific financial transactions often exist as unstructured content.

The list goes on, but the key here is to understand the nature of the unstructured content each department faces.

Step 2: Get it out of the way

Odds are, paper and other physical content like faxes, EKGs, photocopies, and patient charts are in someone’s way. Sifting through a stack of faxes for that one piece of paper a nurse needs leads to frustration, reduces time spent caring for patients, and increases the likelihood that another piece of information may be lost or misfiled.

Even if your organization’s paper content is safely stored in a central filing location, that storage costs money and space that might be better allocated to patient care. An enterprise content management solution can help by allowing you to capture the diverse range of information and content within your organization – paper, faxes, diagnostic and digital images, insurance cards, patient IDs, and more. Capturing this content eliminates physical storage and management reducing frustrations about finding information and saving on storage and filing costs.

Step 3: Put it somewhere safe

Capturing that unstructured content is only the beginning. Now the question becomes — where you will put that information? An ideal solution will provides you with a single, secure repository for electronic storage of this unstructured content, reducing complexity in your IT environment by eliminating disparate, disconnected content silos.

Unstructured information also poses a security risk. Storing content in a secure location reduces the risk of a HIPAA violation while at the same time providing audit trails that make compliance with Joint Commissions, Sarbanes Oxley, and other initiatives much simpler.

Step 4: Make it easy to find

For this content to be useful, the people who need it should be able to find it easily and quickly. When integrated with an organization’s core applications, ECM solutions provide instant access to content within those systems, often with a simple click of the mouse.

For clinicians, that means finding information once in paper charts quickly within the EMR. For those in patient financial services, it means finding transactional billing data within the billing system instead of on an EOB or isolated EDI transaction. And for those in finance and accounting, it means finding an invoice within the ERP system.

Step 5: Send it where it needs to go

The last and final step helps people work more efficiently. Using electronic workflows will direct content to the appropriate staff based on rules you define is. For example, in HIM, coders and analysts receive electronic charts on the basis of encounter type, complexity, facility, or any other criteria suited to that department. In accounting and finance, invoices route to the appropriate approval channels based on amount or invoice type. Users work more efficiently within predictable parameters, ensuring processes run more smoothly and efficiently.

Conclusion

Unstructured content, regardless of its form, leads to user frustration. Following the steps outlined above will help your organization turn a source of annoyance into a point of efficiency. That, in turn, leads to happy users – users who understand the value of the systems and services your IT department delivers and supports.

Dan West is healthcare solutions manager at Hyland Software of Westlake, OH.

Readers Write: Buy or Build: SaaS Can Make Sense for Meaningful Use Reporting

Buy or Build: SaaS Can Make Sense for Meaningful Use Reporting
By John Hotchkiss

The trials and tribulations of Meaningful Use (MU) have given new meaning to the lives of many of us in IT, and often not in a good way. An average 250-bed community hospital submitting its 90-day attestation report must process roughly 3,000 records covering approximately 13,250 patient days, using nearly 300 data elements per record for core and menu measures with up to 600 data elements in each record in support of the clinical quality measures. That’s a tall order.

With a demand for codified and structured data, clearly MU attestation is a different animal than your typical federal report. As a result, most hospitals inevitably face the question of whether to build or buy an MU reporting system, with the possibility of a vendor SaaS-based system taking many of the headaches out of the process.

As a technology professional, I have had exposure to both solutions, and thought I would shed some light on the issues for those still searching for an answer.

Whether for a homegrown or vendor supplied solution, the first steps in report set up are choosing the measures to report and deciding between the various reporting options. To make informed decisions, every data element for Core, Menu, and Clinical Quality Measures has to be reviewed by staff to determine how the hospital wants information to be captured and presented.

Consider, for example, the base population for core and menu measures. Which method will the hospital use for selecting the Emergency Department (ED) patients to include with inpatients in the population? The choices include the Observation Services method, which uses only patients admitted for observation with the appropriate HCPCS code, or the All ED Visits method, using all patients admitting to the ED in the reporting period. The EHR capabilities available in each location inform this decision and drive many others that follow. For example, if the hospital chooses the All ED Visits method, is the ED actually documenting the required BMI and other data elements for all the measures? Must hospital staff be re-trained to do so?

Here’s the fork in the road: to create an in-house solution, IT folks must create a data map to see what fields the MU report needs, determine if those fields currently exist within the modules of the EMR, and then confirm that they are in the required MU format. Very often, IT needs to create new fields or modify existing ones.

Also, multiple modules must be examined because fields often span multiple system components. Without exaggeration, managing that initial data mapping to support the attestation report could take months, not to mention enduring the headaches of ensuring care management staff comply with appropriate data input.

Now finally, your reports are generated. Unfortunately, the first time around, data often fails to meet thresholds. So it must be determined whether this is a problem with the data or whether caregivers are simply not entering the required information in the correct format. This forces IT staff into detective mode to identify and fix the problems.

Applause, applause – the final report is created and filed. Not so fast. This leads to the nightmare of storing hundreds of thousands of auditable data elements and estimating MU storage requirements going forward. Estimates are that a 365-day attestation requires 3.6M to 7.2M data elements. Where will IT store all that data? And, how will the security issues surrounding sensitive patient information be managed? These are the types of issues that keep IT staff up at night.

A SaaS-based MU solution may be a good choice for many hospitals, particularly smaller community facilities without the bandwidth to support all of the above. With multiple challenges, offloading some of that burden makes sense.

Many hospitals will have already determined on their own the measures and reporting options they will use and the information format that required. With that behind them, some SaaS vendors have sophisticated data mapping guides to help hospitals analyze data right from the system itself to identify reporting gaps, to ferret out the problems and to determine information to be added or modified.

Some SaaS vendors can also extract the hospital’s data directly from all system modules to leverage data that the care providers are already entering, thereby eliminating duplicate data entry – a benefit that cannot be overemphasized. Also, some vendors cannot only identify whether measures are in compliance, but can also determine why measures may be failing and help the hospital take steps to correct the issue. As a result, patient care and hospital processes see immediate improvement while the patient is still in the bed.

Of course, with the SaaS solution, users enjoy all the model’s inherent benefits including elimination of software and hardware management, simplification of interface and upgrade management, and unlimited scalability for storage and computational capacity. Obviously some hospitals are just more comfortable with building MU reports themselves and retaining complete control over their data and the process. But for others, SaaS may be just the answer they seek for MU reporting and attestation.

John Hotchkiss is chief technology officer of IHM Services Company.

Readers Write: The Cost Savings Realized by Single-Platform Solutions

The Cost Savings Realized by Single-Platform Solutions
By Deborah Kohn

Medicare cutbacks, increased mergers and acquisitions, and declining revenues and margins are daily realities for healthcare provider organizations. Yet so are costly and often mandatory IT initiatives, such as replacing or implementing electronic health and financial record (EH&FR) systems, integrating and securing the next mobile form factor of computing devices, converting to ICD-10 for reimbursement purposes, and meeting the Affordable Care Act requirements.

How does a CIO not compromise on health information technology (HIT) delivery and still maintain cost containment priorities?

A well-developed, single HIT platform strategy for most applications can realize cost savings by optimizing the IT infrastructure, regardless of whether the platform resides on premise or in the cloud. For purposes of this article, a single computing platform is defined as one that provides a database and set of technologies across a set of heterogeneous applications.

However, still many provider organizations acquire and deploy heterogeneous applications that could be built on a single, common platform. Consequently, this approach continues to generate silos of systems that cannot interoperate and to burn holes in IT operating expense budgets.

Thankfully, no longer is the HIT industry faced with an abundance of best of breed EH&FR applications, typically with each sitting on top of its own proprietary computing platform. Top-selling EH&FR solution vendors finally are offering one or — at most, two — unified platforms for the myriad, structured data-based EH&FR applications.

On the other hand, today, many solutions that complement EH&FR systems remain siloed. Such solutions worth mentioning for this article include but are not limited to Picture Archiving and Communication Systems (PACS) solutions for the storage of image-generating “ology” applications and Natural Language Processing (NLP) solutions for applications such as speech recognition, computer-assisted coding (CAC), and business intelligence (BI). By deploying a single storage platform for PACS solutions or a single NLP platform for speech, CAC and BI applications, chances are that the platform will be around longer than any application an organization has today.

For example, when developing a strategy for managing all the image-generating “ology” applications in the enterprise, it behooves the provider organization to consider a vendor-neutral archive (VNA). This poor choice of name for a storage platform (a more appropriate name might be a PACS-neutral or image file-neutral archive) stores all the heterogeneous, enterprise modality images (DICOM and non-DICOM) in a single, replicated archive. This eliminates the need for each costly, siloed PACS archive and, more appropriately, changes the “A” In PACS from “Archiving” to “Accessing.”

Typically, the platform includes tools to help manage all the different lifecycles of the image data (e.g., retention scheduling and purging mechanisms). And, perhaps the biggest benefit to clinicians is that this platform allows for the creation of an aggregated, patient-centric record of all the enterprise images.

A VNA platform is expensive, requiring a large, complex, capital-intensive project. But well thought out strategies for deploying this platform over time have proven that significant cost savings are realized. Eliminating the organization’s most costly departmental PACS operating expense — recurring migrations with storage media migrations typically occurring every three to four years and PACS replacements requiring massive proprietary data migrations, typically occurring every five to seven years — alone cost justifies this single platform solution.

When developing a strategy for deploying diverse yet complementary EH&FR applications such as speech recognition, CAC software, and BI, it behooves the provider organization to leverage a single NLP platform product that manages each of these technologies well. All NLP engines perform some type of pattern matching, and  to varying degrees, incorporate both rules-based and statistics-based techniques. That means that a plethora of applications can be developed using a single NLP platform.

These applications include but are not limited to speech to text (dictation systems), text to code (medical coding), data analytics (data warehouse systems), foreign language translation (Google Translate), question and answer (IBM’s Watson playing Jeopardy), document classification (Outlook’s spam filtering), candidate identification for clinical trials (determining eligible candidates), adverse events (patients with gunshot wounds), core measures (patients who already had been treated), geographic disease epidemiology, and on and on.

At HIMSS13, several complementary EH&FR application vendors were demonstrating more than one heterogeneous application using a single NLP platform. Currently the challenge is that not one vendor offers most of the above applications or even the same applications. Where one vendor might offer medical coding and data analytics using a single NLP platform, another vendor might offer data analytics and candidate identification using a single NLP platform.

For cost justification and interoperability purposes, it behooves provider organizations to strategically look under the hood and determine where a single NLP platform can be deployed.

Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, CIP is a principal with Dak Systems Consulting.

Readers Write: Optimization and ROI on HIT Investments

Optimization and ROI on HIT Investments
By Dave Vreeland

During HIMSS 13, our company had the privilege of bringing together a select group of HIT executives from some of the nation’s leading health systems for a breakfast discussion. The food was impeccable thanks to Chef Donald Link. The topic was measuring and maximizing ROI on HIT investments.

While incentive dollars offer a simple measure of ROI on the revenue side of the ledger, this represents only one aspect of the substantial benefits clinical systems can yield. The takeaway: a proper optimization program with broader consideration for the projects comprising it can bring a truly positive return to healthcare organizations over a 10-15 year period if properly considered and executed.

Since the passage of HITECH four years ago, we’ve seen vast deployment of clinical information systems across the country, many of which were highly accelerated in the rush to meet Meaningful Use and other regulatory deadlines. We’ve also seen these accelerated implementation projects, both successful and troubled, spawn subsequent optimization efforts, some focused on resolving original implementation issues and some focused on achieving benefits that could not have been anticipated earlier and became evident only after a wide audience of end users was actively working within the system.

We have learned whether an organization approached its baseline implementation strategically, with a focus on workflow and clinical quality goals, or took a more tactical approach targeted toward achieving minimal Meaningful Use and maximizing HITECH incentive payments, is unimportant in the broader scheme of things. The key lesson is that an overall program of work that includes a well-executed, relatively rapid initial clinical system implementation followed by a program of closely monitored optimization projects will maximize the financial return and other benefits.

Over breakfast, we shared a number of lessons learned when it comes to measuring the return on HIT investments:

• Implementing clinical information systems is a significant investment that brings significant value.
• Models to accurately reflect both the costs and the return on these technologies are developing, but this work is complex.
• In order truly maximize the return on these investments, healthcare organizations must view the implementation effort more broadly and make optimization an organizational-wide operation.
• Optimization is critical in achieving a return on HIT investments.

Dave Vreeland is a partner with Cumberland Consulting Group of Franklin, TN.

Readers Write: Epic’s MyChart Signup

Epic’s MyChart Signup
By Anonymous

To borrow from a physician’s comment, “When technology understands what people want from healthcare, our system has a chance. “

Last week while at my physician’s office, I signed up for MyChart. Since my healthcare provider organization went live on Epic about four years ago, my experience from a patient perspective has deteriorated significantly, becoming worse each year. I suspect this is also a result of cost-cutting actions and trying to do more with fewer people. 

My primary physician is terrific, but even she seems to now be distracted by data entry during our annual visit. I took my question list in and we talked about them.  She entered data and then I got home, realizing a couple of the issues were not ultimately addressed with a proposed solution, both of us sidetracked by data entry.

I have to say that I was totally underwhelmed by MyChart.

All I could really see in the record was a list of my meds, the ability to request a refill, and my most recent vaccines. The Health Summary stated that I have no "Health Issues," yet I was referred to a specialist for more tests and treatments.

Test results: I could not view any of my labs  or history of lab results. The message said, "On occasion, there are minor abnormalities reported with patient lab tests which are not significant. Any significant abnormalities will be addressed by your physician, who will give you the appropriate instructions.”

Medical history:  under Diagnosis, there was "anesthesia." I wonder if that diagnosis is for appearing "anesthetized" while navigating my healthcare?

There was more history on my parents than on me in MyChart.

Appointments: they did score here. My past and future appointments did appear. But to schedule the appointments, I had to go through nightmare IVR. One appointment scheduling system left me on hold for 11 minutes before reaching a person to schedule.

I received my first electronic message from one of the specialist’s assistants I am seeing. It was annoying to open the e-mail to find I have to go into the portal (yep,now what is my user name and what is my password…I have forgotten) to merely see an e-mail they sent with a link to an online education for a procedure, easily available to me if I Googled the topic. I was annoyed by the required time to retrieve message and the fact I thought it might be important and require my immediate attention. And later, to go back in to send a response.  

So I didn’t send an electronic response — I called them back. This "assistant" seems to know very little about the procedure. Every time we speak, there is a new tidbit of info which impacts my planning and what happens pre- and post-procedure. When I asked her why I wasn’t told this before, she responded, "I am just reading it now.”  

I still have no clear answers to questions I am posing as an informed healthcare consumer and advocating on my own behalf. I cannot imagine how my parents would navigate through this. In fact, they would not be able to do what I am having to do and would have been no-shows. 

Although I have now signed up for this revolutionary change in healthcare, I see minimal benefit to electronic messaging. I would put money on my actual physician not likely choosing to communicate with me through this portal in the near future.

Readers Write: The Economics of Google Glass in Healthcare

The Economics of Google Glass in Healthcare
By Kyle Samani

Google Glass is a fully-featured modern computer running a derivative of Android that fits into a glasses-like form factor that rests comfortably on your face. That includes CPU, RAM, storage, battery, a heads-up-display, a microphone, camera, speaker, WiFi, GPS, Bluetooth, and bone conduction technology.

Although Google has been shy to admit it, Glass will have some form of bone conduction technology so that you – and only you – can hear. Of course, you’ll be able to take a picture of or record anything at any time and transmit that data to the entire Internet wirelessly in real time. It’s quite an extraordinary technological breakthrough.

A lot of people think Google Glass can be used as a development platform to create amazing healthcare apps. So do I.

Many of these ideas are obvious, and many of them could be relatively simple to develop. But we won’t see most of them commercialized in the first year Glass is on the market, maybe even two years.

The most obvious analogy to Glass is the iPhone. It’s a revolutionary new technology platform with an incredible new user interface. Glass practically begs the iPhone analogy. Technologically, the analogy has the potential to hold true. But economically, it does not. Because of the economics of Glass, many of these great ideas won’t see the light of day any time soon.

First, there’s the cost. Glass will run a cool $1,500 when it lands in the US this holiday season. There’s no opportunity for a subsidy because Glass doesn’t have native cellular capabilities.

Second, and even more importantly, Glass needs to prove compelling given that you already have a pretty incredible smartphone in your pocket. When the iPhone launched, it competed with the non-consumption of 2007: dumb phones. Glass has to compete with a whole new class of non-consumption: iPhones and Androids. That means Glass has to be so incredible that you’re willing to spend $1,500 given that you already have an amazing smartphone in your pocket. Glass only provides marginal value. It’s a tough sell.

Take another look at the Google link from earlier in this post. Would you pay $1,500+ for any of those individual applications? Probably not. As a hospital CIO, would you pay $1,500+ per employee for hundreds of employees for any of those applications? Probably not.

Although these are all good ideas, the vast majority of Glass ideas aren’t compelling enough to justify the cost of Glass itself. This is inherently true in all Google Glass application markets, both consumer and enterprise. It’s especially true in healthcare given the additional costs of integrating into existing systems and processes.

Doctors in outpatient clinics face a similar challenge. Though some physicians, and perhaps some surgeons, will shell out $1,500 early on, most doctors won’t be willing to commit that kind of capital. I’m sure many physicians would feel concerned about making their patients feel socially uncomfortable, even if a given application proves clinical and financial ROI. But at some point down the line, doctors will probably adopt a Glass-like technology platform, especially with something like the MYO Armband. The human computer interaction (HCI) opportunities with a Glass+MYO armband are endless.

Over time, an increasing number of Glass healthcare apps will become available and the price of Glass and its competition (I’m looking at you, Apple. Also, learn why there will be no iWatch) will fall. Eventually, healthcare app developers writing on Glass will find success, but very few will in the first year Glass is on the market.

That does not mean that the Glass ecosystem is destined for failure. Glass has the potential to solve big problems. Capitalism dictates that app developers will figure out how to use it to solve big problems.

My favorite VC proverb is, "Provide pain pills, not vitamins." For every painkiller Glass app, there will be dozens of vitamins. The painkillers will drive the success of this platform. No one needs to buy Glass. But Glass can help people and create new efficiencies in enterprise markets such as healthcare, education, manufacturing, transportation, construction, gaming, tourism, and many others.

I’m incredibly excited about Glass. It will change the world. Maybe not in its first year on the market, but it will. No one thought much of the iPhone in its first year on the market, but it delivered a revolutionary new user interface and provided a new technology platform that app developers will extend to solve an enormous number of previously unsolvable problems. Glass will, too.

Glass developers, off to the races!

Kyle Samani is inpatient deployment manager at VersaSuite of Austin, TX.

Readers Write: Get Ahead with Mobile Job Hunting

Get Ahead with Mobile Job Hunting
By John Yurkschatt

According to a recent report from The World Bank, three quarters of the world now has access to a mobile phone. In addition, ownership of multiple mobile devices is becoming increasingly common, suggesting that their number will soon exceed that of the human population. Unbelievable, right?

Recently, at HIMSS, I encountered numerous people who were there to network about jobs in the industry. While speaking with many, I couldn’t help but notice that they were checking their smartphones often during our conversation. It became apparent that they were engaged in mobile networking at HIMSS as well. In fact, today’s job seekers are avidly using the following job related functions on their smartphones:

1. Search for jobs

2. Receive e-mail job alerts

3. Read about recruitment process and tips for interviewing

4. Apply for jobs

5. Share content on social networks such as Twitter

In the age of mobile technology, the job hunt is only a click away. The rise of mobile technology is changing the face of how job seekers conduct their search and how employers and recruiters are reaching out to top talent.

Savvy job seekers are using a number of mobile apps. I found three apps to be extraordinarily powerful for the job hunt and for meeting those people who have the jobs:

Hidden Jobs

This app provides you with job opportunities that are not posted on the company website. It tracks close to 2 million unadvertised jobs from companies that are growing and making headlines. In addition, if you are ever seeking a job at a particular organization, or within a geographic area, you must try Hidden Jobs.

LunchMeet

According to its site, LunchMeet is a great tool for talent hunters; job seekers; career development professionals; entrepreneurs; people who seek or offer free consultation over lunch or drinks; business school students; business development, sales, and marketing people; and anyone who is interested in strengthening and expanding their professional network.

Sonar

While this app is not necessarily a job search tool, it is the ultimate app to have while attending a conference. In fact, some job networkers at HIMSS found this app handy. Having Sonar enables like-minded individuals to easily connect while attending a conference, or within a certain geographic location. If I were in a networking frenzy, I would turn on my Sonar app and look for folks with similar interests. It is a great way to meet people you may have not known prior to arriving at the conference.

Let’s face it, mobile technology is changing the way people search for jobs and the way companies search for talent. It will only grow in popularity. Get a step ahead, or maybe, don’t get left behind. Take your job search mobile.

John Yurkschatt is project coordinator with Direct Consulting Associates.

Readers Write: The Chasm Between the Vision and Reality of Big Data

The Chasm Between the Vision and Reality of Big Data
By Ed Park

I attended the Bloomberg “Big Data” Conference in DC on Thursday, March 14. It was awesome. Folks from big business, big government, and beyond attended. Everyone was talking about the perils and opportunities of data – big data. As one executive creatively stated, “Data is the new oil, and what we want is the gold.”

I was lucky enough to take part in the healthcare panel. In short, my point of view is that healthcare desperately needs to attack and improve its many inefficiencies — much like how Walmart and FedEx have done — before it can successfully leverage big data to drive clinical enhancements. If we can’t get the simple stuff right— ensuring we follow up on lab orders, getting through Meaningful Use, etc. – we have no hope of getting to all of the great things we know are possible.

Athenahealth has brought insight and analysis to the way insurance claims are processed to ensure that the creation of claims and billing in general is streamlined. While this concept might seem simple, it has a powerful trickle effect. If physician practices can get claims and billing in order, they gain valuable time and resources to focus on care.

I tried to talk about the power of data in a tangible way by approaching the conversation from a “first things first” perspective. I tried my best to detail how data can be used to support primary care physicians’ workflow by selectively involving mid-level practitioners and administrators to take on tasks that doctors shouldn’t be doing. This in turn allows doctors to be fully present with patients.

To the dream-filled audience who perhaps thought the time for robot-driven care delivery was near, my goal was to keep it real by saying there is “no greater distance than the chasm between the promise of big data and where we are today.” The applications that healthcare needs to focus on first when it comes to big data are practical things: being more efficient, making administrative process fail-proof, identifying patient populations that are the most sick and most expensive, understanding what’s working and what’s not in the provider workflow, understanding the way patients act (or don’t act) based on a doctor’s order.

With this focus (to be more efficient), in time we’ll be better able to open the doors for healthcare to tackle data-driven clinical intelligence and improvement.

The future of big data in healthcare is bright. There are grand opportunities for patients and the industry at large as vendors, government, and health systems begin to embrace the idea of and build an infrastructure to support broad-based data liquidity. It is from this data openness that patients and providers will be empowered to take control of information to direct the health-related decisions they make.

It was mentioned at the conference that big data is not new, but what is new is “big, fat, messy, distributed data.” The challenge and opportunity is to bring together data to drive change based on evidence, with confidence.

Ed Park is chief operating officer of athenahealth of Watertown, MA.

Readers Write: Improving Patient Outcomes with Real-Time Decision Support and Analytics in the “Connected Home”

Improving Patient Outcomes with Real-Time Decision Support and Analytics in the “Connected Home”
By Fauzia Khan, MD, FCAP

Over the past decade, technology innovations have continually pushed the boundaries in the healthcare industry. Patient information in the hospital and ambulatory settings is now easily accessible through EHR/PHR systems and sophisticated Health Information Exchanges (HIE). With the addition of clinical decision support (CDS) and real-time analytics, clinicians are empowered to develop the best treatment plans for each patient, using intelligent and actionable information to improve care quality while reducing costs.

The mandate to embrace these technology innovations has been driven by federal government regulations, as well as disruption of the fee-for-service model. Although we have just barely embraced this model in the clinical world, what if these technology platforms could also be effectively used in the home setting?

With clinical decision support, patients could take a more active role in their own care. If the last decade was focused on inpatient, outpatient, and ambulatory data integration and interoperability, the next several years should focus on creating the “Connected Home.”

Data at the point of care in the home should be actionable, comprehensive, and increasingly accessible to patients, physicians, and payers. Whether that data is delivered through an HIE, EHR, or a smart device, patient data needs to be accurately captured and widely available, which will allow for the best healthcare decisions to be made. In time, once we move treatment closer to the individual, this will close crucial gaps, provide greater visibility, and accelerate decisions that lead to better outcomes.

All over the world, people want to be involved in their own care while remaining in their homes. Patients can receive attentive care in a comfortable environment, which ultimately improves their quality of life. If successful, home management will result in fewer urgent medical interactions and a reduction in hospital visits. In a recent Wall Street Journal story, the article demonstrated how the hospital-at-home concept is helping to take care of sick patients in the comfort of their homes.

With mobile technologies, ubiquitous Internet, and smart devices, the boundaries between home, hospital, and ambulatory and long-term care facilities will blur. Today, once data is captured through EHR, HIE, PHR etc., the next step is to make that information actionable.

With patient-specific and real-time information accessible at the point of care (the definition of which will also change), physicians could better manage common chronic conditions and patient populations. In addition to clinical decision support (CDS), another necessary layer to develop would be around analytics. CDS would empower clinicians to make more informed, evidence-based decisions, while real-time analytics would allow clinicians to view and analyze at-risk populations from both a preventative and interventional perspective. Analyzing patient populations and outcomes provides vital information for physicians that can significantly impact patients by triggering earlier interventions, reducing avoidable errors, and improving overall health outcomes.

A fully realized “Connected Home” is still in development, but it is certainly within reach. As we strive for more integrated technologies across hospitals and lab systems, we need to also spend our resources on developing a home network that can provide evidence-based data and real-time alerts to providers, patients, physicians, and even network managers. Once this integration takes place, the healthcare industry can focus its attention where it belongs—on better managing patients and populations.

Fauzia Khan, MD, FCAP is chief medical officer and co-founder of Alere Analytics.

Readers Write: Vendors – Welcome to the World of HIPAA

Vendors – Welcome to the World of HIPAA
By Frank Poggio

For the last decade or so, vendors were on the fringes of the HIPAA regulations. Just sign a somewhat innocuous BA agreement and let the provider worry about the details of compliance.

As of January of this year, the Office for Civil Rights (OCR) formally “invited” vendors into the HIPAA labyrinth of rules and regulations. In the new 500-page HIPAA Omnibus Final Rule, Covered Entities (providers) are required to send out new Business Associate agreements to their suppliers and vendors. You should get yours soon, and as an IT supplier, you will see several new requirements.

The biggest one is that system vendors that touch Protected Health Information (PHI) in any way must agree to commit to achieving full compliance with HIPAA rules by September 23, 2013. Touching means  coming in contact with — whether you create, capture, edit, change, store, pass on, reformat, convert, etc. a single piece of PHI even for even one patient. The HIPAA rules do not differentiate between full EHR systems, EHR modules, application type, middleware, report tools, conversion, or archive tools, etc. Basically, if your system touches it, you own it.

As an extreme example, say your software does only parking lot management for a hospital. If you somehow capture any personal ID data, your firm will have to meet HIPAA compliance.

A more realistic example is the typical analytics tool that takes detailed information, aggregates it, and generates only summary, management, or trend reports. Your analytical system (such as grabbing a UB bill file and calculating averages) may never report out or allow access to any specific patient PHI, but since you received the data on a case-by-case basis even though you may have stripped out the PHI before you stored the records, your firm and software must meet HIPAA compliance.

The Final Rule is clear that if you touch PHI, even if you don’t look at it, you must comply. There are no exemptions for encrypted data, servers in locked cabinets, or remote cloud systems.

As a vendor, what must you do to be HIPAA compliant? Your firm must supply documentation of:

1. Policies addressing HIPAA privacy and security issues
2. Privacy and security procedures
3. Workforce HIPAA training
4. HIPAA-compliant workflows
5. Compliance for an audit or data breach investigation
6. HIPAA compliance of any subcontractors you use

Your clients may require an independent audit of the above at your expense as a requirement for you to continue as their vendor. If you do not provide it, their legal counsel may advise them to replace your system with that of a competitor. Remember, the above must be in place before September 23, 2013. Lastly, if you or your provider client has a data breach and OCR finds you lacking in compliance, you could be fined $1.5million per breach.

As I noted in a past HIStalk Readers Write piece, ONC in Stage 2 “exempted” EHR Module vendors from testing on the privacy and security criteria (if the vendor so chose), but they did state that the vendor must still be HIPAA compliant. Which means, implement the ONC privacy and security criteria.

Welcome to the wonderful world of HIPAA.

Frank Poggio is president of The Kelzon Group.

Readers Write: Not Safer!

Not Safer!
By Ruth Bowen, MBA, CPHQ, CPHIMS

I’m an HIT professional in Philadelphia who lives in an area that supports multiple competing health networks. I am old enough to have a robust problem history and to have records that span multiple networks.

Having worked in this industry for 30 years, I am definitely a believer in the potential of EMR systems. But frankly, I am less safe.

All of my outpatient providers went from paper to a digital record. There wasn’t an opportunity for a conversion. Each of these practice systems took a different approach in terms of what data would initially populate the EMR. There are no standards here, only guidelines. There can be significant expense in terms of abstracting data from a paper record. Much of the data available in my paper records has just disappeared.

In one case, the paper record was simply scanned. I arrived for a visit with no problem list and no medication history and was treated as a new patient. The practice was dependent on my memory of events over 10+ years. In other cases, there was a subset of data, but in each case, most of the history was unavailable. The paper chart may have been scanned, but physicians do not page through images of paper record, so I consider the information unusable.

None of these EMR implementations has an interface from the laboratory system I use. In most cases, a subset of available laboratory results is transcribed into the electronic record. Although the physician also has a copy of the current paper lab results at the time of visit, the history of results in the EMR is incomplete and likely has transcription errors.

One of my physicians used to manually maintain a paper flowsheet for a subset of results significant to his specialty. That history is gone. His system doesn’t support the view he formerly had and there is no historical data that could populate a flowsheet or graph even if the capability was available.

The result is an increased personal safety risk related to multiple EMRs that are incomplete, each with a different subset of data. As it turns out, my responsibility in terms of patient engagement is record reconciliation at the time of visit, a reconciliation that is totally dependent on my memory. Not, I think, what ONC intended.

Ruth Bowen, MBA, CPHQ, CPHIMS is an independent HIT professional in Chesterbrook, PA.

Readers Write: A Balanced EHR Copy Forward Solution

A Balanced EHR Copy Forward Solution
By Kyle Samani

There’s been a recent wave of media coverage surrounding the topic of EHR copy forward functionality. Many have suggested that this function should be outright banned. The reasons vary, but in general most of the problems cited are related to the fact that the copy forward function in EHRs creates garbage and bloat in the patient’s record.

As someone who has experience designing and programming EHRs, who has deployed an EHR in inpatient and outpatient (PCPs and specialists) environments, and who has talked to hundreds of doctors about the subject in various presentations, I have a unique perspective to offer.

Lyle Berkowitz, MD, CMIO of Northwestern Memorial Hospital in Chicago, recently posted on the subject. He’s right. EHR copy forward is a great tool if used correctly. The problem is that EHRs make it too easy to abuse. Most of the copy forward functions in EHRs look at the last note and quite literally copy every field forward into the current note. This is problematic because full-note copy forward allows the doctor to copy forward too much information before all of it can be digested and understood.

There are easily dozens if not hundreds of data points in a given note. Doctors shouldn’t be encouraged to copy hundreds of data points into the current note before having a chance to complete the current assessment. It’s too much, too early in the examination process. The EHR should make it easy to copy forward information in manageable pieces.

I lead the original design of a function in my company’s EHR called Copy to Present in the latter part of 2011. It’s similar to the copy forward feature in most modern EHRs. The primary difference is that it doesn’t copy the entire note forward, just the active area of focus. The function is available in conjunction with a date dropdown on all major sections of the chart.

For example, the physical exam page contains a date dropdown at the top of the page. When a doctor visits the physical exam page, the date dropdown defaults to the current date. Doctors can quickly review an old physical exam summary by selecting from a date in the dropdown, which is populated with dates of previous physical exams for the active patient. When looking at an old date, the Copy To Present button appears. Clicking it copies forward the selected physical exam to the current note. The Copy to Present button doesn’t affect any part of the chart other than physical exam; all other areas are left intentionally untouched. After clicking the Copy to Present button, the physical exam data is editable as if the doctor had entered the data by hand.

A video demonstration of Copy to Present is above and here.

Copy to Present and the date dropdown are useful for data points that need to be collected and updated during every examination. Examples include chief complaints, physical exams, review of systems, and assessments and plans. In these scenarios, the Copy to Present function allows the doctor to understand what they recorded last time before copying forward to the current note. It provides the quick copy-forward function doctors want and need, while still allowing fine-tuned control over what’s copied forward.

However, Copy to Present is irrelevant when dealing with other types of information. For example, allergy lists, medication lists, problem lists, lab results, medical history, and surgical history. The most up-to-date versions of these data points should always be shown regardless of who last updated the list across any care setting (inpatient, outpatient, ED). EHRs should understand (but most don’t) that these pieces of information aren’t part of a particular note as much as they are relatively static pieces of data about the patient. Once labs and allergies are recorded, they should be available to any clinician that needs access to them, and they should always be up to date independent of any clinical note.

EHRs need to understand the kind of information they’re handling. Different pieces of information should be handled differently depending on what the information is, who is accessing it, and what that person needs to do with it. EHR vendors have a responsibility to ensure they provide the tools to make sure clinicians can get what they need, when they need it, and understand it as quickly as possible.

Kyle Samani is inpatient deployment manager at VersaSuite of Austin, TX.

Readers Write: Practice Management Software, Payment Portals, and the Merchant Service Account Problem

Practice Management Software, Payment Portals, and the Merchant Service Account Problem
By Tom Furr

The more than 300 practice management software vendors in the United States help practices that range in size from individual doctors to multi-office groups made up of thousands of health care professionals manage their most important operations, both clinically and financially.

Attuned to the government’s drive to capture critical data and make it available online along with providing greater cost transparency, these practice management software providers are offering payment portals tangential to their core software. These electronic mail slots are intended to let patients see their statements online and then pay their bills through this technology using their debit or credit cards.

Unfortunately, with every payment portal that comes online, every practice is required to establish a merchant service account. In simplest terms, a merchant service account is a specialized account provided by a bank or other financial institution to enable online transactions. This account, which enables credit card transactions, is an agreement between the practice and the bank that contractually binds the practice to obey the regulations established by the bank.

To secure the agreement, a practice needs to complete an MSA application form which, amazingly typically numbers 18 pages or more. Imagine the office manager of a medical practice taking time out of his or her day to handle that. The list of questions that must be answered run the gamut from the practice’s address to its checking account number, the principal’s SSN, employer ID Number, and much more (and those are the easy ones). Let’s not forget the need to get a voided check on the account to be used, a copy of the driver’s license of application signatory, a detailed list of services offered, credit card processing statements of the previous three months, a copy of the articles of incorporation, as well as business tax returns and business financial statements. All in all it’s almost as much paperwork as that which you waded through when you closed on a house, and you remember how much work that was.

In the end, the unfortunate reality is a practice management software vendor often sees a deal come unraveled because of the obvious problems associated with getting an merchant service account in place. It doesn’t have to be that way. There has to be a better solution.

My issue isn’t with the role of a merchant service account or with the very real need to provide patients with a safe, secure, and simple way to pay for healthcare services online. My problem is with the process of setting up or, for that matter, going through nearly the same time-consuming process should changes occur that relate to an merchant service account.

A solution that can work for all involved resides within the practice management software itself where it has a universal merchant services account, like PayPal or Square, for all its practices and automatically receives, posts, and reconciles payments back into the system. This eliminates the merchant services account set-up problem and makes the practice management software all the more useful to the practices using it. The best part is such an approach could cut down on the amount of paper and time used to bill patients, reconcile patient balances, and more.

For the sake of the practices using their software and their potential clients, practice management software vendors should find and fit the sort of solution I’ve sketched out above into their systems. Their practices and their patients will thank them for it.

Tom Furr is CEO of PatientPay of Durham, NC.

Readers Write: The Art and Science of HIMSS Networking

The Art and Science of HIMSS Networking
By Jodi Amendola

By now you have scheduled your meetings, RSVP’d to all your party invitations, and if you’re a Type A personality, you’ve probably already packed your briefcase and most of your suitcase. But you still have some prep work to do if you want to maximize the benefits you receive from attending HIMSS, which remains the best annual forum for networking with prospects, customers, the media, industry analysts, and potential partners.

To achieve success with your networking efforts you must:

1) Know what you want to accomplish (e.g. networking, media interviews, intelligence gathering, lead generation, scouting new partners and/or business opportunities, etc.;

2) Be prepared; and

3) Follow up on your leads after the show.

Sounds pretty simple, right? But the key isn’t accruing a stack of business cards, reciting well-rehearsed talking points, or sending follow-up e-mails before your plane touches down at your local airport. Those activities will probably yield some results, but to achieve the greatest possible success you should think quality vs. quantity.

Just between us… the real secret for getting the most out of HIMSS is getting people to listen—not just hear—you, and to remember you and some of what you discussed. Ideally, you will provide at least one “light bulb” moment that resonates and sticks with your audience. And that’s not simple–or is it?

Below are my secrets for building relationships with the movers and shakers at HIMSS. Remember, you will be competing with lots of noise, hype, giveaways, competitors claiming they’re as good or better than your company, short attention spans, and overstimulated brains. Here’s some tips:

• You never know where your next lead or opportunity will come from. While it might be a pre-planned meeting, you may meet your next business partner or client in the elevator, waiting for or sharing a taxi, or like one of my colleagues, waiting in line at Starbuck’s. Don’t be shy. Smile and take the opportunity to prospect, but do so in a friendly, conversational manner.
• Industry pundits, analysts, and editors are overwhelmed with people and pitches. To break through the trade show tinnitus, you need to be different and compelling. That doesn’t mean you have to be a comedian, the ultimate social butterfly, or the next Steve Jobs. You do have to be you authentic and passionate in certain areas – no one wants to talk to a robot — but be concise and to the point. Why? Because, in reality, you are selling yourself first and your product or company second.
• Get organized. Plan ahead and figure out what you want to say to the various types of professionals who attend HIMSS. You may want to stress different information and benefits depending on whether you’re talking to a CIO, a CMIO, the head of contracting services, or the vice president responsible for performance improvement. Remember you may only have 30 seconds to deliver your elevator pitch and capture someone’s attention so make it relevant. It’s okay to weave in humor if it feels natural, but don’t force it.
• Explain what your company does in simple terms. No marketing fluff — just tell them what you offer and explain why they should care. Be specific about the pain points that your product or services address. This information, framed within a question and answer format, is often an effective means to capture their attention. “How much time do providers waste trying to reach patients about lab results? An average of six calls back and forth. In addition to that time drain, patients become frustrated as they wait for days to hear their diagnosis. With our solution, patients are instantly alerted with a text or e-mail the moment their lab results are available.”
• To break the ice or establish a personal connection, learn and share something personal during your meetings. What’s their best stress reliever during HIMSS or their trick for enduring flight delays? If they are more reserved, start by sharing a story about you, such as how much you’re looking forward to your daughter’s nightly rendition of “If You’re Happy and You Know It” via Skype.
• Try to include easy-to-understand metrics. “Our hospital clients have seen a 40 percent average increase in patient satisfaction within six months of implementation. Patients love it. Providers love it. It’s a win-win.” You can always follow up with more complex data after HIMSS.
• Do some research to prepare for scheduled meetings. For example, if you have media interviews, review their 2013 editorial calendars for relevant future article topics and weave those specifics into your conversations. “Our Chief Technology Officer is deeply involved with helping our customers achieve Meaningful Use Stage 2 requirements. We’d be happy to provide her as a resource for your August Roundup on Meaningful Use or as a sidebar to your October article on EHRs.”
• Express appreciation for their time, reiterate the calls to action, and leave them with a smile. “Thanks again, Bob. I’ll contact you next week regarding the August and October columns,” or, “Great to meet you Steve. I’m impressed with your commitment to ongoing performance improvement. I’ll be in touch next week to go over how we can help.” It’s always a good idea to let them know that, “If you ever need my help, just give me a ring or send an e-mail.” Remember, networking is a two-way street.
• Fulfill your promises. Follow up with an e-mail within a week regarding the opportunities discussed. Don’t forget to mention at least one of the personal aspects that surfaced, such as, “Did you enjoy your tour of the Garden District as much as you expected?” or, “Were you able to get your Starbuck’s before your important meeting?” They’ll notice and appreciate that you cared enough to pay attention.

Truly connecting with people is both an art and a science, as any great leader will tell you, but it’s less daunting if you remember that you’ll mostly be relating to one or two people at a time. The important thing is to be yourself. Smile and they will smile with you. Networking doesn’t have to be a chore or intimidating. Showing up prepared with the right attitude can even make it fun as well as profitable. Have a great HIMSS!

Jodi Amendola is CEO of Amendola Communications of Scottsdale, AZ.

Readers Write: Remote Control: Why Remote Consulting Works for HIT

Remote Control: Why Remote Consulting Works for HIT
By Casey Liakos

With the recent proclamation by Yahoo’s CEO Marissa Mayer that all company employees must work in a Yahoo office, the business world and Internet have been abuzz with arguments for or against this decision. Remote work is something that is on our minds often since it is a service our consulting firm offers in the EHR/Epic space. We haven’t seen anybody join the debate with a specific focus on EHR or Epic consulting, so we thought we’d chime in.

What Yahoo is requiring is really an apples-to-oranges comparison to the onsite/remote debate in EHR consulting. These are two different industries with two different sets of circumstances, and Yahoo’s decision clearly has no direct bearing on the HIT world. But there are corollaries between the two, and we think this is a good time to spur some discussion.

It should be pointed out that we are big fans of Mayer. She’s an inspirational figure in many ways, and above all, she’s from Wisconsin. So we have her back.

Time will tell whether this decision will benefit Yahoo, and there’s no shortage of people who feel strongly about it one way or another. But when we look at remote vs. onsite strictly through the lens of EHR/Epic consulting, we think that the logic Yahoo used in this decision is all wrong.

Why EHR projects are a natural fit for remote consulting

We are not advocating for all HIT consulting to be handled remotely. But we strongly believe that there are certain project phases and key areas where it just makes sense.

By now there have been countless philosophical points made on both sides of the Yahoo debate. But to our company, there are two factors that need to be considered, and these are the only two that truly matter when it comes to assessing value of a consulting purchase: productivity and cost.

Productivity

The remote services model that we offer to our clients has several key advantages when it comes to productivity. First, it puts resources on your team for the entire week. Traditional consulting practices have resources working Monday through Thursday – but of course your business doesn’t stop on Friday. Remote consultants can work a schedule to match your team’s hours, which brings an instant productivity boost.

Another factor that people may forget is that the technology available to us today makes remote work nearly seamless. I don’t need to go into detail — we all know many technologies that can put someone “in the room” when needed. With widespread remote system-access tools and file collaboration products already implemented in your organization, the remote consultants don’t miss a beat.

In fact, there are strong arguments to be made that communication can actually improve with a remote services model. A recent Harvard Business Review blog entry about working remotely makes some nice points:

• Proximity breeds complacency. I’ve worked with leaders who sit in the same office with those they manage but go for weeks without having any substantive face time with them. In fact, they may use e-mail as their primary source of communication when they sit less than 50 feet away. It’s even worse if they sit in different parts of a building or all the way on another floor. This is not to say that these leaders are in any way lazy, just that because the possibility of communicating is so easy it is so often taken for granted.
• Absence makes people try harder to connect. When I managed a team of professionals in nine locations, I made a point of deliberately reaching out to each of them by phone at least once a week and frequently more often. I’m not an anomaly here. Most leaders I work with make an extra effort to stay connected to those they don’t ordinarily run into. They can see that taking even a few minutes to talk about what’s happening in their respective worlds before addressing the tasks at hand makes a difference in maintaining the connection with a colleague. What’s more, because they have to make an effort to make contact, these leaders can be much more concentrated in their attention to each person and tend to be more conscious of the way they express their authority.

Note: we’re not necessarily advocating working from home, which can potentially present its own set of distractions. Our remote teams work together in client teams, primarily from our company offices. This minimizes distractions, encourages collaboration, and helps solve customer issues quickly.

Cost

The most obvious cost savings with remote consulting is the rate. When priced correctly, this model can save your organization a boatload of money over the course of the engagement.

The other key savings with remote work come with eliminating travel expenses. Flights, hotels, rental cars, meals… these are very real and often prohibitive factors when your project requires outside help. With tasks like build, testing, and system bug/incident resolution, the work can almost always be done remotely if managed well. Why pay a huge premium to stick the resource in a cube down the hall all day?

The cost savings of using remote consultants go much deeper than just hard dollars saved on rate and expenses. Easy administration indirectly saves you money. Managing office space, computers, telephones, security badges, etc., all carry a cost that you can eliminate. With remote consultants working from their firm’s offices, these costs are incurred by the firm, not the client.

There’s inherent stability associated with remote consultants as well. Turnover is much less of an issue when you have happy team members sleeping in their own beds every night. The cultural and organizational learning curves associated with consultant turnover carry a large cost that can be eased greatly with a remote model.

Most importantly, we feel remote consulting is the most cost-effective way to find and hire the best consultants for the job. Think about it in the context of Epic. Many of the very best Epic minds and most experienced resources are former Epic employees. A great number of these folks no longer work there because of the travel burden associated with being at customer sites every week.

Epic is a great place to work for a million reasons, but it should be no surprise that the #1 reason cited for leaving Epic is the heavy travel. Hiring remote consultants is the best way to gain access to these resources. They still want to work on Epic projects, they just don’t want to travel or can’t due to family obligations.

Tips for making remote engagements successful

Even if the consultants work remotely, you are still the manager. Speak with consultants or get a status report at least weekly. Any resource that is ignored, whether onsite or remote, has the potential to be working on the wrong things at the wrong time.

You and your team should be responsible for funneling work to consultants. This is the #1 hurdle we’ve seen: getting hyper-productive consultants enough work to stay busy. When all else fails, give them a brand new project to plan and execute from the ground up and watch what they can accomplish with a little support from your team and SMEs.

Make remote workers part of your team. Make sure they’re involved in all team meetings, e-mail lists, and communications.

You are not Yahoo

Many have attributed Marissa Mayer’s decision to the need to foster more innovation within Yahoo. Time will tell whether this move helps achieve that goal. HIT projects require organizations not only to be innovative, but to move quickly and get things done in a cost effective way. For this, a remote consulting solution can be an excellent option.

Casey Liakos is client relations director of Vonlay LLC.