Readers Write: Pagers Cost Hospitals Billions Each Year

Pagers Cost Hospitals Billions Each Year
By Larry Ponemon, PhD

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& Productivity Impact of IT Security on Healthcare” that aims to quantify the impact that the use of pagers and other outdated communication technologies has on healthcare.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

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

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

As organizations struggle to strike this balance, the use of pagers and other outdated communications technologies continues as the status quo, in large part because of the perceived security and compliance risks associated with the use of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

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

This study revealed that the use of pagers and other outdated communication technologies decreases clinician productivity and increases patient discharge times, collectively costing U.S. hospitals more than $8.3 billion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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Point 1

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

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

Point 2

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

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

Point 3

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

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

Point 4

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

Cindy Thomas Wright is the owner of Thomas Wright Partners.

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

Another Step Down the Rabbit Hole
By Data Nerd

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

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

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

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

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

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

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

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

Readers Write: Managing Total Medical Expense While Improving Health Outcomes

Managing Total Medical Expense While Improving Health Outcomes
By Michael Gleeson

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

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

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

So where should you start?

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

Building Trust and Sharing Data

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

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

Patient Attribution and Outreach

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

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

Fast, Accurate, and Actionable Data

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

Transforming Clinical Care Teams

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Healthcare IT vs. Corporate IT

Healthcare IT vs. Corporate IT
By Anonymous

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Never Had a Breach?

Never Had a Breach?
By Kev Larson

Never had a breach? I find it remarkable that so many on the HIStalk Advisory Panel can answer so swiftly, so confidently, and so authoritatively, “No, we have never had a breach.” 

I want to know how they know that. I want to know what they are doing — day in and day out — to monitor, audit, and confirm their operational performance that allows them to make that bold statement – the one that they report to HIStalk and its readers, their boards, and their patients.

I am sure you know the old saying, “The absence of evidence is not the evidence of absence.” For those that are reporting no breaches, just how hard are they looking? Would their staff even know what to report or how to report a potential breach? 

I am not saying that a perfect record is not in the realm of possibility. It is just so incredibly improbable that it defies common sense. I would really love to know the secret formula that has gotten those CIOs that report no breaches to the place where they have that level of confidence and certainty. I am sure others would, too.

Along these lines, I finally got a chance to read ISMG’s Healthcare Information Security Today Annual Survey in which 35 percent of the 200 respondents reported that their organizations had not suffered a breach of any size in the past 12 months. I realize that this is a dangerously low sample size, but let’s just take it at face value for the sake of illustration. The trend is not too terribly off from the responses from the HIStalk Advisory Panel. 

The question and response that really got me chuckling was this one, though. “What type of breach (of any size) has a BA with access to your organization’s patient information had in the past 12 months?” Can you believe that 59 percent of the respondents answered that their BAs had no breach of any size in the past 12 months? That is downright laughable and borderline reckless.   

CEs are doing precious little to evaluate, interrogate, or assess BA risk or compliance performance. Again, the absence of evidence is not the evidence of absence. If a CE responded to this question based on the BA’s self-report to them alone, that should not be enough information to give that BA a clean bill of health. We have to hold them to more rigorous criteria than that. 

The certain truth is the universe of BAs is exponentially larger than that of CEs, and BAs have only recently received the formal mandate to fully comply with HIPAA.  We have a long way to go in the BA community and CEs should be guarded, probative, and assertive in the management of their BAs. We cannot wait 10 years for our BAs to catch up.

What really matters in this discussion is what has changed under Omnibus. One of the most significant changes is that the Omnibus Rule replaces the “risk of harm” test that was so contentious in the interim final rule with a default presumption that any acquisition, access, use, or disclosure of PHI in a manner not permitted by the HIPAA Privacy Rule is a breach unless the CE or BA “demonstrates that there is a low probability that the [PHI] has been compromised based on a risk assessment.” [78 Fed. Reg. at 5,695] 

Kudos to the organizations that have employed a breach risk assessment process and have implemented it consistently. Interestingly, they seem to be the ones reporting their breaches in real time, even the small ones that they could have reported later. They have a real process and are actively demonstrating a posture of continuous compliance, which is the desired state according to OCR. 

However, there are a whole bunch of organizations that are just winging it. They have no process, no criteria, no tools, and no commitment. We see it all too often and it is just not enough.

Take the five-month window before you must comply with Omnibus to shore up this part of your program –  all things related to breach risk. Consider working with an expert consulting firm to help you. This is probably an area where a little investment can go a long way. 

Readers Write: Are Hospital EHR Vendors Primarily Software or Services Companies?

Are Hospital EHR Vendors Primarily Software or Services Companies?
By Kyle Samani

Hospital EHR vendors are not primarily software companies with professional services divisions. They are primarily professional service companies with software divisions.

Although the core value of hospital EHR companies is the software they develop, the bulk of the value they provide is in training, data conversion, setup, logistics, and support. These services are built on top of the software that they support, but are collectively more valuable than the software itself.

I’ve seen the challenge of deploying an EHR in a hospital first hand. Most of the challenges are with the people, not the software. Hospital EHR vendors derive most of their value for their professional services.

Hospital EHR vendors employ more services staff than software staff. At least 60 percent of the employees at the major hospital EHR vendors are in deployment and support services, not software design, development, testing, or administrative functions. Employees, especially road warriors, are expensive. The more employees involved in a given division, the more expensive and valuable that division is.

But perhaps even more important than sheer costs, healthcare IT staff need to receive sophisticated training in hospital workflows and software systems. Before the HITECH Act, there weren’t enough people with healthcare IT skills to deploy the entire country in five or six years. Many argue that there still aren’t enough people. The EHR vendors had to develop large-scale internal training programs to teach all of these people how to set up, train, deploy, and support hospitals. This is one of the greatest sources of value that the big EHR vendors have generated: an educated healthcare IT workforce. The scale and scope at which they’ve done that has been remarkable.

Epic employs 6,400 people and Cerner 11,900. I would estimate that at least 60 percent of those – or 11,000 people in just these two companies – work in training, deployment, and support roles. These companies and many others have developed phenomenally large internal training programs for their employees, who are usually fresh college graduates.

To provide a sense of scale, the University of Texas at Austin — one of the largest universities in the country by enrollment (60,000+ students) and located in a major US technology center — boasts that it has graduated a grand total of 333 people in its 9-10-week-long healthcare IT program since its inception a few years ago. Vendors are educating the workforce, not the educational system.

Training and conversion costs usually prevent hospitals from switching EHRs. These costs are multi-dimensional, spanning financial cost, employee personal costs, and opportunity cost of working through other initiatives such as Meaningful Use 2 and ICD-10.

As an employee at a smaller hospital EHR vendor, I’ve experienced this phenomenon. We are trying to spearhead the replacement market for hospitals that are dissatisfied with their legacy EHRs. Most of them love our product and are even willing to pay, but aren’t willing to change systems because the non-financial costs of change are too great for the organization.

Because the costs of switching are high, the cost of choosing the wrong EHR the first time is even higher. Most large software projects that fail do so because of the people, processes, and cultures, not because the software isn’t capable. In that sense, the services surrounding the software implementation are even more important than the software itself. The majority of the value that the vendors provide is in services, not software.

Looking at hospital EHR vendors as service companies can help understand management decisions that may not have made sense when looking at them as software companies. Decisions are made based on training and deployment realities, not software limitations. This analytical framework can also help explain vendor practices and methodologies (especially hiring), release cycles, growth rates, stability, and many other operating metrics.

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

Readers Write: Achieving Value, A Different Kind of Medical Miracle

Achieving Value, A Different Kind of Medical Miracle
By David Bond

Practice management system (PMS) vendors have long sought to provide their physician customers with more capabilities than just traditional practice management and EHR capabilities. Specifically, providing outsourced patient statements and RCM services are some of the most important opportunities that have been identified to bring greater value to their customers and increased revenue to their firm.

However what I’ve seen is quite frankly an assortment of “half-measure” solutions that don’t efficiently utilize today’s interconnected world: portals that aren’t truly integrated, systems that don’t enhance a practices workflow or focus on usability for both the practice and patient alike. More importantly, that seek to find a solution that yields untapped profit opportunities for those PMS vendors that are able to satisfy these requirements.

In fact, many PMS vendors are mired in paper-based billing methods or a clunky billing portal instead of looking to implement an integrated solution that truly drives value for both the practice and the patient. I also find it interesting that most of these current billing mechanisms do little to significantly boost the profit margins of the PMS vendors offering these services in addition to their core offerings.

My aim is not to criticize these companies, as many have been very successful and offer fantastic products that are of use to their customers, but instead offer insight into new opportunities they can adopt to increase their efficiency and profitability. While the PMS providers might feel their current outsourced paper billing solutions put them in a more favorable light with their physicians, they do little to put more profits in their own pockets, streamline the billing process, help practices with their workflow, create clarity for patients, speed time to payment, or reduce errors on the back end.

Instead of going with a traditional solution that only marginally helps PMS vendors, how about something that can be easily integrated with most solutions and be welcomed with open arms by medical practices and patients alike?

Online billing, patient balance management, and reconciliation services that can be easily integrated with most PMS vendor offerings is in fact a reality today. It drastically reduces the need for paper bills and the cost and delays they create and makes obsolete billing portals that are not truly integrated. Presenting patient statements that are easily understood and allocate the remittance precisely to the services that were received creates clarity for everyone and is highly profitable for any PMS vendor looking to bolster their bottom line through a recurring revenue stream.

Want proof? A major PMS vendor ran the numbers and realized an additional $3 million in pure profit by integrating this capability with its core practice management offering used by 3,500 medical practices. I don’t care who you are, this is real money.

If you’re a PMS vendor and want to achieve real value, both in profitability and long-term customer retention, providing a simple and integrated online bill pay solution will get you there.

David Bond is EVP of PatientPay of Durham, NC.

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.