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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lee Farabaugh is the chief experience officer at PointClear Solutions.

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

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

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

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

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

What are the workload expectations?

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

Can I handle the commute to this job?

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

What is the boss like?

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

What are the people like?

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

What is the career progression?

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

What is the training offered?

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

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

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

CIO Unplugged 7/10/13

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Leadership and Reconciliation

I get knocked on my ass every now and again. Okay … often.

The big fall took place a few years ago. Grace and Mercy picked me up, as they continue to do. They changed my life direction, and I still haven’t gotten over it. Made me a thankful person. Taught me to be a builder of others. I try to be more humble, and still fall short (just ask my wife).

I’m very much a work in progress, but I stay on the path, chin up. When I think too long about my journey, I get weepy. Success has come more by grace and mercy than skill or talent. Unmerited in many respects.

All the above experiences set the stage for me to pursue reconciliation as a leadership practice.

I started this with my family years ago. I knew I had hurt those dearest to me, so I went and reconciled. Today, there is nothing left hidden or unsaid, at least on my end. Memories then came to my mind of all the people I had treated poorly from high school, college, and career. I sought them out, told them I was sorry, and asked what I could do to make things right. Most were receptive. Many relationships were restored. Not all. I did what I knew to do and moved on.

The workplace. Where I have sown hatred, envy, bitterness, malice, brokenness, I have been driven to reverse course and make amends. In some cases, extending grace and mercy as I have received it. In most cases, asking for forgiveness and seeking ways to reverse damages inflicted. Not long ago, I failed here big time, and it haunts me now. I’m compelled to share this with you so you can avoid a similar fate.

Damn. My 2005 mentor, Dr. Achilles Demetriou, died this June. I am who I am partially because of his profound influence in my development as an executive. We had an incredible relationship that was disrupted by my departure from University Hospitals in 2007. We were at a critical juncture in our deployment of an EHR, and I knew my decision to leave upset Achilles in particular. He and I were partnered to ensure success. My timing was imperfect; we both knew it. While I received support and encouragement from others when I moved on, Achilles was physically and emotionally absent.

I needed to reconcile. I never did. Now it’s too late. I’m saddened on multiple levels. Foremost, we lost a great man, leader, scientist, and clinician. But the pain cuts deeper for me. I lost the opportunity to talk through stuff, make peace, and continue the relationship that shaped me.

May it never happen again!

What about you? As you read this, do people come to mind? Family? Friends? Co-workers? What relationships are calling for reconciliation?

Making peace with people doesn’t just happen. It takes a pro-active effort. Reconciliation comes down to leadership. If you’re a leader, you make the first move. Don’t wait for the other person because it likely won’t happen. Get out of the emotional prison and implore the other person to break out with you.

I challenge you, my colleagues, as names come to mind, write them down. In the next 24 hours, reach out to each person. Not every attempt will turn out rosy, but you will have done the right thing. In many cases, you will see restoration. Your call, card, or visit might hit the trigger point that causes transformation or breakthrough in someone’s life. Definitely in yours. Leadership at its best and its hardest. Humility.

Reconcile before death happens and you’ll avoid a haunting pain. Recompense your way to freedom.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Morning Headlines 7/10/13

Stinger Medical Merges with Enovate

Stringer Medical, which manufactures mobile workstations, has merged with its primary competitor Evnovate, resulting in the largest mobile workstation producer in the country.

Health Information Technology in the United States 2013

Since 2010, EHR adoption has tripled in the US, with 42 percent of hospitals and 38 percent of eligible providers successfully attesting to Stage 1 Meaningful Use .

CMS mulls payment policy changes on chronic care, telehealth

CMS is considering paying paying primary care physicians for chronic care management services without requiring an in-person patient visit, suggesting that telehealth services may finally become reimbursable.

OFT probe could ratchet up pressure on health IT providers

In England, the Office of Fair Trading is investigating health IT vendors that intentionally limit interoperability to gain strategic advantage.

News 7/10/13

Top News

Mobile clinical workstation manufacturer Stinger Medical merges with competitor Enovate, forming the country’s largest mobile workstation provider that will operate under the name Enovate Medical. Stinger’s CEO and CFO will continue those roles with the new company, as will Enovate’s COO.

Reader Comments

From HIT Veteran: “Re: death of Milton Antonakos. The industry has lost a sales superstar. Milton was always a top performer because you couldn’t outwork him. He was a bundle of energy, had great life balance, and was always encouraging others. Tragic and a reminder to live every day fully.” Milton Antonakos of CareAnywhere, previously with Allscripts/Misys for 23 years, was killed in the crash of an air taxi in Soldotna, AK on Monday along with his wife and three children. Also killed were Chris McManus, MD, a radiologist with Greenville Health System, his wife and two children, and the plane’s pilot. Condolences to family and friends.

From QSII Watcher: “Re: Quality Systems, parent of NextGen. Looks like another proxy battle ahead. The Clinton Group, an activist investor, has filed an alternative board slate that includes former President Scott Decker. He’s the second former exec to try to join the board – Pat Cline was added in the last (failed) proxy battle by the second-largest shareholder Ahmed Hussein. Doesn’t look like Hussein is officially part of this proxy battle, but the SEC filing alludes to conversations with him. You can bet he’ll vote his shares in their favor. Also on the board slate is Peter Neupert, formerly of Microsoft and now at David Brailer’s Health Evolution Partners.” The  proxy statement says the performance of Quality Systems lags its peers in earnings and total return, with share price flat since 2008 while the S&P 500 rose nearly 60 percent. It cites equity analysts in saying that management has no clear strategic plan, keeps chasing distractions, is losing sales, and has questionable potential in the small hospital segment. Above is the five-year share price of QSII (blue), the Nasdaq composite (red), Cerner (green), and Allscripts (brown).  

From Ricardo: “Re: pet health portal. Yesterday I received an e-mail from dog’s vet introducing me to their new Pet Health Portal, where I can log in to see my pet’s health record, request appointments, search their pet health library, view vaccination history, etc. I actually laughed out loud considering I’ve received no indication whatsoever of a patient portal offering from my primary care physician. Thought you might appreciate that.” I do indeed appreciate that information, having been equally impressed by similar systems, often rolled out by veterinary chains like Banfield. Vets also offer Pet Mail to answer questions. Next time someone says they’ve been treated like a dog, congratulate them.

From Keith: “Re: JAMA opinion piece from Dartmouth, of all places. The educational and cognitive purpose of the evolved medical chart has been devalued by EHR.” The editorial by Robert S. Foote, MD of Dartmouth-Hitchcock’s nuclear stress laboratory says, “Discussions of EMRs have tended to be dominated by descriptions of their potential benefits, while less attention has been paid to their potential hazards, among which are breaches of privacy, incompatibility of different systems, introduction of computer-based errors, and loss of productivity owing to cumbersome procedures that EMRs sometimes require. I think it behooves us as well to consider the impact of these systems on a very basic element of clinical practice, namely, how clinicians think.” Among his comments:

• Epic has “68 tabs, many of which lead to numerous subtabs and links” and lists every field generically (like “code report”) even when they don’t apply to the particular patient
• Notes written by all providers, including non-physicians, are jumbled together and often copied and pasted, interrupting the thought process.
• The system tries to force standardization through the use of checkboxes, but often omits important information as a result, saying that he has never seen a checkbox saying, “my daughter died of the chemotherapy you are proposing for me.”
• The medical record is not data or a repository to hold data, but rather information that has been transformed by caregiver knowledge.
• The medical record is a battleground over the future of healthcare, because “as it becomes more difficult to write like a clinician, sooner or later it will become more difficult to think like one.”

From ColonelPeter: “Re: QlikView. Our organization just chose to purchase a BI technology called QlikView after seeing a demonstration of its integration with Epic at HIMSS. The pre-sales guy was a former Epic veteran who said that they were still working through logistics of a partnership with Epic.  Seems if Epic wants to dispel the belief that they’re difficult to work with, they should be trying to fast track a partnership with these guys. We’ve only had the software two weeks and already have gotten a ton of value from just playing with it.” I’ve mentioned QlikView several times and have played around with their free download. You can try their surgery scorecard live demo.

HIStalk Announcements and Requests

The upcoming HIStalk Webinar, “Five Steps to an Enterprising Imaging Strategy,” sponsored by Merge Healthcare, has been rescheduled for Wednesday, July 24 at 3:00 – 3:45 p.m. Eastern.

Acquisitions, Funding, Business, and Stock

Predixion Software raises $20 million in a Series C financing round led by Accenture and GE Ventures.

Coppersmith Capital Management, LLC, which owns 7 percent of the shares of Alere, launches a proxy fight in nominating its own slate of three directors for consideration at the August 7 Alere shareholder meeting. Its letter to shareholders urges the company to sell its Health Management division, which connects diagnostic devices to health management services.

The Italian subsidiary of Germany’s CompuGroup Medical will acquire a majority stake in Studiofarma Srl, which sells pharmacy software in Italy and has 7,000 customers.

Sales

WellStar Health System (GA) selects Besler Consulting to assist with the identification and recovery of Medicare Transfer DRG underpayments.

CareBridge Palliative Care Services(OH) will implement Authentidata Holding Corp.’s Electronic House Call and Interactive Voice Response telehealth solutions for remote patient care.

Alameda Health System (CA) engages MedAssets for A/R services.

The Children’s Care Alliance (PA) will create a health information exchange for underserved children based on HIE technology from Alere Accountable Care Solutions.

North Shore-LIJ Health System extends its managed services agreement with Allscripts through 2020.

People

Truven Health Analytics names Roy Martin (WELM Ventures) COO of its hospital, clinician, employer/health plan, and life sciences customer channels.

Arcadia Solutions appoints Chuck Garrity (Beacon Partners) RVP.

Dartmouth-Hitchcock (NH) names Terry Carroll chief innovation officer. He was previously SVP of transformation and chief information officer at Fairview Health services (MN) and has held CIO roles at Detroit Medical Center (MI) and Baystate Health Systems (MA). 

Christopher Olivia, who was paid $6 million in his last year as president and CEO of money-losing West Penn Allegheny Health System (PA) before Highmark bought it in 2011, is named president of Continuum Health Alliance, a physician management company whose offerings include IT services.

Announcements and Implementations

Doctors May-Grant Associates (PA) and Lancaster General Health’s Women’s & Babies Hospital (PA) successfully exchange CCDs between the practice’s Greenway Medical platform and the hospital’s Epic system.

Greenway Medical will add PatientPay’s online patient payment solution to its PrimeSUITE EHR/PM platform.

Resolute Anesthesia and Pain Solutions begins a nationwide expansion of Shareable Ink’s Anesthesia Cloud for iPad following an initial deployment at the Boca Raton Outpatient Surgery and Laser Center (FL).

Miami Children’s Hospital implements the AnyPresence solution to enhance development of mobile patient engagement apps.

Northern Ireland launches its national patient record system based on Orion Health’s portal and integration technology.

The Brooklyn Hospital Center implements the MedAptus Professional Charge Capture solution for the coding of inpatient and outpatient encounters.

HIMSS will announce its HIMSS Health IT Value Suite in a July 16 event streamed live from Washington, DC. It sounds like a pitch for the ROI of products and services offered by its vendor members.

Government and Politics

CNSI, whose $200 million Medicaid claims system contract with the State of Louisiana was cancelled over alleged bidding irregularities, claims the state will lose $100 million by keeping its old system instead. A state DHH spokersperson responded, “CNSI really is not in any position to be commenting on costs that may be incurred by the state, especially in light of its own actions.” DHH Secretary Bruce Greenstein, a former CNSI executive, resigned after the probe was announced.

In England, the Office of Fair Trading launches an investigation to determine if hospitals become overly dependent on healthcare IV vendors when outsourcing and whether certain vendors try to stifle competition by limiting their interoperability with competitors. Experts suggest that Cerner, McKesson, and Epic will earn lower margins if they don’t open up their systems to third-party products given NHS England’s interest in best-of-breed systems.

Other

Gartner ranks Dell as the leading provider of healthcare IT services globally based on 2012 revenues.

The annual healthcare IT report from Robert Wood Johnson Foundation finds that 44 percent of hospitals had a basic EHR in 2012, up 17 percentage points from 2011, with the number tripling going back to 2010 when HITECH started paying. Only 42 percent of hospitals met Meaningful Use Stage 1, however, with that number expected to drop for Stage 2, and only 27 percent participated in an HIE. The report also concluded that practices weren’t far behind hospitals in adoption percentages, but small practices continue to lag.

Fitch Ratings upgrades the bonds of Beebe Medical Center (DE) to “stable” despite weaker 2012 operating results partly caused by its write-down of the “not sufficiently robust” McKesson system that was replaced by Cerner at a cost of $37 million.

Vermont’s largest employer is now Fletcher Allen Health Care, with 7,100 employees.

Weird News Andy says the nurses were right again. The Syracuse newspaper uncovers an HHS report describing a series of errors that almost resulted in St. Joseph’s Hospital Health Center harvesting organs from a patient who was not brain dead. The doctor ignored nurses who argued that the overdose patient was responding to touch and breathing on her own. The patient survived her hospitalization, but committed suicide two years later.

Sponsor Updates

• Covisint offers a Direct Toolkit that explains how Direct messaging relates to HIEs and why providers should adopt it.
• Aspen Advisors announces the addition of 19 healthcare clients and 18 employees during the first six months of 2013.
• Perceptive Software releases Document Filters 11, which allows software companies and services providers to embed their solutions with technology to unlock unstructured files and extract data.
• Vitera hosts a July 24 Webinar highlighting steps to prepare for ICD-10 success.
• The Healthcare Network Accreditation Program awards Capario full EHNAC accreditation.
• Staffing Industry Analysts names Intellect Resources the fastest growing staffing firm in the US for 2013 based on its 125.5 percent growth rate.
• Twelve CareTech Solutions customers win honors for their hospital websites.
• Imprivata introduces a suite of proximity and fingerprint readers integrated with Imprivata OneSign to provide an end-to-end identity and access management solution.
• The SSI Group aligns with ABT Medical to provide release of information services to SSI’s RAC solution.
• Orion Health moves forward with expansion plans for its Christchurch, NZ development center.
• Bottomline Technologies will honor Joshua Krantz, an employee who died from injuries received in an assault, at a July 15 memorial service when an award in his name will be announced. 
• The FDA lists iMDsoft’s myAnesthesia app as a Class 1 medical device.
• TrustHCS launches the TrustHCS Academy to train and place coding professionals in advance of ICD-10.
• Impact Advisors leads an online CHIME focus group July 16 discussing optimization services.
• Ingenious Med employees provide financial and onsite support to the Zambia Medical Mission, which provides medical assistance to underprivileged Zambians.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/9/13

Study: Remote Patient Monitoring Adoption Poised For Robust Growth, Says Spyglass Consulting Group

A new study compiling the opinions of more than 100 healthcare leaders working in organizations that provide telehealth services finds that remote patient monitoring solutions are positioned for strong short-term growth, driven by ACOs beginning to formulate population health strategies and hospitals looking to proactively control 30-day readmission rates.

A shorter wait in the ER is just a click away at hospitals with startup’s virtual waiting service

Health IT startup InQuicker is making inroads working to reduce ED wait times. The company has developed an online waiting service similar in functionality to OpenTable. The software, which is accessed from the hospital’s website, allows patients with non-life-threatening conditions to check in from home and wait there during the time they would normally spend in the waiting room.

Brookings finds healthcare jobs soaring over other industries

The Brookings Institution releases a report on job growth that places healthcare ahead of all other sectors, realizing a 22.7 percent employment growth rate over 10 years compared to an average 2.1 percent from all other industries. Across the 100 largest metropolitan areas in the US, healthcare accounted for more than one in every 10 jobs.

JRMC Formally Announces Agreement with Sanford Health

Jamestown Regional Medical Center (ND) has partnered with 35-hospital network Sanford Health in order to have Sanford’s Epic EHR installed at JRMC. In addition to the EHR agreement, Stanford will help expand oncology services offered at Jamestown. The 25-bed hospital will otherwise continue to operate as an independent critical access hospital.

Advisory Panel: Industry Publications Read Regularly

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time, suggested by an HIStalk reader: What healthcare IT industry publications do you read regularly? (please indicate whether you read online or by printed copy)

Prefer online. HIStalk, Radiology Today, Advance, Healthcare Informatics.

Healthcare Informatics, JAMIA, Gartner.

Healthcare IT News, ONC blog and website, HealthLeaders  Media, User conferences and Government Health IT, FierceHealthIT as well as HIMSS online groups. Your blog remains my favorite.

Aside from HIStalk, I don’t read too much directly online.  I get e-mail updates from ACHE, HIMSS, Modern Healthcare, CHIME, and Healthcare IT News that I skim through and might follow a story if it is a hot topic for me. I skim through magazines and journals from Modern Healthcare, ACHE, Clinical Innovation+Technology, and Health Data Management. 

HIStalk, of course! Online. Healthcare IT News,  online and get printed copy too. HIMSS  Newsletters online.

I read most major publications for our industry, including Hospitals & Health Networks, Healthcare Informatics, Health Data Management, Applied Clinical Informatics, CIO Magazine, Executive Insights, Healthcare Executive, Health Management Technology, InformationWeek, Journal of Healthcare Management (ACHE), AND Journal of AHIMA.

HIStalk, Modern Healthcare, HIMSS, Healthcare IT News, iHealthBeat. And about a million blogs. Everything is read online.

Your esteemed blog. Then HealthsystemCIO online, Healthcare informatics online, healthcareIT online, mobihealth news online.

HIStalk and a variety of other electronic publications.

Healthcare Informatics, CIO and Information Week (some HC coverage), Modern Healthcare, Advance for something or other in healthcare, and HIStalk, of course!

HIStalk is my primary (daily) read. I used to read several others but I can’t seem to find time to stay up with the amount of information available.  I generally peruse Health Affairs as well as Healthcare Executive.

HIStalk of course! Also Healthcare Informatics, Healthcare IT News, Beckers Hospital Review, Healthcare Advisory Board, and HealthsystemCIO.  I read online versions. In addition I get a pdf from Michael Lake on latest technology which I find very helpful.

All online: HIStalk suite of course, Computerworld, Informationweek,Wall Street Journal,CSO. Printed: Healthcare Informatics, Health Data Mgt, CIO, CMIO,Clinical Innovation + Technology. It seems like the analogy of drinking from a fire hose would apply here with all the publications that are available on-line and in print. I would really like to hear others’ perspective as to what pubs they monitor and target in order to stay current.

Other than HIStalk :)  FierceHealthIT (online), Healthcare Info Security ENews (online, with daily emails), 3M Health Information Systems (online), iHealthBeat (online), PHIPrivacy.net (online), and the HIPPABlog (online).

Health Affairs (online and print), Modern Healthcare (online and print), Government Health IT (online), Health Data Management (online and print), Healthcare Informatics (online and print), Healthcare IT News (online and print), Health Leaders Media (online and print), American Medical News   (online), For the Record (online), Information Week (online and print).

HIStalk of course, healthcare it news, Becker’s newsletters, HDM newsletters, Health Informatics technology.

HIStalk, Modern Healthcare’s Health IT Strategist, & Smartbrief all online. I receive a dozen or more paper publications that are placed in the department bathroom that I may flip through if the cover looks interesting.

Online – healthcareit news and blogs.

Modern Healthcare, Advance, Health Leaders, HFMA Journal, Health Data Management (all in print) Healthcare IT News (digital) and, of course, HIStalk.

JAMIA (online and printed), but that’s about all I have time for these days unfortunately.

I always read HIStalk online, healthsystemcio.com, and HDM printed edition. Sometimes other HIT publications from CHIME and others. The CHIME online newsletter has an app that makes it hard to read on my iPhone.

Fewer and fewer it seems.  I would say I routinely scan healthcare informatics, hospitals and health networks, and health data management.

HIStalk, of course.  I skim through the paper copy of Clinical Innovation + Technology (formerly CMIO Magazine).  I receive the email updates from iHealthBeat.

Health Affairs, Modern Healthcare, JAMIA, For the Record.  All print.

HIStalk (love it because we know you keep everyone honest); Healthcare IT News.

Healthcare Purchasing News and many security related pubs, both online and print. At work I prefer online pubs, but when reading at home, I prefer print.

JAMIA (print), JIMIA, (print) ,  the rest on line:  your stuff, i-health, fierce, AHRQ announcements, ONC advt for HIT.

HIStalk (online), Health Data Management, Healthcare Informatics, Scott Mace in HealthLeaders (Scott Mace has been writing in the IT industry forever. He wrote for InfoWorld circa 1980; I think the world of his reporting.) I also read Journal of AMIA, Applied Clinical Informatics (online only) and everything John Moore of Chilmark writes (online). Unless noted as "online" I get these on paper and mostly read them that way.

Curbside Consult with Dr. Jayne 7/8/13

I’ve been working on a major project for the last couple of months and tomorrow is the go live. Tuesday is the traditional day for new releases at my organization. Although the IT staff likes to do things over the weekend, we know that Monday mornings are the busiest day in most outpatient practices and asking users to accept (let alone successfully adopt) changes on a Monday is just a bad idea.

The project involves a unified laboratory ordering scheme across multiple reference laboratories and hospitals, some of which are competitors. As a regional player, our health system took charge of this project with the goal of allowing physicians to more easily order tests from different facilities based on insurance and patient preference. I’m sure the side benefit of being able to see the ordering behaviors of non-employed physicians so that the hospital-owned labs can lobby for greater market share might have played a role in our leadership as well.

It would have been challenging enough to obtain the historical order data from the hospital-owned labs and create the crosswalk to send the proper codes to the designated facilities. We knew from standardizing the lab orders within our own health system that you can’t always map apples to apples. They could be Golden Delicious, or Granny Smith, or Fuji. Sometimes they are eaten via biting, sometimes sliced with a paring knife, and sometimes with one of those fancy gizmos that never quite fits in your kitchen drawer. They may each be an apple, but in the lab world they are entirely different orders.

Throw in the fact that we had to obtain order data from competing facilities and things started to get interesting. One national reference lab was very cooperative . They have 85 percent market share for some of the physicians and are eager to keep it that way. They provided the data exactly as requested and included all kinds of additional data we didn’t ask for initially, such as reference ranges, order entry questions and their expected responses, and even the type of tube needed for blood draws. They also provided it within one week of the request, which was outstanding.

Another national reference lab was less cooperative. They have a decent market share, but tend to act like they are the only show in town, and their response to our data request was handled accordingly. They initially provided data that lacked vital fields and wasn’t even for the time period we requested. They would send different parameters for different physicians on different spreadsheets. We had to explain to them multiple times that we needed consistent data to keep our analysis functional across all the practices and facilities. It took nearly eight weeks to finally receive the data.

The rest of the facilities fell somewhere between those two on the spectrum. Thank goodness I had a health information management intern to help out. As the data started to come in, we began the analysis. What we found was interesting, namely that physician ordering patterns were all over the place. We knew that we would see a wide variety of ordering behaviors given different specialties and geographies. We didn’t expect to see as wide a distribution within a single specialty, however.

Once we started to see some of the outlier tests that were being ordered, we also asked for data looking at how often the labs were contacting ordering providers for clarifications or substitutions. The preliminary analysis led us to increase scope and add the complicating factor that’s making me the most worried about tomorrow’s go-live: we made it easier to order the right test and a bit more difficult to order the wrong one rather than just mapping everything that had been used in the past. Given the fact that many of the participating providers have at-risk contracts or are part of an Accountable Care Organization, most people were on board with efforts to drive ordering behavior. How users respond to it in a live environment may vary.

Even without that particular challenge, managing the data was going to be difficult. We compared the lab-provided data to order data extracted from some of the provider EHRs and found that quite a few providers had test libraries with incorrect or outdated order numbers. We had to compare the tests they were intending to order with the current order numbers and ensure that we didn’t have duplicates or mismatches.

We had to work closely with a diverse group of resources – physicians, office managers, nurses, laboratory technicians, pathologists, interface specialists, software developers, and more. It was interesting to see each group’s perspective. However, I was surprised at how little some groups knew about the end user experience and what providers need to order labs accurately and efficiently.

Right before testing began, I thought I was losing my mind with collating all the different facility and provider approvals. I’m extremely grateful to a colleague who presented me with a delightful addition to Excel that helped me do the final bit of data cleansing. I don’t know how I lived without it. I am thankful not only for a new tool in my belt, but for someone who cared enough to see a problem and offer to solve it.

I’m sure there will be some unhappy providers who can’t find the tests they’re used to ordering. We’ll have a fully staffed go-live war room with not only directions to find the correct test, but an explanation of why the “old” tests were retired. I’ll be manning the phones as well, not only for escalations, but to see how the process is working overall. Wish me luck!

E-mail Dr. Jayne.

Morning Headlines 7/8/13

Outsourced UPMC workers protest cuts

Transcriptionists at Pittsburgh’s UPMC protest the decision to outsource their jobs to Nuance. The workers were offered remote positions with Nuance, but at a significant pay cut.

ONC Patient Safety Webinar

ONC will hold a meeting on its recently announced patient safety plan this Wednesday, July 10, at 3:45pm EDT.

Low sign-up for Australian eHealth records

In Australia, the highly publicized national patient portal is criticized after the one-year anniversary of its launch passes with only two percent of the Australian population having created accounts.

Open Letter to Chuck Hagel: DoD still doesn’t know what the hell they are doing

VistA expert Tom Munnecke publishes an open letter to Chuck Hagel in which he explains why implementing VistA would be a logical choice for the DoD and why a commercial solution would be an expensive mistake. He uses England’s NPfIT failure as an example of what can go wrong when a national strategy is centered around integrating multiple systems and points to the NHS’s recent decision to evaluate the use of VistA as a single, integrated solution as validation of that approach.

Monday Morning Update 7/8/13

From Utopic: “Re: Notice of Privacy Practices. HIPAA 2013 regulations require that the NPP and breach notices be written in plain language. That didn’t happen in the original HIPAA notices and probably won’t happen in this version either. Communicating in plain language doesn’t seem to be an issue for any of your survey respondents. I have a three-page summary if anyone is interested.”

HIStalk Webinar July 17

The next HIStalk Webinar will be “Five Steps to an Enterprising Imaging Strategy” on Wednesday, July 17 from 1:00 to 1:45 p.m. Eastern, sponsored by Merge Healthcare and presented by Steve Tolle, senior VP of solutions management. The US performs 800 million studies annually and industry experts predict steady growth over the next three years. How do you plan to share this information across your organization and your referral network and to securely store it? Implementing an enterprise imaging strategy and archiving data in either the world’s largest VNA or the cloud is your ticket to true interoperability.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. According to one of the CIO reviewers who reviewed the rehearsal session, “I have to be honest, I wasn’t sure if a presentation on enterprise imaging would grab me. The presenter did a great job in covering why an enterprise imaging solution is needed in today’s world and what it could do to alleviate issues in hospitals.” Register here.

The vast majority of respondents think McKesson’s customers should care that John Hammergren will get a pension of at least $159 million, although the comments are equally passionate for both sides. New poll to your right: now that implementation of the ACA employer mandate has been pushed back, should healthcare organizations proceed plans to buy software to meet ACA-driven needs?

Welcome to new HIStalk Platinum Sponsor CoverMyMeds. The Columbus, OH-based company has put the Prior Authorization process for prescriptions into modern decision support workflow. Over 100,000 providers use its service for free with health plans, PBMs, and drug companies footing the bill because CoverMyMeds makes them more efficient. Providers access the service through their EHR or from the company’s all-payer portal and get real-time determination. It’s not just about efficiency – when Prior Authorization takes too long, 30 percent of patients to just give up and abandon their prescriptions, causing all kinds of clinical and cost issues. The average doctor spends six hours per week filling out PA forms. If your company sells a pharmacy or EHR system, you can add the “Best Feature Ever” with APIs that can manage PAs either before they are submitted or after they are rejected. Thanks to CoverMyMeds for supporting HIStalk.

I found this YouTube video on how CoverMyMeds works.

Constantine Davides has updated his popular HCIT Consolidation Chart for HIStalk readers. It lists all of the healthcare IT acquisitions by company. Take a look if you (a) wonder why your vendor’s allegedly integrated products aren’t because they were simply bought and relabeled; or (b) you are creating a healthcare IT trivia contest and need hard questions like, “What was the name of the event notification software vendor that Philips acquired?” (answer: Emergin.)

NHS England publishes “Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record” that describes its all-digital goal for 2018 and the $387 million in available grants for NHS Trusts. NHS says it will consider the use of the VA’s VistA, summarizing, “One of the significant products we have investigated is VistA and for reasons described in more detail below we are looking to adopt some of the ethos behind its creation and potentially part, or all, of the technical product, in combination with others to generate NHS VistA. NHS VistA as a concept will focus on bringing together the best of breed capability of Open Source solutions and will be driven by NHS organisations with the support of NHS England and others. The US Veterans Health Administration VistA system was created in the 1980s by clinicians and software engineers from the ground up. It has become renowned across the world as the first truly integrated, clinically owned system. It has been in operation long enough to be able to demonstrate real clinical outcome benefits.”

VistA expert Tom Munnecke’s “Open Letter to Chuck Hagel: DoD Still Doesn’t Know What the Hell They Are Doing” says “DoD is trying to get out of a hole by digging it deeper.” A snip:

Rather than lifting up the VA eligibility problem to a shiny new common information system, you are on the verge of dragging health IT into the same bureaucratic vortex that has already done so much damage in the past. AHLTA was declared “intolerable” in a Congressional hearing four years ago. Yet, not only is it still around (and absorbing $600m/yr operations and maintenance costs), but it is also serving as a template for the next generation of the IEHR – a top down, mega-centralized administrative system far removed from the clinical needs of health care professionals and patients. DoD continues to focus on the organization chart, not the patient, closely coupling their software designs to their bureaucratic stovepipes.  Indeed, it is rare for me to even find the word “patient” in any DoD health IT documents.

Christopher Assad, MD develops a prototype CPR app for Google Glass that walks laypeople through the process of performing CPR effectively following the beat of “Staying Alive,” which coincidentally sets a pace of 100 compressions per minute.  

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Outsourced UPMC transcriptionists hold a rally outside the health system’s headquarters in the US Steel building in Pittsburgh to protest the transfer of their jobs to Nuance. Their union wants them to receive severance pay, health insurance through Nuance, uncontested unemployment claims, and an apology from UPMC CEO Jeffrey Romoff. All were offered jobs by Nuance, but at $8 per hour instead of their previous $12-15.

ONC will hold a Webinar on its just-released patient safety plan on Wednesday, July 10 from 3:45 to 5:30 p.m. Eastern.

Vince covers the death the death last week of computer mouse designed Douglas Engelbart.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/5/13

May 2013: EHR Incentive Program

May marks the slowest growth in eligible professional attestation since June 2011, netting just 892 new EPs and moving total attestation rates from 55.3 percent to 55.4 percent.

Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record

In England, the NHS issues a report which confirms that it is evaluating the implementation of VistA to meet its health IT goals in an open source environment.

Lawmakers release comments on call for ‘reboot’ of Meaningful Use program

Six Republican senators have released the public comments they solicited in April regarding a request to HHS to publish a written plan for how it is implementing the HITECH Act.

Indiana FSSA notifying clients of potential information breach

A computer glitch that caused medical records to be erroneously printed and mailed to the wrong patients is being blamed for a massive personal data breach in Indiana that has impacted as many as 187,000 patients.

News 7/5/13

Top News

A Dow Jones article says Intuit not only found its healthcare portal business to be a poor fit in its financial product lineup, the company had to write down $46 million in May after Allscripts bought Jardogs, which offered a patient engagement platform that will likely eliminate the dependence by Allscripts on the Intuit Health patient portal. The customer comments I heard at ACE 2010 (the Allscripts user group meeting) weren’t complimentary about Intuit’s portal, which it had just bought with its acquisition of Medfusion. It will be interesting to see if Allscripts will make a play for Intuit Health since it has already acquired Jardogs as an alternative.

Those with memory deficits might want to study yet another example of how outsider companies throw down big money to buy their way into the healthcare market because it looks easy, then slink off licking their wounds shortly afterward as they dump customers off to any bidder willing to take over the smoking wreckage of what used to be a decent company and product. That might be a fun exercise: leave a comment about which big company screwed up the most in its unsuccessful foray into healthcare. I always vote for Misys, which I’ve always suspected was created solely to amuse the industry with an exaggerated parody of incompetence.

Reader Comments

From RustBeltFan: “Re: HIPAA Omnibus Rule Advisory Panel responses. Scary answers! Maybe you’d be doing all of us a favor by developing a HIPAA Omnibus Rule 101 series for HIStalk!” Most of the CIO/CMIO respondents said their organizations were generally oblivious to the new rule, which kicks in September 23, 2013. If you are an expert on the topic, consider presenting an HIStalk Webinar to enlighten readers. This would be purely educational, with no commercial bias or sponsorship, and I’ll provide the platform and promotion to let you reach an appreciative audience (and it’s not bad for resume expansion and industry exposure besides.) Contact me if you’d like to present on this or any other educational topic.

HIStalk Announcements and Requests

Happy Independence Day. I’m not a fan of calling it the “Fourth of July” since that’s devoid of creativity and as dull as calling Christmas the “Twenty-Fifth of December” or New Year’s Day the “First of January.” About the only good thing about calling it the Fourth of July is that politicians weren’t tempted to make it a Monday holiday and thus destroy its historical significance simply to give Federal workers (and eventually the rest of us) a long weekend. At any rate, my flag is flying outside and I hope yours is, too. I worked a regular day today at the hospital and now I’m writing HIStalk, so I’ll celebrate by watching a few minutes of “A Capital Fourth,” which I’ve actually seen in person on the National Mall once. It was fun but dangerously hot, and while I’m glad I did it once, I have no plans to do it again other than on TV.

Other than HIStalkapalooza, what HIStalk activities, if any, would you like to see at the HIMSS conference in February? Let me know. I’m planning it now before I get swamped again starting in October.

On the Jobs Board: Senior Healthcare Policy Analyst, Epic Project Director, Android Developer – Healthcare + Google Glass, Staff Software Engineer .NET.

People

   

Scott MacLean, deputy CIO and director of operations at Partners HealthCare, starts his one-year term as chair of the HIMSS board. Carol Steltenkamp, MD (CMIO, University of Kentucky Healthcare), is named vice chair; Paul Kleeberg, MD (CMIO, Stratis Health) becomes chair elect; and Pete Shelkin (Shelkin Consulting) is named vice-chair elect.

New HIMSS board members starting their three-year terms this month are Beverly Bell, RN (VP, Health Care Dataworks); Beth Halley, RN (principal advisor, MITRE Corporation); Rick Schooler (VP/CIO, Orlando Health); and Michael Zaroukian, MD, PhD (VP/CMIO, Sparrow Health System).

Government and Politics

The Wall Street Journal apologizes for not having been critical enough of the Affordable Care Act, which it calls “a fiasco for the ages” and a “rolling train wreck.” It speculates that the Treasury Department pushed for delayed implementation (possibly illegally since Congress didn’t approve a delay) of the employer mandate because its own software isn’t ready to handle the changes. Apparently only the WSJ missed the obvious point that employers could bypass new healthcare expenses by either (a) cutting their headcount to drop below the 50-employee minimum; or (b) turning full-time positions into part-time positions. Their conclusion: the whole ACA could go right down the toilet because it was sloppily written, is impossible to execute, and will hurt employment. 

Speaking of the ACA, here are some interesting thoughts from a well-connected reader who knows what he’s talking about: with the announced delay in the ACA employer mandate and the uncertainty about the individual mandate, will hospitals ever really see the influx of newly insured patients they have expected? And if they have any doubt about that (which they should), will they curtail big software investments now?

Other

US Army Sgt. Kyle Patterson and his wife Ashley thank The Aroostook Medical Center (ME) for using an iPad and Skype to create a video connection that allowed him to participate in the March 29 birth of his daughter from his post in Afghanistan. According to Ashley, “Kyle was just over the moon. He told me before the birth that he was not going to cry, but he did. He sure did.” The family presented TAMC with a flag that Sgt. Patterson flew in their honor at Bagram Airfield. The hospital flew that flag on July 4 to honor all members and veterans of the military.

A New York Times article entitled “American Way of Birth, Costliest in the World” says we spend $50 billion per year on four million births, a lot more than other developed countries that provide comparable access to services and technology. It describes a pregnant woman whose insurance doesn’t cover maternity costs trying to figure out how much money she would need, only to be told by the local hospital that it would be between $4,000 and $45,000. Her response: “How could you not know this? You’re a hospital … I feel like I’m in a used-car lot.” 

Maine Medical Center says it has fixed its problems with Epic, with Epic itself issuing a rare statement in saying MMC’s problems weren’t related to software defects. The hospital admits that the computer issues caused budget problems, but says those aren’t related to the buyout offers it will send out to 400 employees this week.   

The bonds of North Mississippi Health Services (MS) are downgraded because of financial losses largely due to $11 million in one-time expenses in implementing Allscripts at its Tupelo campus. Fitch Ratings says the implementation required more staffing and budget than expected and also increased length of stay.

In England, the head of the defunct NPfIT is called out, along with two other executives, for spending more than $100,000 for a consultant to help them look good in a single meeting with the Public Accounts Committee. A Member of Parliament describes their performance at the hearing as “woeful,” and suggests, “Perhaps they should ask for their money back.”

Weird News Andy succinctly titles this photo, “The ‘M’ stands for … “

EPtalk by Dr. Jayne

A Minnesota study demonstrates improved blood pressure readings using telemonitoring technology. Patients also kept their blood pressures controlled six months after the intervention ended. Pharmacists provided consultation and education over the phone once readings were received.

We know that exercise helps many of us deal with stress. Princeton researchers show that exercise creates new brain cells while also creating calm in other parts of the brain. The study involved mice running on wheels, which is a lot like being employed in the health information technology realm, especially during the summer. So many people assume summer is a “slow” time but I’ve found it to be stressful with many co-workers on vacation and the same amount of work to be done. Don’t forget to get your exercise and be glad you don’t have to be immersed in ice-cold water to be stressed (like the mice were.)

Thank you to everyone who sent comments (both posted and e-mailed) regarding my “tale of the ED” Curbside Consult. I’m happy to report that my sweet grandmother was discharged home to continue living independently. Her medications were adjusted, she’ll have some home therapy, and we’re off tomorrow to see if she’s a candidate for an injection of the pinched nerve that seems to be the root of the problem. I’m pleased to report that the care she received on the med/surg unit was both high touch and high tech, which renews my hope that we don’t have to sacrifice one for the other.

Thank you also to HIStalk contributor Ed Marx, who was the first to wish me a Happy Birthday this morning even though he is in the midst of climbing Mount Elbrus. His team is scheduled to summit on the 10th, so please join me in wishing them a safe journey. For our US readers, enjoy the Independence Day holiday. If you’re working in the trenches, double thanks to you.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect

Advisory Panel: HIPAA Omnibus Rule

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Are your organization’s executives paying a lot of attention to the HIPAA Omnibus Rule or is it just business as usual?

It has been difficult to get executive attention on HIPAA security topics in general. We are going to use the HIPAA Omnibus rule to kick start a new education and training program across the entire organization. We will start with executives first.

Pretty much business as usual.

No, or if they do, we are not aware of it, which is just the same. Business as usual — the yearly training from a hired overpaid consultant so we can check the box for compliance.

[vendor member response] We are paying a lot of attention. As part of a recent acquisition, we are now part of a larger organization that is working to extend coverage of HIPAA, HITECH, and the BAA more broadly.

Business as usual.

It’s primarily business as usual, however, there are some provisions of the rule that may require us to revisit many of our third-party contracts. That has the potential to be a major endeavor, so it is something we are evaluating now.

Business as usual.

IT executives are because we are also on the hook for data security. The ability to not share data on specific encounters defined by payer type (insurance vs. self pay) concerns me a lot. I am not sure the HIS/ EMR/ EHR vendors are ready. I can’t say any of our other executives have even read a brief on the Omnibus rule.

[vendor member response] We are very concerned about the increased risk/liability for breaches. This is a big concern when using contractors. Our clients are not knowledgeable about the changes and truly not focused on it at all. On the ambulatory side of things, practices, even larger ones, are so swamped with EMR/EHR, and revenue loss from managed care that they consider HIPAA a done deal.

No. They are not at all, even after several attempts to raise awareness.

The organization is ignoring the rule, but the expectation is that IT and HIM stay on top of it. I don’t have a problem with that and so IT/HIM are finishing up our changes in order to comply.

We hired a CISO out of the military with a background in technology security. She makes sure the execs are paying attention. We have a team that consists of privacy officer, corporate compliance, audit, and CISO. They meet regularly to address all aspects of HIPAA and HITECH requirements including education.

It is business as usual with no real interest from the senior team or the board.

Our Privacy & Security Officer are, and they’re slowly getting the attention of leadership. We addressed a lot of the changes in the proposed rule, so we don’t have as much to address as we would otherwise.

Business as usual.

[vendor member response] Within our customer base I am seeing customers starting to pay attention to making sure all BAAs are updated and signed. However, I have had a couple of folks tell me there is no ‘hurry, since we have until early fall to totally comply.” I personally am not hearing of any urgency to meet the rule within any conversations I am having at the executive level. I am hoping that urgency is there just not being expressed to me!

Business as usual.

Some attention — trying understand implications…

Except for Compliance, Legal, and IT, it hasn’t had a lot of attention. Many vendors, especially small to mid-sized cloud hosting vendors, have not fully realized the implications.

Appropriate attention has been paid by those over that area.

Our executives have reviewed the rule to see where we need to comply and what actions to take.

Yes.  his has been an agenda item for our executive-level compliance, privacy steering committee. As a result we’ve modified our business associate agreement, are in process of rewriting notice of patient’s right to privacy, same with data breach evaluation criteria.

Just business as usual.  Haven’t heard it come up even once.

Business as usual.

Business as usual. We are overwhelmed right now with MU and NCQA. So many regulations, such limited staff to execute.

If anyone is paying attention to this, it is hard to tell.

More of business as usual. The interpretations and evasions are so vast and pandemic that it more of a series of workarounds than a policy.

All with active BAAs are being touched. Mail-merged form letter, follow-up phone call, lawyer letter if still no response.

Morning Headlines 7/3/13

Health IT Patient Safety Action and Surveillance Plan

ONC releases its much-anticipated patient safety and surveillance plan that tackles a number of issues, such as how patient safety problems will be reported and tracked. EHR certification bodies will be required to confirm functionality and usability not only through testing, but through field observation. The Joint Commission has also been contracted to help identify and address safety issues.

Intuit Announces Next Phase of Structural Moves; Organizational Foundation Now in Place

Intuit will sell its Intuit Health Group, reporting that it had initially evaluated healthcare as a growth opportunity, but that it had come to realize that its health group would be better off with an organization that has a stronger focus on the healthcare industry.

Judge orders Affinity to bargain with union

A judge in Ohio has sided with a nurses’ union at Affinity Medical Center after they filed a unfair labor charge over a rushed Cerner implementation. Nurses claimed that the go-live date was too aggressive and a lack of training compromised patient safety. The judge ruled that Affinity leadership violated labor laws a number of times, first by refusing to negotiate with the nurses’ union, but other less-than-honorable examples cited by the judge included managers reducing the number of nurses in the ICU as retaliation and managers scrutinizing the charts of nurses who were outspoken union supporters in an effort to initiate disciplinary actions.

Washington Hospital "goes live" with $86 million electronic medical records system

In Freemont, CA, 339-bed Washington Hospital goes live on Epic across all inpatient and outpatient departments.

News 7/3/13

Top News

• ONC wants EHRs to be equipped with a “report a problem” type button that would collect information about the issue and send it to Patient Safety Organizations using AHRQ’s Common Formats.
• Certification bodies will be required to “conduct surveillance” to ascertain that the capabilities of a given certified EHR are the same in the field as they were observed in certification testing.
• Certification body surveillance will also monitor EHR vendor responsiveness to user complaints.
• ONC will monitor FDA’s MAUDE medical device problem reporting database to find reported events that are related to health IT.
• Meaningful Use and certification standards will be expanded to cover more patient safety-related objectives.
• ONC will create tools that will allow provider EHR users to assess patient safety in their organizations.
• ONC awards the Joint Commission a sole source contract to assist the ONC in detecting and proactively addressing health IT-related safety issues across a variety of care settings. The Joint Commission will develop an IT incident classification system, provide de-identified reports on related sentinel events, conduct at least five event investigations each in hospitals and practices, develop provider tools to help providers understand IT-related sentinel events, and publish a research paper that analyzes IT-related sentinel events.

From Evangelist: “Re: Epic. Killing it in large practices.”More than half of all EMR-using practices that have 40 or more doctors use Epic, according to SK&A. Allscripts and eClinicalWorks each serve a substantial percentage of the smaller offices and the top 20 vendors support almost three-quarters of all practices using an EMR. Where people get in trouble is trying to infer from this limited information who’s buying what, which is more a question of practice ownership rather than practice size as hospitals keep buying out doctors and sticking Epic and Cerner in there.From Pointy Head: “Re: McKesson. Killing the MED3OOO Unity project and sunsetting InteGreat in favor of Practice Partner. There have been layoffs.” Unverified. McKesson acquired MED3OOO in October 2012 and claimed major go-forward love for InteGreat, so that’s quite a change in stated direction if so.

As reported here this past weekend on HIStalk from an Indoor Privy rumor, Intuit announces plans to divest its health group, including the patient portal business it acquired from Medfusion in 2010 for $91 million. Intuit says it thought the health group could make money, but it needs to be owned by someone who understands healthcare better. It would not be surprising to see one of Intuit’s resellers — such as Allscripts, GE, or Greenway — make a play for the business.A union investment group urges McKesson’s shareholders to vote out Chairman and CEO John Hammergren and two other directors because of Hammergren’s compensation, also demanding that the company split the chairman and CEO roles he holds.

Flagler Hospital (FL) went live this past weekend on Allscripts SCM, ED, lab, radiology, HIM, registration, scheduling, billing, pharmacy, medication administration, and CPOE. According to HIStalk friend CIO Bill Rieger, “So far so good. Mandatory compliance for physician training has led to some great conversations. The Breakaway Group training simulator program has worked and benefited us Day 1 more than we thought it would. MAKE Solutions workflow testing team work really saved us a lot of Day 1 pain as well. Kudos to the Allscripts team for excellent support and response.” CMIO Michael Sanders, MD dressed for the occasion in a brand new Kevlar vest and garish go-live socks, while the command center crew kept on top of the trouble tickets.

Innovation and Research

The Hoosier Healthcare Innovation Challenge will present three developer challenges in Indianapolis on July 12: reduce infant mortality by delivering educational information, eliminate duplicate messages caused by multiple Continuity of Care Documents, and perform medication reconciliation across inpatient and outpatient encounters. Teams can receive cash and an in-kind services worth up to $25,000.

• Vocera demonstrates how its badges work with the Stanley Hugs infant  protection solution.
• Infor integrates NextGate EMPI and identity management solutions with its Cloverleaf integration and information exchange suite.
• ZirMed announces that its first claims acceptance rate is averaging 98 percent or higher.
• Sunquest launches a new website.
• SIS posts a blog entry called “Careers in Nursing Informatics: Applying Your Knowledge.”
• The ONC Beacon-EHR Vendor Affinity Group names SuccessEHR National Director of Government Affairs Adele Allison the group’s co-chair, along with Chuck Tryon of MyHealth Access Network.
• Truven Health Analytics releases the Truven Health Unify ACO solution to help Medicare shared savings program participants manage their ACOs.
• Forrester Research names CommVault a leader in The Forrester Wave: Enterprise Backup Software, Q2 2013.
• Jonathan Handler, MD, MModal’s CMIO, shares his thoughts on population health data and why doctors struggle with it.
• T-System creates a video on its RevCycle+ RCM solution.
• St. Cloud Orthopedics (MN) discuss how the practice earned $342,000 in Medicare incentives payments following its implementation of SRS EHR.
• A Windows 8.1 version of AirStrip ONE Cardiology will be released as part of the company’s strategic partnership in Microsoft’s AppsForSurface program.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect

Morning Headlines 7/2/13

Halamka: IT Must Plan For Disparate EHRs

InformationWeek picks up a blog post by John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, in which he suggests that the "rip and replace" approach to integrating large health systems will not be possible much longer as ICD-10 and Meaningful Use Stage 2 continue to consume capital and IT resources. He advocates a form of affiliation planning in which critical workflows are targeted and automated rather than integrating all care areas.

El Camino Hospital Cuts Readmissions 25% With Health IT

The 433-bed El Camino Hospital in Mountain View, CA reduces readmissions by 25 percent by identifying patients who are likely to be readmitted and taking aggressive action to correct the problems. One solution that shows promise is a tele-transfer planning program that requires clinicians working at long-term facilities to begin participating remotely in discharge planning meetings early in their patient’s stay at the hospital.

Digital health funding is up, but growth slows, says Rock Health

San Francisco-based health IT incubator Rock Health releases a report detailing venture capital investment activity in the health IT startup sector. The report concludes that investments are up 12 percent from last year, with nearly $900 million invested in startups thus far in 2013, but that the pace of growth has slowed as compared to last year.

Facebook grapples with rules for patients seeking organ donors

Facebook is working on implementing a communication platform that will help match patients seeking organ donors with those that may be in a position to respond. This is the second major announcement from Facebook on the subject. The company recently implemented a program that allows users to declare themselves organ donors on their Facebook profiles, an action that automatically launches an official donor registration website where users can register, then posts a message about being an organ donor on the users profile. That initiative has been credited with significantly increasing organ donor registration rates since its deployment.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

George Abatjoglou is CEO of IOD.