Readers Write: Through a Different Lens

Through a Different Lens
By Kathy Krypel

In the end, it was hepatitis. Not some organized alphabetized version, but a quick, no-holds-barred attack from inside that would give me 10 days in the hospital and a look at healthcare from a very different perspective.

I am a clinician. I am also a healthcare IT expert. And now, I am a patient.

My induction into patient life was abrupt and unexpected. I, who had not been hospitalized in 30 years, was afflicted with sepsis in very short order. The trip to the emergency department, the 103 degree fever, and the 10 days spent in the hospital are all a bit of a blur.

Looking at it weeks later, from the slow recovery side of things, I offer these observations.

The Clinicians

I don’t know if they still teach something called ‘bedside manner’, but my experience with clinicians varied significantly. On the high end of the scale were the infectious disease doctor and hospitalist who coordinated care, modeled teamwork, and went out of their way to explain tests and procedures to me and my family. On the low end was the consulting physician, who referred to me as the ‘bile duct in 52’ in a hallway conversation that I happened to overhear.

The nursing, lab, radiology, and transport staff will forever have my gratitude for the way they fiercely protected my modesty (even when I was too sick to care), kept me informed about test results, and treated me and my family with utmost kindness.

The Electronic Medical Record

Ironically, I actually helped build the EMR and train users at the hospital where I was admitted. It was astonishing and very impressive to see it in action. I was able to see how quickly blood test results came back, watch the multiple ultrasounds and CT scans, and even observe my own liver biopsy.

It was fascinating, but reminded me that the EMR is only a tool that offers safeguards and suggestions. The physicians on my case were dogged in their pursuit of this infection, but even with the best of electronic records, they could not grow a blood culture faster or obtain instantaneous results on lab draws. These just take time. As good as an EMR is, it can help with the diagnostic process, but cannot magically make it faster.

The Patient

At the end of the day, it’s the human things that I will remember most – the infectious disease doctor who held my hand in the ED, the hospitalist who sat on the end of my bed for 30 minutes and explained what was happening and said that she would “tell us when to worry,” and the number of nurses who looked me in the eye and said, ‘I am so sorry this is happening.”

Despite advances in healthcare information technology, there’s still an inherent need for the personal connection – the relationship. That is the vehicle for healing. As the industry tackles the patient engagement challenge, the relationship – the patient experience – truly is at the center.

Kathy Krypel, LICSW, PMP is a master advisor for Aspen Advisors.

Readers Write: What’s in YOUR Medical Record?

What’s in YOUR Medical Record?
By Ken Schafer

If my wife were admitted to the hospital with diabetic ketoacidosis (DKA), I’m pretty sure I wouldn’t want her electronic record to erroneously record a leg amputation (BKA). I’m equally confident that if this documentation mistake were made, I wouldn’t care too much how it happened. I would just want it fixed.

And if incorrect documentation on my diabetic wife resulted in an incorrect treatment course, which resulted in her death? You might end up with a $140 million verdict like this one.

Inga’s post on The Atlantic’s “The Drawbacks of Data-Driven Medicine” (from Big Datty,on 6/12/13) illustrates something that we all know to be true. Our medical records often contain mistakes, and electronic errors perpetuate themselves embarrassingly quickly. But her comments – and the source article – miss two very important points.

Doctors are responsible for the content of the records they create. This is true regardless of the method used to document patient encounters. Blaming the speech recognition system for hearing “DKA” instead of “BKA” makes no more sense than blaming a keyboard for a typographical error. If the physician picked the wrong checkbox on an EHR interface, would that be the fault of the EHR? Of course not.

Speech recognition, keyboarding, and dropdown menus are all methods for data capture. For that matter, so is a more traditional transcription process. But all of these methods have one element in common: the final content should be reviewed and validated by the documenting clinician. Physicians who fail to do this put their patients at risk.

Doctors make mistakes. I know a radiologist who dictated “liver” when he meant “heart.” The transcriptionist dutifully returned the report with the word “liver,” and it was signed by the physician. When the mistake was discovered, the audio was retrieved. The doctor listened to himself dictate the wrong organ, and blamed the transcriptionist. The point? Doctors are people, and people make mistakes, whether they own up to them or not.

That same physician was convinced speech recognition would eliminate transcription errors, and he was right – sort of. What speech recognition systems really do is eliminate transcriptionists, not errors. If radiologists are involved, there will still be errors. There’s no speech recognition system that will hear the word “liver” and change it to “heart.”

In fact, in our DKA:BKA example, the doctor may have had a bad day and actually said BKA to the speech recognition system. No matter what, though, the doctor made a mistake – either in what he said, or in what he saw on the screen and failed to correct.

Those with experience greater than mine often post to HIStalk about the shortcomings of EHRs in terms of the data they contain, with usability and completeness being favorite topics. My concern for our records is more specific. Especially when speech recognition is involved, what metrics do we have in place to make sure that narrative data is recorded accurately? If doctors are responsible for the content of their documents, and we know they make mistakes, how do we monitor and improve the quality of the narrative components of our EHRs?

As the government, physicians, patients, and the free market determine what systems we are to use and how they should work, we should never lose sight of this one truth: no matter what’s in the record, it should be right.

Ken Schafer is executive vice president, industry relations for SpeechCheck.

Time Capsule: The Obama-HIStalk Digital Stimulus Grants: Why Letting Me Hand Out the Freshly Printed HIT Cash Makes Sense

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in January 2009.

The Obama-HIStalk Digital Stimulus Grants: Why Letting Me Hand Out the Freshly Printed HIT Cash Makes Sense
By Mr. HIStalk

This government stimulus thing is new to everyone. It’s no wonder all of us (Uncle Sam included) are bumbling around cluelessly, flitting from one hare-brained idea to another on how we’ll improve healthcare by throwing new money at old products used by uncommitted providers who have had minimal impact so far.

Hospitals and vendors are used to being poor, so the pressure is excruciating. Without the excuse of perpetual poverty, people are going to want results. Duh!

(It’s ironic. We got into this mess by living beyond our means. Now Uncle Sam is going to do the same to buy our way out of the recession. If it fails, we’ll be like Zimbabwe printing $100 trillion notes that won’t buy a loaf of bread.)

Nobody can quite figure out what to stimulate with the hundreds of billions. What people are missing is this: it doesn’t matter. The goal is to just blast a lot of freshly printed cash out there. It only has to exchange hands enough times to create the illusion of restored prosperity. Nothing really has to be fixed in return. You might as well kick $100,000 cash bundles out of airplanes. Just get the money into circulation and hope for the best.

(See: Wall Street bailouts. And note: while I enjoyed MBA macroeconomics, I really never understood the whole money supply thing, so I could be slightly off base).

That’s why I humbly nominate myself to personally manage the process for healthcare IT’s $20 billion lottery winnings.

Everybody agrees that the deficit-enhancing stimulus needs to be a shock-and-awe carpet bomb of currency to put out the recessionary fires, kind of like John Wayne in “The Hellfighters” bombing burning oil wells to snuff out the flames. Here’s how I’ll get all that money into circulation and working by April.

I’m going to take all $20 billion to the HIMSS conference (note to self: I’ll need a suite rather than a room, hopefully one with a large in-room safe). When the show opens in the inevitable Chicago snowstorm, I’m going to quietly observe the action and decide in a unilateral but entirely trustworthy manner who I’m going to hand it out to, kind of like Oprah giving away cars or that ‘50s TV show “The Millionaire.” There’s no committee and no paperwork – you just have to impress me while I’m undercover, and I tend to like non-conformists.

Unlike Uncle Sam, I don’t care about your previous track record. Given the state of healthcare IT, the folks with a long industry history aren’t the ones you would want leading a revolution. It’s time to identify some new blood.

I’ll start with the Venture Fair, giving some CEO-wannabe armed with his idea for an EMR written in Excel $50 million. Then on to the opening reception, where anyone willing to publicly say that interoperability is a cruel hoax will find wads of cash in their pockets afterward. CIOs of hospitals under 200 beds doing CPOE get $10 million, no questions asked.

Got a cool booth design that catches my eye? Here’s $25 million – thanks for the chuckle. A session presenter who actually has something interesting to say without any obvious bias? Take this $50 million, my friend, and do good deeds. A bored hooker forced by economically challenged Johns to moonlight as a booth babe? This million will get you through an informatics training program. A replacement for the cheesy HIMSS opening theme, “Now Is Our Time?” AC/DC live right there in the hall, doing “ Information Highway to Hell.”

I’m going to seek out the industry’s downtrodden, the non-suit wearing, non-badge ribboned rank and file who have been rowing hard in the galleys while the millionaire captains were steering the ship aground. As long as you’re passionate, poor, and fun, you get one of the thousands of Obama-HIStalk Digital Stimulus grants (extra points if you’ve been laid off or forced to move to Kansas City).

You might scoff at the frivolous nature of my self-nomination, but I will get the job done better than any HIMSS committee or federal agency. The money will trickle down like nobody’s business. I will make sure only interesting people and not soul-sucking corporations get it and I won’t siphon off 20 percent as my administrative costs. It might work and it might not, but that’s no different than any of the fancy-pants suggestions that are on the table. Everybody’s making it up as they go.

All I ask in return is adoration and maybe an Obama fist-bump. And, the thanks of a grateful nation.

Morning Headlines 6/21/13

Cone Health to lay off 150 workers

Greensboro, NC-based Cone Health will lay off 150 workers, or about three percent of its workforce, to help cut $30 million from its annual budget. Terry Akin, Cone Health president and COO, said that its Epic implementation has been a big short-term expense.

Cerner Launches Pilot Program To Offer Personalized, Quality Care Aligned For Better Health 

Cerner launches a Kansas City area pilot program to test new health delivery model in which retail locations serve as patient access points. Nurses will perform wellness screenings and provide tailored patient education and recommendations.

New Technology in Place for Electronic Submission of Veterans’ Disability Claims

The VA has launched a new Web portal that will allow veterans to submit disability claims electronically. The system is integrated with the VA’s paperless claims processing system VBMS, creating a nearly paperless end-to-end process. Medical records are one of the few claims elements that will still need to be scanned or mailed on paper.

The Regional Extension Center Program in Texas Met the Scope of Services in Their Cooperative Agreements With the Office of the National Coordinator for Health Information Technology

The Office of the Inspector General audits four Texas Regional Extension Centers that were cumulatively awarded more than $30 million in federal funds. The goal of the inspections was to verify that the RECs had meet the requirements outlined in their cooperative agreements with ONC. OIG auditors concluded that the REC programs had meet all requirements and were successful in supporting health IT adoption across their territories.

News 6/21/13

Top News

Healtheway announces its nine founding organizations. The public-private partnership will provide operational support for the eHealth Exchange, formerly known as the Nationwide Health Information Network Exchange.

Reader Comments

From Site Watcher: “Re: HIStalk. Happy 10th anniversary!” Thanks! It has gone by quickly.

From Doug: “Re: Meaningful Use security risk analysis. I would be interested in which of your sponsors offers consulting engagements, especially those appropriate for a 100-bed community hospital.” Thanks for showing preference to HIStalk’s sponsors, any of which that can help Doug can contact me and I’ll forward your information.

From Vascular Surgeon: “Re: health data. A Wired graphic from April finds that Kaiser Permanente’s data set is 31 petabytes, six times the size of the digital collection of the Library of Congress.”

HIStalk Announcements and Requests

Highlights from HIStalk Practice this week include: the top ambulatory EHR, PM, and clearinghouse products according to the KLAS Mid-Term Report (and don’t miss the readers’ comments about the rankings.) A computer outage in the Canadian province of Alberta causes 202 practices to lose access to patients’ charts for over five hours. Almost half of practicing physicians are dissatisfied with their jobs. CMS publishes updated 2014 clinical quality measures for EPs. Technology could improve treatment outcomes for children with chronic illnesses. I whine and wonder about waiting at my doctor’s office. I love new readers almost as much as I love ambulatory HIT news, so sign up for the e-mail updates when you are perusing the news. Thanks for reading.

Some of the interesting recent posts on HIStalk Connect are (International) White Collar Healthcare, Mobile Health App Platform Choices, Apple Markets Its Role in Global mHealth, and Start Me Up HIT Event. Get e-mail notification of new HIStalk Connect posts by signing up.

I’ll be surveying the HIStalk Advisory Panel of primarily CIOs again this week. Let me know if you have a question you’d like me to ask them.

Welcome to new HIStalk Platinum Sponsor Logicare. The Eau Claire, WI company offers patient instructions for hospitals, clinics, and EDs that integrate with all major EHRs including the VA’s VistA. Clinicians enjoy the ability to create a patient-specific teaching document in just a few clicks, while patients can actually understand that document since the content is written at a sixth-grade reading level. Patient instructions are offered for 6,300 topics and the system has earned numerous ONC certifications, making it easy to meet the Meaningful Use requirement to provide electronic discharge instructions (flash drive, secure e-mail) at the time of discharge for patients who request them. Thanks to Logicare for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Clinical Outcomes Management Systems, a provider of disease management technology for the long-term care industry, secures a minority investment of $21 million from Summit Partners.

Agilum Healthcare Intelligence raises $1.82 million of a $2.32 million equity offering.

Sales

Polyclinic Surgery Group (WA) selects ProVation medical software from Wolters Kluwer Health.

The Georgia Department of Community Health selects Truven Health Analytics to build and implement the Georgia Health Information Network.

Chinese Hospital (CA) will deploy NextGen Inpatient Clinicals.

KishHealth System (IL) selects PerfectServe clinician-to-clinician communications platform for two of its hospitals.

WellStar Health System (GA) will deploy Capsule’s DataCaptor software across its five hospitals.

People

Eastern Maine Healthcare Systems announces that VP/CIO Catherine J. Bruno will retire in December.

Ernst & Young names Encore Health Resources CEO Dana Sellers its 2013 Entrepreneur of the Year for Healthcare in the Gulf Coast Area.

Jerry Dennany (Allscripts) joins RazorInsights as CTO.

UltraLinq Healthcare Solutions appoints Ross Hoffman, MD (MedSolutions) CMO.

Announcements and Implementations

Caradigm announces the availability of Provisioning v4.0, which manages clinician access to applications while supporting data privacy regulations.

EHealth Technologies breaks ground on its new company headquarters in Rochester, NY.

Cerner launches a pilot of the Primary Health Network, a health model that uses retail locations as access points for wellness screenings.

Government and Politics

The HHS Office of Inspector General audits four Texas RECs and concludes that each has met the scope of services in their cooperative agreements with the ONC. The audits are the first of their kind by the OIG and focused on outreach activities, vendor selection and implementation assistance, and workflow analysis.

The VA announces the availability of eBenefits, an online portal that will allow veterans to file disability compensation claims electronically.

Hello, Cleveland! MT @ChitraMohla 400 attendees present to listen in on what @JudyMurphyONC has to say. Great venue!

— ONC (@ONC_HealthIT) June 20, 2013

Today’s best use of a “This Is Spinal Tap” reference in a tweet comes from, interestingly enough, the federal government.

Other

Unionized nurses with Affinity Medical Center (OH) call on hospital officials to delay this weekend’s implementation of Cerner EMR, saying patients will be at risk because the nurses have not received sufficient training and will be short staffed during the first days of the live. The nurses detailed their concerns in a letter to hospital officials, but claim that hospitals officials refused to meet with them and would not accept the letter.

Here’s athenahealth’s Jonathan Bush speaking at TEDMED 2013 on healthcare profits, pointing out that non-profit hospitals often make bigger margins than Exxon. “In the mid-1990s, healthcare was annoyingly affordable – annoying if you’re one of the hospitals.” He names names.

Cone Health (NC), facing a $30 million annual budget shortfall, will lay off 150 employees. Both Cone and nearby Wake Forest University Baptist Medical Center say their Epic implementation costs hurt their bottom line at least temporarily.

Sponsor Updates

• HealthEdge, a provider of IT solutions for healthcare payors, partners with NTT DATA to transition Independent Health and Riverside Health to the HealthRules product suite.
• Divurgent posts a video of its DIVOLYMPICS employee spring games event.
• Two members of Wellcentive’s implementation team earn NCQA certification as content experts for patient-centered medical homes.
• Access partners with The Last Well to bring clean water to all of Liberia.
• A Deloitte Center for Health Solutions report explores how CIOs are navigating  day-to-day management challenges.
• Visage Imaging publishes “Three topics you may have missed from #SIIM13” as a follow-up to the recent Society for Imaging Informatics in Medicine 2013 meeting.
• ISirona President Peter Witonsky lists key criteria for evaluating a medical device data system.
• GetWellNetwork announces the Transformative Health Series, a series of short films that recount the personal journeys of patients, families, caregivers, and healthcare professionals who are shaping the patient engagement movement.
• API Healthcare opens its annual conference with a keynote address featuring Paul Spiegelman, author of Patients Come Second: Leading Change by Changing the Way you Lead.
• Verisk Health announces the agenda and speakers for its 2013 national conference September 18-20 in Orlando.
• The Association for Healthcare Documentation selects Emdat as a nominee for the Innovation Through Technology Award.
• A local publication features Canton-Potsdam Hospital (NY) and its online bill-pay service operated by Instamed.
• Strata Rx announces the schedule for its O’Reilly Strata Rx Conference September 25-27 in Boston.
• Aspen Advisor consultant Claudia Blackburn will discuss how to empower population health during a June 25 Webinar.
• Wellsoft’s EDIS earns the top rating for EDIS and Imprivata takes the top spot for Single Sign-On in the KLAS 2013 Mid-Year Performance Software & Services report.
• Former CMS Administrator Donald Berwick, MD discussed the future of healthcare at this month’s 22nd Annual Midas User Symposium.

EPtalk by Dr. Jayne

The American Medical Association’s House of Delegates met in Chicago this week. One of their resolutions addresses sitting in the workplace. Employers are encouraged to make alternatives available including standing desks, treadmill desks, and isometric balls. I’d love to have a treadmill desk, although I spend half my day on conference calls which would render it almost useless. Several schools in my area are experimenting with standing desks in the classroom, citing famous users Thomas Jefferson, Winston Churchill, Charles Dickens, and Ernest Hemingway.

I loved this piece on batch workflow for the medical office that turned up on KevinMD this week. It should be required reading for EHR users. Author Dike Drummond, MD compares physicians that respond to popups and messages in the EHR to a dog with a tennis ball that can’t choose to not chase it once thrown. Watching my colleagues become totally distracted with Instant Messenger, Twitter, Facebook, and e-mail all day long, I can’t help but agree.

Dr. Gregg tweeted earlier in the week about the fundraising effort for Scanadu Scout, being billed as the first real medical tricorder. I e-mailed myself to look at it later and am happy to see that they have raised over a million dollars. I also learned that the Scout is built on the same platform as the Curiosity Rover, which is pretty cool if you’re a science geek like me. Scanadu hopes to use backers to gather data to help refine its algorithms as well as to prepare for FDA approval as a medical device.

Speaking of Twitter, Bill Gates @BillGates noted this week that he is “Excited to join the 200M+ strong @LinkedIn community.” I wonder if his connections will start endorsing him for skill sets that he doesn’t actually have, which is what my connections recently started doing? It’s definitely been amusing.

I’m excited about the new HIStalk webinar series, but unfortunately my day job keeps interfering with my potential attendance. Next week’s webinar addresses “Using Clinical Language Understanding & Infrastructure Planning as Key Strategies to Ensure Clinical Revenue Integrity with ICD-10” and you can register here. I’ll likely register anyway with the hopes that my conflicting meeting will cancel – hope to see you there!

We’ve all heard horror stories about organizations dumping medical records rather than shredding them or unintentionally misplacing paper charts. Now that patients are receiving copies of their visit summaries and other documents at every visit, there’s an increased chance that we’re going to see more than grocery receipts and shopping lists blowing in the wind. Kudos to my friends at DISC Corporation who made sure the full-color copies of a patient’s colonoscopy report made it to the shredder. Not every patient-facing document has a patient or practice address, so that was probably the most ethical course of action.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/20/13

Atul Gawande, Renowned Surgeon And Writer, Launches Innovation Lab

Surgeon Atul Gawande, MD, once named by Time magazine as one of the world’s most influential thinkers and author of The Checklist Manifesto, launches the Adriane Labs health innovation center. It will conduct research focusing on childbirth and death.

Health Law Won’t Bring Prices Down For Patients

At a Capitol Hill hearing Tuesday, Time magazine journalist Steven Brill told Senate Finance Committee members that President Obama’s healthcare law will do little to lower prices for consumers. Brill covered health care costs in a heavily circulated recent Time article titled, "Bitter Pill: Why Medical Bills Are Killing Us."

Healtheway Announces Founding Members for Groundbreaking Public/Private Health IT Exchange

Healtheway, the nonprofit organization that supports the eHealth Exchange, today announced its nine founding organizations, of which Epic is the only EHR vendor and Kaiser Permanente is the only health system.

Affinity nurses seek delay on electronic records 

Unionized nurses at Massillon, OH-based Affinity Medical Center call for a delay in its Cerner implementation scheduled for this weekend, citing insufficient training and patient safety concerns. The nurse’s union is using the issue to demand contract negotiations.

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

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

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

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

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

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

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

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

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

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

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

Readers Write: Have a Seat

Have a Seat
By Ryan Secan, MD, MPH

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

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

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

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

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

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

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

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

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

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

CIO Unplugged 6/19/13

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

Bank Life, Not Vacation Days

If your organization is like mine, you are fairly data driven. We have Key Performance Indicators (KPI) to track business and clinical metrics that help ensure we’re headed down the right path. Our published dashboards let employees and the public know how we are doing in fulfilling our vision and mission. We use the data, drill down as needed, make adjustments, refine processes, improve, and continue forward. There is a reason why data-driven organizations outperform those that aren’t.

You’ve seen me draw these sorts of analogies before. If it works so well in business, why don’t we apply the principles to what matters most? LIFE. So I pondered this . . .

What would the KPIs be for my life? One that jumps to mind is the balance on my Paid Time Off (PTO/Vacation). A high balance warns of danger while a low balance indicates just that — balance.

Confession time. I used to pride myself on statements like, “I am too busy to take PTO” or “My role does not allow me to take much time off.” Poppycock!

When I switched jobs, I enjoyed cashing in the 600-hour balances I maintained. But at what cost? My family and my well-being!

Never again.

Listen to me. I am not waiting until retirement nirvana to spend time with those I love. I may not make it there. And if I do, my “loved ones” may no longer recognize me.

This year, I started taking more time off with the goal of maintaining a PTO balance below 100 hours. Taking time off does not necessarily mean spending money and traveling to Timbuktu. It can mean just staying at home or volunteering at a local service organization. There are numerous organizations that need us. (The staying-home part and the volunteering are my new works in progress. Keep me accountable, and I’ll keep you posted.)

The benefits to routinely spending your hard-earned PTO are numerous. First and foremost is your personal well-being. Ample evidence shows a direct correlation between well-being and happiness. You must take care of yourself so you can help take care of others. When you do this, your family wins, society wins.

Gallup research shows that by increasing well-being, you also increase productivity. The more you rest, the more restored you become, the more effective you are at work. We have all seen the ragged co-worker who never takes PTO, working 60 hours per week. In most cases, when productivity and well-being is sapped, a person becomes impotent.

Been there, done that. Not going back.

Bringing it squarely back to work, think of the benefit to your team. Counterintuitive perhaps? When you’re gone, a couple of things happen. One, they get a much needed break from you. True that! Everyone needs a break from their manager now and again. Nobody is that good, or indispensable.

Two, it demonstrates trust in a way words cannot. I recently took PTO, and my staff had to lead and deal with two major events without me. You know what? They did not miss me. In fact, one could argue they did better because I wasn’t there!

Admittedly, I’m still struggling to unplug once I am off. I have a great team at the office and my worries are few, but I am struggling to break the addiction. That may drive another KPI.

Take your PTO. You earned it. I don’t give a flip what your role is or what projects are coming up. You are not that important. Certainly not more important than what your family needs. You. You in the moment. You rested. You there.

Get your rear out of the office.

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 6/19/13

Robert M. Wah, MD, Elected President-Elect of AMA

Retired Navy medical officer Robert Wah, MD has been elected as the next president of the AMA. Wah is a reproductive endocrinologist and OB-GYN in Washington, DC and serves as chief medical officer of Computer Sciences Corporation. He is also a healthcare IT expert, having previously served as ONC’s first deputy national coordinator.

CareCloud Raises $20 Million to Support Continued Record Growth of Company’s Cloud-Based Clinical and Financial Platform for Physician Practices

CareCloud, a cloud-based EHR vendor, raises $20 million in a Series B funding round which it will use to enhance its EHR platform and to increase pressure on competitors like athenaHealth and Practice Fusion. CareCloud has been competing with athenaHealth on all fronts lately, fighting off a patient infringement lawsuits filed by them one day and then head hunting their executives the next.

Computer problems force docs back to paper charts at Memorial Hospital

Computer problems have forced Belleville, IN-based Memorial Hospital into downtime procedures after its Meditech EHR went down late on Tuesday, June 11. It is not expected to be fully restored until at least Monday, June 24.

First of 4,000 Cerner employees move into new KCK offices

Cerner employees begin moving into the first of two new towers being built at the company’s Kansas City, KS campus. The towers will eventually hold 4,000 employees.

News 6/19/13

Top News

Robert M. Wah, MD, a reproductive endocrinologist, chief medical officer for Computer Sciences Corporation, Navy veteran, and ONC’s first deputy national coordinator, is elected president of the AMA. He’ll take office in June 2014.

Reader Comments

From Alectrona: “KLAS Mid-Term report. Epic was the only acute care EMR to earn a green stoplight.” In KLAS-speak, a green stoplight indicates a customer satisfaction that’s at least six points above the average for that product segment. EpicCare Inpatient scored 90.4 compared to the 12-month segment average of 73.2. Cerner Millennium PowerChart came in a distant second at 77.5. The average score for community hospital EMRs was 70.6, indicating a good deal of discontent across both segments. Ambulatory EMRs fared better, led by PCC EHR (94.5), EpicCare Ambulatory (88.3), and SRSsoft EHR (86.7).

From Stephanie: “Re: EMR. Can you recommend a system that would be ideal for a small, new epidemiology practice?“ I’ll open the floor to suggestions, particularly for EMRs known to work well for a practice of that type.

From Re-Org: “Re: Springfield Clinic. Dual-headed CIO initiates re-org and dismantles the clinical informatics department, which merges with IT. Top talent jumps ship along with dual-headed CIO. HR will no longer meet with confused, misled, and frustrated employees.” Unverified.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor SpeechCheck. The Yorkville, IL company can help prevent errors that occur when physicians (especially radiologists) fail to correct mistakes created by speech recognition systems, which is often a problem with their rapid rollout. Those mistakes can cause embarrassment, loss of reputation, patient care problems, and lawsuits. The company analyzes a facility’s reports, trains their physicians, and develops measurable quality standards that include a goal of 98 percent accuracy and zero critical errors. The result is improved care, risk management, and increased reimbursement. Choose from four service packages that offer choices for type and frequency of auditing, creating or reviewing templates, one-on-one physician training and conversion to self-edit , and compliance updates. See where you stand by finding your documentation quality metric. As the company says, we’ve all seen radiology reports where the technology failed to wreck a nice beach recognize speech. President and CEO Lee Tkachuk is a friend of HIStalk going way back; she also leads ChartNet Technologies and Keystrokes Transcription Service. Thanks to Lee and SpeechCheck for supporting my work.  

Maybe I should have taken a picture with my iPhone. I noticed a guy standing at the urinal in the restroom at work doing his business while frantically keying into his iPad mini with both hands. I dawdled at the sink to see if he washed his hands afterwards since I wondered if he could stand the separation from his beloved gadget. He did, not that it mattered at that point.

Acquisitions, Funding, Business, and Stock

CareCloud secures $20 million in Series B financing led by Tenaya Capital, bringing its total funding to $44 million.

Mobile health monitoring provider Medivo raises a $15 million Series B round.

PaySpan, a provider of automated healthcare payments and reimbursements, acquires the assets of mPay Gateway, a point-of-service patient payment solution for healthcare providers.

Sales

St. Mary’s Health Care System (GA) selects Merge’s iConnect Access and iConnect Enterprise Archive for enterprise imaging.

OnePartner HIE will add the Allscripts dbMotion platform to enhance reporting and connectivity.

Nature Coast ACO (FL) expands its relationship with eClinicalWorks to include eCW’s Care Coordination Medical Record.

Community Health Network (IN) will deploy OpportunityAnyWare business analytic solutions from Streamline Health Solutions.

WellStar Health System (GA) selects Avantas to provide consulting services and its Smart Square labor management software to improve labor performance in its nursing units.

Lehigh Valley Health Network (PA) will implement Salar’s TeamNotes solution to capture clinical documentation and comply with ICD-10.

People

HIMSS Analytics promotes Bryan Fiekers (above) to director of consulting solutions sales and Matt Schuchardt to director of market intelligence solution sales.

CareCloud hires Tom Cady (athenahealth) as VP of professional services.

Former CMS Administrator Donald Berwick announces that he will run for governor of Massachusetts.

John Frenzel (Conifer Health Solutions) joins Convergent Revenue Cycle Management as CFO.

Announcements and Implementations

Cedars-Sinai Medical Center reports it has recovered more than $300 million by reducing net A/R with the help of Hyland Software’s OnBase ECM platform.

Mary Greeley Medical Center (IA) implements PeriGen’s PeriCALM fetal surveillance solution, interfacing it to Epic Stork.

Glenn Medical Center (CA) goes live on CPSI.

Laurel Regional Hospital and Prince George’s Hospital Center, affiliates of Dimensions Healthcare System (MD), activate Cerner.

EvergreenHealth (WA) goes live with PatientKeeper Charge Capture.

Bumrungrad International Hospital (Thailand) deploys the Intelligent InSites RTLS solution.

ARC Community Services (WI) implements Forward Health Group’s PopulationManager to monitor addiction treatment programs.

Cerner will embed the MedAssets Claims Management solution within its patient accounting solution.

University of Ottawa Heart Institute (Canada) goes live on the Med Access EMR.

Adventist Health finishes its implementation of Strata Decision Technology’s StrataJazz for operating budgets and management reporting and will begin rolling out additional StrataJazz modules for capital planning and strategic planning.

Government and Politics

National Coordinator Farzad Mostashari, MD has supposedly confirmed that the ICD-10 transition date will not be extended beyond October 1, 2014. If CMS weren’t notorious for soft deadlines, would this even be news?

White House Senior Advisor Ryan Panchadsaram, a former executive of Ginger.io and former Rock Health fellow, talks about patients accessing their electronic records at TEDMED 2013.

Other

The first of 4,000 Cerner employees begin moving into the first of two high-rise towers at the company’s new Cerner Continuous Campus in Kansas City, KS.

The Meditech system of Memorial Hospital (IL) has been down since June 11 after upgrade-related problems and won’t return to normal operation until June 24, forcing the hospital to go back to paper charts for almost two weeks.

The UK government fines North Staffordshire Combined Healthcare NHS Trust $86,000 for exposing the medical information of three patients by manually entering the fax number of a psychiatric facility incorrectly and sending it instead to someone’s house.

Sponsor Updates

• Optum donates $10,000 to Arnold Palmer Hospital for Children (FL) in connection with its successful “Make Every Step Count” campaign during this week’s HFMA-ANI conference.
• PeriGen pledges support for the first published draft of nursing care quality measures developed by the Association of Women’s Health, Obstetric  and Neonatal Nurses.
• e-MDs expands its headquarters to three locations in the Austin, TX area.
• An eClinicalWorks survey finds that the primary motivator for becoming an ACO or PCMH is to improve patient outcomes, with respondents also stating that an integrated EHR would be the most valuable IT feature.
• 3M Health Information Systems introduces the 3M CAC System, a computer-assisted coding solution for small hospitals.
• Bay Area News Group includes First DataBank on its list of Top Workplaces based on employee feedback.
• David M. Walker, former US comptroller general, provides the keynote address at the SCI Solutions Client Innovation Summit October 15 in Braselton, GA.
• Advocate Health Care (IL) says its use of the Healthcare Workforce Information Exchange from API Healthcare has given the organization the ability to link patient satisfaction with employee satisfaction.
• Craneware introduces enhancements to its Chargemaster Toolkit software.
• Hayes Management Consulting discusses common areas to consider for increased EHR efficiency.
• GetWellNetwork integrates its Interactive Patient Care solution with Rauland Responder nurse call system to improve nursing workflow and communication.
• Capsule posts a white paper that discusses medical device connectivity that is vendor-neutral, open architecture, and device-specific.
• SRSsoft completes the first phase of certification for the 2014 Edition of the SRS EHR.
• HIStalk sponsors AT&T and Ping Identity are included on Computerworld’s “100 Best Places to Work in IT 2013.”
• MedAssets introduces its Procure-to-Pay Solutions suite, which is designed to enhance the management and oversight of contract compliance, standardization, and pricing accuracy.
• Beacon Partners hosts a four-part Webinar on getting the maximum value from HIT systems beginning with a June 21 discussion on optimizing systems to improve workflow around patient access.
• T-System posts a video highlighting its RevCycle+ solutions for physician.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/18/13

Vitera Healthcare Solutions Announces Acquisition of SuccessEHS

Vitera announces the acquisition of Birmingham, AL-based SuccessEHS. Both vendors operate in the ambulatory EHR space. The acquisition expand Vitera’s user base to 10,500 organizations, 415,000 medical professionals, and 85,000 physicians. Financial details were not disclosed.

Mostashari asserts no more ICD-10 delays

Farzad Mostashari, MD gave the keynote address at the HIMSS Media ICD-10 Forum this week, during which he reiterated that there would be no additional deadline extensions for the ICD-10 switchover on October 1, 2014.

Apollo to scale up IT’s role in services 

Apollo Hospital is the first in India to be named a HIMSS (Asia Pacific) Stage 6 hospital, going live with CPOE and physician documentation on its Med-Mantra EHR.

Smooth move to electronic records in PT

Jefferson Healthcare, a Port Townsend, WA-based 25-bed critical access hospital and nine supporting clinics, goes live with Epic on Saturday morning at 2 a.m. The project was reportedly on time and on budget. Jefferson Healthcare is part of the Swedish Health Network.

Curbside Consult with Dr. Jayne 6/17/13

Over the last month or so, I’ve become a frequent flyer patient at an orthopedic surgery practice. It’s been kind of fun because it’s a practice I rotated at when I was a resident. They’re also part of a local IPA and I’m able to see the workings of our competition.

I have to suspend the process redesign part of my brain when I go there because there are some office processes that drive me crazy. I’m amazed that they’re operating this way in 2013 and am hopeful that Meaningful Use will give them a kick start.

At this week’s visit, a sign appeared announcing they’re preparing to implement EHR, so it was hard not to make observations. One of my running buddies is part of the IPA, so I’ve heard her side of how the system is being rolled out. It doesn’t look like they’re taking lessons learned from one practice and carrying them to the others. I’m pretty familiar with their EHR vendor and I hope they’re not surprised when this practice isn’t successful, because what I saw was not pretty. If you haven’t implemented yet either, you might take some of this as a cautionary tale. Here is the recap.

With the market consolidation going on and the concessions vendors are willing to give to ensure a sale, does it make sense to keep a practice management system from a different vendor than your EHR? What about if the PM vendor is notorious for sunsetting products? The EHR vendor also has a practice management system, and in a lot of ways the PM system is stronger than the EHR. I know from my buddy that the vendor offered to throw in the PM system nearly free, but the IPA was concerned about a conversion. Instead, they thought creating a unidirectional interface from the PM to the EHR was a much better idea. The providers will continue to operate on paper fee tickets even after EHR is live.

It might be a good idea to optimize the practice management workflow and office processes before implementing EHR. Although they are strong at scanning the insurance card at every visit, they are still hand-writing receipts in a duplicate book. I would have thought they were on downtime procedures if I didn’t see it five times in a row. They have a credit card swipe device attached to the monitor at check-in (good) but the printer is 25 feet away on a back desk and they have to get up and walk to get the receipt for signature (bad). They then hand-write the co-pay receipt.

The credit card receipt doesn’t even have the practice name or show that it’s a co-pay. On three of four visits, they forgot to write co-pay on the paper receipt, and because their paper receipts doesn’t have the practice name either, patients can’t submit them for reimbursement from flexible spending accounts.

The staff then has to manually staple the top copy to the patient credit card receipt and the bottom copy to the patient demographic sheet, which they didn’t ask me to verify at any visit. On three of three post-procedure visits, they also collected a co-pay during the global period, which they had better be cheerfully refunding to me once I receive my Explanation of Benefits statements. Based on the chaos at the office, it seemed easier at the time just to pay it than to delay my visit with a discussion since I was juggling my appointments around my work schedule.

There are doors at each end of the large L-shaped waiting room to the patient care areas. They don’t warn patients as to which side their physician is working, and the employees don’t speak loud enough to be heard around the corner of the L (or over the loud televisions) when they call patients. This results in delays because patients can’t hear that they’ve been called and take longer to get to the door on crutches or in a wheelchair because they’re waiting on the wrong side.

Check-out is at the same desk as check-in (although with two separate lines), so there is constant competition between getting patients in and out. Each time I was offered a follow-up that was at least a week later than what the physician recommended, and the front desk staff had to call back to the physician area to have me approved as a work-in. I wonder how many patients insist on the follow-up interval they were told versus how many just take what is offered? Where orthopedics is concerned, that can sometimes make a difference in a patient’s return to function if their cast is left on longer than intended or they don’t get timely follow up. It’s also a waste of time to require the front desk to have work-ins approved when they are approved 100 percent of the time, which I witnessed in my multiple tours through the waiting room.

Workflow in the patient care areas was actually pretty good, with smooth handoffs between the medical assistants, radiology tech, and cast techs. There was a delay with the physician, which gave me time to read the brochure about the practice’s upcoming medical mission trip to the Dominican Republic, scheduled to start three days after my most recent appointment. I’ve actually used the EHR that they’re installing, so I chatted a bit with the cast tech about it and found out they were having training that afternoon.

She mentioned they will be going live while half the office is away and that the physicians won’t attend training. Instead, employees will attend he training and then train the physicians when they returned. I shuddered a little at what a terrible idea this is. Although train-the-trainer programs can work, it does take time to develop solid training competency and enough understanding of the software to be able to train it. Expecting front line staff to be able to train their physicians after a single round of training and only a week of real-world experience is not a good idea.

Scheduling a go-live when half the office is out is not the best idea, as those physicians going live will have to cover emergencies and other office tasks for those away. Expecting the rest of the practice to go live the week they return from being out is a disaster in the making, given the existing backlog and wait for patient appointments and the fact that they’re always double (and triple) booking. It’s not as if they didn’t know this trip was coming since they’ve been fundraising for it for six months based on the date of the brochure.

On the way out, I noticed the staff in a conference room, huddled around tablet PCs and going through training. What a way to spend a Friday afternoon! I’m scheduled for a follow-up the week of the second round of go-live, so it should be interesting. I have an add-on appointment at the end of the day, which guarantees it will be good for at least one story. I can’t wait to see their workflow for EHR or how well their train-the-trainer plan went. Stay tuned!

E-mail Dr. Jayne.

Vitera Acquires SuccessEHS

Vitera Healthcare Solutions will announce this afternoon that it has acquired Birmingham, AL-based SuccessEHS, which offers PM/EHR, electronic dental record, dental imaging, and revenue cycle solutions. SuccessEHS, which has doubled in size in the past two years, will be operated as a division of Vitera.

The acquisition will expand Vitera’s user base to 10,500 organizations, 415,000 medical professionals, and 85,000 physicians and will increase its customer base of Community Health Centers.

Vitera has invested $25 million in product development and customer support enhancement in the past 18 months and introduced four new products, including Vitera Intergy Mobile and the Vitera Stat PM/EHR package for small practices.

Morning Headlines 6/17/13

Office of the National Coordinator for Health IT Tackles Pressing EHR Issues

Farzad Mostashari, MD is interviewed by AAFP News, the news outlet representing the American Academy of Family Physicians. The discussion broached a number of topics including EHR usability, return on investment, the recent copy/paste debate and resulting Medicare audits, the future plan and timeline for national interoperability, and the future of the HITECH act beyond 2015.

Review of the final benefits statement for programmes previously managed under the National Programme for IT in the NHS

In England, a final cost-benefit analysis of the now dismantled National Programme for IT shows that the program ended up costing more than twice the value it had delivered at the time it was shut down. Analysts hesitantly forecast a 2024 break even point, but warn that long-range future benefits are nearly impossible to predict with any real accuracy.

11 medical schools earn AMA grants for education innovation

The American Medical Association announces that 11 medical schools have each won $1 million, five-year grants to reshape medical education by implementing innovative programs. NYU and Indiana University plan to create virtual EHRs using de-identified patient data to train students on EHR and population health systems that are becoming the norm in practice.

“OK Glass”: Improve Health Care. Now!

New Google Glass owner Rafael Grossmann, MD discusses the ways the technology might influence his approach to rounds, surgeries, and teaching.

Monday Morning Update 6/17/13

Three-quarters of poll respondents don’t believe EHR vendors should sell the de-identified data of patients who haven’t approved that practice. New (reader-suggested) poll to your right: what will be the effect(s) of the EHR Developer Code of Conduct? You may choose more than one answer and add your comments after voting.

Fans of the smoking doc HIStalk logo will like the old-new mash-up done by the folks at Billian’s HealthDATA. Inga and I think it’s pretty cool.

Welcome to new HIStalk Platinum Sponsor O’Reilly Strata Rx Conference, which runs September 25-27 at Boston Marriott Copley Place. It focuses on improving healthcare by acquiring, analyzing, and applying big data (the conference tagline is “Data Makes a Difference.”) Presenters include Jonathan Bush of athenahealth; James M. Maisel, MD of ZyDoc;  Richard Elmore of Allscripts; Jordan Shlain of Healthloop; Dale Sanders of Health Catalyst; and Michael Weintraub of Humedica. Fun events include speed networking, a startup showcase, and a five-minute presentation track. Use code HIST by August 15 and you’ll get 20 percent off on your registration, which ranges from $645 for Wednesday only to $1,925 for a three-day, all-access pass. Thanks to O’Reilly Strata Rx Conference for supporting HIStalk. I’m looking for interesting fall and winter conferences to attend if I can find the time and this one looks like a contender.

Speaking of HIMSS EHRA’s Developer Code of Conduct, its website doesn’t indicate which vendors have signed it, but Epic has, according to its site.

Mediware will announce Monday that it has acquired Fastrack Healthcare Systems, which will add home medical equipment systems to Mediware’s Alternate Care Solutions business.

Another acquisition will be announced Monday afternoon involving two physician practice system vendors, but I’m non-disclosed on that one.

Here’s a pretty funny video of athenahealth’s Jonathan Bush in a fake screen test (aka an athenahealth pitch) for Health Datapalooza.

From an AAFP interview with Farzad Mostashari: “I think that [physician EHR dissatisfaction] number may grow, because as we expand beyond the early adopters, the expectations for usable and intuitive technology are higher. I sure hope that the EHR vendors are hearing the same levels of dissatisfaction from their customers and their prospective customers that I’m hearing. I hope vendors are focusing on user-centered design in the next iterations of their software instead of adding more bells and whistles.”

Passport announces CareCertainty and PatientSync, which provide real-time notifications  of care transitions for population health management.

An article in the Madison newspaper provides a factoid about the brick building at 2020 Old University Road in Madison: it was the birthplace of both Epic and American Girl.

David LeClair, one of 140 athenahealth employees bicycling an 180-mile route from Maine to Massachusetts in the Trek Across Maine fundraiser for the American Lung Association, was killed Friday by a passing tractor trailer. He was 23.

Lucile Packard Children’s Hospital at Stanford notifies 12,900 patients that their information was present on a broken, unencrypted laptop that was stolen in May.

Among the 11 medical schools earning a $1 million AMA grant for education innovation are New York University and Indiana University, which will develop a virtual EHR using de-identified patient data to each students how to manage population health.

Winner of ONC’s Family Caregivers Video Challenge is “Grandma Safe and Sound,” in which Rachel Rust describes using Independa Angela, a tablet- and TV-based system that gives users video chat, e-mail, health information, schedules, reminders, and photo sharing, to help care for her 91-year-old grandmother. The announcement was six months ago, but I hadn’t seen it until ONC tweeted it.

AMIA launches a Student Design Challenge to re-invent electronic clinical documentation to reduce clinician burden, improve decision-making, encourage teamwork, and support reuse of the captured data. Graduate student team entries are due July 31.

An interesting blog post by Barbara Bronson Gray, RN wonders why we someone doesn’t offer a Genius Bar for everyday health issues. The obvious answer: Apple charges a premium for its products and can therefore afford to spend money improving user satisfaction at no charge, while in healthcare someone would have to be paid to provide services for free. It would be nice for hospital EDs, though.

A Harvard Law symposium contribution on the re-identification of genomic data sets cautions hype-happy newspapers and blogs to understand and accurately portray what they’re writing about, concluding, “… while this recent re-identification demonstration provided some important warning signals for future potential health privacy concerns, it was not likely to have been implemented by anyone other than an academic re-identification scientist; nor would it have been nearly so successful if it had not carefully selected targets who were particularly susceptible for re-identification.” It doesn’t mention similar recent articles describing re-identification of health information for accident victims by matching their records to newspaper accounts, but the conclusion might be similar.

Surgeon and mHealth innovator Rafael Grossman, MD, FACS describes his experience with Google Glass and his ideas for developing medical applications for it. Examples: sharing live OR video, distance education, telemedicine, surgical back-up, and viewing EMR data without being distracted. He calls on the American College of Surgeons to lead the way in using Glass to improve healthcare.

A Dallas newspaper article profiles Vivify Health (mobile apps for patient engagement and population health management) and Axxess (home health agency software.)

England’s National Audit Office finds that the now-defunct NHS National Programme for IT (NPfIT) cost a lot more than the benefits it delivered, and it’s doubtful it will ever pay for itself although estimation is difficult because of uncertainty. Three significant programs (Summary Care Record and the South and London programs) have delivered only two percent of the expected benefits.

Here’s Part 2 of Vince’s HIS-tory of Epic.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Time Out for Pre‐Implementation Training

Time Out for Pre-Implementation Training 
By Tiffany Crenshaw 

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

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

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

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

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

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

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