Readers Write 1/16/13

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Lessons Learned from My First HIMSS in 2007
By Bern Werner

Six years ago I set out on a journey from Pittsburgh, flying to Baltimore to be picked up by my young boss (Todd Johnson, the 25-year-old head of our six-person software company, Salar Inc) in his 140,000 mile-worn Toyota Forerunner for a trip to New Orleans. The truck was loaded with precious cargo and our booth for HIMSS07, packaged neatly in three plastic containers. 

On our first day of the journey, we mused over where the healthcare IT industry was headed and whether there was a future in it for our small company.

When I joined Salar a year earlier, we had begun implementing our physician documentation software at 20-hospital system that already had a major EMR (I’m not saying who the vendor was, but the company name has six letters and I met the owner by chance at HIMSS  before I knew that his booth was worth more than our company). I figured the big fish would just look at our success, then “ borrow” our IP and we’d be out of business in a couple of years. 

We made it safely to New Orleans, and I was excited to be on the floor. I was admittedly green, and knowing the value that we could provide, I was eager to sell it to anything that came within two feet of our booth. 

My favorite memory is of one visitor that walked up to our booth just after the convention hall had cleared for morning session. I was tending the booth on my own. He was accompanied by two booth bunnies. I was alone in front of our 10×10 booth with our slick, new, cloth marketing extravaganza. I asked him if he was interested in seeing a physician documentation tool that is better than anything on the market and drives physician adoption, etc. He was very kind and let me finish before saying, “No, thanks. I was looking for that booth that has a treadmill. Know where that is?” I did not.

As he walked away, my boss was just returning to the booth. He said to me, “Do you know who that was?” I said no. He said, “That was Neal Patterson.” Thus began my real HIMSS education.

I now find myself preparing for HIMSS 13 with the same company, but with two million completed forms and over six million captured charges behind me. Though I’m flying to New Orleans this time, there are many parallels to the 2007 road trip (which included driving through tornadoes on the way home and roaches in the non HIMSS-approved hotel) and events of the past year, with our company changing hands three times. 

One thing for sure is that I’m no longer worried about the big guys getting ahead of us when it comes to innovation. They can steal our ideas and they can try to pilfer our content, but they move like the QE2 we’re still zipping around in our speedboat, changing direction as fast as our customers demand.  

If I find HIMSS 13 to be a sales bust, no biggie. Not only will I be able to recognize some of the industry’s biggest icons, I know I’ll have a good time at the HIStalk party.

Bern Werner is VP of implementation with Salar of Baltimore, MD. 

Ambulatory EHR Adoption: Success vs. Failure
By Justin Scambray, MBA

In a New York Times article, In Second Look, Few Savings From Digital Health Records, David Blumenthal, MD expresses his thoughts on the current struggles the US health care system is facing with the successful adoption of the EHR. Technology “is only a tool,” said Blumenthal. “Like any tool, it can be used well or poorly.”

While there is strong evidence that electronic records can contribute to better care and more efficiency, the systems in place do not always work in ways that help achieve those benefits.

Technology is only a tool, and it is true that it’s all in how you use it. However, it’s not just good use of the technology that will yield results. Physicians need to understand that current processes and the way their practice has run for the last 15-20 years must change.

To put a tool like an EHR in place and expect that it will conform to existing systems and workflow is like changing all the rules in a game, but not changing how the player plays it. This is what many practices end up doing, and the very tools put in place that are supposed to help the practice begin to work against it.

After working in the ambulatory EHR market for seven years, selling and being a part of hundreds of implementations, there is one common attribute that I have seen that separates success from failure: the ability to change and adapt systems and processes to the right tools and right people.

The EHR market has been plagued with the thought that this tool — the EHR — will change the medical practice. The fact of the matter is that it is the practice that needs to change for the EHR to work properly. Careful business process mapping and systems redesign needs to take place prior to implementation of any new tool into a business, and it is no different for a medical practice.

If you have ever sat in on a physician EHR demo, they all want to see the same thing. "Show me how I would see a patient in your system from check-in to check-out." All too often, vendors will immediately start to fumble through a canned patient scenario that really has nothing to do with the current office workflow. The physician will watch, ask a few questions in between taking phone calls and signing off on charts, and never really get a good idea of how the EHR will work in their office.

Is it any wonder that a recent survey conducted by KLAS shows that the number of practices shopping for a replacement EHR jumped from 30 percent in 2011 to 50 percent in 2012? Among the top reasons for switching: decreased productivity.

The EHR is only a tool. It is a tool that requires careful integration and mapping between a current state and desired future state design. If the EHR is going to live up to expectations, it’s a focus on change in workflow, processes, and systems that’s going to get it there.

Justin Scambray is VP ofsSales and marketing for Pacific Medical Data Solutions of Paso Robles, CA

Argument for Healthcare Enterprise Project Management Office
By Joe Crandall

Every hospital project is an IT project.

How many times have you heard that in the past few years? A quick look at the evidence and there is little room for argument:

• Hospital budgets remain stagnant while healthcare IT projects grow. Eight of ten providers expect organizational HIE budgets to significantly increase by 2014 (2012 Black Book State of the Enterprise HIE Industry report).
• Unprecedented HIT spending. $40b investment in all IT related services, $8.2b in software services alone (RNCO study).
• The rise of health data analytics (HDA). Almost every aspect of healthcare can be improved through the use of HDA. Terabytes of healthcare data … terabytes!

As the American healthcare industry moves into its own Information Age, the existing IT infrastructure supporting the projects of today must be realigned strategically across the entire organization to support the projects of tomorrow.

The function of a healthcare Enterprise Project Management Office (EPMO) is pretty simple. The EPMO would be the single source of information related to all strategically aligned projects for the entire organization. This creates more accountability, better communication, and data governance.

Along with implementing an EPMO, an organization must look at the portfolio management process. You can’t have one without the other. The EPMO ensures the projects are done right, but the portfolio management process ensures that the right projects are chosen.

With each IT project being considered a major strategic project, the EPMO becomes the communication hub for the organization. It provides timely and effective mitigation of issues, risks, and budgets. The EPMO makes sure communications are the right message at the right level at the right time. The EPMO also standardizes the best practices of project management across the organization so all projects run smoother.

The other byproduct of elevating the PMO to an EPMO is that the CIO and team become true partners within the organization. The IT staff is already involved in the majority of projects already. Why not leverage their skills to benefit the entire organization?

The benefits to implementing an EPMO are clear:

1. Project alignment. All projects introduced are managed through a central resource and aligned with organizational goals
2. Project capacity. More projects in less time. Long-term planning is simpler and efficient.
3. Project focus. Projects are focused on the strategic goals of the institution and embrace lasting change, not the “flavor of the month.”
4. Project execution. Projects are executed with industry-standard processes resulting in project done right, on time, and completely.
5. Project redundancy. One central location has the knowledge to ensure projects are not duplicative or redundant.

One example. In 2008, Catholic Health Initiatives (CHI) established an IT EPMO with the goal of standardizing best practices and improving project success rates across all hospital IT departments within the health system. Since being established, the EPMO has reached its goals and then some. Due to its success, the EPMO was repositioned to support all enterprise-wide projects in 2012. 

Every hospital project is an IT project.

Joe Crandall is director of client engagement solutions of Greencastle Associates Consulting of Malvern, PA.

Morning Headlines 1/16/13

Primary Partners and AMC Health Team Up to Provide Telemonitoring for High-Risk Patients

Primary Partners, a physician-owned ACO, enters into an agreement with AMC Health to provide telemonitoring services for patients managing diabetes, heart failure, COPD, and other chronic conditions.

HealthEast Care System Employs RelayHealth for Enterprise HIE for Care Coordination Across its Network

HealthEast Care System, a four-hospital health system, selects RelayHealth to manage its network-wide HIE. HealthEast announced a $135 million Epic deal this past December.

Healthcare Leaders Join KLAS Advisory Board

John Halamka (CIO, Beth Israel Deaconess Medical Center), Denni McColm (CIO, Citizens Memorial Hospital), and Wright Lassiter (CEO, Alameda Medical Center) are appointed to the KLAS advisory board.

HIMSS Analytics: Data Show that Meaningful Use is Affecting EHR Adoption

Hospitals achieving HIMSS analytics Stages 5 and 6 increase more than 80 percent since the start of Meaningful Use in 2011. Stage 7 hospital attestation increased 63 percent.

News 1/16/13

Top News

AMA submits comments to ONC urging that Meaningful Use Stages 1 and 2 be evaluated before committing to a Stage 3. It says its members most often express five concerns: (a) passing requires a 100 percent score; (b) the core measures are inflexible with regard to practice patterns and specialties; (c) the program needs to be independently evaluated; (d) EHR certification should place more emphasis on software usability; and (e) healthcare IT infrastructure barriers prevent data sharing. AMA wants three years between stages to give EHR vendors time to prepare – one year for making the rules, one for product development, and one for implementation.

Reader Comments

LOL at JHU revoking parking privileges for clinicians not getting their ducks in a row for EPIC transition. Legit threat in East Baltimore

— Andrew G. (@BioDueDiligence) January 15, 2013

From EHR You Experienced?: “Re: Johns Hopkins Epic motivation for clinicians. Funny.” It is, but I can’t for the life of me figure out why people keep writing Epic in all capital letters. It’s just plain wrong.

HIStalk Announcements and Requests

Need a new Spotify playlist? Here you go. Beach House, Christian Mistress, Young the Giant, The Maldives, and others ranging from popular to obscure (mostly the latter since I strenuously resist musical monotony).

Just for you Smokin’ Doc fans, I’ve had the old logo turned into smaller ones of various sizes and shapes featuring just the doc himself, which I’ll be using regularly here and there. I may even place him permanently at the top of the page since people keep lamenting his apparent demise, which is simultaneously endearing and disturbing. However, just to be clear: (a) I don’t smoke a pipe or anything else and never have; (b) he doesn’t look like me; and (c) you won’t find many doctors wearing reflector thingies on their heads unless you time travel back to the 1960s – they’ve gone electronic.

Acquisitions, Funding, Business, and Stock

Twelve-employee Flatiron Health raises $8 million in a Series A funding round led by Google Ventures. The company, which is running a private beta of its oncology analytics platform, was started by the two founders of media buying platform vendor Invite Media. They sold that company to Google for $81 million in 2010.

Sales

Primary Partners (FL) contracts with telemonitoring provider AMC Health for remote monitoring of discharged patients using biometric devices.

Springhill Medical Center (AL) selects Omnicell for automated medication solutions and business analytics.

Holland PHO (MI) chooses Wellcentive Advance for aggregating and analyzing patient information from multiple EMRs and systems into a central repository to meet BCBS Michigan’s OSC program guidelines.

HealthEast (MN) chooses RelayHealth to power an enterprise HIE that will help coordinate care across its four hospitals and 14 clinics.

Health Services for Children with Special Needs (DC) selects care and claims systems from TriZetto.

Norwegian American Hospital (IL) chooses revenue cycle solutions from HealthWare Systems.

Aetna and Centene Corporation choose readmission predictive analytics software from Predixion Software.

People

KLAS appoints John Halamka (Beth Israel Deaconess Medical Center), Wright Lassiter (Alameda Medical Center), and Denni McColm (Citizens Memorial Hospital) to its advisory board.

Kareo hires Rob Pickell (Strategy for HireRight) as its first chief marketing officer.

HIMSS and the American College of Clinical Engineering recognize Paul H. Frisch (Memorial Sloan Kettering Cancer Center) with the ACCE-HIMSS Excellence in Clinical Engineering and Information Synergies Award for demonstrating leadership in promoting synergies between IT and clinical engineering.

Merge Healthcare Chief Medical Officer Cheryl Whitaker, MD leaves the company to pursue new ventures.

Mike Quinto (Quantros) joins PatientSafe Solutions as regional sales VP.

Former consultant and National Quality Forum SVP/COO Laura Miller joins HP as client principal in the public health sector.

Announcements and Implementations

Optum and Mayo Clinic launch Optum Labs, an open, collaborative research and development facility focused on improving patient care. Participants in the project will have access to Optum and Mayo’s information assets and technologies, including de-identified clinical and claims data.

White Plume Technologies adds AccelaPQRS, powered by Wellcentive, to its solutions suite. Its smart workflows and customized rules capture eligible encounters that allow users to transmit their denominators and numerators to Wellcentive’s registry.

An independent study finds that PeriGen’s PeriCALM Patterns can accurately screen fetal monitoring strips in real time, with its findings matching that of three experts from National Institutes of Health 97 percent of the time. Clinicians can also use the software retrospectively to test new hypotheses on stored fetal heart rate information. I interviewed CEO Matt Sappern in September.

Here’s a new cartoon from Imprivata.

US Rep. Tom Price (R-GA) visits Roswell-based revenue cycle vendor MediStreams.

MModal announces a partner certification program for vendors using its Fluency Direct speech recognition and natural language processing technologies.

Henry Schein MicroMD enhances its PM/EMR automated solutions line with tools for dashboards, patient marketing, data backup, electronic payments, statements, websites, PDR information, and third-party collections.

Government and Politics

CMS expands the MU program to include physicians who assign their reimbursement and billing to critical access hospitals.

William Zurhellen MD, a solo practice pediatrician in the New York City area, petitions the White House to move EHR strategy away from facilitating payment to a national approach for improving outcome and costs. His petition has 123 signatures so far of the 25,000 needed to put it in front of the President. We interviewed him on HIStalk Practice three years ago, where he explained why he wrote his own Unix-based EMR and why he’s not a HITECH fan. “The entire ARRA is a trade for information. We’ll give you money to put in records, but in return, we want you to supply us with performance data. Performance does not equal quality.” A reader reports that a recent CCHIT meeting, he received applause from at least half the audience when he announced, “Certification should focus on improving care. Anything else is a waste of time.”

Innovation and Research

Joe Kiani, founder and CEO of patient monitoring systems vendor Masimo, launches a patient safety conference and calls for fellow vendors to share their monitor information. He envisions a “superhighway of patient data” that can be analyzed by algorithms to provide an early warning of patient problems that will reduce 200,000 preventable deaths that occur under a provider’s care. Promising to share were Circuit Board, GE, Cerner, Smith Medical, SonoSite Fuji, Surgicount Medical, and Zoll Medical. Other solutions discussed were patient checklists, medical mistakes, and hospital overuse of blood from blood banks. Bill Clinton delivered the conference keynote and patient safety expert Peter Pronovost, MD, PhD also presented.

Conor Delaney, MD, a surgeon at University Hospitals Case Medical Center (OH) is profiled in an article about Socrates Analytics, which he founded to develop a system for University Hospitals that analyzes hospital information to support quality improvement efforts.

Other

The Raleigh-area business paper covers the departure of Diane Adams, VP of culture and talent of Allscripts. We detailed her severance package here when it was first filed, but the paper recaps: a year’s salary in cash, her annual target bonus in cash, a year of health benefits, partial accelerated vesting, and other potential bonuses. She gets an extra year’s salary if the company sells out within the next year. She made $1.9 million in 2011 for her job, described as “building a values-based, high-performance environment where people, learning, and fun are the priorities.” It would be interesting to hear from those people whether they enjoyed $1.9 million worth of learning and fun.

HIMSS Analytics reports that in the last five quarters, the number of US acute care hospitals achieving EMRAM Stage 5 or Stage 6 has increased more than 80 percent and the number reaching Stage 7 has grown 63 percent, suggesting that HITECH has spurred the increased implementation and meaningful use of EHRs.

A routine compliance audit by Samaritan Medical Center (NY) uncovers what it says is illegal activity by a sheriff’s department RN who was authorized to review the electronic medical records of inmates, but who was found to be checking out the records of other patients as well.

Pennsylvania’s Department of Vital Statistics warns parents to check the birth certificates of their newborns after a vendor’s newly implemented records software was found to be pulling in incorrect names for the father.

Northwestern University (IL) will spend $1 billion to replace its women’s hospital, planning to tear down an existing structure that preservationists are trying to have designated as a protected landmark.

Weird News Andy finds this story odd: the VA hospital in Buffalo notifies hundreds of patients from 2010 to 2012 that they may have been exposed to HIV or hepatitis because nurses misused insulin pens by correctly discarding the used needles, but re-using the same pen on multiple patients.

Strange: a Washington psychiatric hospital loses its accreditation because of an unsecured karaoke machine. State inspectors said the cord presented a patient safety hazard, no doubt remembering an event from a month before in which one patient at the hospital strangled another in karaoke-unrelated incident.

Sponsor Updates

• HealthMEDX customer Asbury Methodist Village (MD), which recently won an award for its use of technology to improve care transition from long-term care to other settings, is featured in a video from Leading Age and the Center for Aging Services Technologies.
• John McCullough, associate VP of clinical applications for Wake Forest Baptist Medical Center (NC), reviews his organization’s partnership with Intellect Resources, which provided Wake Forest with strategic planning services prior to its go-live.
• Steve Besch, senior systems analyst for Ingenious Med, discusses PQRS and the need for program participation in 2013 to avoid penalties in 2015 in a blog post.
• TrainingWheel introduces its mobile solution for automating help desk issues and support tracking.
• TrustHCS offers advice for the C-suite on preparing for ICD-10 and Meaningful Use in a blog post.
• Velocity Data Centers breaks down how it builds data centers in 90 days and publishes a time-lapse video documenting the start-to-finish process.
• VersaSuite will participate in the Rural Health Care Leadership Conference in Phoenix February 10-13.
• Arian Bichsel, director of client support for Allscripts, shares strategies to reduce hospital readmissions.
• API Healthcare discusses the use of payroll and HR software to drive down the cost of care, boost efficiencies, and improve clinical outcomes.
• Infor recognizes NTT DATA as its 2012 Infor Lawson Service Partner of the Year based on its 250+ successful implementations of Lawson’s ERP software.
• Informatica sponsors GovernYourData.com, a vendor-neutral online community and resource center for data governance.
• ICSA Labs and IHE USA partner to provide industry-accepted certification to complement existing testing of IHE integration profiles.
• The Colorado Health Insurance Cooperative selects Emdeon subsidiary HTMS to provide strategic planning and operational roadmap for the development of a consumer-owned health insurance plan.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/15/13

HIT Policy Committee: Request for Comment Regarding the Stage 3 Definition of Meaningful Use of Electronic Health Records

In a letter to ONC, the AMA expresses concern with the pace of Meaningful Use and asks for a full evaluation of existing EHR and health IT problems before moving on to Stage 3.

Cloud-based EHRs create medical privacy risks

Patient Privacy Rights calls on the government to issue guidance on how cloud-based EHRs should be implemented to minimize the risk of data breaches.

The Rand Study and the impact of EHRs on Healthcare Costs

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, weighs in on the recent Rand study that suggests EHRs may not reduce healthcare costs to the levels originally expected.

CMS: Method II physicians eligible for Medicare EHR incentives

CMS announces that physicians providing outpatient services from Critical Access Hospitals that bill under Method II are eligible to participate in the EHR incentive program. However,they will be unable to attest until 2014 due to CMS system limitations.

Curbside Consult with Dr. Jayne 1/14/13

Just when I thought it couldn’t get any scarier, I had the opportunity to attend a recent presentation on the transition plan for ICD-10 for our ambulatory physicians. It’s been interesting to watch this unfold.

In its infinite wisdom, the hospital created an ICD-10 “task force” that sounded like a good idea at the time. A dedicated team working on a single problem will pull in subject matter experts from various business areas and software teams as needed. Unfortunately, it would have been better described as a “super silo.”

Over the last two quarters, I questioned several times the fact that they haven’t been to see me. I’m on the tip of the spear for our ambulatory physicians, so I expected them to knock on my door at least once. I was told to pipe down and stop micromanaging, so I did.

As the weeks have worn on, however, they’ve been spending more time going directly to the vendors and less time with the actual software support teams. Not exactly a winning strategy in my book. The software teams actually support the users and know their business needs. We know the limits of what they will and will not tolerate as far as workplace disruption. We also know how to effectively use Jedi mind tricks on the users, especially when we have to present something unpalatable.

This week the task force presented the final strategy at our monthly physician meeting. As the presentation unfolded, I was transported back to the college literature class where I first experienced Joseph Conrad’s journey down the Congo River in Heart of Darkness. As more and more PowerPoint slides flashed before my eyes, I felt myself going deep into the wilderness. The physicians’ eyes darted around the room trying to identify which of the department chairs would rebel and which would join the savage oppressors. I buried my head in my hands, grateful that my lack of involvement conferred plausible deniability.

The key points of their transition plan were simple, yet terrible:

• Since the ambulatory vendor plans to release its ICD-10 software in May 2013, we’ll just plan to upgrade in June. Had they talked to my team, they’d have known that it takes us a minimum of three months to prepare for an upgrade once a new code package is available. They’d also know we have a dozen go-lives that must be completed before any upgrade. These are contractual obligations and cannot be moved.
• Providers will dual code from the time of the upgrade until the requirement commences in October 2014. Are you serious? Providers aren’t going to do double work under any circumstances (that is, unless they’re paid extra or threatened with termination). The fact that they even suggested this told me that they didn’t talk to the Practice Operations leadership either. A quick look at the ashen-faced VP two rows behind me confirmed my assumption.
• Provider training will require a full day out of the office and all training will occur during a two-week span. Given the size of our group and the need to stagger training to accommodate various work schedules and vacations and to ensure patient access, this suggestion is simply absurd. Doing the math would conclude that it’s impossible to train all the physicians unless our training rooms run 24×7 during these two weeks.

Those in the group who round in the hospital will receive extra training. Approximately 80 percent of our physicians continue to see inpatients, so failing to include those details in the presentation led to more questions and frustration. Needless to say, the physicians were not pleased and basically handed the task force their heads. Several senior physicians walked out and the more vocal junior physicians started commenting loudly. It reminded me of a raucous session of England’s Parliament, but without the wigs.

The only good thing about the presentation was that it occurred at the end of the meeting’s agenda and effectively ended any lingering comment on any of the other agenda items as well. The first thing I’m doing tomorrow morning is organizing a betting pool. How many days until the application team managers are asked to essentially take this over and start from scratch? My money is on three.

How is your organization planning to transition providers to ICD-10? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 1/14/13

2014 Testing and Certification

ONC announces that certifying agencies may begin testing EHRs for MU Stage 2 certification.

In Second Look, Few Savings From Digital Health Records

The New York Times covers the recently published RAND study that acknowledges a lack of evidence for calling EHR implementations a cost-cutting initiative.

US Health in International Perspective: Shorter Lives, Poorer Health

The Institute of Medicine, in conjunction with the National Research Council, publishes a study measuring overall population health and concludes that the US is dead last of the 17 developed nations and that, among many problems, our healthcare IT is categorized as "worse than average.”

Blue Health Intelligence Creates an “Informatics Center of Excellence” Through Acquisition of Intelimedix

BCBS acquires Intelimedix, a data analytics company specializing in employer group reporting, mass customized communications, and medical cost containment. BCBS manages care for 110 million patients.

Monday Morning Update 1/14/13

From The PACS Designer: “Re: TPD’s list. The latest update of my iPhone apps lists is online. In addition to many new apps is a new section highlighting the apps of HIStalk sponsors.” TPD’s list is here. He’s always up for additions to it.

From Frank Poggio: “Re: Meaningful Use Stage 4.  At the January 8 HIT Policy Committee meeting, Farzard Mostashari, ONC director, waxed eloquently about MU Stage 4. Hey, wait a minute — the original playbill said this was to be a three-act play! Does he think we can stay in this claustrophobic theatre all day and night? How many more acts will there be? One thing for certain — the bonus money will run out long before the last act, but you can be sure the ‘penalty’ clauses will not. This MU theatre of the absurd must be in the Hotel California… you can check in, but you can never check out.”

From Green Space: “Re: Judy Faulkner’s new company to generate electricity for Epic. Search the Wisconsin Department of Financial Institutions for Galactic Wind. Here’s a photo of the wind farm, about 15 miles north of Epic’s main campus.”

From Dragovitz: “Re: Peake Healthcare Innovations. The image sharing joint venture between Johns Hopkins Medicine and Harris Computer appears to be defunct. Rumor has it they found it hard to differentiate themselves from PACS vendors and underestimated the risk of trying to use MINT, a protocol that would have displaced DICOM.” Unverified. The JV was created on March 2011 and their “new approach to medical image management” was rolled out at HIMSS last year.

Sixty percent of us have used a patient portal offered by our PCP. New poll to your right: was the 2005 RAND study naïve, biased, decent but not useful for justifying EMR subsidies, or possibly accurate once more time goes by? Pick the best answer since you get only one.

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

A new report commissioned by the National Research Council and the Institute of Medicine finds that despite the largest per-capita healthcare spending of all countries, the US ranks dead last among 17 developed nations in health. Most surprisingly, it’s not our also legendary number of poor and uninsured residents who are dragging our average down – our unhealthiness is equal opportunity by income and education. If you want your child to live to 50, move to another of those 16 other countries because they’re a target here for being murdered, dying in a car wreck, and not even living long enough to attend pre-school (we’re #1 in all those categories). We’re lucky that one other country beat us in the percentage of people dropping dead of heart problems and lung disease. We’re dead last in the percentage of doctors in primary care, and the graphic above shows IT as one of the “worse than average” items (the others being coordination of care, medical errors, patient dissatisfaction, and miscommunication). No single cause was identified, but it says a lot of the problem starts with being fat, overusing legal and illegal drugs, shooting each other, and wrecking cars, not to mention a healthcare non-system that’s superb at Rambo-style interventions but really bad at almost everything else. The authors found no silver bullet other than spending a lot of taxpayer money, which is another not-so-great #1 they didn’t bring up (the largest national debt at $16 trillion with the lead widening by the minute). Being rugged and self-determinant individualists, we’re not real big on public health programs in the US, so it’s ironic that excellent schools crank out thousands of public health stars who immediately head off to Africa or South America to find work despite a target-rich environment here.

ONC announces that Authorized Certification Bodies are now authorized to test and certify EHRs using the 2014 Edition Standards and Certification Criteria.

My guilty pleasure is reading John Halamka’s “Building Unity Farm” posts on his Life as a Healthcare CIO blog. I skim his other IT-related posts on occasion, but I never miss an episode about how he uses his engineering and IT background to approach building a gentleman’s farm, like Oliver Douglas on Green Acres except he knows what he’s doing. I find myself fascinated by what kind of guinea fowl he favors, his hardwood management plan, and what was on his vegan Christmas menu.

The Illinois Department of Financial and Professional Regulation, the state’s overseer of physicians, will lay off 18 of its 26 medical unit employees next week because of a $9.6 million budget shortfall.

An interesting Alabama Supreme Court ruling allows patients who claim injury from a generic drug to sue the manufacturer of the brand name drug they didn’t take. The court ruled that generic drug makers are required to use the approved labeling of the patented drug, so a lack of warnings isn’t their fault. Alabama high-end real estate values will probably benefit as out-of-state trial lawyers shop second homes there.

Academic Ranking of World Universities, assembled by researchers at a university in China, ranks the world’s best clinical medicine and pharmacy universities, with US schools taking all but four spots in the Top 20, counting ties. In order, Harvard, UCSF, University of Washington, Johns Hopkins, Columbia, UT Southwestern, UCLA, Stanford, University of Pittsburgh, University of Michigan, University of Minnesota, Mayo Medical School, University of North Carolina at Chapel Hill, MD Anderson, Yale, and Vanderbilt.

BCBS’s Blue Health Intelligence acquires Tampa, FL-based Intelimedix, which offers employer and payor analytics from its medical claims database covering 110 million patients.

Miami Children’s Hospital receives a hospital association’s marketing award for sending urgent care wait times via text messages. The hospital uses a service from ER Texting.

RAND Corporation’s admission in a Health Affairs article that its own 2005 study predicting vast savings from EHRs was dead wrong gets major space in The New York Times, even scoring a quote from original National Coordinator David Brailer, MD, PhD, who now says HITECH was a “colossal strategic error” that encouraged providers to earn government checks by buying EHRs quickly and worrying later about actually using them for anyone’s benefit. The new analysis says the original vendor-funded report was “enthusiastically embraced,” but that now “critics of the RAND team’s analysis can claim a measure of vindication.” Some quotes from the new article:

• Lack of interoperability means systems function “less as ATM cards, allowing a patient or provider to access needed health information anywhere at any time, than as frequent flier cards intended to enforce brand loyalty to a particular health care system,“ with the huge amount of information stored by Kaiser and the VA “essentially useless if the patient seeks out-of-network care.”
• EHR adoption is still arond 40 percent instead of the 90 percent threshold RAND said was needed despite billions of HITECH payouts, which it described as, “Most of the action is concentrated among facilities that were already planning to implement or upgrade their health IT systems. Federal incentives have not yet closed the health IT gap between small, rural, and nonteaching hospitals and larger, urban, and academic ones.”
• Patients share the blame, with few of them even signing up to view their electronic records and most of those never actually looking at them.
• “Considering the theoretical benefits of health IT, it is remarkable how few fans it has among health care professionals.” The article says market forces aren’t working to demand more usable systems since comparative system information is not readily available and HITECH encourages just buying whatever’s out there anyway.
• The “do more, bill more”healthcare payment system provides no incentives to use IT to reduce costs or improve outcomes.
• The article concludes, “The optimistic predictions of Hillestad and colleagues in their 2005 analysis of the potential benefits of health IT have not yet come to pass. This is not because of shortcomings in their analysis but rather because of shortcomings in the design, implementation, and use of health IT in the United States. When the preconditions these authors posited are finally realized, the benefits they predicted will be realized as well.”

I bet most readers saw this coming when the exuberant 2005 study started putting stars in the eyes of vendors and the federal government. People who put their hopes in a tool rather than tool users are usually wrong, and it’s almost always true that those tool users will do whatever it is that they’re paid to do, like cranking out procedures, stealing each other’s profitable patients and doctors, and buying EHRs quickly without a lot of thought or commitment.

My take is that the original article was more naïve than biased. The new article, however, puts a lot of the blame on HITECH — which wasn’t implemented until four years after the original article — and not enough blame on a screwed up healthcare system whose technology reflects that unfortunate reality. A vendor could easily develop a usable, interoperable, patient-centered EHR if they didn’t have to deal with mountains of billing rules (most of them coming from the same federal government that’s complaining about complex systems), insurance companies, regulators, and market-force competitiveness, following the specifications of users dedicated to a framework of standardized and repeatable processes. They would, however, have no customers. That’s why only the VA has done it, and they developed their own VistA system having the luxury of a vacuum to work within.

The worst thing about the original RAND study is that it was quickly co-opted by special interests as validation for spending billions of taxpayer dollars to subsidize fast-tracked sales of systems to providers who had already declined to buy them with their own money. We have good providers, good electronic systems, and good patients — we just can’t seem to put the policies in place to move the needle on the marginal ones.

Vince has a great look-back this week, getting some first-hand history of Sphere Healthcare Information Systems as it eventually became NextGen’s financial system.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: The First Lesson I Learned Working for a Vendor: Products Don’t Need to Be Great, Just Good Enough

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 May 2008.

The First Lesson I Learned Working for a Vendor: Products Don’t Need to Be Great, Just Good Enough
By Mr. HIStalk

I took my first vendor job many years ago, moving over to the dark side after a short career in hospitals. It was a common vocational change then and still is today: learn an application as a hospital user, then hire on with the vendor who sells it. Ca-ching!

I was anxious to use my hard-won experience to address the application’s many shortcomings. I figured it would be a slam dunk since none of the vendor’s people seemed all that sharp. My dazzling insight, I reasoned, would not only make the vendor’s application the best on the market, it would sweep me to my inevitable destiny as a software genius.

In other words, I was delusional enough to think that the only thing standing between the vendor and greatness was bringing me on board to share my vast frontline knowledge. I expected awe-struck respect, endless gratitude, and … OK, I’ll say it … maybe an outpouring of publicly proclaimed vendor love from my new best friends that I’d have to smilingly shrug off in amused embarrassment.

Stop your snickering. I admit it – I was naïve (I lost most of that naiveté when the vendor eliminated my job just a few months later with no visible sign of reluctance or regret. I was, as it turned out, highly expendable).

Instead of teaching the vendor some lessons, I had learned a few myself.

Vendors don’t necessarily want their applications to be the best; they only want them to be good enough. In the secret vendor playbook, some applications are simply placeholders to keep them from losing profitable package deals. Anything more is a waste of resources better spent on something more strategic.

Knowing how hospitals work is useful to a vendor, but not essential. In my company, decisions were made by humorless corporate wannabes who were short on brilliance and hospital experience, but long on ambition and political skills. It was like high school, where jocks and bullies ran roughshod over the smart and sensitive kids, except that these particular jocks had MBAs didn’t mind lying to the faces of employees and customers alike and were constantly plotting their upward mobility and the people whose backs they’d happily climb to get it.

Vendors enhance software applications to make new sales, not necessarily to keep current users happy. Leverage drops enormously once a hospital progresses from prospect to signed customer.

It’s not a shortage of good ideas that makes a product mediocre, it’s the decisions executives make about allocating resources to it. Execution is the rate-limiting step, not brilliant planning and design.

Perhaps the most eye-opening lesson for me was to appreciate how disillusionment breeds contempt among product insiders nearly everywhere. They’re like hot dog factory workers – they’ve seen the unsavory manufacturing process and wouldn’t eat one on a dare. “Held together by spit and baling wire,” they’ll snort, “old code cobbled together to form a house of cards on a shaky foundation. It’s junk and needs to be rewritten.”

As a new hire fresh off the hospital front lines, I was uncomfortable hearing my beloved application sneered at by those who developed and supported it. Surely they realized how well it really worked.

Most companies don’t have a place for product lovers. There’s too much compromise and indifference required to work for vendors who sell a broad range of applications. A software application is the end result of years of compromise and mediocrity-seeking, the perfect tension between intentional underinvestment and outright customer revolt.

It’s no wonder that few customers really love their software applications. They were designed to be tolerated, not adored.

Morning Headlines 1/11/13

VA Launches Challenge.gov Contest for Scheduling Appointments

A challenge.gov Medical Appointment Scheduling System contest sponsored by the VA will award $3M to as many as three winners for the creation of a scheduling system to replace the 25-year-old scheduling software in its VistA system.

After evaluating GE’s future EMR strategies, Intermountain will look elsewhere

Intermountain, the Salt Lake City-based 22-hospital health system, sends an internal e-mail notifying staff that it will part ways with GE Healthcare after the organization’s unfinished EMR system that it had been building with GE failed to produce enough functionality to meet MU requirements.

More Doctors, Hospitals Partner to Coordinate Care for People With Medicare

HHS announces the formation of 106 new ACOs, bringing the total to more than 250.

HL7 Announces a CCD to Blue Button Transform Tool and Early Adopters

HL7 releases an interface to allow organizations to send patient information stored in CCD format to the Blue Button Network.

News 1/11/13

Top News

The VA launches a Medical Appointment Scheduling System challenge to replace its VistA scheduling module. Up to three entrants will win up to $3 million each.

Reader Comments

From TV’s Frank: “Re: Intermountain Healthcare. Finally dumping GE Healthcare.” An e-mail from Intermountain CIO Marc Probst to IT employees says the still-incomplete system it’s been building with GE is deficient in clinical documentation, CPOE, and integration with coding and billing. As a result, Intermountain has evaluated GE’s future EMR strategies and decided not to renew their contract, instead considering three options: (a) keep building their homegrown EMR without GE’s involvement; (b) buy Epic, Cerner, or Siemens; or (c) buy best-of-breed and try to integrate. I’ve panned the GE-Intermountain deal since it was announced in 2005, skeptical that dumping a few hundred million dollars and GE’s questionable expertise was going to ever yield anything tangible, which apparently is exactly the case seven-plus years into the 10-year deal. Or as I described it in 2011, “GE-Intermountain screwing around that never seems to provide any real, marketable products (are those Intermountain-led Carecast enhancements just about done?)”

From Jerry Aldini: “Re: Geisinger Health System (PA). I contacted you a while back with the rumor that they were developing a commercial solution for accountable care enablement. It was announced at JPMorgan last week. Announcement attached.” I haven’t seen announcement hit the wires, but it says that Geisinger is launching xG Health Solutions, a for-profit spinoff that will commercialize its intellectual property. On the list: consulting services, population health analytics, care management, healthcare IT optimization, and third-party administration services. Geisinger EVP Earl Steinberg, MD, MPP (above) is named CEO and former Alere Chief Innovation Officer Gordon Norman, MD will be chief medical officer.

From PolishingMyResume: “Re: Allscripts. Preparing for relocations and layoffs in the software development organization for development people who work remotely or outside the seven core offices of Boston, Bangalore, Burlington, Chicago, Raleigh, Pune, and Vancouver.” Unverified. Seems like a smart strategy to me. The problem with indiscriminate acquisitions is that you have people strung out all over the place who understandably don’t want to move, limiting your opportunity for the synergy or culture management that Allscripts could use quite a bit of right about now (not to mention expense reduction, ditto). One of quite a few bad decisions by Eclipsys before Allscripts overpaid to buy the company was hiring CEOs who refused to relocate and instead occasionally jetted a few time zones over when the troops needed demoralizing, so I assume that lesson was learned and Paul Black will work out of the Chicago office.

From Joan Hovhanesian: “Re: Howard University Hospital. Went live on Soarian clinical documentation on January 7.” Congratulations to the folks there. That’s a gutsy move going live immediately after the holidays. I still think of Joan as being with FCG and later VP/CIO of Shands Healthcare, so I’m out of touch – she’s with Program Advisors now.

HIStalk Announcements and Requests

HIStalk Practice highlights from the last week include: only 16 percent of providers met PQRS requirements in 2010. Primary care physicians are more likely to demonstrate improvement on measures of care when they have had sustained and extensive technical assistance. A billing service and four pathology groups agree to pay $140,000 to settle allegations that they improperly disposed of thousands of medical records found in a public dump. Job opportunities for physicians will continue to rise in 2013. The AMA and other professional medical organizations urge CMS to stop the implementation of the ICD-10 code set for outpatient diagnosis coding. Galen Healthcare releases a plug-in for Allscripts Enterprise EHR that sends providers EHR task updates to their PC or smartphone. It’s a new year and I hope your 2013 resolutions include not only a commitment to good health, but also a vow to expand your HIT ambulatory knowledge by faithfully perusing HIStalk Practice. Thanks for reading.

On the Job Board: Marketing Manager, Senior Applications Engineer – EMR.

Welcome to new HIStalk Gold Sponsor HTTS (Health Technology Training Solutions). For you vendors out there, this is my theory: customers often slam your product on KLAS surveys when their problem is really inadequate user training, not your software. The last thing you want customers to experience before go-live is a hastily thrown together set of PowerPoints and talking head demos put together by someone who knows the application but has no knowledge of instructional design and adult learning theory. You’ll hear an earful afterward, but not just on your training evaluation forms – users will under-use your systems, overload your help desk, and badmouth your product on reference calls. The HTTS team of healthcare IT and instructional design experts can help eliminate those problems by reviewing your training strategy, conducting a training needs analysis for new products or releases, and developing your training content using state-of-the-art learning techniques. Check out the testimonials of vendors who have engaged HTTS to optimize their training experience. If you’ve experienced professionally designed software training (both online and instructor-led), it’s easy to distinguish it from the more typical variety assembled by well-meaning amateurs. Now’s a good time to arrange a HIMSS conference connection to learn more. Thanks to HTTS for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

7 Medical Systems closes on its acquisition of HealthLink Minnesota Management Group, a provider of administrative and IT services to clinics.

ManTech International completes its acquisition of CMS contractor ALTA Systems.

EBSCO Publishing expands its evidence-based pediatric content with the acquisition of PEMSoft, a pediatric point-of-care clinical information library and multimedia decision support system.

Sales

Saint Luke’s Health System (MO/KS) expands its use of Perceptive Software solutions to include integration with Epic.

CalHIPSO contracts with ClearDATA Network to offer cloud hosting, offsite backup, and disaster recovery services to CalHIPSO provider members.

Emergency Medicine Physicians selects athenaCollector and athenaCommunicator for its 800-physician group. athenahealth also announces that Prospira PainCare with deploy athenaClinicals, athenaCollector, and athenaCommunicator.

Children’s Mercy Hospitals & Clinics (MO) selects GE Healthcare’s Centricity Business as its enterprise-wide RCM solution.

Straith Hospital for Special Surgery (MI) chooses the ONE EHR from RazorInsights.

Flagler Hospital (FL) contracts with Surgical Information Systems for Sunrise Surgery.

Doylestown Hospital (PA/NJ) subscribes to the CapSite Database to assist with the capital planning and purchasing processes.

Lincoln Orthopaedic Center (NE) selects SRS EHR for its 14 providers.

Vanderbilt University Medical Center will use event-driven software from Tibco to support its clinical decision support capabilities.

Rainbow Babies & Children’s Hospital (OH) will encourage non-emergent ED patients to instead use HealthSpot telemedicine kiosks staffed by medical assistants and equipped with monitoring instruments. Also announced: telehealth provider Teladoc will offer HealthSpot’s kiosks.

People

MedSys Group names Steven Heck (First Consulting Group) president and Luther Nussbaum (First Consulting Group) chairman of the board.

URAC President and CEO Alan P. Spielman announces his resignation.

Announcements and Implementations

Sentara Healthcare (VA) begins implementation of Morrisey Associate’s Concurrent Care Manager software across its 10 hospitals and 100 medical facilities.

The dbMotion-powered ClinicalConnect HIE (PA) expands its reach to 1.3 million patients.

South West Medical (KS) and Rems Murr Kliniken in Germany go live on iMDsoft’s MetaVision platform.

Hospital messaging services vendor Critical Alert Systems partners with Mobile Heartbeat, which provides hand-held messaging and alarms, to create an enhanced nurse call solution.

3M Health Information Systems opens an innovation center in Silver Spring, MD that will showcase its offerings.

Meta Healthcare IT Solutions announces customized versions of its clinical documentation, CPOE, pharmacy, and medication administration software that meet the requirements of Canada-based customers.

Government and Politics

The FCC announces it will make available up to $400 million in annual funding to healthcare providers to spur development of broadband networks for telemedicine.

HHS Secretary Kathleen Sebelius announces the formation of 106 new Medicare ACOs.

Former CMS administrator Don Berwick, MD says he is strongly considering running for Massachusetts governor in 2014. He says healthcare experience gives him sensitivity to issues, adding, “I get more and more excited about the idea of Massachusetts as a model.”

Technology

Panasonic announces an expanded line of Toughpad enterprise-grade tablets that include a 10-inch model running Windows 8 Pro ($2,899) and 7-inch ($1,199) and 10-inch ($1,299) Android versions.

HL7 releases a CCD to Blue Button Transform Tool that allows organizations using the CCD format to allow patients to download information as ASCII text.

Other

A heavily recruited professor couple at University of Minnesota’s School of Public Health, one of them director of the ONC-funded University Partnership for Health Informatics (UP-HI), quit amidst charges they were double-dipping by simultaneously being paid by another university employer. The State of Georgia handed down felony indictments against Julie Jacko in 2011 after finding that she and Francois Sainfort were collecting full-time paychecks from both UM and Georgia Tech, but dropped charges in return for a plea agreement, restitution payments, and probation by Sainfort. Jacko ran the UP-HI project, funded by a $5.1 million ONC grant.

A California judge refuses to grant Kaiser Permanente access to the PCs and e-mail accounts of a couple whose small document storage business it hired to manage paper patient records. The state health department found last month that Kaiser put medical records at risk by turning them over to the small company without a signed contract. Kaiser claims it picked up the paper records, but the couple didn’t return everything.

Vermont’s Department of Financial Regulation scolds Porter Hospital for overrunning the $4.3 million budget of its Meditech-MedHost EMR project by 63 percent. The hospital undertook the project to earn HITECH money and to participate in Vermont Blueprint for Health. The hospital’s VP of public relations said, “The Meditech folks would hand you a box and say, ‘Good luck, do you have any questions?’” The hospital admits that during the physician practice rollout, all of its practices stopped accepting new patients for an unstated period, with the article ironically concluding, “Porter found that the productivity of doctors took a big hit each time the software was rolled out at a new practice … Officials said it has not been unusual for a doctor who normally saw 20 patients an hour to be able to see only 10 or 12 once the productivity-enhancing software was introduced.”

Weird News Andy finds this story a HIPAA stretch. Police confiscate the cell phone of a man filming an arrest on a public street, with a deputy telling him, “If I end up on YouTube, I’m gonna be upset.” The man was charged with obstruction and disorderly conduct, with the deputy claiming it was a HIPAA violation. A Stanford law expert opines the obvious: “There’s nothing in HIPAA that prevents someone who’s not subject to HIPAA from taking photographs on the public streets. HIPAA has absolutely nothing to say about that.”

It’s not an April 1 gag: the iPad-ready children’s iPotty debuts at CES. My only surprise is that the adult model wasn’t rolled out first.

Sponsor Updates

• Jim Stilley, director of clinical workflow consulting for Versus, will discuss the use of RTLS to improve patient flow and efficiency at the 2013 Patient Flow Management Congress January 28-29 in Las Vegas.
• The Advisory Board Company offers a February 14 Web conference on the inpatient value-based purchasing program.
• MedHOK earns full 2013 NCQA HEDIS software certification for its 360Measures v2.56.
• Bill Bithoney, MD of Truven Health Solutions discusses innovative and targeted approaches for reducing costs by improving care quality for better patient outcomes in a blog posting.
• Medicity publishes a white paper discussing how to build patient centeredness into the ACO model.
• iMDsoft highlights some of its 2012 milestones, including successful implementations in Canada and the Czech Republic, 60 critical care and anesthesia projects, and go-lives of MetaVision in 17 countries.
• Prognosis HIS doubles its client base for the second consecutive year and announces that all of its eligible clients exceeded baseline requirements to complete Stage 1 MU attestation using ChartAccess EHR.
• Beacon Partners defines population health management and its relation to ACOs in a January 18 Webinar.

EPtalk with Dr. Jayne

CMS is seeking comments from hospitals, EHR vendors, and “other interested parties” on its electronic quality reporting. Starting in 2014, the Hospital Inpatient Quality Reporting (IQR) program requires use of the Quality Reporting Document Architecture (QRDA) standard. According to the e-mail, “CMS wants to increase efficiency and reduce the burden for providers…” If that’s true, I have some other suggestions for them as well. The comment period closes January 22, so sharpen those pencils and fire up those keyboards.

Speaking of CMS, don’t forget that if you completed your 2012 reporting period on time, you only have until February 28 to attest for Medicare. Those attesting with Medicaid should check for their specific state deadlines.

One more CMS deadline-related item and then I’ll quit, I promise. The comment period for ONC’s Health IT Patient Safety Action & Surveillance Plan is open until February 4. Goals of the plan include making it easier for clinicians to report patient safety events, engaging vendors to “embrace their shared responsibility for patient safety,” and incorporating health IT safety in post-market surveillance of certified EHRs. It’s only 40 pages, considerably shorter than most ONC reads.

From Follow Up Fred: “Re: sticky workplace problems. Good topics for discussion! One solution I’ve successfully employed for years is this. If I need a prompt response to a question or request communicated by voicemail or e-mail, I always end the message by asking for a response by a certain date and time. Typically, “Hey Jane, I’d appreciate it if you’d get back to me by close of business Thursday, January 10.” I then flag the e-mail or voicemail follow-up date on phone in the event the requested deadline is missed. I’ve found it very effective for myself but also the recipient, who in turn can prioritize the return response.” An excellent point, especially in a workplace where people won’t do anything until they’re absolutely up against a deadline.

The AMA continues to play Chicken Little with their ongoing pleas for CMS to halt implementation of ICD-10. Citing the cost and administrative burden, they ask that it not simply be delayed again, but to call on “appropriate stakeholders to assess an appropriate replacement for ICD-9.” There has already been significant expense to prepare for implementation and I know many people will be aggravated at the lost time, money, and effort if they’re successful. Do I sense an HIStalk poll in the making?

Inga and I are hard at work designing the beauty queen sashes for HIStalkapalooza. Thanks to some virtual BFF shoe shopping (via camera phone and text message), I’m ready for HIMSS. Do you have your shoes picked out and your accessories coordinated? E-mail me.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/10/13

Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communication

Analysis from this month’s issue of Heath Affairs concludes that the anticipated primary care physician shortage could be resolved by moving to a team-oriented care model and expanding the use of non-physicians. The study was conducted jointly by Columbia and Wharton Business Schools and included no clinicians on the research team.

Benefits Consulting Firms Form Acclaim Health Analytics, LLC

Consulting firms Peel & Holland, Silberstein Insurance Group, and Virtus Benefits create a jointly owned data analytics company called Acclaim Health Analytics, which aims to aggregate health data to identify actionable health risks.

LifeBridge Health Names Tressa Springmann Chief Information Officer

LifeBridge Health, a Baltimore-based three-hospital health system, names Tressa Springmann as CIO.

Hottest IT jobs are in health care

Healthcare ranked as the fastest growing segment of the IT jobs market in 2012 and looks to repeat in 2013. Insurance and finance also outperformed the overall IT jobs market.

 At CES, staying healthy the high-tech way

The Boston Globe covers the growth of health IT startups representing the industry at this week’s CES tradeshow.

Readers Write 1/9/13

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Why Medical Practices Must Manage A/R Better … Now
By Tom Furr

“I didn’t go to med school to be an accountant.” How many times have we heard those words being muttered from a physician’s mouth?

Until now, that’s been an acceptable sentiment for any doctor. Today such thinking is financially dangerous if not downright disastrous. Even doctors in practice for as little as 10 years kept their focus on the insurance company, the source of 85 to 95 percent of their income. That almost predictable cash flow made reviewing accounts receivable reports — universally known as A/R — barely necessary.

Today, looking at A/R is an absolute requirement because of four letters that are having a huge impact on medical practices of all sizes and types – HDHP, which stands for High Deductible Health Plans.

These insurance plans have sent a loud and clear message to doctors across the United States: the game has changed. Simply stated, those practices that adjust quickly and wisely will be better able to survive. Those that don’t will be at risk of needing to sell out to hospitals or suffer serious issues with cash flow that could threaten the survival of their practices.

According to the annual report of America’s Health Plans, the number of U.S. residents using HDHPs rose nearly 20 percent in the past year. In 2013, 70 percent of larger employers will offer HDHPs, noted a Tower and the National Business Group of Health study. While the growth rate of this type of plan varies from region to region, no practice can think it won’t affect them soon.

The new reality is deductibles as a percent of contracted rates are about 50 percent. The days of the $25 co-pay are gone. Now practices are tasked with securing half the service bill’s balance from the patient. Unfortunately, physicians today don’t know the amount due until weeks after service, making it a priority to get the patient bill out as soon as the claim is adjudicated by the insurance company. That’s especially the case at the start of a calendar or plan year.

No one is suggesting doctors turn in their white coats and stethoscopes for green eye shades and a handful of sharpened pencils. However, they must become more attuned to the state of their practices’ financial condition. If a system is not embedded in their practice management software to manage patient bills and balances as well as produce insightful A/R reports, the doctor and his/her office manager should identify one and put it into place. Even if a new practice management system has just been deployed, that doesn’t mean you don’t need to ask the questions immediately of how to capture patient balances and post them automatically.

In the HDHP environment, everyone in the practice has a role to play, from front desk personnel to physicians. Each member of a practice should be educated on the new reality of HDHPs and how patients understand this new reality. However, it is also the responsibility of the practice to provide patients a simpler way to meet their financial obligations to the practice and continue to keep their healthcare relationships sound. If patients understand and have easy ways to remit payments, the physician keeps a sharp focus on the practice of medicine, secure in the fact that the A/R is being managed.

However, make no mistake, there is a limit on how much delegation a doctor or his/her office manager can allow. The tough calls need to be made by those individuals leading the practice. Decisions of the sort that most medical professionals could never have conceived of during their internships, like “firing” a patient.

Think about it:  with HDHPs, the shift from patient to deadbeat can occur in a matter of weeks if close attention is not paid to A/R.

Tom Furr  is CEO of PatientPay of Durham, NC.

NLP and Physician Workflow: An End to Physician Resistance?
By Chris Tackaberry, MB, ChB

“I hate all the EMRs out there, including the one our practice just bought. Notes that come from an EMR have so much extra stuffing in them that it takes me forever to figure out what you guys really had to say about the patient I referred to you. I have to wade through lines and lines of empty verbiage to finally find a meaningful sentence or two that tells me what I need to know.”

While the promise of the EHR/EMR remains as great as ever for healthcare providers, so too does the issue of physician resistance, as evidenced by this doctor’s comment, part of a conversation highlighted in a MedPageToday online article. Since EHRs came on the scene decades ago, physicians have remained slow to adopt the technology, even with the promise of improved workflow automation, enhanced care quality, rapid data exchange, and increased efficiencies. While the issue of physician resistance is certainly not new, it becomes an ever-more important concern as many hospitals continue to struggle to achieve Meaningful Use requirements.

There may be several reasons why physicians remain slow to come on board, but the most obvious is simply that doctors want to spend their time caring for patients, not struggling to use technology that introduces foreign, cumbersome tasks into their workflow. The truth is, even with today’s best systems, EHR data remains, on the whole, insufficiently descriptive or lacking in clinical context. Complete patient details often reside within historical notes embedded deep inside the EHR, and manually reviewing them for each and every patient, if a physician can access them, is incredibly time consuming and cumbersome.

Even with the technological advancements EHRs have seen over the years, physicians still have to spend tremendous amounts of time describing patient problems, medications, allergies, etc., in cumbersome forms or templates. As my colleague Tielman Van Vleck, PhD, Clinithink’s director of language processing, recently stated: “There is an intrinsic inefficiency in this process because so much of this information must be documented in the clinical notes repeatedly. As a result, there has been significant physician pushback against EHRs, despite their potential to improve both the quality and efficiency of physician-delivered care.”

NLP effectively embedded into an EHR has shown remarkable promise when it comes to minimizing the negative impact EHRs have on physician workflow. Rather than burdening physicians, NLP delivers more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

This is an important concern for providers dealing with Meaningful Use requirements, particularly Stage 2 and ICD-10, where capturing patient problem lists with unfamiliar coding terminology is another big deterrent to physicians. The good news is that NLP within an EHR can automatically tag all the problems referenced in a patient note, which in addition to facilitating analytics and clinical decision support not previously possible, can also support the capture of medications and allergies, saving physicians time associated with filling and maintaining these lists.

Physician resistance to EHRs won’t end tomorrow. But with the advent of Natural Language Processing and the manner in which this technology compliments physician workflow and will ultimately improve care quality, the light at the end of the tunnel may be considerably closer. Dr. Van Vleck recently noted, “NLP isn’t just a bigger hammer to build better widgets. If we do this right, we can improve medicine, helping people lead healthier, longer lives; we can simplify healthcare delivery and involve patients more; we can even help researchers make medical discoveries or respond to new diseases. There are a million ways that NLP can be leveraged in healthcare.”

It would seem tough to find a physician who could resist that scenario.

Chris Tackaberry, MB, ChB is CEO of Clinithink of London, England.

Vendor Resolutions for 2013
By Vince Ciotti

I tried to go to the gym today, but couldn’t get in. Too many people making New Year’s resolutions to exercise! So I went back to the office early and wrote this piece on New Year’s resolutions for our top 13 vendors, listed in order of their annual revenue.

1. McKesson. So big (over $3B in annual revenue) that they made two: (a) find jobs for the 200+ well-paid Horizon veterans they laid off last year, all with 15+ years experience in healthcare, programming, etc., and (b) hire 200+ new employees for the expanded Paragon line, following the Epic model of young, inexperienced, and cheap.
2. Cerner. Kick Paul Black’s butt.
3. Siemens. Use the excellent marketing materials and RFP responses for Soarian financials to start the design and programming soon.
4. Allscripts. Make Neal Patterson sorry he ever let Paul get away.
5. Epic. Find a NYC bank with a high interest rate on CDs.
6. GE. Sell something to somebody, somewhere, sometime, somehow …
7. Meditech. Start the design work on Release 7.
8. NextGen. Integrate the brochures, proposals, and PowerPoints for Opus, Sphere, and IntraNexus.
9. CPSI. Sell a large hospital (over 25 beds).
10. QuadraMed. Take a Quantim leap backwards.
11. NTT/Keane. Optimize their disparate product lines.
12. HMS. Get ready for Primus time.
13. Healthland. Rearrange their various products in Concentriq circles.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

Morning Headlines 1/9/13

More Changes in Health Care Needed to Fulfill Promise of Health Information Technology

RAND releases a study that recognizes that the cost savings expected from EMR implementations have not been realized. The study points the finger at the cumbersome design of healthcare IT systems and the lack of integration across the systems.

NARMC Becomes First of Many Hospitals to Launch SHARE

North Arkansas Regional Medical Center (NARMC) announces that it is the first hospital to launch SHARE (State Health Alliance for Records Exchange), Arkansas’ fledgling health information exchange.

Guidelines Released for $10 Million Qualcomm Tricorder X PRIZE Reveal Health Condition Sets for Winning Solution

Qualcomm announces contest guidelines for a $10 million prize which will be awarded to the team that can produce a Star Trek Tricorder-inspired home medical device that can wirelessly monitor vital signs and accurately diagnose any five of the following conditions: anemia, UTI, type 2 diabetes, atrial fibrillation, stroke, obstructive sleep apnea, tuberculosis, COPD, pneumonia, otitis, leukocytosis, and Hepatitis A.

Why Athena Bought Epocrates

Travis Good of HIStalk Connect outlines the most viable ROI strategies that Athena will target after the Epocrates acquisition is finalized.

Health Catalyst Closes $33M Series B Investment From Norwest Venture Partners, Sequoia Capital and Sorenson Capital

Health Catalyst, a leader in healthcare data warehousing, announces it has closed $33 million in Series B funding. Norwest Venture Partners, which led the investing, will add managing partner Promod Haque to the Health Catalyst board as part of the deal.

News 1/9/13

Top News

A RAND study finds that the cost-saving promise of healthcare IT it predicted in a vendor-subsidized 2005 study has not been reached because deployed systems are not connected and not easy to use. The study’s authors blame shortcomings in the design of IT systems and recommend improving interoperability between systems, providing better access to records for patients, and designing more intuitive systems. The original RAND study published in Health Affairs (above), partly paid for by Cerner, claimed that electronic medical records would save at least $81 billion per year, which the Congressional Budget Office said at the time was a ridiculously inflated number. Still, the study was cited repeatedly to justify government spending on EHR-related programs. Another RAND study predicted that HIEs would generate hundreds of billions of dollars per year in healthcare savings.

Reader Comments

From Homecare: “Re: interesting misstep. From a VC-backed home care tech vendor.” Family Care Medical Services (WI) files suit against medical equipment and home health billing service vendor Brightree, claiming that the billing company Brightree acquired made inadequate efforts to collect money owed to the business. Brightree, an investment of Battery Ventures, acquired home health and hospice software vendor CareAnywhere late last week.

From Big O: “Re: HL7. Announced in September they were going to open up their standards for free in Q1. Anyone know the specific data?” I inquired via HL7’s contact page. They didn’t respond. I found a bunch of free downloads on their site, but I don’t know what else they’ll be releasing.

From Mickie: “Re: CenTrak RTLS lawsuit. Attached.” AeroScout, owned by Stanley Black & Decker, claims Centrak violated its patent for a WLAN-based RFID asset tag and locating system.

From Brandywine: “Re: Octo Barnett, MD at Massachusetts General Hospital. He’s officially retired and is not giving interviews any more.” I’m sorry to hear that since I really wanted to interview him. He should write his biography since he’s one of the pioneers of healthcare IT, along with the recently deceased Homer Warner and a few other key players. Octo developed the MUMPS programming language in the 1960s with Meditech Chairman Neil Pappalardo, which more than 40 years later still runs the systems used to care for probably 90 percent of hospitalized patients in the US.

HIStalk Announcements and Requests

Mr. H and I have been talking HIStalkapalooza the last few days. I’m not sure he is quite ready to leak all the details, but here’s what I can share. The party, which will likely be the most fun event of HIMSS 2013, will be bigger than ever and include exotic shoes, excellent food and drink, entertaining music, a few contests, and even a bit of dancing. And of course the annual HISsies awards. You will want to keep your calendar open for the evening of Monday, March 4.

Acquisitions, Funding, Business, and Stock

Health Catalyst, known until recently as Healthcare Quality Catalyst, raises $33 million in Series B funding from Norwest Venture Partners, Sequoia Capital, and Sorenson Capital Partners. I interviewed co-founder Steve Barlow in 2011 and SVP Dale Sanders this past October.

Point-of-care technology vendor PatientSafe Solutions closes a $20 million Series C round led by the Merck Global Health Innovation Fund.

Private equity firm Riverside Partners invests in Stinger Medical, a provider of mobile clinical workstations and medical technologies.

Care Thread, a provider of secure mobile messaging and a recently named “App of the Month” by Nuance Healthcare, secures $250,000 in seed funding from Slater Technology Fund.

Lightbank, the venture fund launched by Groupon’s founders, leads a $1.4 million investment in fertility app vendor Ovuline. The startup’s next product is a pregnancy monitoring app.

Data analytics company Blue Health Intelligence acquires Intelimedix, a healthcare analytics firm specializing in employer group and payer reporting solutions.

Passport Health Communications acquires California-based Data Systems Group, a provider of revenue cycle software solutions.

Travis analyzes possible reasons that athenahealth acquired Epocrates on HIStalk Connect.

Sales

ICON selects Cerner’s Discovere Late Phase platform to support its pharma and device studies.

The Health Information Trust Alliance designates Booz Allen Hamilton a Common Security Framework Assessor, tasked with conducting information security audits of healthcare organizations.

The Liverpool Heart and Chest Hospital NHS Foundation Trust augments its Allscripts electronic patient record with Hyland Software’s OnBase solution for enterprise content management.

St. Anthony’s Medical Center (MO) selects Capsule Tech’s device connectivity technology for use in multiple areas to automate the flow of patient data into Epic.

Stellaris Health Network (NY) signs a multi-year agreement with MedAssets for strategic sourcing, BI, and process improvement consulting.

Delaware Health Information Network approves the AlliedHIE Company as a Direct messaging provider for the HIE’s enrolled practices, with messaging and interoperability technology provided by ICA’s CareAlign Direct Messaging and Exchange solutions.

People

CHIME and HIMSS name University of Utah Health Care CIO James Turnbull its John E. Gall, Jr. CIO of the Year.

LifeBridge Health names Tressa Springmann (Greater Baltimore Medical Center) as CIO.

Blackford Middleton, MD, MPh, MSc (Partners HealthCare) will join Vanderbilt University as assistant vice chancellor, chief informatics officer, and professor of biomedical informatics.

O’Neil Britton, MD is appointed chief health information officer of Partners HealthCare, replacing David Blumenthal MD, who left earlier this year to head The Commonwealth Fund.

The South Florida REC promotes Amy Rosa from assistant director to interim director.

Vocera Communications names M. Bridget Duffy, MD (ExperiaHealth) CMO.

QuantiaMD names Daniel Malloy (IMS Health) SVP, promotes President Mike Coyne to CEO, and appoints CEO Eric Schultz to executive chairman.

Home monitoring systems vendor Healthsense names A.R. Weiler (Emdeon) as CEO.

Announcements and Implementations

North Arkansas Regional Medical Center becomes the first facility to implement the State Health Alliance for Records Exchange (SHARE), the statewide HIE for Arkansas.

CareCloud and the online physician platform QuantiaMD partner to survey QuantiaMD members on key practice trends.

Philips Healthcare introduces Lifeline GoSafe, a mobile personal emergency response system that includes fall detection capabilities, locating services, and two-way cellular voice communications.

Coding software vendor Trucode announces a cloud-based product that allows vendors to incorporate coder functionality into their systems. Customers include ChartWise, BayScribe, Dolbey, MModal, Precyse, and PlatoCode.

Florida Hospital Wesley Chapel (FL) completes the first phase of its nurse response system, which includes a Rauland-Borg nurse call system, Cisco wireless handsets, and Extension middleware.

Innovation and Research

The X PRIZE Foundation announces ambitious competition guidelines for the $10 million Qualcomm Tricorder X PRIZE, for which 255 teams have already registered. Along with monitoring vital signs and specific conditions, devices will need to address a core set of 12 conditions that include diabetes, atrial fibrillation, stroke, TB, and COPD.

Other

Hunting and fishing supplies retailer Cabela’s apologizes for a New Year’s Day computer glitch that added the Affordable Care Act’s 2.3 percent medical device tax to every purchase. The company says it has no idea how that happened.

In the UK, an NHS surgery practice blames human error on its creation of over 4,000 summary patient records without giving patients the chance to opt out.

Xerox files a protest with the West Virginia Department of Health and Human Services after the state awards a $248 million Medicaid claims processing system contract to Molina Medicaid Solutions. Xerox claims the state’s 2011 contract with Incumbent vendor Molina to upgrade the state’s existing system gave that company an unfair advantage.

An article on patent trolling identifies a maze of closely held companies that are sending out threatening letters to businesses, demanding license payments of $900 to $1,200 per employee for their patent that covers e-mailing scanned documents. The article says a study of startups found that 22 percent of them ignore patent trolling letters, 35 percent fight back at average court cost of $870,000, and 18 percent go out of business.

VistA guru Tom Munnecke observes that Secretary of Defense nominee Chuck Hagel was intimately involved with the MUMPS-based VistA system in its skunkworks early days as a VA deputy director, praising him for supporting the “Underground Railroad” despite the objections of VA brass who wanted to run a huge, centralized hospital information system instead.

Weird News Andy is stuffed with good news: the guy who invented the Segway is working on a gadget that will let people gorge themselves on food, then pump their own stomachs through a surgically installed abdominal valve. WNA says Dean Kamen obviously “has his finger on America’s thready pulse” since his inventions discourage walking and encourage gluttony.

Sponsor Updates

• The PriMed (CT) provider group and MED3OOO distributed coats, sleeping bags, and gift bags to the needy through the Bridgeport Rescue Mission’s Sleeping Bag Give-Away event right before Christmas.
• The local paper profiles Don Catino,who co-founded New Hampshire-based Digital Prospectors in 1999.
• McKesson Paragon is named Best in KLAS Community Hospital Information System for the seventh straight year.
• API Healthcare participates in the ACNL 2013 Annual Conference in San Diego February 10-13.
• AdvancedMD hosts a January 23 Webinar  that provides a crash course on qualifying for Meaningful Use.
• T-System offers complimentary benchmark information that considers the timeliness and quality of ED care.
• Nuance Healthcare’s Jonathon Dreyer, director of mobile solutions, predicts that 2013 will be the “year of the mHealth user” with more widespread availability and adoption of mobile health technology.
• CSI Healthcare IT earns satisfaction scores 2.2 times higher than the industry average for staffing firms in an independent satisfaction survey, also earning a74 percent “would recommend’ score.
• Vocera releases updates to its software platform that enhance nurse workflow and provide improved analytics and reporting. 
• Medseek looks at patient engagement, MU, and meeting patient expectations with technology in a January 16 Webinar. 
• Billian’s HealthDATA releases a white paper that focuses on the top innovations in HIT.
• Imprivata names Johns Hopkins Medicine the winner of its 2012 Healthcare Innovator of the Year Award for an exceptional implementation of OneSign.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 1/8/13

Athenahealth to Acquire Mobile Health Leader Epocrates

Athenahealth agrees to terms on a deal to acquire Epocrates for $11.75 per share, in cash, for a total of approximately $293 million. The purchase price represents a 22 percent premium over the closing price per share of Epocrates on NASDAQ on Friday.

James Turnbull Named CHIME-HIMSS 2012 John E. Gall, Jr. CIO of the Year

CHIME names James Turnbull of the University of Utah Health Care System as CIO of the Year for 2012.

NextGen Healthcare and Medline Partner to Expand Integrated Solutions

NextGen has entered into an agreement with Medline Industries, the nation’s largest privately held manufacturer and distributor of medical devices. The agreement provides sales support to NextGen from Medline’s 1,100 sales representatives along with marketing access to Medline’s more than 100,000 customers.

Vast cache of Kaiser patient details was kept in private home

Kaiser Permanente is under federal investigation for violation of patient privacy in connection with a document storage firm it hired that was discovered to be storing more than 300,000 patient medical records in the private home of its husband and wife owners.

EHR Design Talk with Dr. Rick 1/7/13

The Overview-by-Category Design

We have been considering two alternative high-level EHR designs for organizing a patient’s data over time – the Snapshot-in-Time design and the Overview-by-Category design.

In a recent post, I made the argument that the Snapshot-in-Time design supports our mental model of how a dynamic system, such as a patient’s state of health, changes over time.

In my last post, I proposed that the user interface (UI) that results from the Snapshot-in-Time design supports how the human visual system takes in and processes information.

While the Snapshot-in-Time design is at the core of much paper-based medical charting (see Why T-Sheets Work), for a number of reasons — only some of them due to technical limitations — it has not been widely adopted as a high-level EHR design. Instead, most EHRs employ an Overview-by-Category design.

The Overview-by-Category design places emphasis on the patient’s present state of health. A single summary screen displays multiple categories of EHR data (History of Present Illness, Assessment and Plan, Medications, etc.) each as a separate pane or table containing time-stamped data from both present and past encounters.

In my opinion, the Overview-by-Category design has several fundamental limitations:

• The patient’s story does not unfold as a narrative.
• Significant cognitive and mouse / keystroke effort is required to make sense of how entries in the different categories fit together.
• The overview screen tries to convey too much information. To see details, the user either has to scroll within the tables (see The Problem with Scrolling), to scroll the overview screen itself, or to navigate to entirely different screens (see Humans Have Limited Working Memory).

To help compare the two designs, I have constructed mockups below based on the Overview-by-Category design, using exactly the same patient database that I used for the Snapshot-in-Time mockups in my last post.

The Overview-by-Category mockups below are based on a widely-used EHR. While these illustrations are for an ambulatory patient, similar designs are common in hospital-based EHR systems.

In order to see the mockups and read the accompanying text, enlarge them to full screen size by clicking on the ‘full screen’ button

in the lower right corner of the SlideShare frame below.

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Curbside Consult with Dr. Jayne 1/7/13

I lucked out this year by having the privilege of being on IT backup call for both Christmas Eve and New Year’s Eve. Since health IT is by definition part of the 24 x 7 world of health care, a lot of us were working. Although our clinical departments never take a day off, our administrative organization is trying something new this year and actually allowing a full day off for Christmas Eve and New Year’s Eve rather than the traditional half days. I always thought the half days off were kind of silly, since any work that was actually attempted was half-hearted at best.

With the long weekend over New Year’s and the short work week to follow, I hoped our team would take advantage and spend time with family and friends or otherwise recharge their energy for the coming year. The team knows better than to expect responses from me on e-mail when we’re officially not working. However, I forgot to sign time cards, so I found myself online on New Year’s Eve. I found dozens of e-mails waiting. Several of them wanted answers or decisions.

Apparently in addition to signing time cards, I also forgot that we have a couple of staffers working on our team who are on loan from another part of the organization. From the looks of my inbox, a couple of them decided to spend their long weekend working, and I could tell that at least one of them was still online. I instant messaged him and reminded him it was a holiday and that he really needed to take a break. We went back and forth a bit and he eventually figured out that I wasn’t kidding, that I wanted him offline and doing something other than work.

When we returned to the office on Wednesday, I approached him to talk about the weekend / holiday work situation. He admitted that in his “home” department, they are expected to check e-mail several times a day, even on weekends, “in case someone needs something.” Like a lot of people, he had a hard time just “checking” e-mail and would get sucked in to answering e-mails and working on projects and had difficulty letting things sit. I reminded him that in our department we have on-call coverage for that eventuality – someone is always reachable via the help desk. Should the on-call person not respond, the help desk has permission to contact the managers or directors (or even me) to make sure our clinicians have what they need.

In his department, there seems to be a lack of trust that the help desk group knows how to appropriately escalate issues to the on-call team or that the on-call person will be able to solve the problem. The team doesn’t necessarily trust each other and they don’t feel that there is adequate cross training to allow for rapid problem solving. It leads to a cycle of continuous frustration and feeling like they can’t get anything done and that they always need to be watching over their shoulders.

It was a good conversation and really got me thinking about our team culture of time management and what makes teams effective versus what makes teams struggle. I thought about some of the most productive teams I’ve been a part of and some of the worst team experiences I’ve had. With that bit of reflection, I’d like to share my thoughts on what I think works.

Have an E-mail Policy

I personally like a “three day” policy. This means that people have three business days from the time the e-mail is sent before a response is due. This also means that if you need an answer sooner than three days, you need to either call the person or speak to them personally – no texting. This also applies to meetings, since invitations come via e-mail. If you need to schedule something with less than three days’ notice, you have to reach out to people by phone or in person.

Our policy discourages people from working e-mail at night unless there are unusual circumstances or employees are working flex time. Staff who aren’t routinely at their desks are encouraged to block time on their calendars to handle e-mail. They quickly learn that calendars fill if they’re left open, so it’s to their advantage to set up regular times to focus on e-mail. They’re also encouraged to not check e-mail during meetings, which can be incredibly disruptive. Some individuals even need to avoid trying to check e-mail between meetings if they’re not disciplined at knowing what they can answer quickly and what will be a time suck. In addition, appropriate use of “out of office” replies is required.

Have a Voice Mail Policy

If you’re a field employee, indicate on your outgoing greeting how often you check your voice mail and if you prefer an alternative method of contact. Some of our field employees (such as trainers and desktop support liaisons) don’t even have voice mail, because they’re never at their desks to check it. My voice mail greeting specifically says to not leave a message as it will not be returned. You’d be surprised at how many people leave messages anyway. That gives me a general idea about those folks and their listening skills, especially when they do it more than once.

Have a Text Message / Instant Message Policy

The text message policy is easy at our organization. The hospital doesn’t pay for texting service, so people don’t use it except for personal messages. Although instant messenger is in use (and integrated into our e-mail suite), I don’t encourage my team to use it and actively discourage some staff from using message notifier popups. The constant distractions on the screen are lethal to those who have difficulty paying attention. (This goes for e-mail notifiers also.) Instant message is also challenging because it often doesn’t leave an easily followed trail. Saving chat logs isn’t as efficient as using e-mail reply tracking when you have to prove who you told, what you told them, and when the message was delivered.

Have a Meeting Policy

Meetings should have agendas which should be distributed at least one full business day in advance. I used to have a team member who routinely sent the agenda for an 8 a.m. meeting the night before at 8 p.m. Note the use of the past tense. Sending agendas in a timely manner allows people to actually read them and speak to you if there is a problem with the agenda or if they’re not prepared to discuss an item. Agendas should be adhered to. If the leader isn’t a good time manager, he or she needs to appoint a time keeper to stay on track.

The most successful teams I’ve ever been a part of have meetings that only last 45 minutes. The trick to squeezing an hour meeting into that block is to start on time and end on time. This prevents productivity loss at the beginning due to late arrivals and at the end due to those scooting out to attend the next meeting. This allows 15 minutes between meetings for people to check e-mail, walk to the next meeting, return to their desks to dial into conference calls, or take care of other needs.

Another trick – do not recap for late arrivals. Nothing is worse than being on time for a conference call and having the leader recap the roll call and activities for late arrivals. A word on conference calls – if you have access to web meeting software, require its use and require people to sign in so you can see who is on the call, avoiding the whole roll call issue altogether. Many packages even allow you to sign in from your cell phone, removing that as an excuse for not signing in.

My last meeting pointer is to always end on time. Adherence to the agenda is paramount. If a topic is taking too long, that means it likely needs its own meeting. A key element of my team culture is ending early whenever possible. People who try to cram new agenda items into three free minutes are quickly neutralized by their self-policing teammates.

For many of you, these are common sense items, and hopefully most of you follow similar rules in the office. I know from experience though that there are a large number of workplaces that have no clue about these (or many other) time management and team management dynamics. If you’re on the leadership team and you don’t have these policies in place, consider implementing them as part of your resolutions for the new year. You might find yourself with stronger teams, happier workers, and greater output.

Have a solution for sticky workplace problems? E-mail me.

E-mail Dr. Jayne.