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The Top 3 Reasons Your Health IT Systems Take So Long To Integrate – Optimize Healthcare Integration Series

Posted on July 1, 2015 I Written By

The following is a guest blog post by Stephane Vigot, President of Caristix, a leading provider of healthcare integration products and services. This post is part of the Optimize Healthcare Integration series.
Stephane Vigot - Caristix
The push for interoperability is on. What’s at the core of interoperability that truly supports next generation analytics, real patient engagement, true care coordination, and high value population health? Data exchange through interfacing. And that means HL7.

HL7 represents 95% of interfacing in hospital environments for clinical systems and many other information systems in healthcare.  Many people make the error of thinking HL7 is just simple strings, but it’s a lot more than that. It’s a system of data organization, a dynamic framework that establishes the base of data exchange through its specifics, syntax and structure. But, despite standards, if you take two identical systems, same vendor, deployed in two different environments, you’ll find discrepancies 100% of the time when it comes to data management.

What’s the result? It takes too long to take systems live. And that means time, money, resource drain, and headaches for integrators, maintenance and quality teams. The most critical impact is on essential clinical care. Beyond that, this negatively impacts your short and long term business goals over time. This impact will grow with the increasing demands of interoperability, particularly with the drive for automation and easy data access and analytics.

There are three primary challenges that feed into this problem of getting a system live. These are:

Aligning the integration goals for business and technology users – This step alone will differentiate success or failure. Without a clear picture of your goals and environment from day one, you can’t measure the required investment and resources. Project planning becomes a wild guess. How do you get everyone involved on deck with a common understanding of the overall project?  Is it crystal clear how your new system fits into your existing ecosystem in the context of your data flow and structure? Do you know what information you need from whom, when? Is all documentation readily available? Are the business impacts of the interface understood?

Complete and clear data transformation requirements – It’s common to manually compare outdated specs, list the differences and jump into the code. This makes it virtually impossible to quickly come up with a complete list. Complete requirements are not identified until too late in the project, sometimes not until it’s in production. Are all data flows and system workflows identified? Are the system’s data semantics clear? Are documented system specs accurate? Has customized data been included?  Are all the transformations and mappings defined?  Have you automated the processes that define requirements?

Testing/Verification – Your QA team knows this is about a lot more than making sure all the dots are connected. You want to get this right before your go live and avoid handling data related emergencies in production with constant break-fix repairs. Are you doing enough testing before go live so your caregivers can count on applications being completely functional for their critical patient care? Are your test cases based on your requirements? Are you testing against your clinical workflows? Do you include edge cases and performance in your testing? Are you testing with de-identified production data that accurately represents your system’s data flow and needs? Is your testing HIPAA compliant? Are you prepared for ongoing maintenance and updating with reusable test cases backed by reliable and repeatable quality measures? Is your testing automated?

What’s the most efficient solution to these three challenges?  Productivity software that supports your integration and workflow process from start to finish. With the right solution, you understand the big picture before you start with complete requirements built upon your specifications that set you up for robust system testing and maintenance. The right solution will cut your project timelines in half, reduce your resource drain and costs, and guarantee predictable results while streamlining the repetitive tasks of your teams. In addition, gap analysis, automatic specification management, HL7 message comparison and editing, debugging tools, PHI de-identification, documentation building, and team collaborative depositories should be included. As seen in the charts below, savings of up to 52% can be realized through optimization with productivity software.
Healthcare Integration Project Time Chart
Do these healthcare integration challenges resonate with you? What is your organization experiencing? We’d love to hear your thoughts in the comments.

Caristix, a leading healthcare integration company, is the sponsor of the Optimize Healthcare Integration blog post series.  If you’d like to learn more about how you can simplify your healthcare integration process, download this Free Whitepaper.

About Stéphane Vigot
Stéphane Vigot, President of Caristix, has over 20 years of experience in product management and business development leadership roles in technology and healthcare IT. Formerly with CareFusion and Cardinal Health, his experience spans from major enterprises to startups. Caristix is one of the few companies in the health IT ecosystem that is uniquely focused on integrating, connecting, and exchanging data between systems. He can be reached at stephane.vigot@caristix.com

How Much Time Do You Spend Cleaning Your Data?

Posted on June 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently came across this really great blog post talking about data scientists wasting their time. Here’s a quote from the article (which quotes the NYT):

“Data scientists, according to interviews and expert estimates, spend 50 percent to 80 percent of their time mired in [the] mundane labor of collecting and preparing unruly digital data, before it can be explored for useful nuggets.”
– Steve Lohr, NYT

Then, they have this extraordinary quote from Monica Rogati, VP for Data Science at Jawbone:

“Data scientists are forced to act more like data janitors than actual scientists.”

Every data scientist will tell you this is a problem. They spend far too much time cleaning up the data and they all wish they could spend more time actually looking at the data to find insights. I’ve seen this all over health care. In fact, I’d say we have more data janitors than data scientists in healthcare. Sadly, many healthcare data projects clean up the data and then don’t have any budget left to actually do something with the data.

The solution to this problem is easy to write and much harder to do. The solution is to create an expectation and a culture of clean data in your organization.

I predict that over the next 5-10 years, healthcare data is going to become the backbone of healthcare data decision making. Those organizations that houses are a mess are going to be torn down and sold off to the hospital that’s kept a clean house. Is your hospital data clean or dirty?

Interoperability Becoming Important To Consumers

Posted on June 26, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The other day, I was talking with my mother about her recent primary care visit — and she was pretty po’d. “I can’t understand why my cardiologist didn’t just send the information to my family doctor,” she said. “Can’t they do that online these days? Why isn’t my doctor part of it?”

Now, to understand why this matters you need to know that my mother, who’s extremely bright, is nonetheless such a technophobe that she literally won’t touch my father’s desktop PC. She’s never opened a brower and has sent perhaps two or three e-mails in her life. She doesn’t even know how to use the text function on her basic “dumb” phone.

But she understands what interoperability is — even if the term would be foreign — and has little patience for care providers that don’t have it in place.

If this was just about my 74-year-old mom, who’s never really cared for technology generally, it would just be a blip. But research suggests that she’s far from alone.

In fact, a study recently released by the Society for Participatory Medicine and conducted by ORC International suggests that most U.S. residents are in my mother’s camp. Nearly 75% of Americans surveyed by SPM said that it was very important that critical health information be shared between hospitals, doctors and other providers.

What’s more, respondents expect these transfers to be free. Eighty seven percent were dead-set against any fees being charged to either providers or patients for health data transfers. That flies in the face of current business practices, in which doctors may pay between $5,000 to $50,000 to connect with laboratories, HIEs or government, sometimes also paying fees each time they send or receive data.

There’s many things to think about here, but a couple stand out in my mind.

For one thing, providers should definitely be on notice that consumers have lost patience with cumbersome paper record transfers in the digital era. If my mom is demanding frictionless data sharing, then I can only imagine what Millenials are thinking. Doctors and hospitals may actually gain a marketing advantage by advertising how connected they are!

One other important issue to consider is that interoperability, arguably a fevered dream for many providers today, may eventually become the standard of care. You don’t want to be the hospital that stands out as having set patients adrift without adequate data sharing, and I’d argue that the day is coming sooner rather than later when that will mean electronic data sharing.

Admittedly, some consumers may remain exercised only as long as health data sharing is discussed on Good Morning America. But others have got it in their head that they deserve to have their doctors on the same page, with no hassles, and I can’t say the blame them. As we all know, it’s about time.

Bosch’s Telemedicine Shutdown Suggests New Models Are Needed

Posted on June 25, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While many new telehealth plays are rapidly gaining ground, the previous generation may be outliving its usefulness. That may be the message one can take from one giant German conglomerate’s decision to shut down its U.S. telemedicine division.

Robert Bosch GmbH recently announced that it would shut down its U.S. telehealth unit, Robert Bosch Healthcare Systems, which makes business-to-business telemedicine systems. Its offerings include patient interfaces, software and platforms.

You may never have heard of this healthcare company, nor of its massive corporate parent Robert Bosch GmbH, but it’s part of a very large conglomerate with virtually infinite resources.

As it turns out, Bosch is a massive firm which competes with market leaders like GE and Siemens. Robert Bosch GmbH, which has existed since 1886, has more than 350 subsidiaries across about 60 countries and employs about 306,000 people. (I could share more, but I’m sure you get the idea.)

While the failure of one company’s telemedicine strategy doesn’t necessarily mean death for all similar plays, it does suggest that the nimble smaller firms may have more of an advantage than it appears.

Bosch Healthcare was actually way ahead of the market with its offerings, which included remote monitoring tools such as a touch-screen device for home use after hospital discharge and a family of mHealth tools aimed at chronic care management.But they appear to have been held back by proprietary technologies in a market that demands cheap and easy.

Ultimately, the end came when the parent company wasn’t happy with how the telehealth division was performing financially, and decided to cut and run. A statement from the company said that Bosch plans to shift its medical focus to sensor technologies to support improved diagnostics.

It’s hardly surprising that a company Bosch’s size would fail to keep up with the marketplace, given its size. No matter how smart the division’s 125 employees were, they were probably saddled with big company politics which prevented them from making big changes. Not to mention low priced tablets appeared and created a low cost competitor.

The question is, will other large players follow Bosch’s lead? It will be worth noting whether other large companies cede the telehealth market to small and emerging entrants as well. It’s not a no-brainer that this will happen; after all, there’s billions to be made here. But they may actually be wise enough to know when they’re ill-equipped to proceed.

I’ll be particularly interested to see what strategies existing health IT players adopt toward telehealth. It’s unclear how they’ll react to rising consumer and professional interest in telehealth technology, but whatever they do it will probably be worth analyzing.

That being said, with smaller companies out there breaking new ground with next-gen telemedicine apps and tools, they’re probably going to be in the unusual position of playing catch up. And in this case, slow and steady may not win the race.

Lessons To Consider When Weathering M&A Transitions

Posted on June 24, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

These days, the need for sophisticated IT infrastructure and the shift to risk-bearing insurance contracts are increasingly favoring large, muscular players. Not surprisingly, healthcare industry M&A is reaching a new peak.  Just about any substantial healthcare organization is facing the question of whether to acquire outside players and bulk up, merge with a bigger healthcare player or risk going it alone.

Particularly if you’re doing the acquiring, however, achieving critical mass is just the first in a long, difficult series of steps necessary to success. Health systems, in particular, face difficult management challenges when they try to integrate all of the moving parts necessary to survive as a next-gen organization.

A new study commissioned by West Monroe Partners, however, may shed some light on how to think about M&A integration issues. The study, which focuses on mid-market deals (between $300M and $2B) looks at post-merger integration across several industries, but I’d argue that its lessons still make sense for hospitals. Their tips for managing post-merger transitions include the following:

  • Start planning early:  West Monroe researchers found that companies which considered integration strategies as they began targeting and negotiating with merger partners were more successful in integration. Specifically, these companies were able to integrate more deeply than firms that didn’t began planning till pre-merger preparations were already under way.
  • Pay close attention to cultures: Here’s an eye-opening stat: more than half of companies surveyed by researchers said that merger value was lost due to lack of attention to differences in corporate cultures. Clearly, giving lip service to this issue but failing to address it intelligently can be costly.
  • Poor change management impacts future dealmaking:  In a clear case of “sadder but wiser,” a whopping 94% of survey respondents said that they would place more emphasis on change management next time they managed post-merger integration efforts. The study doesn’t spell out why but it seems likely that their past efforts blew up on them. Given that many health systems won’t stop at one deal in this climate, this is an important point.
  • Communicating change well is essential: About three-quarters of mid-market execs said that communicating change to their staff was one of the hardest parts of integration, and 62% said that communicating to outsiders was a major challenge. Many seem unhappy with the results of the past efforts, as 57% said this was a key area for improvement.

Some of these suggestions may be discouraging for hospital leaders. After all, required and important changes like the ICD-10 transition and ongoing EMR changes may already have staffers near burnout, and they may react badly to coping with added cultural changes.

That being said, the survey results also suggest that many of the integration challenges healthcare organizations face can be headed off somewhat by smart planning.  At least there’s something execs can do to cushion the blow.

EHR Usability Survey – Share Your Opinions

Posted on June 23, 2015 I Written By

The following is a guest request to participate in a research survey on EHR usability from Natasha Ocean, a Masters student at the University of Tennessee. Natasha said she’d probably be able to share the results with us. So, let’s help her out in collecting the data.

As we embark on an era of healthcare reform in this country, it is vitally important that all hospital employees have the tools they need to be able to do their work effectively and efficiently. Yet there has been little research on whether the EHR system, an important tool for many hospital employees, is designed to help those users optimize their productivity.

That’s why I chose the topic of EHR usability for my Master’s thesis at the University of Tennessee Health Science Center.

I would really appreciate it if you could take about 5 minutes to complete this survey.

The survey contains 20 multiple choice questions about how EHR usability issues affect your efficiency at work.

Please click here to take the survey.

This is NOT a marketing survey; it is being done solely for the purpose of academic research.

You may read the IRB-approved Informed Consent Statement here (short version: the survey is completely anonymous and no personal or identifying information will be collected).

Thank you so much for your assistance!

About Natasha Ocean
Natasha Ocean, originally from St. Petersburg, Russia, was a practicing neonatologist specializing in life support and critical care before moving to the United States in 2004. She then transitioned her career into IT, working first as a technical project coordinator, then as a healthcare data analyst. She can be reached at ocean.natasha@gmail.com.

The Next Big Healthcare IT Brands

Posted on June 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed it, I wrote a post on EMR and HIPAA that talks about how patients will choose healthcare. In the article we talk about the impact of brand on healthcare decision making. Plus, I talk a bit about how many real national healthcare brands there are in the industry.

With this in mind, I was struck by this tweet from @theEHRGuy:

As the post above illustrates, I’d considered the impact of brand on healthcare decision making by patients. I hadn’t thought about the power of brand for healthcare IT companies. Over the past couple of years, we’ve definitely seen how important brand has been as many hospitals have chosen to buy from the brand as opposed to taking a best of breed approach to their IT systems. This has been an extremely important trend in healthcare IT.

In my recent post, I also talked about the move away from Best of Breed EHR systems and how that could apply to patient engagement solutions as well. I think this cycle is inevitable and I think patient engagement could be an area where a big brand establishes their name in the industry. Especially because the incumbent EHRs aren’t competing well in the patient engagement space.

I’ve also written about how I think that the Care Management System could be the next system purchase now that we’ve done HIS/PM and EHR. Could someone or a group of companies build a great brand for Care Management Systems? Could they build momentum around the need for every hospital to invest in some sort of Care Management System the way there’s been momentum for hospitals to adopt EHR?

Back to the tweet embedded above, I think it’s pretty interesting to think about the next big healthcare IT brands. Which brands do you think are going to be the next big ones? Every hospital CIO should be spending some time thinking about and watching these trends.

Healthcare IT Jobs – The Move from Consultant to FTE

Posted on June 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In hospital IT we’re seeing a lot of changes happening with how a hospital IT department staffs itself. The past couple years, most hospitals have been busy implementing their EHR. This required them to hire a lot of EHR consulting companies that could scale up their manpower requirements for the implementation. In fact, many of these so called EHR consulting companies were actually just staff augmentation companies dressed as consultants. I even noted that the Healthcare IT Industry was addicted to consultants.

I think over the last 6 or so months, we’ve seen a move away from hiring as many consultants (we still love a good consultant) towards hiring more FTEs in hospital IT. This makes sense. As the EHR product has matured, the manpower needs are more stable and so it makes a lot of sense to hire a full time person to manage the ongoing needs.

We’ve seen that first hand on our healthcare IT job board. There are still some lingering consulting positions that are needed for the remaining EHR implementations, but hospitals are hiring more FTEs. I think this trend will continue for a good while to come.

In fact, we’re seeing a shift in consulting. Many EHR consulting companies are turning into EHR help desks. Others are going after value based reimbursement and healthcare analytics. In some cases, the consulting companies are turning into product companies. In other cases, they’re finally starting to consult.

Best of Breed in Patient Engagement?

Posted on June 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve been thinking more about the future of healthcare IT, I wrote that I think the next major healthcare IT product could be a Care Management System. Maybe it will go by a different name, but the functionality that’s described by a care management system is already going into place. Regulations are headed that direction and every organization will need to have a care management system.

At the core of a care management system will be functionality that engages the patient. I use that term in the broadest sense possible and not the fully corrupted meaningful use version of patient engagement. I’m talking about truly engaging the patient in their care in a bi-directional way that includes communication, support, education, social influence, and more.

As I consider the broad possibilities around patient engagement, there are hundreds of companies (possibly thousands) working in this space. Some are working with diabetic patients while others are focused on cardiac issues. Others are using text messages while some startups are leveraging full smart phone applications. A few tie in with the EHR vendors and many don’t. A hospital system is going to need a patient engagement solution that cuts across all of these slices.

With that in mind, it begs the question, “Are we going to implement and manage a cobbled together “best of breed” solution for patient engagement?

If EHR history tells us anything, most hospitals will adopt some point patient engagement solutions and then over time they’ll realize that the best of breed approach to patient engagement has gotten unwieldy and they’ll start looking for an all in one patient engagement solution. In some ways, this has to be the path forward. There’s no all in one patient engagement solution today. So, hospital systems have to choose to either sit on the sideline and wait for the all in one system to arrive (like many did with EHR software) or they have to go best of breed to start while the all in one patient engagement solutions come together.

I’m not sure this path is such a bad thing. It’s good for a health system to understand patient engagement in a smaller way before expanding across the entire system. We’re starting to see more of this happen in hospitals. However, be sure to keep your eye on the long game being one unified patient engagement system.

Moving from the Era of Push to the Era of Pull for Healthcare Data

Posted on June 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I thought this image and comment were really interesting in the context of healthcare data. Healthcare data has generally been stuck in the push era. I’m excited to see the discussion expanding to the pull era. It’s a very different world when you can just pull the healthcare data you want when you need it. The above conference is from a medical imaging conference. Are they leading the way with pull data in healthcare?