Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Doctor Who? Reaction to Female Casting an Opportunity to Revisit Gender Equality in Healthcare

Posted on July 24, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

On Sunday, immediately after Roger Federer defeated Marin Čilić for his eighth Wimbeldon title, BBC One announced to the world that the next actor to play Doctor Who would be…wait for it…a woman! It is the first time in 13 iterations of Doctor Who (fans call it regenerations) that a woman will play the titular character.

Jodie Whittaker of Broadchurch and Attack the Block fame, will become The Doctor following the annual Christmas special later this year when current actor Peter Capaldi ends his run on the show.

The announcement of Whittaker set off a firestorm of tweets and online comments. Although many were supportive of the move, there were some who felt betrayed by the show’s producers in casting a woman to be The Doctor. Although many tweets came from women-hating trolls (I’m choosing not to give them more air time by highlighting them in this blog), there seem to be an equal number of comments about how this breaks too far from the tradition of the show.

These tweets got me thinking about what it was like for Elizabeth Blackwell, the first female physician in the US and Jennie Kidd Trout, the first woman to be a practicing physician in Canada. If we were to transport ourselves back in time (see what I did there?) I can easily imagine hearing the same “but the doctor has always been a man and always should be” refrain from the medical establishment.

Traditions have their place – like Thanksgiving dinners and ice-cream after baseball games – but traditions based on gender (or race for that matter) deserve to be torn down. Healthcare is steeped in tradition and it wasn’t that long ago when the idea of a female clinician was deemed ludicrous. It took courageous people like Dr. Blackwell and Dr. Trout to tear down the walls of medicine’s male-only traditions and blaze the trail for the many women that would come after them. Over the years women have had to fight become physicians, nurses, surgeons, administrators and CEOs. It has been and continues to be a difficult road when compared to their male counterparts.

The same is true for women in HealthIT. You would think that in 2017 gender bias would have gone the way of COBOL, but it lingers. Although it is no longer strange to see women in IT roles, they still have to put up with being bullied, belittled and objectified online and at industry events. There really is no place for this type of behavior. I applaud the efforts of people like Mandi Bishop, Jennifer Dennard, Linda StotskyMel Smith Jones and Regina Holliday who stand up for gender equality in healthcare, yet at the same time I’m sad that their efforts are needed.

If the reaction to the Jodie Whittaker as Doctor Who is any indication, we collectively still have a lot of gender equality work to do. We should take Whittaker’s announcement as an opportunity to revisit the issue of inequality in healthcare.

 

 

KLAS Keystone Summit and Enterprise Imaging

Posted on July 21, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed


Recently, KLAS Research hosted their annual invite only Keystone Summit surrounding Enterprise Medical Imaging solutions.. The goal? To improve the success with which enterprise imaging solutions are deployed and adopted. A group of 24 executives from healthcare provider organizations and 10 enterprise imaging vendors met for the exclusive work day at Snowbird, Utah. In the sea of noise about healthcare technology Utah has been quietly innovating and improving outcomes. I was honored to be able to attend and see the results of their hard work.

Healthcare innovation needs voices that move out of the echo chamber and collaborate. We need more makers and quality information across measurement. Consistent messaging between large healthcare organizations as well as between vendors and providers improves outcomes for enterprise imaging.  

Adam Gale of KLAS shared his personal experiences leading youth in a pioneer trek during his remarks to the group and likened it to leading this market. Prior to the conference, Adam went as a leader for youth to travel some of the trails that early settlers of Utah followed. These settlers are called “The Pioneers” and the experience of a short pilgrimage can help today’s over connected and digital youth understand to a small degree, what past generations experienced in walking through Wyoming.

Adam Gale told of his experience:  “I spent several unique days last week on the plains of Wyoming with about 400 young people. The goal was to instill in them an appreciation for the legacy that comes from these early pioneers. You can imagine the enthusiasm of these youth switching from video games to handcarts. We had a lot of fun, but there were also some reverent moments when we walked by the gravesites of those that died on the trail. It was a touching moment for these young individuals to see the sacrifices of those who had come before them, and for them to take inspiration from the dead to move forward in life”

This personalized vision of in the midst of sensationalized health stories about predicting death and shiny technology, we are charged with caring for people’s lives. There are solutions that save lives, and for many patients access to images across providers allows them to get critical medical care.

Adam Gale went on to mention Mark Twain’s quote:

“Do the right thing. It will gratify some and astonish the rest.”

Leaders from the KLAS summit met together to outline what that “right thing” looks like and create a way to measure if Enterprise imaging was on track, and how to get on track. Current and expected functionality was outlined for five areas, including: Capture, Storage, Viewing, Interoperability and Analytics. They also outlined common delivery and implementation failures and Executive Recommendations.

Enterprise Imaging is a vital part of healthcare delivery and care and often doesn’t translate well between hospital systems or between providers. Don Woodstock, VP and GM of enterprise imaging for GE Healthcare, spoke about this vision of patient centered care and the collaborative effort:

“Images are an absolutely vital component of patient-centered care.  Providing every physician and caregiver that full comprehensive view of the patient to feed into their diagnostic and treatment decisions is so important but to date has been challenged.  This collective effort with KLAS, leading providers, and the major imaging vendors is leading the way for us to realize this vision.”

One of the complexities surrounding enterprise imaging is that each healthcare system is personalized. Richard Wiggins MD, is the Director of Imaging Informatics for the University of Utah Health Science Center and directs the Society for Imaging Informatics in Medicine. I spoke with him about some of the important aspects of Imaging Informatics as a field and developing a structure for enterprise imaging. Diversity of workflow in each health care system makes a one sized fits all enterprise imaging strategy untenable. He spoke about his experience working with the University of Utah:

“The University of Utah started incorporating visible light images for Enterprise imaging (EI) into our PACS in 2012. We believe that the PACS should be the repository for all digital imaging, not the EMR. Initially there was the usual issue of changing the mindset from individual silos of data to an enterprise imaging strategy for UUHSC.  Usually institutional imaging strategies are focused on being an individual service line, the changes in governance take time and energy.

Radiology already has an established workflow for digital imaging, with the order, RIS interface (or EMR if integrated) which drives a modality worklist to allow the tech to identify the patient, then the image is created on the modality, and then the image is sent to PACS in an organized fashion with metadata that is searchable. An order is needed for this system because it provides a clear entry point and assignment of a unique ID with some contextual information, but there are other imaging workflows that require an encounter workflow running in parallel to the traditional radiology order workflow. We need this workflow to allow for mobile devices, since they are ubiquitous not only for the medical professional, but also for the patient, with authentication, security, and the ability to have an app iOS and Android that will allow for multiple high resolution images and video to be acquired in a fashion that they can easily be incorporated into PACS, possibly through the EMR, while the images or video is not stored permanently on the device.”

This collaborative patient centered event reviewed some of the challenges and successes which each stakeholder had with enterprise imaging. They also made official recommendations for leadership. These recommendations for provider leadership are a must read for healthcare executives responsible for understanding. The recommendations from the KLAS whitepaper are:

  • Providers often fail to prepare enough for the deep commitment of an enterprise imaging journey. This preparation includes the investment of resources, personnel, and understanding. Organizations need to understand, prepare and commit that these deployments often take years.
  • Providers often ask vendors for quotes without knowing what they want to accomplish as an organization. Providers need to do more work upfront and have alignment on the scope and goals. When the provider customers do not know what they want to accomplish, vendors are put into a box. How can a vendor provide a solution to customers who do not know what they want to solve?
  • The views of clinical users must be included in an enterprise imaging strategy. The number of image users/viewers dwarfs the number of image producers, and if the systems are built only by the producers, we will miss the mark.
  • The C-suite really needs to lead out with enterprise imaging, but today, enterprise imaging is regulated to a position of limited resources and alignment. That hurts the likelihood of success. The message of value to the c-suite is lacking today, and that is a challenge. Vendors and providers need to work together to educate c-suite leaders.
  • Governance is difficult to set up because it takes a group of people who are willing to govern as well as a group of people who are willing to be governed. Leaders from many departments need to be drawn into this conversation. If a provider organization does not have multiple departments and specialties involved in the governance, they don’t have a true governance model, and the governance will die on the vine.

 

Without a strong leadership structure and clearly delineated roles, providers and hospital systems will resist even helpful change. Change has to be provider driven, not IT driven. The dedication of top leaders must be paired with end user buy in from physicians. The KLAS Keystone Summit had four provider leaders that collaborated before and during the June Meeting to developme tools for measuring progress. One of the most important aspects of a hospital system improving enterprise imaging is clear standards for workflow.

Richard Wiggins, MD of the University of Utah spoke about the value of working together and creating as a group with diverse experiences:

“The ability to have input from the executives,  providers, and vendors, and thought leaders all combined allows for a powerful forum.  The integration of short talks with table discussions and then cross table pollination of ideas and the systematic placement of providers, vendors and thought leaders all intermixed at the tables led to some good discussions. Frequently there are systems, like PACS that have features that were likely very exciting and interesting to the CS and EE people who put it together, but have no actual use in the imaging clinical workflow. In addition, we have found that each site has its own idiosyncratic workflow and productivity issues, so one PACS may work great in one shop, but not in another, and this becomes more complicated with the integration PACS/SR/RIS.  A combination of the systems at one shop may work great, and the same combination may not work well at another site.”

The measurement vehicle for enterprise imaging adoption, progress and success was defined by a group of four provider leaders:

  • Rasu B. Shrestha, MD, MBA: Chief Innovation Officer, UPMC
  • Alexander J. Towbin, MD: Associate Chief, Clinical Operations and Radiology Informatics, Cincinnati Children’s Hospital Medical Center.
  • Paul G. Nagy, Ph.D: Associate Professor of Radiology, John Hopkins University.
  • Christopher J. Roth, MD: Assistant Professor of Radiology, Vice Chair Information Technology and Clinical Informatics, Director of Imaging Informatics Strategy, Duke Health.

These measures are to be administered to organizations who have in place a multi-speciality governance and one of the following:

  1. Capture including DICOM and at least one of the following: visible light images, audio, or waveforms.
  2. Storage of images in a single enterprise archive or in a federated by connected set of archives.
  3. Viewing of images through a universal viewer integrated into the EMR.

This measurement tool will be available through KLAS research and can be used for industry wide information and ongoing system management. Alexander Towbin MD shared his experiences in creating the measurement vehicle and meeting with colleagues at the Keystone Summit:

“I was impressed that so many thought leaders in imaging IT – both on the provider side and the vendor side- were able to come together to discuss enterprise imaging.  There was palpable excitement in the room that we were working on the next BIG thing in healthcare IT and that our work would allow providers of all types to better care for their patients.”

Better patient care is always the center of Keystone Summit meetings. Creating standards for deployment and adoption of imaging will benefit doctors in providing patient care and improve collaboration within and between healthcare organizations, enabling better care for each individual. Standards development by a group of experts in the field will help improve vendor and provider clarity.

Many of the participants worked for competitors or had worked together at different points in their careers. Don Woodlock shared some of his experiences with the collaboration between key stakeholders involved in Enterprise Imaging.

“I personally loved the discussion, love taking the lead from our luminary providers, and working together across vendors to come up with the ideal workflow, user experience, and image availability solutions.  From a vendor perspective this was much more of a community trying to make patient care better than a group of competitors doing their own things.  In my case this may have been helped by personally having 4 people that worked for me over the years now at 4 different vendors at the meeting with me – friendships, a common vision, and serving the patient and the physician always trump competition.  We’ll all get our chance to innovate and create our own unique variants to this common vision down the road.”

Collaborating across interest groups and with provider entities and vendors is one of the best ways to ensure that products meet provider needs and expectations. This work will allow providers to give better care and improve future enterprise imaging product creation. KLAS research facilitated the meeting of leaders to reflect on the current state of enterprise imaging and plan for the future. Moving the needle from hype and hyperbole to hope for better patient care. KLAS Research is quietly facilitating nationwide leadership from the mountains of Utah. The pioneers of healthcare will take inspiration from current experts and lead the next generation of people dedicated to do what is right.

Finding Civility in Payer Relationships: Audits, Reviews and HIM – HIM Scene

Posted on July 19, 2017 I Written By

The following is a HIM Scene guest blog post by Greg Ford, Director, Requester Relations and Receivables Administration at MRO.  This is the first blog in a three-part sponsored blog post series focused on the relationship between HIM departments and third-party payers. Each month, a different MRO expert will share insights on how to reduce payer-provider abrasion, protect information privacy and streamline the medical record release process during health plan or third-party commercial payer audits and reviews.

Civility is defined by Webster’s as courtesy and politeness. It is a mannerly act or expression between two parties. While civility in politics has waned, it appears to be on the rise in healthcare.

New opportunities for civility between payers and providers have emerged with the shift from fee-for-service to value-based reimbursement. Population health, quality payment programs and other alternative payment models (APMs) are opening the door to better collaboration and communications with payers. Optimal patient care is a mutual goal between payers and providers.

HIM professionals can also contribute to stronger payer-provider relationships. Our best opportunity to build civility with health plans and payers is during audits and reviews. HIM professionals who take the time to understand the differences will make notable strides toward a more polite and respectful healthcare experience.

Payer Audits vs. Payer Reviews: What’s the Difference?

It’s no secret to most HIM professionals that the volume of health plan medical record requests continues to increase significantly. In fact, between 2013 and 2016 the number of requests for HEDIS and Risk Adjustment reviews increased from one percent to 11 percent of the total Release of Information requests received by MRO.

The main difference between audits and reviews is the potential negative financial impact to providers. Payer audits include risk for revenue recoupment while payer reviews do not.

For example, audits conducted by third-party payers are intended to recoup funds on overpaid claims. The most common reason for a post-payment payer audit is to confirm correct coding and sequencing as billed on the claim to determine if payment was made to the provider correctly. In audits, the health plan’s intention is to recoup funds on overpaid claims.

Payer reviews do not carry financial risk to the provider. Instead, payer reviews deliver valuable insights providers can use to improve their relationships with health plans and patient populations.

The Upside of Payer Reviews

HEDIS and Risk Adjustment reviews are the most common types of payer reviews. Payer data submissions for HEDIS are due to the National Committee for Quality Assurance (NCQA) by June of every year. Medicare Risk Adjustment results are due in January and Commercial in May.

Since these payer reviews both overlap and occur simultaneously, HIM departments are deluged with medical record requests. Understanding the importance of these reviews improves communication between HIM, Release of Information staff and health plan requesters.

HEDIS Reviews

HEDIS reviews can benefit providers during contract negotiations because the HEDIS performance rankings can be used to gauge the quality and effectiveness of different health plans for potential participation with the facility.

Risk Adjustment Reviews

With these reviews, health plans are required to prove the needs of the population to CMS so they can continue to provide services for higher risk patients and pay providers for the care of this population.

In both cases, medical records are needed to provide the analysis, so HIM is involved.

HIM’s Role: Reimbursable Release of Information

In 2015, 85 percent of MRO’s audit and review requests came from third-party vendors representing health plans. Both post-payment audit and review requests are typically chargeable to the requesting party. Due to the importance of collecting medical record documentation, health plans and payers are willing to pay for records.

HIM professionals are encouraged to pursue reimbursement for payer requests. This is especially true if your HIM department is working diligently to accommodate the payer deadline for record receipt.

A provider’s Release of Information staff should be able to work directly with these requesters to ensure payment for the timely delivery of records. HIM professionals can reduce payer-provider abrasion and ultimately strengthen relationships to improve compliance. It’s the first step to increasing civility in healthcare.

Watch for our August HIM Scene post to learn more about how to secure patient privacy when sending records to payers and health plans.

About Greg Ford
In his role as Director of Requester Relations and Receivables Administration for MRO, Ford serves as a liaison between MRO’s healthcare provider clients and payers requesting large volumes of medical records for purposes of post-payment audits, as well as HEDIS and risk adjustment reviews. He oversees payer audit and review projects end-to-end, from educating and supporting clients on proper billing practices and procedural obligations, to streamlining processes that ensure timely delivery of medical documentation to the requesting payers. Prior to joining MRO, Ford worked as Director of Operations and Sales at ARC Document Solutions for 15 years. He received his B.A. from Delaware Valley University.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

New Healthcare CXO Scene Podcast

Posted on July 17, 2017 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.

We recently did the inaugural recording of our new bi-weekly Healthcare CXO Scene podcast where David Chou, Vice President and Chief Information and Digital Officer at Children’s Mercy Kansas City and John Lynn, Founder of HealthcareScene.com sit down to talk about the latest happenings in Healthcare IT. We expect CXO Scene to be a lively, but practical look at the topics that matter most to Healthcare CXOs.

Here were our 3 topics for the inaugural CXO Scene podcast:
* Petya – Ransomware and HIT Security are keeping us all up at night
* MACRA – A look at the new proposed rule
* Organizational Blindness – Not becoming desensitized to your organization’s weaknesses

You can watch the full CXO Scene video podcast on the Healthcare Scene YouTube Channel already:

Note: We’re still working on distributing CXO Scene on your favorite podcasting platform. We’ll update this post once we finally have those podcast options in place.

Resources from CXO Scene #1:
http://www.emrandhipaa.com/emr-and-hipaa/2017/07/03/the-petya-global-malware-incident-hitting-nuance-merck-and-many-others/
http://www.hospitalemrandehr.com/2017/07/03/wannacry-will-make-a-cio-cry/
http://www.emrandehr.com/2017/06/26/2018-qpp-proposed-rule-what-it-means-for-mips-quantifying-the-impact-on-specialty-practices-macra-monday/
http://www.hospitalemrandehr.com/2017/06/26/are-you-desensitized-to-whats-happening-in-your-organization/

We’ll be holding the 2nd CXO Scene podcast on July 20th at 1 PM ET (10 AM PT). You can watch the CXO Scene #2 live stream recording on YouTube where you can also chime in during the recording with your own comments and questions. Plus, we welcome your feedback on how we can make CXO Scene more valuable to you or if there are any topics you’d really like us to cover. Just let us know on our Contact Us page.

If you’d like to receive future health care CXO Scene content in your inbox, you can subscribe to future Health Care CXO Scene content here.

The EHR Dress Rehearsal: Because Practice Makes Perfect

Posted on July 14, 2017 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

Over the past year I have been leading the implementation of Epic for University Medical Center of Southern Nevada (UMC). On July 1st, we went live at our primary care and urgent care clinics. The go-live was a great success. While no go-live is flawless, we encountered minimal issues that could not be quickly resolved and user adoption was excellent despite the majority of the users using an EHR for the first time.

Today is July 8th, and I’m spending a quiet day in our command center just one week after go-live and reflecting on the factors that made this transition exceed even our optimistic projections. By Day 3, users were comfortable with basic workflows and bills were going out the door. One week into go-live, we are scaling back our on-site support and discussing closing down the command center earlier then expected. Our team universally agrees that the most significant factor in our success was a last minute addition to the methodology – what I refer to as the Workflow Dress Rehearsal.

In my experience regardless of the quality of training that is provided, the classroom is not enough to prepare the staff for what happens when the patients start to walk in the door. Learning in your actual environment helps staff to gain comfort and uncovers challenges in technology and workflow that even the best testing will not reveal.

The concept of doing a true dress rehearsal that mirrors the real experience as closely as possible is one that dates back to retail point of sale and inventory implementations that I did 20 years ago. During those projects, we would shut the doors of the operation and have the staff go through a “day in the life” on the new system – doing everything as they would do it on go-live day – using their actual workstations and logging into the production system. We decided to apply this same concept to an EHR implementation and provide a full-day experience for the entire clinic staff as the final component of their training.

The logistics of making this happen across 8 physical locations and 15 busy clinics required extensive planning and execution. We created a full-day experience starting with scripted patients who would be represented by a clipboard that moved from the front desk and to triage before being roomed. Nurses and physicians went in and out of rooms as they would with real patients, completing the appropriate steps in each room. Later as they gained more comfort, we substituted the clip boards with actual people who represented patients – making up symptoms to help the staff learn how to navigate the EMR and be prepared for what would happen with a real person answering questions, such as providing information out of order of the screens. By the end of the day, the staff was gaining confidence in the application and in themselves. They were also learning how to work as a team in an EMR environment. Most of all, they found the experience more fun, and more directly beneficial then their classroom experience.

The benefits to this process were numerous, and the key contributor to the reduction in our support needs at go-live. Here are just a few examples of the benefits it provided:

1) Security was validated – Every user had the chance to log into production and do actual work just as they would on go-live day. As a result, security issues were resolved during the rehearsal and we had less then a dozen security calls during the first week.
2) Hardware was tested – Taking the previously completed technical dress rehearsal one step further, every workstation and ancillary hardware device was used just as it would be on go-live day. The result was we identified gaps in available hardware, incorrectly mapped printers, and configuration issues that could be resolved the same day, eliminating issues during the actual go-live.
3) End to End Workflow Validation – Nurses, Front Desk, and Physicians had received training individually as each had different content to learn, but didn’t fully appreciate how it all came together. The Workflow Dress Rehearsal allowed them to understand the full life cycle of the patient in the clinic and how their documentation impacts others later in the process. Through this process, they gained an appreciation for each of their respective roles in the EHR experience.
4) Practice, Comfort, and Speed – Working on the system in their actual work environment helped them to gain confidence and get faster using the application. While our mock patient experience is not the same as having a real sick patient in front of them – it was the closest experience that we could create so when the actual patients walked in the door, they knew what to do.
5) Content – We encouraged physicians and nurses to try common orders and medications that they use on a regular basis to make sure they were available and setup properly. Inevitably, we uncovered missing or incorrect information and were able to correct them well before go-live. The result was minimal missing content at go-live as we had already worked out those issues.

The Workflow Dress Rehearsal process allowed us to uncover many of the issues that would have happened at go-live while also allowing the staff to gain comfort with the new solution in a lower-pressure environment. The result? A quiet go-live with minimal complications and a happier staff. Encounters were all being closed the same day, and staff were going home on schedule. These rehearsals also created an educational experience that was fun and motivating to the staff and was of more value to them then another day in the classroom would have been.

I believe that this process can be applied to the implementation of any software solution in any environment. Its not always easy, and we realize that it will be much more complicated to create this experience as part of our hospital go-live later this year. However, the time invested paid off as it saved us so much time in the support of the system during go-live, and created a better experience for our patients during our first week on Epic.

Consider how you can create a Workflow Dress Rehearsal experience for your ERP, EHR, and other solution deployments and you may find that it is a critical success factor to your go-live as well.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

EMR Clinical Optimization Infographic – EMR Clinical Optimization Series

Posted on July 12, 2017 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Strategy, at Galen Healthcare Solutions.


(See Full EMR Optimization Infographic)

In this infographic, Galen Healthcare Solutions provides critical information and statistics pertaining to EMR optimization including:

  • EMR Market Maturation
  • EMR Capital Investment Priorities
  • EMR as a Valuable Asset vs Required Repository
  • Clinical Optimization Goals & Benefits
  • Types of Clinical Optimization
  • Clinical Optimization Effort & ROI Matrix

EMR products get widely varying reviews. There is strong support and appreciation for EMRs in some HDOs, where the sentiment exists that the EMR is well-designed, saves time, and supports clinical workflows. That said, in other HDOs, providers using the same EMR complain that EMRs add work, decrease face time with patients and create usability issues and slowdowns. Multiple prompts and clicks in an EMR system impact patients and contribute to physician burnout. The resounding sentiment for these set of providers is that the EMRs are not designed for the way they think and work. Why then the varying response among providers to the same EMR products? Deficient implementations.

Under the pressure of moving ahead to meet the requirements of the Meaningful Use program, most EMRs were implemented using a Big Bang approach, and very rapidly. While this approach may have been the most effective to capture incentives, generic, rapid EMR implementation led to several unintended consequences, resulting in widespread user dissatisfaction. EMRs today serve more as a transactional system of record than a system of engagement. To be used to their full capacity, the different components and modules of the EMR should be evaluated against baseline metrics to harness additional capabilities including clinical decision support, analytics at the point of care, and efficiency of workflow. To realize lasting impact from the EMR, extensive post go-live enhancement and optimization is needed. Leveraging the operational data in the EMR system can support many initiatives to improve workflows, as well as clinical and financial performance. Prioritization of the levers that can be adjusted depends on the HDO’s implementation baseline and strategic goals.


(Click to see larger version of graphic)

A robust EMR optimization strategy can help HDOs realize the promised value from implementation of an EMR. EMR optimization is the driver of strategic value, and can become a sustainable competitive advantage through leadership, innovation and measurement. Success requires a disciplined, data-driven, outcomes-based approach to meet a defined set of objectives.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration, and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the EMR Clinical Optimization Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Smart Bottles, Incentives & Social Support Not Enough for Adherence

Posted on July 10, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

The Journal of the American Medical Association recently released the results of a study that looked at the effect of technology and behavioral interventions on patient outcomes following a heart attack.

The researchers found no significant difference between the medication adherence or clinical outcomes of those in the control group vs those that were given a combination of technologies and incentives.

According to one of the study’s authors, Dr. David Asch, executive director of Penn Medicine’s Center for Health Care Innovation, “It was a surprise. We went into this study thinking that it would be effective and it wasn’t”. Fellow author, Dr. Kevin Volpp echoed that same sentiment: “What we found was a little bit surprising and a little bit disappointing”.

The study was conducted at the University of Pennsylvania Health System (UPHS) over a span of 12 months. There were 1,509 patients involved in the study; all hospital inpatients who had experienced a heart attack and had been hospitalized between 1 and 180 days. The average age of the study group was 61 and they were all insured with five carriers who had Medicare fee-for-service arrangements with UPHS. All of the patients had been prescribed at least two daily medications (statin, aspirin, beta-blocker or antiplatelet).

The control group of 506 patients was given the standard post-discharge medication instructions and treatment. The remaining 1,003 patients were given additional tools to help them post-discharge:

  • A smart pill bottle that tracked whether or not it had been opened at the prescribed intervals
  • Participation in a daily lottery with a 1 in 5 chance of winning $5 and a 1 in 100 chance of winning $50 each day medications were taken as prescribed
  • An option to enlist a friend or family member to receive notifications if the participant failed to use the smart pill bottle twice in any 3-day span
  • Access to social work resources
  • A hospital-based advisor to answer questions and reinforce medication adherence over the phone

On the surface, the failure of this level of support and intervention is disheartening for anyone developing medication adherence technology or involved with helping a loved one recover from being hospitalized. However, if you listen to the post-study podcast or spend time looking at how the incentives/technology was administered to the study group, important clues emerge as to why this failure may not mean abandoning hope for technology-based interventions.

First, only 878 of the 1,003 patients activated their smart pill-bottles and only 70% of that same group fully participated in the incentives and technology. This indicates that the lack of adherence may not have anything to do with technology when its working, but rather that there is a challenge to get patients using that technology in the first place.

Second, the fear of another heart attack may have been enough of an incentive to keep patients on their medication regimens. Put another way, perhaps the control group already had sufficient incentive to follow their prescriptions and thus technology would have little impact.

Third, and perhaps most significantly, an average of 41 days elapsed between the time the patients were discharged from the hospital and the time they were activated on the incentive/intervention program. This delay was attributed to the delay in the insurance process. According to Dr. Volpp:

If we had been able to engage these patients earlier, for example. If this had been a hospital-based intervention and this could have started at the time of discharge [rather than weeks later], then we would have had a greater opportunity to influence these patients and change the course of their care

I personally found this last point by Dr. Volpp fascinating. This study may have inadvertently shown that the timeliness of implementing post-discharge behavior and technology incentives matters as much as the types being implemented. 41 days after discharge is a long time – almost a month and a half.

Consider this example. Say you get caught for speeding and as part of the ticket-writing process the police officer activated a reminder system in your car that (a) warned you when you were 5 miles over the limit and (b) sent a message to your significant other whenever you receive two such warnings in the same day. From personal experience I can tell you that the week after I got a speeding ticket, I followed every posted speed limit. Why? Because the trauma of getting caught was still fresh in my mind.

Now imagine the same scenario but instead of immediately activating the warning system it took until 41 days after getting your ticket. By the time the system was in place you would have already fallen back into old habits and assured yourself that you were “fine” driving the way you were.

It would be interesting to see if analysis of this study’s data revealed a correlation between the length of time before incentive implementation and adherence. Even if it doesn’t, this study holds a cautionary tale for anyone in HealthIT – timeliness of implementation may matter as much as your solution itself.

Hospital Execs Underestimate QPP Impact

Posted on July 7, 2017 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.

A new survey by Nuance Communications suggests that hospital finance leaders aren’t prepared to meet the demands of MACRA’s Merit-Based Incentive Payment System (MIPS), and may not understand the extent to which MIPS could impact their bottom line. Worse, survey results suggest that many of those who were convinced they knew what was involved in meeting program demands were dead wrong.

The survey found that many hospital finance leaders weren’t aware that if they don’t participate in the MIPS Quality Payment Program (QPP), they could see a 4% reduction in Medicare reimbursements by 2019.

Not only that, those who were aware of the program didn’t have a great grasp of the details. More than 75% respondents that claimed to be somewhat or very confident about their understanding of QPP got the 4% at-risk number wrong. Meanwhile, 60% of respondents either underestimated the percent of revenue at risk or simply did not know what the number was.

In addition, a significant number of respondents weren’t aware of key QPP reporting requirements. For example, just 35% of finance respondents that felt confident they understood QPP requirements actually knew that they had to submit 90 day of quality data to participate. Meanwhile, 50% either underestimated or did not know how many days of data they needed to provide.

On a broader level, as Nuance noted, the issue is that hospitals aren’t ready to meet QPP demands even if they do know what’s at stake. Too many aren’t prepared to capture complete clinical documentation, develop business processes to support this data capture and raise provider awareness of these issues. In other words, not only are finance leaders unaware of some key QPP requirements, they may not have the infrastructure to meet them.

This is a big deal. Not only will their organizations lose money if they don’t meet QPP requirements, but they’ll miss out on a 5% positive Medicare payment adjustment if they play by the rules.

Lest the respondents sound careless, let’s do a reality check here. Without a doubt, the transition into the world of MIPS isn’t a simple one. Hospitals and medical practices will have to meet deadlines and present quality data in new ways. That would be a hassle in any event, but it’s particularly difficult given how many other quality data reporting requirements they must meet.

That being said, I’d argue that even if they’ve gotten a slow start, hospitals have enough time to meet the basic requirements of QPP compliance. For example, turning over 90 days of quality data by March of next year shouldn’t be a gigantic stretch in contrast to, say, submitting a year’s worth of data under advanced Meaningful Use models. Not to mention the Pick Your Pace option of only 1 measure which avoids all penalties.

Clearly, having the right health IT tools will be important to this process. (Not surprisingly, Nuance is picking its own reporting tools as part of the mix.) But I’m struck by the notion that organizations can’t live on technology alone in this case. As with many problems in healthcare, tech solutions aren’t worth much if the business doesn’t have the right processes in place. Let’s see if finance executives know at least that much.

A Look at HIM and the Impact of ICD-10 – HIM Scene

Posted on July 6, 2017 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.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

After all of the noise that was made around the move to ICD-10, I’m now talking to more and more people about what impact the switch to ICD-10 has had on their organizations.  The reality for many organizations is they don’t really know what the new normal is under ICD-10.  So, they’ve had a hard time evaluating if their ICD-10 work has been going well or not.

With this in mind, I was excited to talk with Eileen Dano Tkacik, Director of Operations & Information Technology at AVIANCE Suite Inc, about a survey they did that looked at ICD-10 accuracy and productivity.  Learn more about the results of this survey in the video below and review the full survey results. Also, check out their 2017 ICD-10 coding contest which includes $5000 in prizes and begins July 17, 2017.

Eileen is so right that the transition to ICD-10 definitely sucked up people’s time and the QA process suffered. I hope now that ICD-10 has been around for almost 2 years that more efforts will go back to QA. We’re going to need to given the ICD-10 accuracy results from their survey.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

WannaCry Will Make a CIO Cry

Posted on July 3, 2017 I Written By

David Chou is the Vice President / Chief Information & Digital Officer for Children’s Mercy Kansas City. Children’s Mercy is the only free-standing children's hospital between St. Louis and Denver and provide comprehensive care for patients from birth to 21. They are consistently ranked among the leading children's hospitals in the nation and were the first hospital in Missouri or Kansas to earn the prestigious Magnet designation for excellence in patient care from the American Nurses Credentialing Center Prior to Children’s Mercy David held the CIO position at University of Mississippi Medical Center, the state’s only academic health science center. David also served as senior director of IT operations at Cleveland Clinic Abu Dhabi and CIO at AHMC Healthcare in California. His work has been recognized by several publications, and he has been interviewed by a number of media outlets. David is also one of the most mentioned CIOs on social media, and is an active member of both CHIME and HIMSS. Subscribe to David's latest CXO Scene posts here and follow me at Twitter Facebook.

If you like CXO scene, you can subscribe to future Health Care CXO Scene posts here or read through the CXO Scene archive. Also, join us for the live recording of our first ever CXO Scene podcast on Thursday, 7/6/17 at 1 PM ET (10 AM PT) where we’ll be talking Petya, MACRA, and Organizational Blindness.

As continuous research is done to create better defenses against malicious computer attacks, cybercriminals have also come up with more ways to get cash into their pockets as quickly as possible.  In the past years, a new breed of computer virus has started infecting computers and mobile devices. These viruses are unlike the previous malware as they lock down the computer including the precious files in it and only unlocks it when the user has paid the demanded amount. WananCry, Cryptolocker, Cryptowall, and TeslaCrypt are the new computer viruses that belong to a family of infections known as ransomware.

Cryptolocker is the earliest version of ransomware that started infecting computers in 2013. It easily infects computers through phishing links usually found in email attachments and through computer downloads.  Once a computer has been infected with ransomware, all the computer files are held as ‘hostage’ of the cybercriminals. In some cases, ads of pornographic websites appear on the screen each time a user clicks. These cybercriminals demand payment in order to unlock the files and restore the computer to its previous state.  As an added pressure, these criminals threaten users to delete all files if certain demands are not met within a specified period (usually within 24 hours). The desperate user usually doesn’t have any choice but to give in.

Ransomware Threat in Hospitals

Threats from ransomware has been widespread and it has affected computers of hospitals. In a Reuters report, it stated that a study from Health Information Trust Alliance on 30 mid-sized U.S. hospitals revealed that over half of these establishments (52%) were infected with the malicious software.  Recently we are starting to see countries get shutdown due these attacks while a global voice dictation vendor was shut down and this interfered with the doctor’s ability to voice dictate their notes.

How Companies Can Prevent Ransomware Attacks

Ransomware attacks are serious threats in healthcare. When computers in hospitals stop functioning, there will be delay in information access and flow and may compromise the safety of the patients. When there is ransomware attack, caregivers will have no access to patients’ data which can be crucial for those who are unconscious. It can also result in delayed or undelivered lab requests and prescriptions. And since there are medical devices that rely on computers to be operated, they can be inoperable all throughout the period the computer is held ‘hostage.’

With more medical facilities relying heavily on technology for its operation, it’s crucial to keep the computers malware-free. The following are some tips on how you can prevent these ransomware attacks:

  • Back up your data
    One of the best things companies can do to protect themselves from ransomware is to regularly do backups. Regularly backing up your files can give you a peace of mind even if a malicious attack happens. Since ransomware can also encrypt files on mapped drives, it’s important to have a backup regimen on external drives or backup services that are not assigned a drive letter. The one key element that is missing during the backup process is testing the backup to make sure that it is working. Do not miss the testing step.
  • Make file extensions visible
    In many cases, ransomware arrives as a file with a .PDF.EXE extension. By adjusting the settings to make these file extensions visible, you can easily spot these suspicious files. It also helps to filter email files with .EXE extension. Instead of exchanging executable files, you may opt for zip files instead.
  • Take advantage of a ransomware prevention kit
    The rise of ransomware and its threats have paved way for cybersecurity companies to come up with ransomware prevention kits. These kits protect the computer by disabling files that are run from the App Data, Local App Data folders, and executable files run from Temp directory.
  • Disable the RDP
    The RDP or Remote Desktop Protocol is a Windows utility that enables others to access your desktop remotely. If there is no practical use of RDP in your daily operations, then it’s best to disable it as it’s often used by ransomware to access targeted machines.
  • Update your software regularly
    Running outdated software makes your computer more vulnerable to ransomware attacks. So, make sure to regularly update your software.
  • Install a reliable anti-malware software and firewall
    This is applicable to malware in general. Having both the anti-malware software and firewall creates a double-wall protection against these malicious attacks. If some gets past the software, the firewall serves as the second level of protection from the malware.
  • When ransomware attack is suspected, disconnect immediately from the network
    While this isn’t a foolproof solution, disconnecting immediately from the network or unplugging from the WiFi as soon as ransomware file is suspected can reduce the damage caused by the malware. It may take some time to recover some files but doing this can sometimes cut back the damage.

Ransomware poses a serious threat not just to the security of hospital files but as well to the patients’ safety. Hence, companies, especially healthcare facilities, must not take this malware issue lightly.  Your biggest security risk exposure is internal so make the effort to educate your internal workforce as a priority as well.

If you’d like to receive future health care C-Level executive posts by David in your inbox, you can subscribe to future Health Care CXO Scene posts here.