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Rumor Control: These are the Facts

Posted on January 16, 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.

Why is it that one of the largest challenges on any project is miscommunication and out of control rumors? While many projects need and would benefit from more communication, even with the best of communication plans, project teams can spend more time dispelling false information than proactively communicating.

I believe in strong communication plans for EHR and ERP projects that include a wide range of communication including town halls, newsletters, emails, signage, internet sites, and other methods of sharing correct information. But on every project, no matter how much we communicate, certain hospital staff will find other sources of information.

I can see the rumor coming when an email or conversation starts with “I heard that…” or “Is it true that…”. These are telltale signs that I am about to hear a rumor. Rumors can range from minor details to far-reaching implications such as a perceived change in project scope or even the live date. While most rumors are just annoyances, responding to them and controlling them can be a significant strain on the project team’s time.

I believe that hospitals have a unique challenge in that proactive communication is more challenging than in many traditional businesses because it is common for a large portion of the staff, including nurses and physicians, to rarely check email. As a result, they are often in a position where “hallway conversation” is how they first hear information and are more likely to give it credibility.

While I admit that I have personally never been able to fully eliminate the rumor challenge, I’d like to share several ideas about what I have seen as an effective way to keep the rumor mill under control:

1) Establish a clear Source of Truth – From the very beginning of the project, communicate to every possible audience how decision and communications will be distributed and who they should contact with questions and information. If it doesn’t come from one of the accepted Sources of Truth, its not true. When I lead a project, I prefer to be the Source of Truth – if it doesn’t come from me verbally or in writing, it isn’t true.

2) Encourage questions and respond to all of them timely – When I am running a project, my motto is “Ask me anything, anytime”. At times, I will get dozens or even hundreds of questions a day through meetings, phone calls, texts, and emails. I respond to every question, providing the truth if I have it, or getting them to the person who can provide the truth. Rumors often start because staff members are not getting answers or don’t feel their questions are welcomed. How do I respond to so many requests? I do it immediately so they can’t accumulate – which also helps inspire confidence and a feeling that they can ask rather than assume.

3) Town Halls – I strongly believe that a change management and communication strategy must include town halls. During town halls, project teams should provide an overview of what is occurring that is relevant to the staff, do occasional software demonstrations, and most importantly – field questions. Creating those proactive communication channels is a powerful way to avoid people creating their own truths.

4) Provide the complete truth – Sometimes the answer to a question is not known because it has not been determined, or has not been considered. Sometimes it is not what the person wants to hear. Regardless, provide the truth – and the complete truth. There is nothing wrong with saying that you don’t know – but can find out. Or that a decision has not been made, but now that they have raised the concern we will make it and get back to them. Responding immediately doesn’t always mean providing an answer immediately, as long as the follow-up is done once the answer is available.

5) Communicate Everywhere – A communication plan must be extensive and include many different points of contact. Intranet sites can look impressive and have lots of great information on them – but usually only a small percentage of the staff will check them. Consideration must be given as to how to communicate with contracted employees, physicians, and traveling nurses. This is particularly challenging during an EHR roll-out when all of these parties must be enrolled in training classes and kept up-to-date on the go-live. Find and use every possible communication challenge. There are always questions about how much communication is too much – but they apply to the volume of communication you push through a particular communication channel – not the number of different communication channels you use.

Finally, accept that no matter what you do, rumors will form and will need to be dispelled. Its part of project management and change management that always had existed, and always will. Properly controlled, the rumors can be a minor distraction at worst – entertainment at best.

Please share any ideas you have found to be successful in keeping rumors under control.

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.

McKesson and Infor Go-To-Market Partnership – What Happens Now?

Posted on January 9, 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.

A couple weeks ago, McKesson and Infor announced a partnership that will have McKesson EIS (Enterprise Information Solutions) offering Infor Cloudsuite as their cloud-based ERP (Enterprise Resource Planning) solution for human resources, supply chain, and financials. What does each party have to gain from this partnership and what does this mean for existing customers of McKesson ERP solutions?

Infor continues to be the dominant player in the ERP space for healthcare providers. Its healthcare applications, previously known as Lawson (and probably always known as Lawson to many of us), have the largest market share with the majority of larger hospitals and healthcare systems. Its closest competitor in the past, Peoplesoft, is now owned by Oracle which is focused on developing and promoting its Fusion product and has released the final version of the Peoplesoft product. Workday, the cloud-only solution that is publicly traded and making significant strives in many industries, has won deals in human resources and financials implementations but lacks a supply chain solution, critical to any integrated ERP deployment. SAP, the largest ERP provider in the world, has a strong presence in healthcare manufacturers but does not provide a supply chain solution well suited for the unique needs of healthcare providers, and therefore has a very small market share.

McKesson, once a strong player in this space, has faded over the years in ERP as they have with EHR solutions. The majority of the McKesson ERP customer base, using the products commonly referred to as Pathways, have been long-time legacy customers. Pathways has not been kept up with modern ERP needs, and it has been many years since I have seen a hospital consider Pathways as a potential solution, but rather it is typically the solution being replaced.

Infor has invested significantly in creating a cloud-based solution, referred to as CloudSuite. However, the existing healthcare customer base typically has an on-premise installation and therefore cloud adoption has been focused on new customers as well as those that are specifically looking to transition away from on-premise. McKesson has not had a cloud offering, therefore it would make sense for them to partner with someone to offer it as an alternative to Pathways.

Infor will gain access to the Mckesson customer base, many of whom are likely considering leaving Pathways for other solutions anyway. In addition, Infor will be able to provide Mckesson’s Strategic Sourcing solution for their customers.

However, it is unclear what that means for Pathways. While McKesson press releases state that CloudSuite is an alternative to Pathways, one has to wonder why Infor would want to expose their solution to someone who is actively selling a competitive solution, and why McKesson would continue to invest in Pathways when it has access to a much more mature and robust solution as a go-forward path for its Pathways customers.

Therefore while it is likely that McKesson will keep Pathways supported and up-to-date with regulatory improvements for the time being, it seems very unlikely that they would continue to enhance it – and inevitable that it will eventually be sunset in favor of transitioning those customers to Infor Cloudsuite. If history is indeed an appropriate predictor of the future, consider that McKesson announced its BetterHealth 2020 plan – in which they announced a focus on Paragon as their EHR but continued support of the older Horizon EHR product. Shortly after that they went back on that commitment and announced they would sunset Horizon in 2018.

Meaningful Use has led to a focus of resources on Electronic Health Records implementations which have led many customers to hold onto their older ERP solutions past their useful life. I suspect that the next two years will see a re-focus to ERP solutions with customers with more modern solutions focusing on upgrades and new feature deployment while customers with older solutions making a change.

Those customers who stayed on Horizon for too long are currently in a rush to implement replacements before the March 2018 sunset date.Customers on Pathways products should likely start the conversation now about their long-term ERP plans and consider if they want to get ahead of any sunset announcement.

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.

Indecision in Upgrading Infrastructure – Blamed on Meaningful Use

Posted on January 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.

In a conversation I had with Steve Prather, CEO at Dizzion, he made a really interesting observation about meaningful use causing delays in upgrading infrastructure at many healthcare organizations. It’s not hard to see how spending millions, hundreds of millions or even billions of dollars on EHR and related services in order to meet the meaningful use requirements could cause budget cuts in other areas like upgrading infrastructure.

Of course, the opposite can be true as well. I know when we first implemented an EHR, a good portion of the EHR budget was to upgrade some of the infrastructure needed to support the new software. I’m sure that probably means that some infrastructure benefited from the EHR upgrade and meaningful use, but I’m sure some infrastructure spending also got cut or delayed.

In my conversation with Steve he went on to observe that much of the hardware in healthcare organizations had gotten so old, indecision and delays were no longer a choice. Having talked to many CIOs, they feel this in their organizations. While many CIOs want to move on to more strategic efforts, there’s still a big part of any CIOs job that requires them to maintain and upgrade their IT infrastructure. Although, it seems that many of them are looking to push this responsibility off to a kind of IT COO position.

I’ll be interested to watch and see how these organizations approach their infrastructure upgrades. Will most continue to do all the work in house or will they start to outsource this essentially commodity task to an outside company? There’s a really interesting case for why organizations should outsource this work as opposed to continuing to do it in house. All of this points back to the CIO becoming a vendor management organization.

Has your infrastructure upgrades been delayed by meaningful use? Is your organization looking to finally upgrade or is MACRA going to delay things further?

Top Hospital EMR and EHR Blog Posts for 2016

Posted on December 30, 2016 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.

It’s that time of year when you look back at the past year and think about what you’ve accomplished. At Hospital EMR and EHR, we like to look back at the stats for the top blog posts we’ve published. It’s always interesting to see what’s resonated with people. Plus, it’s interesting to see how things have changed since we’ve posted on a topic. So, without further ado, here’s a look at the top blog posts in 2016 for Hospital EMR and EHR along with some commentary on each.

1. Why Is It So Hard to Become a Certified Epic consultant? – This is by far the top post generating 4-10 times as much traffic as the posts below.  It’s also why I’ve wanted to make the time to do a whole series of blog posts on Epic Certification and along with it Cerner Certification, MEDITECH Certification, etc.  When you make something like Epic Certification hard to get, people want it even more.  It’s just too bad they’re so closed since it drives up the prices for Epic consultants and thus the cost to implement Epic.  Certainly, we’ll be writing about this more in the future.

2. NYC Hospitals Face Massive Problems With Epic Install – This was a big story back in 2013 and still is today.  We should probably look at doing a follow up story to see what’s happening at NYC hospitals a few years after this story hit.

3. Epic Install Triggers Loss At MD Anderson – No surprise, people love to read about challenges in EHR implementations.  We saw quite a few of these from Epic in 2016 and people were interested in what went wrong.  The problem from the outside is it’s really hard to know who is to blame for the failure.  What has become clear over this year is that many healthcare organizations are blaming Epic for their revenue issues.

4. Hospital EMR and EHR Vendors – This page needs some work, but no doubt many people want to know who the big players in the hospital EMR and EHR market are.  This is true if they’re selecting a new EHR, switching EHR or looking to partner with EHR companies.

5. Why Do People Dislike Epic So Much? Let Me Count The Ways – This post is 5.5 years old and still going strong.  I imagine many people are still counting the ways they hate Epic.  I think I read that Epic finally hired a PR person.  Maybe that new hire can work on this.

6. A Study on the Impact of ICD-10 on Coding and Revenue Cycle – This was a good study that illustrated the impact of ICD-10.  It also gave some good words of caution about the impact of ICD-10 going forward.

7. Epic EMR Costs Drag Down Finances At Brigham and Women’s – Another example of the cost to implement Epic.  I knew this was a hot topic this year and the stats show that people were interested in the details.

8. The Argument for Meditech – I can’t believe this post is 5 years old already, but it still rings true today.  MEDITECH is not without its challenges, but it also doesn’t get the credit it deserves either.  I had a chance to visit their offices near Boston this year.  I’ll be really interested to see where MEDITECH takes their product next.  Many people have counted them out, but I certainly haven’t.

9. Can HIM Professionals Become Clinical Documentation Improvement Specialists? – We’ve published a lot about the changing world of HIM thanks to our new series of HIM Scene blog posts.  This post was a great example of how there are a lot of new opportunities for HIM professionals that are willing to embrace change and adapt as needed.

10. Great Healthcare IT Leaders – This is a great list of healthcare IT leaders as shared by David Chou.  David made the case for meeting up with them at HIMSS 2016, but the nice part is thanks to social media you can follow most of them year round.

An honorable mention to the 11th post on the list which talks about Dr. Rasu Shrestha helping an injured passenger on his way to HIMSS 2016.  Love stories like this.  Did you have a favorite post on Hospital EMR and EHR?  Was there an idea or concept you read on Hospital EMR and EHR?  We’d love to hear about it in the comments.

What’s the Role of a Hospital CIO in Business Model Transformation?

Posted on December 23, 2016 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 don’t think anyone would argue that the healthcare business model is changing. There are a number of dynamics at play that are requiring every healthcare organization to evaluate what their business will look like in the future. Some examples of these changes include:

  • Patients with High Deductible Plans
  • Accountable Care Organizations
  • Other Risk Based Care Models
  • Value Based Reimbursement
  • Telemedicine
  • Chatbots and AI Assistants
  • Health Sensors
  • Retail Clinics

I could go on and on, but I think that highlights some of the major ones. What’s interesting about these trends is that it requires a change in business model. However, pretty much every one of these changes in business models requires the use of technology to facilitate the change. Some of them are impossible to do without technology.

If technology is going to play an important role in healthcare’s business transformation, what role should the hospital CIO play in the organization?

What’s shocking to me is how many CIOs don’t want any part in the business transformation part of healthcare. At CHIME I heard one CIO say, “We don’t want anything to do with MACRA. We just want to supply them the systems and let them figure it out.” I’m not sure the “them” he was referring to, but I think this approach is a big mistake. We’re all in this together and have to act as a team to get it done in the most efficient and effective way possible.

I was impressed by another hospital CIO who said basically the opposite. She said, “Oh no, we’re going to be in charge of MACRA and MIPS. I don’t want them taking over MACRA and MIPS, because if they’re in charge of it they’ll select a bunch of items for which we’re not capable of doing.”

Once again, this points to the need for collaboration to occur. You need the clinical insight together with the technical and software based insight in order to make the best decisions possible.

More importantly is I think it’s a big mistake for the hospital CIO to not be part of the business transformation. If the hospital CIO doesn’t take part in business transformation, then IT essentially becomes a commodity. The worst thing you can be in an organization is a commodity. When you’re a commodity they squeeze the budget out of you and you’re seen as non-essential or non-critical to an organization. What CIO wants to be in that type of organization?

I do see most progressive healthcare IT leaders outsourcing much of the “commodity IT” to other third party providers so they can focus their efforts on becoming a more essential part of their organization’s business transformation. The problem is that this requires a different set of skills and interests than what was essentially an operational role managing servers, desktop, and the network.

What type of CIO are you? What type of CIO does your organization need or want?

We’re Great at Creating Policies and Procedures, but Awful At Removing Them

Posted on December 21, 2016 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.

Ever since I heard Tony Scott, the US CIO, talk about his goal of taking stuff off the federal books, I’ve been chewing on that concept. There’s little doubt that the federal government is really great at creating laws and regulations, but they’re really poor at getting rid of old laws and regulations. It’s hard to blame them. I don’t really know anyone that enjoys what amounts to “spring cleaning.” Needless to say, the US government could certainly be part of an episode (or even multiple seasons) of Hoarders the way they keep laws and regulations sitting around gathering dust.

While it’s easy to slam the government for their hoarding tendencies, I don’t think healthcare is immune to this problem either. Sometimes we’re required to “hoard” patient medical records by law. That’s not a bad thing since it’s good to comply with the law. However, it is a bad thing when we no longer are required to retain the data and the data in this old data has limited value.

In fact, much of that old outdated data could pose a risk to patients. We all know that many of our first IT systems were implemented quickly and therefore resulted in poorly collected data. Keeping around incorrect data can lead to disastrous consequences. It might be time for some spring cleaning (yes, it can be done in Winter too).

What’s more troublesome than this is many of the policies and procedures that exist in most hospital systems. Much like the government these policies and procedures get put in place, but we rarely go back and take them off the books. My least favorite thing to hear in a hospital when I ask why they do something a certain way is “We’ve always done it this way.”

If we don’t know why we’re doing something, that’s the perfect opportunity to ask the question and figure out the answer. Many times there is a good answer and a good reason for the policy and procedure. However, more often than most people realize, we’re just doing something because we’ve always done it that way and not because it’s the best way to do something.

I love Tony Scott’s effort to purge things from the books that are outdated, useless, or even harmful. Every hospital organization I’ve seen could benefit from this approach as well. Their organization would benefit, their employees would benefit, and ultimately patients would benefit as well.

When was the last time you got rid of a policy or procedure?

Easing The Transition To Big Data

Posted on December 16, 2016 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.

Tapping the capabilities of big data has become increasingly important for healthcare organizations in recent years. But as HIT expert Adheet Gogate notes, the transition is not an easy one, forcing these organizations to migrate from legacy data management systems to new systems designed specifically for use with new types of data.

Gogate, who serves as vice president of consulting at Citius Tech, rightly points out that even when hospitals and health systems spend big bucks on new technology, they may not see any concrete benefits. But if they move through the big data rollout process correctly, their efforts are more likely to bear fruit, he suggests. And he offers four steps organizations can take to ease this transition. They include:

  • Have the right mindset:  Historically, many healthcare leaders came up through the business in environments where retrieving patient data was difficult and prone to delays, so their expectations may be low. But if they hope to lead successful big data efforts, they need to embrace the new data-rich environment, understand big data’s potential and ask insightful questions. This will help to create a data-oriented culture in their organization, Gogate writes.
  • Learn from other industries: Bear in mind that other industries have already grappled with big data models, and that many have seen significant successes already. Healthcare leaders should learn from these industries, which include civil aviation, retail and logistics, and consider adopting their approaches. In some cases, they might want to consider bringing an executive from one of these industries on board at a leadership level, Gogate suggests.
  • Employ the skills of data scientists: To tame the floods of data coming into their organization, healthcare leaders should actively recruit data scientists, whose job it is to translate the requirements of the methods, approaches and processes for developing analytics which will answer their business questions.  Once they hire such scientists, leaders should be sure that they have the active support of frontline staffers and operations leaders to make sure the analyses they provide are useful to the team, Gogate recommends.
  • Think like a startup: It helps when leaders adopt an entrepreneurial mindset toward big data rollouts. These efforts should be led by senior leaders comfortable with this space, who let key players act as their own enterprise first and invest in building critical mass in data science. Then, assign a group of core team members and frontline managers to areas where analytics capabilities are most needed. Rotate these teams across the organization to wherever business problems reside, and let them generate valuable improvement insights. Over time, these insights will help the whole organization improve its big data capabilities, Gogash says.

Of course, taking an agile, entrepreneurial approach to big data will only work if it has widespread support, from the C-suite on down. Also, healthcare organizations will face some concrete barriers in building out big data capabilities, such as recruiting the right data scientists and identifying and paying for the right next-gen technology. Other issues include falling reimbursements and the need to personalize care, according to healthcare CIO David Chou.

But assuming these other challenges are met, embracing big data with a willing-to-learn attitude is more likely to work than treating it as just another development project. And the more you learn, the more successful you’ll be in the future.

ReadsforRads is Working to Democratize Radiology

Posted on December 14, 2016 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.

At the RSNA 2016 conference, Healthcare Scene learned about a new platform for radiologists that’s looking to democratize radiology. This new platform is called ReadsforRads. In our conversation with Dr. Phillip A. Templeton, Chief Medical Officer at ReadsforRads, we learned more about ReadsforRads and their mission to democratize radiology. I love the approach they’re taking to make radiology better for both radiology departments and imaging centers. Plus, doing so will ultimate benefit the patients the most.

To learn more about ReadsforRads and the way they benefit the health system, radiologists, and patients, check out our video interview with Dr. Templeton below:

No doubt ReadsforRads has some challenges as they work to scale their platform, but I was impressed by the progress they’ve already made. Their efforts on managing radiologists credentialing was quite interesting. I mentioned the ReadsforRads platform to my radiologist neighbor and his wife instantly said “Yes! Moonlight so we can buy a house.”

While the opportunity for a radiologist to make some extra cash moonlighting is interesting, I was extremely excited about ReadsforRads ability to get the right radiologist reading the radiology image. There are a lot of situations where the radiology image needs to be read by a true expert and that person might be on vacation or small institutions might not be able to afford that type of radiologist expertise in house. ReadsforRads can cover these gaps and make sure the read is done by the most qualified person. That can really benefit all of healthcare.

EMR Replacement & Migration Perspective: Tim Schoener, VP/CIO, UPMC Susquehanna

Posted on December 8, 2016 I Written By

header-chime
In the midst of a merger with a major Pennsylvania healthcare organization, Tim Schoener is wholly focused on EHR transition. He outlines Susquennaha’s plan for each aspect of transition, offering innovative and unique approaches to each. In addition, Schoener provides cogent insights regarding the intricacies involved with a multi-database system, the expenses associated with archival solutions, and the challenges associated with migrating records. This interview touches on many of the considerations necessary for a successful EHR transition as Schoener discusses minimizing surprises during a transition; why migrating a year’s worth of results is optimal; and how their document management system fulfills archival needs.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Looking for additional EMR replacement perspectives & lessons learned? View a recent panel where HCO leaders discussed their experiences with EHR transition, data migration & archival.

KEY INSIGHTS

Absolutely, we have problem lists that can’t be reconciled; there’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all.

We’re being told, if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.

Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

Let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move.

It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare.

CHIME is a great way to challenge yourself as a CIO and in your leadership. It pushes me in my leadership skills and helps to focus me back to what’s critical in the industry.
tim-schoener
Campbell: Tell me a little about yourself and your organization’s initiatives

Schoener: I’m Tim Schoener, the VP/CIO of, originally Susquehanna Health, which, as of October 1st, is now a part of the University of Pittsburgh Medical Center (UPMC) and re-named to UPMC Susquehanna. We’re located in central Pennsylvania, four hours away from Pittsburgh.

A major IT initiative for us is that we’re swapping out our EMR over the next couple of years. We are currently a Cerner Soarian customer. In fact, we were the initial Soarian beta site for Financials and second for Clinicals. We determined we eventually need to migrate to something else – that’s an Epic or Cerner decision for us at this point. UPMC’s enterprise model is Cerner and Epic, Cerner on the acute care side and Epic on the ambulatory side. As of this writing, we’ve made the decision to migrate to the UPMC blended model. Over the past nine months we’ve been focused on an EMR governance process, trying to get our team aligned on the journey that we’re about to take and by late next year we will likely be starting an implementation.

We currently leverage NextGen on the Ambulatory side, with approximately 300 providers that use that software product. We’re a four hospital system: two of which are critical access, one which is predominately outpatient, and the other a predominately inpatient facility. We were about a $600MM organization prior to our UPMC acquisition.

Campbell: Related to your current implementation, tell me a little bit about your data governance strategy and dictionary mapping that may occur between NextGen and Soarian.

Schoener: We definitely have a lot of interfaces, a lot of integration between the two core systems. From an integration perspective, we have context sharing, so physicians can contextually launch and interoperate from NextGen to Soarian, and vice-versa. We do pass some data back and forth—allergies and meds can be shared through a reconciliation process—but we certainly aren’t integrated. It’s the state of healthcare.

Campbell: That’s why you anticipate moving to a single platform, single database?

Schoener: Absolutely, we have problem lists that are not reconciled. There’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all. Meds and allergies are pretty much all we get in terms of outpatient to inpatient clinical data sharing today.

Campbell: Do you leverage an archival solution for any legacy data?

Schoener: We use EMC and have large data storage with them. I wouldn’t call it archival, but we have an electronic document management system – Soarian’s eHIM.

There’s a huge amount of data out there and I know you have some questions related to our thinking with respect to migration. I have some thoughts around that related to levering our document management system versus archiving into a separate system. I’m pretty certain we would be thinking ‘why not use eHIM as our archival process, and just put other data in that repository as necessary?’ For results data, for instance, what we’re thinking of migrating, or what our providers are requesting, is a years’ worth of results. ‘Give me a year’s worth of results, and then make sure everything else is available in eHIM.’

Campbell: As such, your default is to migrate a year’s worth of data?

Schoener: Yes. We would presume that the provider is probably not going to refer back to lab results or radiology results beyond a year, other than for health maintenance kind of things such as mammograms, pap smears, PSAs; those types of things.

Campbell: What expectations have you set with physicians when they go live on the new EMR?

Schoener: From an ambulatory perspective, we’re thinking that it would be nice to have the most recent note from the EMR available. All of the other notes for that patient would be consolidated into one note via a single pdf attachment. The note that’s the separate most recent note, we envision that being in a folder for that particular date. That note would reside in the appropriate folder location just like it would in the current EMR. Our goal is to bring the clinical data forward to the new EMR, taking all the other notes and placing them in a “previous notes” folder.

Campbell: Can you elaborate on your consideration of PAMI (Problems, Allergies, Medications, Immunizations) as part of the data migration?

Schoener: Sure. The disaster scenario would be the physician sits down with patient for first time with new EMR, and there are no meds, no allergies, and no problems! They’ll spend 25 minutes just gathering information, that would not work.

We’re thinking of deploying a group of nurses to assist with the data conversion and migration process. Our intent is to have them to retrieve CCDAs to populate those things I mentioned by consuming them right into the medical record, based on the physicians’ input. We expect there to be a reconciliation process to clean-up potential duplicates. Or, to be candid, we’ve talked about automating the CCDA process, consuming discrete clinical items from it by writing scripts and importing into the new EMR. I think we’re leaning towards having some staff involved in the process though.

Now if you share the same database between your acute and ambulatory EMR, and the patient was in ambulatory setting but now they’ve been admitted, it’s the same database: the meds are there, the problems are there, the allergies are there; it’s beautiful, right? If they weren’t, then the admission nurse is going to have to follow the same CCDA consume process that the ambulatory nurse followed. Or you start from scratch. On the acute side, we start from scratch a lot. Patients come in and we basically just start asking questions in the ER or in an acute care setting. We start asking for their meds, allergies, or problems – whatever they may have available.

Campbell: We’ve discussed notes, results and PAMI. Are there other clinical data elements that you’ve examined? How will you handle those?

Schoener: From an acute care perspective, our physicians are very interested in seeing the last H & P (History & Physical Examination) and the last operative note, so we’re going to consider two different ideas. One would be that all of that data would still reside in document management, which has the ability to be sorted. It’s currently very chart centric. For instance, you can easily pull the patient’s last acute care stay. There is the ability, however, to sort by H & P, operative note, or discharge summary—something along those lines for the separate buckets of information. Therefore, a physician could view the most recent H & P or view all sorted chronologically. In addition, they’ll be able to seamlessly launch directly from the new EMR to the old EMR, bypassing authentication, which is important to mitigate context switching.

One of the areas we’re struggling with is the growth chart. A physician would love the ability to see a child’s information from start to finish, not just from the time of the EMR transition. So that means some sort of birth height/weight data that we would want to retrieve and import into the new system so a growth chart could be generated. The other option is to somehow generate some sort of PDF of a growth chart up until the place where we transitioned to the new EMR. The latter however, would result in multiple growth charts, and a physician’s not going to be happy with that. So we’re trying to figure that one out.

Another area of concern is blood pressure data. We’re struggling with what to do with a patient we’re monitoring for blood pressure. We’d like to see more than one blood pressure reading and have some history on that.

Campbell: Thank you for elaborating on those items. What about data that is not migrated. How will that be addressed and persisted going forward?

Schoener: For the most part, everything else would be available in the document management system. We can generate that data from document our document management system and make it available to be queried by OIG or whoever else requires that data from a quality perspective. We are aware that an archival solution is very expensive. We’re being told, ‘if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.’ If that’s what the advisors and consultants are saying, then our thought is that probably isn’t going to be the direction we’re going to go. We’re likely going to stick with some type of document management system for archival.

Campbell: Very good. How are you gathering feedback from different specialties and departments? Do you have a governance process in place?

Schoener: So as you may have gathered, we’re getting ready. I don’t want surprises. I want physicians to be prepared and to set expectations for what’s going to be available. What I just described to you, we’ve vetted that out with our primary care docs. Now we’re going to take that to our cardiologists and ask them what they think. Then on to our urologists to allow them to weigh in. Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

There will definitely be a learning curve with the new EMR, but we want to be clear and set expectations with respect to data migration and conversion, so that when the physician does use the new EMR they’re not saying ‘that darn Cerner or Epic.’  It’s more ‘that’s a part of the data migration process and we weren’t able to accomplish that.’

Campbell: What about legacy applications support. Will all of your staff be dedicated to the new project?

Schoener: I mean, let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move. We still haven’t decided what to do.

Campbell: I agree that no staff member wants to be left behind. I’ve talked to organizations where they use folks for both and it just doesn’t end well. You can’t expect them to do both, learning the new system while supporting the old one.

Schoener: I guess it depends on the capacity and the expectation of that particular project they’re working on. Maybe there is a person who has less involvement with the new EMR and they have availability where they can support both, although it’s unlikely. Sometimes you end up having someone who wants to retire within the time period. In that case, they can almost work their way to retirement and then not ever support the new EMR, although that situation is also unlikely.

It’s a great question, and one we’re going to have to have folks help us determine.

Campbell: Shifting gears a little bit, what are your thoughts on health data retention requirements? Too loose? Too stringent?  As you know, it varies state-to-state, from 7-10 years, but I feel like there’s a huge responsibility that is placed on organizations to be the custodians of that data. Do you agree?

Schoener: I think that’s just healthcare. A lot of it is legal considerations and our need to protect ourselves. That’s why do we do a lot of the things we do. We’re protecting ourselves from lawsuits and litigation. I think it’s expected; it’s just the nature of the business. Just think of what we had in a paper world. We used to have rooms and rooms full of charts and now that’s all gone. With our current process, any paper that comes in is scanned in within the first 24 hours. So it’s not something I worry about. My focus now is making sure our providers can perform excellent patient care on the new EMR.

Campbell: Could you provide some advice, insight or wisdom for healthcare organizations pursuing EMR/EHR replacement & transition?

Schoener: Get ready for some fun! Affiliations and acquisitions are greatly impacting these decisions. It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare. One bit of wisdom for anyone is: if you’re not interested in that type of transition and change occurring, healthcare’s not for you. That’s the nature of the business we’re in.

I would say from an EHR transition process, I found that having an advisor is extremely beneficial to help me think outside of my day-to-day operations. They’re able to look outside of your organization and ask the right questions. If you pick the right advisor, they’ll protect you and protect your organization. I think it’s been very healthy for us to have someone from the outside give us counsel and advice because it’s a tough process. It’s extremely expensive, and extremely polarizing.

Campbell: Outside of the networking, what did you come to CHIME focused on this year?

Schoener: CHIME is a great way to challenge yourself as a CIO and in your leadership, it pushes me in my leadership skills and helps to focus me back to what’s critical in the industry. It helps me to think more strategic and broad, not to get too engaged in one particular topic. I think it’s just great for professional development. CHIMEs the best out there with respect to what I do.

This interview has been edited and condensed.

Evaluate options, define scope and formulate a strategy for EHR data migration by downloading Galen’s EHR Migration Whitepaper.

About Tim Schoener
Tim Schoener is the Vice President/Chief Information Officer for UPMC Susquehanna, a new partner of UPMC since October 1, 2016, which is a four-hospital integrated health system in northcentral Pennsylvania including Divine Providence Hospital, Muncy Valley Hospital, Soldiers + Sailors Memorial Hospital and Williamsport Regional Medical Center. UPMC Susquehanna has been Most Wired for 14 of the last 16 years and also HIMSS Level 6. Tim has worked at Susquehanna for over 24 years, 19 of those years in Information Technology.  He also has responsibilities for health records, management engineering and biomedical engineering. He is a CHCIO, HIMSS Fellow and CPHIMS certified. Tim received his undergraduate degree from The Pennsylvania State University with a BSIE in Industrial Engineering and his MBA from Liberty University. 

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 Tackling EHR & EMR Transition 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.

EMR Data Archival Strategy Deep Dive – Tackling EHR & EMR Transition Series

Posted on November 14, 2016 I Written By

The following is a guest blog post by Robert Downey, VP of Product Development at Galen Healthcare Solutions.

Inside the world of data archival (Download this Free Data Archive Whitepaper for a deep dive into the subject), there are nearly as many different types of archives as there are vendors. Many of the existing archival solutions that have gained popularity with large healthcare organizations are ones that are also frequently utilized by other sectors and often claim to be able to “archive anything.”

This can be very appealing, as an organization going through a merger will often retire dozens or even hundreds of systems, some clinical, but most only tangentially related to the delivery of care. HR systems, general ledger financial systems, inventory management, time tracking, inventory tracking systems, and CRMs are just a few of the systems that might also be slated for the chopping block. The idea of retiring all of these into a single logical archival solution is very appealing, but this approach can be a dangerous one. The needs of healthcare organizations are not necessarily the same as the needs of other sectors.
ehr-data-archiving-process
To understand why some archival approaches are superior to others, it’s useful to visualize the way each of the solutions extract, store, and visualize data. The methodologies used typically trade fidelity (how well it preserves the original shape and precision of the data) for accessibility (how easy it is to get at the information you need), and they trade how easily the solution can archive disparate sources of data (such as archiving both an EMR and a time-tracking system) with, again, accessibility.

There are certainly other ways to judge an archival solution. For instance, an important factor may be whether or not the solution is hosted by the archival vendor on-premises or remotely. Some factors, such as the reliability of the system, service level agreements, or its overall licensing cost are big inputs into the equation as well, but those aren’t necessarily specific to the overall archival strategy utilized by the solution. There are also factors that are so critical, such as security and regulatory compliance, that deficiencies in these areas are deal-breakers. Now that we have the criteria with which to judge the solution, let’s delve into the specific archival strategies being used in the marketplace.

Raw Data Backups
raw-healthcare-data-backups
A shockingly large number of organizations treat raw data backups of the various databases and file systems as their archival solution. There are some scenarios in which this may be good enough, such as when the source system is not so much being retired as it is being upgraded or otherwise still maintained. Another scenario might be when the data in question comes from systems so well known that the organization won’t have significant issues retrieving information when it becomes necessary. The greatest benefit to this approach is that acquiring the data is fairly trivial. Underlying data stores almost always offer easy built-in backup mechanisms. Indeed, the ability to back up data is a certification requirement for EMRs, as well as a HIPAA and HITECH legal requirement. This strategy also offers “perfect” data fidelity, as the data is in the raw, original format.
health-data-archive-fidelity
Once it actually comes time to access the “archived” data, however, the organization is forced to fully reverse engineer the underlying database schemas and file system encodings. This leads to mammoth costs and protracted timelines for even simple data visualization, and it’s a major undertaking to offer any kind of significant direct clinician or compliance access to data.

Another danger with raw database backups is that many clinical system vendors have language in their licensing related to the “reverse engineering” of their products. So while it may be “your” data, the vendor may consider their schema intellectual property — and the act of deciphering it, not to mention keeping a copy of it after the licensing agreements with the system vendor have been terminated — may well be a direct violation of the original licensing agreement.

Hybrid Modeled / Extracted Schema
extracted-schema-data-archiving
A common approach utilized by healthcare-specific archival solutions is to create a lightweight EMR and practice management schema that includes the most common data attributes from many different source system vendors and then map the data in the source system to this fully modeled schema. The mapping involved is usually limited to fieldtype mapping rather than dictionary mapping, although occasionally, dictionary data which feeds user interface aspects such as grouping (problem categories, for instance) may require some high-level mapping.

This approach usually yields excellent clinical accessibility because the vendor can create highly focused clinical workflows just like an EMR vendor can. Since these visualizations don’t need to be created or altered based on the source system being archived, it means that there is generally no data visualization implementation cost.
healthcare-data-archiving
As the mapping is limited to the schema, the extraction and load phase is usually not as expensive as a full EMR data migration, but because every required source field must have a place in the target archival schema, the process is typically more time-consuming and expensive than the hybrid modeled / extracted schema or non-discrete document approaches. That said, vendors that have a solid library of extraction processes for various source systems can often offer lower initial implementation costs than would otherwise be possible.

The compliance accessibility and data fidelity of this strategy can be problematic, however, as unknown fields are often dropped and data types are frequently normalized. This fundamentally alters a substantial portion of the data being archived in the same way that a full data migration can — although, again, not as severely given the typical lack of data dictionary mapping requirements. In some cases, vendors will recommend that a full backup of the original data be kept in addition to the “live” archive, providing some level of data fidelity problem mitigation. Should a compliance request require this information, however, the organization may be left in a similar position to those utilizing raw data backups or extracted schema stores with no pre-built visualizations.

Archival solutions utilizing this strategy may also frequently require augmentation by the vendor as new sources of data are encountered. This can make the implementation phase longer, as those changes typically need to happen before any data can be loaded.

Summary
There will never be a one-size-fits-all archival solution across organizations, and even within an organization, when determining the strategy for multiple systems. Another key takeaway is to always be wary of all the “phases of implementation.” Many vendors will attempt to win deals with quick and inexpensive initial implementations, but they leave significant work for when the data actually needs to be visualized in a meaningful way. That task either falls on the organization, or it must be further contracted with the archival solution provider.

It also is valuable to consider solutions specifically designed for archival purposes and, ideally, one that focuses on the healthcare sector. There are simply too many archival-specific scenarios to utilize a general purpose data backup, and many organizations find that the healthcare-specific requirements make general purpose archival products ill-suited for their needs.

Download Galen Healthcare’s full archival whitepaper to evaluate available EMR data migration & EMR data archival options and processes critical to EMR replacement and legacy system decommissioning.

About Robert Downey
Robert is Vice President, Product Development, at Galen Healthcare Solutions. He has nearly 10 years of healthcare IT experience and over 20 years in Software Engineering. Robert is responsible for design and development of Galen’s products and supporting technology, including the VitalCenter Online Archival solution. He is an expert in healthcare IT and software development, as well as cloud based solutions delivery. Connect with Robert on 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 Tackling EHR & EMR Transition 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.