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Getting More Out of the EHR Than What You Put In

Posted on January 21, 2015 I Written By

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

When I first met with Stoltenberg Consulting a few years back at CHIME, they said something really interesting that I’m still thinking about today. In fact, I might be thinking about this more today than I was doing before.

Per my notes (so I won’t make it a direct quote), they commented that doctors were putting a lot into the EHR, but they don’t feel like they’re getting a lot out of the EHR.

It’s a powerful idea that is really important for any hospital executive to understand.

I recently wrote about the choice between the Best-of-Breed EHR and the All-In-One EHR approaches on EMR and HIPAA. Here’s the money section:

The real decision these organizations are making is whether they want to put the burden on the IT staff (ie. supporting multiple EHRs) or whether they want to put the burden on the doctors (ie. using an EHR that doesn’t meet their needs). In large organizations, it seems that they’re making the decision to put the burden on the doctors as opposed to the IT staff. Although, I don’t think many organizations realize that this is the choice they’re making.

Choice of EHR is only one of the main reasons why doctors likely feel that they’re getting less out of the EHR than they’re putting into it. Certainly reimbursement requirements and meaningful use should still take a lot of the blame as well. Regardless of how we got here, it’s a very precarious position when the doctors feel like they’re getting less out of the EHR than they are putting into it.

There is a solution to this problem. First, you must work to maximize the physician workflow. Sometimes this means involving the nursing staff more. Sometimes this involves a scribe. Other times it requires a change to your EHR. Other times it means building out high quality templates that make the doctor more efficient.

Second, we must all focus on more ways doctors can get more value out of their EHR. The buzzword analytics has potential, but has been a little too much buzz word and not enough practical improvement for the doctor and patient. We need more advanced tools that leverage all the data a doctor’s putting in the EHR. Clinical Decision Support, Drug to Drug and Drug to Allergy checking are just the first steps. We can do so much more, but unfortunately we’ve been too distracted by government regulation to deal with them. Plus, let’s not kid around. These aren’t easy problems to solve. They take time and effort. Plus, we need a better way for doctors and hospitals to be able to diffuse their discoveries across the entire healthcare community. Sharing these discoveries is just too hard and too slow right now.
EHR Scale
At the end of the day, it’s a simple scale. On the one side you have the time and effort a doctor puts into the EHR. On the other side is the value the doctor gets from the EHR. You can solve this by making the doctor’s EHR work more efficient or by finding more ways the EHR can provide value to the doctor. Much easier said than done. However, if this stays out of balance too long, you can count on a big EHR backlash from doctors.

CIOs Want More Responsibility — And It’s About Time They Get It

Posted on January 19, 2015 I Written By

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

The life of a healthcare CIO is a tough one. More than ever before, healthcare CIOs walk a fine line between producing great technical results and thinking strategically about how technology serves clinicians. As with their more junior peers, many healthcare CIOs only get noticed when something breaks or goes offline. Worse, healthcare CIOs may get the blame dumped on them when a big project — especially a mission-critical one like an EMR implementation — fails due to problems beyond their control.

But despite the political battles they must fight, and the punishing demands they must meet, healthcare CIOs are largely satisfied with their career paths — as long as they have a shot at getting more responsibility that can help them move their organization’s strategy forward. This, at least, is the conclusion of a new survey by SSi-SEARCH.

SSi-SEARCH surveyed 169 CIOs to learn how they felt about key aspects of their job, according to iHealthBeat.  All told, the researchers found that CIOs are most satisfied with the trajectory of their career, compensation and strategic involvement. (This is a significant change from a couple of years ago, when CIOs told SSi-SEARCH that their pay wasn’t keeping up with the growth in their responsibilities.)

On the other hand, healthcare CIOs were markedly dissatisfied with the resources available to them, and almost half (48%) said that there will need to be changes within the next year. That’s certainly no surprise. As we’ve noted in this space before, not only do healthcare CIOs need to implement or further augment EMRs and handle the switch from ICD-9 to ICD-10, many need to make costly upgrades to or replace their revenue cycle management systems.

Even if their institution can’t increase their budget, healtlhcare CIOs would be somewhat mollified if they got some respect for some of the softer skills they bring to the table.

Forty-five percent of those surveyed said they wanted recognition for improving patient safety, 44 percent said they wanted to be recognized for innovation, and 37 percent wanted CEOs to appreciate their skill at “bringing departments together,”  SSi-SEARCH found.

Not surprisingly, they want to be appreciated for their overall contributions to their institutions as well. While 69 percent of CIOs felt that their work was “critically important” to the strategic mission of their organization, and 29 percent felt they had been “very important,” some of their employers don’t seem to see it. In fact, 23 percent of those CIOs surveyed felt that they hadn’t been recognized at all.

Sadly, though the healthcare CIO’s job has evolved far from bits and bytes to projects and strategies that directly impact outcomes, not every institution is ready to give them credit. But if they have CIOs pigeonholed as tech wizards, they’d better change their tune.

Giving CIOs the latitude, responsibility and budget they need to do a great job is enormously important. If healthcare organizations don’t, they’ll never meet the demands they currently face, much less emerging problems like population health management, big data and mobile health. This is a make-or-break moment in the dance between healthcare organizations and IT, and it’s not a good time for a misstep.

FHIR Adoption Needs Time to Mature

Posted on January 7, 2015 I Written By

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

In John Halamka’s look at Health IT in 2014 he offered some really great insight into how regulators should look at standards and adoption of standards.

Here’s one section which talks about the lesson learned from meaningful use stage 2:

“Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.”

Then, he offers this money line about FHIR and how we should handle it:

“We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption”

There’s no doubt that FHIR is on Fire right now, but we need to be careful that it doesn’t just go down in flames. Throwing it into a regulatory program before it’s ready will just smother it and kill the progress that’s being made.

Healthcare Leadership Learnings from Niagara Falls

Posted on December 31, 2014 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.

Niagara Falls in Winter
As this picture shows, my wife and I recently got to spend some time alone (ie. no kids) at Niagara Falls. My wife comes from upstate NY and I proposed to my wife while at Niagara Falls. So, it’s a special place to us. As such, we’ve visited it many times. Plus, I just adore waterfalls.

As I was watching the waterfalls this time, I was again blown away by the volume of water that pours over the falls consistently, all day, every day and has for years. It’s extraordinary that it’s even possible, but the power of all that water is awe inspiring.

Thinking about this wonder of the world, I started to think about healthcare. At first I thought that those of us in healthcare IT were strapped at the bottom of the falls and couldn’t leave. The regulations kept coming over the falls and hammering us over and over. The regulations were unrelenting and we just had to try and find a way to survive. I imagine that many reading this could relate to that feeling. In fact, I bet many of you are tired of the regulations and ready to give up and float down the river.

As my mind continued to wander, I thought that the same was true when it comes to a team working consistently on a problem. A well organized team that keeps consistently hammering away at something over time is a powerful powerful force for good. Instead of being strapped to the waterfall, our teams could be the waterfall that’s hammering away over and over at the problems of healthcare.

Never underestimate the power of many people all working consistently to solve a problem. I’ve been part of teams like that and the results are amazing! Where do you find yourself? Are you at the bottom of the falls or are you the falls?

The Impact of AI and Robots on Healthcare

Posted on December 30, 2014 I Written By

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

As we end 2014, it seemed appropriate to post a little bit of mental floss for those of us who are trying to consider where all of this technology in healthcare is headed. Luckily, Twitter provides a lot of mental floss and these two tweets will give you a lot to consider when it comes to artificial intelligence (AI), robots, and the mixture of related technologies. We can’t see it now, but 10 years from now we’ll be just as disrupted as we were 6 years ago when the iPhone was introduced.

Here are two tweets that will hopefully help you to reframe your thinking:

What do you think all of this means for the future of healthcare?

Hospitals Put Off RCM Upgrades Due To #ICD10, #MU Focus

Posted on December 29, 2014 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.

If you look closely at the financial news coming out of the hospital business lately, you’ll hear the anguished screams of revenue cycle managers whose infrastructure just isn’t up to the task of coping with collections in today’s world. Though members of the RCM department — and outside pundits — have done their best to draw attention to this issue, signs suggest that getting better systems put in has been a surprisingly tough sell. This is true despite a fair amount of evidence from recent hospital financial disasters that focusing on an EMR at the expense of revenue cycle management can be quite destructive.

And a new study underscores the point. According to a recent Black Book survey of chief financial officers, revenue cycle upgrades at U.S. hospitals have taken a backseat to meeting the looming October 2015 ICD-10 deadline, as well as capturing Meaningful Use incentives. Meanwhile, progress on upgrades to revenue cycle management platforms has been agonizingly slow.

According to the Black Book survey, two thirds of hospitals contacted by researchers in 2012 said that they plan to replace their existing revenue cycle management platform with a comprehensive solution. But when contacted this year, two-thirds of those hospitals still hadn’t done the upgrade. (One is forced to wonder whether these hospitals were foolish enough to think the upgrade wasn’t important, or simply too overextended to stick with their plans.)

Sadly, despite the risks associated with ignoring the RCM upgrade issue, a lot of small hospitals seem determined to do so. Fifty-one percent of under 250 bed hospitals are planning to delay RCM system improvements until after the ICD-10 deadline passes in 2015, Black Book found.

The CFOs surveyed by Black Book feel they’re running out of time to make RCM upgrades. In fact, 83% of the CFOs from hospitals with less than 250 beds expect their RCM platforms to become obsolete within two years if not replaced or upgraded, as they’re rightfully convinced that most payers will move to value-based reimbursement. And 95% of those worried about obsolescence said that failing to upgrade or replace the platform might cost them their jobs, reports Healthcare Finance News.

Unfortunately for both the hospitals and the CFOs, firing the messenger won’t solve the problem. By the time laggard hospitals make their RCM upgrades, they’re going to have a hard time catching up with the industry.

If they wait that long, it seems unlikely that these hospitals will have time to choose, test and implement RCM platform upgrades, much less implement new systems, much before early 2017, and even that may be an aggressive prediction. They risk going into a downward spiral in which they can’t afford to buy the RCM platform they really need because, well, the current RCM platform stinks. Not only that, the ones that are still engaged in mega dollar EMR implementations may not be able to afford to support those either.

Admittedly, it’s not as though hospitals can blithely ignore ICD-10 or Meaningful Use. But letting the revenue cycle management infrastructure go for so long seems like a recipe for disaster.

Should the Sony Hack Have Hospitals Concerned?

Posted on December 23, 2014 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.

If you haven’t heard the details of the Sony hack, then lucky you. It seems that coverage of the hack has been everywhere. Long story short, Sony wasn’t careful and the hackers got a lot of really private information like emails. It was embarrassing to the company in a variety of ways and the effects of it and them eventually pulling The Interview are going to be felt for a long time to come. In fact, some of the hack included Sony’s insurance records which included medical information.

Should hospitals be concerned by the hack of Sony? The hack itself shouldn’t be of particular concern, but it should be a stark reminder that anyone is vulnerable if the hackers want to hack you enough. Unfortunately, the game of privacy and security is a cat and mouse game of trying to make what you have so difficult to access that hackers choose other, simpler targets.

With that said, if Sony, Google, Target, etc can be hacked, then anyone could be hacked. While it’s absolutely critical that you’re doing everything you can to make it hard for hackers to access your systems, it’s also important to make sure that you have proper breach procedures in place as well. How you handle a breach is going to be incredibly important for every organization.

While the Sony hack is going to cost them a lot of money. A breach in healthcare could incur some of the same embarrassment publicly, but there are also stiff HIPAA penalties for a breach. This could get very expensive for organizations that aren’t taking health IT security seriously. If you thought the coming MU penalties are bad, try to calculate in some major HIPAA fines and reduced patient load because patients no longer trust your organization. It will be devastating for organizations.

What is your organization doing to avoid breaches? Are you going beyond the HIPAA risk assessment?

The Value of Goals in Hospital IT

Posted on December 17, 2014 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.

When someone sends me a press release that says that a hospital has attested to meaningful use or has achieved HIMSS stage 7, I kind of roll my eyes and move on. As a blogger, it really doesn’t tell me much about that organization. It’s one small data point in what I try to look at in the broader health IT ecosystem. Now, if I don’t see these things happening, I’ll start to wonder what’s going on. However, one individual announcement to me isn’t that interesting.

That’s not to say that healthcare organizations shouldn’t participate in programs like meaningful use and the various HIMSS stages. Sure, the incentive money is great and the adoration of your colleagues at HIMSS when you achieve HIMSS stage 7 is great as well, but that’s not why you should do either of these (ok, maybe the money in MU is worth doing it for).

The best reason your organization should look at going after something like HIMSS stage 7 is because there’s a lot of value in an organization working towards a goal. Of course you should look at the goals you’re trying to achieve to make sure your pointed in the right direction, but nothing unifies an organization like trying to achieve a special recognition. It’s hard to underestimate the value that’s created working towards a common goal.

Having an ambitious goal for your organization helps everyone in your organization to perform better and takes your organization to a higher level than you could have ever dreamed. We could argue over the value or lack thereof of meaningful use. What can’t be argued is the way organizations have come together to be meaningful use compliant.

Also, don’t underestimate the power of celebrating these achievements. While it’s one thing to celebrate your achievements internally (and you should), it’s also really valuable for those in your organization to receive accolades and recognition from their peers in other organizations.

Next time you look at some of these recognition, definitely consider if they espouse the values your organization wants to achieve. However, also take into account the powerful force a high goal and recognition for achieving that goal can provide your organization.

How Is Your Hospital Approaching ICD-10?

Posted on December 12, 2014 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’ve been writing quite a bit recently about ICD-10. You may enjoy this post I wrote about the real problem of ICD-10 being UNCERTAINTY. I’ve seen a lot of good reasons why we should go forward with ICD-10 and there’s no doubt that the move to ICD-10 does not come without a cost (training, implementation, system testing, etc). Although, not knowing if ICD-10 is coming or not is absolutely killer.

There are a lot of great ICD-10 resources out there to help you with your ICD-10 transition strategies. Although, I think most hospitals are wondering if they should prepare for ICD-10 or not. Those that were getting prepared last year got burned. Now they’re likely wondering if they’re going to get burned again. Those that weren’t prepared for ICD-10 last year were saved and they’re likely hoping to be saved again.

How is your hospital approaching ICD-10? Are you going forward with ICD-10 preparation using projects that are masked as Clinical Documentation Improvement (CDI) programs? Are you in wait and see mode? Are you going full bore in preparing, training, and testing for ICD-10?

I said that last one kind of ironically. I haven’t seen any organization that’s doing that right now which is really amazing. Last year at this time, I knew a bunch of organizations that were fully engage in preparations for ICD-10. This year, no such message. Last year at this time, many were calling for ICD-10 preparation. This year, people are afraid that they’re going to be “the boy who cried wolf.” There’s only so many times you can cry ICD-10 before people stop listening. We might be there already. It’s amazing the power of uncertainty.

As I said in my ICD-10 uncertainty post linked above:

My gut tells me that if ICD-10 isn’t delayed in the SGR Fix bill next year, then ICD-10 will probably go forward. You’ll notice that probably was the best I could say. Can anyone offer more certainty on the future of ICD-10? I don’t think they can and that’s the problem.

How Is Your Hospital Approaching ICD-10?

Healthcare IT Consulting Job Slowdown

Posted on December 1, 2014 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.

A recent poll on HIStalk, caught my eye. In the poll he asked readers “For health systems: how much IT related consulting will you use in 2015 vs. 2014?” Here’s an image of the responses:
Healthcare IT Consulting

It seems only fair to acknowledge that this wasn’t a deep study. It was an online poll with plenty of potential sample bias. Plus, it only had 107 respondents to the poll. Especially with it being an online poll, I’d have liked to see more respondents. However, it’s worth noting that 50% of those who did respond are planning to use less healthcare IT consulting in 2015. Although, just as surprising is that 14% plan to use more health IT consulting.

This was somewhat expected from my point of view. The consulting market just exploded over the past couple years as hospitals raced to implement an EHR and show meaningful use. As that program has started to mature, there isn’t as much need for consultants. So, it’s no surprise that the government incentivized EHR consulting market would contract back down to a more reasonable market.

That’s not to say that there aren’t still lots of opportunities for EHR consulting still. In fact, I’d argue that the opportunity for EHR consulting has never been bigger. It’s the EHR staff augmentation companies which often dress up as EHR consultants that are likely taking the hit. My feeling is that EHR staff augmentation is way down and EHR consulting is going to continue trending up. All of these hospitals need to start maximizing their EHR investment. That requires a consultant as opposed to more hands on deck for the EHR go-live.

We’re currently seeing this play out on the Healthcare IT Central job board. The type of jobs that are being posted are much more advanced. Plus, we’re seeing a maturing of EHR adoption and that’s shifting towards more full time EHR staff vs consulting.

What are you seeing in the market? Are you using more health IT consultants or fewer? Where do you see the industry headed?