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ROI in the Business Office: Why HIM Should Keep a Watchful Eye – HIM Scene

Posted on August 16, 2017 I Written By

The following is a HIM Scene guest blog post by Lula Jensen, MBA, RHIA, CCS, Director of Product Management at MRO.  This is the second 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.

According to most business office staff, pulling information and releasing medical record documentation to payers is a necessary evil to get claims paid and reduce accounts receivables. It is not their core competency.

Whether the request is unsolicited or solicited by the payer, time required to compile information and respond wreaks havoc on business office productivity. Also in efforts to meet payer deadlines and expedite claims, human mistakes can be made. Incorrect patient information might slip through the cracks.

Despite concerns, many business office directors prefer that payer disclosures be sent out by their own business staff—versus by the HIM department. If your organization follows that practice, this HIM Scene blog post is for you.

Two Types of Business Office Requests

There are two instances of business office Release of Information (ROI) to know: unsolicited and solicited requests. The unsolicited process takes place when medical documentation containing all the additional information pertinent to the service being billed is submitted proactively by the provider with the initial claim. The solicited process occurs when the original claim is sent without additional supporting medical record documentation and the payer subsequently (during the adjudication process) determines that additional information is needed. The payer then places a request for the additional documentation from the provider.

Unsolicited Releases During Claims Processing

The purpose of releasing information during claims processing is to expedite payment. In an effort to get the claim paid faster, medical records are sent proactively with the claim. This is especially true for high-dollar claims, payer policies, readmissions within 30 days and the published Office of Inspector General (OIG) Work Plan.

Sounds like a good intention with the organization’s best financial interests in mind. However, three concerns arise when business offices send medical record documentation to payers—versus having HIM professionals take charge.

  1. Business office staff may not know which parts of the medical record will be required to support the claim. Often, the entire chart is sent—a process that is not practical for high-dollar or long-length-of-stay cases.
  2. Sending the entire record is also not compliant with HIPAA’s Minimum Necessary Standard. By sending too much information, hospitals are at risk for HIPAA breach.
  3. Upon receipt of prepay documentation, the payer’s staff logs each record received, scans or otherwise digitizes the documents, and incorporates them into their own electronic systems. This creates a huge administrative burden on payers.

Similar challenges ensue with solicited payer medical record requests that occur during the adjudication process or retrospective reviews.

Business Office Disclosures for Payer Audits and Reviews

There has been significant uptick in payer audits and reviews, a topic that was covered by HIM Scene last month. This includes governmental and third-party commercial. According to one central business office director at an MRO client site, “The pull lists for payer audits and reviews keep getting longer and the piles of medical records to send keep getting higher.”

To reduce administrative burdens with payers, some organizations are allowing payers direct access to their EMRs and EHRs to obtain the required information during audits and reviews. While this process may lighten the load for billing personnel, it is laden with additional privacy risks.

Business office personnel complain about the travails of responding to all the various requests for records. However, a significant number of business office directors still insist on owning the ROI process for payer audits and reviews. When this is the case, there are several important steps for HIM directors to consider.

Three Steps for HIM: Educate, Track and Talk

For both types of business office disclosures, it is important to educate billing staff about the implications of a HIPAA breach and privacy risks listed above. Establish an organization-wide standard for ROI to keep PHI safe during all types of business office disclosures. Educating all personnel involved in business office ROI (whether for claims processing, audits or reviews) helps relieve frustration with the record release process.

Billers should also track which specific records, and what sections of each, were sent. By documenting and then reviewing this information, organizations gain valuable knowledge about payer trends—insights that can be used to prevent denials and negotiate more favorable terms for payer contracts.

Collaborate with privacy and the business office to determine which release information to track. Then establish a common database or software application to document each release to payers. Here are four ways to make the most of business office ROI tracking data:

  • Look for patterns in what payers are requesting. Any trends in payer request activity could offer opportunities for provider improvement.
  • Identify risk. Analytics can help business offices detect weaknesses in the revenue cycle, involving coding, documentation or other internal processes.
  • Educate coders, biller, collectors, physicians, etc. on payer trends and how collaboration can promote accurate, complete billing for services rendered and support a claim via medical record documentation.
  • Use data analysis. When payer contract negotiations arise, use payer trend statistics to your advantage in the next round of negotiations.

Talk with local payers and stay updated on policy changes related to claims processing, audits and retrospective reviews. Open communication with each payer is recommended to ensure records are sent in the most secure way possible. Communication with payers also reduces phone tag and minimizes payer-provider abrasion.

Finally, due to the importance of collecting medical record documentation, health plans are willing to pay for records. Business offices and HIM departments fulfilling these requests are encouraged to discuss and pursue reimbursement from payers.

About Lula Jensen

In her role as Director of Product Management for MRO, Jensen drives product enhancements and new product initiatives to ensure MRO’s suite of solutions enable the highest levels of client success and end-user satisfaction. She has more than 15 years of experience in healthcare, focusing on Health Information Management (HIM), Revenue Cycle Management, analytics, software development and consulting. In addition to holding product management roles at McKesson Health Solutions and CIOX Health, she also served as Revenue Cycle Manager at Fox Chase Cancer Center and taught a course on ICD-9 CM Coding and Reimbursement at Bucks County Community College. Jensen is an active member of the Healthcare Financial Management Association (HFMA), American Health Information Management Association (AHIMA) and Pennsylvania Health Information Management Association (PHIMA); she is a 2005 PHIMA Scholar Award recipient. Jensen holds a B.S. in HIM from Temple University and an M.B.A. in Health Care Administration from Holy Family University.

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

Is It Time To Put FHIR-Based Development Front And Center?

Posted on August 9, 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.

I like to look at questions other people in the #HIT world wonder about, and see whether I have a different way of looking at the subject, or something to contribute to the discussion. This time I was provoked by one asked by Chad Johnson (@OchoTex), editor of HealthStandards.com and senior marketing manager with Corepoint Health.

In a recent HealthStandards.com article, Chad asks: “What do CIOs need to know about the future of data exchange?” I thought it was an interesting question; after all, everyone in HIT, including CIOs, would like to know the answer!

In his discussion, Chad argues that #FHIR could create significant change in healthcare infrastructure. He notes that if vendors like Cerner or Epic publish a capabilities-based API, providers’ technical, clinical and workflow teams will be able to develop custom solutions that connect to those systems.

As he rightfully points out, today IT departments have to invest a lot of time doing rework. Without an interface like FHIR in place, IT staffers need to develop workflows for one application at a time, rather than creating them once and moving on. That’s just nuts. It’s hard to argue that if FHIR APIs offer uniform data access, everyone wins.

Far be it from me to argue with a good man like @OchoTex. He makes a good point about FHIR, one which can’t be emphasized enough – that FHIR has the potential to make vendor-specific workflow rewrites a thing of the past. Without a doubt, healthcare CIOs need to keep that in mind.

As for me, I have a couple of responses to bring to the table, and some additional questions of my own.

Since I’m an HIT trend analyst rather than actual tech pro, I can’t say whether FHIR APIs can or can’t do what Chat is describing, though I have little doubt that Chad is right about their potential uses.

Still, I’d contend out that since none other than FHIR project director Grahame Grieve has cautioned us about its current limitations, we probably want to temper our enthusiasm a bit. (I know I’ve made this point a few times here, perhaps ad nauseum, but I still think it bears repeating.)

So, given that FHIR hasn’t reached its full potential, it may be that health IT leaders should invest added time on solving other important interoperability problems.

One example that leaps to mind immediately is solving patient matching problems. This is a big deal: After all, If you can’t match patient records accurately across providers, it’s likely to lead to wrong-patient related medical errors.

In fact, according to a study released by AHIMA last year, 72 percent of HIM professional who responded work on mitigating possible patient record duplicates every week. I have no reason to think things have gotten better. We must find an approach that will scale if we want interoperable data to be worth using.

And patient data matching is just one item on a long list of health data interoperability concerns. I’m sure you’re aware of other pressing problems which could undercut the value of sharing patient records. The question is, are we going to address those problems before we began full-scale health data exchange? Or does it make more sense to pave the road to data exchange and address bumps in the road later?

The Evolution of Forms in Healthcare – Working to Empower the Patient

Posted on July 31, 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.

I recently had a chance to see a demo of the new FormFast Connect product which empowers the patient to complete all their healthcare forms at home or wherever they may be.  Talking with FormFast was really informative since they are the experts at healthcare forms with over 1100 customers using their technology to handle the sometimes messy job of healthcare forms management.

It’s worth taking a second to look at the evolution of forms in healthcare.  Everyone remembers the stack of pre-printed forms at registration and the nursing station.  Then, over time, FormFast and others started creating bar coded forms that could easily be scanned and integrated into your IT systems using document workflow management software.  Shortly after that we started to see forms generated on demand with patient information printed dynamically.  Then, we moved to electronic forms and eSignature capabilities which converted the analog paper form model into a digital one.  The natural next step in the evolution of forms is to push the forms out to the patient outside of the four walls of the hospital.  That’s what FormFast Connect does and is a great evolution of the FormFast product.

We all know that filling out forms in the doctor’s office or hospital registration area is suboptimal.  Many patients don’t have the information with them to fill the forms out completely and the waiting room or registration desk often create a rushed environment to complete the forms.  In fact, many organizations have resorted to making time consuming, expensive phone calls to patients in order to collect the pre-registration paper work they need from the patient.

This is why an online form solution, like FormFast Connect, that is completed by the patient before the visit is going to be an important tool for every hospital.  The reality is that patients are starting to expect the same kind of online conveniences they experience in their normal life in healthcare.  Filling out forms electronically before a patient visit is one area where healthcare can provide a much improved online experience that mirrors the conveniences provided by other industries.

The real question is why has it taken so long for healthcare to create and adopt these solutions?  Many EHR vendors offer some half baked form options in their patient portal, but that’s exactly the problem.  A half baked form option in your patient portal doesn’t really address the issue.  Forms management is a challenging problem and most EHR vendors have been too busy worrying about regulations and other requirements that they haven’t created a high quality forms management solution.

For example, we know that the majority of patients now have some sort of cell phone or mobile device that they would like to use when filling out pre-registration forms.  Any form solution that pushes to the patient outside of the hospital needs to provide a mobile optimized option for the patient or it will likely fail to engage the patient in completing the forms.  Most EHR vendor forms aren’t mobile optimized and thus fail to achieve the desired outcome.  Plus, it’s not enough for the form to be mobile optimized for the patient.  The form must also create an output that is legally structured for the provider and the legal medical record.  Sounds easy, but I assure you it is not and EHR vendors haven’t executed across all these areas in the forms they offer.

One exciting part of a mobile optimized form solution is it opens up a number of opportunities that were a challenge previously.  For example, mobile devices can easily snap a picture of the patient’s insurance card as part of the form completion process.  The same goes for an electronic signature which is easily captured on a mobile device thanks to all the great touch screen technology found in all our mobile devices these days.  I’m also interested to see how smart form technology continues to evolve and improve as data becomes more liquid in healthcare and certain portions of the form can auto complete for you.

It’s great that we’re finally pushing form completion out to the patient where they can do it in a convenient, comfortable environment.  This is valuable to the patient who enjoys a better experience and for the hospital who receives better quality information.  Plus, even if the patient elects not to fill out the forms before the visit, this is one more opportunity for the hospital to build a relationship with the patient outside of the hospital.  That relationship is going to be key in the new world of value based reimbursement.

FormFast is a proud sponsor of Healthcare Scene. 

With 25 years exclusively focused on healthcare needs and over 1100 hospital clients, FormFast is recognized as the industry leader in electronic forms and document workflow technology. FormFast’s enterprise software platform integrates with EHRs and other core systems to automate required documents, capturing data and accelerating workflows associated with them. By using FormFast, healthcare organizations achieve new levels of standardization and operational efficiency, allowing them to focus on their core mission – delivering quality care. Learn more about FormFast at formfast.com.

CXO Scene Episode 2: EMR As a Commodity, Shadow IT, Health IT Training, and Printer Security

Posted on July 28, 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 case you missed the live taping of the second CXO Scene podcast with David Chou, Vice President and Chief Information and Digital Officer at Children’s Mercy Kansas City and John Lynn, Founder of HealthcareScene.com, the video recording is now available below.

Here were the 4 topics we discussed on the 2nd CXO Scene podcast:
* Did Meaningful Use Turn EMRs Into a Commodity?

* Shadow IT – How should healthcare leaders deal with Shadow IT?

* The EHR Dress Rehearsal – Should this be a best practice for every health IT implementation?

* Printer Security – Where do printers and print devices rank on security risks for an organization?

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.

Take a look back at past CXO Scene podcasts and posts and join us for the live recording of future CXO Scene podcasts.

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.

Thoughts On Innovation In Healthcare

Posted on June 30, 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.

Sure, innovation can be fun and interesting and energizing. But how do you move from innovation as a sport to innovation as a true growth strategy, especially in a conservative business like healthcare? New research by consulting firm PwC might offer some answers.

To conduct its study, P2C surveyed more than 1,200 executives in 44 countries, conducting in-depth interviews with leaders responsible for managing innovation initiatives.

The research, which cut across multiple industries, found that firms that applied customer-engagement strategies leveraging design thinking and user-driven requirements — from idea generation to a product or service launch — saw better results. In fact, they were twice as likely to expect growth of 15% or more over the next five years, PwC found.

In conducting the research, PwC researchers identified five strategies which contribute to effective innovation efforts. They include:

  • Use smart metrics to measure innovation success: Whatever you invest, if you track the benefits of innovation by how it boosts revenue and contains cost – along with building sales – you’ve likely got a sustainable model. Sixty-nine percent of respondents named sales growth as the most important way to measure innovation success.
  • Don’t make “blind bets” — build viable business initiatives: Make sure you find a way to square your innovation strategy with your business strategy. And be aware that doing so may be challenging. The PwC report notes that 65% of companies investing 15% or more of their revenue in innovation saw connecting innovation with business goals was their top strategic challenge.
  • Create silo-busting innovation models: To succeed at innovation, break down traditional organization barriers within and outside of your organization, which helps you leverage a wider pool of ideas, insights, talents and technology. Consider more-inclusive operating models like open innovation, design thinking and co-creation with partners, customers and supplies rather than traditional R&D. Thirty-five percent of PwC respondents reported that customers were their most important innovation partners.
  • Leverage a broad base of human experience: See to it that your innovation teams seek input from across a variety of disciplines, rather than letting technology drive your process. For example, while big data may help you know how customers behave, data alone won’t explain why they behave that way. It’s better to bring the right human judgment and intuition to bear on the data rather than sticking strictly with IT experts. Sixty percent of companies surveyed said that internal employees help to drive innovation within their organization.
  • Support technical innovation: While technology is far from the only tool you can use to innovate, it remains a compelling option. Many companies looking to technology to create markets for novel products and services that don’t yet exist, and to meet needs that customers may not even know they have. Half of PwC’s respondents rated technology partners as their most important innovation collaborators.

So, what can the healthcare industry learn from this study? A few things come to mind.

For one thing, I believe that healthcare leaders could do far more to turn silo-busting activities into group innovation projects. In other words, don’t just merge data from different departments into a common database, involve the people in those departments with the process, and ask them how breaking down barriers could change the organization in a positive way.

Another thing that comes to mind that healthcare technology leaders could stand to integrate non-technical opinions into innovation efforts. Right now, health IT organizations are remarkably siloed themselves, and while they may involve clinicians in their process at times, it’s rare for them to take in the opinions of non-medical employees who don’t use advanced IT functions very often. (Yes, a janitorial services worker may have something to offer.)

And what about picking the right metrics to measure innovation success? Of course, existing models emphasizing clinical improvement aren’t misguided, nor are measures of IT performance, but there’s more to consider. Particularly within the ecosystem of a large hospital, as many departments outside IT care delivery which contribute to the organization’s overall health.

Ultimately, what makes innovation valuable is the extent to which it draws upon an organization’s unique strengths.  But it never hurts to take broad principles like these into account, as they may help you extract the full benefits of the innovation process.

Are You Desensitized to What’s Happening In Your Organization?

Posted on June 26, 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.

What a great Monday Motivation fron Jake Poore. We’ve all seen what Jake is talking about. Once we get into our daily habits we stop noticing the details of the things around us.

Jake also mentioned Patient Experience in his tweet and becoming desensitized to the patient experience is a great example of what he’s talking about. I remember one CIO telling me that his enemy is the “we’ve always done it this way” culture at his hospital. Someone responding that way is the epitome of someone who has become desensitized to the world around them. Patients suffer when this becomes the modes operandi.

However, this principle goes well beyond just the way we see and interact with patients. It also happens in the way we interact with each other. An organization’s workflows and processes become such a part of their culture that it’s hard to disrupt them. We become desensitized to their weaknesses because they’re the devil we know. Adopting a new technology or a new process that will disrupt our normal processes causes us to wonder what new devils will we discover and do we want to deal with those? The fear of those unknown are often much stronger than the benefits new opportunities can offer us.

I’ve seen many organizations that have become desensitized to the follies of their EHR. Some are dealing with awful workflows and awful setups, but most have given up trying to change it. They no longer feel how awful they are in their lives. They’ve become desensitized to these pains and just consider them part of doing business. How awful is that to consider?

What can we do to overcome these challenges?

The best thing you can do is to get outside of your box and talk to other people. Meeting other people who have different experiences and perspective can reopen your eyes to the things you no longer see. This is why I think EHR user groups are so valuable. You can hear from other people who suffered through the challenges you’re facing and often even find a solution.

With that said, user groups can often be about commiseration as opposed to rectification and solutions. That’s why I think we need a place for true peer connection across EHR vendors. You’d think this would happen at a place like HIMSS, but it usually doesn’t. It’s so large that people flock together in their usual groups.

What do you do to make sure you don’t become desensitized?

How Many Platforms Does Each Hospital Own?

Posted on June 2, 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.

I was recently thinking about how nearly every healthcare IT company I talk to today has some sort of platform. Yes, even our beloved EHR vendors (or not so beloved) often talk about their EHR system as an EHR platform. Is there anything that’s implemented in healthcare IT today that’s not a platform? Everything seems to be a platform these days.

If they have hundreds of health IT systems, then they have hundreds of platforms.

Given this is the case, are they really all platforms? Do we need all of these platforms? Has the word platform just been corrupted and really doesn’t have any meaning any more?

I wonder if hospital CIOs now would be interested in purchasing a piece of healthcare IT software that wasn’t a platform. Would it be better to market a healthcare IT software product as a solution rather than a platform? I’m guessing that most hospital CIOs probably feel like they have plenty of platforms. Am I wrong?

I should be clear. I think the idea of creating a platform with something is a good thing. At least it’s a good thing if you define a platform as something that connects and integrates with other systems and software. This would be a good trend in healthcare since so many so called platforms were at best very closed platforms and at worst not platforms at all. If platform would be defined as being open and interoperable, then I would welcome all these platforms with open arms.

The problem is that I think many healthcare IT vendors (EHR vendors leading this charge) look at their platform as a way to entrench the customer with them. They want to create the end all be all platform that all of a hospital’s future healthcare IT purchases need to integrate with the hospital. This is where the platform idea can fall flat when it comes to health IT customers and patients.

I love a good platform as much as the next person. It’s a powerful way to do business and can really do amazing things to improve the care a patient receives and how efficient a healthcare organization can operate. However, once everything says their a platform it loses meaning. I think we’ve reached that point with the word platform.

Promoting Internal Innovation to Drive Healthcare Efficiency

Posted on June 1, 2017 I Written By

The following is a guest blog post by Peyman S. Zand, Partner, Pivot Point Consulting, a Vaco Company.

Technical innovation in healthcare has historically been viewed through the lens of disruption. As tech adoption in the industry matures, perceptions on the origin of innovation are evolving as well. Healthcare leadership teams are increasingly leaning on feedback from the front lines of care delivery to identify ways to eliminate waste and drive greater efficiency. Rather than leaving innovation up to third parties, many health organizations are formalizing programs to advance innovation within their own facilities.

There are two schools of thought on healthcare innovation. Some argue that the market’s unique challenges can only be understood by those in the field, leaving outside influencers destined to fail. Others view innovation success in outside markets as an opportunity for healthcare stakeholders to learn from the wins and losses of more technically progressive industries. By mimicking other industries’ approach to promoting innovation (as opposed to their byproducts) in our hospitals and health systems, healthcare can draw from the best of both worlds. What we know is that the process in which innovation is adopted is very similar in all industries. However, the types of innovations and specific models can and should be tailored to the healthcare industry.

Innovation in Healthcare: Three Examples at a  Glance

There are several examples of health organizations successfully forging a path to institutionalized innovation. University of Pittsburg Medical Center (UPMC), Intermountain Healthcare and Mayo Clinic have pioneered innovation programs that merge internal clinical expertise with technical innovators from vertical markets in and outside healthcare. This article highlights some of the ways these progressive organizations have achieved success.

Innovation at UPMC

UPMC Enterprises boasts a 200-person staff managed by top provider and payer executives at UPMC. The innovation team is presently engaged in more than a dozen commercial partnerships, including support for Vivify Health’s chronic care telehealth solutions, medCPU’s real-time decision support solutions and Health Catalyst’s data warehousing and analytics solutions. Each project is focused on the goal of improving patient outcomes. The innovation group was recently rumored to be partnering with Microsoft on machine learning initiatives and the results may have a profound impact on how we use technology in care delivery.

UPMC Enterprises supports entrepreneurs—both internal individuals and established companies—with capital, technical resources, partner networks, recruiting and marketing assistance to support innovation. Dedicated focus in the following areas lends structure to the innovation program:

  • Translational science
  • Improving outcomes
  • Infrastructure and efficiency
  • Consumer engagement

All profits generated from investments are reinvested to support further research and innovation.

Innovation at Intermountain Healthcare

Like UPMC, Intermountain’s Healthcare Transformation Lab supports innovation in the areas of telehealth and natural language processing (NLP), among others. Like most providers, one of Intermountain’s primary goals is controlling costs. The group’s self-developed NLP program is designed to help identify high-risk patients ahead of catastrophic events using data stored in free-text documents. Telehealth innovations let patients self-triage to the right level of care to incentivize use of the least expensive form of care available. Intermountain’s ProComp solution offers its providers on-the-spot transparency about the cost of instruments, drugs and devices they use. That innovation alone net the health system roughly $80 million in reduced costs between 2013 and 2015.

Most of Intermountain’s innovation initiatives are physician led or co-led. The program strives for small innovations in day-to-day work, supported by a suite of innovation support services and resource centers. Selected innovations from outside startups are supported by the company’s Healthbox Accelerator program involvement, while internal innovations are managed by the Intermountain Foundry. Intermountain offers online innovation idea submissions to promote easy participation. The health organization’s $35 million Innovation Fund supports innovations through formalized investment criteria and trustee governance resources. It is important to note that Intermountain Healthcare is interested in all aspects of innovation including supply chain and other non-clinical related projects.

Innovation at Mayo Clinic

Mayo Clinic’s Center for Innovation (CFI) brings in innovation best practices from both healthcare and non-healthcare backgrounds to drive new ideas. The innovation team’s external advisory council is comprised of both designers and physicians to drive innovation and efficiency in care delivery. The CFI features a Multidisciplinary Design Clinic that invites patients into the innovation process as well.

CFI staff found it was essential to show physicians data that demonstrated known problems and how proposed innovations could make a difference to their patients. They emphasize temporary changes, or “rapid prototyping,” to garner physician buy-in. Mayo’s CFI promotes employee involvement in innovative design through its Culture & Competency of Innovation platform, which features weekly meetings, institution-wide classes, lunch discussion groups and an annual symposium. Mayo’s innovation efforts include these additional physician-led platforms:

  • Mayo Clinic Connection—supporting shared physician experience
  • Prediction and Prevention
  • Wellness—promoting patient education
  • Destination Mayo Clinic—focused on improving patient experience

While these innovation examples represent large healthcare organizations, fostering innovation does not require a big budget. Mayo Clinic’s “think big, start small, move fast” approach to innovation illustrates a common thread among successful innovation programs. Here are practical strategies to advance innovation in healthcare, regardless of organizational size or budget.

Four Steps to Implementing an Innovation Program in Your Organization

Innovation doesn’t have to be grandiose or expensive. Organizations can start small. Begin by opening a companywide dialogue on innovation and launching a simple, online idea submission process to engage personnel in your organization. The most important part of this process is educating your teams to understand how to evaluate new innovations against a relatively pre-defined set of criteria.  For example, are you trying to improve patient safety, quality of care, reduce cost, increase patient or physician satisfaction, etc.

Another key element of successful innovation is encouraging collaboration and participation across a wide variety of stakeholders. Cross-functional teams bring multifaceted perspectives to the problem-solving process. Strive for incremental gains in facilitating opportunities for cross-department collaboration in your organization. This is particularly important for the implementation step.

Measure success using performance metrics where clinical efficiencies are concerned. Physician satisfaction, while difficult to quantify, can also pose big wins. You can expect some failures, but stack the odds by learning from other departments, organizations and industries to avoid making the same mistakes.

To work, innovation must happen often and organically. Dedicate funding, establish cross-department teams and build a formal process for vetting internal ideas. Consider offering staff incentives to drive engagement. Not all ideas will succeed. Identify metrics that will help determine ROI (not all ROIs are measured in dollars) on pilot programs so you can weed out initiatives that aren’t delivering early on to protect resources. Also, keep in mind that you can improve these innovations at each iteration.  Make the process iterative and roll out the initiatives quickly. If it fails, shut the process down quickly and move on. If it is successful, improve it for the next iteration and scale it quickly to maximize the benefits.

Whether you’re cross-pollinating internal teams to promote innovation, building partnerships with other organizations or leveraging technology to better connect providers and patients, healthcare’s ability to successfully collaborate is vital to advancing innovation in healthcare.

About Peyman S. Zand
Peyman S. Zand is a Partner at Pivot Point Consulting, a Vaco company, where he is responsible for strategic services solving healthcare clients’ complex challenges. Currently serving as interim regional CIO for Tenet Healthcare, Zand was previously a member of the University of North Carolina Healthcare System, leading Strategy, Governance, and Program/Project Management. He oversaw major initiatives including system-wide EHR implementation, regulatory programs, and physician practice rollouts. Prior to UNC, Zand formed the Applied Vision Group, a firm dedicated to assisting healthcare organizations with strategic planning, governance, and program and project management for key initiatives.

Zand holds a Bachelor’s of Science in Computational Mathematics and Engineering from Michigan State University, and a Master of Business Administration from the University of Michigan.