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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.

The Millennial Paradox and My New Year’s Resolution

Posted on January 2, 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.

Simon Sinek always has some incredible insights. My wife pointed out this interview, the Millennial Paradox – it tackles the question of what Millennials are looking for in the workplace and also addresses issues with technology overload and our increased need for constant communication.

He speaks quite extensively about how technology is preventing us from establishing meaningful relationships. Its discussed in relationship to why Millennials have workplace challenges but while I am a generation removed from them I see that I share in these challenges and would likely find that many readers of this article do as well.

I suspect I’m not alone, but I have to admit that I’m allowing my phone to dominate my daily life and priorities. In the video, Simon describes how people take their phones to meetings and as a result, are not spending time building relationships with those they work with. I’ve been doing that lately – I put my phone on the table and feel the constant pull to check it. I need to check my email. I feel the siren call of the the vibrating phone and must see what it is.

I don’t generally do New Year’s resolutions. But this year, I’m making an exception. 2017 is the year I don’t carry my phone at every moment, the year that I might not respond to every text or email regardless of the hour, and overall the year that I reclaim control of my life from my iphone.

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.

Managing Health Information to Ensure Patient Safety

Posted on August 17, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

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

Electronic Medical Records (EMRs) have been a great addition to healthcare organizations and I know many would agree that some tasks have been significantly improved from paper to electronic. Others may still be cautious with EMRs due to the potential patient safety concerns that EMRs bring to light.

The Joint Commission expects healthcare organizations to engage in the latest health information technologies but we must do so safely and appropriately. In 2008, The Joint Commission released Sentinel Event Alert Issue 42 which advised organizations to be mindful of the patient safety risks that can result from “converging technologies”.

The electronic technologies we use to gather patient data could pose potential threats and adverse events. Some of these threats include the use of computerized physician order entry (CPOE), information security, incorrect documentation, and clinical decision support (CDS).  Sentinel Event Alert Issue 54 in 2015 again addressed the safety risks of EMRs and the expectation that healthcare organizations will safely implement health information technology.

Having incorrect data in the EMR poses serious patient safety risks that are preventable which is why The Joint Commission has put this emphasis on safely using the technology. We will not be able to blame patient safety errors on the EMR when questioned by surveyors, especially when they could have been prevented.

Ensuring medical record integrity has always been the objective of HIM departments. HIM professionals’ role in preventing errors and adverse events has been apparent from the start of EMR implementations. HIM professionals should monitor and develop methods to prevent issues in the following areas, to name a few:

Copy and paste

Ensure policies are in place to address copy and paste. Records can contain repeated documentation from day to day which could have been documented in error or is no longer current. Preventing and governing the use of copy and paste will prevent many adverse issues with conflicting or erroneous documentation.

Dictation/Transcription errors

Dictation software tools are becoming more intelligent and many organizations are utilizing front end speech recognition to complete EMR documentation. With traditional transcription, we have seen anomalies remaining in the record due to poor dictation quality and uncorrected errors. With front end speech recognition, providers are expected to review and correct their own dictations which presents similar issues if incorrect documentation is left in the record.

Information Security

The data that is captured in the EMR must be kept secure and available when needed. We must ensure the data remains functional and accessible to the correct users and not accessible by those without the need to know. Cybersecurity breaches are a serious threat to electronic data including those within the EMR and surrounding applications.

Downtime

Organizations must be ready to function if there is a planned or unexpected downtime of systems. Proper planning includes maintaining a master list of forms and order-sets that will be called upon in the case of a downtime to ensure documentation is captured appropriately. Historical information should be maintained in a format that will allow access during a downtime making sure users are able to provide uninterrupted care for patients.

Ongoing EMR maintenance

As we continue to enhance and optimize EMRs, we must take into consideration all of the potential downstream effects of each change and how these changes will affect the integrity of the record. HIM professionals need prior notification of upcoming changes and adequate time to test the new functionality. No changes should be made to an EMR without all of the key stakeholders reviewing and approving the changes downstream implications. The Joint Commission claims, “as health IT adoption becomes more widespread, the potential for health IT-related patient harm may increase.”

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

Is It a Hot or Cold Hospital EHR Buying Market? – Response

Posted on August 15, 2016 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.

This article is in response to John Lynn’s recent posting, Is It a Hot or Cold Hospital EHR Buying Market?

In his recent posting, John Lynn asked the question “Is it a Hot or Cold Hospital EHR Buying Market?”. In it he highlights a recent KLAS report that over 490 hospitals, a staggering 10% of the entire market, were involved in an EHR decision in 2015. After reading his posting, I wanted to take a moment to share my observations.

2015 was indeed an amazing year for EHR sales, partly driven by the pending sunset date of Mckesson Horizon forcing many customers to switch EHR solutions. Some of those customers are going to Paragon, but many more purchased or are evaluating other solutions. During a recent trip to Epic University, I was surprised to find that nearly half of the attendees of the classes were hospitals switching from Mckesson Horizon to Epic – and all had just recently completed their purchases (late 2015/early 2016) and were facing the same live dates of late 2017/early 2018.

Hospitals who have purchased and implemented Epic or Cerner are very unlikely to make a change. Regardless of which solution is preferred, the investment in these solutions and the level of effort required to switch from one to another is so high, that it would take a significant triggering event for a hospital to make that change. Therefore it is likely that customers on these solutions will not be making a change in the near future.

However, KLAS reports that nearly 40% of MEDITECH customers would change EMR’s if they could, and that Paragon customers also report unrest. Therefore in addition to the shrinking number of those that have not implemented a viable EHR solution, the possibility that there will be a wave of customers switching from one of these solutions to Epic or Cerner remains a consideration. There is also the question of how the recent spin-off of Mckesson’s software division will impact the future of Paragon. If Paragon were discontinued or sold, it could lead to another explosion of EHR decisions. If instead there was a significant investment in the solution, it could become a more viable alternative as customers look to switch from one EHR to another.

I suspect that 2016 will be another strong year from EHR sales in general and for Epic and Cerner in particular. Beyond that, much will depend on the strength of the other solutions and which ones break out into the top tier. Regardless, the recent explosion of EHR sales and the rush to replace Horizon will in many cases lead to minimized installs – where the bare minimum work was completed and there is significant opportunity to improve business processes, implement new modules, and roll out advanced functionality within those solutions. As a result I believe that within a few years, the market will be more stabilized with fewer customers switching solutions, and instead focusing on maximizing what they have.

Unless another player comes in and disrupts the marketplace or a significant shift in the industry creates a reason to make a change yet again…

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.

Hospital Software Selection Done Right – Part 1: Introduction

Posted on August 1, 2016 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.

Making a decision on which new EHR, ERP, or other major software solution is a process that must be taken seriously. The right decision can lead the hospital to the next level of automation, efficiency, and patient safety. The wrong decision can lead to a disaster, and therefore be a career-limiting move for those that make it. In addition, the right decision is subjective. Those that did not participate in the selection process may have their own opinions. At best, they could exhibit behaviors of frustration with the decision or passive resistance. At worst, they could actively look for opportunities to challenge the project decisions and increase risk of failure.

Over the course of several articles I will be analyzing the software selection process piece-by-piece and share the key components of a successful software selection. We will be looking at the process from a variety of goals and perspectives. This will include making sure that the result is the best possible solution, ensuring the process is run effectively, and getting engagement from the right members of the hospital staff to obtain buy-in and excitement, or at least acceptance, of the end decision.

An effective software selection starts with assembling the right team which must be a good representation of the user base while also being nimble enough to make effective decisions. In the first article of the series, I will share suggestions and lessons learned about how to structure and staff software selection teams including engaging physician and clinical staff in the process.

Additional articles will look at the RFI/RFP process and how to create an effective RFP with minimal effort, including critical aspects of content and how to complete the RFP process with minimal or no third party assistance. Often healthcare organizations spend significant amounts of money and time creating RFP documents that provide minimal value and slow down the selection process.

I will also look at the process of narrowing down vendors and actual selection logistics. That includes what to look out for in vendor demonstrations, how to maximize the time of your staff, surveying, reference checks, and driving to final decisions.

I hope that readers enjoy the articles and find that it helps you as you plan future software selections. Please share where you agree and disagree as well as comments and suggestions along the way.

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.

HIMSS: The View from the Other Side of the Booth

Posted on February 29, 2016 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.

Today is the first day of the largest IT conference in our industry. Chief Information Officers and other technology leaders from hospitals across the country have started to arrive in Las Vegas for a week of presentations, networking, and entertainment. I have participated in HIMSS and other conferences in the past in many capacities – as a speaker, as media, as someone doing research on products, and in many circumstances as a vendor using the show to promote our products and services. As our readers are primarily hospital staff, I thought perhaps it would be beneficial to share what it is like attending a conference from the other side of the booth.

As the owner of a consulting firm that attended many different events, what I will always remember about them is the amount of work that goes into having a booth at a large trade show. The week begins with excitement about meeting with current and potential customers and ends with physical and mental exhaustion as the long hours and fast pace begin to take its toll.

Vendors make a huge investment into trade shows. For many vendors attending HIMSS, their presence at the show may be the largest marketing investment that they make each year. There are so many factors of cost to consider. There is the booth itself, both creating an effective and interesting booth display as well as paying for the space on the convention floor. Getting the booth setup and broken down is often also a costly affair as shipping costs can be substantial and most convention centers require use of expensive union labor to move your booth to its location and to complete setup or breakdown. Brochures and other takeaways must be printed, various booth loot for people who stop by must be created and shipped. The cost for travel of staff to the show, hotels, and meals can often exceed the costs for displaying at the event. Then there is the often substantial investment in sponsoring events or providing entertainment and meals to current, and hopefully future clients.

HIMSS is such a big event, with 40,000 people expected to attend and 1,300 vendors, that it can be very challenging for each vendor to stand out and get attention. A large booth in an area with heavy traffic will be a major investment and require significant number of staff to participate. A small booth in a slower area will be a smaller investment, but risks providing minimal return as such as small percentage of potential customers will pass through. Each vendor must decide how to balance the costs with the potential benefits and make sure that their significant investment is maximized and worthwhile.

Tracking success of shows often is also complicated. Large IT decisions are rarely made at trade shows. More often, these shows represent the beginning of the decision making process that could take months or years as CIO’s explore options. These shows are also about connecting with existing customers to show them that you value their business – while every other vendor tries to take that business away from you. Often its not only new business that drives vendors to participate in these events – but also the cost of not attending is considered and the message that it may send to your existing customer base. A booth at a show is a demonstration of a vendor’s commitment to the industry and to be where there customers are going to learn about the changes in the industry.

Vendors will invest significantly in entertainment events – liberally inviting any CIO they can find to dinners or drinks in the hopes of building a new relationship or reinforcing an existing one. These can range from simple dinners to something more elaborate and unique. At one trade show in San Diego, another firm rented a deck on the Midway so that their customers could attend a party on an aircraft carrier. Personally I never valued these events much as a potential customer nor as a vendor, but for many attendees it is a highlight of attending trade shows and for many vendors their largest investment.

I recall at one event my company decided to get branded stress balls. We got the highest quality stress balls we could find – not wanting to give out something cheap but rather something that people would keep on their desk and actually use. They cost us $4 each. I remember being at the booth and having many people stop by because they saw the stress balls from someone else – which was great because it brought more people to the booth. But then people starting coming by and taking handfuls of them without even looking at our booth or talking to us. They made comments about how they could make great chew toys for their dogs or they were getting extra for their kids. As these thousands of stress balls disappeared, it occurred to me that our huge marketing budget was going to, literally, end up in the dog house.

Perhaps the purpose in writing this posting is to send a message to all of you that are attending HIMSS to respect the substantial investment that those on the other side of the booth make into these events. These vendors are directly responsible for most of the entertainment events and meals that you enjoy during the show. Indirectly they are a substantial portion of the show revenue that makes all the education events possible. Take the time to wander through the vendor halls and see what they are offering. You can’t stop at all of them, but choose the ones that you have a genuine interest in rather then those that offer the best chotskis. Choose to attend events for companies that are your business partners to help to support them, or companies with which you have a genuine interest in a business partnership. The best long term friendships and business relationships can come from these events if they are approached properly.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here.

Introduction to Healthcare Optimization Scene

Posted on February 17, 2016 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.

Editor’s Note: We want to offer a warm welcome to the latest blogger to join the Healthcare Scene family, Brian G. Rosenberg. Brian will be writing our new series we’re calling the Healthcare Optimization Scene. Brian has an incredible background and experience with ERP and EHR in healthcare and will be able to bring some really unique and in the trenches perspectives on how to get the most out of your EHR and ERP investments. We’re so excited to have Brian join us and we think you’ll be glad too.

Welcome to Healthcare Optimization Scene, the newest member of the Health Scene blog network.

Healthcare IT projects are often about much more then replacing software.  They often represent significant transformations in business operations and alter the role of people and processes within the hospitals.   The ability of an organization to understand and manage these changes as well as ultimately to embrace them is often as important, if not more important, then the actual capabilities of the software solutions being implemented.   Change Management and Project Management of significant software projects, primarily as it relates to EHR and ERP projects, will be one of our key topics of discussion in this blog series.

One of the most common mistakes in implementation of these software solutions is the expectation is that the date of go-live for a major new software initiative is the end of the project.   The reality is that the go-live is the middle of the project, the end of the implementation phase and the beginning of the on-going optimization phase. Without optimization, the true value of the software is never achieved and the slow but steady breakdown of the standardization and benefits of the software begins.  Another topic for this blog series will be to discuss how to create a culture of continual improvement in the use of software within your healthcare organization with the goal of fully realizing the reasons the solution was implemented.

I have been working for nearly twenty years in leading software implementation and optimization projects for healthcare providers for both EMR/EHR and ERP projects.  I will be sharing with you my ideas about how to lead successful implementations as well as techniques to optimize the use of software within your organizations.  In addition, I will be sharing articles and industry news that relates to these topics.  Here are just a few examples of the subjects that you can expect to see discussed on Healthcare Optimization Scene:

  • Software selection
  • Implementation Strategy
  • Change Management and Communication Planning
  • Project Management
  • Metrics and Key Performance Indicators
  • Driving value out of EHR and ERP solutions
  • Business Process Improvement
  • Why projects succeed – and why projects fail (as well as defining what succeeding or failing means)

I encourage you to share your ideas for the type of content you would like to see covered in this forum.  Please share your ideas and comments on the articles and ideas presented.  The more the readers share their ideas, the more valuable the forum will be for everyone.

Be sure to connect with me on LinkedIn as well.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here.