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Achieve MU3: Measure 3 with these 5 MEDITECH Clinical Decision Support Interventions (CDSi)

Posted on August 11, 2017 I Written By

The following is a guest blog post by Kelly Del Gaudio, Principal Consultant at Galen Healthcare Solutions.

Over the past several years, there has been significant investment and effort to attest to the various stages of meaningful use, with the goal of achieving better clinical outcomes. One area of MU3 that directly contributes to improved clinical outcomes is implementation of Clinical Decision Support Interventions (CDSi). Medicaid hospitals must implement 5 CDSi and enable drug-drug and/or drug-allergy checking.

From looking at this measure it seems like a walk in the park, but how does your organization fair when it comes to CDS?

Thanks to First Databank, users of EMR’s have been accomplishing drug to drug and drug to allergy checking for over a decade, but what about the edge cases you think will be covered but aren’t? Take a patient that is allergic to contrast for example. Since imaging studies requiring contrast are not drugs, what happens when they are ordered? Are they checking for allergies? In most cases, additional configuration is required to get that flag to pop. This is usually where we come in.

Let’s take a look at a simple CDSi definition provided by CMS.gov

“CDS intervention interaction. Interventions provided to a user must occur when a user is interacting with technology. These interventions should be based on the following data:  Problem list; Medication list; Medication allergy list; Laboratory tests; and Vital signs. “

Without a decent rule writer on staff, there are limitations within MEDITECH for accomplishing full CDSi. The primary reason we started recording these discrete data elements in the first place is the glimmer of hope that they would someday prove themselves useful. That day is here, friends. (If you don’t believe me, check out IBM’s Watson diagnosing cancer on YouTube. . .you might want to block off your schedule.)

In collaboration with 9 hospitals as part of a MEDITECH Rules focus group – Project Claire[IT] – we researched and designed intuitive tools to address Clinical Quality Measures (eCQM’s) and incorporated them into a content package. If your organization is struggling to meet these measures or you are interested in improving the patient and provider experience, but don’t have the resources to dedicate to months of research and development, Project Claire[IT]’s accelerated deployment schedule (less than 1 month) can help you meet that mark. Below are just some examples of the eCQM’s and CDS delivered by Project Claire[IT].

CMS131v5     Diabetes Eye Exam
CMS123v5     Diabetes: Foot Exam
CMS22v5       Screening for High Blood Pressure and Follow-Up Documented

Synopsis: The chronic disease management template will only display questions relevant to the Problem List (or other documented confirmed problems since we know not everyone uses the problem list). Popup suggestions trigger orders reminding the provider to complete these chronic condition follow-up items before letting the patient out of their sights. Our goal was to save providers time by ordering all orders in 1 click.

CMS71v7     Anticoagulation Therapy for Atrial Fibrillation/Flutter
CMS102v6   Assessed for Rehabilitation

“The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation.” – CMS71v7

The above quote is taken directly from this measure indicating the use of the Framingham Heart Study we used to identify and risk stratify stroke. Claire[IT] content comes complete with three Framingham Scoring tools:

                Framingham Risk for Stroke
                Framingham Risk for Cardiovascular Disease
                Framingham Risk for Heart Attack

These calculators use all the aforementioned data elements to drive the score, interpretation and recommendations and the best part is they only require one click.

*User adds BP. BP mean auto calculates. Diabetes and Smoking Status update from the Problem List. Total Cholesterol and HDL update from last lab values.
Ten year and comparative risk by age auto calculates.

*User adds BP. BP mean auto calculates. Diabetes, Smoking Status, CVD, Afib and LVH update from the Problem List. On Hypertension meds looks to Ambulatory Orders.
Ten year risk auto calculates.

*User adds BP. BP mean auto calculates. Diabetes and Smoking Status update from the Problem List. Hypertension meds looks to Ambulatory Orders. Total Cholesterol and HDL update from lab values.
Ten year risk auto calculates.

CMS149v5      Dementia: Cognitive Assessment

Synopsis: Not only is this tool built specifically as a conversational assessment, it screens for 4 tiers of mental status within one tool (Mental Status, Education, Cognitive Function and Dementia). The utilization of popup messages allows us to overcome the barrier of character limits and makes for a really smooth display on a tablet or hybrid. Our popups are driven by the primary language field in registration and our content currently consists of English and Spanish translations.

CMS108v6     VTE Prophylaxis
CMS190v6     VTE Prophylaxis is the ICU

Synopsis: Patients that have an acute or suspected VTE problem with no orders placed for coumadin (acute/ambulatory or both) receive clinical decision support flags. Clicking the acknowledge tracks the user mnemonic and date/time stamp in an audit trail. Hard stops are also in place if NONE is chosen as a contraindication. The discharge order cannot be filed unless coumadin is ordered or a contraindication is defined. These rules evaluate the problem list and compare it to the medication list to present the provider with the right message.

Learn more about the work of our focus group and Project Claire[IT] by viewing our MEDITECH Clinical Optimization Toolkit.

VIEW THE TOOLKIT TO ACCESS:

  • Deliverable Package of Complex Rules, Assessments, CDS’s and Workflows
    • Problem List Evaluation
    • Total Parenteral Nutrition
    • Manage Transfer Guidance
  • Surveillance Dashboard Setup Guide
    • Dictionary Setup & Validation
  • 6.x Rules Setup Guide
    • Basic Rules for Assessments, Documents & Orders
  • IV Charge Capture Setup Guide

About Kelly Del Gaudio
Kelly is Principal Consultant at Galen Healthcare Solutions, and has been optimizing MEDITECH systems for over 10 years. She worked for MEDITECH on an elite 4-person team (the MEDITECH SWAT Team), whose sole concentration was clinical optimization, ROI analysis, MU certification, and achievement of HIMSS EMRAM Stage 6/7. Kelly currently leads Galen’s MEDITECH practice, and championed a focus group, which led to the delivery of Project Claire[IT], a MEDITECH content package of complex rules, assessments, CDS’s, and workflows that evaluate, suggest, and support documentation of chronic and acute problems. Learn more about Kelly in the #IAmGalen series.

About Galen Healthcare Solutions

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

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?

Patient Engagement and Collaborative Care with Drex DeFord

Posted on August 7, 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.

#Paid content sponsored by Intel.

You don’t see guys like Drex DeFord every day in the health IT world. Rather than following the traditional IT career path, he began his career as a rock ‘n roll disc jockey. He then served as a US Air Force officer for 20 years — where his assignments included service as regional CIO for 12 hospitals across the southern US and CTO for Air Force Health — before focusing on private-sector HIT.

After leaving the Air Force, he served as CIO of Scripps Health, Seattle Children’s Hospital and Steward Health before forming drexio digital health (he describes himself as a “recovering CIO”). Drex is also a board member for a number of companies and was on the HIMSS National board and the Chairman of CHIME.

Given this extensive background in healthcare IT leadership, we wanted to get Drex’s insights into patient engagement and collaborative care. As organizations have shifted to value based reimbursement, this has become a very important topic to understand and implement in an organization. Have you created a culture of collaborative care in your organization? If not, this interview with Drex will shed some light on what you need to do to build that culture.

You can watch the full video interview embedded below or click from this list of topics to skip to the section of the video that interests you most:

What are you doing in your organization to engage patients? How are you using technology to facilitate collaborative care?

EMR Clinical Optimization CIO Perspectives – EMR Clinical Optimization Series

Posted on July 26, 2017 I Written By

The following is a guest blog post by Julie Champagne, Strategist at Galen Healthcare Solutions.

Most HDOs today face a decision: start over with a new EMR or optimize what you have. A poorly executed implementation, coupled with substandard vendor support, makes EMR replacement an attractive and necessary measure. Further, the increase in mergers and acquisitions is driving system consolidation and consequently increasing the number of HDOs seeking EMR replacement to address usability and productivity concerns.

Galen Healthcare Solutions spoke with two prominent health information technology leaders, who have quite a bit of experience in the optimization field to hear their views on the topic. Sue Schade, MBA, LCHIME, FCHIME, FHIMSS, is a nationally recognized health IT leader and Principal at StarBridge Advisors, providing consulting, coaching and interim management services. Jim Boyle, MPH, CGEIT is Vice President of Information Services of St. Joseph Heritage Healthcare (Anaheim, Calif.). In his current role, Jim oversees the delivery of applications and technology and is a member of the executive leadership team. Below are their perspectives

Opportunities for EMR optimization generally fall into three categories:

  • Usability & efficiency: Improve end-user satisfaction and make providers more efficient and productive
  • Cost Avoidance: Improve workflows to increase utilization and decrease variability
  • Increase Revenue: Implement analytics to transition from volume to value


Recently, three prominent Boston-area physicians contributed an opinion piece to WBUR, “Death By A Thousand Clicks”. They postured that when doctors and nurses turn their backs on patients in order to pay attention to a computer screen, it pulls their focus from the “time and undivided attention” required to provide the right care. Multiple prompts and clicks in an EMR system impact patients and contribute to physician burnout.

HDOs should then limit their intake to what can be accomplished within one quarter, referred to as a sprint. Accountability should be assigned, and visual controls or Kanban should be leveraged.


 
For HDOs that experienced failed EMR implementations, making corrections and reengineering is a necessary first measure. Typically, a deficiency in the additional support for the system implementation is to blame, and employing qualified application support staff will help to address and resolve end user dissatisfaction.
 
 
 
To realize lasting impact from the EMR, extensive post go-live enhancement and optimization is needed. Leveraging the operational data in the EMR system can support many initiatives to improve workflows, as well as clinical and financial performance. Prioritization of the levers that can be adjusted depends on the HDO’s implementation baseline and strategic goals.

 
The most important deciding success factor for an optimization project is focusing effort and ensuring the scope is not too large. Further, it is of critical importance to set measurable and attainable metrics and KPIs to gauge the success and ROI of the initiative. Quantification of staff effort and IT investment is also important.

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

About Sue Schade
Sue Schade, MBA, LCHIME, FCHIME, FHIMSS, is a nationally recognized health IT leader and Principal at StarBridge Advisors providing consulting, coaching and interim management services. Sue is currently serving as the interim Chief Information Offi cer (CIO) at Stony Brook Medicine in New York. She was a founding advisor at Next Wave Health Advisors and in 2016 served as the interim CIO at University Hospitals in Cleveland, Ohio. Sue previously served as the CIO for the University of Michigan Hospitals and Health Centers and prior to that as CIO for Brigham and Women’s Hospital in Boston. Previous experience includes leadership roles at Advocate Health Care in Chicago, Ernst and Young, and a software/outsourcing vendor. Sue can be found on Twitter at @sgschade and writes a weekly blog called “Health IT Connect” – http://sueschade.com/

About Jim Boyle
Jim Boyle, MPH, CGEIT is a Vice President of Information Services of St. Joseph Heritage Healthcare (Anaheim, Calif.). Jim Boyle is nationally recognized as part of a new generation of health care informatics professionals who understand IT’s full potential to greatly improve peoples’ lives. In his current role Jim oversees the delivery of applications and technology and is a member of the executive leadership team for St. Joseph Heritage Healthcare, which comprises over 860 medical group providers and 1300 affiliated physicians across California. Since joining St. Joseph Health 12 years ago, he has held eight different positions, including project manager, application analyst and IT director at Fullerton, Calif.-based St. Jude Medical Center. Jim can be found on Twitter at @JBHealthIT and LinkedIn.

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

 

KLAS Keystone Summit and Enterprise Imaging

Posted on July 21, 2017 I Written By

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

EMR Clinical Optimization Infographic – EMR Clinical Optimization Series

Posted on July 12, 2017 I Written By

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


(See Full EMR Optimization Infographic)

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

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

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

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


(Click to see larger version of graphic)

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

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

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

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

WannaCry Will Make a CIO Cry

Posted on July 3, 2017 I Written By

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

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

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

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

Ransomware Threat in Hospitals

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

How Companies Can Prevent Ransomware Attacks

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

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

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

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

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Deriving ROI from Data-driven EMR Clinical Optimization

Posted on June 28, 2017 I Written By

The following is a guest blog post by Justin Campbell Vice President, Strategy, at Galen Healthcare Solutions.  Learn more about their work by downloading their EHR Clinical Optimization Whitepaper.

Resistance to change is natural. People are uncomfortable with it. Organizations are frightened by it. Acceptance of healthcare information technology took a long time and even in these first two decades of a new century, despite incentives such as the Meaningful Use program, and promises of increased efficiency, implementation of Electronic Medical Records has been a bumpy ride.

Between 2008 and 2016, healthcare organizations spent more than 20 billion dollars adopting electronic health record systems. Many different approaches were applied. Many HCOs decided to act quickly, using what we now call a “Big Bang” fix. Installations of generic systems were in place but users of the new systems were unhappy. In 2013, with the process well underway throughout the nation, two thirds of doctors polled said they used EMR systems unwillingly, with 87% of these aggravated physicians complaining about usability and 92% of physician practices complaining that their EMRs were “clunky” and/or too difficult. Specifically, only 35% reported that it had become easier to respond to patient issues, one third said they could not more effectively manage patient treatment plans, and despite the belief that technology would permit caregivers to spend more time with their patients, only 10% said this was occurring.

The medical side was not alone in expressing dissatisfaction. Hospital executive and IT employees who had replaced their Electronic Health Record systems reported higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits gained:

  • 14% of all hospitals that replaced their original EMR since 2011 were losing inpatient revenue at a pace that would not support the total cost of their replacement EMR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive-level respondents admitted they feared losing their jobs as a result of the EMR replacement process
  • 66% of the system users believe that interoperability and patient data exchange functionality have declined.


Not all reviews are negative. There is strong support and appreciation for EMRs in some Healthcare Delivery Organizations (HDOs) who believe well-designed EMRs save time and support clinical workflows. But, there is no escaping the majority sentiment: EMRs are not designed for the way providers think and work.

Today, most HDOs are at a crossroads. They can start over with a new EMR or optimize the one they have. The case for a do-over is supported by sub-standard vendor support for their existing systems and the increase in mergers and acquisitions, which drive system consolidation. One fifth of large practices and clinics report they intend to replace their EMRs and studies show that the EMR replacement markets will likely grow at an annual rate of 7%-8% over the next five years. The case for the status quo is made primarily by the HCOs that do not have the financial resources to undertake EMR replacement.

All options face the same key inter-related questions: how to generate additional margin? How to maximize return on technology investments? Which path will best serve the HCO, caregivers and patients?

This is a bit of vicious circle. HCOs are cash-strapped and the transition from fee for service to value-based care exerts downward cost pressures, exacerbating the problem. But patchwork fixes have not resolved that problem. Alternatively, some attempted to do too much too quickly and became frustrated because they lacked the depth of experience and knowledge to perform remediation. And, as KPMG concluded after studying the problem, “The length of time to resolve the issues increased and frustrations mounted as clinical, senior management, IT and human resources staff found themselves spinning their wheels.”

Like a patient being pressured to swallow medicine, HDOs are beginning to accept their situation. According to a recent survey conducted by KPMG in collaboration with CHIME, 38% of 112 respondents ranked EMR/EMR optimization as their top choice for the majority of their capital investments for the next three years.

EMR adoption is already approaching maximum levels. Consequently, healthcare delivery organizations have begun to shift their EMR strategies from short-term clinical documentation data repositories to long-term assets with substantial functionality in support of clinical decisions, health maintenance planning and quality reporting. They are coming to see their IT investments as platforms rather than limited systems of record or glorified data banks. In short, they now understand that the capture of information is only the most basic attribute of an EMR, and that instead, the EMR in which they invest can be flexible and extensible, capable of adopting emerging technologies that are driving insights to the point of care.

Assess opportunity, formulate strategy, improve usability & derive additional ROI & by downloading our EHR Clinical Optimization Whitepaper.

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

About Galen Healthcare Solutions

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

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?

Talking Secure Healthcare Communication with Telmediq Founder and CEO

Posted on June 9, 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’ve had a keen interest in the secure text message space ever since I started advising a company in the space many years ago. That company has since been acquired, but I’ve still been keeping watch over the secure text message market. Even back in the early days, we knew that the real holy grail of secure text was to integrate with the EHR and other applications and become a full communication suite and not just a simple text message platform. However, it would take time to really get there. What’s exciting is that we’re starting to see companies that are finally getting there.

One company that’s been making great progress in this direction is a company called Telmediq. Unlike most secure text message companies who started with the physicians, Telmediq approached the secure healthcare communication problem initially from the perspective of nurses. This together with a number of their integrations with EHR and other hospital IT systems prompted me to sit down with Ben Moore, Founder and CEO at Telmediq to learn more about their company and the evolving healthcare communication market.

If you’ve never heard about Telmediq or if you’re interested in what’s happening in the healthcare communication space now and where it’s heading in the future, then you’ll enjoy our interview with Ben Moore. We cover a lot of ground including things like EHR integration, voice integration, alert fatigue, hands free communication, and future items we’re just starting to see like AI and chatbots.

Enjoy our interview with Ben Moore, Founder and CEO at Telmediq: