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The Forgotten Pieces of Healthcare IT

I’ve obviously been thinking a lot lately about the rest of the healthcare IT world beyond EHR software. We’ve had such a focus on EHR software, that we’ve forgotten a lot of other IT projects that need attention. I saw a quote recently that a CIO is no longer just managing the IT infrastructure. I believe that’s spot on.

A hospital CIO needs to be an integral part of the business decisions of their organization. You can’t buy a few hundred million (or a few billion) dollar EHR and not think that it won’t have a major economic impact on your organization. However, while a hospital CIO needs to do more than just IT infratructure, they still have to do the IT work as well.

I was thinking about all of the various IT projects that a hospital CIO could still be managing:

  • Internal Network
  • External Internet Connection
  • Firewalls
  • Data Center (this could be a few hundred things in itself)
  • Servers/Virtualization
  • Desktops (virtual or otherwise)
  • Mobile Devices (cell, tablets, etc.)
  • Telephony
  • Identity Management
  • Email
  • Shared Drives
  • Printers
  • Scanners
  • Biometrics

I’m sure I’m leaving some obvious ones off. Please add to the list in the comments. However, even just looking at this is pretty overwhelming. Luckily, most hospital CIOs have a lot of people helping them support all of these efforts. However, each one needs to be considered and managed.

Take a simple example like email. You’d think we’d have it down to a science and we kind of do. However, if you host it in house, you have to constantly stay on top of it, update the software, manage mailbox sizes, spam filters, etc. Whether you outsource your email or keep it in house you also have to manage all the account creation and deletion. You have to provide ongoing help desk support and training.

The point I’m trying to make is that each one of these technologies has its little nuances. It takes time and effort to do them well. Unfortunately, many of them have been transgressed as the all hands on deck EHR efforts have occurred. Now we’re heading back to clean up these messes. Looking at the list above, there are a lot of possible messes waiting for a hospital CIO.

August 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

The Place of EHR in the Hospital IT Ecosystem

I’ve been thinking a lot about EHR software and the part it plays in the hospital IT ecosystem. The $36 billion of EHR stimulus money has shined a big light on EHR software. No doubt the EHR incentive money has increased EHR adoption, but at what cost. I wonder if the EHR incentive money has caused many hospital IT teams to place undue emphasis on the EHR software.

The reality of a hospital IT ecosystem is that they usually have hundreds of healthcare IT systems in their organization. The EHR is just one of those systems. In fact, it might not even be the largest system. Their ERP system (usually Peoplesoft or SAP in large hospitals) could be larger. However, try being system #90 at a hospital. Do you think the IT people at a large hospital system are paying much attention to what’s happening to that system? Not only are they distracted chasing the EHR incentive money, but even without that incentive there are 89 other systems in front of it.

I’m reminded of this Healthcare CIO Mindmap that I posted previously. It’s a great image of the amazing complexity that a healthcare CIO is facing. Each of the branches on that mindmap represent one or more IT systems that have to be managed by an organization. That’s a complex and challenging task.

I guess my message here is that while the EHR is extremely important to an organization, don’t lose track of all the other healthcare IT systems you support. They won’t likely be noticed in the short term, but transgressing these smaller health IT systems will create organizational debt that will be hard to overcome in the future.

August 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Negative Maintenance Leadership

It seems like I have a little trend of leadership posts going on. This one goes along the lines of my previous post where I talked about Surpassing Expectations. The next leadership concept that I want to talk about comes from Brad Feld and he calls it Negative Maintenance.

Here’s how Brad describes it from his perspective:

There are days that I’m high maintenance. Everyone is. But if you subscribe to my “give before you get”, or #givefirst, philosophy, you are constantly contributing more than you are consuming. I’ve talked about this often in the context of Startup Communities, but I haven’t really had the right words for this in the context of leadership, management, and employees in a fast growing company.

I think that this description applies just as well to healthcare organizations. We all know the Hospital CIO who takes more than he gives. The hospital CIO that makes a project 10 times harder than it needs to be with the exact same (or sometimes worse) results. Hopefully you’ve also known leadership that makes your life easier. They remove roadblocks. They clearly articulate the path forward. They make the work easier as opposed to harder.

The same applies to anyone on a project team. There are those people on a team that are high maintenance, no maintenance, and negative maintenance. The highest performing teams are those that have a team full of negative maintenance people.

What kind of team member are you?

August 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

EHR Consolidation Continues as Cerner Acquires Siemens Soarian

The big news that had been rumored for a while was that Cerner was going to acquire the Siemens Health Services product line including Soarian. The rumor became reality as the acquisition was announced today. You can see the investor slide deck they published here. Most notably, Cerner has committed to supporting the Siemens Soarian product line for a decade:

Following the acquisition, support for Siemens Health Services core platforms will remain in place. Current implementations will continue, and Cerner plans to support and advance the Soarian platform for at least the next decade.

Of course, it’s one thing to suggest this in a press release. It’s another thing to actually do it in practice. However, it was smart of them to announce this approach to allay the fears of Soarian customers. If enough Soarian customers move over to Cerner, then you can be sure the announcement to sunset Soarian will happen. That’s a feature of EHR acquisition and consolidation. It’s just too expensive, especially in this regulatory environment, to maintain two code bases which perform the same functions.

These stats about the combined organizations are quite interesting:

  • 20,000 associates in more than 30 countries
  • 18,000 client facilities, including some of the largest health care organizations in their respective countries
  • $4.5 billion of annual revenue
  • $650 million of annual R&D investment

The last one is interesting given yesterday’s post on R&D companies. However, I think one of the key numbers there is the associates in 30 countries. Siemens Health Services has approximately 5,000 client facilities in over 40 countries including a strong presence in Germany, Sweden, Austria, Spain, Norway, and the Netherlands. You can be sure that a large part of this acquisition by Cerner is being able to go after the global market. There’s a huge opportunity in many countries that haven’t had billions of dollars falsely stimulating the market.

What I found particularly interesting on the investor call about the deal was Siemens efforts to take care of their existing customers. I’d describe it as finding a soft landing for their customers. You can understand why this is important. Many of those Soarian customers are still Siemens customers in other parts of the business like radiology. Siemens no doubt didn’t want to kill their other business by selling Siemens Health Services.

We’ll see what comes of the Siemens and Cerner $100 million innovation budget. If you look at the wording it says stuff like up to $100 million budget. Plus, these two companies are going to have to work together on some projects regardless. Cerner needs the data Siemens has and Siemens will need to get the data into Cerner. Will anything beyond that really occur, I’m not as optimistic.

I did find Neil Patterson’s comments on the post-Meaningful Use era interesting. I’d love to explore more of what he sees in that future. One person described it as a move from documenting the care given to a patient to technology that drives the care given a patient.

I’m not sure hospital execs should be that excited about this acquisition. It takes out another competitor from keeping EHR vendors honest. This really is getting down to a two horse race between Cerner and Epic and I think this acquisition will put Cerner just ahead of Epic in market share.

I liked this tweet from Hospital CIO Will Weider about the acquisition:

August 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Do Consulting Firms Increase or Decrease Your Bottom Line?

I’ve been learning a lot more about the Health IT and EHR consulting industry as I work with many of them who post jobs on our Health IT job board. In fact, I’ve written previously asking the question, “Are Most EHR Consulting Companies Really Staffing Companies?” The reality is that many of the so called consulting companies out there are much more like staffing companies than they are consultants. It’s just a lot more sexy to call someone a consultant than a temporary staff member. Plus, it’s hard to charge the rates they do as a temporary staff member, but a consultant seems to justify the higher rates.

I should make clear that there’s nothing wrong with this approach to business. Many healthcare organizations need the temporary staff that consulting companies provide. However, it has diluted the term consulting quite a bit in the process.

If you’re looking for a good way to know what type of consulting company you’re working with consider this question: Does the Consulting Firm Increase or Decrease Your Bottom Line?

The reality is that consultants are expensive. It costs money to get someone to come in and share their time and expertise with you. Plus, when you look at how many “billable hours” a consultant has available to them with travel, finding business, etc, they have to charge a premium to make up that time. However, just because something costs money doesn’t mean that it’s not worth it.

If I told you that you could spend $50,000 and you would save $200,000, every one of you would do it. If I asked you if you’d spend $100,000 in order to generate $500,000 in increased revenue you’d all be interested. This is the model a great consultant provides. Sure, the numbers are projections of value and that what makes it difficult. Although, many consultants are hired these days to complete specific tasks as opposed to provide ROI. That’s how you can quickly recognize the difference between a true consultant and a temporary staff.

The challenge consulting companies face is that it’s much easier to prove that tasks were complete. It’s much harder to really impact a company’s bottom line.

July 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

HIPAA Compliant Texting

We’re quickly seeing HIPAA compliant texting as a standard in healthcare. Certainly there are some organizations that are resisting, but I fear for those healthcare organizations that are letting SMS run rampant in their organization. SMS is not HIPAA compliant and so that’s a real risk for an organization that allows it to go on. However, I’m seeing organizations across the country adopting a secure text messaging solution.

I’ve often said that the best way to solve a problem is to make doing the right thing easy or better than doing the wrong thing. This can easily be applied to HIPAA compliant texting. I outlined 11 reasons why a secure text message solution was better than SMS before and one of those reasons wasn’t the fear of HIPAA. Can someone really argue that SMS is better or acceptable?

Besides the argument that secure text messaging is dramatically better than SMS, the great part is that a plethora of secure text messaging solutions are available that are just as easy as SMS. I’m personally bias to docBeat since I’m an advisor to them and they’ve created a really great product. However, there are lots of other dedicated secure messaging companies including TigerText, docHalo, qliqSoft, and many more. Plus, that doesn’t even include large companies like Imprivata who offer Cortext and even athenahealth’s Epocrates has secure text messaging built into their product.

The day will soon come when a hospital gets hit with a HIPAA violation (possibly during a HIPAA audit) and insecure SMS will be the culprit. Considering the advancements in secure text messaging options, hospitals won’t have anywhere to hide. It’s very clear that there are HIPAA compliant options available and so I can’t imagine they’ll be lenient with organizations that aren’t doing something about it.

I’d love to hear your experience with HIPAA compliant text messaging. Do you use it in your hospital? What do you love or hate about it? Are you still using SMS?

July 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Do Hospital Leadership Pay Attention to Healthcare Startups?

Today I got the press release announcing the 2014 class of startup companies that will be participating in the New York Digital Health Accelerator (NYDHA) program. I’ll put the list of companies in the 2014 class at the bottom of this post for those that are interested.

While I find all of the various healthcare IT incubator/accelerator programs quite interesting, I wonder how many hospital executives are really paying attention to what’s happening with these companies. My gut feeling tells me that very few of them are watching it at all. The reality is that most of them are so busy with the operational aspects of their business that they don’t have time to look at the latest batch of healthcare IT startup companies. Although, I think this is a mistake since they could learn a lot about trends in the industry by looking at these companies.

However, I think there’s a deeper issue here than them just making the time to look at these companies. The larger issue is that most of these health systems write off the idea of working with these “startup” companies without even taking a look at what they’re doing. I think that this is part of the industrialized thinking that we need to change in healthcare to really improve.

Let’s also not confuse what I’m describing with being wreckless. We have a special duty in healthcare to take care of patients in the best way possible. I think working with healthcare IT startup companies helps us fulfill that duty. Sadly, I think many executives don’t see it that way.

What I think could help these executives is to have a forum where they could easily sort through the latest and greatest of what’s happening. Unfortunately, I don’t think anyone’s created that forum yet.

2014 NYDHA Healthcare Startup Companies
AllazoHealth addresses the problem of medication non-adherence by leveraging existing member data to anticipate which patients will not take their medications to predict how best to effectively influence each patient to take their medication.  (www.allazohealth.com)

Clinigence’s solution—built around clinical data analytics, sematic data aggregation, and predictive modeling—provides real-time clinically-based reports about care gaps which help healthcare providers improve outcomes to proactively address the shift to value-based models and the growing demand for quality patient care. (www.clinigence.com)

Covertix helps healthcare organizations protect and control confidential data shared between patients, healthcare professionals, hospital networks and third party vendors to improve their coordination of care.  (www.covertix.com)

iQuartic’s technology merges, structures and mines EHR, PBM, claims and mHealth data for analytics that inform and benchmark care based on outcomes/best practices and adjusted population.  (www.iquartic.com)

Noom makes software to help people live healthier.  For consumers, the Noom Weight Loss Coach, with over 11 million downloads, coaches users on nutrition and exercise. Noom’s different patient engagement apps are based on its consumer-facing app. (www.noom.com).

Quality Reviews empowers patients through their flagship product, RateMyHospital.com, a real-time, mobile patient feedback tool.  (www.q-reviews.com) 

Sense Health uses mobile technology to build personal connections between providers and high-risk Medicaid patients to improve outcomes and the quality of care.  (www.sensehealth.com)

July 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Balancing Operations with Strategic Thinking

One of the biggest challenges I see hospital CIOs facing is trying to balance the operational requirements of their organization with the high level strategic thinking that’s really needed to make an organization effective. I think we all underestimate the operational challenges that most hospital CIOs face. Most health IT organizations are relatively young and were put together at a break neck pace. This provides an exceptional challenge for hospital CIOs.

If all the hospital CIO was tasked with doing was meaningful use of a certified EHR, that could consume all of their time and it would still be a challenge to do it effectively. However, meaningful use is far from the only thing that hospital CIOs are dealing with in their organization.

Meaningful use gets all the press and so we often forget about all of the IT tasks that were originally associated with the office of the CIO. Things like managing the network, the computers, and all the other IT infrastructure has come a long way, but still requires a high quality leader to keep it up to date and working efficiently. A lot of us look at these things as commodities that every organization just has and does. This really discounts the effort and time that’s required to do this effectively.

When considering all these tasks that require the CIO’s attention, it’s no wonder that many don’t have (or don’t make) the time required to think about their organization in a strategic way. I’d suggest two ways that hospital CIOs can spend more time thinking strategically.

First, learn to delegate and trust the other leaders in your organization. This is much easier said than done. In some cases this means changing the leaders in your organization. However, more often it requires a shift in mentality as a leader. Trusting other people is hard, but absolutely necessary for you to make the most as a leader.

Second, schedule time into your calendar for strategic thinking. I assure you that you’ll feel a little odd doing this. It almost feels like you’re cheating your organization to schedule in time to work on the strategy of your organization. However, there’s definitely truth in scheduling. We do what we schedule. Just don’t cheat yourself during that time. It will be really easy for you to fudge that time and work on other things. Turn off the email. Turn off the cell phone if needed and spend the time focused on where you should take your organization.

Finding time and making an effort to not be overwhelmed by operations and think strategically is the very best thing you can do. Don’t cheat yourself or your organization by focusing on the wrong things.

July 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Large Health Facilities Have Major Patient Data Security Issues

Many healthcare organizations have security holes that leave not only their systems, but their equipment susceptible to cyberattacks, according to two recent studies.

The researchers included Scott Erven, head of information security for multi-state hospital and clinic chain Essentia Health, and Shawn Merdinger, an independent consultant. According to iHealthBeat, the two presented their findings last week at the Shakacon conference.

Erven and his colleagues conducted a two-year study addressing the security of Essentia’s medical equipment. As part of their study they found that hackers could manipulate dosages of drugs provided by drug infusion pumps, deliver random defibrillator shock to patients or prevent medically needed shocks from taking place, and change the temperature settings in refrigerators holding blood and drugs.

The research team also looked for exposed equipment within other healthcare organizations, and the results were appalling. Within only 30 minutes, iHealthBeat notes, they found one healthcare organization which had 68,000 devices that exposed data.  Across all of the health systems they studied, they found 488 exposed cardiology systems, 323 PACS systems, 32 pacemaker systems, 21 anesthesiology systems and and several telemetry systems used to monitor elderly patients and prevent infant abductions.

Both Erven and Merdinger found that the organizations are leaking data because an Internet-connected computer had not been configured securely. Typically, data leaks occurred because sys admins had allowed Server Message Block –a protocol used to help admins find and communicate with computers internally — and allowed it to broadcast information turning private data into publicly-accessible data.

According to Erven, these issues are “global” and impact thousands of healthcare organizations. He suggests that too often, healthcare organizations focus on HIPAA compliance and don’t put enough effort into penetration testing and vulnerability protection.

This should come as no surprise. After all, Proficio’s Takeshi Suganuma notes, HIPAA was developed to protect PHI for a wide range of organizations, and as he puts it, “one size seldom fits all.”  While HIPAA compliance is important, collection, analysis and monitoring of security events are also critical activities for medium- to large-sized organizations, Suganuma suggests.

He also warns that healthcare organizations should be aware that cyberattackers are exploiting not only traditional network vulnerabilities, but also vulnerabilities in printers and medical devices. Networked medical devices are a particularly significant issue, since provider IT teams can’t upgrade the underlying operating system embedded in these devices — and too many of the devices are using older versions of Windows and Linux with known security holes.

The key point Suganuma, Erven and Merdinger are making is that while HIPAA compliance is good, healthcare organizations must pay greater attention to new attack vectors, or they face high odds of security compromise.  Seems like there’s a lot of work (and investment) afoot.

July 2, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Sutter Health Ready To Deploy HIE, But Can It Succeed?

Sutter Health doesn’t have a great reputation when it comes to EMR implementation. Late last year, when we reported that Sutter’s Epic EMR crashed for an entire day, comments came pouring in about the company’s questionable approach to training its staff on using the system.

According to Epic consultants who’d been involved in the project, Sutter leaders decided that Epic experts were there to “facilitate” training done by inexperienced in-house teams, rather than actually teach key users what they need to know. The result was strife, disorder and anxiety, according to several consultants who’d been involved. Since then, Sutter has connected its EMR to five medical foundations and 17 hospital campuses; by next year, it expects the EMR to connect to information on 3 million patients. But there’s no reason to think it’s changed its training strategy, which could cast a bit of a pall over the new project.

Now, Sutter Health is building out a health information exchange, working with Orion Health, which will tie together hospitals and doctors both inside and outside of its network across northern California. Sutter plans to begin deploying the HIE in phases this summer, starting with data integration with the Epic EMR and extending to testing exchange of inbound and outbound data. If the project works out, it seems likely that it will be a plus for every provider that does business with Sutter.

The question is, will Sutter do a better job of managing this process than it did in rolling out its EMR? While it’s easy to boast that your plans are going to be a “gamechanger” for the market, it’s hard to take that claim at face value when your EMR implementation hasn’t gone so splendidly.

Certainly, Orion is a reputable HIE vendor which has been praised for having strong products and service. And Sutter certainly has the financial wherewithal to see such an effort through. The thing is, if Sutter leaders (seemingly) took a wrongheaded approach to the all-important issue of EMR training, who knows what curveballs they might throw into the process of rolling out an HIE? Even if its EMR has stabilized and Sutter has somehow gotten past its training hurdles, its past missteps don’t inspire confidence.

If I were with Orion, I’d draw a firm line where training was concerned, as Sutter’s past strategy only seems to have cast its last major HIT vendor in a bad light. If not, I’d make sure the contract had a workable bailout clause…or be prepared for some serious headaches.

June 30, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.