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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.

Georgia EMR Disaster: Was IT Department Responsible?

A few weeks ago, heads began to roll at Georgia’s Athens Regional Health System when its $31 million Cerner rollout began to fall apart. After clinicians complained that a rushed rollout process was generating a host of medication errors and other mistakes, President and CEO James Thaw resigned, and less than a week later, SVP and CIO Gretchen Tegethoff left as well.

Since then, however, the political landscape there has changed, with the facility’s chief medical officer, as well as Cerner executives, contending that the disaster was due to mistakes by the health systems IT team, according to HealthcareITNews. The Cerner execs, CMO and others are arguing that IT leaders made strategic decisions that should’ve been made by clinicians, the publication says.

A local paper, the Athens Banner Herald, notes that the Cerner rollout was done largely by the hospital’s IT team, and that few end-users were involved. That, at least, is what Cerner VP Michael Robin told the paper.  And a different Cerner VP, Ben Himes, took another shot at the IT department, arguing that this implementation seems to have come out on the IT side of things, rather than stressing clinical involvement.

The bottom line seems to be that regardless of what actually happened, the clinicians at the hospital seem to of felt left out of the process, never good thing when we’re dealing with a tool that they’ll need to use everyday.  Regardless of what actually happened, it seems the hospital’s IT department didn’t do a good job of engaging clinicians and getting their feedback; under those circumstances, the likelihood of kicked up a fuss even if implementation was otherwise smooth.

On the other hand, I’m always a little skeptical when vendors point fingers at their customers and say it was their fault when things go wrong. OK, I realize that there may be some truth to their accusations, and that Cerner has a right to defend itself, but it’s hardly a good PR move to dump problems with the implementation completely in the customer’s lap.

The truth is, will probably never know exactly what happened with this EMR implementation. Considering the scale of the project, and the number of people involved, it’s inevitable that this will go down in a blaze of finger-pointing. But it never hurts to be reminded that EMR implementations which leads physicians feeling as though they’re on the sidelines are politically risky at best, and potentially disastrous at worst.

 

June 18, 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.

Do You Hate Portals?

I was really interested in this summary of today’s #HITsm Twitter chat. Do people hate portals?

I think if we look at the portals as they stand today, it’s fair to say that people hate portals. They can’t remember their login. They’re complicated. They don’t solve the problems they want them to solve. There are too many of them. It’s just a mess.

I think we all agree that the idealized patient portal would be something we all value. Here are the characteristics of an idealized patient portal:

  • One Login
  • All Health Data from Every Provider (Yes, that includes labs, x-rays, etc)
  • Messaging with Clinic Staff
  • Messaging with Provider
  • Refill Requests
  • Appointment Request
  • Bill Payment
  • One Standard Health History (Intake) Form Accepted by All
  • Data from Personal Health Sensors and Trackers
  • Smart Notifications and Processing of Data

I’m probably missing something, but this list does a pretty good job covering what the ideal patient portal would look like. If someone could execute this patient portal, then we would all love to use it and there would be near universal adoption of it (minus a few people who don’t get on a computer). Sure, we’d still complain about the user interface or some other thing because we love to complain, but we’d all use it just the same.

There are actually some providers who have completed this list for everything that they control (ie. they don’t include data from other providers, don’t handle the intake forms for other providers and don’t do the sensor data). These providers have seen some pretty good traction with their portals, but they wane in use since just having one provider on it isn’t as compelling as a portal that has our entire health history. For many providers you might only see them every 3-5 years (or less). After 3 years, it’s just easier to pickup the phone than to figure out the portal.

This is the reason why Kaiser’s portal has been quite successful. They control the whole spectrum and so they can get pretty close to the above portal nirvana. Until we’re able to do something like that across the spectrum of healthcare in one place, many people will hate their portal (or maybe I should have said “their dozens of portals”).

I personally wonder if we’ll ever get there. If we do, I think it will be some company which goes in and solves one element in a way that provides immediate value to everyone involved. Then, they’ll layer the other features on top of it until they create the portal that everyone loves.

June 6, 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.

Hospital CEO Resigns Over Failed EHR Implementation

The social media world has grabbed on to a story at Athens Regional where it looks like the poorly done Cerner EHR implementation has “forced” the CEO to resign. Before I talk about the story, I’ve been amazed at how many tweets and retweets there have been for this story. It’s like the proverbial rubber neck we all get when we pass a car accident. I guess reading about a CEO resigning over a failed EHR implementation is must tweet HIT.

Getting back to the story, it seems like the real death nail in this hospital CEO’s coffin was when the doctors started dropping their privileges at the hospital. Here’s a quote from the story linked above:

“The Cerner implementation has driven some physicians to drop their active staff privileges at ARMC,” noted the letter. “This has placed an additional burden on the hospitalists, who are already overwhelmed. Other physicians are directing their patients to St. Mary’s (hospital) for outpatient studies, (emergency room) care, admissions and surgical procedures. … Efforts to rebuild the relationships with patients and physicians (needs) to begin immediately.”

The comments on the article are quite interesting with one doctor talking about how doctors were finally taking control and pointing out the harm these EHR systems are causing. Obviously, I think that’s a huge stretch. Uncooperative doctors can contribute to the harm an EHR can cause as much as the EHR software itself. Although there is a subset of doctors that feel like they need to start a revolution against EHR.

The reality is that the job of hospital CEO isn’t easy. That’s why they get paid millions of dollars (at least a lot of them). In fact, leadership in general is not easy. It’s a hard balance to know when you should trust your team and when you need to dig a little deeper and find out what’s really going on. Either way, this story should be a huge warning to hospital CEOs that they better have a deeper relationship with the hospital CIO.

I’m always surprised when a hospital still doesn’t have the hospital CIO as part of the executive team. Going forward, your EHR and other healthcare IT is going to be one of the biggest factors in the success of your organization. This story illustrates that really well.

I think we’d all agree that the number one thing you can do as a leader is make sure you hire and retain the very best employees. This story is a great example of why your EHR and how you implement it matters when it comes to getting and retaining the very best people. Plus, this is only going to become more important as technology continues to improve.

I obviously don’t know the particulars of this specific story. No doubt there are a few hundred views of what happened. Although considering the stories of what’s coming out, I’m guessing there is plenty of blame to go around. The hospital CEO was just the scapegoat for much larger issues.

Let this be a warning to hospital leadership. Make sure you’re paying enough attention to healthcare IT. It’s now an integral part of what you do.

June 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.

Homegrown versus Vendor Supported Order Set Solutions

I was reading through a whitepaper from Elsevier which asks a good question, “Are Your Order Sets in Order?.” The whitepaper discusses a lot of important issues related to order sets including integration with EHRs, order set workflow, evidence based content, regulatory requirements and next generation order set solutions. These are all really important and interesting, but I was intrigued by the discussion of a homegrown versus vendor-supported order set solution.

I’ll admit up front that I’m a strong proponent for a vendor supported order set solution. In the past this might not have been the case because the technology wasn’t there to integrate a third party vendor’s order set solution into a hospital’s technology stack. However, today that’s just not the case.

What I think is happening is that many organizations started doing their own order sets because that was really the only viable option at the time. Plus, there were probably a few that were arrogant about their order sets being better than what anyone externally could create (although, this is probably a much smaller group). Once the cultural of internally created order sets was created, it’s been really hard for organizations to get out of that cultural rut of homegrown order sets.

I think we’re quickly reaching the point where the home grown order set creators just can’t keep up. Plus, in many cases organizations invested in the creation of the order sets, but didn’t put in the proper maintenance expense to keep them up to date.

The order set whitepaper I mentioned says that their survey found 36% of hospitals used vendor supported order sets while 37% used homegrown ones. That only leaves a quarter of hospitals that aren’t using an order set solution. I think that number will continue to decrease as people realize the value of incorporating standardization into their ordering workflow. Plus, I think we’ll see an increase in hospitals using vendor supported solutions as well.

Do you agree or disagree with this prognostication? Where are order sets heading in the future?

May 29, 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.