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The Value of Goals in Hospital IT

Posted on December 17, 2014 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.

When someone sends me a press release that says that a hospital has attested to meaningful use or has achieved HIMSS stage 7, I kind of roll my eyes and move on. As a blogger, it really doesn’t tell me much about that organization. It’s one small data point in what I try to look at in the broader health IT ecosystem. Now, if I don’t see these things happening, I’ll start to wonder what’s going on. However, one individual announcement to me isn’t that interesting.

That’s not to say that healthcare organizations shouldn’t participate in programs like meaningful use and the various HIMSS stages. Sure, the incentive money is great and the adoration of your colleagues at HIMSS when you achieve HIMSS stage 7 is great as well, but that’s not why you should do either of these (ok, maybe the money in MU is worth doing it for).

The best reason your organization should look at going after something like HIMSS stage 7 is because there’s a lot of value in an organization working towards a goal. Of course you should look at the goals you’re trying to achieve to make sure your pointed in the right direction, but nothing unifies an organization like trying to achieve a special recognition. It’s hard to underestimate the value that’s created working towards a common goal.

Having an ambitious goal for your organization helps everyone in your organization to perform better and takes your organization to a higher level than you could have ever dreamed. We could argue over the value or lack thereof of meaningful use. What can’t be argued is the way organizations have come together to be meaningful use compliant.

Also, don’t underestimate the power of celebrating these achievements. While it’s one thing to celebrate your achievements internally (and you should), it’s also really valuable for those in your organization to receive accolades and recognition from their peers in other organizations.

Next time you look at some of these recognition, definitely consider if they espouse the values your organization wants to achieve. However, also take into account the powerful force a high goal and recognition for achieving that goal can provide your organization.

Healthcare Interoperability – Learning From Proprietary PC History

Posted on December 16, 2014 I Written By

Interoperability; Some vendors have the unmitigated gall to try and keep their systems proprietary. When they refuse to make code or training available to others, competition will have difficulty achieving interoperability and customers will not be able to move too far from the vendor and their own profitability is secured. Competition is greatly reduced.  Capitalism at its finest.

A long, long time ago in a land far away, 4 vendors in the minicomputer and PC markets attempted to do just about the same thing. Wang, Data General and Digital Equipment were almost totally proprietary. Interoperability was little more than a dream. Proprietary would secure success.  The fourth company was the leader in the PC world. They also were not able to communicate with competitors and vice versa. For years, IBM compatible meant the difference between success and failure. Why? Try profit. If you control a market and can keep others away, profits remain high.   After a time, as with IBM there will come a time that giving up the proprietary nature of the product will cause an increase in sales and profits.

Throughout the 80’s and 90’s IBM’s competitors and some large users complained bitterly about all four company’s proprietary nature. The 3 minicomputer companies “bet the farm” that they could succeed by being proprietary. IBM did the same. The rest is history. One won and three lost.

Epic is in the same boat as those four. Being proprietary is increasing their profitability currently.  As time progresses will Epic decide that the time is right to allow the competition access to their product and code and, like IBM, will they do it at the right time to remain the market leader.  Any bets?

The Ergonomics of EHR – Hospital Liability?

Posted on December 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We often hear about the ways technology causes ergonomic problems for us and our health. Whether it’s wrist pain from all the typing or back pain from the way we sit or eye strain from looking at a screen all day. Technology has a number of really major challenges when it comes to ergonomics.

Unfortunately, I don’t think most hospitals have put much thought into the ergonomic impact of an EHR on their nurses and doctors. Since many of these health issues happen over time, I think we haven’t yet awoken to these problems. This is an issue that’s likely going to impact a lot of hospitals in the next 3-5 years.

Think about the potential liability a hospital could have because of a poorly done EHR implementation which causes back pain, wrist strain and kills people’s eyesight. That’s a really big deal and worth considering.

A while back I actually saw this infographic dedicated to some of the ergonomic challenges that nurses face in a hospital. We need to start talking about these topics a lot more or it’s going to grow into an enormous problem.

Hospital EHR Ergonomics

Should Hospitals Be Engines of Economic Development?

Posted on December 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was absolutely intrigued by this Wired article by Mark E. Coticchia, Vice President and Chief Innovation Officer of the Henry Ford Health System, titled Hospitals as Engines of Economic Development. In the article, Mark makes the case for the value that a hospital provides its community and the added value they could create as an economic engine by leveraging the know-how and knowledge of its clinicians. Here’s a small quote from the article about how he thinks this should happen:

Medical and administrative know-how and inventions are positively impacting patient care, patient costs and hospital revenue. Yet almost all of the formalized programs to transfer technology to patient bedsides are within major academic medical centers not at the thousands of community hospitals nationwide, many of which have become or are looking to become part of a larger health care system through acquisitions, mergers and affiliation arrangements.

We need to have technology commercialization expertise available to more hospitals. This includes health care systems expanding their technology commercialization functions to their affiliated community hospitals. Alternatively, I anticipate that certain hospitals with substantial technology commercialization capabilities will offer their services to other hospitals with which they aren’t affiliated.

Obviously, Mark is a bit biased since he comes from a large health system. However, he is right that these smaller community hospitals are a place of untapped potential. In many ways it makes sense for these untapped community hospitals to leverage the technology commercialization expertise of these larger hospital systems. Those are things that the community hospital could likely never afford to create. Sounds like a great win win to me.

The real challenge I have with this idea is that it will take more than a partnership to extract value from these community hospitals. The problem with many of the community hospitals is that they haven’t ever had a culture of commercialization. Many of the doctors at these community hospitals will have to have a shift in mentality for this type of partnership to really work. Commercializing an idea isn’t something that most community hospital doctors have thought about doing. This mentality would need to be changed for a partnership like this to be a success.

What do you think of this idea? Is it a good one? Are hospitals an engine of economic development for their communities? Could they be if they’re not today? Should hospitals be pursuing these commercialization efforts?

More CDI and EHR Optimization Discussion

Posted on December 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to the question I posted in yesterday’s blog post, “What’s the Difference Between CDI Programs and EHR Optimization?“, Richard Tomlinson, Founder and CEO of Nuclei Health Consultancy offered this response that I thought would help continue the discussion and be interesting for readers:

In answer to your excellent question, no. CDI and EHR optimization are not the same; in fact the two models are significantly different, as are their goals.

Without deep dives here, the root decision tree to choose CDI over optimization should be based upon analysis results to the issues and goals identified. What are the identified issues? And what are the identified and measurable goals.

I will share that workflow analysis is one significant differentiator between CDI and Optimization. If one of the goals mentioned above for example is to reduce time documenting , or, a shift of role assignment in portions of workflows to reduce cost or improve provider thruput, then optimization here may include the addition of technology. Sounds counterintuitive, nevertheless the business model of optimization is indeed different.

Reducing clicks in clin doc has been cited as optimization, but I am here to tell you that alone is not the case. I would tend to take that stand alone as CDI, although one can argue reducing clicks does not “improve” clinical documentation.

As an overall, I would tend to say optimization is holistic in its foundation to include analysis of workflows, content build specifications, ROI of additional technology/tools, education, with the cumulative impact compared to a set of defined clinical and business goals. CDI by contrast may support only a goal as simplistic as rearrangement or placement of data to achieve a specific benefit.

I look forward to hearing other people’s thoughts on this subject.

What’s the Difference Between CDI Programs and EHR Optimization?

Posted on December 4, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently heard someone describe their EHR optimization as a Clinical Documentation Improvement (CDI) project. It made me start to wonder if CDI and EHR optimization were quickly becoming the same thing.

While some CDI programs require EHR optimization, not all CDI programs require it. Some EHR optimization can improve clinical documentation, but not all of them. However, there is a decent overlap between the two efforts.

There are a lot of ways a CDI program can improve your clinical documentation. As we start to see full adoption of EHR software, most of the CDI programs are going to focus on the way the visit is documented in the EHR. While the EHR use might be to blame in many cases, the most important part of any CDI effort is the people that use that program. In fact, it’s often not even about how they use the program, but just the choices they make.

What has become very valuable is that EHR’s have made CDI programs much more efficient. They can run the program remotely. They can run reports that focus on common clinical documentation errors and focus their program on those specific errors. Technology can really help a CDI program to focus on the pieces of the chart that matter most.

EHR optimization on the other hand could have nothing to do with improving the clinical documentation. It very well may be that the clinical documentation is perfect. In an EHR optimization, you may only be looking at how to improve the physician workflow while maintaining the high level of clinical documentation.

EHR optimization is a powerful thing and not enough organizations are doing it. I get that they’re too distracted by meaningful use, but if we’re going to really benefit from EHR software we need more organizations focused on optimizing their EHR use.

It will be interesting to see how hospital leadership handles the governance of CDI and EHR optimization programs. They are both going to be very important going forward.

Healthcare IT Consulting Job Slowdown

Posted on December 1, 2014 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.

A recent poll on HIStalk, caught my eye. In the poll he asked readers “For health systems: how much IT related consulting will you use in 2015 vs. 2014?” Here’s an image of the responses:
Healthcare IT Consulting

It seems only fair to acknowledge that this wasn’t a deep study. It was an online poll with plenty of potential sample bias. Plus, it only had 107 respondents to the poll. Especially with it being an online poll, I’d have liked to see more respondents. However, it’s worth noting that 50% of those who did respond are planning to use less healthcare IT consulting in 2015. Although, just as surprising is that 14% plan to use more health IT consulting.

This was somewhat expected from my point of view. The consulting market just exploded over the past couple years as hospitals raced to implement an EHR and show meaningful use. As that program has started to mature, there isn’t as much need for consultants. So, it’s no surprise that the government incentivized EHR consulting market would contract back down to a more reasonable market.

That’s not to say that there aren’t still lots of opportunities for EHR consulting still. In fact, I’d argue that the opportunity for EHR consulting has never been bigger. It’s the EHR staff augmentation companies which often dress up as EHR consultants that are likely taking the hit. My feeling is that EHR staff augmentation is way down and EHR consulting is going to continue trending up. All of these hospitals need to start maximizing their EHR investment. That requires a consultant as opposed to more hands on deck for the EHR go-live.

We’re currently seeing this play out on the Healthcare IT Central job board. The type of jobs that are being posted are much more advanced. Plus, we’re seeing a maturing of EHR adoption and that’s shifting towards more full time EHR staff vs consulting.

What are you seeing in the market? Are you using more health IT consultants or fewer? Where do you see the industry headed?

Here’s What Makes Henry Ford Health System’s Employee Innovation Program Tick

Posted on November 25, 2014 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.

Hospitals are increasingly launching efforts designed to leverage new technologies, be they working with healthcare accelerators, taking advantage of employee ideas or setting up onsite centers designed to support a culture of innovation. One institution which has gotten a little further down the road than many of its peers is Henry Ford Health System, whose innovations program has paid off handsomely, generating countless smart, useful inventions from its employees.

So serious is the health system about exploiting its employees’ great ideas that it’s made organized efforts to reward such thinking directly. For example, HFHS just completed the competition among employees to submit their best ideas in clinical applications for wearable technology. The institution not only encouraged employees to participate, but sweetened the pot by offering a total of $10,000 in prizes to winners of the contest.

Winning entries included:

*  A system designed to record and encourage mobility of acute care patients by using wearable activity trackers
*  A recovery tool for total hip replacement patients which monitors and limits range of motion to rehab by using wearable sensors
*  A health and wellness reminder system for elderly patients, leveraging location-based sensors and smart watches
*  A mobile game interface, powered by activity trackers, designed to encourage childhood exercise and fight obesity

Certainly, the employees must appreciate the cash prizes, but they told a Forbes reporter that they’d participate even if there were no prizes, because what they really enjoy is having the experience and access to the program. That’s a pretty telling indicator that simply appreciating their concepts goes a long way.

This contest comes as part of larger efforts to make the health system innovation friendly. “The most important word is yes,” said Nancy Schlichting, the system’s CEO in a Forbes interview. “It is difficult to create a culture of innovation. If you shut down one person to shut down everyone, because bad news travels fast. When it comes to innovation, my mantra is yes.”

Other efforts to encourage employee intrapreneurship include big rewards for success in product development. The HFHS intellectual property policy offers a 50% share of future revenues coming from product ideas that end up in the market. That’s a pretty impressive call to action for employees who might have a great idea in their hip pocket.

Yet a third way the health system encourages innovation is to bypass employees’ natural fear of failure by tapping into their desire to help people. By encouraging clinicians to focus on patient care improvements, for example, the system drew staff cardiologist Dr. Dee Dee Wang to create a breakthrough method for more accurately sizing artificial heart valves and planning trans-catheter surgeries using 3-D printed models from CT scans. (She worked with Dr. William O’Neill in this work.)

So if they can generate great innovations, why aren’t more health systems and hospitals launching programs like these?

I don’t think the direct cost of creating such a program is much of an obstacle, especially for a multi-hospital system. It may require hiring a senior exec to spearhead the effort, but that’s not a huge investment for entities that size.

My guess is that one reason they don’t move ahead is management bandwidth — that health leaders simply don’t feel they have the time, energy and focus to kick off such a program at the moment. But I also suspect that C-suite execs just haven’t given much thought to the untapped potential their employees have for creating incredible solutions to critical health care problems. Sadly, I suspect it’s more the latter than the former.

CFO Pleads Guilty To Meaningful Use Fraud

Posted on November 24, 2014 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.

It had to happen eventually — the money is just too good.  The former chief financial officer of a now-closed Texas hospital has plead guilty to charges that he defrauded the meaningful use program, in what may be the first prosecution of its kind.

According to Healthcare IT News the former CFO of Shelby Regional Medical Center in Center, TX, has been indicted on charges that he falsely attested that Shelby Regional met meaningful use requirements for fiscal year 2012. The alleged fraud garnered the medical center $783,655 in payments, according to the indictment.

It’s not that hospitals haven’t wrongly claimed large amounts of meaningful use cash before. In fact, Florida-based Health Management Associates seems to have wrongfully claimed $31 million in meaningful use payments last year prior to its acquisition by Community Health Systems, with 11 of 71 HMA hospitals failing to meet meaningful use criteria.

But it does seem to be unusual, if not unprecedented, for CMS to catch providers in the act of willfully falsifying meaningful use attestations. Either the self-attestation honor system is working or CMS  is failing to catch a great deal of monkey business.

In Shelby Regional’s case, the hospital relied on paper records throughout fiscal year 2012 and only minimally used an EMR, according to the feds. To make sure the facility still captured its meaningful use payout, CFO Joe White instructed the software vendor and employees of the hospital to input data from paper records into the EMR, sometimes months after patients were discharged and after the fiscal year. (If convicted, White faces five years in prison).

What makes the purported fraud at Shelby Regional seem all the more egregious is that it was apparently part of a much larger scheme. Tariq Mahmood, MD, who owned Shelby Regional and five other Texas hospitals, is also being investigated by federal prosecutors for alleged healthcare fraud. The six hospitals owned by Mahmood collected a total of $16.8 million in meaningful use incentives for fiscal 2011 and 2012.

The truth is, there’s probably a lot more fraud going on in the meaningful use program that hasn’t been caught. After all, a report by the Office of the Inspector General for HHS issued early this year concluded that CMS fraud auditors such as the Recovery Audit Contractors weren’t doing a great job of reviewing EMR records, failing to take basic steps such as reviewing EMR audit logs to verify that medical records support a claim. It’s little wonder they haven’t caught more providers deliberately gaming the meaningful use system.

Hospitals can do more to avoid accidental problems with meaningful use claims, too. Observers have noted that few hospitals have sufficient safeguards in place to catch attestation problems before they happen.

Epic Salary Info

Posted on November 20, 2014 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.

Many of you probably remember that we helped promote an Epic Salary Survey. As promised, they’ve published the results of the survey and we thought that many readers would be interested in the Epic Salary survey results.

The survey had 753 responses. Not bad for an online survey that was promoted across various blogs and social media outlets. Although, as you can imagine, some states are better represented than others. It’s the challenge of having 50 states.

This is my favorite chart from the Epic salary survey results (you can download the full survey results and data by states here):
Average Epic Salary by Job Position

As I look at some of these salaries, I’m reminded of the doctor who said that they shouldn’t be spending time learning their EHR. The hospital CFO then told the doctor, “I’m sorry, but that Epic consultant costs a lot more than you.”

Now I’d like to see one from Meditech and Cerner.