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Is Allscripts An Also-Ran In The Hospital EMR Business?

Posted on August 18, 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.

It all began with a question, as many classic tales do. Someone writing for the HIStalk.com website  – I think it was ever-anonymous, eponymous  leader Mr. HISTalk – asked readers to answer the question “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

The survey results were themselves worth a read:

* Approximately 29% voted for “McKesson customers”
* About 27% voted for “Allscripts customers”
* 8.4% voted for “McKesson shareholders”
* Roughly 23% voted for “Allscripts shareholders”
* About 13% voted for “Allscripts competitors”

Two things about these responses interested me. One is that almost a third of respondents seem to think McKesson will make the bigger score after being acquired by Allscripts. The other is that a not-inconsiderable 13% of the site’s well-informed readers think the deal will help Allscripts’ competitors. If these readers are right, perhaps Allscripts should rethink the deal.

I was even more engaged by the analysis that followed, which the writer took a close look at the dynamics of the hospital EMR market and commented on how Allscripts fit in. The results weren’t surprising, but again, if I were running Allscripts I’d take the following discussion seriously.

After working with data supplied by Blain Newton, EVP of HIMSS Analytics, the writer drew some firm conclusions. Here are some of the observations he shared:

  • While McKesson has twice as many hospitals as Allscripts, most of these hospitals have less than 150 beds, which means that the acquisition may offer less benefit, he suggests.
  • In addition to having only 3% of hospitals overall, Allscripts controls only 6% of the 250+ bed hospital market, which probably doesn’t position it for success. In contrast, he notes, Epic controls 20% of this market and Meditech 19%.
  • His sense is that while hospitals typically want a full suite of products when they work with Epic, Cerner or Meditech, Allscripts customers may be more prone to buying just a few key systems.
  • Ultimately, he argues, Cerner, Epic and Meditech have a commanding lead in this market, for reasons which include that the three are well ahead when it comes to the overall number of hospital served.
  • Given his premise, he believes that Epic is at the top of the pyramid, as it has almost double the number of hospitals with 500+ beds that Cerner does.

To cap off his analysis, Mr. HISTalk concludes that market forces make it unlikely that a dark horse will squeeze out one of the top hospital EMR vendors: “Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case.”

It would take a separate analysis to predict whether the top three hospital EMR vendors are likely to win out over each other, but Epic seems to hold the most cards. Last year, I wrote a piece suggesting that Cerner was edging up on Epic, but I’m not sure whether or not my logic still holds. Epic may indeed be King of the (HIT) Universe for the foreseeable future.

E-Patient Update: When EMRs Make A Bad Process Worse

Posted on August 14, 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.

Last week, I wrote an item reflecting on a video interview John did with career CIO Drex DeFord. During the video, which focused on patient engagement and care coordination, DeFord argued that it’s best to make sure your processes are as efficient as they can get before you institutionalize them with big technology investments.

As I noted in the piece, it’d be nice if hospitals did the work of paring down processes to perfection before they embed those processes in their overall EMR workflow, but that as far as I know this seldom happens

Unfortunately, I’ve just gotten a taste of what can go wrong under these circumstances. During the rollout of its enterprise EMR, a health system with an otherwise impeccable reputation dropped the ball in a way which may have harmed my brother permanently.

An unusual day

My brother Joey, who’s in his late 40s, has Down’s Syndrome. He’s had a rocky health history, including heart problems that go with the condition and some others of his own. He lives with my parents in the suburbs of a large northeastern city about an hour by air from my home.

Not long ago, when I was staying with them, my brother had a very serious medical problem. One morning, I walked into the living room to find him wavering in and out of consciousness, and it became clear that he was in trouble. I woke my parents and called 911. As it turned out, his heart was starting and stopping which, unless perhaps you’re an emergency physician, was even scarier to watch than you might think.

Even for a sister who’d watched her younger brother go through countless health troubles, this is was a pretty scary day.  Sadly, the really upsetting stuff happened at the hospital.

Common sense notions

When we got Joey to the ED at this Fancy Northeastern Hospital, the staff couldn’t have been more helpful and considerate. (The nurses even took Joe’s outrageous flirting in stride.)  Within an hour or two, the clinical team had recommended implanting him with a pacemaker. But things went downhill from there.

Because he arrived on Friday afternoon, staff prepared for the implantation right away, as the procedure apparently wasn’t available Saturday and Sunday and he needed help immediately. (The lack of weekend coverage strikes me as ludicrous, but it’s a topic for another column.)

As part of the prep, staff let my mother know that the procedure was typically done without general anesthesia. At the time, my mother made clear that while Joey was calm now, he might very well get too anxious to proceed without being knocked out. She thought the hospital team understood and were planning accordingly.

Apparently, though, the common-sense notion that some people freak out and need to be medicated during this kind of procedure never entered their mind, didn’t fit with their processes or both. Even brother’s obvious impairment doesn’t seem to have raised any red flags.

“I don’t have his records!”

I wasn’t there for the rest of the story, but my mother filled me in later. When Joey arrived in the procedure room, staff had no idea that he might need special accommodations and canceled the implantation when he wouldn’t hold still. Mom tells me one doctor yelled: “But I don’t have his records!” Because the procedure didn’t go down that day, he didn’t get his implant until Monday.

This kind of fumbling isn’t appropriate under any circumstances, but it’s even worse when it’s predictable.  Apparently, my brother had the misfortune to show up on the first day of the hospital’s EMR go-live process, and clinicians were sweating it. Not only were they overtaxed, and rushing, they were struggling to keep up with the information flow.

Of course, I understand that going live on an EMR can be stressful and difficult. But in this case, and probably many others, things wouldn’t have fallen apart if their process worked in the first place prior to the implementation. Shouldn’t they have had protocols in place for road bumps like skittish patients or missing chart information even before the EMR was switched on?

Not the same

Within days of getting Joey back home, my mom saw that things were not the same with him. He no longer pulls his soda can from the fridge or dresses himself independently. He won’t even go to the bathroom on his own anymore. My mother tells me that there’s the old Joe (sweet and funny) and the new Joe (often combative and confused).  Within weeks of the pacemaker implantation, he had a seizure.

Neither my parents nor I know whether the delay in getting the pacemaker put in led to his loss of functioning. We’re aware that the episode he had at home prior to treatment could’ve led to injuries that affect his functioning today.  We also know that adults with Down’s Syndrome slip into dementia at a far younger age than is typical for people without the condition. But these new deficits only seemed to set in after he came home.

My mother still simmers over the weekend he spent without much-needed care, seemingly due to a procedural roadblock that just about anyone could’ve anticipated. She thinks about the time spent between Friday and Monday, during which she assumes his heart was struggling to work “His heart was starting and stopping, Anne,” she said. “Starting and stopping. All because they couldn’t get it right the first time.”

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?

Hospital CIOs Still Think Outcomes Improvement Is The Best Use Of EMR Data

Posted on August 4, 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.

Sure, there might be a lot of ways to leverage data found within EMRs, but outcomes improvement is still king. This is one of the standout conclusions from a recently-released survey of CHIME CIOs, sponsored by the trade group and industry vendor LeanTaaS, in which the two asked hospital CIOs five questions about their perceptions about the impact of EMR data use in growing operating margins and revenue.

I don’t know about you, but I wasn’t surprised to read that 24% of respondents felt that improving clinical outcomes was the most effective use of their EMR data. Hey, why else would their organizations have spent so much money on EMRs in the first place?  (Ok, that’s probably a better question than I’ve made it out to be.)

Ten percent of respondents said that increasing operational efficiencies was the best use of EMR data, an idea which is worth exploring further, but the study didn’t offer a whole lot of additional detail on their thought process. Meanwhile, 6% said that lowering readmissions was the most effective use of EMR data, and 2% felt that its highest use was reducing unnecessary admissions. (FWIW, the press release covering the survey suggested that the growth in value-based payment should’ve pushed the “reducing  readmissions” number higher, but I think that’s oversimplifying things.)

In addition to looking at EMR data benefits, the study looked at other factors that had an impact on revenue and margins. For example, respondents said that reducing labor costs (35%) and boosting OR and ED efficiency (27%) would best improve operating margins, followed by 24% who favored optimizing inpatient revenue by increasing access. I think you’d see similar responses from others in the hospital C-suite. After all, it’s hard to argue that labor costs are a big deal.

Meanwhile, 52% of the CIOs said that optimizing equipment use was the best approach for building revenue, followed by optimizing OR use (40%). Forty-five percent of responding CIOs said that OR-related call strategies had the best chance of improving operating margins.

That being said, the CIOs don’t exactly feel free to effect changes on any of these fronts, though their reasons varied.

Fifty-four percent of respondents said that budget limitations the biggest constraint they faced in launching new initiatives, and 33% of respondents said the biggest obstacle was lack of support resources. This was followed by 17% who said that new initiatives were being eclipsed by higher priority projects, 17% said they lacked buy-in from management and 10% who said he lack the infrastructure to pursue new projects.

Are any of these constraints unfamiliar to you, readers? Probably not. Wouldn’t it be nice if we did at least solved these predictable problems and could move on to different stumbling blocks?

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.

 

The EHR Dress Rehearsal: Because Practice Makes Perfect

Posted on July 14, 2017 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

Over the past year I have been leading the implementation of Epic for University Medical Center of Southern Nevada (UMC). On July 1st, we went live at our primary care and urgent care clinics. The go-live was a great success. While no go-live is flawless, we encountered minimal issues that could not be quickly resolved and user adoption was excellent despite the majority of the users using an EHR for the first time.

Today is July 8th, and I’m spending a quiet day in our command center just one week after go-live and reflecting on the factors that made this transition exceed even our optimistic projections. By Day 3, users were comfortable with basic workflows and bills were going out the door. One week into go-live, we are scaling back our on-site support and discussing closing down the command center earlier then expected. Our team universally agrees that the most significant factor in our success was a last minute addition to the methodology – what I refer to as the Workflow Dress Rehearsal.

In my experience regardless of the quality of training that is provided, the classroom is not enough to prepare the staff for what happens when the patients start to walk in the door. Learning in your actual environment helps staff to gain comfort and uncovers challenges in technology and workflow that even the best testing will not reveal.

The concept of doing a true dress rehearsal that mirrors the real experience as closely as possible is one that dates back to retail point of sale and inventory implementations that I did 20 years ago. During those projects, we would shut the doors of the operation and have the staff go through a “day in the life” on the new system – doing everything as they would do it on go-live day – using their actual workstations and logging into the production system. We decided to apply this same concept to an EHR implementation and provide a full-day experience for the entire clinic staff as the final component of their training.

The logistics of making this happen across 8 physical locations and 15 busy clinics required extensive planning and execution. We created a full-day experience starting with scripted patients who would be represented by a clipboard that moved from the front desk and to triage before being roomed. Nurses and physicians went in and out of rooms as they would with real patients, completing the appropriate steps in each room. Later as they gained more comfort, we substituted the clip boards with actual people who represented patients – making up symptoms to help the staff learn how to navigate the EMR and be prepared for what would happen with a real person answering questions, such as providing information out of order of the screens. By the end of the day, the staff was gaining confidence in the application and in themselves. They were also learning how to work as a team in an EMR environment. Most of all, they found the experience more fun, and more directly beneficial then their classroom experience.

The benefits to this process were numerous, and the key contributor to the reduction in our support needs at go-live. Here are just a few examples of the benefits it provided:

1) Security was validated – Every user had the chance to log into production and do actual work just as they would on go-live day. As a result, security issues were resolved during the rehearsal and we had less then a dozen security calls during the first week.
2) Hardware was tested – Taking the previously completed technical dress rehearsal one step further, every workstation and ancillary hardware device was used just as it would be on go-live day. The result was we identified gaps in available hardware, incorrectly mapped printers, and configuration issues that could be resolved the same day, eliminating issues during the actual go-live.
3) End to End Workflow Validation – Nurses, Front Desk, and Physicians had received training individually as each had different content to learn, but didn’t fully appreciate how it all came together. The Workflow Dress Rehearsal allowed them to understand the full life cycle of the patient in the clinic and how their documentation impacts others later in the process. Through this process, they gained an appreciation for each of their respective roles in the EHR experience.
4) Practice, Comfort, and Speed – Working on the system in their actual work environment helped them to gain confidence and get faster using the application. While our mock patient experience is not the same as having a real sick patient in front of them – it was the closest experience that we could create so when the actual patients walked in the door, they knew what to do.
5) Content – We encouraged physicians and nurses to try common orders and medications that they use on a regular basis to make sure they were available and setup properly. Inevitably, we uncovered missing or incorrect information and were able to correct them well before go-live. The result was minimal missing content at go-live as we had already worked out those issues.

The Workflow Dress Rehearsal process allowed us to uncover many of the issues that would have happened at go-live while also allowing the staff to gain comfort with the new solution in a lower-pressure environment. The result? A quiet go-live with minimal complications and a happier staff. Encounters were all being closed the same day, and staff were going home on schedule. These rehearsals also created an educational experience that was fun and motivating to the staff and was of more value to them then another day in the classroom would have been.

I believe that this process can be applied to the implementation of any software solution in any environment. Its not always easy, and we realize that it will be much more complicated to create this experience as part of our hospital go-live later this year. However, the time invested paid off as it saved us so much time in the support of the system during go-live, and created a better experience for our patients during our first week on Epic.

Consider how you can create a Workflow Dress Rehearsal experience for your ERP, EHR, and other solution deployments and you may find that it is a critical success factor to your go-live as well.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

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.

Hospital Execs Underestimate QPP Impact

Posted on July 7, 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.

A new survey by Nuance Communications suggests that hospital finance leaders aren’t prepared to meet the demands of MACRA’s Merit-Based Incentive Payment System (MIPS), and may not understand the extent to which MIPS could impact their bottom line. Worse, survey results suggest that many of those who were convinced they knew what was involved in meeting program demands were dead wrong.

The survey found that many hospital finance leaders weren’t aware that if they don’t participate in the MIPS Quality Payment Program (QPP), they could see a 4% reduction in Medicare reimbursements by 2019.

Not only that, those who were aware of the program didn’t have a great grasp of the details. More than 75% respondents that claimed to be somewhat or very confident about their understanding of QPP got the 4% at-risk number wrong. Meanwhile, 60% of respondents either underestimated the percent of revenue at risk or simply did not know what the number was.

In addition, a significant number of respondents weren’t aware of key QPP reporting requirements. For example, just 35% of finance respondents that felt confident they understood QPP requirements actually knew that they had to submit 90 day of quality data to participate. Meanwhile, 50% either underestimated or did not know how many days of data they needed to provide.

On a broader level, as Nuance noted, the issue is that hospitals aren’t ready to meet QPP demands even if they do know what’s at stake. Too many aren’t prepared to capture complete clinical documentation, develop business processes to support this data capture and raise provider awareness of these issues. In other words, not only are finance leaders unaware of some key QPP requirements, they may not have the infrastructure to meet them.

This is a big deal. Not only will their organizations lose money if they don’t meet QPP requirements, but they’ll miss out on a 5% positive Medicare payment adjustment if they play by the rules.

Lest the respondents sound careless, let’s do a reality check here. Without a doubt, the transition into the world of MIPS isn’t a simple one. Hospitals and medical practices will have to meet deadlines and present quality data in new ways. That would be a hassle in any event, but it’s particularly difficult given how many other quality data reporting requirements they must meet.

That being said, I’d argue that even if they’ve gotten a slow start, hospitals have enough time to meet the basic requirements of QPP compliance. For example, turning over 90 days of quality data by March of next year shouldn’t be a gigantic stretch in contrast to, say, submitting a year’s worth of data under advanced Meaningful Use models. Not to mention the Pick Your Pace option of only 1 measure which avoids all penalties.

Clearly, having the right health IT tools will be important to this process. (Not surprisingly, Nuance is picking its own reporting tools as part of the mix.) But I’m struck by the notion that organizations can’t live on technology alone in this case. As with many problems in healthcare, tech solutions aren’t worth much if the business doesn’t have the right processes in place. Let’s see if finance executives know at least that much.