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Five Key Takeaways from CHIME17

Posted on November 10, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

I recently had the chance to attend the 2017 CHIME Fall CIO Forum (CHIME17) for the first time. It was a fantastic experience.

What struck me most about the event was the close-knit feeling. In the hallways and in the sessions, it felt more like a class reunion than a healthcare IT conference. It was common to see groups of attendees engaged in deep conversations and there were frequent shouts of “hello” from across the hall. I can honestly say that I spoke with more CIOs at CHIME17 than the all the other 2017 conferences I have attended combined.

I learned at lot from my CIO conversations. Below are my top five takeaways:

Hospital CIOs are real people

At every other conference, you have to search pretty hard to find a hospital CIO. They tend to hide and run quickly from one pre-arranged meeting to another. They also do not spend a lot of time visiting the exhibit hall except with companies they are doing business with. At CHIME17 CIOs roamed the halls freely and were very approachable, especially at lunch. It was easy to strike up conversations at CHIME17 and it didn’t take long before funny stories of technology gone awry were being told. I came away from CHIME17 with a much stronger appreciation for CIOs – they are funny, caring people under a lot of pressure.

Optimization is the new black

Many of the conversations at CHIME17 were around the best ways to optimize existing IT systems – particularly EHRs. This optimization had two flavors. First, CIOs spoke about optimizing the user interfaces to reduce clinician frustration and to streamline workflows. This form of optimization was seen as a “quick win”. Second, CIOs spoke about optimizing/leveraging the data collected by their various systems. Many were investing in analytics tools and talent in order to unlock the value in the health data within their EHR, imaging and other applications. Optimization was the dominant topic at CHIME. For more details, check out my blog on this topic.

Attracting and retaining talent is a challenge

Another hot topic of discussion, or more accurately, a heated point of frustration at CHIME17 was the difficulty in attracting and retaining IT talent. CIOs at large urban hospital were frustrated at losing talented staff to HealthIT vendors and to “cooler” tech companies in their cities (like Google and Amazon). CIOs at smaller rural hospitals were frustrated at losing talented staff to their urban counterparts and to those same tech companies. With healthcare budgets frozen, CIOs were having to find more creative ways to attract and retain staff – like allowing work-from-home, hiring out-of-state resources and providing time for employees to pursue their own healthcare research projects. This war for HealthIT talent threatens to stymie healthcare innovation and is a challenge worth keeping an eye on.

The role of the Hospital CIO is evolving rapidly

Several sessions at CHIME17 were dedicated to the rapidly changing role of technology in healthcare organizations and to the role of the CIO itself. There was a lot of talk about the new emerging roles of:

  • CSO – Chief Security Officer
  • CMIO – Chief Medical Information Officer
  • CNIO – Chief Nursing Information Officer
  • CDO – Chief Data Officer
  • CHIO – Chief Health Information Officer

As information technology permeates everyday hospital operations, the CIO role will fracture into hybrid operational+technology roles like the ones listed above. There was heated debate as to whether all these roles should report into the CIO or whether they should be kept separate from. John Lynn wrote a great blog on this topic.

Size doesn’t matter

The challenges being discussed by the CIOs at CHIME were independent of the size of their organizations. Whether it was attracting talent, finding good vendor/partners or dealing with slashed budgets – CIOs from small rural hospitals to large urban systems, were struggling with the same challenges. On one hand it was comforting to know the problems were universal but on the other, it was worrying to see how pervasive these challenges were.

BONUS: Marketing tchotchkes are an invasive species

CHIME is one of the few healthcare conferences that does not have an exhibit hall. Despite this, there was still a lot of tchotchke available to attendees – proving that Marketing Tchotchke should really be labeled as an invasive species at healthcare conferences.

Shout-out to CHIME organizers for putting on such a fantastic event.

By Tradition, or By Design?

Posted on March 11, 2015 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 few of my healthcare social media family are my friends on Facebook and so a get a smattering of work on my Facebook account. Today when I was browsing through my Facebook feed (likely avoiding some other work) I found this great question from Dirk Stanley, MD, MPH (@dirkstanley), and CMIO at Cooley Dickinson Hospital:

By Tradition, or By Design?

4 words that caused me to stop my day and think. Hopefully it does the same for you.

Dirk is a great guy if you don’t know him. I love running into him at HIMSS since he always seems to be hanging around a bunch of other CMIOs who are overwhelmed by the craziness of HIMSS. It then leads to great conversations since he’ll pose questions like the one above.

There are so many ways we could talk about the question of tradition and design in healthcare. I think we could all come up with examples where tradition was an amazing thing for healthcare and where tradition has been detrimental. The same could be said for design. Like in most things in life, it depends.

With that as framework, I’m more interested in talking about how often we’re stuck designing around traditions. When the tradition is a good thing, that can lead to excellent results. When the tradition is a bad thing, it can lead to awful results. Once our traditions are incorporated into design, it’s REALLY hard to change those traditions.

Our billing system is a great example of this challenge. EHR systems were built around the traditions we’ve created in our billing system. For doctors wanting to be reimbursed for their work, it’s been a good thing. They need to get paid and early iterations of EHR were often able to get doctors paid at a higher level just based on their ability to create more complete documentation. The tradition of creating fluffy documentation that would get paid at a higher level has now been designed into most EHR systems. Every doctors knows the impact of this and it’s not a very pretty result. Plus, now it’s EXTREMELY hard to change.

The good news is that the only way to solve this problem is to design new traditions that avoid these challenges. That’s what they’re trying to achieve with ACOs. Although, the above example should be a warning to those designing these new reimbursement models. If you design them well so they become a tradition that’s integrated into our systems, all will be well. However, the opposite is also true.

By Tradition, or By Design? I’d love to hear your thoughts.

Physician Coaches Can Increase EMR Engagement

Posted on July 24, 2013 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.

Today I read an interesting piece in HealthSystemCIO.com about the approach Naples, FL-based NCH Health System has taken to help its physicians ease into using its EMR.  According to Helen Thompson, VP & CIO, NCH has created a corps of physician coaches to help doctors get and stay comfortable with EMR use.

As she not too surprisingly notes, physicians are her toughest customers, rightfully demanding that the EMR helps them to deliver better care and supports their process. However, getting physicians situated is a very difficult challenge, given that they’re having to learn new processes and a new language.

To address this challenge, NCH has developed a new model for training, involving physician coaches in pre-conversion, implementation and post-conversion support for doctors. While these coaches don’t necessarily have direct clinical experience, they are very knowledgeable about both the EMR and physician workflow issues, Thompson says

The process of using the coaches works as follows:

* Preconversion:  The coaches work on programs for teaching and behavior change management plus develop an online education component.  As the teaching and behavior change takes place, they monitor progress and report as milestones are reached. To make themselves accessible, the coaches provide “concierge-like” services including making rounds with doctors or offices.

* During conversion: Coaches are available for dedicated “at the elbow” support to physicians as needed.

* Post-conversion:  The coaches offer refresher courses and change management support, as well as continuing to be available for at the elbow coaching to physicians as needed.

The coaches seem to be quite a success. NCH has seen a significant improvement in CPOE and electronic documentation measures, with adoption and engagement increased by roughly 5 percent to 10 percent. What’s more, the coaches share physician feedback with hospital leaders, allowing for ongoing improvement. (Thompson also hired a CMIO to further boost the process, which drove up e-documentation and CPOE use by a total of 25 percent.)

From my vantage point, the coaching program sounds like a very good idea. My only question is whether hospital IT departments will typically have the resources to build up a team of coaches, given that they’re generally short on time and staff as it is.  But it does seem to me that it’s a no-brainer for hospitals that can manage it to give this idea a try; after all, getting physicians on board with your EMR is worth just about any effort you put into it.

Medicare’s New Requirement for Evidence-based Order Sets

Posted on August 13, 2012 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.

The following is a guest post by Sean Benson. Sean Benson is co-founder of ProVation Medical and Vice President of Innovation at Wolters Kluwer Health.

In-house creation and maintenance of order sets by hospital staff just got a bit more challenging.

Without much fanfare, a small but significant change to Medicare’s Conditions of Participation (CoP) for hospitals went into effect in mid-July.  The Centers for Medicare and Medicaid Services (CMS) has decreed that Medicare-participating hospitals that use order sets, pre-printed or electronic standing orders and protocols for patient orders must ensure that they are consistent with nationally recognized and evidence-based guidelines and recommendations.

To be clear, this new CoP rule does not prohibit an individual hospital from developing its own pre-printed and electronic order sets. It does define the criteria for doing so, however.  CMS expects a hospital to look to nationally recognized guidelines, which should always be evidence-based, and to its own experiences and in-house studies and data.  CMS wants hospitals to avoid using anecdotal evidence, theories that have not been proven effective, or the old fallback of ‘that’s the way we’ve always done it’ as a basis for establishing its orders and protocols.

In-house creation of order sets has always presented challenges for hospitals.  Significant staff time must be devoted to drafting individual order sets, which can number in the hundreds at some institutions.  Subsequent review and consensus-building by the appropriate clinicians can also prove burdensome and difficult.  And then there is the need to periodically check and update existing order sets to make sure they reflect best practices.

Now CMS has added the requirement that order sets be based on the latest evidence and guidelines. The sheer volume of new medical evidence scattered across hundreds of sources that must be evaluated when creating an order set – an estimated 2 million scientific articles are published each year – means compliance will be a significant drain on internal resources. It also means that flow of evidence must be continuously monitored to determine when it necessitates a change in practice and, thus, a change in one or more existing order sets.

Compliance with the new CoP requirement can readily be achieved by “going digital”.  Electronic order set authoring tools offer pre-defined templates populated with content drawn from medical reference databases that track the latest clinical advances. This streamlines creation of new order sets and maintenance of existing ones, which remain linked to the reference databases. Alerts are generated whenever new evidence or guidelines necessitate a protocol change and, in some cases, impacted order sets can be updated with a single click.

Order Set authoring tools are already being widely deployed in many hospitals seeking to achieve the Computerized Physician Order Entry (CPOE) requirements of Meaningful Use.  Hospitals that have joined new accountable care organizations are also leveraging these solutions to help promote evidence-based medicine in their care coordination efforts.  Medicare’s new CoP rule requiring evidence-based order sets offers CIOs and CMIOs with yet one more incentive to digitize the order set creation process.

Hospital IT Jobs Likely To Expand Dramatically As EMR Adoption Proceeds

Posted on December 1, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

Think you already have a full plate? Think again.  Just wait until you’re responsible for making sure most of the key medical devices in your hospital can talk to your EMR.  As device-EMR integration becomes the norm, hospitals are likely to rely more heavily on leaders with both IT and clinical credentials, according to a new study by HIMSS.

As their EMR installations mature, hospitals are beginning to integrate a bunch of standard devices like fetal monitors, anesthesia machines, balloon pumps, cardiac output monitors and ventilators. To manage this process, hospitals are increasingly shifting responsibility to chief medical informatics officers and chief nursing informatics officers, HIMSS researchers note.

Even if hospitals bring more clinicians into IT, however, medical device integration is no joke. It’s great to see them putting clinicians in place to nurture the development of their EMR, but it might have worked better if they did so, say, five years ago.

After all, integrating your hospital’s devices would be pretty complicated even if they ran on the same operating systems and used the same protocols as standard network devices, given the number you’ll have to manage.  But they don’t, of course.  Adding a clinician to the mix might help streamline the process, but we’ve still got one heck of an IT problem here.