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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?

An Effective Strategy for Long-term Epic Training

Posted on January 27, 2017 I Written By

The following is a guest blog post by Chris Cooley, Training Advisor at Pivot Point Consulting, a Vaco Company.

Ensuring that you have enough staff to cover day-to-day, new-hire, remedial, and monthly EHR update training is not an easy task. At the most recent Epic User Group Meetings and Spring Councils, sessions dedicated to building steady training teams were among the best attended. To be sure, Epic training is a hot topic in healthcare organizations—particularly as it relates to new hires. Here are some best-practice suggestions to help establish a long-term and successful Epic training program.

The Necessary Evils

eLearning
Many organizations are opting for eLearning in lieu of classroom training to reach multiple groups. The difficulty with this approach is the inability to truly know if the participant grasped the material. Most participants can pass a quick post-exam without completely understanding or retaining the information.

Timing is also an issue. Even a two-day lapse between an eLearning session and practicing the learned material can pose the risk of an 80 percent information loss, requiring retraining or additional support during the first shift following training. That said, when used correctly, eLearning can be quite effective when used in conjunction with traditional classroom training and immediate practice.

For those familiar with Epic, an interactive eLearning session that speaks to the specifics of your organization can easily be implemented in lieu of classroom training. When using eLearning, make sure to follow adult learning principles. Keep courses short, interactive, and challenging to keep end users engaged. To help participants retain information, include built-in exercises to prevent advancing without completing an action.

Classroom Training
In a preceptor-led training model, about four to eight hours of classroom training should be sufficient. Stick to the basics of navigation, terminology, and one or two main workflows to get comfortable working in the system.

For physicians, schedule a one-on-one follow-up with the trainer to set up preference lists and customizations within the same week. Avoid doing this day one or two, as the physician will need to be familiar with the existing orders and sets before customizing further.

Beyond the Classroom

Routine Training Integration
Standard training and orientation programs offer great opportunities to incorporate Epic-specific training elements where applicable. Nurses, for example, have a day or more of skill validation when starting a new position. For every skill they perform, an Epic training opportunity exists. Have participants find the order in Epic, perform the skill, then document the appropriate procedure and follow up. Collaborate with the education department and affected department leaders to add Epic workflows into routine training outlets.

Preceptorship
Learning happens best when on the floor, in the department, or repeatedly completing a task. Assign new hires a preceptor who is well versed in Epic and department workflows. Have them log in and perform the work while the preceptor guides them through their duties. After two to three days of side-by-side work, your new employee should be off and running.

Draw preceptors from within the new employee’s department and remove them from their daily duties when onboarding new hires. Choose your preceptors wisely. Just because Jane Doe is the resident Epic expert on your floor doesn’t mean she’ll be the best preceptor. Look for someone who embodies your organization’s culture, is a cheerleader for Epic, and has the patience to answer the same question multiple times.

Other Considerations

Materials
Materials must be well written, well organized, and—most important—accessible. Often, materials are outdated, in print form only, or not easily found by the end user. The use and regular maintenance of Learning Home Dashboards can ensure the latest materials are organized, intuitive, and available.

Consider turning tip sheets into two-minute-or-less video snippets. More often than not, watching and then repeating a process is preferable to deciphering a tip sheet and/or screen shots—especially for physicians and millennials looking for the quickest answer.

Remedial Training
While new hires account for about 30-50 percent of a trainer’s time, some individuals or departments will always need a little extra help. For example, evaluating a workflow to offer a faster/easier process, retraining, or providing additional one-on-one time with the end user can account for another 20 percent of a trainer’s time.

Update Training
Each month, a new set of Epic updates must be showcased to employees. This can be accomplished via monthly training or eLearning. In my experience, the time to coordinate and deliver monthly update training accounts for about 10 percent of the trainer’s time.

Rounding
End users often struggle in silence. When my trainers are not actively training, or working on materials, they are rounding in the departments they support looking for opportunities to strengthen knowledge. In addition to rounding, trainers attend huddles and meetings, offer help, and bring vital intel about updated or ill-working workflows to the principal trainer’s attention.

Help Desk
Trainers will also spend a good deal of time working “tickets” to assist end users (and often analysts) in identifying and communicating problems and resolutions.

Learning Management System (LMS) Administration
Hundreds of small details go into ensuring that Epic training is meeting the needs of an organization.  Who is expected in training? When and where can training be held? Who has completed training and can be activated in the system? It is imperative to dedicate at least one full time LMS administrator or coordinator to these ongoing Epic needs. Depending on the organization’s size, this may require up to four full-time resources.

Effective Coverage 
The number of Epic trainers needed will vary according to the organization’s size and hiring volume. Depending on the application and the hiring schedule, your principal trainer may be able to handle all training without the support of additional resources. However, I recommend having at least one credentialed trainer available for backup—to cover vacations, assist in remedial training, etc. Consider cross-training to make trainers versatile in related apps. Maintain expertise amongst your trainers by limiting cross-training to three areas of focus.

The example below includes enough trainers to cover the needs of a two hospital system and surrounding clinics in the same geographical location.

CT1: SBO, HB/PB
CT2 ClinDoc, Stork, Orders
CT3 ClinDoc, Beaker, Orders
CT4 Ambulatory, HOD, Cadence
CT5 Ambulatory, HOD, Cadence
CT6 Radiant, Cupid
CT7 Beacon, Willow
CT8 ASAP, OpTime, ANA
CT9 HIM, GC
CT10 HIM, GC

 

PT1 GC, Cadence
PT2 Ambulatory, HOD
PT3 ClinDoc, Stork
PT4 Orders, ASAP, Beaker
PT5 OpTime, ANA
PT6 Radiant, Cupid
PT7 Beacon, Willow
PT8 HIM, HB, PB, SBO

 
Creating partnerships throughout your organization, along with a steady, recurring training schedule, is the key to running an efficient, low-budget training team. With exceptional, easily accessible training materials and operational preceptors, training can be efficient, low-cost, and have employees in their positions with minimal classroom time.

About Chris Cooley
Chris Cooley is a Subject Matter Expert for the LIVESite division of Pivot Point Consulting, a Vaco Company. Previously, she worked as a full-time training manager, with 14 EMR implementations under her belt. With a combined knowledge of adult learning principles, technical writing, project management and the healthcare world, Chris is known for her creative solutions.

ACO-Affiliated Hospitals May Be Ahead On Strategic Health IT Use

Posted on December 26, 2016 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.

Over the past several years I’ve been struck by how seldom ACOs seem to achieve the objectives they’re built to meet – particularly cost savings and quality improvement goals – even when the organizations involved are pretty sophisticated.

For example, the results generated the Medicare Shared Savings Program and  Pioneer ACO Model have been inconsistent at best, with just 31% of participants getting a savings bonus for 2015, despite the fact that the “Pioneers” were chosen for their savvy and willingness to take on risk.

Some observers suggested this would change as hospitals and ACOs found better health IT solutions, but I’ve always been somewhat skeptical about this. I’m not a fan of the results we got when capitation was the rage, and to me current models have always looked like tarted-up capitation, the fundamental flaws of which can’t be fixed by technology.

All that being said, a new journal article suggests that I may be wrong about the hopelessness of trying to engineer a workable value-based solution with health IT. The study, which was published in the American Journal of Managed Care, has concluded that if nothing else, ACO incentives are pushing hospitals to make more strategic HIT investments than they may have before.

To conduct the study, which compared health IT adoption in hospitals participating in ACOs with hospitals that weren’t ACO-affiliated, the authors gathered data from 2013 and 2014 surveys by the American Hospital Association. They focused on hospitals’ adherence to Stage 1 and Stage 2 Meaningful Use criteria, patient engagement-oriented health IT use and HIE participation.

When they compared 393 ACO hospitals and 810 non-ACO hospitals, the researchers found that a larger percentage of ACO hospitals were capable of meeting MU Stage 1 and Stage 2. They also noted that nearly 40% of ACO hospitals had patient engagement tech in place, as compared with 15.2% of non-ACO hospitals. Meanwhile, 49% of ACO hospitals were involved with HIEs, compared with 30.1% of non-ACO hospitals.

Bottom line, the authors concluded that ACO-based incentives are proving to be more effective than Meaningful Use at getting hospitals adopt new and arguably more effective technologies. Fancy that! (Finding and implementing those solutions is still a huge challenge for ACOs, but that’s a story for another day.)

Of course, the authors seem to take it as a given that patient engagement tech and HIEs are strategic for more or less any hospital, an assumption they don’t do much to justify. Also, they don’t address how hospitals in and out of ACOs are pursuing population health or big data strategies, which seems like a big omission. This weakens their argument somewhat in my view. But the data is worth a look nonetheless.

I’m quite happy to see some evidence that ACO models can push hospitals to make good health IT investment decisions. After all, it’d be a bummer if hospitals had spent all of that time and money building them out for nothing.

Hottest Job Skills For Health IT Pros This Year

Posted on January 9, 2012 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.

Here’s a nice little take on how the health IT recruiting market is shaping up for this year.

According to recruiter Guillermo Moreno, vice president of recruiting firm Experis Healthcare, not only will IT leaders be fighting for team members with EMR/EHR skills, there’s also five other health IT skillsets that will be in high demand:

* ICD-10/5010 expertise:   With companies migrating to ICD-10, demand for informed pros will be  at an “all time high” in 2012, Moreno notes. (Editor’s note: If you haven’t hired them already, or at least begun reaching out, you’re really, really late to the game. Surely you’re better prepared, readers?)

* Applications insights:  Moreno notes that healthcare organizations need strong developers to create apps focused on measuring quality and meeting standards. Hard to argue that.

* Security and compliance chops:  This year, providers are moving from focusing largely on internal security to making sure information moves safely from one location to another, Moreno says. So pros with a strong grasp of information security management will be hotly pursued this year.

*  Data management abilities:  As Moreno sees it, there’s still some data management and data security skillsets that aren’t too common in healthcare.  In the near future, he says, such experts will be badly needed, in part to make sure organizations have plans in place to prepare for possible losses of protected information.

* BI/analytics experience:  If providers hope to aggregate data in a sophisticated way — something that will be more needed each year as quality measurement standards spike — they’ll need to recruit more pros with business intelligence and analytics skills.  That’s particularly the case now, given that current packaged healthcare analytics tools aren’t that mature, Moreno argues.

I find it hard to argue that these are all hot areas for health IT recruiting. There’s a couple others I think should be hot recruiting items too:

* CMIO/CNIO etc.:  If hospitals are smart, they’ll do more to recruit crossover medical/IT pros who can speak to both sides and make clinicians comfortable with new tech. Putting volunteer “champions” in place can’t do much if the technology wasn’t a good clinical fit in the first place.

* Health IT project managers:   With health IT departments swamped with  big picture demands, simply getting the day to day project work done is no joke. Sure, hospitals may have big-ticket consulting firms in place to handle the checkbox work right now, but when those folks pack up, will your IT organization have enough smart project  managers in place be able to keep the trains running on time?

I’d argue that there’s also room to create as-yet unknown jobs which are more or less pure EMR cheerleader, user experience researchers and vendor harassment liasons. (OK, the last one is a bit over the top…but I stand by the other two. And while we’re at it, is there anyone whose day-to-day job it is to hold vendors’ feet the fire?)

 

Why U.S. Enterprise Health IT Companies Struggle for Success in Europe

Posted on November 22, 2011 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 U.S. market for new sales of enterprise health information technology (HIT) in large hospitals is dwindling, despite the incentives heaped upon the market by the Health Information Technology for Economic and Clinical Health (HITECH) Act. While buying has picked up a bit, this uptick is universally acknowledged as a short-term blip which will run its course as timelines expire and federal funds are depleted. For U.S. vendors of HIT, a logical question arises, “where do we go next?”

The Middle East garners some attention, but Europe is a natural choice for market expansion given the comparable standard of living and adoption of technology. Yet, despite years of effort and millions of dollars invested there, U.S. companies struggle to gain a real foothold in Europe.

All Politics is Local

Each country in Europe has its own healthcare climate due to differing approaches to healthcare administration. For example, France would seem to be an inviting market due to its size, amount of money dedicated to the healthcare system, and relatively high proportion of private hospitals. However, U.S. companies unexpectedly struggle to make inroads due to the strong French preference for a local company with local staff. If foreign companies want to sell there, whether American or European, the company must have a local office with local executives, at the least.

Italy also represents a large market, but does not represent a single HIT market. The healthcare governance system has, in effect, created twenty regional markets where each administrative zone has authority to set unique rules and guidelines, thereby influencing vendor selection criteria and funding capacities. Vendors which decide to build a presence in Italy will need to create regional strategies for each administrative zone.

The Right Price

Compared to their counterparts in the U.S., hospitals in Europe typically purchase enterprise HIT at a significantly lower cost. These prices range widely depending on geographic region and hospital type. Also, because of political issues with local, national, and European Union tender processes, the sales cycle can take two to three times longer than even the largest IDN deals in the U.S.

Hospitals in the Netherlands expect to pay a price that is nearly on par with what a comparable hospital in Canada would spend on an enterprise solution. Yet, across the border in next-door Germany, that same product would have to be priced nearly eighty percent lower for consideration.

Relative HIT Prices for Large Hospitals

HIT Priorities Vary

European hospitals have a set of functional priorities which diverge from the priorities which U.S. hospitals have. The following are a few of the more prominent examples:

  • Nursing: While CPOE is a huge priority in the U.S. and a centerpiece of meaningful use initiatives, European hospitals and vendors have focused more attention on automating nursing functions. That is not to say they do not have physician ordering tools, which they do, but nursing has been more of a priority.
  • Closed-loop medication administration: U.S. vendors would be treated as second-rank if they did not have closed-loop capability with tightly interwoven pharmacy functionality. Not so in Europe where lack of closed-loop is fairly common and is not a high priority during the tender process.
  • Connectivity: Beyond robust data flow within a hospital, sharing clinical information regionally within countries has long been a priority in Europe. Several countries have constructed digital spines to which vendors must connect in order to allow client hospitals to share clinical patient information with other hospitals, regions and government agencies.

Who has crossed the pond?

No U.S. firm has yet to find cross-national success in Europe with enterprise clinical solutions. The best-selling large-hospital vendors in the U.S., Cerner and Epic, have found very limited success in promoting their clinical application suites to European hospitals. Cerner initially won business with the NHS Trust in the UK, but those implementations were not particularly successful. Epic seems committed for the long haul in Northern Europe but its growth has been modest thus far. McKesson seems to be withdrawing from certain European markets, and Meditech isn’t spoken of much in Europe. Some U.S. companies may decide to acquire their way into Europe, like CSC is doing via the acquisitions of Scandihealth and iSOFT. Despite the challenges, this much is certain: U.S. HIT firms must continue to explore and expand in Europe as the U.S. matures into a total replacement market. The key, as always, is to do it right.

Chris O’Neal is Managing Partner at KATALUS Advisors, a strategic consulting firm focused on the healthcare vertical. We help vendors grow, guide hospitals into the future, and advise private equity groups on their investments. Our clients are found in North America, Europe, and Asia. www.KATALUSadvisors.com

Industry Does Too Little, Too Late On HIT-Related Safety Issues

Posted on November 11, 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.

This week, a pair of HIT organizations — including a HIMSS-backed group and an alliance focused on HIT safety — came together to help track HIT-related patient safety problems. The two groups have broad-based vendor support, and they seem to have the right goals. Unfortunately for them, though, the HIT safety ship may have already sailed.

Participants in the current linkup include the iHealth Alliance, part of the  EHR safety group EHRevent.com run by the publishers of the Physicians’ Desk Reference, and the HIMSS EHR Association, a collection of 44 EHR vendors working together to work on key industry issues.

The safety group, which offers a quick form allowing people to report EHR-related safety concerns, is an official, federally-certified Patient Safety Organization. That gives providers the chance to report such events in a privileged, confidential manner.

That being said, regulators seem to have gotten the jump on the software folks. As some of you may know, regulators are already preparing to begin, well, regulating HIT safety results. The FDA, which issued draft guidance on mobile medical apps this summer, may cast its eye on EHRs at some point.

Another possible angle comes from the Institute of Medicine, which recently issued a report recommending that HHS create a new watchdog agency investigating health IT safety issues.  National Coordinator for Health IT Farzad Mostashari recently told reporters that his agency, the ONC, has already begun developing an EHR safety and surveillance plan which should be out within the next 12 months.

(If you want this process to be as painless as possible, you’d better hope that the IOM gets its way; vendors, you don’t want to face the kind of FDA struggles pharmaceutical companies do, right?)

Honestly, someone who’s watched regulators do their thing for decades, I’m betting this latest industry effort will be too little, too late.

Folks, as I see it the only way you’ll get the agencies off your back is to start reporting on safety issues with EMRs/EHRs and other health IT tools aggressively. But given that many organizations aren’t even at the stage where their EMR installation is stable, good luck!