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Balancing Operations with Strategic Thinking

Posted on July 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of the biggest challenges I see hospital CIOs facing is trying to balance the operational requirements of their organization with the high level strategic thinking that’s really needed to make an organization effective. I think we all underestimate the operational challenges that most hospital CIOs face. Most health IT organizations are relatively young and were put together at a break neck pace. This provides an exceptional challenge for hospital CIOs.

If all the hospital CIO was tasked with doing was meaningful use of a certified EHR, that could consume all of their time and it would still be a challenge to do it effectively. However, meaningful use is far from the only thing that hospital CIOs are dealing with in their organization.

Meaningful use gets all the press and so we often forget about all of the IT tasks that were originally associated with the office of the CIO. Things like managing the network, the computers, and all the other IT infrastructure has come a long way, but still requires a high quality leader to keep it up to date and working efficiently. A lot of us look at these things as commodities that every organization just has and does. This really discounts the effort and time that’s required to do this effectively.

When considering all these tasks that require the CIO’s attention, it’s no wonder that many don’t have (or don’t make) the time required to think about their organization in a strategic way. I’d suggest two ways that hospital CIOs can spend more time thinking strategically.

First, learn to delegate and trust the other leaders in your organization. This is much easier said than done. In some cases this means changing the leaders in your organization. However, more often it requires a shift in mentality as a leader. Trusting other people is hard, but absolutely necessary for you to make the most as a leader.

Second, schedule time into your calendar for strategic thinking. I assure you that you’ll feel a little odd doing this. It almost feels like you’re cheating your organization to schedule in time to work on the strategy of your organization. However, there’s definitely truth in scheduling. We do what we schedule. Just don’t cheat yourself during that time. It will be really easy for you to fudge that time and work on other things. Turn off the email. Turn off the cell phone if needed and spend the time focused on where you should take your organization.

Finding time and making an effort to not be overwhelmed by operations and think strategically is the very best thing you can do. Don’t cheat yourself or your organization by focusing on the wrong things.

CIO and CTO Positions Were Created in a Hardware World

Posted on November 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

When you think about the evolution of IT in healthcare (and really every industry), the positions of CIO and CTO were created in a world where a huge portion of their work was focused on managing the IT hardware of the organization. Going all the way back to the million dollar server purchases organizations were making, you needed someone who could manage purchases of that magnitude. Not to mention all of the networking which had to be installed and managed. I’m sure every hospital CIO and CTO has stories about the challenges of getting hard wired ports to various parts of their hospitals.

The problem for many of these CIOs and CTOs is that we’re in a very different world today. I met one hospital CIO at CHIME who had basically outsourced all of the hardware portions of his IT environment. The way he looked at, those things were a commodity service that didn’t really need to be done in house. In fact, in many ways having the IT staff in house would be a disadvantage.

For example, in his hospital (granted this is a smaller hospital) he only had enough servers to support one server administrator. Everyone knows that the word one in this situation is problematic. What happens when that one person is sick or goes on vacation? What happens if that one person leaves the organization and takes their knowledge with them? Outsourcing the hardware side of this can be a great way to remedy this situation.

The reality is that cloud computing has gotten really good. In the case mentioned above, the hospital CIO can roll up a virtual server anytime he wants using the outside service provider. Gone are the days of selecting the server, ordering the server, waiting for the server to arrive, installing the server, wiring the facility for the server, etc. No, he (or his staff) just go online and click “create new server.” Bam! New server started, provisioned and ready in a production ready environment.

Of course, this is just one example of the shift in roles that a hospital CIO and CTO will have going forward. Many are behind the curve on this and stuck in old entrenched ways. It’s hard to teach an old dog new tricks. However, if you’re a CEO at one of these hospitals, you should be having these discussions with your CIO and CTO. Their worlds are changing rapidly and it requires different skillsets to navigate the changes.

Raising HCAHPS Scores Through Automated Medication Teaching Workflow

Posted on November 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

In the current government regulation controlled environment we live in called healthcare, there’s little time or attention available to doing really cool innovative things. Yes, we’re doing really innovative things to meet meaningful use, but that’s not cool. However, I was pretty intrigued by this recent case study that looked at the integration of Cerner’s EHR with GetWellNetwork’s interactive TV system.

The integration looked to help automate the medication teaching workflow at Christiana Hospital. Here are the goals they listed for the project:

  • Provide efficient staff workflow
  • Increase medication education HCAHPS scores
  • Increase patient and staff satisfaction
  • Improve education consistency
  • Increase the number of patient that take part in education
  • Provider secure access to the patient’s medication list
  • Meet Christiana Care Health System and Join Commission standards for patient education

Is it really innovative to connect a hopsital’s HIS system with a patient beside TV? Anyone who’s worked on integrations knows this is a challenge. Plus, how many other hospital systems have achieved this level of integration? If innovation is the wrong word, then how about impactful?

The best illustration of the impact was the improvement in HCAHPS scores that the hospital saw after implementing this medication education workflow. In fact, let’s be honest. If I hadn’t mentioned that this improved HCAHPS scores, then you probably wouldn’t have been reading this post at all. There are only a few things that get the attention of hospital CIOs today. One of those is improved HCAHPS scores.

Hospital CIO Challenges at CHIME13

Posted on October 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

For those who haven’t discovered my new EHR video website, you should go check it out now and sign up for it’s email list. I’ll be doing regular interviews with some of the top healthcare IT leaders in the country. I think many of you will enjoy it.

This week however, I knew I’d be at the CHIME Fall CIO Forum and so I decided to twist things up a little and have our very own Anne Zieger interview me about what I’d seen and heard at CHIME. We talk a lot about the challenges hospital CIOs face when it comes to meaningful use, ICD-10, HIEs and changing reimbursement. I think you’ll enjoy the insights that are shared. Enjoy the video embedded below (please excuse the poor lighting, but maybe that’s better since it’s me on camera).

Also, let us know if there are other people you’d like to see us interview. We’re always interested in hearing our readers/viewers thoughts on where we should take it.

Great Whitepaper Summary of OpenVista Features

Posted on July 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The week after I got my first job implementing EHR, I went into the medical records office where I was shown an article about the government’s decision to open source the Vista EHR software. The HIM manager was drawn by the idea of a free EHR. Of course, the clinic I was working for had already invested hundreds of thousands of dollars on an EHR system. In fact, this is likely what made the HIM manager so interested in the idea of a free EHR. She didn’t know why we’d spent hundreds of thousands of dollars when the government was offering an EHR for free.

What she didn’t understand was that just because the software is free doesn’t mean that the EHR is free. Plus, she (and I at the time) had little understanding of what the Vista EHR software really encompasses. Implementing Vista in that small clinic would have been like taking a sledgehammer to a 2 penny nail. In fact, that might even be underestimating the breadth of what could be done with Vista.

Of course, if we had been in the hospital environment, then we should have definitely considered Vista. However, back then there were a lot of unknowns with how Vista would transition to open source and how it would work in a commercial healthcare environment. 8+ years later, the companies working with the open source EHR is much more mature.

One of the leaders when it comes to implementing Vista in hospitals is a company called Medsphere. Medsphere’s version of Vista is called OpenVista. What’s amazing is the stark contrast in costs between an open source EHR versus many of the proprietary alternatives. No doubt Medsphere and others are benefiting from the billions of dollars the VA spent developing Vista.

For those of you not familiar with Medsphere and OpenVista, check out this whitepaper summary of OpenVista. It’s a really great summary of the capabilities of the software and what Medsphere has done to improve on the Vista software.

I’m sure there are still many hospital CIOs that aren’t brave enough to choose an open source EHR when “know one gets fired for buying Epic.” Although, I think it’s a big mistake when hospital CIOs don’t even consider the open source EHR options. When you see the breadth and depth of what’s available in Vista, it’s definitely worth considering.

Plus, since it’s open source, you can still develop custom additions to the software without worrying whether your EHR vendor will let you create a deep connection to the EHR software. I see an open source EHR software as a great option for those hospitals that are use to developing custom applications in house, but also see how a commercial vendor has expertise that they don’t have in house.

What are your thoughts on Vista as a hospital EHR?

Hospital CIOs Overwhelmed with Operations

Posted on June 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

With the hundreds of CIOs that I’ve talked to over the years, I’m starting to see a real trend happening in their work life. Many hospital CIOs that I talk to are overwhelmed so much with the operations requirements that they don’t take the time to look at more strategic decisions. From the outside it’s easy to see how this is going to pose a problem, but in the heat of the work day it’s hard to recognize.

Think about all the operational pressures that exist for a hospital CIO today. The first on their list is likely meaningful use and the EHR incentive money. Some might question if this is an operational agenda item and I assure you that it is indeed an operations question and not a strategic question. This alone is quite overwhelming. However, there are many more government regulations that are sitting on their back and requiring a lot of work. 5010, ICD-10, ACA, are a few that are close to the heart of this. None of these operational requirements even takes into account things like desktop replacements, network upgrades, server maintenance, server upgrades, mobile device management, etc etc etc. Not to mention security and HIPAA.

The point is that it’s easy for a hospital CIO to get caught up in all the day to day operational requirements that they can’t see any room for a strategically important project. This is a really significant problem and one that ONC should be worried about as well. Are hospitals so overwhelmed with operational requirements that they’re not going to be ready for the future?

There’s an easy way for a hospital CIO to know how they’re doing with this. Sit down and take a look back at your schedule for the last week. How much was spent on strategic thinking and implementation for your organization? I think most hospital CIOs will find a severe lack of time spent strategically improving their organization.

The only way to get there as a leader of a hospital organization is to have people on your team who you trust enough to delegate important operational tasks. Yes, the operational tasks must go forward, but you have to delegate the operational tasks so you can focus on the strategic.

Paper to EMR is Much Easier to Justify Than EMR to EMR

Posted on May 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

When I was last in DC at the Healthcare Forum, I heard hospital CIO Bill RiegerStep Out” and talk about some of the challenges he faces as a hospital CIO. One of the things he said in his talk really rang true to me and is going to become an increasingly important topic in healthcare.

His comment: The ROI from Paper to EMR is Much Easier to Justify than EMR to EMR

This is a powerful and challenging thing to consider. I’m sure those at Epic, Cerner, Meditech, etc are licking their chops knowing that it will take a hospital CIO with special leadership skills to overcome this challenge. Yes, from their perspective they have some incredible customer lock in. However, Bill went on to describe that it’s not impossible to lead such an effort. In fact, his hospital was switching EMR software shortly after I heard him speak.

The biggest challenge with this idea isn’t that there’s no ROI to switch from one EMR to another EMR. There can be a significant ROI, but most hospital CIOs are afraid to make such a call. They’re afraid to really dig in deeply to find out what a new EMR might mean for their hospitals. Sometimes this is because they were the one who implemented the first EMR. Other times it’s they’re too risk averse to take on such a challenging project. It’s often easier to sweep thing under the rug than it is to pull up the rug and really see what’s going on under the covers.

I’m of course not suggesting that switching EMR software is always the right decision either. One of the first lessons I learned out of college was that change doesn’t always mean better. In fact, a change can make things worse.

I do believe that continuous improvement leads to beautiful results. Too many in healthcare IT are satisfied with status quo. If we’re going to continuously improve, one area we can start is to dig deeply into the ROI of going from electronic to electronic.

The Cloud and Hospitals

Posted on November 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Let’s talk about The Cloud and Hospitals for a minute. At a session I attended at CHIME a hospital CIO said, “There’s still a lot of unknown with cloud.”

At first I was a little taken back by the comment. As an IT guy, it seems like cloud has been around forever. Plus, I would bet that every single hospital has a number of cloud based IT systems in their IT environment.

What then could be the unknown issues with the cloud that this CIO was talking about?

I found this really great resource on the IBM website about the cloud and healthcare. They hit on what is probably the biggest unknown with the cloud, HIPAA. Here’s a section which describes why it’s such an unknown.

Cloud providers hold a unique position as BAs entrusted with EPHI. When HIPAA was enacted, the concept of “the cloud” didn’t exist and probably could not have been predicted. Covered entities and other BAs are increasingly choosing to store health information in the cloud.

Then he adds in these cloud challenges:

Transferring data to the cloud comes with unique issues that complicate HIPAA compliance for covered entities, traditional BAs, and now cloud providers themselves. They include issues of control, access, availability, shared multitenant environments, incident preparedness and response, and data protection

All of these should provide any hospital CIO a moment of pause. As another hospital CIO I talked with said, “we’re still doing the cloud, but we are careful about who we work with in the cloud and how we do it.”

I think this will be the reality for the forseeable future. It takes a really well done trusted relationship for a hospital to trust a cloud provider. In the small ambulatory practice space it’s very different since there’s little doubt that the cloud provider can do much better than your neighborhood tech guy. However, this is not the case in hospitals where the decision to use the cloud or your existing in house IT staff and resources is much more complex.

The reality is that every hospital is likely going to have a mixed hosting strategy with some software hosted in house and some software hosted in the cloud. This means that every hospital CIO is going to have to figure out the cloud even if there’s still some difficult to answer questions.

My Surprise Breakfast with Epic CEO Judy Faulkner

Posted on October 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of the highlights of my experience at CHIME 2012 was a surprise breakfast that happened on the final day of CHIME. I actually was a touch late to breakfast after skipping out of a mostly empty room talking about HIPAA (imagine that on the last day of a conference). I got my breakfast and sat down at a table of what turned out to be mostly hospital CIOs.

Meals at CHIME turned out to be a great time to meet, connect and learn from the hospital CIOs that attended. A lively conversation was happening when a lady sat down next to me. I looked up and to my surprise the lady sitting next to me was none other than Judy Faulkner, CEO of Epic. I’m sure she had no idea who I was and I later realized that she likely sat next to me because on the other side of her was a hospital CIO she wanted to apologize to for something that had happened months before.

As an EHR blogger, I admit that I was probably a bit star struck sitting next to Judy. This was probably accentuated by the stigma (right or wrong) that Epic doesn’t like the media very much. So, I decided that rather than probe into Judy like a normal media person (I prefer to be a thought leader as much as I am a journalist anyway), I decided to just sit back and mostly listen.

It made for a really interesting experience since one of the first things Judy talked about was apologizing to this hospital CIO. I’m sure the cynics out there would say that she was probably apologizing because she wanted to further Epic’s business with that CIO. However, that wasn’t the impression I got from Judy. Instead, I got the impression that she had a real feeling of guilt that something she had done had caused other people some amount of trouble. In fact, how troubled she was by something most of us wouldn’t think twice about I think says something about Judy. I think some like to characterize her as a tough, driven, hard-nosed, business woman. Maybe she is in the boardroom, but my experience at breakfast was of her as a very thoughtful caring person.

When I told some of my colleagues about my experience with Judy, she told me I’d been seduced. Maybe she’s right. From my experience I saw a very kind, compassionate Judy.

I’ll wait to share all of the things I learned from my time with Judy for another time, but I did also have an interesting conversation with Judy about Twitter and social media. I think the conversation began because I playfully suggested that she should post whatever we were talking about to Twitter. I say playfully, because I was quite sure I’d never seen Judy on Twitter or any other social media and so I was interested to see her response. She responded something like, “I hope I live my whole life and never go on Twitter.”

While I was partially taken back by the sharpness of her response (Although, thinking back I shouldn’t have been surprised), I replied that “Twitter’s not about ‘what I ate today’ and that there was real value to engaging on Twitter.” To Judy’s credit, she then asked why I thought she should be on Twitter.

My response in the moment was pretty terrible. I told her about Twitter’s ability to “connect people.” While this is valuable to many people, the last thing that Judy wants in her position is more random people connecting with her. After giving such a lackluster response, I decided a broader answer I could have given would be, “Social media is about people and people are the most valuable asset in the world. Social media leverages people in amazingly powerful ways.”

That answer is still not perfect without examples and application, but at least the answer applies more broadly in a way that she could benefit from social media. After this experience, I asked myself if I was doing a keynote on healthcare social media, what would I say?

I’ve already come up with 21 ways to benefit from social media. I’ve also started creating a list of very specific examples of social media in healthcare. If you have more examples, I’d love to hear them in the comments. It only seems fitting that I’d use social media to help me put together this resource, right?

I’m still debating the best way to spread what I gather about healthcare social media, but I think it needs to happen. I still run into far too many people that think that social media is just about what you ate for lunch or your drunken pictures with friends. More people need to be informed about the amazing possibilities with healthcare social media. Plus, next time I happen upon breakfast with Judy Faulkner, I’ll have a much better answer for her.