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A Nursing Informatics Perspective on Healthcare Analytics – Interview with Charles Boicey

Posted on September 21, 2018 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.

Healthcare informatics has been around for a long time. However, from my perspective, it feels like there’s something different in the air when it comes to healthcare informatics. I get the feeling that we’re on the precipice of something really special happening. In fact, I think we already start to see value being created by healthcare informaticists.

As Healthcare Scene continues to explore this subject, we sat down with informatics expert, Charles Boicey, Chief Innovation Officer at Clearsense, to talk with him about what’s changed in healthcare informatics that makes it different today than in the past. We also talk about what’s needed to make healthcare analytics efforts successful at organizations and what analytics trend he’s watching most. Plus, we had to talk about his background as a nurse and how a nursing background really helps his informatics work.

If you want to hear of some practical uses of healthcare analytics and how your organization can benefit from it, you’ll enjoy our interview with Charles Boicey.

Be sure and subscribe to all of Healthcare Scene’s videos on YouTube. Also, take a minute to check out EXPO.health and join us in Boston to mix and mingle with amazing healthcare IT professionals like Charles Boicey.

Do We Need Another Interoperability Group?

Posted on September 20, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Over the last few years, industry groups dedicated to interoperability have been popping up like mushrooms after a hard rain. All seem to be dedicated to solving the same set of intractable data sharing problems.

The latest interoperability initiative on my radar, known as the Da Vinci Project, is focused on supporting value-based care.

The Da Vinci Project, which brings together more than 20 healthcare companies, is using HL7 FHIR to foster VBC (Value Based Care). Members include technology vendors, providers, and payers, including Allscripts, Anthem Blue Cross and Blue Shield, Cerner, Epic, Rush University Medical Center, Surescripts, UnitedHealthcare, Humana and Optum. The initiative is hosted by HL7 International.

Da Vinci project members plan to develop a common set of standards for data exchange that can be used nationally. The idea is to help partner organizations avoid spending money on one-off data sharing development projects.

The members are already at work on two test cases, one addressing 30-day medication reconciliation and the other coverage requirements discovery. Next, members will begin work on test cases for document templates and coverage rules, along with eHealth record exchange in support of HEDIS/STARS and clinician exchange.

Of course, these goals sound good in theory. Making it simpler for health plans, vendors and providers to create data sharing standards in common is probably smart.

The question is, is this effort really different from others fronted by Epic, Cerner and the like? Or perhaps more importantly, does its approach suffer from limitations that seem to have crippled other attempts at fostering interoperability?

As my colleague John Lynn notes, it’s probably not wise to be too ambitious when it comes to solving interoperability problems. “One of the major failures of most interoperability efforts is that they’re too ambitious,” he wrote earlier this year. “They try to do everything and since that’s not achievable, they end up doing nothing.”

John’s belief – which I share — is that it makes more sense to address “slices of interoperability” rather than attempt to share everything with everyone.

It’s possible that the Da Vinci Project may actually be taking such a practical approach. Enabling partners to create point-to-point data sharing solutions easily sounds very worthwhile, and could conceivably save money and improve care quality. That’s what we’re all after, right?

Still, the fact that they’re packaging this as a VBC initiative gives me pause. Hey, I know that fee-for-service reimbursement is on its way out and that it will take new technology to support new payment models, but is this really what happening here? I have to wonder.

Bottom line, if the giants involved are still slapping buzzwords on the project, I’m not sure they know what they’re doing yet. I guess we’ll just have to wait and see where they go with it.

Looking Forward to #AHIMACon18 – HIM Scene

Posted on September 19, 2018 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.

This weekend is the start of the AHIMA Annual Convention happening in Miami, Florida. For those not familiar with the AHIMA organization, it brings together HIM professionals from across the country. Something that I think makes AHIMA unique is that around the HIM conference are multiple days of training and certifications for HIM professionals. I’m always amazed at how much work HIM professionals have to put in to keep up with their certifications and to stay up with things like the ever-changing world of medical coding. HIM definitely doesn’t get the credit they deserve in this regard.

As I think what topics will be hot at this year’s AHIMA Annual convention, I’m most interested to hear what the HIM crowd thinks about the changes to the Physician Fee Schedule and E&M Coding. This is going to be a big deal for healthcare and medical coders are going to be the ones charged with dealing with the changes. Sure, doctors will have to change how they are documenting as well, but verifying that it was documented correctly and making sure the medical coding matches that documentation is mostly done by HIM professionals.

I’m really interested to hear what HIM professionals think about these medical coding changes. What do you think of the new time based coding options? Does this make life easier or not? Let us know what you think and what you’re hearing in the comments. The obvious part to me is that in the short term it’s not going to make medical coders’ lives easier at all. It’s just one more code they’re going to have to deal with and it doesn’t have a history of practices to support what’s acceptable or not. It’s not like these new codes are doing away with the old codes. At least I don’t think that’s how most practices are going to handle these new codes, but we’ll see. Let us know your thoughts in the comments.

Another big change that could impact HIM professionals, particularly medical coders, are the new remote monitoring and digital care coordination codes. I’ve heard a lot of people saying that these codes show some promise. However, I’m starting to hear overtures that the codes aren’t going to live up to their billing (excuse the pun). What are you seeing when it comes to the new coding for telemedicine, remote monitoring, and digital care coordination?

Outside of these two big topics, I’ll be interested to hear how HIM professionals are looking at security and privacy. It’s become a huge topic in the CIO and healthcare IT world. I wonder how much it will impact the HIM world. There’s always an interesting dance when a breach happens. The HIM world is great at understanding disclosures and HIPAA violations, but breaches often bring out a lot of different people. The reality is that when a breach occurs it needs to be all hands on deck. However, my guess is that many HIM professionals aren’t part of the discussion when a breach occurs. How’s your experience been in this regard? If you haven’t had a breach (lucky you), you should still have some policies and some drills in place to make sure you’re ready. So, you should have an idea of what HIM’s role would be in a breach.

Another trend I’ve been watching for a number of years is the push for more and more HIM professionals to be involved in things like healthcare analytics. This was highlighted by a recently published article in the Journal of AHIMA that makes the argument that all healthcare professionals need to learn data analytics. I argued something similar in this article on how HIM professionals can use Information Governance to ensure they’re heard. These are important messages that I think many in HIM are largely ignoring. It will be interesting to see how this shakes out. Those that embrace the changes will be well positioned for the future.

What other things should we be watching for from an HIM perspective? What’s keeping you up at night? What’s getting you most excited about your job? Let us know in the comments or on Twitter @HealthcareScene.

Looking to Improve Patient Experience? Simple Options Can Yield Big Results.

Posted on September 18, 2018 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.

Improving patient experience is a top priority. Instead of grandiose new programs, hospitals and practices would see better results by focusing on simple options that have a big impact – like an eConsent solution. eConsent makes it easier for organizations to treat patients with respect and gets patients involved in their care.

Over the past several years more and more attention has been placed on improving the patient experience. This is partly due to a recognition by healthcare organizations that experiences could euphemistically be called less-than-ideal and partly because of changes to reimbursements that tie $$$ to patient satisfaction (specifically HCAHPS scores). From a patient and patient champion perspective this attention has been a welcome change.

There is a tendency, however, for healthcare organizations to gravitate towards large-scale projects to improve patient experience. Although projects like renovating patient suites and implementing AI chatbots can indeed have a positive impact, these initiatives are resource-intensive and can take a long time to yield results. Instead, hospitals and physician practices should focus on doing small things better and reap the benefits of improved patient experience sooner.

According to a study published by BMJ Open in 2016, positive patient experiences were “closely linked to effective patient-health professional interaction and logistics of the hospital processes”. The authors of the study also found that “positive aspects of the hospital experience were related to feeling well informed and consulted about their care”.

In 2014 a study found that delays in healthcare (wait times) impacted the perceived quality of care received. The longer the delay, the more that confidence in the care provider eroded. Having confidence in the care provider is a key factor in the online ratings patients give to healthcare organizations. Online ratings are the new real-time way to gauge patient satisfaction.

Taken in combination, these studies tie patient satisfaction/experience directly to (1) interactions between patients and their health professionals; and (2) smooth hospital processes.

Interactions with Patients

So what can hospitals do to improve interactions between health professionals and patients? They could implement new communication tools (like real-time chat). They could renovate offices so that patients and clinicians can look at screens together. They could even hire navigators to help patients interact with health professionals. All of these are fantastic initiatives, but all of them will take time and in some cases, a lot of resources.

There are, however, a number of simple things that hospitals could do that do not require significant investments of time or dollars. One would be to train clinicians to ask patients: “Is there anything we have covered today that I can help clarify or that you have questions about” rather than the standard “Do you have any questions?”. Another would be to implement electronic forms during the intake process so that patients only have to enter their information once. There is nothing more annoying than having each department ask for the same information over and over again.

Along these lines, an often overlooked yet quick-hit improvement area, is the informed consent process. The American Medical Association defines it as follows.

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

  • The diagnosis (when known)
  • The nature and purpose of recommended interventions
  • The burdens, risks, and expected benefits of all options, including forgoing treatment

(c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”

The informed consent process is a golden opportunity for hospitals to improve the patient experience. It is a chance for health professionals to engage patients in their care. This engagement has numerous benefits including:

  1. Reducing the anxiety patients have about the upcoming procedure, which in turn helps improve patient outcomes. This study published in the British Journal of Surgery, shows patient who are less anxious have fewer post-procedure wound complications.
  2. Demonstrating that the health professional (and by extension the hospital) care about the patient as a person.
  3. Mitigating the risk of malpractice. Lack of communication and feeling like clinicians didn’t care about them are common reasons cited by patients who decide to sue for malpractice. This New York Times article has an excellent summary of various studies into this phenomenon.

A simple way to improve the informed consent process is to move away from paper-based consent forms, which can be lost and are often confusing to patients, to electronic consent forms (commonly referred to as eConsent).

According to Robin McKee, Director of Clinical Solutions at FormFast, which offers an eConsent solution, “It’s the right time to be having the conversation about the costly risks associated with a paper-based process. Over 500 organizations recently experienced compliance issues due to missing informed consent forms according to the Joint Commission). Adopting an electronic solution is an easy and quick way to offer a better patient experience during the consent process.”

With an eConsent solution like FormFast’s, hospitals would be able to:

  • Have patients fill out forms on a user-friendly tablet
  • Pre-populate information on the forms with EHR data
  • Link to educational material that explains the procedure and risks in more detail
  • Quickly recall consent forms prior to the procedure by scanning the patient’s wristband
  • Provide a copy of the consent form (and links to the educational material) to patients

Smooth Hospital Processes

Feeling respected as an individual is key to a good patient experience. In fact, a 2015 Consumer Reports Survey found that patients who said they did not feel respected by the medical staff were 2.5 times as likely to experience a medical error versus those who felt they were treated well.  One of the easiest ways to show respect for patients is to value their time and prevent long delays during their hospital stay.

For patients, it is a horrible feeling to show up at the appointed time for a procedure, only to be carted to a waiting area in nothing but a flimsy robe and left to wait with no explanation. Now imagine how it would feel after 20 minutes of waiting to have a member of staff come and ask you to fill out another set of consent forms because your originals had been lost. Of course, while the patient is filling out the form, the staff member must review all the risks and implications of the procedure before you can sign the forms again. I know I would be about as calm as a palm tree in a hurricane.

This situation is referred to as “gurney consent” and is something that many hospitals are trying to eliminate. The National Center for Ethics in Health Care has a special guideline that prohibits gurney consent – VHA Handbook 1004.01 – Informed Consent for Clinical Treatments and Procedures. That handbook states that “Patients must not, as part of the routine practice of obtaining informed consent, be asked to sign consent forms ‘on the gurney’ or after they have been sedated in preparation for a procedure.” This clause was meant to ensure the consent does not occur “so late in the process that the patient feels pressed or forced to consent or is deprived of a meaningful choice because he or she is in a compromised position.”

Sadly, gurney consents are an all too common occurrence in hospitals that use paper-based consent forms. JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing each hospital over $500K each year. This of course does not count the emotional toll it takes on patients.

It would be remiss not to point out that members of staff equally hate the need to have patients re-sign consent forms. It’s not comfortable to be the bearer of bad news and stand there while an upset patient vocalizes their displeasure. After all, the staff member is not the one that lost the form. Medscape’s recent National Physician Burnout & Depression Report found that the top contributor to physician burnout was excessive administrative tasks. Asking for another consent form from a patient certainly qualifies as an excessive administrative task.

“By modernizing document workflows, FormFast gives patients, their family member and clinicians the information they need, when they need it,” says Rob Harding, CEO of FormFast. “Digitizing the informed consent process helps ensure procedures go according to plan – no one is running around trying to find a paper document or asking for forms to be filled out yet again. A frictionless workflow makes for smooth operation which helps both patients and health professionals. eConsent is really a win-win.”

Conclusion

There are a myriad of ways to improve the patient experience. Big, bold initiatives and small, simple changes to existing processes. Although it is not an either-or situation, in the current economic and regulatory environment, hospitals should look for “small wins”, like eConsent, as an affordable and pragmatic way to improve the overall patient experience. As an added bonus, clinicians and administrators will also reap the benefits of lower stress and smoother workflows.

No matter what initiative, a hospital takes, ANY effort made to improve patient experience is a step in the right direction.

FormFast is a proud sponsor of Healthcare Scene.

Prioritizing Nursing Sepsis Awareness and Compliance

Posted on September 17, 2018 I Written By

The following is a guest blog post by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Health Learning, Research & Practice, Wolters Kluwer.

September is Sepsis Awareness Month—an opportune time to reflect on the state of industry as it relates to reducing the impact of this potentially deadly condition. In terms of reach, the numbers are sobering: 1.5 million people in the U.S. contract sepsis each year, and a quarter of a million die annually from the condition.

In recent years, the healthcare industry has taken important steps to improve the sepsis outlook by keeping awareness and best-practice developments front and center. The Surviving Sepsis Campaign’s (SSC’s) 2018 release of the updated hour-1 bundle reflects this commitment by keeping care delivery in sync with the latest evidence—in this case the International Guidelines for Management of Sepsis and Septic Shock 2016.

The new bundle combines the SSC’s previously-released 3-hour and 6-hour bundles and prioritizes the need for early identification and more immediate response. Nurses play a critical role in this equation as the clinicians working on the frontlines of care. While sepsis is more likely to present in emergency departments and critical care environments, it is imperative that all nurses have the knowledge to quickly identify symptoms and begin appropriate treatment protocols.

The sepsis challenge is both mammoth and complicated, requiring a multi-pronged, multi-disciplinary approach that draws on the latest evidence and institutional accountability. There is much at stake for hospitals in terms of reputation as sepsis performance scores are now published on the Centers for Medicare and Medicaid Services’ Hospital Compare website, where patients can quickly and easily see how their facility of choice stacks up in terms of sepsis mortality.

Consequently, it is more important than ever for hospital clinical leaders to prioritize nursing education on the early signs of sepsis, especially when caring for at-risk patients. In addition, nurses need quick access to hour-1 bundle protocols at the point of care to ensure they are properly following the guidelines to optimize sepsis outcomes and save lives.

Sepsis Bundle Primer

The latest revision of the SSC bundles seeks immediate resuscitation and management of sepsis. In the update, SCC authors note: “We believe this reflects the clinical reality at the bedside of these seriously ill patients with sepsis and septic shock—that clinicians begin treatment immediately, especially in patients with hypotension, rather than waiting or extending resuscitation measures over a longer period.”

The guidelines detail five steps that should take place within one hour of identifying sepsis including:

  • Measure lactate level. Remeasure if initial lactate level > 2 mmol/L.
  • Obtain blood cultures before administering antibiotics.
  • Administer broad-spectrum antibiotics.
  • Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L.
  • Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

The premise of the bundled elements is that the whole is better than the one. When implemented as a group, these protocols have the greatest impact on outcomes.

The Sepsis Knowledge Gap Challenge

Hospitals face nursing knowledge gaps related to sepsis on two fronts: 1) early identification; 2) adhering to best practice protocols. While nurses working in the ED or critical care are likely to have experience with sepsis and the hour-1 bundle, those working on the medical-surgical floor or in other specialty areas often lack a deep understanding of the complexities and urgency surrounding early identification and response.

To promote early identification, nurses need to first understand the symptoms that occur in patients who are septic. Key observations include:

  • Delirium
  • Extreme high or low temperatures
  • Shortness of breath
  • Extreme pain or discomfort
  • Elevated heart rate and/or low blood pressure
  • Cool and clammy skin

While the answers to these questions can provide a baseline, the reality is that sepsis is a complicated diagnosis that requires critical thinking. For instance, fever alone is not always the best indicator of the condition, as hypothermia and low temperatures are often more predictive of severity and death. In addition, nurses need awareness that certain patients are at higher risk of mortality, such as the very young and the elderly or those with certain co-morbidities like COPD, heart failure and diabetes.

The Quick Sepsis Related Organ Failure Assessment (qSOFA) provides an effective point-of-care prompt for identification of a suspected infection. The tool uses three criteria to determine sepsis mortality risk. These include one point for each of the following: low blood pressure (SBP≤100 mmHg); high respiratory rate (≥ 22 breaths per minute); or altered mentation. Nurses need to be educated to use this system and be made aware of alerts that point to these variables. For example, a positive score of 2 or higher would point to the need for intervention by a provider or initiation of rapid response protocols.

Standardizing Sepsis Identification and Response

To eliminate variations in sepsis care and ensure best-practice protocols are followed, hospitals must implement comprehensive and ongoing education programs for nurses that address three areas: 1) identification of early signs of sepsis; 2) hour-1 treatment bundle protocol and 3) use of qSOFA scoring. Technology is an important part of any strategy and should be a priority consideration for both education and point of care guidance.

The best clinical decision support tools at point of care provide automated updating of new evidence as it is established. In the case of the hour-1 sepsis bundle, these solutions foster confidence that nurses have that right information when they are with the patient, and if they forget, a quick look-up can provide the needed guidance.

Access to the most up-to-date digital professional development education resources help nurses garner a deeper understanding of sepsis, the latest standards and practice application. Hospitals can draw on the latest advancements to quickly create customized programs and exams that allow students to progress and master skills at their own unique level.

Sepsis mortality rates sit at greater than 40 percent. In the era of value-based care which focuses on patient outcomes, that’s significant and problematic for hospitals on many levels. Improving sepsis outcomes necessitates that clinical leaders invoke strategies that promote adoption of the latest evidence to move the needle on performance.

About Anne Dabrow Woods
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN is the Chief Nurse of the Health Learning, Research and Practice business unit at Wolters Kluwer.  She is also a critical care nurse practitioner for Penn Medicine, Chester County Hospital, and she is adjunct faculty for Drexel University in the College of Nursing and Health Professions.

CMIOs Say Medication Management Is Improving, But Still Needs Work

Posted on September 14, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey suggests that chief medical information officers are optimistic about the progress they’ve seen in medication management processes though they still see some obstacles that need to be tackled. Their top concerns seem to be related to the sharing of prescription information and a lack of faith in the medication lists as they’re currently generated.

According to research conducted by the Association of Medical Directors of Information Systems (AMDIS) and vendor DrFirst, medication management improvement efforts have made a positive impact on the rate of adverse drug events over the past five years.

About half of the CMIOs said they were satisfied with their existing medication management process, while 12% said they were dissatisfied.

The CMIOs reported that the biggest gaps in the medication management process were incomplete patient medication histories (cited by 80%) and misaligned medication reconciliation and care transition cycles (75%). Respondents said that this kind of misalignment sometimes lead to misinformed decisions by care teams.

Another vulnerability respondents identified was lack of visibility into patients’ medication adherence levels, with 91% calling it the biggest gap in medication history adherence and monitoring. They didn’t name any particular solution that could address the problem, though existing medication management apps for consumers might at some point address this issue.

Eight-five percent of responding CMIOs said that when patients don’t participate in the medication reconciliation process it leads to gaps in the patient medication history. They didn’t specify the point in the process at which it might be most helpful to involve patients.

In addition, 95% of respondents said that it would help matters to cut down on the order entry and data validation tasks pharmacists and clinical staffers had to perform, arguing that it would enhance patient safety and improve efficiency.

Other patient safety concerns they cited included a lack of process buy-in and/or process compliance (77%), a lack of process ownership (73%) and workflow variations across departments (91%).

As part of the discussion, the surveyed CMIOs noted that the right technology approach could help them address the opioid epidemic.

As things stand, they told AMDIS, it’s not clear the providers are able to prevent opioid abuse since at times they can’t easily distinguish between drug “shoppers” and other patients.

However, 65% of CMIOs said that if providers could access an integrated clinician workflow including e-prescribing of controlled substances, access to state Prescription Drug Monitoring Programs to track patients’ opioid histories and access lists of other prescriptions, it would be easier for them to avoid potentially harmful drug combinations.

Electronic Health Records – Is Your Organization Committed to Adoption or Just Implementation?

Posted on September 13, 2018 I Written By

The following is a guest blog post by Heather Haugen PhD from Atos Digital Health Solutions.

Several years ago, a reputable IT vendor offered our organization a trial version of their software in exchange for our feedback. The software provided equipment monitoring that would be valuable to us. Initially, we were excited because the functionality aligned with our needs and the application was robust enough to grow with us. It seemed that the software would fulfill our need. The new software system served IT directly, so our Director of IT led the implementation and kept our senior management team updated on the progress. We were impatient to get access to the dashboard of data the vendor promised. But months later, we were still waiting.

The price tag had lured us in, but we quickly realized the high cost in maintenance and labor required to make the application truly valuable. This story drives home a concept that we all understand, but often overlook; sometimes we underestimate the “care and feeding” required to maintain a valuable investment, putting the entire project at risk. In fact, we all need to remember the importance of sustainability after the initial excitement about an investment’s value. It is common to under-appreciate the effort it will take to maintain the value of our investments.

Let’s consider the shift in thinking required to move from implementing an Electronic Health Record to maintaining high levels of adoption over the life of the application. Many organizations focus on the implementation cost without truly appreciating the long-term cost of maintaining these large, complex systems.  We often see this in healthcare organizations, no matter what size.  Costs that are often underestimated include IT resources required for system maintenance; recruiting and retaining talent for new areas; ongoing training for new employees; upgrades for resources, training, and hardware; time and resources for optimizing systems and workflow; and expertise in finance and reporting needed to gain the value promised by the EHR.

In the world of EHR adoption, we often spend too much time focusing solely on implementing new software solutions. We know how to prepare well for the go-live event, but after go-live, organizations typically discontinue the investment of time and resources required to see the process through to the adoption phase. When this happens, users tend to fall back on work-arounds and ineffective workflows, and new users receive insufficient training. The process of adoption requires a radically different discipline, where the real effort begins at go-live.

After we successfully implement a new technology, our tendency is to move on to the next project. In a world where it is common to juggle multiple projects, we actually feel some relief in moving it off our list of highest priorities. What we need is a plan to sustain the long-term changes required.  A sustainment plan addresses two important areas. First, it establishes how the organization will support the end users’ ongoing needs for the life of the application. This includes communication, education and maintenance of materials and resources. Second, it establishes how and when metrics will be collected to assess end user adoption and performance. By planning and executing a sustainment plan, we can avoid the steady deterioration in end user adoption that otherwise occurs over time.

Effective sustainability plans require resources, time, and money. Keep in mind that adoption is never static; it is continually either improving or degrading in the organization.  Without a plan for training sustainment, a series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for and fund the investment in sustainment because the ultimate goal is improved performance. Many organizations only achieve modest adoption levels after a go-live event. To truly achieve sustained adoption levels, it takes relentless focus on improving quality of care, patient safety, and financial outcomes. The most successful sustainability plans are part of the organization’s initial budgeting and planning stages for EHR.

Sustainment means more than maintaining the status quo. If sustainment becomes a passive process, it is a waste of resources. The difference between a highly effective sustainment plan and one that is just mediocre is metrics. Consistently measuring end-user knowledge and confidence creates a barometer for proficiency levels and provides the earliest indication of adoption, or use of the application according to best practices. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining, or regressing in their adoption of a new system. If the warning that proficiency is slipping comes early in the process, we have an opportunity to react quickly to address the problem. Knowledge and confidence metrics ensure that the organization is progressing toward high levels of adoption, overcoming barriers, and achieving the efficiencies promised by EHR adoption.  Metrics allow us to adjust quickly and proactively; they are the first indicator of falling back into old behaviors that are inconsistent with sustainable adoption.

Metrics also keep us on track when performance does not meet expectations. Let’s consider two different scenarios to illustrate this idea. In both scenarios, the go-live event was successful, but specific performance metrics did not meet expectations. In the first scenario, the system is being used inefficiently. This may be due to inadequate training and subsequently lower end user proficiency. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and ensure they receive the education they need to become proficient. Once users are proficient, we can refocus our attention on the performance metrics. The second scenario is less common and also more difficult to diagnose: our metrics show that users are proficient, but specific performance measurements are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be delays in achieving certain metrics, especially if the measurements are examining small changes. Normal delays can wreak havoc if we start throwing quick fixes at the problem instead of staying the course and having the confidence in the metrics that will bring about desired results.

Ultimately, leaders must commit the resources, time, and effort to adoption that lasts long after go-live ends.

About Heather Haugen
Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos. She is also the author of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.

Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

Healthcare Communication Software with the Patient at the Center

Posted on September 12, 2018 I Written By

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

I was recently at the KLAS Digital Health Investment Summit where I met a ton of great people. One of those people was Brent Lang, CEO of Vocera. I have a long history with Vocera, but I’d never had a chance to meet Brent in person. As fate would have it, we sat down by each other at the opening dinner and had a great conversation about our overlapping connections, about Vocera, and the healthcare communications market in general.

Of all the insights Brent shared, I couldn’t stop thinking about his comment that Vocera was working hard to make the patient be the center of all their communication.

I’m sure some critics out there might wonder why the patient wasn’t at the center to start. Notice that he didn’t say that they were putting the patient at the center of their work. Knowing them as I have, I think they’ve been putting the patient first for a long time. However, as I understand it, Brent is suggesting a paradigm shift in how provider communication is designed.

Here are my thoughts on what he was saying. It makes sense when you’re first designing their popular Vocera badge communication (1 million+ badges) why most of the communication would be focused around the providers. The goal of those communication devices was to enhance provider communication. The nurse and doctors needed an “inbox” for their messages so they could read or listen and reply as needed. Having the providers at the center of those communications makes a lot of sense. The technology was looking to replace things like pagers and overhead speakers and it did that well.

The challenge comes as Vocera has taken on more and more communication modalities. Vocera now has secure text messaging, alarms and alerts, and integrations with a wide variety of clinical and EHR systems. Many of these messages need to be sent to a wide variety of providers and which provider needs the message can change over time. It’s no longer a one to one communication that’s needed. Plus, the history of messages for a specific patient across multiple platforms and multiple providers can be as valuable as the specific, in the moment message. Thus the need to put patients at the center of the messaging.

It’s a powerful idea that a provider could see all the messages for a patient in one location. It is probably how messaging should have always been done, but the implementation of technology is an iterative thing. If you try and do everything you end up doing nothing. It’s great to see Vocera iterating in a way that puts the patient at the center of their communication platform.

As I thought about this change, I wondered what other healthcare IT systems should have the patient at the center. It’s actually hard to think of healthcare IT applications where the patient is at the center. EHRs are largely focused around the provider workflow and not the patient. Some of them are trying to make this shift too. We do see it happening with new healthcare IT companies. I advise a company called CareCognitics that is an example of a company that puts the patient at the center. I recently wrote about Patient Directed that puts the patient at the center as well. It will be interesting to see which older healthcare IT companies adapt and put the patient at the center like Vocera is doing and which new companies come along with this paradigm shift built in.

Always Remembering 9/11

Posted on September 11, 2018 I Written By

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

I’m not sure what it’s like for other people, but 9/11 is a day full of really mixed emotions for me. I’ve been reminded of it over the past couple weeks when people want to schedule meetings with me. As we’ve talked over schedules, I’ve wondered if I should schedule a work meeting on 9/11. The feelings are so raw for me that a part of me feels like that’s not appropriately honoring all of the people that lost their lives. The other part of me feels like carrying on is the best way to honor those that lost their lives. I palpably remember the feeling that the evil people win when we stop doing what we do. So, I try to have a normal day on a very not normal day.

We all have to deal with tragedies in our own way. I was grateful last night when my daughter came and asked me if I wanted to talk to her before she went to sleep. I laid down next to her and just talked. That’s a great moment and one that I’d remember and be grateful for if tragedy struck. I need to create more of those moments and never take them for granted.

There are so many stories out there from 9/11. I’m grateful that my children are learning about it from all of the movies and documentaries done about it. However, I don’t think they can fully understand. When I’m blogging on 9/11, I’ll always think of the story of Dirk Stanley on 9/11.

Many of you probably know Dirk since he’s active in healthcare IT social media. If you have met Dirk you would know almost instantly that he’s an amazing individual. However, this story takes the cake when it comes to illustrating the type of people we have working in healthcare IT. Plus, Dirk doesn’t really think much of it and certainly doesn’t want any honor. I’ve heard him say that he was just doing what he could to help even as a 3rd year medical student. That’s what makes him so special. Enjoy Dirk’s inspiring story below as told by ABC News Channel 7 in New York.

What a tragic day, but stories like Dirk’s still give me hope for the future.

Pricing Transparency and Provider Quality: Insights from Utah HIMSS

Posted on September 10, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

Working to improve Health IT has been a major focus of Utah HIMSS this year. I am honored to serve as part of the Utah HIMSS Board. Utah HIMSS hosts educational events and luncheons for members. On August 29, 2018  the meeting focused on Pricing Transparency and Provider Quality. Health Informatics is positioned to help reduce waste in healthcare and providing better care for patients.

Bob White works with Select Health, one of the major insurance providers in the state, which is a subsidiary of Intermountain Healthcare. He was able to talk about payment models and value based care work within the Select Health group. Providing more visibility into the cost for patients and physicians has been a major focus on Select Health and payer provider entities have a unique market position. They want the cost of care delivery to be lower since they are paying the cost. Point of service adjudication requires that a lot of workflows need to be coordinated before the patient leaves the office.

Bob asked: How often do we feel like we don’t have complete information to know what is going on and what your options are?

One of the most notable things that he spoke about was the lack of adoption. They have great visibility but not everyone knows where to find that information. Some of the employees at Selecthealth have high deductible plans and in effect, become self-pay members. Becoming more educated consumers is a huge part of what Select Health has done with their pricing transparency.

Katie Harwood from the University Of Utah discussed their pricing transparency tool. The University of Utah is one of the first systems in the country to create an online interactive tool to help predict cost to patients. Patients can look up what a procedure might cost and enter information about their copay and caps. Most importantly, the cost estimator included the cost of facility and cost of provider, so patients don’t get stuck with unexpected out of network bills.

The most common search? Vaginal delivery without complications. I was thrilled to hear them speak because I’m pregnant and my provider is with the University of Utah Health. I got a cost estimate on my second visit to the OB and I was pleasantly surprised that they gave that information.  I was able to pay for what (might be) the cost of my maternity care. Being able to plan ahead is very valuable. The University of Utah has invested in creating bundled payment models to improve care coordination and as a patient, having that information has improved my healthcare experience.

While in development, the University of Utah wanted to add appointment scheduling for patients. Harwood mentioned this created a larger data matching challenge, as it was difficult to match exact providers with procedures. Insurance companies are trying to make it easier for patients to schedule and understand what their costs will be, and physician directories create unique challenges. What if you were a surgeon who performed a total knee replacement but you didn’t have the information connected with the correct insurance company for you to appear in the online scheduling tool?

Interestingly, many people go to the cost estimator tool enter “I don’t know” for some of their search criteria such as deductible and copay. Bridging the consumer gap to give even better information and creating the most accurate scheduling possible starts with efforts to create great health IT tools and adjusting them according to user behavior.

Holly Rimmasch from Health Catalyst was able to ask great questions and mentioned a program that Health Catalyst is doing to promote women in health IT. She served as a moderator and has an extensive background with pricing. They have promoted women in Health IT in the Utah area, including providing student scholarships for their Healthcare Analytics Summit in September.  A key question that Holly has focused on is “Are we making a difference in both quality and costs?”  “Does it translate into cost savings for those that are paying?” Part of her work involves bringing data sources together (clinical, financial, claims, etc.) to create transparency to services and care being provided and at what cost.  Over the last 6 years, Holly has been involved in developing a more accurate activity-based costing system. Accurate costing leads to more accurate pricing and more accurate pricing leads to improved price transparency. I am looking forward to learning more about what Health Catalyst does for improving Healthcare IT in Utah.

Norm Thurston is a Utah State Representative and I was surprised how much I enjoyed his presentation and I will tell you why. Norm Thurston has a background in statistics and I felt confident that the Utah legislature was getting good information about improving healthcare. Representative Thurston spoke about the availability of state data to see things like prescribing trends and billing trends among physicians. He asked Bob White about upcoding- and how the government of Utah looks at billing data to make that information more transparent for payers and providers. The checks and balances of legislators asking about trends based on data aren’t something I see every day in healthcare. Data backed inquiry can improve prescribing. Utah has had a decrease in opioid deaths in the last year, and the healthcare system and state efforts have actively used data to improve the numbers. Utah has historically been a state with a problem and has actively worked to improve rates of opioid deaths. One of the audience comments that I enjoyed was a question from Todd Allen, MD about how they evaluate the statistical significance of prescribing and billing differences. How do we know if using this drug or billing code 75% of the time has better outcomes that in the hospital where it is used less than 65% of the time? Having visibility and data is part of the equation for improving healthcare outcomes, and another part is interpreting the data and deciding best practices.