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PESummit Day 1 – Empathy is Hot in Cleveland

Posted on June 19, 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.

With the mercury hitting an incredible 90+ in downtown Cleveland, it was only fitting that the speakers and attendees at the 2018 Patient Experience: Empathy and Innovation Summit (#PESummit) turned up the heat on the passion for more empathy in healthcare WITHOUT a corresponding increase in burnout.

Day 1 at PESummit kicked off with Cleveland Clinic’s dynamic duo of Adrienne Boissy @boissyad, Chief Experience Officer and K. Kelly Hancock @kkellyhancock, Executive Chief Nursing Officer. Boissy issued a challenge to the audience in her opening:

They were followed by Cleveland Clinic President and CEO, Tomislav Mihaljevic MD @TomMihaljevicMD who shared a number of things that we could each do to increase empathy in our daily work. The clear favorite was eating lunch with someone you don’t know, and get to know them:


But the most poignant part of Mihaljevic’s time on stage came when he shared a failure from his past – the time he lost a patient in the OR. He spoke about how he and his team was unable to repair the damage to a patient’s heart and how devastated the team was when despite their best effort, the patient died. As the leader Mihaljevic held himself accountable and not only did he have to support the patient’s family in dealing with their loss, he had to help his own team deal with the death as well.

It was a pleasant surprise to hear Mihaljevic talk about the feelings he had in the moment and how he learned lessons that he carries with him today.

The highlight of the breakout sessions was the panel discussion on “When Patient and Healthcare Innovation Meet” that featured Grace Cordovano @GraceCordovano, Julie Rish @julie_rish, Christine Traul MD @traulc and Michael Seres @mjseres.


My favorite was Cordovano’s tip for patients to go into the doctor appointments PREPARED – with questions they are seeking answers to.

Day 1 ended with Thomas H Lee MD @ThomasHLeeMD, CMO of Press Ganey talking about “grit” (aka resilience) at the individual and team levels.


Lee’s most provocative statement was when he cited his research that found that it is ineffective to use financial incentives to motivate behavior that is inherently non-financial in nature. This punched a hole through the concept of paying people to sleep more than 7 hours that was mentioned by one of the morning keynotes and other gamification techniques that have become popular over the past few years.

Day 1 at PESummit was fantastic and I’m looking forward to a equally great Day 2. Follow along on Twitter #PESummit

 

 

 

 

The Truth about AI in Healthcare

Posted on June 18, 2018 I Written By

The following is a guest blog post by Gary Palgon, VP Healthcare and Life Sciences Solutions at Liaison Technologies.

Those who watched the television show, “The Good Doctor,” in its first season got to see how a young autistic surgeon who has savant syndrome faced challenges in his everyday life as he learns to connect with people in his world. His extraordinary medical skill and intuition not only saves patients’ lives but also creates bridges with co-workers.

During each show, there is at least one scene in which the young doctor “visualizes” the inner workings of the patient’s body – evaluating and analyzing the cause of the medical condition.

Although all physicians can describe what happens to cause illness, the speed, detail and clarity of the young surgeon’s ability to gather information, predict reactions to treatments and identify the protocol that will produce the best outcome greatly surpasses his colleagues’ abilities.

Yes, this is a television show, but artificial intelligence promises the same capabilities that will disrupt all of our preconceived notions about healthcare on both the clinical and the operational sides of the industry.

Doctors rely on their medical training as well as their personal experience with hundreds of patients, but AI can allow clinicians to tap into the experience of hundreds of doctors’ experiences with thousands of patients. Even if physicians had personal experience with thousands of patients, the human mind can’t process all of the data effectively.

How can AI improve patient outcomes as well as the bottom line?

We’re already seeing the initial benefits of AI in many areas of the hospital. A report by Accenture identifies the top three uses of AI in healthcare as robot-assisted surgery, virtual nursing assistants and administrative workflow assistance. These three AI applications alone represent a potential estimated annual benefit of $78 billion for the healthcare industry by 2026.

The benefits of AI include improved precision in surgery, decreased length of stay, reduction in unnecessary hospital visits through remote assessment of patient conditions, and time-saving capabilities such as voice-to-text transcription. According to Accenture, these improvements represent a work time savings of 17 percent for physicians and 51 percent for registered nurses – at a critical time when there is no end in sight for the shortages of both nurses and doctors.

In a recent webinar discussing the role of AI in healthcare, John Lynn, founder of HealthcareScene.com, described other ways that AI can improve diagnosis, treatment and patient safety. These areas include dosage error detection, treatment plan design, determination of medication adherence, medical imaging, tailored prescription medicine and automated documentation.

One of the challenges to fully leveraging the insights and capabilities of AI is the volume of information accumulated in electronic medical records that is unstructured data. Translating this information into a format that can be used by clinical providers as well as financial and administrative staff to optimize treatment plans as well as workflows is possible with natural language processing – a branch of AI that enables technology to interpret speech and text and determine which information is critical.

The most often cited fear about a reliance on AI in healthcare is the opportunity to make mistakes. Of course, humans make mistakes as well. We must remember that AI’s ability to tap into a much wider pool of information to make decisions or recommend options will result in a more deeply-informed decision – if the data is good.

The proliferation of legacy systems, continually added applications and multiple EMRs in a health system increases the risk of data that cannot be accessed or cannot be shared in real-time to aid clinicians or an AI-supported program. Ensuring that data is aggregated into a central location, harmonized, transformed into a usable format and cleaned to provide high quality data is necessary to support reliable AI performance.

While AI might be able to handle the data aggregation and harmonization tasks in the future, we are not there yet. This is not, however, a reason to delay the use of AI in hospitals and other organizations across the healthcare spectrum.

Healthcare organizations can partner with companies that specialize in the aggregation of data from disparate sources to make the information available to all users. Increasing access to data throughout the organization is beneficial to health systems – even before they implement AI tools.

Although making data available to all of the organization’s providers, staff and vendors as needed may seem onerous, it is possible to do so without adding to the hospital’s IT staff burden or the capital improvement budget. The complexities of translating structured and unstructured data, multiple formats and a myriad of data sources can be balanced with data security concerns with the use of a team that focuses on these issues each day.

While most AI capabilities in use today are algorithms that reflect current best practices or research that are programmed by healthcare providers or researchers, this will change. In the future, AI will expand beyond algorithms, and the technology will be able to learn and make new connections among a wider set of data points than today’s more narrowly focused algorithms.

Whether or not your organization is implementing AI, considering AI or just watching its development, I encourage everyone to start by evaluating the data that will be used to “run” AI tools. Taking steps now to ensure clean, easy-to-access data will not only benefit clinical and operational tasks now but will also position the organization to more quickly adopt AI.

About Gary Palgon
Gary Palgon is vice president of healthcare and life sciences solutions at Liaison Technologies, a proud sponsor of Healthcare Scene. In this role, Gary leverages more than two decades of product management, sales, and marketing experience to develop and expand Liaison’s data-inspired solutions for the healthcare and life sciences verticals. Gary’s unique blend of expertise bridges the gap between the technical and business aspects of healthcare, data security, and electronic commerce. As a respected thought leader in the healthcare IT industry, Gary has had numerous articles published, is a frequent speaker at conferences, and often serves as a knowledgeable resource for analysts and journalists. Gary holds a Bachelor of Science degree in Computer and Information Sciences from the University of Florida.

Mobile Policy Enforcement Issues Could Expose Hospitals To Security Problems

Posted on June 15, 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 several years, mobile device management has become a critical issue for hospital IT departments. As mobile use by both clinicians and patients has soared, hospitals have been scrambling to keep up. Now, a new study suggests that the policies hospitals develop to manage mobile devices are enforced inconsistently, a finding which should concern hospital leaders.

To perform the study, which was backed by mobile communications firm Spok, researchers collected responses from roughly 300 healthcare professionals from across the U.S. The survey reached not only IT leaders but also clinicians, who made up 44% of respondents. Another 40% included a wide range of professions, including pharmacists, medical technicians, business analysts, social workers and lab managers. IT respondents made up just 10% of those surveyed.

One of the results of the survey was that hospitals vary widely in the maturity of their mobile management strategies and their ability to execute them.

Certainly, the mobile management concerns have become a bigger deal over the last several years. Back in 2012, when Spok first asked survey participants about their mobile approach, only a third said that they had a formal strategy in place. By 2017, though, the number of respondents reporting that they had a mobile strategy had climbed to 65%. (That number actually fell to 57% in 2018, for reasons that are unclear.)

That being said, these strategies are relatively new. Forty-six percent of respondents said their organization had a mobile strategy in place for one to three years, and another 12% reported having a formal mobile management strategy for just one year.

The most common mobile strategy was focused on mobile management and security (56%), followed by mobile device selection, integration with the EMR (48%), infrastructure assessment (45%), clinical workflow evaluation (43%), device ownership strategy e.g. BYOD (34%), mobile app strategy (29%), mobile app catalog (16%), mobile strategy governance (14%) and business intelligence and reporting (12%).

Hospital leaders are continuing to rebuild their strategies as needed. Many hospitals have upgraded their mobile strategy over time, for reasons that included better meeting the needs of end users (39%), changes in clinical workflows (28%)  and addressing security and compliance requirements (25%).

Despite all of this effort, however, there seems to be a gap between mobile strategy development and the extent to which mobile strategies are enforced and understood by hospital staff. While 43% of hospitals have security teams, telecommunications teams or clinical informatics teams enforce mobile policies, many hospitals are struggling to give these rules some teeth.

True, 39% of respondents said that their hospital enforced mobile policies extremely well, and on a consistent basis, and another 33% said they were enforced well most of the time, and another 24% said they were not sure. This suggests that those institutions aren’t educating employees and clinicians about these issues, nor are they getting tough about enforcement. And of course, if hospital clinicians and staff don’t even know whether a strategy is in place, they’re probably not following it.

Gamification in Healthcare: Just Play or Real Value?

Posted on June 14, 2018 I Written By

The following is a guest blog post by Thomas McFarland, Kerry Harbeck, and Andrea Kamper from Atos.

As early as the 1900s, educators started using rewards to motivate learners. Today, we know that incorporating rewards into learning has limited value; however, gamification spans a much broader strategy than simple reward systems. Coined in 2002, the term gamification takes a variety of complex factors into consideration when studying what makes a person decide to do something; it refers to a multifaceted approach that utilizes psychology, design, strategy, and technology.  The efficacy of gamification relies on experts, often instructional designers, to explore innovative pedagogical solutions.

Jane McGonigal, author of Reality is Broken: why games make us better and how they can change the world, demonstrated the power of games in solving real world problems.  She demonstrates how games can teach players how to make complex decisions and strategize for addressing issues from poverty to climate change. For instance, the game World Without Oil is a simulation designed to use brainstorming in order to avert the challenges of a worldwide oil shortage. Evoke, a game commissioned by the World Bank Institute, teaches players to find strategies for addressing issues from poverty to climate change. McGonigal makes a strong case for significant advantages held by organizations who can think beyond traditional training. She places a high value on simulation learning that involves strategy and role-based behaviors.

What value does gamification provide in healthcare?  Previous research indicates that gamification strategies enhance learning in a few key areas such as content recall and retention. Simulation of complex, critical processes may be one of the most valuable applications in healthcare. For example, the Education Technology group at the Stanford School of Medicine developed an application to teach physicians how to identify and treat sepsis. The web-based program, Septris, quickly gained popularity and led to a group of surgeons requesting a new application, SICKO, to teach doctors about surgical decisions.  Reception of Septris was immediately positive, and it enjoyed widespread usage. Within one year of launch, the game received more than 32,000 visits, with 16,700 plays and 2,500 completions of the game. Also, while 55% of hits were direct/organic, the other 45% of hits came from referrals. The authors demonstrated both the clinical and financial benefits of gamification for these more complex processes.

A vast set of opportunities exists in healthcare around learning that focuses on clinical & financial outcomes. Revenue cycle is a particularly challenging area for healthcare organizations because of its complex workflow, multiple stakeholders, turnover in job roles and importance of both accuracy and timeliness. Revenue cycle education is an excellent fit for gamification. We at Breakaway Adoption Solutions have created a strategy and role-specific approach called Revenue Cycle $im. It presents the learner with the multi-faceted revenue cycle environment as a computerized board game with animated characters, interactive problem solving, and real-world scenarios. This method allows the learner to quickly absorb the complex and role-specific interactions that have a significant impact on rev cycle success.

Check out some of the screenshots from Revenue Cycle $im below (click on the images to see the larger version) or request a full demo:


 
If you plan to use gamification in your healthcare organization, you should begin by asking if gamification is appropriate for the desired learning objectives. In general, gamification is more effective when the learning method meets the following criteria:

  • The learning includes a complex set of processes
  • The learning involves problem solving
  • The learning content creates a realistic simulation or link to real or analogous processes
  • The subjects require reinforcement over time
  • The learning content or processes have multiple “right” answers or various paths to successful completion
  • The activities or processes have multiple stakeholders that require collaboration and cooperation
  • The learning should use a creative and fun approach

Gamification has tremendous potential to create an interactive, memorable, rich experience for a healthcare learner.

About the Authors
Thomas McFarland is the Research and Development Manager for Breakaway Adoption Solutions, Atos
Kerry Harbeck is the Director of Learning Innovation for Breakaway Adoption Solutions, Atos
Andrea Kamper is the Innovations Operations Manager for Breakaway Adoption Solutions, Atos

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.

Near-Fatal Med Incident Leads Hospital To Redesign Alerts

Posted on June 13, 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.

It only took a couple of mistakes – but they nearly led to tragedy.

Not long ago, a patient with a deadly allergy to a common pain reliever was admitted to Brockton, Mass.-based Good Samaritan Medical Center. The patient’s allergy was recorded in the EMR. But somehow, despite the warning generated by the system, a nurse practitioner ordered the medication and a pharmacist approved it. The patient recovered but was forced to spend time in the ICU, according to a story in the Boston Globe.

When state and federal regulators descended upon the hospital, its leaders said that they felt alert fatigue was a factor in the error. Of course, this forced the hospital to address some complex issues and the path wasn’t simple. CMS almost booted Good Samaritan from the Medicare program over the issue, in part because it didn’t address the problem quickly enough.

Since then, parent company Steward Health Care has made changes to the EMRs at all of the facilities to cut the chances of patients being harmed by alert fatigue.

Today, if a new patient at any of the Steward hospitals has a serious drug to allergy, they must follow a new procedure. Under new rules, a pharmacist cannot place an order for any of the potentially harmful drugs until they speak with the doctor or nurse to discuss alternative treatments.

Dr. Joseph Weinstein, chief medical officer at the health system, told the newspaper that the new procedure forces staff who are “moving through screens at a rapid pace” to stop. “The two people have to sign off on [the prescription] together,” he said. “This is one of the safest ways to reduce alert fatigue.”

Steward also cut back the list of reasons providers can override analogy alert from 14 to 7 of the most important, giving them a shorter list of items to read through and check off as part of the process.

It’s good to see that Steward was able to learn from the medication error and improve the alarm systems across its entire hospital network. These changes are likely to make a difference in day-to-day patient care and reduce the odds of patient harm.

That being said, clinicians are still besieged by alerts generated for other reasons, and simplifying one process, however vital, can only shave off points of the larger problem.

It seems to me that vendors ought to be more involved in the process of refining alerts rather than making individual hospitals figure out how to do this. Sure, hospitals need to address their individual circumstances but vendors need to take more responsibility the problem. There’s no getting away from this issue.

Healthcare Interoperability is Solved … But What Does That Really Mean? – #HITExpo Insights

Posted on June 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.

One of the best parts of the new community we created at the Health IT Expo conference is the way attendees at the conference and those in the broader healthcare IT community engage on Twitter using the #HITExpo hashtag before, during, and after the event.  It’s a treasure trove of insights, ideas, practical innovations, and amazing people.  Don’t forget that last part since social media platforms are great at connecting people even if they are usually in the news for other reasons.

A great example of some great knowledge sharing that happened on the #HITExpo hashtag came from Don Lee (@dflee30) who runs #HCBiz, a long time podcast which he recorded live from Health IT Expo.  After the event, Don offered his thoughts on what he thought was the most important conversation about “Solving Interoperability” that came from the conference.  You can read his thoughts on Twitter or we’ve compiled all 23 tweets for easy reading below (A Big Thanks to Thread Reader for making this easy).

As shared by Don Lee:

1/ Finally working through all my notes from the #HITExpo. The most important conversation to me was the one about “solving interoperability” with @RasuShrestha@PaulMBlack and @techguy.

2/ Rasu told the story of what UPMC accomplished using DBMotion. How it enabled the flow of data amongst the many hospitals, clinics and docs in their very large system. #hitexpo

3/ John challenged him a bit and said: it sounds like you’re saying that you’ve solved #interoperability. Is that what you’re telling us? #hitexpo

4/ Rasu explained in more detail that they had done the hard work of establishing syntactic interop amongst the various systems they dealt with (I.e. they can physically move the data from one system to another and put it in a proper place). #hitexpo

5/ He went on and explained how they had then done the hard work of establishing semantic interoperability amongst the many systems they deal with. That means now all the data could be moved, put in its proper place, AND they knew what it meant. #hitexpo

6/ Syntactic interop isn’t very useful in and of itself. You have data but it’s not mastered and not yet useable in analytics. #hitexpo

7/ Semantic interop is the mastering of the data in such a way that you are confident you can use it in analytics, ML, AI, etc. Now you can, say, find the most recent BP for a patient pop regardless of which EMR in your system it originated. And have confidence in it. #hitexpo

8/ Semantic interop is closely related to the concept of #DataFidelity that @BigDataCXO talks about. It’s the quality of data for a purpose. And it’s very hard work. #hitexpo

9/ In the end, @RasuShrestha’s answer was that UPMC had done all of that hard work and therefore had made huge strides in solving interop within their system. He said “I’m not flying the mission accomplished banner just yet”. #hitexpo

10/ Then @PaulMBlack – CEO at @Allscripts – said that @RasuShrestha was being modest and that they had in fact “Solved interoperability.”

I think he’s right and that’s what this tweet storm is about. Coincidentally, it’s a matter of semantics. #hitexpo

11/ I think Rasu dialed it back a bit because he knew that people would hear that and think it means something different. #hitexpo

12/ The overall industry conversation tends to be about ubiquitous, semantic interop where all data is available everywhere and everyone knows what it means. I believe Rasu was saying that they hadn’t achieved that. And that makes sense… because it’s impossible. #hitexpo

13/ @GraceCordovano asked the perfect question and I wish there had been a whole session dedicated to answering it: (paraphrasing) What’s the difference between your institutional definition of interop and what the patients are talking about? #hitexpo

14/ The answer to that question is the crux of our issue. The thing patients want and need is for everyone who cares for them to be on the same page. Interop is very relevant to that issue, obviously, but there’s a lot of friction and it goes way beyond tech. #hitexpo

15/ Also, despite common misconception, no other industry has solved this either. Sure, my credit card works in Europe and Asia and gets back to my bank in the US, but that’s just a use case. There is no ubiquitous semantic interop between JP Morgan Chase and HSBC.

16/ There are lots of use cases that work in healthcare too. E-Prescribing, claims processing and all the related HIPAA transactions, etc. #hitexpo

17/ Also worth noting… Canada has single payer system and they also don’t have clinical interoperability.

This is not a problem unique to healthcare nor the US. #hitexpo

18/ So healthcare needs to pick its use cases and do the hard work. That’s what Rasu described on stage. That’s what Paul was saying has been accomplished. They are both right. And you can do it too. #hitexpo

19/ So good news: #interoperability is solved in #healthcare.

Bad news: It’s a ton of work and everyone needs to do it.

More bad news: You have to keep doing it forever (it breaks, new partners, new sources, new data to care about, etc). #hitexpo

19/ Some day there will be patient mediated exchange that solves the patient side of the problem and does it in a way that works for everyone. Maybe on a #blockchain. Maybe something else. But it’s 10+ years away. #hitexpo

20/ In the meantime my recommendation to clinical orgs – support your regional #HIE. Even UPMC’s very good solution only works for data sources they know about. Your patients are getting care outside your system and in a growing # of clinical and community based settings. #hitexpo

21/ the regional #HIE is the only near-term solution that even remotely resembles semantic, ubiquitous #interoperability in #healthcare.
#hitexpo

22/ My recommendation to patients: You have to take matters into your own hands for now. Use consumer tools like Apple health records and even Dropbox like @ShahidNShah suggested in another #hitexpo session. Also, tell your clinicians to support and use the regional #HIE.

23/ So that got long. I’ll end it here. What do you think?

P.S. the #hitexpo was very good. You should check it out in 2019.

A big thank you to Don Lee for sharing these perspectives and diving in much deeper than we can do in 45 minutes on stage. This is what makes the Health IT Expo community special. People with deep understanding of a problem fleshing out the realities of the problem so we can better understand how to address them. Plus, the sharing happens year round as opposed to just at a few days at the conference.

Speaking of which, what do you think of Don’s thoughts above? Is he right? Is there something he’s missing? Is there more depth to this conversation that we need to understand? Share your thoughts, ideas, insights, and perspectives in the comments or on social media using the #HITExpo hashtag.

What? In Some Cases, Additional IT Spending May Not Prevent Breaches

Posted on June 11, 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 research study has come to a sobering conclusion – that investing more in IT security doesn’t necessarily reduce the number of breaches.

The research, which appeared in the MIS Quarterly, looked at how many breaches hospitals experienced relative to their IT security spending. The study authors started with the assumption that hospitals spending more on security would enjoy better protection from breaches.

The researchers assumed that looked at broadly, some security investments were “symbolic,” making superficial improvements that don’t get to the root of their problem, while others were substantive investments which met well-defined security needs.

After reviewing their data, researchers noted that many classes of hospitals turned out to be symbolic security investors, including members of smaller health systems, older hospitals, smaller hospitals and for-profit hospitals. They also noted that faith-based and less-entrepreneurial hospitals were prone to such investments. The only category of hospitals routinely making substantive security investments was teaching hospitals.

But that’s far from all. Their more controversial conclusions focused on the role of IT security investments in preventing security breaches. In short, their conclusion was pretty counterintuitive.

First, they found that larger IT security investments did not in and of themselves lower the likelihood of security breaches. Not only that, researchers concluded that the benefits of substantive adoption wouldn’t generate greater breach protection over time.

Researchers also concluded that the benefits of substantive IT security adoption by hospitals would take time to be realized. If I’m reading this correctly, mature IT security systems should offer more advantages over time, but not necessarily better breach protection.

Meanwhile, researchers concluded that the negative consequences of symbolic adoption would grow worse over time.

I don’t know about you, but I was pretty surprised by these results. Why wouldn’t substantively increasing security spending reduce the occurrence of breaches within hospitals? It’s something of a head-scratcher.

Of course, the answer to this question may lie in what type of substantive security investment hospitals make. The current set of results suggests, to me at least, that current technologies may not be as good at preventing breaches as they should be. Or maybe hospitals are investing in good technology but not hiring enough IT security experts to get the installation done right. Plus, purchasing security infrastructure can only do so much to stop bad user behavior. The issue deserves further research.

Regardless, this study offers food for thought. The industry can’t afford to do a bad job with preventing breaches.

New Mexico Hospital Battles Addiction with Health Information Technology Apps

Posted on June 8, 2018 I Written By

The following is a guest blog post by David Dellago, Former Chairman of McKinley County Commission

(This byline focuses on the efforts of David Conejo, CEO, RMCHCS Hospital who spoke on the Health IT Expo Data Integration Panel, May 31 at 2:30 pm.)

McKinley County, New Mexico, is the namesake of the assassinated 25th U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks.  Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”

For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness, and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.

McKinley County Is One of Poorest in U.S.

There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup, there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.

The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.

Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians was board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the 6th leading cause of death for New Mexicans and the 7th leading cause in the U.S.

RMCHCS Hospital Fights Addiction with Behavioral Health Apps

Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received $400,000.00 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grants out of which NCI was born.

The leader of that effort in the 80s and 90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) where he leads the fight against addiction with traditional tactics, but also behavioral healthcare innovations which have captured the attention of the healthcare industry.

Turing the Tables on Addiction

When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.

The center is operated by Ophelia Reeder, a long time health care advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the Behavioral Special Projects Director.  He opened “Bill’s Place”, an outdoors facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group which he founded and serves as president.  The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s casework, provide behavioral health services and are certified in peer support.

High Information Tech in High Gear

From this traditional form of behavioral health addiction treatment, Conejo has turned to health information technology in his pursuit of behavioral health care remedies while leveraging government insurance changes in Medicare and Medicaid Services (CMS), under the Obama Administration. Rather than traditional acute care services, CMS began to shift its focus on preventive care, identifying a 6:1 cost savings ratio.

Conejo recognized that RMCHCS would benefit by offering preventative care services which fit perfectly with his behavioral care plans while creating a new revenue center through reimbursements by CMS. To achieve this, he recognized the need for the convergence of hospital information across clinical, financial, and operational systems.

He began by integrating data from the hospital’s three clinics—the College Clinic for family and internal medicine, the Red Rock Clinic for general surgery and the Acute Clinic for emergencies and occupational health. He used a cloud suite application from Zoeticx which integrates and streamlines data from the Center for Medicaid and Medicare Services (CMS) including Annual Wellness Visits (AWV), Chronic Care Management and Care Transition between physical and behavioral health services.

Integrating Data and Patients

The cloud application streamlines data from Annual Wellness Visits (AWVs) and integrates it with the hospital’s Electronic Health Record (EHR) systems from Athena Health and MedTech. The app also allows for the management of tracking for patient wellness visits, provides a physical assessments guide through preventative exams and maps out the risk factors for potential diseases for patient follow-up visits.

In addition, the Zoeticx app includes other services that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurer requirements for organizations like Blue Cross/Blue Shield. The app’s time tracker capability automates invoices for faster billing.

RMCHS’ business is growing with full or near-full coverage compliance. And with its Accountable Care Organization (ACO) in startup mode, RMCHS is also receiving a bonus check from Medicare for containing costs, in addition to the new revenues being generated. During the first five months of using the Zoeticx app, the new revenue has matched the financial incentive from its ACO, with the outlook of at least doubling the bonus from the ACO. Furthermore, RMCHS does not increase its current operational cost to achieve this type of outcome.

Joe Wright, the hospital’s director of clinical services, has found the apps provide significant time savings for the nurses and medical assistants when disparate EHR data is integrated and streamlined. He also notes more patients can be seen. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day, that’s an extra 180 minutes. More minutes, more patients.

In addition, his chronic care patient practice has grown significantly since the recent implementation of Zoeticx’s Chronic Care Management where many patients suffer from diabetes. Patients participating in AWV visits have grown to 250, a 50 percent increase since the apps have been installed. The AWV appointments also mean less patient visits to the hospital. At the hospital’s Behavioral Health Services facility where addiction to alcohol and opioids are the main patient affliction, all 68 beds are full.

Telemedicine Next Step

Conejo’s next big technology push will be a telemedicine program enabling reservation patients to be seen by mobile healthcare physicians connected by satellite to the Internet to extend the hospital’s outreach to patients who can’t visit the hospital for various reasons.  This will enable patients to be treated as if they were at one of the hospital’s clinics with all their data entered into the appropriate systems and ready to be whisked off to the insurance organizations.

Healthcare Prominently Featured at Information Builders Summit

Posted on June 6, 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.

It was a pleasant surprise to see healthcare clients prominently featured at the 2018 Information Builders Summit (#IBSummit) in Orlando FL. Best known for their work in financial services, government and retail, Information Builders has recently carved out healthcare as an industry of focus. That focus was on full display with presentations from: Floyd Healthcare, St. Luke’s University Health Network, Markham Stouffville Hospital, and the Healthcare Association of New York State.

According to experts at GE Healthcare, the average US hospital generates in excess of 50 Petabytes (PB) of data each year. That’s inclusive of all images, lab results, EHR data, financial information, and every other bit of operational as well as clinical information. To help put that amount of data in perspective:

  • 1GB = 7min of HDTV video [1]
  • 1TB = 1024 GB = 130,000 digital photos
  • 1PB = 1024 TB = 3.4 years worth of HDTV video, or about the size of the movie Avatar
  • 50PB = The entire written works of mankind from the beginning of recorded history in all languages [2]

With this much data, it’s no surprise that many companies are putting energy behind Big Data and Machine Learning (ML) initiatives to help wring value from this growing mountain of information. Companies like IBM Watson, Health Catalyst, Caradigm and Optum all offer advanced data analytics platforms that use various forms of ML to discern patterns within healthcare data. However, most healthcare organizations do not have the technology infrastructure, funds or executive buy-in to adopt these heavy-weight solutions.

Luckily, Information Builders (IB) offers healthcare organizations a way to ease into advanced analytics that does not require the hiring of a data scientist as step one.

According to Grace Auh, Manager of Business Intelligence & Analytics at Markham Stouffville Hospital (located north of Toronto, Ontario), IB provided a smooth on ramp to data analytics. “Instead of trying to go from zero to 100 KPH (MPH for those in the US) in a single step, we adopted IB’s webFOCUS tool to whet the appetite of internal stakeholders” said Auh. “We started with ED pay-for-performance metrics that are tied to reimbursement bonuses here in Ontario. We created a series of reports that executives could drill-down into for deeper analysis. We update the clinical data monthly and the financial data quarterly.”

Auh and the team at Markham Stouffville opted for simple reports/charts rather than fancy data visualization in order to help gain executive buy-in. By keeping things simple, Auh was able to quickly convince executives that the data within the IB reports were indeed accurate (something that had been a challenge with previous data initiatives).

“The goal,” explained Auh. “Is to have a fully integrated and real-time system that is the single source of truth for the hospital. We want to empower program and hospital leaders to self-serve their data needs. It’s our job to build the platform so that they can get the data they want in the format they need it whenever they want. It’s got to be clean, simple, complete and easy to consume. We even want physicians to start using it.”

Floyd Healthcare, an independently-owned community hospital network in Georgia, had a similar goal.

“We have a vision to roll out our dashboards to directors, supervisors and even front-line staff,” said Drew Dempsey, Director of Planning & Business Intelligence at Floyd Medical Center. “We already have a data-driven culture at Floyd because of our lean six-sigma work. The appetite for metrics is high and our level of data maturity grows each day. The data we are able to get through IB is helping us achieve our goals and drive operational efficiencies.”

Using IB’s new Omni-HealthData platform, Dempsey and his team put together a surgical volume dashboard for their CEO. It showed surgeries by speciality, by surgeon and by location. This type of report was a regular part of executive meetings. It used to take days to compile this information by hand and required 120 PowerPoint slides to present it to the level of detail needed for the meeting. The entire report is now automated within Omni and offers executives multiple ways to slice the data.

“We used to spend a lot of time compiling data,” recalled Dempsey. “But now with Information Builders we are able to spend more time analyzing and interpreting the data – a far better use of everyone’s time. We build everything once and it gets used many times.”

The team at Floyd is now working to expand into other reports that provide Service Line and Operational leaders with clinical as well as financial reports that will allow them to make better strategic decisions. From there they plan to tackle revenue cycle reporting, quality metrics, population health indicators and PCMH reporting.

It would be fair to say that Floyd and Markham Stouffville are both fairly early in their analytics journey with IB. St. Luke’s University Health Network, however, is highly advanced in their use of IB’s tools for clinical and operational insight. A ten hospital system centered in Bethlehem PA with over 300 sites of care, St. Luke’s is a top performer on the Truven Top 100 (now IBM Watson Top 100) hospital analytics list.

St. Luke’s codeveloped the Omni-HealthData platform in cooperation with the team at IB. Many of the out-of-the-box report objects and visualizations are the refinement of the reports that St. Luke’s created for their internal users. These reports include:

  • Department/Service Line Performance
  • Patient Safety Indicators
  • In-patient Quality Metrics (ALOS, SSIs)
  • Marketing Analytics
  • Value-based Contract Metrics

In total there are over 90 self-service reports (called applications in IB vernacular) available.

“We borrowed proven tactics from the retail industry,” explained Dan Foltz, Managing Director at Parnassus Consulting, who helped St. Luke’s with their IB implementation. “With IB we were able to do targeted patient outreach based on cohorts of interest. Using data from multiple systems we were able to determine which patients might benefit from education and special programs. For example, the hospital wanted to make early stage Parkinsons patients aware of a deep brain stimulation program. We were able to achieve an 80-90% uptake – something unheard of in healthcare. It was amazing.”

The St. Luke’s electronic data warehouse consolidates information from six main (and silo’d) systems:

  1. Find-a-doc
  2. Allscripts
  3. McKesson
  4. EPIC
  5. Enrollment
  6. Credentialling

Over the next few years they plan to consolidate all their source systems into the warehouse and use their IB portal to provide insights. They currently have 40 data sources integrated within IB.

You can read more about the St. Luke’s implementation of IB in this success story.

I came away from IBSummit impressed by the success that Information Builders has helped its healthcare clients achieve. Every healthcare client that I spoke to raved about how the IB team helped them avoid project traps like diving too deeply into data specifics, losing sight of overall strategic goals, and not gaining sufficient executive buy-in.

“We’re sticking to what has made us successful in so many other industries,” said Jake Freivald, Information Builder’s Vice President of Product Marketing (Healthcare). “We are here to help healthcare organizations collect information faster & easier, and providing tools that allow them to present that information in valuable ways. The one thing we see our healthcare clients needing is more help in the data consolidation step. That’s where we are focusing more attention.”

It will be interesting to revisit IB’s early-stage healthcare clients at next year’s Summit to see how much progress they have made.

Bias In Medical Records Can Affect Patient Care

Posted on June 4, 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.

In the past, doctors wrote whatever they wanted in their notes, including sarcastic and derogatory comments about the patient, assuming that the comments were no big deal. And largely, they were right, as in prior times, few patients would have asked for those records.

Today, however, such records are becoming increasingly public, particularly through the efforts of the Open Notes project. Not only that, when an EMR connects the health system, such notes may be viewed by many types of professionals, ranging from hospital-based doctors to outpatient physicians, residents to outpatient specialists and more.

But how important is this? Doctors need to reduce tension with a bit of gallows humor, don’t they? Is it worth making the effort to discourage such comments and criticism in the notes? A recent study of physicians in training suggests that it is.

The study, which appears in the Journal of General Internal Medicine, was designed to measure whether patient records serve as a means of transmitting bias from one clinician to another. Specifically, the study was intended to assess whether stigmatizing language written in a patient medical record had an effect on students’ clinical decision-making and attitudes toward the patient.

To tease out this information, the researchers created chart notes, one of which used stigmatizing language in the other neutral language to describe hypothetical patient, a 28-year-old man with sickle-cell disease.

Researchers then surveyed medical students and residents in internal and emergency medicine programs at an urban academic medical center to see how their subjects related to the vignette.

The conclusions drawn by this study should concern everyone in the healthcare business. Researchers found that when the medical students and residents were exposed to stigmatizing language in the notes, the exposure was associated with more negative attitudes toward the patient. Even more concerning, the note using stigmatizing language was associated with less aggressive management of the patient’s pain level.

Addressing this problem is not just an ethical issue, as important as that is on its own. If stigma and bias affect how medical students and residents care for patients, it undermines larger goals of the health system, particularly the need to manage populations effectively, promote patient-centered care and reduce healthcare disparities, it’s a clinical and operational issue as well.

No one is suggesting that it’s possible to squeeze all bias out of the healthcare process. However, it seems reasonable to limit how much of this bias makes it into the chart and influences other providers.