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Insights, Intelligence and Inspiration found at #AHIMACon18 – HIM Scene

Posted on October 15, 2018 I Written By

The following is a guest blog post by Beth Friedman, BSHA, RHIT.

Last month’s HIM Scene predicted important HIM insights would be gained at the 90th AHIMA Annual Convention. And this prediction certainly came true! Thousands of HIM professionals discussed changes to E&M coding, physician documentation and information security during the organization’s Miami event. HIM’s expanding role in healthcare analytics was also recognized. Half of AHIMA’s “hot topics” presentations covered data collection, analytics, sharing, structure and governance.

For example, HIM’s role in IT project management was the focus of an information-packed session led by Angela Rose, MHA, RHIA, CHPS, FAHIMA, Vice President, Implementation Services at MRO. She emphasized how enterprise-wide IT projects benefit from HIM’s knowledge of the patient’s health record, encounter data, how information is processed and where information flows. In today’s rapid IT environment, there is a myriad of new opportunities for HIM—the annual AHIMA convention casts light on them all.

Amid all the futurecasting, AHIMA attendees also received valuable insights and fundamental best-practice advice for the profession’s stalwart tasks: enterprise master person index (EMPI), clinical coding and release of information (ROI). Here are few of the highlights.

Merger Mania Brings Duplicate Data Challenges

Every healthcare merger includes strategic discussions, planning and investments focused on health IT. System consolidation can’t be avoided—and it shouldn’t be. Economies of scale are a fundamental element of merger success. However, merging multiple systems into one means merging multiple master person indexes (MPIs).

Letha Stewart, MA, RHIA, Director of Customer Relations, QuadraMed states, “It’s not uncommon to see duplicate medical record rates jump from an industry average of 8-12 percent to over 50 percent during IT system mergers due to the high volume of overlapping records that result when trying to merge records from multiple systems or domains”. As entities come together, a single, clean EMPI is fundamental for patient care, safety, billing and revenue. This is where HIM skills and know-how are essential.

Instead of leaving HIM to perform the onerous task of duplicate data cleanup after a merger and IT system consolidation, Stewart suggests a more proactive approach. Here are four quick takeaways from our meeting:

  • Identify duplicate data issues during the planning process before new systems are implemented or merged.
  • Use a probabilistic duplicate detection algorithm to find a higher number of valid duplicates and lower number of false positives.
  • Clean up each system’s MPI before IT system consolidation occurs and as implementations proceed. Be sure to allocate sufficient time for this process prior to the conversion.
  • Maintain ongoing duplicate data detection against the new enterprise patient population to prevent future issues.

Maintaining a clean MPI has always been a core HIM function—even back to the days of patient index cards and rotating metal bins. Technology in combination with merger mania has certainly upped the ante and elevated HIM’s role.

Release of Information Panel Raises Red Flags for Bad Attorney Behavior

Another traditional HIM function with nascent issues is ROI. A standing-room-only panel session raised eyebrows and concern for AHIMA attendees regarding a pervasive issue for most HIM departments: patient-directed requests.

Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, VP Privacy, Compliance and HIM Privacy, MRO, moderated the panel that included other ROI and disclosure management experts. Bowen, a healthcare privacy savant, asked how many attendees receive patient-directed requests that are actually initiated by an attorney’s office. Dozens of hands went up and the discourse began. Here’s the issue.

To avoid paying providers’ fees for record retrieval and copies, attorneys are requesting medical records for legal matters under the guise of a patient-directed request. During the session, four recommended strategies emerged:

  • Inform your state legislators of this bad attorney behavior
  • Discuss the issue with HIM peers in your area
  • Hold meetings with your OCR representative to determine the best course of action
  • Question and verify suspicious patient-directed requests to clarify and confirm the consent

Finally, no AHIMA convention would be complete without significant attention to clinical coding!

Coding Accuracy Takes Center Stage

One of the AHIMA convention’s annual traditions includes announcement of Central Learning’s annual national coding contest results. Eileen Tkacik, Vice President, Information Technology at Pena4, sponsor of the 3rd annual nationwide coding contest to measure coding accuracy, reported that inpatient coding accuracy fell slightly in 2018 compared with the 2017 results. “Average accuracy scores for inpatient ICD-10 coding hovered at 57.5 percent while outpatient coding accuracy experienced a slight bump from 41 percent in 2017 to 42.5 percent in 2018,” according to Tkacik.

While some were concerned about the results, others expected a decline as payers become more aggressive with coding denials and impose greater restrictions on coders’ ability to determine clinical justification. This is especially true for chronic conditions—another hot coding topic among AHIMA attendees.

Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, Director of Coding Quality and Professional Development at TrustHCS, emphasized the need for accurate hierarchical condition category (HCC) code assignment for proper risk adjustment factor (RAF) scoring under value-based reimbursement. Everything physicians capture—and everything that can be coded—goes into the patient’s dashboard to impact the HCCs, which are now an important piece of the healthcare reimbursement puzzle.

Finally, Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, Coding Manager at KIWI-TEK, presented an informative session on the new coder’s roadmap to accuracy and compliance. She reiterated the need for compliance with coding guidelines and shared examples of whistleblower cases. In addition, Smith provided valuable pointers for newly employed clinical coders to consider:

  • Understand the important role that coders play in compliance
  • Know the fraud and abuse laws
  • Implement checks and balances to compare payer-driven code requirements to best-practice coding guidelines
  • Review the components of an effective compliance plan
  • Do not participate in fraudulent activities because coders and billers can be held civilly and/or criminally liable

Inspiration Found at the Beach and on the Dance Floor

Beyond the convention center, the educational sessions and the exhibit hall, I made time at this year’s AHIMA convention to enjoy the beach. Two power walks and a few meditation moments were the icing on my #AHIMACon18 cake this year. I intentionally found time to enjoy the warm sunshine and moonlit evening festivities including MRO’s signature event and AHIMA’s blanca party. Dressed in white, AHIMA attendees kicked up their heels to celebrate 90 years of convention fun—and think about AHIMA 2019 to be held September 14–19 in Chicago, Illinois. We’ll see you there!

About Beth Friedman
Beth Friedman is the founder and CEO of Agency Ten22, a healthcare IT marketing and public relations firm and proud sponsor of the Healthcare IT Marketing and PR Community. She started her career as a medical record coder and has been attending the AHIMA conference for over 20 years. Beth can be reached at beth@ten22pr.com.

Healthcare Leaders: Feeling a Bit Discombobulated?

Posted on October 11, 2018 I Written By

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

After passing through the security checkpoint at Milwaukee International Airport (MKE), a frazzled traveler is greeted by a low-hanging placard.  It reads: Recombobulation Area.  Clearly someone on the MKE management team with a sense of humor was acknowledging the fact that many travelers become a bit discombobulated as they proceed through security and that many probably need an area where they can get their collective psyche back in order.

The idea of a Recombobulation Area seemed especially appropriate as we returned from a healthcare conference on Lake Geneva where a wide spectrum of thought leaders presented and discussed their experiences from the past decade.  The group’s shared conclusion was that no one could have prepared for or predicted the level of change experienced in the healthcare environment over the past decade.

The changes we discussed encompass every aspect of how care is delivered, from EHRs to ERPs. Healthcare leaders navigate clinical, financial, and compliance hurdles daily – often all tangled together. Clinicians face new technologies, new workflows, new regulations and standards (that often conflict), new reimbursement requirements, new governance models, and something new… coming soon.  How can we expect better care in such a tumultuous environment?

During this time of dramatic change, it is important to identify a way to measure progress (or lack thereof) so that we can stay focused on our goals and desired outcomes.  One of the best mechanisms for assessing the impact of our work in healthcare is the use of data.  A simple research plan such as the one below can be used to assess the impact of changes – and could possibly even elucidate new ideas.

  • Research question: An overarching question to define the effort
    • For example:
      1. How effective are EHR alerts in preventing medication errors?
  • Specific aims: Specific objectives that address the overarching question
    • For example:
      1. To characterize the differences in medication errors before and after EHR implementation
      2. To understand the factors that increase alert fatigue
  • Methodology: How to address each specific goal. This step often requires some collaboration with a statistician or someone with research experience.
    • Define the sample population
    • Define the data elements to collect
    • Determine appropriate timeframes
    • Data analysis plan
  • Results: The presentation of the analyzed data
  • Conclusions: Discussion of the results and their meaning. What are the actionable steps for the organization?

Healthcare has evolved significantly to embrace new advancements in technology, but the challenges we continue to face need to be assessed objectively.  Thus far, our research has focused on the factors that influence adoption of new technology.  It has been fascinating and the outcomes caused us to consider new ideas and better approaches. Our EHR research published in Beyond Implementation remains relevant and valuable to healthcare leaders.  We are committed to helping healthcare organizations shift from the tumultuous set of ongoing changes to a research-based approach to ensure ongoing process improvement and discipline for technology adoption.  Our colleagues’ experiences, the rich research and data that exist today, and the stories of successes and challenges in healthcare organizations provide us with a critical Recombobulation Area. We must take the time to pause and learn from objective data and research methodologies to ensure that all this change focuses on improving patient care.

About the Authors:
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.

Bridging the Communication Gap Between Health Plans and Providers

Posted on October 3, 2018 I Written By

The following is a guest blog post by Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Effective communication and trust are the essential keys to any relationship, and the plan-provider relationship is no different. A shift towards value-based coordinated accountable care has urged health plans and providers to collaborate to improve population health and patient experience while lowering costs. Most plan-provider communication revolves around rate negotiations.

An open, honest relationship with transparent communication and cooperation is needed to bridge the communication gap and create mutually beneficial partnerships. Sharing data, creating health plan-provider networks, utilizing audits and providing access to new technologies are all methods health plans and providers could use to help promote collaboration and bridge communication.

Data Sharing Across the Care Continuum

To foster collaboration, data sharing should be implemented and incentives should be aligned across the care continuum so that both parties are motivated to improve outcomes and lower costs. Data sharing is one of the key benefits of bridging the communication gap between health plans and providers.

Health plans hold the bulk of useful data and, when that data is combined with the providers’ clinical expertise, the likely result is better patient outcomes. Sharing data gives providers access to claims information that also provides with them a patient’s entire medical history. This information is useful in helping educate patients about their health risks and to boost transparency in plan-provider communication.

Health plans and providers keep a vast amount of patient information. Health plans have historical claims data while providers have clinical data. Both parties use their data for checks and balances and to mutually determine the best treatment and most appropriate care for patients. Lack of collaboration, usually due to interoperability challenges, means both data types aren’t shared. A key aspect to achieving collaboration and alignment is trust. Sometimes parties are lacking in trust when it comes to the use of their data; however, advancements in technology and use of the blockchain to create transparency are helping to change the tides.

Health plans and providers must have upfront discussions on what information will be shared, and each party must share data that is useful to the other. For health plans, this means understanding how reimbursement is determined, the factors that influence the payments they receive and how they are reimbursed based on clinical outcomes rather than interventions delivered. In turn, providers must clearly communicate the clinical outcomes health plans are or are not achieving. Ultimately, all measures should include preventative care, lower per capita cost and improve population health as well as patient experience and satisfaction. They should also improve how data is managed and transitioned. Providers that implement a strategic quality management approach to deliver high-quality, valued-based care can achieve better clinical outcomes.

Health Plan-provider Networks

Plan-provider communication networks are needed to efficiently and effectively harness data from both parties and enable rapid innovation and the sharing of real-time data for immediate response. Health plan-provider networks utilize care management, electronic health records (EHRs), and analytics to seek to resolve communication and collaboration challenges between health plans and providers. In keeping with HIPAA regulations, communication between health plans and providers must be customized to include only information that is relevant to specific attributed patient populations, physicians, reimbursement and care delivery models. The goal of plan-provider networks is to present both parties with transparent, high-quality data to improve trust and increase health plan-provider engagement to improve communication and, ultimately, population health.

Using Audits to Bridge Communication

The rise of audit requests has posed a problem in the plan-provider relationship. Both health plans and providers must work toward greater compliance, and auditing medical records is a crucial step in the process.

Providers struggle with numerous types of information requests from various third-party health plans, governmental agencies and national health plans, which often have different deadlines and vernaculars. As a result, health plans are forced to repeatedly call health information management (HIM) and audit departments when claims data inaccurately identifies place of service, provider or other patient information. An upsurge in audit requests from commercial and other health plans threatens to exacerbate these problems.

The audit process can change the plan-provider relationship from adversarial to advantageous by improving communication. Bridging communication gaps and language barriers through clearer record requests would take the burden off providers and alleviate plan problems. Technology will also play a critical role in making this entire process as automated as possible.

Chart requests that come from commercial health plan audits represent just five percent of all requests that providers receive. Hospitals also receive high volumes of medical record requests from other hospitals, physicians, attorneys, patients and more. The problem is that commercial plans often assume they are the only requestor. Education is required on both sides of the audit equation to improve processes and reduce plan-provider friction.

For providers, all data from each request and submission should be entered in a centralized audit management software application for the organization. This helps providers track audit activity by health plan and type of audit, maintain a record of all documents sent, better manage requests, and stay abreast of audit trends.

Patient access, clinical coders, billers and collectors perform unique functions and speak different languages across the hospital revenue cycle. Similarly, commercial health plans have multiple departments and terminology involved in audit processing. In many cases, inter-departmental communication and language barriers are the main obstacles to overcome.  However, technology is playing a growing role in creating greater transparency within the healthcare ecosystem—by acquiring, digitizing and giving shape to both structured and unstructured records.

Time Will Tell

Bridging the communication gap will not happen overnight. It will take time and effort from all parties involved; however, these methods are a good starting point.

As the digital era has taken hold, our attentions are turning to a better utilization of the vast data flowing through both providers and health plans. This will translate into a better understanding of patient outcomes, improved revenue cycles and more insightful growth strategies for all parties.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

Informed Consent: Let Go of the Status Quo

Posted on October 1, 2018 I Written By

The following is a guest blog post by Shahid Shah.

We’ve all heard it before: “healthcare is slow to adopt new technologies.” In fact, we’ve heard it so many times that we just accept it as gospel and don’t give it much thought.

It’s not true though.

For example, I remember when the iPhone was first released, it was easily adopted by doctors because it gave them something they craved: increased freedom by having access to information on the go.

What’s probably true is that “healthcare institutions are slow to adopt new technologies that impact status quo.

Why is that?

Because the perceived cost of maintaining the status quo is smaller than the cost of the innovation (e.g. product or solution), even if that innovation is free.

When the cost of not doing something new is low, nothing will change: and bad leadership is often able to keep the cost of maintaining status quo very low. Poor leaders add hurdles, like requiring unknowable ROI analyses, for introducing innovation but don’t penalize maintenance of status quo. This means that it’s easier to not introduce anything new – because the cost of not innovating is low but the cost of innovating is high.

Let’s take a look at digital patient consent as an example of an innovation – obtaining patient consent to perform a healthcare service is something that no hospital can do without. Called “informed consent”, this is a document that patients are required to sign before any procedure or health service is delivered. You’d think that because this form is the initial and primary document before almost any other workflow is started, that it would be the first to be digitized and turned into an electronic document.

Unfortunately, it’s 2018 and informed consent documents remain on paper. Thus:

  • JAMA reports that two-thirds of procedures have missing consent forms
  • JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing hospitals over $500k per year
  • Joint Commission reports over 500 organizations annually experience compliance issues because of missing consent forms. There’s almost a 1 in 4 chance that your own organization has this compliance problem.
  • A recent JAMA Surgery paper estimated that two thirds of malpractice cases cited lack of informed consent, which increases liability risk
  • Superfluous paperwork directly contributes to clinician burnout
  • Patients often don’t understand their procedures or aren’t properly educated about the service they’re about to use

Today, many healthcare institutions go without automation of consent documents – which I’m calling the status quo. Even though this document is essential, and its non-digital status quo creates many financial, clinician, and compliance burdens, it’s not high in the list of priorities for digitization or automation.

As I enter my third decade as a health IT architect, after having built dozens of solutions in the space that are used by thousands of people, I still find it difficult to explain why even something as simple as an informed consent isn’t prioritized for automation.

It’s not because solutions aren’t out there – for example, FormFast’s eConsent is a universally applicable, easy to deploy, and easy to use software package with a fairly rapid return on investment. With eConsent software, clinicians aren’t interrupted in their workflows, patients are more satisfied, compliance becomes almost guaranteed, and procedures aren’t delayed because of lost paperwork.

A senior network engineer at East Alabama Medical Center recently wrote “the comparison of creating a form in the EHR vs. an eForms platform? There is no comparison. We are saving thousands of dollars by using eForms technology and the form creation is simple.”

Why do you think even something essential like patient consent forms remain on paper? Drop us a line below and let us know why the status quo is so powerful and what’s keeping your organization from adopting electronic forms solutions.

Note: 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.

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.

Hospital Patient Transfers with Optional Protocols

Posted on September 4, 2018 I Written By


The following is a guest blog post by General Devices.

Patient Transfers are business. Serious business for all patients involved; transferring hospitals, transport service, agent and – the patient. They hold the balance to patient care, place and time plus the business side of healthcare. If a patient transfer is initiated and the ED/ EMS staff are unable to follow protocols it could result in not only the breaking of federal law, but also impact outcomes and costs. “Inter-hospital transfers can have negative financial (operational, and liability) implications for the patient, transferring and accepting facilities, and the health care system” (Academic Emergency Medicine: Inter-hospital Transfers from U.S. Emergency Departments; 2013). This article will explain:

  • EMTALA and how it will affect your transfer process
  • The different types of transfers
  • How transfer process and workflow can be made simpler, with less risk, using digital protocols.

In 2017, the United States saw 1,391,712 hospital transfers. Faster approved transfers lead to much better outcomes and more lives saved. Transfers can be necessitated by a multitude of reasons which include overcrowding, limited resources, lack of expertise, proper equipment for a specific treatment specializations, and more. A transfer can happen both during initial transport to the hospital or during the patient hospital stay. There are times where an incoming EMS call is immediately deemed transfer necessary, referred to as a diversion. Other times, a patient could be stablizied in the emergency room or during their hospital stay and require a treatment which is better suited for another hospital. Once the need for transfer is confirmed there are certain liabilities and protocols that must be followed.

E M T A L A, the federal law, requires the patient transferred from one hospital to another to be first stabilized and treated. This can include forms that must be completed, pre-transfer stabilization and preparation, as well as communication between the EDs, the transporting staff and transfer centers. EMTALA includes its’ own steps that must be followed during a transfer.

Transfer centers were established in an attempt to better manage the process. The simple fact is, their communication technologies do not allow team collaboration.

How can a configurable mobile telemedicine app help?

During a transfer, timing is one of the most crucial components to ensure effective patient treatment. Having inflexible protocols potentially restrict the ease of transferring a patient when needed. Every hospital, EMS and healthcare environment operate differently and have different needs, which is why a canned set of protocols will not work for everyone. – This is where a configurable mobile telemedicine solution comes in. Whether it’s an intra-hospital, inter-hospital or EMS transfer, a good mobile telemedicine will give you the capabilities you need to ensure the patients best interests. Proper Documentation is a result of a proper MT app and can be used for audit purposes for workflow improvement and investigating the flaws in the patient transfer.

About GD (General Devices)
GD enables smarter patient care by empowering hospitals, EMS, community healthcare, and public safety with the most comprehensive, interactive, configurable, affordable, and integrated FDA listed medical communications and mobile telemedicine solution. The benefits of which are enhanced workflows, minimized risk, reduced costs and improved patient outcomes.

Centralizing HIM Operations: An Enterprise Approach

Posted on August 15, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

Technological advances, policy changes and organizational restructures are continuously bringing trends to the healthcare industry, specifically impacting healthcare facilities. Centralization of operations is one of those trends. Driven by a value-based model, the centralization of health information management (HIM) aims to streamline operations, standardize processes, reduce costs and improve quality of care and patient satisfaction.

Oftentimes, HIM departments operate with disparate processes due to legacy standard processes and acquisitions of new entities and are unable to efficiently integrate and access information when it is derived from multiple sources. This causes inconsistencies in processes and procedures, as well as incompleteness of information and unavoidable redundancies. Furthermore, decentralization can result in risks such as ineffective information management, inaccurate coding and breaches.

Silos of information hinder standardization, and as a result create compartmentalized pockets of information from sources, slowing down communication and making change more difficult. However, through the use of electronic HIM technology, secure information can be shared and processed across various departments and facilities at a quicker pace than ever before. Taking these efficiencies one step further, instead of siloes of information, many organizations are moving to a centralized model that can reduce operational costs by streamlining organizational performance, establishing consistent processes through standardization and eliminating redundancies.

Patient health information must be linked across the healthcare continuum to provide the best quality of care. Additionally, sources of information must be linked to electronic health records (EHRs) to support centralization and enhance patient care. To connect silos and reduce risks, healthcare facilities must centralize HIM operations to create standardization and improve coordination across the continuum of care.

Benefits of Centralization

Healthcare facilities can greatly benefit from incorporating the centralization of HIM operations into their long-term organizational plans. In fact, the benefits are greater than any hurdles encountered during the transition. Benefits include:

  1. Improves operational efficiency: Moving from a fragmented system to a model that streamlines operations improves efficiency and decreases administrative and operational costs.
  2. Eliminates redundancies and reduces errors: Helps to standardize processes, procedures and forms across a healthcare system to ensure they are the same throughout facilities.
  3. Improves financial performance: Restructuring improves productivity and efficiency as resources are centrally located, which positively impacts the bottom line.
  4. Fosters collaboration: Eliminates silos of communication that cause a stagger in the flow of information – improving communications and optimizing patient outcomes.
  5. Increases accessibility: Provides the benefit of system-wide accessibility to patient information for release purposes, such as billing and coding.
  6. Optimizes workflow: Allows opportunities to reexamine workflows for optimal efficiencies across the HIM continuum, bringing business value.

Driving Transition Towards Centralization

When an organization transitions to centralized HIM operations, it’s important that the journey be completed with the right preparation and execution. HIM professionals must establish processes that foster opportunities for consolidation and standardization that then result in reduced cost, mitigation of risk and overall improved patient care.

Prior to implementing a centralized model, HIM professionals must take certain steps into consideration:

  • Acquire an executive sponsorship to provide direction, support, budget and resolution to potential problems that may arise during the transition.
  • Establish a multidisciplinary steering committee to address centralization and your organization’s information policy, aligning resources with strategy.
  • Identify challenges, gaps, risks and opportunities while working with collaborators to achieve goals for improvements.
  • Define and establish standards, processes and procedures.

Centralization: The Decision is Yours

It is important for HIM professionals to be proactive when determining his or her organization’s vulnerabilities and address them immediately, as breaking down barriers that add risk ultimately drives down costs and improves efficiencies.

Additionally, everyone in an organization may not support the transition. However, executive sponsorship and collaboration between staff, departments and facilities is essential. To gain consensus, HIM professionals must understand the culture of the departments involved and how to leverage their individual technological capabilities.

The work of healthcare professionals is being reshaped by the centralization of HIM operations. If you’re looking to succeed during this ambiguity of change, transforming HIM to a centralized model throughout an enterprise provides healthcare facilities with a competitive advantage, as the integration of emerging technology continues to become a crucial step towards efficient, successful operations.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and is a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

Edge Computing Provides Security for EHR, Healthcare Applications

Posted on August 10, 2018 I Written By

The following is a guest blog post by Eric Fischer is the Digital Marketing Specialist for Estone Technology.

As more and more practices, both small and large, move from traditional patient records to fully electronic health records, the advantages of cloud-based EHR systems are becoming more readily apparent. In a cloud-based EHR system, data is stored on an external server, usually owned and operated by a third-party company, reducing an individual practice’s investment. Setup is often limited to installing certain software, and subsequently, data can be accessed anywhere.

However, in the modern day of HIPAA rules and patient privacy regulations, sending all of your patient data to a third party service can be dangerous if not managed properly. Even worse, as more and more devices gain intelligence and connectivity, joining the Internet of Things, patient data is often sent as soon as it as gathered, without human input, creating backlogs of pointless data and additional windows for data theft or misuse.  Though cloud-based records systems should offer flawless security, it only takes one person at any level in data processing to be careless with their password, or one device affected with malware to render patient records totally insecure. In a recently reported story, a security expert identified a data breach caused when an employee plugged their eCigarette into their work computer’s USB port to charge. The eCigarette had been loaded with secret data harvesting software.

The IoT has made the problem more severe as it grows, as many simple, connected devices lack any sort of security measures whatsoever, and simply send gathered data on as they have been programmed to do, no matter how they were programmed to do so. It is shockingly simple for these devices to be compromised and misused. The benefits of patient data recorders that automatically send their data to EHR’s is obvious, but the danger is also quite clear.

Cloud-Based IoT systems automatically send much of requested patient data from sensors directly to third party companies, ripe for data theft as well as failure in a network outage. *Data from the Journal of Intensive and Critical Care.

Fortunately, there is a solution. As small, embedded chips and boards have become more and more powerful, the need to send all data to the cloud to be processed and stored has lessened. Today, the IoT is shifting rapidly towards a new model of computing – Edge Computing. In this new computing format, data from individual IoT devices like patient monitors and data recorders is processed by intelligent, embedded boards and devices at the edge of the local network. Once the processing has been completed, any relevant data can be encrypted and forwarded to the cloud for additional processing and storage.

This improves data security in a few very simple, fundamental ways – first of all, more data stays local. Everything from blood pressure to MRI scans can be processed locally by edge devices using machine learning techniques. Most of this data is, of course, irrelevant and can be discarded. But when the Edge Computing device identifies something important, it can forward that data to the cloud-based EHR system, ready for additional use.

Secondly, since these devices are more powerful, and managed locally, they’re easier to secure than other IoT devices, or third-party managed cloud devices. It’s possible to load embedded boards performing edge computing functions with modern operating systems and anti-malware programs that keep data secure. This barrier between your internal devices, and the digital world offers a layer of protection for your most sensitive patient data.

Developers of hospital networks and hospital IT managers, EHR software developers, and other healthcare information technology professionals can work with hardware designers and manufacturing firms to discuss Edge Computing solutions for themselves and their customers.

About Eric Fischer
Eric Fischer is the Digital Marketing Specialist for Estone Technology – a designer and manufacturer of OEM/ODM computer solutions for Medical and Rugged Industries. Our solutions include specialized Tablet and Panel PCs, Embedded Boards, and Industrial Computers. We offer solutions that are IEC-60601 certified, waterproof, and antimicrobial, specialized for hospital environments.

Experts Tell All: How Leaders Ensure Successful Healthcare ERP Adoption

Posted on August 9, 2018 I Written By

The following is a guest blog post by Sallie Parkhurst, Carol Mortimer, Michelle Sanders, and Heather Haugen PhD from Atos Digital Health Solutions.

According to Gartner, approximately 75% of Enterprise Resource Planning (ERP) implementations fail despite the significant opportunity for process management improvement in key business areas including human resources, payroll, supply chain management, and finance.  We gathered critical feedback from experts who have lived through hundreds of implementations across a broad spectrum of industries. Their advice was insightful!

Our discussion focused on three distinct areas where leaders should focus in order to avoid some of the common missteps of large complex implementations. That is, leaders must clearly define their strategic approach to these key business functions beyond the selection of ERP tools. This work spans the system selection and implementation phases of an ERP project. Engaging the appropriate internal experts early in the process ensures effective governance, reality in the “current state” and data accuracy.  This effort is required for the entire life cycle of an ERP.  Finally, leaders need to consider the resources, time and leadership required to continue successful adoption after implementation; this is often left until after implementation and creates significant financial surprises and resource constraints.

Clearly Defined Strategy:

  • Leadership and Communication: Most ERP systems have an impressive array of functions and options to make processes more efficient and effective. How those systems are used in your organization must be defined, communicated, and governed throughout the entire process.  The leadership team is ultimately responsible for this effort, but must consider how to best communicate and engage the entire organization to achieve the goals.  The change management effort is quite extensive and is a key predictor of success!
  • Functionality: The functionality you need should be driven based on your business needs. While this seems obvious, many organizations buy a suite of products that includes more advanced functionality than they need, functionality they can’t take advantage of because of other system constraints, or functionality that requires data from other systems they don’t have. Set the parameters for demos and consider defining the scenarios to get an accurate picture of system capabilities for your specific needs.
  • Interfaces: ERP systems can interface with many different systems ranging from clinical systems to warehouse applications. This is a great opportunity to ensure better overall integration of business processes, but don’t underestimate the work required. Ask about the cost of interfaces, maintenance required, potential impact from upgrades, and any limitations of your current systems and data specifications for accurate and efficient electronic transmission. Also, be sure to ask about any third party vendor software required during discussions involving interfaces.

Engagement of Experts:

  • Knowledge Experts: Most organizations don’t engage their internal experts early enough in the project. Involving your subject matter experts during system selection can be tricky, but it pays big dividends in the end. These experts know the current systems or manual processes, but they also know the workarounds and issues that need to be addressed. Ensure that these people are also involved in defining data tables and other “area specific” customization.
  • Document Current State: This is cumbersome work, but organizations that take the time to define their current workflows gain more efficiency and cost savings from their new ERP systems. When this step is skipped, implementations stressors (time and resources) force the new system to mimic old system processes or manual processes that degrade the overall value of the new system.
  • Competencies and Development: Your new ERP system will probably stretch your team’s competencies, and will often require additional team training. This is a great opportunity to offer growth opportunities in your organization.  It may also require hiring for specific skill sets.
  • Priorities: The toughest question a leader faces when implementing a new system is “What are we going to stop doing to ensure the success of this effort?” Give your team time to focus on and perform high quality work.

Long-Term Commitment

  • Resource commitments: Any large system capable of making dramatic improvements in efficiency and accuracy of business processes will always require an investment of time and resources after implementation. Organizations almost always underestimate the long-term investment associated with maintenance, upgrades, training, and optimization. However, organizations that commit even a few hours per week in a disciplined manner find it easy to maintain and even improve on the value they expect from their ERP.
  • Beyond implementation – achieving adoption: The difference between simply installing a system and achieving business value lies in the long-term commitment by an organization’s leaders to optimize the use of the system.

ERP tools offer a significant opportunity to better manage critical business functions, but adoption of those systems requires:

  1. A clearly defined strategy for the key ERP business functions you plan to implement;
  2. Engagement of your internal experts early and often; and
  3. Commitment of resources and funds to realize the value of your investment.

About the Authors: 

  • Sallie Parkhurst is Senior Project Manager and an expert in Finance for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Carol Mortimer is Senior Consultant and an expert in Supply Chain Management for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Michelle Sanders is Senior Project Manager and an expert in HR and Payroll for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Heather Haugen is the Chief Science Officer for Atos Digital Health Solutions.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

What Clients Value about Atos’ ERP Solutions and Services:

  • Expertise across all ERP business functions
  • Depth of knowledge of the ERP systems and how they function in various environments
  • The combination of industry expertise and system expertise
  • Ability to solve problems and understand clients’ challenges
  • How our team cares about their problems and challenges like they are our own

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.