Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Important Patient Data Questions Hospitals Need To Address

Posted on July 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.

Obviously, managing and protecting patients’ personal health information is very important already.  But with high-profile incidents highlighting questionable uses of consumer data — such as the recent Facebook scandal – patients are more aware of data privacy issues than they had been in the past, says Dr. Oleg Bess, founder and CEO of clinical data exchange company 4medica.

According to Bess, hospitals should prepare to answer four key questions about personal health information that patients, the media and regulators are likely to ask. They include:

  • Who owns the patient’s medical records? While providers and EHR vendors may contend that they own patient data, it actually belongs to the patient, Bess says. What’s more, hospitals need to be sure patients should have a clear idea of what data hospitals have about them. They should also be able to access their health data regardless of where it is stored.
  • What if the patient wants his or her data deleted? Unfortunately, deleting patient data may not be possible in many cases due to legal constraints. For example, CMS demands that Medicare providers retain records for a fixed period, and many states have patient record retention laws as well, Bess notes. However, if nothing else, patients should have the ability to decline having their personally-identifiable data shared with third parties other than providers and payers, he writes.
  • Who is responsible for data integrity? Right now, problems with patient data accuracy are common. For example, particularly when patient matching tools like an enterprise master patient index aren’t in place, health data can end up being mangled. To this point, Bess cites a Black Book Research survey concluding that when records are transmitted between hospitals that don’t use these tools, they had just a 24% match rate. Hospital data stewards need to get on top of this problem, he says.
  • Without a national patient ID in place, how should hospitals verify patient identities? In addition to existing issues regarding patient safety, emerging problems such as the growing opioid abuse epidemic would be better handled with a unique patient identifier, Bess contends. According to Bess, while the federal government may not develop unique patient IDs, commercially developed master patient index technology might offer a solution.

To better address patient matching issues, Bess recommends including historical data which goes back decades in the mix if possible. A master patient index solution should also offer enterprise scalability and real-time matching, he says.

Improving Data Outcomes: Just What The Doctor Ordered

Posted on May 8, 2018 I Written By

The following is a guest blog post by Dave Corbin, CEO of HULFT.

Health care has a data problem. Vast quantities are generated but inefficiencies around sharing, retrieval, and integration have acute repercussions in an environment of squeezed budgets and growing patient demands.

The sensitive nature of much of the data being processed is a core issue. Confidential patient information has traditionally encouraged a ‘closed door’ approach to data management and an unease over hyper-accessibility to this information.

Compounding the challenge is the sheer scale and scope of the typical health care environment and myriad of departmental layers. The mix of new and legacy IT systems used for everything from billing records to patient tracking often means deep silos and poor data connections, the accumulative effect of which undermines decision-making. As delays become commonplace, this ongoing battle to coordinate disparate information manifests itself in many different ways in a busy hospital.

Optimizing bed occupancies – a data issue?

One example involves managing bed occupancy, a complex task which needs multiple players to be in the loop when it comes to the latest on a patient’s admission or discharge status. Anecdotal evidence points to a process often informed manually via feedback with competing information. Nurses at the end of their shift may report that a patient is about to be discharged, unaware that a doctor has since requested more tests to be carried out for that patient. As everyone is left waiting for the results from the laboratory, the planned changeover of beds is delayed with many knock-on effects, increasing congestion and costs and frustrating staff and patients in equal measure.

How data is managed becomes a critical factor in tackling the variations that creep into critical processes and resource utilization. In the example above, harnessing predictive modelling and data mining to forecast the number of patient discharges so that the number of beds available for the coming weeks can be estimated more accurately will no doubt become an increasingly mainstream option for the sector.

Predictive analytics is great and all, but first….

Before any of this can happen, health care organizations need a solid foundation of accessible and visible data which is centralized, intuitive, and easy to manage.

Providing a holistic approach to data transfer and integration, data logistics can help deliver security, compliance, and seamless connectivity speeding up the processing of large volumes of sensitive material such as electronic health records – the kind of data that simply cannot be lost. These can ensure the reliable and secure exchange of intelligence with outside health care vendors and partners.

For data outcomes, we’re calling for a new breed of data logistics that’s intuitive and easy to use. Monitoring interfaces which enable anyone with permission to access the network to see what integrations and transfers are running in real time with no requirement for programming or coding are the kind of intervention which opens the data management to a far wider section of an organization.

Collecting data across a network of multiple transfer and integration activities and putting it in a place where people can use, manage and manipulate becomes central to breaking down the barriers that have long compromised efficiencies in the health care sector.

HULFT works with health care organizations of all sizes to establish a strong back-end data infrastructure that make front-end advances possible. Learn how one medical technology pioneer used HULFT to drive operational efficiencies and improve quality assurance in this case study.

Dave Corbin is CEO of HULFT, a comprehensive data logistics platform that allows IT to find, secure, transform and move information at scale. HULFT is a proud sponsor of Health IT Expo, a practical innovation conference organized by Healthcare Scene.  Find out more at hulftinc.com

An HIM Perspective of What Was Shared at #HIMSS18 – HIM Scene

Posted on March 9, 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.

Today is the final day of the HIMSS 2018 Annual Conference. While there are nearly 44k attendees at the conference and 1350 vendors, I didn’t meet a single HIM professional. I certainly didn’t meet all 44k attendees, but it’s safe to say that the HIM community wasn’t well represented at the HIMSS conference. It’s unfortunate because healthcare IT initiatives can really benefit from the HIM perspective.

Since many HIM professionals weren’t in attendance, I thought it would be beneficial to share some insights into trends I saw at HIMSS 2018 that could be beneficial to HIM professionals.

AI (Artificial Intelligence)
AI was the hottest topic at HIMSS 2018. It seemed like every vendor was saying that they were doing some sort of AI. Of course, many used the AI term very broadly. It included everything from simple analytics to advanced AI. In some ways, that’s corrupted the term AI, but what’s clear is that lots of companies are using data to provide insights and to automate a wide variety of healthcare work.

Another great insight I heard was that revenue cycle management and other financial areas are a great place to start with AI because they’re seen as less risky. When you’re applying AI to clinical use cases, you have to worry a lot more about being wrong. However, the consequences aren’t nearly as damaging when you’re talking about the financial side of healthcare.

Information Governance and Clean Data
At HIMSS 2018 I heard over and over the importance of having clean data. If AI was the hottest topic at HIMSS 2018, none of that AI will really matter or provide the value it should provide if the data is inaccurate and not trusted. This is why the work that HIM professionals do to ensure effective information governance is so important. It’s almost cliche to say bad data in leads to bad insights out. However, it’s cliche because it’s true. HIM needs to play an important role in making sure we have accurate data that can be trusted by AI applications and therefore the providers that receive those insights.

Texting Patients Is Not a HIPAA Violation
No doubt this will feel like news for many of you. It may even scare many HIM professionals. However, OCR Director Severino made it clear that Texting Patients is Ok. I won’t dive into the details here, but read the article by Mike Semel which outlines what was said at HIMSS 2018 in regards to texing patients.

Healthcare Chatbots
I didn’t see any healthcare chatbots that are solving HIM’s problems. However, when you look at the various healthcare chatbots out there, there’s no reason why a healthcare chatbot couldn’t do amazing things for HIM professionals. Here’s a framework for healthcare chatbots that companies should consider. What mundane tasks are well defined that could be automated by a healthcare chatbot? When you ask this question, you’ll see how chatbots are something HIM professionals should embrace. There’s a lot of mundane HIM work that could be done by a chatbot which frees them to work on the more challenging HIM issues.

Patient Access to Medical Records Is No Longer Controversial
While some specific individuals have fears related to access to medical records, it’s been proven across every type of healthcare organization that providing patients’ access to their medical records is right thing to do. The fears people have are unfounded and that patients find this extremely valuable. I heard one person say that they no longer will do visits with doctors who will not give them access to their records.

Those were some high level insights from a HIM perspective. Lots of exciting things when it comes to technology and HIM. What do you think of these changes, announcements, and trends? We’d love to hear your thoughts and perspectives in the comments.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Tri-City Medical Center: Achieving a Middleware First

Posted on March 2, 2018 I Written By

The following is a guest blog post by Adam Klass, Chief Technology Officer, VigiLanz.

In the age of value-based care, it’s all about performance as hospitals continually face increased financial pressure to meet a number of different criteria related to decreasing length of stay, hospital-acquired infection rates and hospital readmissions. Today’s hospital organization must improve healthcare analytics and core measures, avoid penalties, and secure reimbursement, so it can continue to grow and thrive. This shift means hospitals must now consider cost avoidance instead of expecting direct reimbursement for patient care.

The challenge then becomes how to support and enable next-generation healthcare providers by delivering real-time results from disparate platforms and technology into any clinical workflow. It’s no surprise, then, that 62 percent of hospital CIOs identify interoperability as a top priority and 80 percent of accountable care organizations also cite integrating data as a top challenge for their IT departments.

To accomplish this goal, medical facilities like Tri-City Medical Center, a 388-bed full service, acute care hospital in Oceanside, California, require a services-oriented architecture and open application programming interface (API) capability that enables efficient aggregation, interaction and exchange of disparate data throughout the healthcare enterprise and across any of its software technologies, including EMRs and third-party single-point-solution vendors.

APIs Versus HL7

APIs fit the bill by allowing access to all of the data a digital health application and a health system would need, in real-time. Clinicians and administrators can now rapidly integrate new clinical and business information for better decision-making and, most importantly, for improved patient care with new interoperability services.

Tri-City Medical Center, which also operates a primary care clinic and employs more than 700 physicians practicing in 60 specialties, is the first VigiLanz customer site to utilize our middleware API solution, VigiLanz Connect, to convert health data from its EMR into uniform, actionable intelligence in the VigiLanz Platform. The hospital organization’s use of this solution turns its closed EMR systems into open platforms through robust services that do not rely on HL7 interfaces. Instead, our platform handles connectivity and normalizes data structures across major EMR platforms, like Cerner’s, which Tri-City Medical Center uses, to quickly unlock the data. Benefits include reduced integration time from months to days, elegant workflows, decreased maintenance costs and minimized risk.

“An API is definitely the way to go,” explained Mark Albright, Vice President of Technology, Tri-City Medical Center. “Anytime we have a choice between an interface and an API, we always go with APIs. It’s just so much easier to install and get up and running.”

“Not only are APIs easy to use but they are a no-brainer when it comes to rapid and successful implementation,” continued Albright. “Using VigiLanz’s middleware API helped us maximize the platform in a different, modern way. Not only is it a simpler effort than using a solution like HL7 but it’s also stable and steady so it’s easy to maintain, despite the significant amount of data being pulled.”

Taking EMR Systems to the Next Level

Clinical intelligence and interoperability services complement today’s EMR systems which, on their own, may be insufficient to deliver agile, real-time intelligence services. In contrast, a middleware API can interoperate with EMR systems and is built with innovative abstract data architectures that help hospitals like Tri-City Medical Center improve patient care and operational performance.

In contrasting his organization’s middleware API experience with what would have traditionally been an HL7 integration, Albright noted, “Our hospital charged a non-programmer, non-developer, non-HL7 person with spearheading this project, something that could have not happened in an HL7 world. She would have never been able to master that.”

That “she” is Melody Peterson, a senior systems analyst, who stepped into the project post-decision, after Tri-City’s pharmacy, infection control and clinical surveillance departments had already made the decision to purchase the middleware API, separate from the organization’s IT department.

“I was tasked with making this middleware API work, without having been part of the research or purchase decision,” explained Peterson. “Because VigiLanz supports the clinical and business sides of our hospital, though, it was easy to implement this ‘plug-and-play’ integration solution, in a way that applied to all areas critical to optimizing care – from risk scoring to antimicrobial stewardship.”

A middleware architecture is often the best technological solution for addressing the problem of EHR interoperability because it facilitates the transparent, yet secure, access of patient health data, directly from the various databases where it is stored. No longer does a hospital organization like Tri-City Medical Center have to do all of the development itself, but instead can rely on off-the-shelf applications to solve problems. Middleware brings an application-agnostic approach to connecting EMRs to one another while allowing for specific development to enhance the significant investment by hospitals, health systems and physicians.

The Full Spectrum of Information Governance – HIM Scene

Posted on February 7, 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.

Information governance is such an important topic across so many areas of healthcare. It impacts almost every organization and quite frankly takes the full organization to buy in to ensure proper information governance. Doing it right is going to be essential for any healthcare organization to work efficiently and effectively in the future.

While information governance impacts everyone in healthcare, I have to give credit to AHIMA and their HIM professional community for leading the way on the topic of information governance. A great illustration of this leadership is in the AHIMA Information Governance Adoption Model Competencies (IGAM):


*Thanks to HIM professional, Katherine Downing for sharing it on Twitter.

I think a lot of people that work in a hospital and healthcare system don’t recognize a lot of these areas of information governance. At least they don’t look at them from that lens.

My favorite part of this model is that it starts with creating the right information governance structure and the strategic alignment. If you don’t get the right people assigned as part of their job to work on information governance, it will never happen. Plus, if you don’t realize how information governance aligns with the organizations priorities, then you’ll fall short as well.

How far along are you in your information governance efforts? Have you incorporated all of the above elements into your information governance strategy? We’d love to hear your experiences, insights, and perspectives in the comments.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

The Disconnect Between Patient Experience and Records Requests – HIM Scene

Posted on April 19, 2017 I Written By

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

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

This week I met with one of the digital marketing team at a children’s hospital. We had a great conversation about the hospital website and the way the hospital’s website represented the organization to the patient. Plus, we talked about how patients choose to interact with the hospital through their website. There are a wide variety of patient requests through the website, but one of those requests was a request for their patient record.

It wasn’t really a surprise that this digital marketer didn’t really know the details of what’s required for a patient to make an appropriate medical record request from his hospital. In his defense, he didn’t usually answer the questions, but just created the website that collected the questions. However, it was quite clear that the workflow for any medical records request was to send it to their HIM department and let them figure it out.

Most organization then have their HIM staff play phone tag with the patient to explain how to make a proper records request which will allow them to release the information to the patient. The progressive organizations might send the patient an email. However, many of them will then ask the patient to mail, drop off or fax in the official records request. If this sounds painful, I can assure you that it’s as painful as it sounds.

This illustrates the massive disconnect between creating a great patient experience and most organization’s current records request process. Please note that I’m not blaming the digital team at hospitals for the issue and I’m not blaming the HIM people for this problem. I’m blaming the disconnect between the two organizations because the only way to solve this problem is to have both organizations involved.

The best patient experience would actually be for the patient to go to their patient portal and download their whole record. Maybe we’ll get their one day, but there are hundreds of systems in a hospital where a patient’s data is stored. So, it’s going to take a while for us to reach the point where a patient can self-service their data requests.

Since I’m not holding my breath on this amount of data sharing happening between disparate systems, I’m more interested in making the current processes so it’s a seamless experience for the patient. If you can model a medical records request on paper, then you can do it digitally. To their credit, I’ve seen a few organizations working on this. In fact, their system is part education about records requests and part getting the information that’s needed to fulfill a records request.

It’s time that HIM and a hospital’s digital and tech teams come together to make the process for requesting records a seamless patient experience. And if you think using a fax machine is a seamless experience for patients, then you’re part of the problem.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

A Look at the HIM World with Dr. Jon Elion from ChartWise Medical Systems – HIM Scene

Posted on April 5, 2017 I Written By

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

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Healthcare Scene had a chance to interview Dr. Jon Elion, founder and president of ChartWise Medical Systems where we asked him about some of the big happenings in Health Information Management (HIM) and how world of HIM is evolving. Dr. Elion offers some really great insights into the HIM profession. You can watch the full video interview embedded at the bottom of this post or click on one of the questions below to hear Dr. Elion’s answer to that question.

Find more great Healthcare Scene Interviews.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Who’s Over MACRA? CIO? COO?

Posted on March 22, 2017 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.

In no surprising way, MACRA is a major topic in pretty much every hospital and health system in the US. There’s a lot of money to be had or lost with MACRA. This is especially true for health systems with a lot of providers. Plus, it sets the foundation for the future as well. I believe MACRA will be as impactful as meaningful use, but without as many incentive payments (chew on that idea for a minute).

As I’ve talked to hundreds of organizations about MACRA, I’ve seen a whole array of responses for how they’re addressing MACRA and who is in charge. Is this a CIO responsibility since MACRA certainly requires EHR and other technology? Is this a COO job because MACRA is more of an operations problem than it is a technical problem? Some might make the case for the CMO/CMIO to be in charge since MACRA requires so much involvement from your providers.

From my experience, the decision usually comes down to choosing between the CIO and the COO, but with input and buy-in from the CMO/CMIO. How the CIO positions themselves will determine if they are over MACRA or not. Some CIOs see themselves as tech people and so they shy away from touching MACRA. Other CIOs see themselves as integral part of their business success and so they want to have MACRA under their purview. Most progressive CIOs that I talk to want the later.

I’m an advocate for a CIO that’s involved in the business side of things. Those CIOs that don’t want this duty are going to miss out on strategic opportunities for their organization. I heard one CIO describe that they viewed their IT organization as Information As A Service provider. Their job as the IT department was just to provide the information from the IT systems to someone else who would deal with the information, the MACRA regulations, etc.

The Information as a Service provider concept has issues on multiple levels. The most important is that if you’re just an information provider, then you lose out on the opportunity to be a strategic part of your organization. However, from a more practical MACRA level, it’s really challenging to provide the right information for MACRA when you’re just an information provider and know little about the regulation. We all know how quickly communication can break down when the person needing the information is disconnected from the people who provide the information and they’re disconnected from the people entering the information.

No doubt a healthcare CIO has to be careful what projects they add to their plate. However, I don’t think MACRA is one of those projects that should be pushed off to someone else. Certainly there can be specific organization cultures where it makes sense for the COO to run things, but I think that should be pretty rare.

How are you approaching MACRA at your organization? Who’s over it? I look forward to hearing your experiences in the comments.

EMR Replacement & Migration Perspective: Tim Schoener, VP/CIO, UPMC Susquehanna

Posted on December 8, 2016 I Written By

header-chime
In the midst of a merger with a major Pennsylvania healthcare organization, Tim Schoener is wholly focused on EHR transition. He outlines Susquennaha’s plan for each aspect of transition, offering innovative and unique approaches to each. In addition, Schoener provides cogent insights regarding the intricacies involved with a multi-database system, the expenses associated with archival solutions, and the challenges associated with migrating records. This interview touches on many of the considerations necessary for a successful EHR transition as Schoener discusses minimizing surprises during a transition; why migrating a year’s worth of results is optimal; and how their document management system fulfills archival needs.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Looking for additional EMR replacement perspectives & lessons learned? View a recent panel where HCO leaders discussed their experiences with EHR transition, data migration & archival.

KEY INSIGHTS

Absolutely, we have problem lists that can’t be reconciled; there’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all.

We’re being told, if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.

Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

Let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move.

It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare.

CHIME is a great way to challenge yourself as a CIO and in your leadership. It pushes me in my leadership skills and helps to focus me back to what’s critical in the industry.
tim-schoener
Campbell: Tell me a little about yourself and your organization’s initiatives

Schoener: I’m Tim Schoener, the VP/CIO of, originally Susquehanna Health, which, as of October 1st, is now a part of the University of Pittsburgh Medical Center (UPMC) and re-named to UPMC Susquehanna. We’re located in central Pennsylvania, four hours away from Pittsburgh.

A major IT initiative for us is that we’re swapping out our EMR over the next couple of years. We are currently a Cerner Soarian customer. In fact, we were the initial Soarian beta site for Financials and second for Clinicals. We determined we eventually need to migrate to something else – that’s an Epic or Cerner decision for us at this point. UPMC’s enterprise model is Cerner and Epic, Cerner on the acute care side and Epic on the ambulatory side. As of this writing, we’ve made the decision to migrate to the UPMC blended model. Over the past nine months we’ve been focused on an EMR governance process, trying to get our team aligned on the journey that we’re about to take and by late next year we will likely be starting an implementation.

We currently leverage NextGen on the Ambulatory side, with approximately 300 providers that use that software product. We’re a four hospital system: two of which are critical access, one which is predominately outpatient, and the other a predominately inpatient facility. We were about a $600MM organization prior to our UPMC acquisition.

Campbell: Related to your current implementation, tell me a little bit about your data governance strategy and dictionary mapping that may occur between NextGen and Soarian.

Schoener: We definitely have a lot of interfaces, a lot of integration between the two core systems. From an integration perspective, we have context sharing, so physicians can contextually launch and interoperate from NextGen to Soarian, and vice-versa. We do pass some data back and forth—allergies and meds can be shared through a reconciliation process—but we certainly aren’t integrated. It’s the state of healthcare.

Campbell: That’s why you anticipate moving to a single platform, single database?

Schoener: Absolutely, we have problem lists that are not reconciled. There’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all. Meds and allergies are pretty much all we get in terms of outpatient to inpatient clinical data sharing today.

Campbell: Do you leverage an archival solution for any legacy data?

Schoener: We use EMC and have large data storage with them. I wouldn’t call it archival, but we have an electronic document management system – Soarian’s eHIM.

There’s a huge amount of data out there and I know you have some questions related to our thinking with respect to migration. I have some thoughts around that related to levering our document management system versus archiving into a separate system. I’m pretty certain we would be thinking ‘why not use eHIM as our archival process, and just put other data in that repository as necessary?’ For results data, for instance, what we’re thinking of migrating, or what our providers are requesting, is a years’ worth of results. ‘Give me a year’s worth of results, and then make sure everything else is available in eHIM.’

Campbell: As such, your default is to migrate a year’s worth of data?

Schoener: Yes. We would presume that the provider is probably not going to refer back to lab results or radiology results beyond a year, other than for health maintenance kind of things such as mammograms, pap smears, PSAs; those types of things.

Campbell: What expectations have you set with physicians when they go live on the new EMR?

Schoener: From an ambulatory perspective, we’re thinking that it would be nice to have the most recent note from the EMR available. All of the other notes for that patient would be consolidated into one note via a single pdf attachment. The note that’s the separate most recent note, we envision that being in a folder for that particular date. That note would reside in the appropriate folder location just like it would in the current EMR. Our goal is to bring the clinical data forward to the new EMR, taking all the other notes and placing them in a “previous notes” folder.

Campbell: Can you elaborate on your consideration of PAMI (Problems, Allergies, Medications, Immunizations) as part of the data migration?

Schoener: Sure. The disaster scenario would be the physician sits down with patient for first time with new EMR, and there are no meds, no allergies, and no problems! They’ll spend 25 minutes just gathering information, that would not work.

We’re thinking of deploying a group of nurses to assist with the data conversion and migration process. Our intent is to have them to retrieve CCDAs to populate those things I mentioned by consuming them right into the medical record, based on the physicians’ input. We expect there to be a reconciliation process to clean-up potential duplicates. Or, to be candid, we’ve talked about automating the CCDA process, consuming discrete clinical items from it by writing scripts and importing into the new EMR. I think we’re leaning towards having some staff involved in the process though.

Now if you share the same database between your acute and ambulatory EMR, and the patient was in ambulatory setting but now they’ve been admitted, it’s the same database: the meds are there, the problems are there, the allergies are there; it’s beautiful, right? If they weren’t, then the admission nurse is going to have to follow the same CCDA consume process that the ambulatory nurse followed. Or you start from scratch. On the acute side, we start from scratch a lot. Patients come in and we basically just start asking questions in the ER or in an acute care setting. We start asking for their meds, allergies, or problems – whatever they may have available.

Campbell: We’ve discussed notes, results and PAMI. Are there other clinical data elements that you’ve examined? How will you handle those?

Schoener: From an acute care perspective, our physicians are very interested in seeing the last H & P (History & Physical Examination) and the last operative note, so we’re going to consider two different ideas. One would be that all of that data would still reside in document management, which has the ability to be sorted. It’s currently very chart centric. For instance, you can easily pull the patient’s last acute care stay. There is the ability, however, to sort by H & P, operative note, or discharge summary—something along those lines for the separate buckets of information. Therefore, a physician could view the most recent H & P or view all sorted chronologically. In addition, they’ll be able to seamlessly launch directly from the new EMR to the old EMR, bypassing authentication, which is important to mitigate context switching.

One of the areas we’re struggling with is the growth chart. A physician would love the ability to see a child’s information from start to finish, not just from the time of the EMR transition. So that means some sort of birth height/weight data that we would want to retrieve and import into the new system so a growth chart could be generated. The other option is to somehow generate some sort of PDF of a growth chart up until the place where we transitioned to the new EMR. The latter however, would result in multiple growth charts, and a physician’s not going to be happy with that. So we’re trying to figure that one out.

Another area of concern is blood pressure data. We’re struggling with what to do with a patient we’re monitoring for blood pressure. We’d like to see more than one blood pressure reading and have some history on that.

Campbell: Thank you for elaborating on those items. What about data that is not migrated. How will that be addressed and persisted going forward?

Schoener: For the most part, everything else would be available in the document management system. We can generate that data from document our document management system and make it available to be queried by OIG or whoever else requires that data from a quality perspective. We are aware that an archival solution is very expensive. We’re being told, ‘if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.’ If that’s what the advisors and consultants are saying, then our thought is that probably isn’t going to be the direction we’re going to go. We’re likely going to stick with some type of document management system for archival.

Campbell: Very good. How are you gathering feedback from different specialties and departments? Do you have a governance process in place?

Schoener: So as you may have gathered, we’re getting ready. I don’t want surprises. I want physicians to be prepared and to set expectations for what’s going to be available. What I just described to you, we’ve vetted that out with our primary care docs. Now we’re going to take that to our cardiologists and ask them what they think. Then on to our urologists to allow them to weigh in. Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

There will definitely be a learning curve with the new EMR, but we want to be clear and set expectations with respect to data migration and conversion, so that when the physician does use the new EMR they’re not saying ‘that darn Cerner or Epic.’  It’s more ‘that’s a part of the data migration process and we weren’t able to accomplish that.’

Campbell: What about legacy applications support. Will all of your staff be dedicated to the new project?

Schoener: I mean, let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move. We still haven’t decided what to do.

Campbell: I agree that no staff member wants to be left behind. I’ve talked to organizations where they use folks for both and it just doesn’t end well. You can’t expect them to do both, learning the new system while supporting the old one.

Schoener: I guess it depends on the capacity and the expectation of that particular project they’re working on. Maybe there is a person who has less involvement with the new EMR and they have availability where they can support both, although it’s unlikely. Sometimes you end up having someone who wants to retire within the time period. In that case, they can almost work their way to retirement and then not ever support the new EMR, although that situation is also unlikely.

It’s a great question, and one we’re going to have to have folks help us determine.

Campbell: Shifting gears a little bit, what are your thoughts on health data retention requirements? Too loose? Too stringent?  As you know, it varies state-to-state, from 7-10 years, but I feel like there’s a huge responsibility that is placed on organizations to be the custodians of that data. Do you agree?

Schoener: I think that’s just healthcare. A lot of it is legal considerations and our need to protect ourselves. That’s why do we do a lot of the things we do. We’re protecting ourselves from lawsuits and litigation. I think it’s expected; it’s just the nature of the business. Just think of what we had in a paper world. We used to have rooms and rooms full of charts and now that’s all gone. With our current process, any paper that comes in is scanned in within the first 24 hours. So it’s not something I worry about. My focus now is making sure our providers can perform excellent patient care on the new EMR.

Campbell: Could you provide some advice, insight or wisdom for healthcare organizations pursuing EMR/EHR replacement & transition?

Schoener: Get ready for some fun! Affiliations and acquisitions are greatly impacting these decisions. It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare. One bit of wisdom for anyone is: if you’re not interested in that type of transition and change occurring, healthcare’s not for you. That’s the nature of the business we’re in.

I would say from an EHR transition process, I found that having an advisor is extremely beneficial to help me think outside of my day-to-day operations. They’re able to look outside of your organization and ask the right questions. If you pick the right advisor, they’ll protect you and protect your organization. I think it’s been very healthy for us to have someone from the outside give us counsel and advice because it’s a tough process. It’s extremely expensive, and extremely polarizing.

Campbell: Outside of the networking, what did you come to CHIME focused on this year?

Schoener: CHIME is a great way to challenge yourself as a CIO and in your leadership, it pushes me in my leadership skills and helps to focus me back to what’s critical in the industry. It helps me to think more strategic and broad, not to get too engaged in one particular topic. I think it’s just great for professional development. CHIMEs the best out there with respect to what I do.

This interview has been edited and condensed.

Evaluate options, define scope and formulate a strategy for EHR data migration by downloading Galen’s EHR Migration Whitepaper.

About Tim Schoener
Tim Schoener is the Vice President/Chief Information Officer for UPMC Susquehanna, a new partner of UPMC since October 1, 2016, which is a four-hospital integrated health system in northcentral Pennsylvania including Divine Providence Hospital, Muncy Valley Hospital, Soldiers + Sailors Memorial Hospital and Williamsport Regional Medical Center. UPMC Susquehanna has been Most Wired for 14 of the last 16 years and also HIMSS Level 6. Tim has worked at Susquehanna for over 24 years, 19 of those years in Information Technology.  He also has responsibilities for health records, management engineering and biomedical engineering. He is a CHCIO, HIMSS Fellow and CPHIMS certified. Tim received his undergraduate degree from The Pennsylvania State University with a BSIE in Industrial Engineering and his MBA from Liberty University. 

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

HIM’s Role in Healthcare Security and Privacy – HIM Scene

Posted on November 30, 2016 I Written By

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

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

One of my go-to experts on healthcare privacy and security is Mac McMillan, CEO and Co-Founder of CynergisTek. He’s built a really great company that focuses on privacy and security in healthcare and he’s a true expert.

While at AHIMA 2016, I talked with Mac about the role that HIM plays in healthcare privacy and security. We also talk about where healthcare privacy is heading and which part of healthcare privacy and security doesn’t get enough attention. I also asked Mac to make a big 20 year prediction on what will happen with privacy and security in healthcare.

Check out our interview with Mac McMillan, CEO and Co-Founder of CynergisTek:

We shot a number of other videos at AHIMA 2016 which we’ll be posting shortly. If you enjoyed this video, be sure to Subscribe to Healthcare Scene on YouTube and watch our full archive of Healthcare Scene interviews.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.