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Mobile Policy Enforcement Issues Could Expose Hospitals To Security Problems

Posted on June 15, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

Gamification in Healthcare: Just Play or Real Value?

Posted on June 14, 2018 I Written By

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

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

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

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

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

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


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

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

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

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

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

Near-Fatal Med Incident Leads Hospital To Redesign Alerts

Posted on June 13, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

Posted on June 12, 2018 I Written By

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

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

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

As shared by Don Lee:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bias In Medical Records Can Affect Patient Care

Posted on June 4, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

Mayo Clinic EMR Install Goes Poorly For Nurses

Posted on June 1, 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.

Ordinarily, snagging a contract to help with an Epic install is a prized opportunity. Anyone involved with this kind of project makes very good money, and the experience burnishes their resume too.

In this case, though, a group of nurse contractors says that the assignment was a nightmare. After being recruited and traveling across the US to work, they say, they were treated horribly by the contractor overseeing the Mayo Clinic’s go-live of its Epic EMR.

According to a recent news story, the Clinic hired a team of seven nurses to help with the final stages of the rollout. The nurses, all of whom were familiar with Epic, were recruited by Mayo vendor the HCI Group. One nurse, Angela Coffaro, was offered $15,000 for her work. However, she found the way she was treated to be so offensive that she quit after only days on the job. Working conditions were “horrendous,” she told the reporter.

Nurse.org reported that another nurse said the contract nurses were verbally abused, intimidated, and even threatened that they would lose their jobs on an “hourly” basis. They also noted being assigned to positions well outside the skill set. For example, Coffaro said, she was sent to the outpatient eye clinic instead of the OR, and an OR nurse to radiology.

What’s more, the HCI Group executives apparently treated the nurses brutally during training sessions. According to some, they were not permitted to leave the training room even to use the restroom during 6 to 8-hour orientation sessions.

Adding insult to injury, the contractor allegedly failed to provide adequate housing. For example, Nurse.org tells the story of Cleveland-based nurse practitioner Kumbi Madiye, who arrived at 9 AM the day before her training was scheduled to begin and found only chaos. Madiye told the publication that she waited 14 hours without a room, only to find out at 11 PM that her assigned room was an hour and a half away.

The story stresses that while the nurses said they were astonished by HCI Group’s attitude and performance, they had no problem with the way they were treated by Mayo Clinic personnel.

That being said, if even half of the allegations are true, Mayo would certainly bear some responsibility for failing to supervise their vendor adequately. Also, my instinct is that one or more of the nurses must have told Mayo what was going on and if the Clinic’s leaders did anything about the problem the nurses never mentioned it.

I’m also very surprised any vendor might have abused IT-savvy nurses with precious Epic experience. As sprawling as the health IT world is, word gets around, and I doubt anyone can afford to alienate a bunch of Epic experts.

Hospital Using AI To Handle Some Tasks Usually Done By Doctors And Nurses

Posted on May 30, 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.

One of the UK’s biggest facilities has announced plans to delegate some tasks usually performed by doctors and nurses to AI technology. Leaders there say these activities can range from diagnosing cancer to triaging patients.

University College London Hospitals (UCLH) has signed up for a three-year partnership with the Allen Turing Institute designed to bring machine learning to bear on care, a project which could ultimately spark additional AI projects across the entire National Health Service. The NHS is the body which governs all healthcare in the UK’s universal health system.

UCLH is making a big bet on artificial intelligence, investing what UK newspaper The Guardian describes as a “substantial” sum to develop the infrastructure for the effort.

UCLH officials believe — like other health organizations around the world — that machine learning algorithms may someday diagnose disease, identify people at risk for serious illness and more. Examples of related projects abound. Just one case in point is a project begun in 2016 by New York-based Mount Sinai Hospital, which launched an effort using AI to predict which patients might develop congestive heart failure and offer better care to those who have already done so.

Professor Bryan Williams, director of research at University College London Hospitals NHS Foundation Trust, said the move will be a “game changer” which could have a major impact on patient outcomes. “On the NHS, we are nowhere near sophisticated enough,” Williams told The Guardian. “We’re still sending letters out, which is extraordinary.”

UCLH’s first AI effort, which is already underway, is intended to identify patients likely to miss appointments. Using existing data, including demographic factors such as age and address plus outside factors like weather conditions, researchers there have been able to predict with 85% accuracy whether the patient will show up for outpatient visits and MRIs.

Another planned project includes improving the performance of the hospital’s emergency department, which, like many NHS hospitals, isn’t meeting government performance targets such as maximum four-hour wait times. “[This is] an indicator of some of the other things in the entire chain concerning the flow of acute patients in and out of the hospital,” UCLH chief executive Professor Marcel Levi told the newspaper.

The hospital envisions solving its wait-time problem with machine learning. Drawing on data taken from thousands of patients, machine learning algorithm might be able to determine whether a patient with abdominal pain suffers from severe problem like intestinal perforation or a systemic infection, then fast-track those patients. This kind of triage is generally performed by nurses in hospitals around the world.

That being said, the partners agree that machine learning performance must be incredibly accurate before it has any major role in care. At that point, it will be ready to support clinicians, not undercut them. According to Professor Chris Holmes of The Alan Turing Institute, the whole idea is to let doctors do what they do best: “We want to take out the more mundane stuff that’s purely information driven and allow time for things the human expert is best at.”

“We’re Goin’ Live with Epic Now” – An EHR Go-live Parody Video

Posted on May 25, 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.

Many of you may remember the Hamilton parody video that Mary Washington Healthcare did back when they selected Epic as their new EHR. Well, Mary Washington Healthcare’ CEO, Mike McDermott, and his Epic team are back again with another Hamilton parody video as they go live on Epic. Check out the video below:

I’m sure many people wonder why a healthcare leader would engage their employees in a video like this. Many underestimate the value of bringing a team together to create a project like this. It’s an extremely valuable team building experience. Plus, it’s nice to have a little fun together when dealing with something as grueling as an Epic EHR implementation.

Furthermore, one of the keys to effectively implementing an EHR is creating a deep relationship with your EHR vendor. There are always problems that come up where you need your EHR vendors support to solve the problems. What better way to get noticed and appreciated by your EHR vendor than to create a video like the one above?

Nice work to the team at Mary Washington Healthcare for creating such a great video. I especially like the drone shots and the shout out to the Epic employees not dressed in the period clothes like everyone else.

In The Aftermath Of Sutter Health EMR Crash, Nurses Raise Safety Questions

Posted on May 24, 2018 I Written By

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

In mid-May, Sutter Health’s Epic EMR crashed, accompanied by other technical problems. Officials said the system failures were caused by the activation of the fire suppression system in one of their IT buildings.

As you might expect, employees at locations affected by the downtime weren’t able to access patient medical records. On top of that, they didn’t have access to email or even use their phones. In addition, the system had to contact some patients to reschedule appointments.

On the whole, this sounds like the kind of routine issue which, though embarrassing, can be brought to heel if an organization does the disaster planning and employee training on how to react to the situations.

According to some nurses, however, Sutter Medical Center may not have handled things so well. The nurses, who spoke on condition of anonymity with The Sacrament Bee, told the newspaper that the hospital moved ahead with some forms of care before the outage was completely resolved.

The nurses told that when some patients were admitted after the systems failure, clinicians still didn’t have access to critical patient information. For example, a surgical nurse noted that the surgical team relies upon EMR access to review patient histories and physicals performed within the previous 30 days. According to Sutter protocols, these results need to be certified by the physician as still being valid on the date of surgery.

Instead, patients were arriving with their histories and physical exam records on paper, and those documents didn’t include the doctor’s certification that the patient’s condition hadn’t changed. If something went wrong during elective surgery, the team would’ve had to rely on paper documents to determine the cause, the nurses said.

They argue that Sutter Medical Center shouldn’t have taken those cases until the EMR was fully online. “Other Sutter hospitals canceled elective surgeries,” one nurse told a reporter. “Why did Sutter Medical Center feel like they needed to do elective surgeries?”

Also, they say that at least one surgical procedure was affected by the outage, when a surgeon needed a particular instrument to proceed. Normally, they said, operating room telephones display a directory of numbers to supply rooms or nurse stations, but these weren’t available and it forced the surgical team to break its process. Under standard conditions, the team tries not to leave the operating room because a patient’s condition can deteriorate in seconds. In this case, however, a nurse had to hurry out of the room to get instruments the surgeon needed.

While it’s hard to tell from the outside, this sounds a bit, well, unseemly at best. Let’s hope Sutter’s decision-making in this case was based on thoughtful decisions rather than a need to maintain cash flow.

Let this also be an important reminder to every healthcare organization to make sure you have well thought out disaster plans that have been communicated to everyone in your organization. You don’t want to be caught liable when disaster strikes and your staff start free wheeling without having thought through all of the potential consequences.

Enterprise Resource Planning: Critical Factors for Increasing End-User Adoption

Posted on May 23, 2018 I Written By

The following is a guest blog post by Mark Muddiman, Sallie Parkhurst & Maureen Tellefson from Atos.

Healthcare organizations continue to be bombarded with technology implementations that span every critical path in healthcare, from clinical applications to business processes.  EHR implementations alone increased over 75 percent from 2009 to 2015 (NCHS, 2015).  The change continues at a pace that makes adoption of these systems a difficult journey for IT leadership, administrators, clinicians, and the teams who support them.  Mergers and acquisitions within healthcare are at an all-time high.  Acquiring or being acquired requires system consolidation, new technologies, and decisions about workflow and training.  Sharing the lessons learned from successful implementations will drive improved outcomes and create a better understanding of the factors that contribute to successful adoption.

Surgery Partners, a leading operator of surgical facilities and ancillary services, continues to grow both organically and through acquisitions.  With financial systems at end of life, Surgery Partners worked in partnership with Atos to select a new ERP to help manage their business.  ERP systems play a critical role in the transition to value-based care.  About 69 percent of IT leaders said they will prioritize healthcare supply chain in 2017 as “the most valuable asset for actionable data mining” rather than population health and data analytics tools (Black Book, 2016).  Surgery Partners engaged Atos as a consultant to assist with a thorough system selection that would best meet their needs.  The resulting strategic decision was to implement Infor Lawson to replace all legacy systems for Finance and Supply Chain.

The multitude of challenges that arise during large technology implementations are rarely captured, but can provide significant value when shared.  The leadership team at Surgery Partners was highly engaged and disciplined in how they managed and measured adoption of Infor Lawson.  They utilized a research-based methodology, The Breakaway Methodology, published in a book titled Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.  As their partner, Atos provided expert guidance in navigating the adoption process and measuring the work outcomes according to the methodology.

Surgery Partners understood that their business had to overcome a few unique challenges during their implementation.  With hundreds of users spanning 20 locations in 12 states, their geographic footprint made it challenging to educate their employees on the new Infor Lawson solution.  Traditional classroom training is expensive and time-consuming when users are spread across multiple locations. And, without proper training, many ERP system implementations fail.  Instead, Surgery Partners used a novel approach based on The Breakaway Methodology to educate their employees on Infor Lawson.  Atos developed “simulators” which allowed every user to practice relevant tasks and workflows in a realistic environment that mimicked the actual system without compromising real application data.

Atos and Surgery Partners measured the effectiveness of this novel approach throughout their implementation and continue to measure these factors post-implementation.  Eighty-seven percent of employees assigned to the supply chain learning completed their education and 69% of employees assigned to the accounts payable learning completed their education.  In comparison, less than 60% of employees typically complete traditional e-learning.  More importantly, the employees who completed the supply chain learning achieved an average proficiency score of 94% on challenging, workflow-based assessments in a simulated environment.  Employees who completed the finance learning achieved an average proficiency score of 89%.  In addition, users were asked to rate the quality and effectiveness of every simulation.  Based on 656 responses, 94% believed the simulator courses were valuable to their role.  Eighty-eight percent indicated that the simulations provided the knowledge they needed to perform key tasks in the new system, and 90% would recommend the simulations to colleagues going through similar implementations.

A key component of Surgery Partners strategy for managing change involved engaged leadership.  Executive leadership communicated messages to learners that were jointly developed with Atos.  Varying levels of leadership, from Senior Directors through local leaders, were selected as adoption coaches to assist learners with questions and direct them to the appropriate resources.  This approach that was defined as leading by example, set a tone throughout the organization that the adoption of Infor Lawson was imperative and that leaders were there to ensure success.

Achieving ERP adoption also requires continued investment long after go-live.  Surgery Partners developed standard processes to re-examine workflows and continue to educate users on changes or modifications due to system upgrades.  Adoption of technology often erodes over time due to employee turnover, so they put programs in place to teach new users how to use Lawson Infor and develop the same high levels of proficiency in the system achieved during the initial implementation.

Technology adoption creates significant changes in workflow, resource needs and overall governance.  Surgery Partners knew that simply installing a new ERP wouldn’t be enough; to realize the value they expected from the purchase, they had to ensure that every user across their organization successfully adopted the system.  The results Surgery Partners experienced provide important insight for other organizations going through similar technology implementations.

Recommendations and Best Practices:

  • Align business needs and vendor capabilities using a disciplined vendor selection process. Surgery Partners understood the value of selecting the right system and following a disciplined process for achieving adoption.
  • Executive engagement is a significant predictor of implementation success: prioritize the effort across the entire organization, remove organizational barriers, and develop a communication strategy.
  • Lack of training can cause failure. Provide role-based education that is relevant to user roles and allow users to practice realistic workflows. Simulation learning saves time and results in higher user proficiency.
  • Customize your policy and procedure learning. Implement best practices for specific procedures consistently across all locations, and ensure that the simulator training reflects best practices.
  • Develop a plan to sustain high levels of adoption after go-live. Surgery Partners updates their learning regularly and educates new employees to prevent erosion of adoption over time.

“We were highly committed to adopting Infor Lawson and we appreciated the guidance, leadership, responsiveness, and  expertise of the Atos team.” – Cathy Borst, Senior Vice President, IT.

“The learning has gone very smoothly.  I think this has been extremely valuable.”  – Rick Daniel, Senior Director of Supply Chain and Materials Management at Surgery Partners.

Acknowledgements:
Thank you to the leadership at Surgery Partners for their dedication to this project: Cathy Borst (SVP of IT), Chris Vandercook (Director, Technical Services Hospital Division), Sallie Parkhurst-PM, Carol Mortimer (SME), John Hart (CFO), Kara Baker (VP Finance/Corporate Controller), and Doug Watkins (VP of Supply Chain Management).

About the Authors
Mark Muddiman is an Engagement Manager for Breakaway Adoption Solutions, Atos
Sallie Parkhurst is a Project Manager for Digital Health Solutions Consulting, Atos
Maureen Tellefson is an Engagement Manager for Digital Health Solutions Consulting, Atos

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