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Ukulele Serenade for a Thankless Healthcare Job

Posted on December 12, 2018 I Written By

The following is a guest blog post by CT Lin MD, CMIO at University of Colorado Health.

I just spent some time on the phone with an informatics colleague going through a particularly tough time with an EHR replacement and upgrade. Some bad things had happened at the organization: a major visionary physician leader had quit, a department chair had assumed control and was tightening the control on “physician productivity”. Furthermore, a major EHR upgrade had gone wrong resulting in a major multi-day outage and highlighting glaring gaps in “down-time procedures.” Morale was very low.

This physician informaticist was reflecting on their ability to make a difference in an incredibly challenging environment- “Am I still up for confronting all the challenges of this job?” This person pointed out that “decisions are made and I’m left holding the bag.” “Physicians are angry and I have no good news to tell them and no resources to do anything about it.”

AND YET…

When I asked the pointed question- “Is it time for you to quit?” The response was telling.

“Actually, even if they asked me to step down from this informatics position, I LOVE getting in there and solving complicated problems so much that I would probably still do this work. Even for free.”

This eloquent statement reflects the core drivers of an effective and valuable physician informaticist.

Friedman, in a recent New York Times article, talks about the triple acceleration: climate change, globalization, and technology acceleration.  These are upending our world, rewriting the rules, and causing us to re-evaluate everything we thought we knew.

Our informatics work in healthcare is very similar. The rules change all the time- leaders change, visions change, vendors and products are always changing. Informaticists are the nexus between IT and clinicians, and are often blamed for anything that goes wrong. True story, when the WannaCry virus struck and took out the server farms at our transcription vendor last year (for SEVERAL WEEKS, our physicians and surgeon could not dictate their notes), the rumor within our organization was “You know, I heard that CT Lin shut that down because he just wants us to TYPE in his #*$&#$’ing EHR.”

If only I was that powerful. We often deal with problems not of our own making, limited or non-existent resources, and a lot of ambiguity.  So, “What can I do?” Here is my advice after walking a mile in my colleague’s shoes.

  1. Being a physician informaticist (PI) is often a thankless job. The quiet work we do: creating collaboration, understanding both IT and healthcare deeply, we translate and often avert disasters (avoiding bad design in templates, order sets, automated tools) that only we can see. When it works, the response is “Of course it was going to work. It is so simple.” When it doesn’t work, everyone knows it was you, even if it wasn’t.
  2. Your value to the leadership of the organization becomes more apparent over time- stay the course. When the PI stands up and helps calm the masses, when the PI can send email broadcasts or go to meetings and explain WHAT happened, and more importantly WHY and what is going to be done about it, he/she is usually more clear than the technologists and can speak the medical language of clinicians and patients. Over time, his/her value grows from being clear, steadfast, and a calming influence. Maybe the executives start including him/her in higher level decisions because they remember that value.
  3. Your value to the front line physicians and nurses is also incalculable. One time, a physician presumed that “Oh, the EHR project is going terribly… see how CT was walking with his head down and with that frown. Bad news.” On the other hand, being clear and concise (even if you can’t fix it) and being transparent about what is happening now and why, allows the PI to be a beacon in a storm, and the go-to person for clarity. PI’s often become a valued representative for physician interests.

As we talked this week, I had flashbacks of my years on the front lines doing this work. Over time, these memories are less like PTSD attacks and more like valued battle scars that one shows off proudly.

Thank you to our physician informaticists and our many colleagues working to adopt new technology- this song is dedicated to YOU.

Dear Burned Out Colleague (to Dear Theodosia, from Hamilton, the musical)

About CT Lin
CT Lin is a technophile, father, husband, ukulele enthusiast, and practicing physician. Dr. Lin is the Chief Medical Information Officer at University of Colorado Health. He writes a weekly blog on informatics and physician leadership at http://ctlin.blog.  CT uses creative and memorable techniques to help his organization through change from ukulele parodies to Haiku poems.

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.

Will Chatbots Be Embedded In Health IT Infrastructure Within Five Years?

Posted on December 10, 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.

Brace yourself: The chatbots are coming. In fact, healthcare chatbots could become an important part of healthcare organizations’ IT infrastructure, according to research released by a market analyst firm. I have my doubts but do read on and see what you think.

Jupiter Research is predicting that AI-powered chatbots will become the initial point of contact with healthcare providers for many consumers. As far as I know, this approach is not widespread in the US at present, though there are many vendors developing tools that they could deploy and we’ve seen some success from companies like SimplifiMed and big tech companies like Microsoft that are enabling chatbots as well.

However, Jupiter sees things changing rapidly over the next five years. It predicts that the number of chatbot interactions will shoot up at an average annual growth rate of 167%, from an estimated 21 million per year in 2018 to 2.8 billion per year in 2023.  By that point, healthcare will represent 10% of all chatbot interactions across major verticals, Jupiter says.

According to the market research firm, there are a number of reasons chatbot use in healthcare will grow so rapidly, including consumers’ growing comfort level with using chatbots to discuss their care. Jupiter also expects to see healthcare providers routinely use chatbots for customer experience management, though again, I’ve seen little evidence that this is happening just yet.

The massive growth in patient-chatbot interactions will also be fueled by a rise in the sophistication of conversational AI platforms, a leap so dramatic that consumers will handle a growing percentage of their healthcare business entirely via chatbot, the firm says. This, in turn, will free up medical staff time, saving countries’ healthcare systems around $3.7 billion by 2023.  This would prove to be a relatively modest savings for the giant US healthcare system, but it could be quite meaningful for a smaller country.

As healthcare organizations adopt chatbot platforms, their chief goal will be to see that information collected by chatbots is transferred to EHRs and other important applications, the report says. To make this happen, these organizations will have to make sure to integrate chatbot platforms with both clinical and line-of-business applications. (Vendors like PatientSphere already offer independent platforms designed to address such issues.)

All very interesting, no? Definitely. I share Jupiter’s optimistic view of the chatbot’s role in healthcare delivery and customer service and have little doubt that even today’s relatively primitive bots are capable of handling many routine transactions.

That being said, I’m thinking it will be more like 10 years before chatbots are used widely by providers. If what I’ve seen is any indication, it will probably take that long before conversational AI can truly hold a conversation. If we hope to use AI-based chatbots routinely at the front end of important processes, they’ll just have to be smarter.

A Digital Roadmap to Improved Patient Access – An Interview with Richard McNeight

Posted on December 4, 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.

We recently interviewed Richard McNeight, Executive Vice President & Chief Digital Officer at Health First, to learn about there efforts to implement new patient access and provider data management solutiuons from Kyruus.
In this interview, Richard McNeight offers some great insights into patients’ expectations and ways his organization is trying to meet these expectations.

What led you to the decision to invest in more patient access technologies?

“Dramatically improved consumerism” is one of our key Integrated Delivery Network (IDN) digital strategic goals. The first and most important consumer priority is to “Find a Provider.” Not just any provider, but the right provider that can best treat the exact condition, has significant experience treating it with high-quality outcomes and has performance ratings for success.

What kind of buy-in did you need to go in this direction?

As Chief Digital Officer, my first responsibility was to develop an IDN digital strategic plan, which identified provider search as the most demanded customer request. The digital strategy was first approved by our Strategic Planning Council. Once adopted by our Executive Team, the initial collaboration was with our Marketing Department, which confirmed the most important consumer initiative was to “Find a Doctor.” A requirements specification was then developed for a provider portal, with input from all major IDN stakeholders, and a request for approval (RFP) process solicited bids for the provider portal solution, ultimately resulting in the selection of Kyruus.

What benefits do you expect to achieve from the implementation of ProviderMatch?

The key benefit we will achieve using the Kyruus ProviderMatch tool is meeting our customer’s goal to find the “right provider.” This is achieved by allowing the patient to complete a robust search by entering their “clinical condition” in simple, easy-to-understand textual language. ProviderMatch leverages a taxonomy of more than 18,000 clinical terms, which helps match the patient’s condition to a provider who specializes in treating that condition. This is in addition to the normal search criteria and qualifiers such as geolocation, insurance network, provider gender and more.

Which challenges do you still face when it comes to patient access?

The biggest challenge we see in implementing Kyruus is appropriately defining the “Scope of Practice” for each provider, narrowing it to only the top conditions that provider specializes in treating. Related to that is the discussion we will be having with our providers as to acceptable and accurate provider quality rating, frequency of procedures performed and outcome results that will be displayed in the search results profile for the provider.

How have your providers reacted to the idea of allowing online appointment booking to patients?  What did you do to get them on board?

Over the last year, we have methodically been preparing for online scheduling by standardizing and minimizing the number of appointment templates for our employed providers, initially for primary care providers, and by the end of this year, for most specialists.

Where are you looking next when it comes to improving the patient’s experience?

As defined in our IDN digital strategy for consumerism, after “Find a Doctor,” the next three online features our customers want most are:

  • Make an Appointment – Online scheduling, providers (Kyruus DirectBook), diagnostic procedures, urgent care and more than 20 additional online scheduling activities
  • Price Transparency – Cost estimation, ease of payment and bill simplification
  • View my Medical Record – Easy, single mobile-enabled access to their unified health record

Once our customer finds the “right provider,” they will have the option to either immediately schedule an appointment online using ProviderMatch DirectBook or be shown a phone number to call to schedule the appointment. Our digital roadmap addresses technology solutions and implementation timelines for all of the other consumer experience features listed above.

Less Than Half of Healthcare Users Trust Critical Organizational Data

Posted on November 29, 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.

If you’re a healthcare CIO, you must hope that your users trust and feel they can leverage data to do their jobs better. However, some of your colleagues don’t seem to be so sure. A new study has concluded that less than half of users in responding healthcare organizations have a high degree of trust in their clinical, operational or financial data.

The study, which was conducted by Dimensional Insight, surveyed 85 chief information officers and other senior health IT leaders. It asked these leaders how they rated trust in the data leveraged by their various user communities, the percentage of user population they felt was self-service oriented and making data-driven decisions, and whether they planned to increase or decrease their investments in data trust and self-service analytics.

When rating the level of data trust on a 10-point scale, just 40% of respondents rated their trust in financial data at eight or above, followed by 40% of clinical data users and 36% of operational data users.

Perhaps, then, it follows that healthcare organizations responding to the survey had low levels of self-service data use. Clinical data users had a particularly low rate of self-service use, while financial users seemed fairly likely to be accessing and using data independently.

Given these low levels of trust and self-service data usage, it’s not surprising to find out that 76% of respondents said they plan to invest in increasing their investment in improving clinical data trust, 77% their investments in improving operational data trust and 70%  their investment in financial data trust.

Also, 78% said they plan to increase their spending on self-service analytics for clinical data and 73% expect to spend more on self-service analytics for operational data. Meanwhile, while 68% plan to increase spending on financial self-service analytics, 2% actually planned to decrease the spending in this area, suggesting that this category is perhaps a bit healthier.

In summing up, the report included recommendations on creating more trust in organizational data from George Dealy, Dimensional Insight’s vice president of healthcare applications. Dealy’s suggestions include making sure that subject matter experts help to design systems providing information critical to their decision-making process, especially when it comes to clinicians. He also points out that health IT leaders could benefit from keeping key users aware of what data exists and making it easy for them to access it.

Unfortunately, there are still far too many data silos protected by jealous guardians in one department or another. While subject matter experts can design the ideal data sharing platform for their needs, there’s still a lot of control issues to address before everyone gets what they need. In other words, increasing trust is well and good, but the real task is seeing to it that the data is rich and robust when users get it.

AI May Be Less Skilled At Analyzing Images From Outside Organizations

Posted on November 26, 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.

Using AI technologies to analyze medical images is looking more and more promising by the day. However, new research suggests that when AI tools have to cope with images from multiple health systems, they have a harder time than when they stick to just one.

According to a new study published in PLOS Medicine, interest is growing in analyzing medical images using convolutional neural networks, a class of deep neural networks often dedicated to this purpose. To date, CNNs have made progress in analyzing X-rays to diagnose disease, but it’s not clear whether CNNs trained on X-rays from one hospital or system will work just as well in other hospitals and health systems.

To look into this issue, the authors trained pneumonia screening CNNs on 158,323 chest X-rays, including 112,120 X-rays from the NIH Clinical Center, 42,396 X-rays from Mount Sinai Hospital and 3,807 images from the Indiana University Network for Patient Care.

In their analysis, the researchers examined the effect of pooling data from sites with a different prevalence of pneumonia. One of their key findings was that when two training data sites had the same pneumonia prevalence, the CNNs performed consistently, but when a 10-fold different in pneumonia rates were introduced between sites, their performance diverged. In that instance, the CNN performed better on internal data than that supplied by an external organization.

The research team found that in 3 out of 5 natural comparisons, the CNNs’ performance on chest X-rays from outside hospitals was significantly lower than on held-out X-rays from the original hospital system. This may point to future problems when health systems try to use AI for imaging on partners’ data. This is not great to learn given the benefits AI-supported diagnosis might offer across, say, an ACO.

On the other hand, it’s worth noting that the CNNs were able to determine which organization originally created the images at an extremely high rate of accuracy and calibrate its diagnostic predictions accurately. In other words, it sounds as though over time, CNNs might be able to adjust to different sets of data on the fly. (The researchers didn’t dig into how this might affect their computing performance.)

Of course, it’s possible that we’ll develop a method for normalizing imaging data that works in the age of AI, in which case the need to adjust for different data attributes may not be needed.  However, we’re at the very early stages of training AIs for image sharing, so it’s anyone’s guess as to what form that normalization will take.

Top 10 Health Technology Hazards

Posted on November 23, 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.

Over the years, it’s always been interesting to take a look at the Top 10 Health Technology Hazards reports that the ECRI Institute puts out each year. Healthcare IT always seems to show up on the list which is interesting since I hear very few healthcare IT salespeople talk about the risks of their systems vs the benefits.

I’m not exactly sure when ECRI puts out these annual reports, but the 2019 report is already out. However, before we look at the Top 10 Health Hazards for 2019, I like to look back at what was on their list from 2018:
1. Ransomware and Other Cybersecurity Threats to Healthcare Delivery Can Endanger Patients

2. Endoscope Reprocessing Failures Continue to Expose Patients to Infection Risk

3. Mattresses and Covers May Be Infected by Body Fluids and Microbiological Contaminants

4. Missed Alarms May Result from Inappropriately Configured Secondary Notification Devices and Systems

5. Improper Cleaning May Cause Device Malfunctions, Equipment Failures, and Potential for Patient Injury

6. Unholstered Electrosurgical Active Electrodes Can Lead to Patient Burns

7. Inadequate Use of Digital Imaging Tools May Lead to Unnecessary Radiation Exposure

8. Workarounds Can Negate the Safety Advantages of Bar-Coded Medication Administration Systems

9. Flaws in Medical Device Networking Can Lead to Delayed or Inappropriate Care

10. Slow Adoption of Safer Enteral Feeding Connectors Leaves Patients at Risk

And now a look at the list of healthcare technology hazards for 2019:
1. Hackers Can Exploit Remote Access to Systems, Disrupting Healthcare Operations

2. “Clean” Mattresses Can Ooze Body Fluids onto Patients

3. Retained Sponges Persist as a Surgical Complication Despite Manual Counts

4. Improperly Set Ventilator Alarms Put Patients at Risk for Hypoxic Brain Injury or Death

5. Mishandling Flexible Endoscopes after Disinfection Can Lead to Patient Infections

6. Confusing Dose Rate with Flow Rate Can Lead to Infusion Pump Medication Errors

7. Improper Customization of Physiologic Monitor Alarm Settings May Result in Missed Alarms

8. Injury Risk from Overhead Patient Lift Systems

9. Cleaning Fluid Seeping into Electrical Components Can Lead to Equipment Damage and Fires

10. Flawed Battery Charging Systems and Practices Can Affect Device Operation

In a bit of a surprising result to me, the only thing on the list that qualifies as healthcare IT to me is the first one focused on hackers accessing health IT systems and disrupting the healthcare operations. It’s no surprise that hackers are on the list, but I’d have thought more health IT components would be on there. Even something like inappropriate alerts or incorrect information in the EHR or even health IT system downtime.

I’m not sure if we should applaud healthcare IT for not really making the list or whether it’s more of an indication of the other things being more hazardous. What is an important takeaway from these lists is that healthcare organizations have a lot of different hazards to deal with in their environment. Poorly implemented health IT is only one of them.

Interoperability Problems Undercut Conclusions of CHIME Most Wired Survey

Posted on November 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.

Most of you have probably already seen the topline results from CHIME’s  “Healthcare’s Most Wired: National Trends 2018” study, which was released last month.

Some of the more interesting numbers coming out of the survey, at least for me, included the following:

  • Just 60% of responding physicians could access a hospital network’s virtual patient visit technology from outside its network, which kinda defeats the purpose of decentralizing care delivery.
  • The number of clinical alerts sent from a surveillance system integrated with an EHR topped out at 58% (alerts to critical care units), with 35% of respondents reporting that they had no surveillance system in place. This seems like quite a lost opportunity.
  • Virtually all (94%) participating organizations said that their organization’s EHR could consume discrete data, and 64% said they could incorporate CCDs and CCRs from physician-office EHRs as discrete data.

What really stands out for me, though, is that if CHIME’s overall analysis is correct, many aspects of our data analytics and patient engagement progress still hang in the balance.

Perhaps by design, the hospital industry comes out looking like it’s doing well in most of the technology strategy areas that it has questions about in the survey, but leaves out some important areas of weakness.

Specifically, in the introduction to its survey report, the group lists “integration and interoperability” as one of two groups of foundational technologies that must be in place before population health management/value-based care,  patient engagement and telehealth programs can proceed.

If that’s true, and it probably is, it throws up a red flag, which is probably why the report glossed over the fact that overall interoperability between hospitals is still very much in question. (If nothing else, it’s high time the hospitals adjust their interoperability expectations.) While it did cite numbers regarding what can be done with CCDs, it didn’t address the much bigger problems the industry faces in sharing data more fluidly.

Look, I don’t mean to be too literal here. Even if CHIME didn’t say so specifically, hospitals and health systems can make some progress on population health, patient engagement, and telehealth strategies even if they’re forced to stick to using their own internal data. Failing to establish fluid health data sharing between facility A and facility B may lead to less-than-ideal results, but it doesn’t stop either of them from marching towards goals like PHM or value-based care individually.

On the other hand, there certainly is an extent to which a lack of interoperability drags down the quality of our results. Perhaps the data sets we have are good enough even if they’re incomplete, but I think we’ve already got a pretty good sense that no amount of CCD exchange will get the results we ultimately hope to see. In other words, I’m suggesting that we take the CHIME survey’s data points in context.

MRI Installation Slip Disables Hospital iOS Devices

Posted on November 9, 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.

The following is the story of an MRI installation which took a surprising turn. According to a recent post on Reddit which has since gone viral in the IT press, a problem with the installation managed to shut down and completely disable every iOS-based device in the facility.

A few weeks ago, Erik Wooldridge of  Chicago’s Morris Hospital, a perplexed member of the r/sysadmin subreddit, posted the following:

This is probably the most bizarre issue I’ve had in my career in IT. One of our multi-practice facilities is having a new MRI installed and apparently something went wrong when testing the new machine. We received a call near the end of the day from the campus that none of their cell phones work after testing [the] MRI… After going out there we discovered that this issue only impacted iOS devices. iPads, iPhones, and Apple Watches were all completely disabled.

According to Wooldridge, the outage affected about 40 users. Many of the affected devices were completely dead. Others that could power on seemed to have issues with the cellular radio, though the Wi-Fi connections continued to work. Over time, the affected devices began to recover, but one iPhone had severe service issues after the incident, and while some of the Apple Watches remained on, the touchscreens hadn’t begun working after several days.

At first, Morris and his colleagues feared that the outage could be due to an electromagnetic pulse, a terrifying possibility which could’ve meant very bad things for its data center. Fortunately, that didn’t turn out to be the problem.

Later the vendor, GE, told the poster and his colleagues that the problem was a leakage of liquid helium used for the MRI’s superconducting magnets. GE engineers turned out to be right that the leak was the source of the problems, but couldn’t explain why Android devices were untouched by the phenomenon.

Eventually, a blogger named Kyle Wiens with iFixit.org seems to found an explanation for why iOS devices were hit so hard by the helium leak. Apparently, even Apple admits that exposing iPhones to evaporating liquefied gases such as helium could take them offline.

While no one’s suggesting that liquefied helium is good for any type of microelectronic device, the bottom line seems to be that the iOS devices are more sensitive to this effect than the Android devices. Let’s hope most readers never need to test this solution out.

The Leadership Demands of Value Based Care

Posted on November 8, 2018 I Written By

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

The topics of Population Health and Value Based Care continue to swirl through nearly every healthcare conversation.  Leaders across the healthcare provider and payer industries are looking for strategies to reduce costs and improve quality in hopes of improving the bottom line and increasing the viability of the organization within the community; and every vendor has a solution. We recently formed an expert panel to study and better understand the current state of work being done across healthcare provider organizations.  We explored the topics of leadership strategy and commitment, data aggregation, data analytics, and consumer engagement.  Our conversations reinforced the importance of developing a research-based approach to help healthcare leaders navigate the breadth and depth of this critical initiative: value based care.  Our findings continue to drive our work in defining solutions that meet healthcare leaders’ needs to better serve their organizational missions as care providers and employers in their communities.

The expert panelists included Zach Goodling, Director, Population Health and Care Coordination at Multicare; Randy Osteen, VP Applications, Information Management at CHRISTUS Health; and Ruth Krystopolski, SVP of Population Health at Atrium Health.

The panel discussion gave attendees the opportunity to:

  1. Understand experiences and lessons learned from industry population health and informatics leaders in preparing for value-based care opportunities to improve care quality and reduce costs in their communities
  2. Learn about approaches to data aggregation and analytics to support population health’s strategic and operational priorities
  3. Gain an understanding of various care models deployed by different organizations to manage high risk populations
  4. Appreciate the organizational culture and leadership challenges faced within each of the value-based care journeys of three different dynamic organizations

The discussion began by recognizing that the current state of healthcare is isolated and disconnected; it has interoperability challenges, misaligned incentives for employers, payers, providers, and community services; it tends to focus on sickness for an uninformed and confused user population; and it places accountability on providers that often results in duplication or even scarcity of services.

The opportunity here is tremendous!  We can find ways to:

  • Enhance the ability to improve care quality and consumer (patient, member, employee) quality of life and reduce the cost of care.
  • Come together in consumer-centric manner, using interoperable, technology-enabled, data-driven, innovative business models that cross stakeholder boundaries and focus on quality of life across the continuum of care and services, acknowledging shared risk and creating a more accountable consumer population.

Key messages from the group were enlightening and reflected the progression of the entire healthcare industry.

We heard from all three panelists about the arduous work required to make even small amounts of progress. “We have been on a five-year journey to create capabilities in population health management, managing plans to assist members, identify care gaps, and develop care plans.”  The topic of data arose throughout our interviews.  The panel discussed various concerns around data aggregation. “The biggest hurdle is aggregating data from non-affiliated places and various systems.”  “Data is vital to supporting a broad view of each patient; without it, it is very difficult.” And they cautioned organizations about relying on too much data. “When it comes to analytics, being more actionable is better than gathering more data.”

Many leaders find the array of solutions and systems available to healthcare organizations overwhelming. Our experts provided some insight on platform strategy. “Must identify consistent, reliable, scalable solutions.  It is difficult when you have too many solutions/platforms. If you can get users onto the same system, even if it is not the best of class, using the same governance model and tools creates important consistency and scale.”

The panelists had some ideas about other success factors beyond the tool set.  “Social determinants are often the biggest impact when managing a population. We joke that we are all social workers. We are putting these resources in place and able to monitor 400-450 patients with some of the highest risk patient populations.” They encouraged a paradigm shift for those setting strategy for value based care. “I am often impressed by the level of expertise in healthcare, but surprised by the lack of awareness about the macro environment.  We need to ensure we help our people understand the “why” behind the need for change. The organizational work pales in comparison to the cultural changes required to make progress.” Several panelists also reinforced the long-term focus required for value based care programs to succeed. “This is an iterative process that will evolve over time, not a program with a beginning and end.”

Key Themes from Panelists

  1. A clearly defined leadership strategy and commitment are imperative.
  2. Most organizations are still in the early stages of defining their value based care processes. They are working to improve their understanding of consumer engagement and activities that potentially influence consumers. They are exploring new ways of leveraging technologies to engage consumers and provide new models of care.
  3. The lack of interoperability makes data aggregation difficult and the application of meaningful analytics even more challenging.

A Value Based Care Model

Understanding these key themes provides healthcare leaders with a better understanding of where to focus their efforts, but they still need a model to navigate the various domains of value based care.  The model below includes five areas of consideration for healthcare leaders to use as they continue to define their value based care efforts.

  1. Leadership Strategy & Commitment: Define, refine, and commit to a strategy that allows the organization to realize the benefits of value based care. Leadership engagement is imperative and has the power to accelerate or limit the amount of progress in every domain.
  2. Data Aggregation: Compilation of disparate clinical, financial, social, supply chain, administrative, public, and consumer data is vital for supporting clinical and business decisions.
  3. Data Analytics and Business Intelligence: The ability to utilize aggregated data to make informed clinical and business decisions that improve quality, reduce costs, and offer value to consumers
  4. Models of Care: Leveraging digital technology as appropriate, selection of a care delivery model based on collaboration and communication among all health care providers, payers, consumers, and community resources that contribute to individual consumers’ health and well-being
  5. Consumer Engagement: Connection and engagement between external stakeholders (consumers) and organizations (company or brand) through various channels of correspondence. This connection can be a reaction, interaction, effect, or overall customer experience that takes place online and offline.

Maturity and Organizational Evaluation

An example of the progression in organizational competency within each dimension is shown below, focusing on the most important dimension: Leadership Strategy and Commitment.

Value based care domains establish a critical foundation for assessing progress.  Organizations can then begin to evaluate their maturity within each domain. Atos is developing an innovative algorithm to rank organizational maturity within each domain, as seen in the following chart:

This type of insight helps healthcare leaders to think more strategically about where they invest and how they prioritize the many competing initiatives that impact value based care. This strategic view often results in new operating models and elucidates new ideas, innovative approaches, and ultimately better outcomes for consumers, both inside and outside of the healthcare system.

Atos believes that the digital transformation in healthcare is facing three shockwaves:

  1. Shockwave 1: Requires leaders to rationalize and streamline existing systems, notably through real-time clinical delivery and an EHR, in addition to the integration of financial, revenue cycle, and clinical data to fully understand care quality and costs that impact overall revenue and the organization’s financial viability
  2. Shockwave 2: Interconnect and increase collaboration between all ecosystem players, notably through collaboration and digital solutions. Deeply analyze and optimize treatments with new big data and cognitive technologies for population health (achieve early detection of epidemics, discover new risk factors, uncover new treatments, etc.). This is also at the heart of the research in which Atos is participating.
  3. Shockwave 3: Leverage the latest advances in artificial intelligence, machine learning, and genomics analysis. Leverage high performance computing solutions to enable precision medicine. This is probably the most striking advance on the healthcare horizon.

It will be no small feat for organizations to navigate these shockwaves, respond to ongoing payment reform, and address a changing consumer population; it will require discipline and focus. A complete, thoughtful approach will enable healthcare organizations to move from systems of reactive, disconnected care to a global health system that supports individuals throughout their lives.

About the Authors:

  • Mary Sirois is the Vice President of Integrated Solutions Delivery, focused on population health and value-based care services and technology delivery across all of Atos’ solutions. In addition, Ms. Sirois is a member of the Atos Scientific Community.
  • Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

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

Many Providers Lack Dedicated Budget For Connected Medical Device Security

Posted on November 5, 2018 I Written By

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

A new vendor survey has concluded that while most providers haven’t dedicated much of their budget specifically to managing and securing connected devices, most are convinced they have the situation under control.  Rightly or wrongly, this seems to be part of a larger picture in which support for connected health devices hasn’t matured as much of the rest of the IT infrastructure.

The survey, which was conducted by Zingbox, developer of a healthcare Internet of Things analytics platform, collected responses from about 200 healthcare IT professionals in 200 clinical/biomedical engineers in the U.S., weighting results to US census levels for age, gender, region, and income.

According to Zingbox researchers, 87% of healthcare IT professionals responding to the survey said they were confident that their connected medical devices were protected from cyberattacks, and 79% said that their organization had real-time information of which on these devices might be vulnerable to cyberattacks.

Also, 69% said they believe that existing security solutions using secure laptops and servers were capable of securing their connected medical devices. Not surprisingly, the vendor’s report argued that this may not be the case, given that they aren’t designed to support on-device security solutions like anti-virus software, and that the blocking ports or protocols via gateways lead to problems that include device malfunction.

When asked whether their organizations had a budget allocated specifically to securing connected medical devices, 53% said yes, and that the amount was sufficient, while 41% said no, that they didn’t have dollars allocated to the problem or hadn’t set aside enough dollars. (I’d be interested to know how they decided whether their device security was adequate; given the relative youth of this category their standards might be worth a look.)

Meanwhile, roughly 85% of clinical/biomedical engineers said they were confident they had an accurate inventory of connected medical devices in their network, with 64% of respondents noting that such device inventories were completed manually. Thirty-four percent said they did a manual room-to-room audit to get this job done, and about 30% said they did static asset management.

To determine which devices were in use, 55% of respondents said they did so manually, while 38% said they used an automated solution. Of those clinical/biomedical engineers doing manual checks, 28% walk over to the device location to check in person, and 27% find out by contacting someone.

To keep these devices online, 73% of these engineers said they conducted maintenance on a fixed schedule, including 29% that followed manufacturer recommendations, 27% adhering to internal schedules and 17% taking a cue from reseller recommendations.