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The FHIR Backpedal, Voice Interfaces, OpenNotes, and Complacency – Twitter Roundup

Posted on December 6, 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.

Let’s take a quick trip around the Twittersphere and share some of the best healthcare related tweets we’ve seen recently. Plus, we’ll add a little commentary for each tweet as well. We hope you’ll add your commentary on Twitter with @healthcarescene and in the comments.


This might be a media back pedal. Everyone I’ve talked to that really understood FHIR has always said that the FHIR standard was not the end all be all interoperability solution. In fact, they specifically noted its limitations. Of course, that didn’t keep many outlets from reporting FHIR as the cure all. Glad to see they’re finally reporting on FHIR accurately. It’s good, but not a cure all interoperability solution.


Anyone that’s heard Colin Hung speak knows this is going to be a great webinar. Voice search and voice interfaces have become extremely popular. If you want to learn how they’re impacting healthcare, sign up for Colin’s webinar.


Powerfully simple story.


I think Aimee underestimates the power of complacency. However, I hope she’s right since long term complacency will feel really bad.

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.

From Fragmented to Coordinated: The Big Data Challenge

Posted on November 27, 2018 I Written By

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

When healthcare organizations have access to as much data as possible, that translates into improved coordination and quality of care, reduced costs for patients, payers and providers, and more efficient medical care. Yet, there is a void in the healthcare data landscape when it comes to securing the right information to make the right decision at the right time. It is becoming increasingly critical to ensure that providers understand data and are able to properly utilize it. Technologies are emerging today that can help deliver a full picture of a patient’s health data, which can lead to more consistent care and the development of improved therapies by helping providers derive better insights from clinical data.

Across the country, patient data resides across multiple systems, and in a variety of structured and unstructured formats. The lack of interoperability makes it difficult for organizations to have access to the data they need to run programs that are critical to patient care. Often, various departments within an organization seek the same information and request it separately and repeatedly, leading to a fragmented picture of a patient’s health status.

Managing Complexity, Inside and Out

While analytics tools work well within select facilities and research communities, these vast data sets and the useful information within them are very complex, especially when combined with data sets from outside organizations. The current state of data illiquidity even makes it challenging to seamlessly share and use data within an organization.

For example, in the life sciences arena, disease staging is often the foundation needed to identify a sample of patients and to link to other relevant data which is then abstracted and mined for real world use; yet clinical and patient reported data is rarely documented in a consistent manner in EHRs. Not only do providers often equivocate and contradict their own documentation, but EHR conventions also promote errors in the documentation of diagnostic findings. Much of the documentation can be found in unstructured EHR notes that require a combination of abstraction and clinician review to determine the data’s relevance.

Improved Interoperability, Improved Outcomes

Problems with EHR interoperability continue to obstruct care coordination, health data exchange and clinical efficiency. EHRs are designed and developed to support patient care delivery but, in today’s world of value-based care, the current state of EHR interoperability is insufficient at best.

Consider the difficulty in collecting a broad medical data set. The three largest EHRs combined still corner less than one-third of the market, and there are hundreds of active EHR vendors across the healthcare landscape, each bringing its own unique approach to the information transfer equation. Because many hospitals use more than one EHR, tracking down records for a single patient at a single hospital often requires connecting to multiple systems. To collect a broader population data set would require ubiquitous connection to all of the hundreds of EHR vendors across the country.

The quality integration of health data systems is essential for patients with chronic conditions, for example. Patients with more serious illnesses often require engagement with several specialists, which means it is particularly important that the findings and data from each specialist are succinctly and properly communicated to fellow doctors and care providers.

Leveraging Technology

As the industry matures in its use of data, emerging technologies are beginning to break down information road blocks. Retrieving, digitizing and delivering medical records is a complex endeavor, and technology must be layered within all operations to streamline data acquisition and make executable data available at scale, securing population-level data more quickly and affordably.

When planning to take advantage of new advanced technologies, seek a vendor partner that provides a mix of traditional and emerging technologies, including robotic process automation (RPA), computer vision, natural language processing (NLP) and machine learning. All of these technologies serve vital functions:

  • RPA can be used to streamline manually intensive and repetitive systematic tasks, increasing the speed and quality at which clinical and administrative data are retrieved from the various end-point EHRs and specialty systems.
  • NLP and neural networks can analyze the large volume of images and text received to extract, organize and provide context to coded content, dealing with ambiguous data and packaging the information in an agreed-upon standard.
  • With machine learning, an augmented workforce can be equipped to increase the quality of records digitization and the continuous learning across the ecosystem, where every touchpoint is a learning opportunity.

Smarter, faster and more qualitative systems of information exchange will soon be the catalysts that lead paradigm-shifting improvements in the U.S. care ecosystem, such as:

  • Arming doctors with relevant information about patients
  • Increasing claims accuracy and accelerating providers’ payments
  • Empowering universities and research organizations with timely, accurate and clinically relevant data sets
  • Correlating epidemics with the preparedness of field teams
  • Alerting pharmacists with counter-interaction warnings

Ultimately, improving information exchange will enable healthcare industry professionals to elevate patient safety and quality, reduce medical and coding errors tenfold and enhance operational efficiencies by providing the relevant data needed to quickly define treatment.

Achieving this paradigm shift depends almost entirely on taking the necessary steps to adopt these emerging technologies and drive a systematic redesign of many of our operations and systems. Only then will we access the insights necessary to truly impact the quality of care across the healthcare landscape.

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

Will Remote Medical Coders Ever Return to the Hospital? – HIM Scene

Posted on November 14, 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.

This week on the Journal of AHIMA blog, Elena Miller, Director of Coding Audit and Education at a healthcare system, posted this really fascinating question:

Will Coders Ever Return to the Office?

Elena does a good job of explaining how quickly remote work has become part of the medical coder’s life and the benefits it provides. However, she looks at large companies like IBM that are eschewing remote work and bringing their employees back to the office. It’s fair to wonder if the same thing will happen with medical coders who are requested to work from the hospital as opposed to their home.

I’d suggest that this is extremely unlikely to happen. First, I think it’s a mistake for IBM to bring everyone back to the office. Second, the reasons that IBM wants to bring everyone back to the office don’t apply to medical coders as much as it does IBM employees.

While IBM made a big splash with their announcement of bringing everyone back to their office, I think they’re going to regret this decision. They’re going to lose some of their best people who want to work remotely and that’s going to leave them in a bad place. Finding and keeping high quality people is the hardest thing to do at any company. The problem is that the most skilled people in your workforce can find a job anywhere at any time and your competitors are still offering remote work. It’s such a bad idea to lose all of these quality people by getting rid of remote work across the board.

I’m sure IBM needed to change the culture of the company where many remote workers weren’t being efficient in their work. That needs to be addressed, but banishing remote work across the board has all sorts of bad consequences. Don’t be surprised if IBM has made a bunch of exceptions for their highest performing people and if they go back on such a broad policy. A hospital or health system that does this will find the same problem and most can’t afford to lose their best medical coders who can certainly find remote coding work elsewhere if needed.

All of this said, the bigger issue is that remote coding work is quite different than most of the IBM jobs. Most IBM jobs benefit from collaboration and they’re hard to track as far as results. This is why they benefit from being in the same office with their colleagues with whom they need to collaborate and that can hold them accountable.

While medical coders certainly run into challenging cases where they benefit from collaboration, for the most part, medical coding is an individual sport. Plus, there are good ways to track coders productivity, accuracy, etc so you can hold them accountable for their work regardless of whether they’re at home or in the office. This is why I think it’s pretty unlikely that medical coders will return to the office.

Sure, there may be some edge cases where certain healthcare leaders who bring all their coders back as a way to send a message to staff. I think that’s what happened in the IBM case. However, much like I think will happen with IBM, those leaders will backtrack to remote coding soon enough. No doubt there will also be some edge cases where it makes sense to bring a specific coder back on site for training or other remediation for poor performance. Some medical coders may even request to be on site based on their own needs. However, if you can’t trust them to code remotely, my feeling is that you probably shouldn’t trust them to code at all.

Elena does make a great point in her article about remote coders not having the same opportunities to advance in their organization. Being present definitely matters if you are aspiring into leadership positions. What’s not clear to me is how many remote coders really aspire to leadership positions. Those that do seem to be doing remote coding on the side to supplement their income as they rise through the HIM leadership ranks. Maybe I’m wrong and there are a lot of remote medical coders that aspire to leadership in their organizations.

Let us know what you think in the comments and on social media @HealthcareScene. Will remote medical coders return to the office? Will remote coding hurt HIM professionals’ leadership opportunities?

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.

Five Guiding Principles for Leveraging the Healthcare Contact Center

Posted on November 2, 2018 I Written By

The following is a guest blog post by Mike Wisz, Director, Analytics – Healthcare, Advisory Services, and Melissa Baker, Business Analyst, Healthcare, Advisory Services, at Burwood Group.

Consumer experience is more critical than ever for healthcare organizations. Today, the financial performance of health systems increasingly depends on converting consumers into patients and retaining patients within network—patients who now have expanding options for urgent, primary, and elective care. A contact center is a critical component of an inviting “digital front door” for consumers—which is why forward-looking healthcare organizations are envisioning how to transform call centers into patient engagement centers.

As part of an enterprise approach to patient access and experience, each organization will chart its own path in building out contact center capabilities. Healthcare CEOs increasingly recognize that consumers want to interact with their healthcare services as they do with companies in other industries, such as retail or hospitality.

The following are five guiding principles for developing a consumer-grade contact center experience.

First do no harm.

A poorly performing call center can result in frustrated patients or guests whose experience prompts them to look elsewhere for services. So first, deal with current problems, even if they are not easily discoverable. Using all available data sources, assess call handle times, customer effort required, and call routing accuracy against established targets or external benchmarks. If service levels are not acceptable, these problems must be resolved.

Make it easy for patients to connect.

Health systems should make it very easy for customers to access services using their preferred channel of communication. This access should be aligned from the customer’s perspective across touchpoints such as consumer-facing websites, patient portals and self-scheduling applications, and mobile applications offered to patients.

Remember: Productive agents create happy customers.

Consolidating contact center operations should result in more efficiency. Improving efficiency while offering additional services across more medical groups requires automation. Domain-specific knowledge support including scripts and protocols, empowers agents to rapidly resolve service requests. Skills-based routing gives managers the ability to staff flexibly while ensuring target service level performance. Desktop integrations with scheduling, billing, and clinical systems inform agents of highlighted information to reduce contact handle times and increase first-contact resolution rates.

Focus on outcomes. Measure and monitor.

Identify the business outcomes that are most important to determining success. These will likely focus on customer experience, agent productivity, and overall operational effectiveness. Many KPIs and metrics can be measured, but pick a few that will highlight performance against your most important outcomes. Ensure reports are available that provide visibility into key metrics and that reporting is timely enough to be actionable.

Align to enterprise vision and objectives.

It is not always clear in healthcare organizations who owns the “consumer experience.” Leaders from groups representing marketing, population health, clinical quality, and revenue cycle management should align and work together to ensure the contact center serves as a vital component of the organization’s comprehensive approach to patient experience.

In this new environment driven by consumerism, competition for patients will only continue to escalate. Successful health systems will learn to better leverage their contact centers as a way to attract and retain patients and optimize physician utilization, and to tackle a complex set of new challenges.

About Burwood Group
Burwood Group, Inc. is an IT consulting and integration firm. We help forward-thinking leaders design, use, and manage technology to transform their business and improve outcomes. Our services in consulting, technology, and operations are rooted in business alignment and technical expertise in cloud, automation, security, and collaboration. Burwood Group was founded in Chicago, IL and is celebrating over 20 years in business. Today, Burwood includes 250 employees and seven U.S. offices including a 24×7 Operations Center in San Diego, CA. Whether you are developing strategy, deploying technology, or creating an operational model, Burwood is a dedicated partner. To learn more, visit www.burwood.com.

Proactive Management of End-User Experience – Flipping the Paradigm

Posted on October 23, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Managing the performance of HealthIT systems improves the end-user experience which leads to less burnout, better patient experiences and a healthier bottom line. Instead of monitoring individual systems, Goliath Technologies is flipping the paradigm.

Each day, hidden gremlins in HealthIT systems are eating into productivity and sapping team morale. These gremlins are relentless and just when you think you’ve caught one, two new ones rise to take its place. The net result is negative end-user experiences.

What is a negative end-user experience? It is any situation where an end-user of an IT system experience something unexpected that impacts their work in a negative way. This could mean:

  • Slow response times (click and wait)
  • Sluggish application performance (typing faster than words appear on the screen)
  • Inability to access the system at all
  • Frozen screens
  • Unexplained workstation reboots
  • Loss of network connection

…the list goes on and on.

In healthcare, when a negative end-user experience happens, patient care is impacted. Sometimes the impact is small – like having to wait a few extra seconds for the lab result to appear on the screen. Sometime the impact is significant – like having to reschedule or delay a procedure because clinicians cannot access the patient’s record to see contraindications.

Negative end-user experiences also increase the stress on the end-users themselves – adding to an already stressful environment.

“We are almost at the point in healthcare where reacting to negative end-user experiences is no longer acceptable,” says Thomas Charlton, CEO of Goliath Technologies. “When a system is slow, or not available, patient lives are impacted. Clinicians expect systems to be available when they need it and they want those systems to work as expected. It’s no longer about having an uptime of 99.999%, we have to monitor and manage the actual end-user experience itself.”

“Most of the time, people troubleshoot with free tools provided by the vendor,” says Donna Grare, EVP and Chief Technology Officer at Goliath Technologies. “When a user reports a problem like ‘I can’t connect to application A’, IT starts a troubleshooting tree from scratch because there are many things that could be the cause of the problem.  It could be limited to this user – an issue with their computer or their local network, for example.  It could be a broader issue based on changes made to profiles that impact many users – generally IT only finds this out when one call becomes 10, 50, or 500.  With that many calls coming in, it’s clearly not a simple, one person issue, but IT is stuck looking for the common thread between them.  This is very frustrating for both IT and the users.  One comment we hear often is IT saying ‘I’m very good at my job, and I can fix problems.  It would just be great if I could be proactive and get ahead of the problem instead of only hearing about it after it happens.’”

This is a very standard approach to system management. IT departments monitor the performance of discrete systems: server response times, network packet speeds, application error logs, etc to determine if something is wrong. Although better than nothing, this approach has several drawbacks.

“This traditional approach leads to a lot of finger pointing,” explains Charlton. “If I’m the manager responsible for the servers, I will point to my server logs and say that the issue isn’t with the hardware since all the servers are ‘green’. The application managers say the same thing and on and on. Everyone is reporting green yet end-users are still experiencing issues. That’s the second problem with the traditional approach, ‘green’ is often a state defined by the vendors of the systems. Just because something is green doesn’t mean that end-user experience isn’t deteriorating. Lastly, the traditional approach ignores how healthcare applications are inter-connected. Slow performance in one application can have a cascading effect on applications that rely on it for data.”

So what does proactive management of end-user experience look like? According to Charlton, proactive management means flipping the old approach to IT systems management on its head. Instead of looking at the individual elements of HealthIT systems, Charlton and the team at Goliath Technologies approach things the other way around. They start by monitoring the actual end-user experience and help IT teams work backwards from there.

“When healthcare organizations deploy our technology, they gain visibility to key end-user experience metrics right away,” continues Charlton. “We gather the performance from all internal systems into one place. There is embedded intelligence in our platform that is based on years and years of experience troubleshooting system issues. This intelligence monitors the gathered information and alters the IT team when system performance begins to deteriorate, often before the call from the end-users start coming in.”

This early warning is key to minimizing the impact on end-users.

For a real-life account of how the Goliath platform was used to address slowness with an EHR (spoiler alert: the problem wasn’t with the EHR application), check out this article.

I have to admit that before I sat down with Charlton and Grare, I had no idea that platforms like Goliath’s existed. Their platform is the result of years of work with other industries: banking, legal and managed services. Smartly, Goliath realized that they would have to pre-build connections to popular healthcare applications before organizations would adopt their platform. They currently have connections to: Allscripts, MEDITECH, Cerner and EPIC.

Given that the Goliath platform isn’t exactly new, I had to ask Charlton why more organizations haven’t already adopted the approach of pro-actively monitoring end-user experience. “I think there are three reasons why proactive monitoring hasn’t been as widely adopted as we would like to see,” says Charlton. “First, many have spent a ton of money on their core systems, but have not allocated enough to the tools they need to support those systems. So they end up just using what came with it. Those tools are good, but they look at systems in isolation. Second, I think many believe they have ‘proactive monitoring’ but are just doing the bare minimum – like pinging a system to see if it is up and running. That is very different than true proactive performance tracking. Third, I think IT people are just not aware there is a pro-active tool available like what Goliath offers.”

“We hear it all the time,” continues Charlton. “In fact we recently had a customer tell us: ‘I had no idea that this type of technology was available. I was trying to troubleshoot issues with the tools that came with the core system. Now that I look at Goliath’s system I realize I was trying to do brain surgery with a butter knife’. I couldn’t have said it better myself.”

What’s the bottom line for HealthIT leaders? End-user experience (system performance) is a key contributor to workplace stress and clinician burnout. As competition in healthcare becomes more intense, patients as well as clinicians, will opt for healthcare organizations where negative end-user experiences are minimized. They will leave for green pastures where they don’t have to wait for a record to come up or explain to a patient how their surgery was delayed due to a systems issue.

If you would like to find out more information about pro-active end-user management, check out this upcoming live-webinar by Goliath Technologies on Tuesday October 30th at 12:30pm ET

Goliath Technologies is a proud sponsor of Healthcare Scene. 

 

Taming the Healthcare Compliance and Data Security Monster: How Well Are We Doing?

Posted on October 18, 2018 I Written By

The following is a guest blog post by Lance Pilkington, Vice President of Global Compliance at Liaison Technologies.

Do data breach nightmares keep you up at night?

For 229 healthcare organizations, the nightmare became a reality in 2018. As of late August, more than 6.1 million individuals were affected by 229 healthcare-related breaches, according to the Department of Health and Human Services’ HIPAA Breach Reporting Tool website – commonly call the HIPAA “wall of shame.”

Although security and privacy requirements for healthcare data have been in place for many years, the reality is that many healthcare organizations are still at risk for non-compliance with regulations and for breaches.

In fact, only 65 percent of 112 hospitals and hospital groups recently surveyed by Aberdeen, an industry analyst firm, reported compliance with 11 common regulations and frameworks for data security. According to the healthcare-specific brief – Enterprise Data in 2018: The State of Privacy and Security Compliance in Healthcare – protected health information has the highest percentage of compliance, with 85 percent of participants reporting full compliance, and the lowest compliance rates were reported for ISO 27001 and the General Data Protection Regulation at 63 percent and 48 percent respectively.

An index developed by Aberdeen to measure the maturity of an organization’s compliance efforts shows that although the healthcare organizations surveyed were mature in their data management efforts, they were far less developed in their compliance efforts when they stored and protected data, syndicated data between two applications, ingested data into a central repository or integrated data from multiple, disparate sources.

The immaturity of compliance efforts has real-world consequences for healthcare entities. Four out of five (81 percent) study participants reported at least one data privacy and non-compliance issue in the past year, and two out of three (66 percent) reported at least one data breach in the past year.

It isn’t surprising to find that healthcare organizations struggle with data security. The complexity and number of types of data and data-related processes in healthcare is daunting. In addition to PHI, hospitals and their affiliates handle financial transactions, personally identifiable information, employee records, and confidential or intellectual property records. Adding to the challenge of protecting this information is the ever-increasing use of mobile devices in clinical and business areas of the healthcare organization.

In addition to the complexities of data management and integration, there are budgetary considerations. As healthcare organizations face increasing financial challenges, investment in new technology and the IT personnel to manage it can be formidable. However, healthcare participants in the Aberdeen study reported a median of 37 percent of the overall IT budget dedicated to investment in compliance activities. Study participants from life sciences and other industries included in Aberdeen’s total study reported lower budget commitments to compliance.

This raises the question: If healthcare organizations are investing in compliance activities, why do we still see significant data breaches, fines for non-compliance and difficulty reaching full compliance?

While there are practical steps that every privacy and security officer should take to ensure the organization is compliant with HIPAA, there are also technology options that enhance a healthcare entity’s ability to better manage data integration from multiple sources and address compliance requirements.

An upcoming webinar, The State of Privacy and Security Compliance for Enterprise Data: “Why Are We Doing This Ourselves?” discusses the Aberdeen survey results and presents advice on how healthcare IT leaders can evaluate their compliance-readiness and identify potential solutions can provide some thought-provoking guidance.

One of the solutions is the use of third-party providers who can provide the data integration and management needs of the healthcare organization to ensure compliance with data security requirements. This strategy can also address a myriad of challenges faced by hospitals. Not only can the expertise and specialty knowledge of the third-party take a burden off in-house IT staff but choosing a managed services strategy that eliminates the need for a significant upfront investment enables moving the expense from the IT capital budget to the operating budget with predictable recurring costs.

Freeing capital dollars to invest in other digital transformation strategies and enabling IT staff to focus on mission-critical activities in the healthcare organization are benefits of exploring outsource opportunities with the right partner.

More importantly, moving toward a higher level of compliance with data security requirements will improve the likelihood of a good night’s sleep!

About Lance Pilkington
Lance Pilkington is the Vice President of Global Compliance at Liaison Technologies, a position he has held since joining the company in September 2012. Lance is responsible for establishing and leading strategic initiatives under Liaison’s Trust program to ensure the company is consistently delivering on its compliance commitments. Liaison Technologies is a proud sponsor of Healthcare Scene.

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

Posted on October 15, 2018 I Written By

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

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

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

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

Merger Mania Brings Duplicate Data Challenges

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

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

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

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

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

Release of Information Panel Raises Red Flags for Bad Attorney Behavior

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

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

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

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

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

Coding Accuracy Takes Center Stage

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

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

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

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

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

Inspiration Found at the Beach and on the Dance Floor

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

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

Healthcare Leaders: Feeling a Bit Discombobulated?

Posted on October 11, 2018 I Written By

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

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

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

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

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

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

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

About the Authors:
Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos. She is also the author of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.

Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

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