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Are You Still Doing the Happy Dance for Your EHR?

Posted on February 16, 2018 I Written By

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

Today I stumbled upon this video from 6 years ago with Flagler Hospital celebrating the implementation and launch of the Allscripts EMR in their organization. Here’s the video in case you’ve never seen it:

We’ve written previously about the value of these videos bringing the team at your hospital together. Any big project such as an EHR implementation is a challenging thing and it’s important to get your whole team involved and to have some fun in the process.

At the end of the video they hold up a sign that says Good Bye Paper. 6 years later, I wonder how they feel about this video and their EHR implementation. Would they still be doing the happy dance? Could they make another video celebrating their EHR?

I know a few organizations where they could. They’ve implemented the EHR effectively and are happy with how it works. Sure, they still have things they’d like changed, updated, modified, etc. However, they’re generally happy to be on an EHR over paper charts. Plus, there’s a whole generation of doctors now that don’t know the paper charts world and know no difference.

Unfortunately, there are many other hospitals that are cursing their EHR software. They might do a video about their EHR, but it would be a satire video about the challenges they still face using an EHR.

Where are you at with your EHR? Are you doing a happy dance or are you disappointed, frustrated, or upset with having to use an EHR in your hospital? Share your thoughts in the comments.

How Mobile Computer Carts Reduce Errors and Increase Efficiency

Posted on February 2, 2018 I Written By

The following is a guest blog post by Andy Lurie, Director of Marketing and Partner Relations at Add On Data.

Mobile computing carts have been a mainstay in the hospital environment since the electronic medical records (EMR) mandate took effect in the United States. To show meaningful use of electronic health records in the healthcare environment, facilities across the nation have adopted mobile computing carts as the primary means of addressing EMR at the point-of-care. Mobile carts offer better ergonomics and productivity than tablets or mobile devices.

Mobile computer carts aren’t just a means of satisfying the new meaningful use requirements for EMR however, they’re becoming vital aspects of workflow optimization and error reduction strategies at healthcare facilities everywhere. Hospitals that initially overlooked the practical benefits of satisfying the EMR mandate are now benefiting from fewer recording errors in patient records, more accurate medication administration, and enhanced worker productivity. Keep reading to find out how!

Mobile Computer Carts Help Care Providers Get More Done

It’s easy to imagine how the introduction of mobile workstations to the healthcare environment has enhanced productivity, especially for the nurses and physicians that use this equipment daily. Here’s what a workflow for patient visits might have looked like before the introduction of mobile workstations:

  1. The nurse visits the patient’s room.
  2. The nurse interviews the patient and conducts any relevant assessments (blood pressure, vitals, etc.)
  3. The nurse visits the medication/equipment room to get materials needed by the patient.
  4. The nurse returns to the patient and administers treatments.
  5. The nurse returns to the stationary workstation located at the nurse’s station.
  6. The nurse records the patient’s condition and documents the treatment provided.
  7. The nurse is ready to visit a new patient.

With mobile computer carts, nurses can reduce many of the walking steps in this process. Basic medical supplies and medications can be stored securely in the drawers of a mobile computing cart, reducing the need for trips to supply rooms. The nurse can also update patient records at the bedside, eliminating the need to repeatedly return to a stationary workstation throughout their shift. A 10-20% reduction in the time taken for a patient visit represents massive productivity gains for an organization.

Mobile Computer Carts Reduce Errors in EMR Recording

EMR recording errors are an insidious and completely unnecessary cause of adverse outcomes for the patient, but they’re a sad reality of an inefficient workflow that separates the processes of patient care from the process of documentation.

We all trust our healthcare providers to provide attentive and conscientious care for each patient, but it’s easy to imagine how documentation errors can occur. Nurses who routine to a stationary workstation between patient visits may sometimes find that computer occupied, meaning they have to wait before documenting the most recent interaction. Sometimes nurses encounter distractions on their way to document a patient interaction – it could be a medical emergency, an urgent request from another staff member, a disruptive patient or visitor, or anything else.

Nurses and physicians need to be accountable for accurately documenting every interaction they have with patients, and this is best achieved with mobile computer carts. Mobile carts ensure the presence of an available workstation at the point of care, ensuring that patient care is documented as it happens and without delay. This reduces data entry errors and enhances patient safety.

Mobile Computer Carts Help Ensure Secure and Accurate Medicine Administration

Mobile computer carts have been used effectively to ensure the security, accuracy, and timeliness of medication administration in hospitals. Carts can be customized with secure drawers for holding medication, as well as bar-code scanners that nurses use to correctly identify patients and match them with the appropriate medications. The combination of medication verification software and organized storage of patient medications virtually eliminates the possibility of patient medication errors.

A study that assessed adverse drug events (ADEs) found that each hospital experiences a medication error every 22.7 hours and every 19.73 admissions. Miscommunication and “Human Factors” have been identified as leading factors contributing to these mistakes, along with similar labeling on medications and patient name confusion. Using bar-code scanners and software to match patients with their proper medications reduces these errors and ultimately saves lives by addressing sources of error that are inherent to the manual administration of medicines in the hospital setting.

Conclusion

While the implementation of mobile computer carts in the healthcare environment is important for satisfying the EMR mandate, hospitals should not overlook the real opportunities to generate and capitalize on the other benefits of mobile carts. Effective usage of mobile computing carts reduces errors and increases hospital efficiency, helping facilities reduce their costs and improve patient safety and health outcomes.

The 4 P’s of Innovation in Health Science

Posted on January 31, 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.

You’ll never meet anyone that loves health data science more than Prashant Natarajan. He literally wrote the book on the subject (Check out Demystifying Big Data and Machine Learning for Healthcare to see why I mean literally). He recently gave a presentation on the 4 P’s of Innovation in Health Science which included this slide:

Sadly, I couldn’t find a recording of his presentation. However, this slide puts health data science in perspective. Prashant boiled it down to 4 simple points. The problem is that too many healthcare organizations are unable to really execute all 4 P’s in their health science innovation efforts.

No doubt each of these 4 P’s is challenging, but the most challenging one I see today is the first P: People.

I’m not sure all of the ways that Prashant addresses the people problem, but it’s somewhat ironic that people is the biggest problem with health science innovation. I see the challenge as two fold. First, finding people who have the health science mindset are hard to find. Competition for people with these skills is fierce and many of them don’t want to get into healthcare which is complex, regulated, and often behind.

The second major health science challenge revolves around the people who collect, aggregate, and enter the data. It’s easy for a front line person to not care about the downstream effects of them entering poor quality data. Not to mention being consistent in what you enter and how you enter it.

It’s somewhat apart of human nature for us to jimmy rig a solution to the problem we face. Those workaround solutions wreaked havoc downstream in your data science efforts. I recently heard the example of a hospital always choosing Mongolian for some setting because it was a setting that would never be used otherwise. The culture of the hospital just knew this is what to do. Once the data scientists started looking at the data they wondered why this Mongolian population kept coming up in their results. Every healthcare organization has their “mongolian” workaround that causes havoc on data science.

What do you think of these 4 Ps of Innovation in Health Science? Is there something missing? Do you see one of these as more important than another?

The Anti Moonshot Conference – Focusing on Practical #HealthIT Innovation

Posted on January 5, 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 all love to hear about and read about healthcare IT companies with massive visions that are making big bets on some moonshot idea. In fact, there’s a lot of value in thinking about and having moonshot ambitions that could disrupt healthcare as we know it. However, what’s unfortunate is that it seems like every healthcare IT conference out there is far too focused on these moonshot ideas that they miss talking about and collaborating on ways to innovatively deal with the real life challenges hospital IT professionals face every day.

This is the genesis behind why I finally pulled the trigger and launched a new healthcare IT conference called Health IT Expo. I’ve talked to far too many hospital IT professionals that go away from a health IT conference totally empty and in some cases upset that a conference could be so disconnected from the true healthcare IT challenges and realities they face in their hospitals and health systems.

As I’ve discussed this new conference with people, some get the wrong impression about what we’re trying to accomplish. Some suggest that we’re shunning healthcare innovation. I’d argue quite the opposite. At Healthcare IT Expo, our goal is to embrace the full spectrum of innovation and not just those innovations that might be considered “disruptive” or “breakthrough” innovations.

Let’s consider some of the areas that hospital and health system professionals would really like to see innovation and find answers:

  • How can I more effectively manage and secure my desktop and mobile device infrastructure?
  • What’s the right approach to virtualization in my organization? Is it really cost effective? What are the pitfalls I should be aware of?
  • How do I deal with all these legacy applications?
  • What’s the appropriate steps to take when a security breach occurs? (Yes, I already know a security breach is going to occur)
  • How can I ensure the data in my EHR is high quality data that’s useful in analytics applications?
  • What’s the best way to get data out of my EHR so I can use it for [insert project here]?
  • What actionable things can I do to “secure” my biggest security risk: people?
  • How can I streamline my 15 communication systems?
  • In what ways can I improve my EHR training and ensure my users are performing at optimum levels even with inevitable turnover?
  • What should I really be doing with my portal that’s effective for patients and providers?
  • How can I cost effectively handle my support desk so it can handle level 1, level 2, and level 3 support issues 24/7/365 without alienating the wide variety of users we need to support?
  • Do I need a data center? How should I approach my existing server infrastructure and new cloud options?
  • How can I improve patient identification and patient matching across all of my IT systems?
  • What can I do to improve patient registration?
  • Is single sign-on really possible and what can I do to better handle user provisioning?
  • Have I done a proper HIPAA risk assessment? What’s the right way to do remediation? Have I done remediation of any HIPAA risks found?
  • That’s great that you want to user virtual reality, but how am I going to secure it?
    How are we going to clean it? What’s the product lifecycle going to look like?
  • What’s the proper way to do penetration testing?
  • Where can I find real time analytics that are ready to be implemented today?
  • How can I better manage the hundreds of forms across my organization?
  • etc etc etc

I could go on and on and these are just touching the surface of the challenges. No doubt there are a hundred more challenges that don’t get covered at most healthcare IT Conferences because they have the wrong focus and the wrong people attending.

We all want to talk about AI, but what’s the point if I’m still trying to make sure the data is clean and that it’s stored in something other than a PDF or some inaccessible archaic system? Health IT Expo is focused on practical innovation.

If you’re a healthcare IT professional dealing with these real challenges and are looking for practical innovations that will help you and your organization, please join us at Health IT Expo. We want as many in the Healthcare Scene community to join us in New Orleans, so you can also get $300 off your registration (Only $395 to attend after the discount) for Health IT Expo by using the promo code hcscene on the normal registration page. We’re certain you’ll find no other conference out there that provides as much value for the price.

Plus, the Call for Speakers is still open if you have a practical innovation you can share. We even have options for 15 minute sessions if your innovation is useful and impactful, but doesn’t require a speaking degree to share.

Sorry for the sales pitch, but as you can tell I’m excited by Health IT Expo. I think we’ve created a unique conference that will help many hospital IT professionals find a more satisfying conference experience. As someone who’s attended hundreds of healthcare IT conferences, I’ve seen first hand the good, the bad, and the ugly of conferences. We’re taking all of those learnings and packing them into Health IT Expo.

What do you think of this approach? What do you think of Health IT Expo? What other problems do you have that you think we should cover? We’d love to hear from you in the comments or on our contact us page.

Merged Health Systems Face Major EHR Integration Issues

Posted on January 2, 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.

Pity the IT departments of Advocate Health Care and Aurora Health Care. When the two health systems complete their merger, IT leaders face a lengthy integration process cutting across systems from three different EHR vendors or a forklift upgrade of at least one.

It’s tough enough to integrate different instances of systems from the same vendor, which, despite the common origin are often configured in significantly different ways. In this case, the task is exponentially more difficult. According to Fierce Healthcare, when the two organizations come together, they’ll have to integrate Aurora’s Epic EHR with the Cerner and Allscripts systems used by Advocate.

As part of his research, the reporter asked an Aurora spokesperson whether health systems attempt to pull together three platforms into a single EHR. Of course, as we know, that is unlikely to ever happen. While full interoperability is obviously an elusive thing, getting some decent data flow between two affiliated organizations is probably far more realistic.

Instead, depending on what happens, the new CIO might or might not decide to migrate all three EHRs onto one from a single vendor. While this could turn out to be a hellish job, it certainly is the ideal situation if you can afford to get there. However, that doesn’t mean it’s always the best option. Especially as health system mergers and acquisitions get bigger and bigger.

To me, however, the big question around all of this is how much the two organizations would spend to bring the same platforms to everyone. As we know, acquiring and rolling out Epic for even one health system is fiendishly expensive, to the point where some have been forced to report losses or have had ratings on the bond reduced.

My guess is that the leaders of the two organizations are counting often-cited merger benefits such as organizational synergies, improved efficiency and staff attrition to meet the cost of health IT investments like these. If this academic studies prove this will work, please feel free to slap me with a dead fish, but as for now I doubt it will happen.

No, to me this offers an object lesson in how mergers in the health IT-centered world can be more costly, take longer to achieve, and possibly have a negative impact on patient care if things aren’t done right (which often seems to be the case).

Given the other pressures health systems face, I doubt these new expenses will hold them back from striking merger deals. Generally speaking, most health systems face little choice but to partner and merge as they can. But there’s no point minimizing how much complexity and expense EHRs bring to such agreements today.

Breaking Bad: Why Poor Patient Identification is Rooted in Integration, Interoperability

Posted on December 20, 2017 I Written By

The following is a guest blog post by Dan Cidon, Chief Technology Officer, NextGate.

The difficulty surrounding accurate patient ID matching is sourced in interoperability and integration.

Coordinated, accountable, patient-centered care is reliant on access to quality patient data. Yet, healthcare continues to be daunted by software applications and IT systems that don’t communicate or share information effectively. Health data, spread across multiple source systems and settings, breeds encumbrances in the reconciliation and de-duplication of patient records, leading to suboptimal outcomes and avoidable costs of care. For organizations held prisoner by their legacy systems, isolation and silo inefficiencies worsen as IT environments become increasingly more complex, and the growth and speed to which health data is generated magnifies.

A panoramic view of individuals across the enterprise is a critical component for value-based care and population health initiatives. Accurately identifying patients, and consistently matching them with their data, is the foundation for informed clinical decision-making, collaborative care, and healthier, happier populations. As such, the industry has seen a number of high-profile initiatives in the last few years attempting to address the issue of poor patient identification.

The premature end of CHIME’s National Patient ID Challenge last month should be a sobering industry reminder that a universal solution may never be within reach. However, the important lesson emanating in the wake of the CHIME challenge is that technology alone will not solve the problem. Ultimately, the real challenge of identity management and piecing together a longitudinal health record has to do with integration and interoperability. More specifically, it revolves around the demographics and associated identifiers dispersed across multiple systems.

Because these systems often have little reason to communicate with one another, and because they store their data through fragmented architecture, an excessive proliferation of identifiers occurs. The result is unreliable demographic information, triggering further harm in data synchronization and integrity.

Clearly, keeping these identifiers and demographics as localized silos of data is an undesirable model for healthcare that will never function properly. While secondary information such as clinical data should remain local, the core identity of a patient and basic demographics including name, gender, date of birth, address and contact information shouldn’t be in the control of any single system. This information must be externalized from these insulated applications to maintain accuracy and consistency across all connected systems within the delivery network.

However, there are long-standing and relatively simple standards in place, such as HL7 PIX/PDQ, that allow systems to feed a central demographic repository and query that repository for data. Every year, for the past eight years, NextGate has participated in the annual IHE North American Connectathon – the healthcare industry’s largest interoperability testing event. Year after year, we see hundreds of other participating vendors demonstrating that with effective standards, it is indeed possible to externalize patient identity.

In the United Kingdom, for example, there has been slow but steady success of the Patient Demographic Service – a relatively similar concept of querying a central repository for demographics and maintaining a global identifier. While implementation of such a national scale service in the U.S. is unlikely in the near-term, the concept of smaller scale regional registries is clearly an achievable goal. And every deployment of our Enterprise Master Patient Index (EMPI) is a confirmation that such systems can work and do provide value.

What is disappointing, is that very few systems in actual practice today will query the EMPI as part of the patient intake process. Many, if not most, of the systems we integrate with will only fulfill half of the bargain, namely they will feed the EMPI with demographic data and identifiers. This is because many systems have already been designed to produce this outbound communication for purposes other than the management of demographic data. When it comes to querying the EMPI for patient identity, this requires a fundamental paradigm shift for many vendors and a modest investment to enhance their software. Rather than solely relying on their limited view of patient identity, they are expected to query an outside source and integrate that data into their local repository.

This isn’t rocket science, and yet there are so few systems in production today that initiate this simple step. Worse yet, we see many healthcare providers resorting to band aids to remedy the deficiency, such as resorting to ineffective screen scraping technology to manually transfer data from the EMPI to their local systems.

With years of health IT standards in place that yield a centralized and uniform way of managing demographic data, the meager pace and progress of vendors to adopt them is troubling. It is indefensible that a modern registration system, for instance, wouldn’t have this querying capability as a default module. Yet, that is what we see in the field time and time again.

In other verticals where banking and manufacturing are leveraging standards-based exchange at a much faster pace, it really begs the question: how can healthcare accelerate this type of adoption? As we prepare for the upcoming IHE Connectathon in January, we place our own challenge to the industry to engage in an open and frank dialogue to identify what the barriers are, and how can vendors be incentivized, so patients can benefit from the free flow of accurate, real-time data from provider to provider.

Ultimately, accurate patient identification is a fundamental component to leveraging IT for the best possible outcomes. Identification of each and every individual in the enterprise helps to ensure better care coordination, informed clinical decision making, and improved quality and safety.

Dan Cidon is CTO and co-founder NextGate, a leader in healthcare identity management, managing nearly 250 million lives for health systems and HIEs in the U.S. and around the globe.

Healthcare Always Has a Why Not – Essential to Focus on the Why To

Posted on December 11, 2017 I Written By

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

I recently hosted two roundtables at the Digital Healthcare Transformation conference around the topics of IoT (Internet of Things) and Wearables. The discussion at these roundtables was fascinating and full of promise. Although, it was also clear that all of these healthcare organizations were trying to figure out what was the right strategy when it came to IoT and wearables in their hospitals and health systems. In fact, one of the big takeaways from the roundtables was that the best strategy right now was to have a strategy of experimentation and learning.

While good advice, I was also struck by a simple concept that I’ve seen over and over in healthcare:

If you want a reason not to do something in healthcare, you’ll find one.

It’s a sad, but true principle. Healthcare is so complex that if you want to make an excuse find a reason not to do something, then you can easily find it. In fact, you can usually find multiple reasons.

The most egregious example of this is HIPAA. HIPAA has been an excuse not to do more things in healthcare than any other excuse in the book. When someone says that “HIPAA won’t allow us to do this” then we should just start translating that to mean “I don’t want to do this and so I’m pulling my HIPAA card.” HIPAA certainly requires certain actions, but I know of almost anything that can’t be done in healthcare that could still satisfy HIPAA requirements. At a minimum, you can always ask the patient to consent to essentially wave HIPAA and if the patient consents then you’re not in violation of HIPAA. However, in most cases you can meet HIPAA security and compliance requirements without having to go that far. However, if you’re looking for a reason not to do something, just say HIPAA.

Another one I’ve seen used and is much harder is when someone says, “I think this risks the quality of care we provide.” Notice the emphasis on the word THINK. Healthcare providers don’t have to have any evidence that a new technology, workflow, process, etc actually risks the quality of care. They just have to think that it could reduce the quality of care and it will slow everything down and often hijack the entire project. Forget any sort of formal studies or proof that the changes are better. If the providers’ gut tells them that it could risk the quality of care, it takes a real leader to push beyond that complaint and to force the provider to spend the time necessary to translate why their gut tells them it will be worse.

If we focus on the Why Not in healthcare, we’ll always find it. That’s why healthcare must focus on the Why to!

Use the examples of IoT or wearables and think about all the reasons healthcare should use these new technologies. It’s amazing how this new frame of reference changes your perspective. Wearables can help you understand the patient beyond the short time they spend in the hospital or doctor’s office. Wearables can help you better diagnose a patient. Wearables can help you better understand a chronic patient’s habits. etc etc etc. You obviously have to go much deeper into specific benefits, but you get the idea.

What I’ve found is that once you figure out the “Why to” make a change or implement a new technology, then it’s much easier to work through all of the “Why nots.” In fact, it turns the Why Nots into problems that need to be solved rather than excuses to not even consider a change. You can solve problems. Excuses are often impossible to overcome.

I’d love to hear your experience with this idea. Have you seen Why Nots hijack your projects? What are some of the other Why Not reasons you’ve seen? Has the move to asking “Why to” helped you in your projects?

Study Suggests That Hospitals Do Better With Richer Clinical EHR Tech Support

Posted on November 29, 2017 I Written By

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

It’s hardly a mystery that providers get more use out of health IT when they get good support from the vendors who created it. According to one study, however, today’s vendors need to go further with the tech support offerings, including services extending from helpdesk through engineering interventions.

The study, conducted by research firm Black Book, involved interviewing 4,446 nurses and physicians about the quality of clinical tech support services needed to have an impact on patient care. A large majority (85%) of clinicians said that delivery of patient care services is undermined substantially by subpart user tech support, Black Book reports.

Additional interesting data came from the 1,103 respondents who reported having worked in varied facilities using different EHR systems, which gave them perspective on how tech support options impacted clinical care. Of that group, 77% of nurses and 89% of doctors said the hospitals benefited from advanced tech support, which created an excellent EHR end-user experience.

All that being said, hospital financial leaders didn’t seem confident that they could afford to pay for top-tier tech support for health IT tools. According to the survey, 155 of the 180 CFOs and financial executives who responded to the survey felt they faced too many challenges and had too few resources budgeted for 2018 to spend on additional EHR support next year.

On the other hand, the CFOs are going to get pushback from their colleagues in other departments, the survey suggests. According to the study, 49 of 82 CMOs said they were routinely discontented with a range of tech support provided to the nursing and physician employees. Meanwhile, 80% of the 1,319 IT management and CIO respondents reported that they were seeing a steep increase in clinical grievances after EHR implementation, especially among physicians.

And if they have the opportunity, they’re going to demand more from vendors on the tech support front. In fact, 70 of the 82 hospital CMOs surveyed believe that the availability of multi-level tech support from their health records vendors will be a top competitive differentiator distinguishing one inpatient EHR from the others.

So here, we have the makings of some serious financial tensions between hospitals and EHR vendors. On the one hand, CFOs are signaling that they don’t want to pay extra for additional support, even if it has the potential for improving clinical performance. CIOs and CMO’s, for their part, are willing to shortlist vendors that do a better job of supporting key end-users like physician after EHR rollouts.

Will the more aggressive vendors absorb the cost of delivering more comprehensive, clinical-friendly tech support? Or will hospital financial leaders give in to internal pressure and pay for more sophisticated support?  It’s too soon to tell who has more muscle here, but my guess is that given the still-crowded EHR market, the vendors will eventually be forced to give in and offer better tech support options as part of their base price. My guess is that hospitals still hold more of the cards.

Providing ongoing support for an EHR and other healthcare IT has become such a challenge, we’ve made it one of the themes at our new Health IT Expo conference. If finding a sustainable way to support your EHR at every tier, then join us in New Orleans to learn and share with other hospital organizations that are going through the same challenges.

CHIME Suspends the $1 Million Dollar National Patient ID Challenge

Posted on November 17, 2017 I Written By

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

CHIME just announced that they’ve suspended their National Patient ID Challenge. For those not familiar with the challenge, almost 2 years ago CHIME Announced a $1 million prize for companies to solve the patient identification and matching problem in healthcare. Here’s the description of the challenge from the HeroX website that hosted the challenge:

The CHIME National Patient ID Challenge is a global competition aimed at incentivizing new, early-stage, and experienced innovators to accelerate the creation and adoption of a solution for ensuring 100 percent accuracy in identifying patients in the U.S. Patients want the right treatment and providers want information about the right patient to provide the right treatment. Patients also want to protect their privacy and feel secure that their identity is safe.

And here’s the “Challenge Breakthrough” criteria:

CHIME Healthcare Innovation Trust is looking for the best plan, strategies and methodologies that will accomplish the following:

  • Easily and quickly identify patients
  • Achieve 100% accuracy in patient identification
  • Protect patient privacy
  • Protect patient identity
  • Achieve adoption by the vast majority of patients, providers, insurers, and other stakeholders
  • Scale to handle all patients in the U.S.

When you look at the fine print, it says CHIME (or the Healthcare Innovation Trust that they started to host the challenge) could cancel the challenge at any time without warning or explanation including removing the Prize completely:

5. Changes and Cancellation. Healthcare Innovation Trust reserves the right to make updates and/or make any changes to, or to modify the scope of the Challenge Guidelines and Challenge schedule at any time during the Challenge. Innovators are responsible for regularly reviewing the Challenge site to ensure they are meeting all rules and requirements of and schedule for the Challenge. Healthcare Innovation Trust has the right to cancel the Challenge at any time, without warning or explanation, and to subsequently remove the Prize completely.

It seems that CHIME’s legally allowed to suspend the challenge. However, that doesn’t mean that doesn’t burn the trust of the community that saw them put out the $1 million challenge. The challenge created a lot of fanfare including promotion by ONC on their website, which is a pretty amazing thing to even consider. CHIME invested a lot in this challenge, so it must hurt for them to suspend it.

To be fair, when the challenge was announced I hosted a discussion where I asked the question “Is this even solvable?” At 100% does that mean that no one could ever win the challenge? With that in mind, the challenge always felt a bit like Fool’s Gold to me and I’m sure many others. I thought, “CHIME could always come back and make the case that no one could ever reach 100% and so they’d never have to pay the money.” Those that participated had to feel this as well and they participated anyway.

The shameful part to me is how suspending the competition is leaving those who did participate high and dry. I asked CHIME about this and they said that the Healthcare Innovation Trust is still in touch with the finalists and that they’re encouraging them to participate in the newly created “Patient Identification Task Force.” Plus, the participants received an honorarium.

Participation in a CHIME Task Force and the honorarium seems like a pretty weak consolation prize. In fact, I can’t imagine any of the vendors that participated in the challenge would trust working with CHIME going forward. Maybe some of them will swallow hard and join the task force, but that would be a hard choice after getting burnt like this. It’s possible CHIME is offering them some other things in the background as well.

What’s surprising to me is why CHIME didn’t reach out to the challenge participants and say that none of them were going to win, but that CHIME still wanted to promote their efforts and offerings to provide a solid benefit to those that participated. CHIME could present the lessons learned from the challenge and share all the solutions that were submitted and the details of where they fell short and where they succeeded. At least this type of promotion and exposure would be a nice consolation prize for those who spent a lot of time and money participating in the challenge. Plus, the CIOs could still benefit from something that solved 95% of their problems.

Maybe the new Patient Identification Task Force will do this and I hope they do. CHIME did it for their new Opioid Task Force at the Fall Forum when they featured it on the main stage. How about doing the same for the Patient Identification Challenge participants? I think using the chance to share the lessons learned would be a huge win for CHIME and its members. I imagine it’s hard for CHIME to admit “failure” for something they worked on and promoted so much. However, admitting the failure and sharing what was learned from it would be valuable for everyone involved.

While I expect CHIME has burnt at least some of the challenge participants, the CHIME CIO members probably knew the challenge was unlikely to succeed and won’t be burnt by this decision. Plus, the challenge did help to call national attention to the issue which is a good thing and as they noted will help continue to push forward the national patient identifier efforts in Washington. Maybe now CHIME will do as Andy Aroditis, Founder and CEO of NextGate, suggested in this article where Shaun Sutner first reported on issues with the CHIME National Patient ID Challenge:

Aroditis complained that rather than plunging into a contest, CHIME should have convened existing patient matching vendors, like his company, to collaborate on a project to advance the technology.

“Instead they try to do these gimmicks,” Aroditis said.

I imagine that’s what CHIME would say the Patient Identification Task Force they created will now do. The question is whether CHIME burnt bridges they’ll need to cross to make that task force effective.

The reality is that Patient Identification and Patient Matching is a real problem that’s experienced by every healthcare organization. It’s one that CHIME members feel in their organizations and many of them need better solutions. As Beth Just from Just Associates noted in my discussion when the challenge was announced, $1 million is a drop in the bucket compared to what’s already been invested to solve the problem.

Plus, many healthcare organizations are in denial when it comes to this problem. They may say they have an accuracy of 98%, the reality is very different when a vendor goes in and wakes them up to what’s really happening in their organization. This is not an easy problem to solve and CHIME now understands this more fully. I hope their new task force is successful in addressing the problem since it is an important priority.

AMIA17 – There’s Gold in Them EHRs!

Posted on November 13, 2017 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.

If even 10% of the research presented at the 2017 American Medical Informatics Association conference (AMIA17) is adopted by mainstream healthcare, the impact on costs, quality and patient outcomes will be astounding. Real-time analysis of EHR data to determine the unique risk profile of each patient, customized remote monitoring based on patient + disease profiles, electronic progress notes using voice recognition and secondary uses of patient electronic records were all discussed at AMIA17.

Attending AMIA17 was an experience like no other. I understood less than half of the information being presented and I loved it. It felt like I was back in university – which is the only other time I have been around so many people with advanced degrees. By the time I left AMIA17, I found myself wishing I had paid more attention during my STATS302 classes.

It was especially interesting to be at AMIA17 right after attending the 3-day CHIME17 event for Hospital CIOs. CHIME17 was all about optimizing investments made in HealthIT over the past several years, especially EHRs (see this post for more details). AMIA17 was very much an expansion on the CHIME17 theme. AMIA17 was all about leveraging and getting value from the data collected by HealthIT systems over the past several years.

A prime example of this was the work presented by Michael Rothman, Ph.D of Pera Health. Rothman created a way to analyze key vital signs RELATIVE to a patient’s unique starting condition to determine whether they are in danger. Dubbed the Rothman Index, this algorithm presents clinicians and caregivers with more accurate alarms and notifications. With all the devices and systems in hospitals today, alarm fatigue is a very real and potentially deadly situation.

Missed ventilator alarms was #3 on ECRI Institute’s 2017 Top 10 Health Technology Hazards. It was #2 on the 2016 Top 10 list. According to ECRI: “Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death”. The challenge is not the response but rather how to determine which alarms are informational and which are truly an indicator of a clinical condition that needs attention.

Comments from RNs in adverse-event reports shared in a 2016 presentation to the Association for the Advancement of Medical Instrumentation (AAMI) sums up this challenge nicely:

“Alarm fatigue is leading to significant incidents because there are so many nuisance alarms and no one even looks up when a high-priority alarm sounds. Failure to rescue should be a never event but it isn’t.”

“Too many nuisance alarms, too many patients inappropriately monitored. Continuous pulse oximetry is way overused and accounts for most of the alarms. Having everyone’s phone ring to one patient’s alarm makes you not respond to them most of the time.”

This is exactly what Rothman is trying to address with his work. Instead of using a traditional absolute-value approach to setting alarms – which are based on the mythical “average patient” – Rothman’s method uses the patient’s actual data to determine their unique baseline and sets alarms relative to that. According to Rothman, this could eliminate as much as 80% of the unnecessary alarms in hospitals.

Other notable presentations at AMIA17 included:

  • MedStartr Pitch IT winner, FHIR HIEDrant, on how to mine and aggregate clinically relevant data from HIEs and present it to clinicians within their EHRs
  • FHIR guru Joshua C Mandel’s presentation on the latest news regarding CDS Hooks and the amazing Sync-for-Science EHR data sharing for research initiative
  • Tianxi Cai of Harvard School of Public Health sharing her research on how EHR data can be used to determine the efficacy of treatments on an individual patient
  • Eric Dishman’s keynote about the open and collaborative approach to research he is championing within the NIH
  • Carol Friedman’s pioneering work in Natural Language Processing (NLP). Not only did she overcome being a woman scientist but also applying NLP to healthcare something her contemporaries viewed as a complete waste of time

The most impressive thing about AMIA17? The number of students attending the event – from high schoolers to undergraduates to PhD candidates. There were hundreds of them at the event. It was very encouraging to see so many young bright minds using their big brains to improve healthcare.

I left AMIA17 excited about the future of HealthIT.