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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.

AI Project Set To Offer Hospital $20 Million In Savings Over Three Years

Posted on October 4, 2018 I Written By

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

While they have great potential, healthcare AI technologies are still at the exploration stage in most healthcare organizations. However, here and there AI is already making a concrete difference for hospitals, and the following is one example.

According to an article in Internet Health Management, one community hospital located in St. Augustine, Florida expects to save $20 million dollars over the next the three years thanks to its AI investments.

Not long ago, 335-bed Flagler Hospital kicked off a $75,000 pilot project dedicated to improving the treatment of pneumonia, sepsis and other high mortality conditions, building on AI tools from vendor Ayasdi Inc.

Michael Sanders, a physician who serves as chief medical informatics officer for the hospital, told the publication that the idea was to “let the data guide us.” “Our ability to rapidly construct clinical pathways based on our own data and measure adherence by our staff to those standards provides us with the opportunity to deliver better care at a lower cost to our patients,” Sanders told IHM.

The pilot, which took place over just nine weeks, reviewed records dating back five years. Flagler’s IT team used Ayasdi’s tools to analyze data held in the hospital’s Allscripts EHR, including patient records, billing, and administrative data. Analysts looked at data on patterns of care, lengths of stay and patient outcomes, including the types of medications docs and for prescribing and when doctors were ordering CT scans.

After analyzing the data, Sanders and his colleagues used the AI tools to build guidelines into the Allscripts EHR, which Sanders hoped would make it easy for physicians to use them.

The project generated some impressive results. For example, the publication reported, pathways for pneumonia treatment resulted in $1,336 in administrative savings for a typical hospital stay and cut down lengths of stay by two days. All told, the new approach cut administrative costs for pneumonia treatment by $800,000.

Now, Flagler plans to create pathways to improve care for sepsis, substance abuse, heart attacks, and other heart conditions, gastrointestinal disorders and chronic conditions such as diabetes.

Given the success of the project, the hospital expects to expand the scope of its future efforts. At the outset of the project, Sanders had expected to use AI tools to take on 12 conditions, but given the initial success with rolling out AI-based pathways, Sanders now plans to take on one condition each month, with an eye on meeting a goal of generating $20 million in savings over the new few years, he told IHM.

Flagler is not the first, nor will it be the last, hospital to streamline care using AI. For another example, check out the efforts underway at Montefiore Health, which seems to be transforming its entire data infrastructure to support AI-based analytics efforts.

Bridging the Communication Gap Between Health Plans and Providers

Posted on October 3, 2018 I Written By

The following is a guest blog post by Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Effective communication and trust are the essential keys to any relationship, and the plan-provider relationship is no different. A shift towards value-based coordinated accountable care has urged health plans and providers to collaborate to improve population health and patient experience while lowering costs. Most plan-provider communication revolves around rate negotiations.

An open, honest relationship with transparent communication and cooperation is needed to bridge the communication gap and create mutually beneficial partnerships. Sharing data, creating health plan-provider networks, utilizing audits and providing access to new technologies are all methods health plans and providers could use to help promote collaboration and bridge communication.

Data Sharing Across the Care Continuum

To foster collaboration, data sharing should be implemented and incentives should be aligned across the care continuum so that both parties are motivated to improve outcomes and lower costs. Data sharing is one of the key benefits of bridging the communication gap between health plans and providers.

Health plans hold the bulk of useful data and, when that data is combined with the providers’ clinical expertise, the likely result is better patient outcomes. Sharing data gives providers access to claims information that also provides with them a patient’s entire medical history. This information is useful in helping educate patients about their health risks and to boost transparency in plan-provider communication.

Health plans and providers keep a vast amount of patient information. Health plans have historical claims data while providers have clinical data. Both parties use their data for checks and balances and to mutually determine the best treatment and most appropriate care for patients. Lack of collaboration, usually due to interoperability challenges, means both data types aren’t shared. A key aspect to achieving collaboration and alignment is trust. Sometimes parties are lacking in trust when it comes to the use of their data; however, advancements in technology and use of the blockchain to create transparency are helping to change the tides.

Health plans and providers must have upfront discussions on what information will be shared, and each party must share data that is useful to the other. For health plans, this means understanding how reimbursement is determined, the factors that influence the payments they receive and how they are reimbursed based on clinical outcomes rather than interventions delivered. In turn, providers must clearly communicate the clinical outcomes health plans are or are not achieving. Ultimately, all measures should include preventative care, lower per capita cost and improve population health as well as patient experience and satisfaction. They should also improve how data is managed and transitioned. Providers that implement a strategic quality management approach to deliver high-quality, valued-based care can achieve better clinical outcomes.

Health Plan-provider Networks

Plan-provider communication networks are needed to efficiently and effectively harness data from both parties and enable rapid innovation and the sharing of real-time data for immediate response. Health plan-provider networks utilize care management, electronic health records (EHRs), and analytics to seek to resolve communication and collaboration challenges between health plans and providers. In keeping with HIPAA regulations, communication between health plans and providers must be customized to include only information that is relevant to specific attributed patient populations, physicians, reimbursement and care delivery models. The goal of plan-provider networks is to present both parties with transparent, high-quality data to improve trust and increase health plan-provider engagement to improve communication and, ultimately, population health.

Using Audits to Bridge Communication

The rise of audit requests has posed a problem in the plan-provider relationship. Both health plans and providers must work toward greater compliance, and auditing medical records is a crucial step in the process.

Providers struggle with numerous types of information requests from various third-party health plans, governmental agencies and national health plans, which often have different deadlines and vernaculars. As a result, health plans are forced to repeatedly call health information management (HIM) and audit departments when claims data inaccurately identifies place of service, provider or other patient information. An upsurge in audit requests from commercial and other health plans threatens to exacerbate these problems.

The audit process can change the plan-provider relationship from adversarial to advantageous by improving communication. Bridging communication gaps and language barriers through clearer record requests would take the burden off providers and alleviate plan problems. Technology will also play a critical role in making this entire process as automated as possible.

Chart requests that come from commercial health plan audits represent just five percent of all requests that providers receive. Hospitals also receive high volumes of medical record requests from other hospitals, physicians, attorneys, patients and more. The problem is that commercial plans often assume they are the only requestor. Education is required on both sides of the audit equation to improve processes and reduce plan-provider friction.

For providers, all data from each request and submission should be entered in a centralized audit management software application for the organization. This helps providers track audit activity by health plan and type of audit, maintain a record of all documents sent, better manage requests, and stay abreast of audit trends.

Patient access, clinical coders, billers and collectors perform unique functions and speak different languages across the hospital revenue cycle. Similarly, commercial health plans have multiple departments and terminology involved in audit processing. In many cases, inter-departmental communication and language barriers are the main obstacles to overcome.  However, technology is playing a growing role in creating greater transparency within the healthcare ecosystem—by acquiring, digitizing and giving shape to both structured and unstructured records.

Time Will Tell

Bridging the communication gap will not happen overnight. It will take time and effort from all parties involved; however, these methods are a good starting point.

As the digital era has taken hold, our attentions are turning to a better utilization of the vast data flowing through both providers and health plans. This will translate into a better understanding of patient outcomes, improved revenue cycles and more insightful growth strategies for all parties.

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.

Montefiore Health Makes Big AI Play

Posted on September 24, 2018 I Written By

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

I’ve been doing a lot of research on healthcare AI applications lately. Not surprisingly, while people find the abstract issues involved to be intriguing, most would prefer to hear news of real-life projects, so I’ve been on the lookout for good examples.

One interesting case study, which appeared recently in Health IT Analytics, comes from Montefiore Health System, which has been building up its AI capabilities. Over the past three years, it has created an AI framework leveraging a data lake, infrastructure upgrades and predictive analytics algorithms. The AI is focused on addressing expensive, dangerous health issues, HIA reports.

“We have created a system that harvests every piece of data that we can possibly find, from our own EMRs and devices to patient-generated data to socio-economic data from the community,” said Parsa Mirhaji, MD, PhD, director of the Center for Health Data Innovations at Montefiore and the Albert Einstein College of Medicine, who spoke with the publication.

Back in 2015, Mirhaji kicked off a project bringing semantic data lake technology to his organization. The first pilot using the technology was designed to find patients at risk of death or intubation within 48 hours. Now, clinicians can also see red flags for admitted patients with increased risk of mortality 3 to 5 days in advance.

In 2017, the health system also rolled out advanced sepsis detection tools and a respiratory failure detection algorithm called APPROVE, which identifies patients at a raised risk of prolonged ventilation up to 48 hours before onset, HIA reported.

The net result of these efforts was dubbed PALM, the Patient-centered Analytical  Learning Machine. PALM “represents a very new way of interacting with data in healthcare,” Miraji told HIA.

What makes PALM special is that it speeds up the process of collecting, curating, cleaning and accessing metadata which must be conducted before the data can be used to train AI models. In most cases, the process of collecting data for AI use is largely manual, but PALM automates this process, Miraji told the publication.

This is because the data lake and its graph repositories can find relationships between individual data elements on an on-the-fly basis. This automation lets Montefiore cut way down on labor needed to get these results. Miraji noted that ordinarily, it would take a team of data analysts, database administrators and designers to achieve this result.

PALM also benefits from a souped-up hardware architecture, which Montefiore created with help from Intel and other technology partners. The improved architecture includes the capacity for more system memory and processing power.

The final step in optimizing the PALM system was to integrate it into the health system’s clinical workflow. This seems to have been the hardest step. “I will say right away that I don’t think we have completely solved the problem of integrating analytics seamlessly into the workflow,” Miraji admitted to HIA.

Looking Forward to #AHIMACon18 – HIM Scene

Posted on September 19, 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 weekend is the start of the AHIMA Annual Convention happening in Miami, Florida. For those not familiar with the AHIMA organization, it brings together HIM professionals from across the country. Something that I think makes AHIMA unique is that around the HIM conference are multiple days of training and certifications for HIM professionals. I’m always amazed at how much work HIM professionals have to put in to keep up with their certifications and to stay up with things like the ever-changing world of medical coding. HIM definitely doesn’t get the credit they deserve in this regard.

As I think what topics will be hot at this year’s AHIMA Annual convention, I’m most interested to hear what the HIM crowd thinks about the changes to the Physician Fee Schedule and E&M Coding. This is going to be a big deal for healthcare and medical coders are going to be the ones charged with dealing with the changes. Sure, doctors will have to change how they are documenting as well, but verifying that it was documented correctly and making sure the medical coding matches that documentation is mostly done by HIM professionals.

I’m really interested to hear what HIM professionals think about these medical coding changes. What do you think of the new time based coding options? Does this make life easier or not? Let us know what you think and what you’re hearing in the comments. The obvious part to me is that in the short term it’s not going to make medical coders’ lives easier at all. It’s just one more code they’re going to have to deal with and it doesn’t have a history of practices to support what’s acceptable or not. It’s not like these new codes are doing away with the old codes. At least I don’t think that’s how most practices are going to handle these new codes, but we’ll see. Let us know your thoughts in the comments.

Another big change that could impact HIM professionals, particularly medical coders, are the new remote monitoring and digital care coordination codes. I’ve heard a lot of people saying that these codes show some promise. However, I’m starting to hear overtures that the codes aren’t going to live up to their billing (excuse the pun). What are you seeing when it comes to the new coding for telemedicine, remote monitoring, and digital care coordination?

Outside of these two big topics, I’ll be interested to hear how HIM professionals are looking at security and privacy. It’s become a huge topic in the CIO and healthcare IT world. I wonder how much it will impact the HIM world. There’s always an interesting dance when a breach happens. The HIM world is great at understanding disclosures and HIPAA violations, but breaches often bring out a lot of different people. The reality is that when a breach occurs it needs to be all hands on deck. However, my guess is that many HIM professionals aren’t part of the discussion when a breach occurs. How’s your experience been in this regard? If you haven’t had a breach (lucky you), you should still have some policies and some drills in place to make sure you’re ready. So, you should have an idea of what HIM’s role would be in a breach.

Another trend I’ve been watching for a number of years is the push for more and more HIM professionals to be involved in things like healthcare analytics. This was highlighted by a recently published article in the Journal of AHIMA that makes the argument that all healthcare professionals need to learn data analytics. I argued something similar in this article on how HIM professionals can use Information Governance to ensure they’re heard. These are important messages that I think many in HIM are largely ignoring. It will be interesting to see how this shakes out. Those that embrace the changes will be well positioned for the future.

What other things should we be watching for from an HIM perspective? What’s keeping you up at night? What’s getting you most excited about your job? Let us know in the comments or on Twitter @HealthcareScene.

CMIOs Say Medication Management Is Improving, But Still Needs Work

Posted on September 14, 2018 I Written By

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

A new survey suggests that chief medical information officers are optimistic about the progress they’ve seen in medication management processes though they still see some obstacles that need to be tackled. Their top concerns seem to be related to the sharing of prescription information and a lack of faith in the medication lists as they’re currently generated.

According to research conducted by the Association of Medical Directors of Information Systems (AMDIS) and vendor DrFirst, medication management improvement efforts have made a positive impact on the rate of adverse drug events over the past five years.

About half of the CMIOs said they were satisfied with their existing medication management process, while 12% said they were dissatisfied.

The CMIOs reported that the biggest gaps in the medication management process were incomplete patient medication histories (cited by 80%) and misaligned medication reconciliation and care transition cycles (75%). Respondents said that this kind of misalignment sometimes lead to misinformed decisions by care teams.

Another vulnerability respondents identified was lack of visibility into patients’ medication adherence levels, with 91% calling it the biggest gap in medication history adherence and monitoring. They didn’t name any particular solution that could address the problem, though existing medication management apps for consumers might at some point address this issue.

Eight-five percent of responding CMIOs said that when patients don’t participate in the medication reconciliation process it leads to gaps in the patient medication history. They didn’t specify the point in the process at which it might be most helpful to involve patients.

In addition, 95% of respondents said that it would help matters to cut down on the order entry and data validation tasks pharmacists and clinical staffers had to perform, arguing that it would enhance patient safety and improve efficiency.

Other patient safety concerns they cited included a lack of process buy-in and/or process compliance (77%), a lack of process ownership (73%) and workflow variations across departments (91%).

As part of the discussion, the surveyed CMIOs noted that the right technology approach could help them address the opioid epidemic.

As things stand, they told AMDIS, it’s not clear the providers are able to prevent opioid abuse since at times they can’t easily distinguish between drug “shoppers” and other patients.

However, 65% of CMIOs said that if providers could access an integrated clinician workflow including e-prescribing of controlled substances, access to state Prescription Drug Monitoring Programs to track patients’ opioid histories and access lists of other prescriptions, it would be easier for them to avoid potentially harmful drug combinations.

Electronic Health Records – Is Your Organization Committed to Adoption or Just Implementation?

Posted on September 13, 2018 I Written By

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

Several years ago, a reputable IT vendor offered our organization a trial version of their software in exchange for our feedback. The software provided equipment monitoring that would be valuable to us. Initially, we were excited because the functionality aligned with our needs and the application was robust enough to grow with us. It seemed that the software would fulfill our need. The new software system served IT directly, so our Director of IT led the implementation and kept our senior management team updated on the progress. We were impatient to get access to the dashboard of data the vendor promised. But months later, we were still waiting.

The price tag had lured us in, but we quickly realized the high cost in maintenance and labor required to make the application truly valuable. This story drives home a concept that we all understand, but often overlook; sometimes we underestimate the “care and feeding” required to maintain a valuable investment, putting the entire project at risk. In fact, we all need to remember the importance of sustainability after the initial excitement about an investment’s value. It is common to under-appreciate the effort it will take to maintain the value of our investments.

Let’s consider the shift in thinking required to move from implementing an Electronic Health Record to maintaining high levels of adoption over the life of the application. Many organizations focus on the implementation cost without truly appreciating the long-term cost of maintaining these large, complex systems.  We often see this in healthcare organizations, no matter what size.  Costs that are often underestimated include IT resources required for system maintenance; recruiting and retaining talent for new areas; ongoing training for new employees; upgrades for resources, training, and hardware; time and resources for optimizing systems and workflow; and expertise in finance and reporting needed to gain the value promised by the EHR.

In the world of EHR adoption, we often spend too much time focusing solely on implementing new software solutions. We know how to prepare well for the go-live event, but after go-live, organizations typically discontinue the investment of time and resources required to see the process through to the adoption phase. When this happens, users tend to fall back on work-arounds and ineffective workflows, and new users receive insufficient training. The process of adoption requires a radically different discipline, where the real effort begins at go-live.

After we successfully implement a new technology, our tendency is to move on to the next project. In a world where it is common to juggle multiple projects, we actually feel some relief in moving it off our list of highest priorities. What we need is a plan to sustain the long-term changes required.  A sustainment plan addresses two important areas. First, it establishes how the organization will support the end users’ ongoing needs for the life of the application. This includes communication, education and maintenance of materials and resources. Second, it establishes how and when metrics will be collected to assess end user adoption and performance. By planning and executing a sustainment plan, we can avoid the steady deterioration in end user adoption that otherwise occurs over time.

Effective sustainability plans require resources, time, and money. Keep in mind that adoption is never static; it is continually either improving or degrading in the organization.  Without a plan for training sustainment, a series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for and fund the investment in sustainment because the ultimate goal is improved performance. Many organizations only achieve modest adoption levels after a go-live event. To truly achieve sustained adoption levels, it takes relentless focus on improving quality of care, patient safety, and financial outcomes. The most successful sustainability plans are part of the organization’s initial budgeting and planning stages for EHR.

Sustainment means more than maintaining the status quo. If sustainment becomes a passive process, it is a waste of resources. The difference between a highly effective sustainment plan and one that is just mediocre is metrics. Consistently measuring end-user knowledge and confidence creates a barometer for proficiency levels and provides the earliest indication of adoption, or use of the application according to best practices. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining, or regressing in their adoption of a new system. If the warning that proficiency is slipping comes early in the process, we have an opportunity to react quickly to address the problem. Knowledge and confidence metrics ensure that the organization is progressing toward high levels of adoption, overcoming barriers, and achieving the efficiencies promised by EHR adoption.  Metrics allow us to adjust quickly and proactively; they are the first indicator of falling back into old behaviors that are inconsistent with sustainable adoption.

Metrics also keep us on track when performance does not meet expectations. Let’s consider two different scenarios to illustrate this idea. In both scenarios, the go-live event was successful, but specific performance metrics did not meet expectations. In the first scenario, the system is being used inefficiently. This may be due to inadequate training and subsequently lower end user proficiency. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and ensure they receive the education they need to become proficient. Once users are proficient, we can refocus our attention on the performance metrics. The second scenario is less common and also more difficult to diagnose: our metrics show that users are proficient, but specific performance measurements are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be delays in achieving certain metrics, especially if the measurements are examining small changes. Normal delays can wreak havoc if we start throwing quick fixes at the problem instead of staying the course and having the confidence in the metrics that will bring about desired results.

Ultimately, leaders must commit the resources, time, and effort to adoption that lasts long after go-live ends.

About Heather Haugen
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.

Changing Leadership’s Mentality to Be More Agile

Posted on August 28, 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.

It’s become increasingly clear that most healthcare CIOs have become leaders and vendor managers. The CIO of today needs to have an understanding of technology, but the majority of their job is managing people and vendors. Hospital CIOs aren’t managing technology.

Much of what a CIO can accomplish is based on the mentality and behaviors they inspire in their people. One of the latest trends in technology thinking is around agile. Many in healthcare have pushed against the concept of agile in healthcare supposing that agile equals reckless. However, it’s been proven that just because you choose to change quickly and efficiently doesn’t mean that you’re changing recklessly in ways that will harm patients.

The move to agile has been hard for many hospital CIOs. This was highlighted recently by hospital CIO, David Chou when he shared this image and tweet:

Culture change in an organization is not really something you can buy. Plus, as the quote specifies, the change to an agile culture is really hard because it is often not the behaviors that put leaders in senior positions in the first place.

The biggest fear with any change is failure. Ironically, an agile approach embraces failure as part of the learning process and incorporates a quick recovery when something goes wrong. This is a massive change in mindset for many senior healthcare executives. It goes counter to the group decision making driven by large committees that occurs in most of healthcare. That’s why it’s scary and why most CIOs don’t do it. However, it’s exactly what’s needed to be prepared for the future.

Centralizing HIM Operations: An Enterprise Approach

Posted on August 15, 2018 I Written By

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

Technological advances, policy changes and organizational restructures are continuously bringing trends to the healthcare industry, specifically impacting healthcare facilities. Centralization of operations is one of those trends. Driven by a value-based model, the centralization of health information management (HIM) aims to streamline operations, standardize processes, reduce costs and improve quality of care and patient satisfaction.

Oftentimes, HIM departments operate with disparate processes due to legacy standard processes and acquisitions of new entities and are unable to efficiently integrate and access information when it is derived from multiple sources. This causes inconsistencies in processes and procedures, as well as incompleteness of information and unavoidable redundancies. Furthermore, decentralization can result in risks such as ineffective information management, inaccurate coding and breaches.

Silos of information hinder standardization, and as a result create compartmentalized pockets of information from sources, slowing down communication and making change more difficult. However, through the use of electronic HIM technology, secure information can be shared and processed across various departments and facilities at a quicker pace than ever before. Taking these efficiencies one step further, instead of siloes of information, many organizations are moving to a centralized model that can reduce operational costs by streamlining organizational performance, establishing consistent processes through standardization and eliminating redundancies.

Patient health information must be linked across the healthcare continuum to provide the best quality of care. Additionally, sources of information must be linked to electronic health records (EHRs) to support centralization and enhance patient care. To connect silos and reduce risks, healthcare facilities must centralize HIM operations to create standardization and improve coordination across the continuum of care.

Benefits of Centralization

Healthcare facilities can greatly benefit from incorporating the centralization of HIM operations into their long-term organizational plans. In fact, the benefits are greater than any hurdles encountered during the transition. Benefits include:

  1. Improves operational efficiency: Moving from a fragmented system to a model that streamlines operations improves efficiency and decreases administrative and operational costs.
  2. Eliminates redundancies and reduces errors: Helps to standardize processes, procedures and forms across a healthcare system to ensure they are the same throughout facilities.
  3. Improves financial performance: Restructuring improves productivity and efficiency as resources are centrally located, which positively impacts the bottom line.
  4. Fosters collaboration: Eliminates silos of communication that cause a stagger in the flow of information – improving communications and optimizing patient outcomes.
  5. Increases accessibility: Provides the benefit of system-wide accessibility to patient information for release purposes, such as billing and coding.
  6. Optimizes workflow: Allows opportunities to reexamine workflows for optimal efficiencies across the HIM continuum, bringing business value.

Driving Transition Towards Centralization

When an organization transitions to centralized HIM operations, it’s important that the journey be completed with the right preparation and execution. HIM professionals must establish processes that foster opportunities for consolidation and standardization that then result in reduced cost, mitigation of risk and overall improved patient care.

Prior to implementing a centralized model, HIM professionals must take certain steps into consideration:

  • Acquire an executive sponsorship to provide direction, support, budget and resolution to potential problems that may arise during the transition.
  • Establish a multidisciplinary steering committee to address centralization and your organization’s information policy, aligning resources with strategy.
  • Identify challenges, gaps, risks and opportunities while working with collaborators to achieve goals for improvements.
  • Define and establish standards, processes and procedures.

Centralization: The Decision is Yours

It is important for HIM professionals to be proactive when determining his or her organization’s vulnerabilities and address them immediately, as breaking down barriers that add risk ultimately drives down costs and improves efficiencies.

Additionally, everyone in an organization may not support the transition. However, executive sponsorship and collaboration between staff, departments and facilities is essential. To gain consensus, HIM professionals must understand the culture of the departments involved and how to leverage their individual technological capabilities.

The work of healthcare professionals is being reshaped by the centralization of HIM operations. If you’re looking to succeed during this ambiguity of change, transforming HIM to a centralized model throughout an enterprise provides healthcare facilities with a competitive advantage, as the integration of emerging technology continues to become a crucial step towards efficient, successful operations.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and is a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

Experts Tell All: How Leaders Ensure Successful Healthcare ERP Adoption

Posted on August 9, 2018 I Written By

The following is a guest blog post by Sallie Parkhurst, Carol Mortimer, Michelle Sanders, and Heather Haugen PhD from Atos Digital Health Solutions.

According to Gartner, approximately 75% of Enterprise Resource Planning (ERP) implementations fail despite the significant opportunity for process management improvement in key business areas including human resources, payroll, supply chain management, and finance.  We gathered critical feedback from experts who have lived through hundreds of implementations across a broad spectrum of industries. Their advice was insightful!

Our discussion focused on three distinct areas where leaders should focus in order to avoid some of the common missteps of large complex implementations. That is, leaders must clearly define their strategic approach to these key business functions beyond the selection of ERP tools. This work spans the system selection and implementation phases of an ERP project. Engaging the appropriate internal experts early in the process ensures effective governance, reality in the “current state” and data accuracy.  This effort is required for the entire life cycle of an ERP.  Finally, leaders need to consider the resources, time and leadership required to continue successful adoption after implementation; this is often left until after implementation and creates significant financial surprises and resource constraints.

Clearly Defined Strategy:

  • Leadership and Communication: Most ERP systems have an impressive array of functions and options to make processes more efficient and effective. How those systems are used in your organization must be defined, communicated, and governed throughout the entire process.  The leadership team is ultimately responsible for this effort, but must consider how to best communicate and engage the entire organization to achieve the goals.  The change management effort is quite extensive and is a key predictor of success!
  • Functionality: The functionality you need should be driven based on your business needs. While this seems obvious, many organizations buy a suite of products that includes more advanced functionality than they need, functionality they can’t take advantage of because of other system constraints, or functionality that requires data from other systems they don’t have. Set the parameters for demos and consider defining the scenarios to get an accurate picture of system capabilities for your specific needs.
  • Interfaces: ERP systems can interface with many different systems ranging from clinical systems to warehouse applications. This is a great opportunity to ensure better overall integration of business processes, but don’t underestimate the work required. Ask about the cost of interfaces, maintenance required, potential impact from upgrades, and any limitations of your current systems and data specifications for accurate and efficient electronic transmission. Also, be sure to ask about any third party vendor software required during discussions involving interfaces.

Engagement of Experts:

  • Knowledge Experts: Most organizations don’t engage their internal experts early enough in the project. Involving your subject matter experts during system selection can be tricky, but it pays big dividends in the end. These experts know the current systems or manual processes, but they also know the workarounds and issues that need to be addressed. Ensure that these people are also involved in defining data tables and other “area specific” customization.
  • Document Current State: This is cumbersome work, but organizations that take the time to define their current workflows gain more efficiency and cost savings from their new ERP systems. When this step is skipped, implementations stressors (time and resources) force the new system to mimic old system processes or manual processes that degrade the overall value of the new system.
  • Competencies and Development: Your new ERP system will probably stretch your team’s competencies, and will often require additional team training. This is a great opportunity to offer growth opportunities in your organization.  It may also require hiring for specific skill sets.
  • Priorities: The toughest question a leader faces when implementing a new system is “What are we going to stop doing to ensure the success of this effort?” Give your team time to focus on and perform high quality work.

Long-Term Commitment

  • Resource commitments: Any large system capable of making dramatic improvements in efficiency and accuracy of business processes will always require an investment of time and resources after implementation. Organizations almost always underestimate the long-term investment associated with maintenance, upgrades, training, and optimization. However, organizations that commit even a few hours per week in a disciplined manner find it easy to maintain and even improve on the value they expect from their ERP.
  • Beyond implementation – achieving adoption: The difference between simply installing a system and achieving business value lies in the long-term commitment by an organization’s leaders to optimize the use of the system.

ERP tools offer a significant opportunity to better manage critical business functions, but adoption of those systems requires:

  1. A clearly defined strategy for the key ERP business functions you plan to implement;
  2. Engagement of your internal experts early and often; and
  3. Commitment of resources and funds to realize the value of your investment.

About the Authors: 

  • Sallie Parkhurst is Senior Project Manager and an expert in Finance for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Carol Mortimer is Senior Consultant and an expert in Supply Chain Management for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Michelle Sanders is Senior Project Manager and an expert in HR and Payroll for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Heather Haugen is the Chief Science Officer for Atos Digital Health Solutions.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

What Clients Value about Atos’ ERP Solutions and Services:

  • Expertise across all ERP business functions
  • Depth of knowledge of the ERP systems and how they function in various environments
  • The combination of industry expertise and system expertise
  • Ability to solve problems and understand clients’ challenges
  • How our team cares about their problems and challenges like they are our own

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.