Physicians are people too…right?

When it comes to working with physicians,  we’ve seen their involvement in this healthcare technology world at opposite ends of the spectrum.

The younger,  more technologically savvier physicians who have been used to technology from the early 80s to now, seem to somewhat adapt to using EMRs. They are characterized by their comfort with all things digital and their disdain for a paper process and being eco-friendly. While this isn’t always the case, this is mostly attributed to younger, 45/50 and under physicians.

The older,  more experienced physicians who have been around practicing for 3 decades or more have generally been extremely resistant to the current change and have at times,  even retired rather than continue to use EMRs on the grounds that it takes away from their focus on the patient, which can make for an good debate. I’ve also heard that some of the older physicians don’t feel like they need to be “engaged with their patients” as “the way they have been practicing medicine all these years is fine”. Millennial physicians,  early to mid 30s take to technology as if they were born with it. As digital natives,  they have the ability to be the most productive and efficient when it comes to EMR usage.

Also, their has been a divide when it comes to adoption by small and large practices. Smaller practices have had to think about how they can deal with the process of purchasing EMR capabilities and this has not always been easy. During a project in California, we studied how we can get pediatricians to refer patients to the hospital I was working at and how to make sure the referral process was smooth for them; whether it was directly from their PC and their own EMR system or if they needed to login to a portal with their credentials and how it would then go to the correct clinic at the specialty pediatric facility I was working at the time.

For anyone in the care delivery IT arena, this is old news, but really needed to be said. The question is whether if the digital divide has an impact on the quality of your care and if this trend continues, will we lose our senior, experienced physicians to Meaningful Use?

According to an article out by USA Today (dated 6/30/2014), the United States is expected to need 52,000 more primary care physicians by the year 2025 based on research by the Robert Graham Center and funding for teaching hospitals expires in the latter part of 2015. Due to the Affordable Care Act, the need for family physicians to 8000. As a nation, we cannot afford to lose these experienced physicians at a juncture when more physicians are required than ever before.

Fewer clicks is the trick! Optimization initiatives key to clinical efficiencies

I was talking to a leader in a well-known pediatric facility in the south west the other day and they had mentioned that they had identified a few hundred separate opportunities for optimization and they planned to rank these to understand the order in which they focus their resources, time and energy over the next several months. Several thousand hours of work effort can be the timeframe for such initiatives and this occurs when clinical workflow follows the EMR versus the other way round.

As organizations are now facing the prospect of having to improve the efficiency of their EMR workflow, their initiatives to optimize across their clinical settings become more imperative. Improving the workflow of the physicians and clinicians that use the EMR for patient care needs to occur if the full potential of these very expensive systems implementations can be realized. After attesting for meaningful use for and receiving payment from CMS many early adopter organizations put in a great deal of work effort to quickly install, train and begin to using their EMR system so that their physicians would see some return from the efforts. Not all of the deployments of EMRs can as closely match the pre-EMR implementation workflow and exact documentation prior to go live of the system.

These initiatives are reminiscent of the post ERP implementation days right after Y2K when many organizations had implemented their ERP systems without taking into account their own internal processes and they focused on implementing the software without a thought for post implementation support. Other projects such as EMR upgrades, break fix, meaningful use and we continue to deal with ICD-10 would hinder the work of the resources as getting them to focus on a particular project when 4 to 5 others are still on the docket, is incredibly difficult.

While realizing that many physicians (at least mostly more experienced ones) are not as excited about using their EMR, they will be the ones that will ask if they can get their patient care completed with “fewer clicks”. Working with your EMR vendor to understand best practices that they have had the opportunity to work on, being able to focus on enhancing particular areas that your current post implementation functionality does not yet support and possibly sun setting some systems as their day has arrived due to their technology being obsolete or to expensive to maintain.

Focus on “Defining” what your optimization objective needs to be and make sure that you create a governance structure as your optimization initiative must be able to be reviewed by a governing body of IT, physician champions and operational leaders that aligns your optimization initiative with your organization’s mission and goals and the decision making for the initiative is clear and efficient. Make sure that your Project Charter clearly sets forth your optimization goals. “Measuring” what process you want to improve needs to be completed. For instance, if it is truly reducing the number of clicks that a physician has to go through, then understand what their current process is and record the data for how they perform patient care currently.

Analyzing the data to understand what makes the process defective and then discuss with the clinician what they think could be a better workflow. Work with the vendor to see if their suggestions can be incorporated to “Improving” the process and after “go live” of the new process, make sure that the sign off by the physician/clinician has occurred and “Control” the environment so that the new process can take effect smoothly.

Getting your optimization initiative done right will pave the way for qualitative and quantitative rewards for your organization. In the world of increased patient engagement and “digital native-ness” of the patient population, having a thoughtful clinical optimization strategy will give your provider organization the efficiencies it needs to compete in a faster paced healthcare ecosystem.



The Healthcare Ecosystem – IT initiatives at Payers and Providers

Provider & PayerI enjoy understanding the different aspects of the healthcare IT ecosystem and working to make collaboration in healthcare a much more transparent process. I’ve been fortunate that for the most part over the last couple of years, I have worked with very collaborative people. In a sense, I’ve seen the positive aspects of great collaboration.

During a meeting earlier today, I was able to get insight into some of the priorities at the other side of the healthcare ecosystem; the payer side of the world. While some of the regulatory priorities are the same, it sounded like that there was a much better maturity in terms of their ability to govern their initiatives and pivot where required. One thing though is somewhat similar. ICD-10 project is suspended and possibly postponed. Concern over whether CMS will do away with ICD-10 altogether is somewhat high. That isn’t going away as it has been delayed twice already and all of healthcare is not happy about their hard work over the last couple of years not bearing fruit. Thoughts are that ICD-10 projects would be suspended until the end of the year by payers, (generally much better at getting those initiatives accomplished) or the beginning of next year and integrated testing between payers and providers may resume, barring any further delay by Washington. XP to Win7 migrations still seem to be going on as are optimization initiatives. Security will continue to dominate and the movement to utilize the cloud needs to get stronger as each day passes. If we can do banking transactions online and file our taxes online, why can’t we securely get our healthcare initiatives executed through the cloud.

ERP though (yes I did say ERP, a voice from the past comes back) is still on the minds of Payers and they will need to think about the alternatives there in order to lower the costs of management as they have cost pressures due to the 80/20 rule and the 85/15 rule that I have spoken about in the past and will discuss in a future post again. Retaining members, being able to derive analytics from their data and be able to accurately leverage it for member benefit was a nice thing I heard today.

There still seems to be quite a bit of ambiguity as to the healthcare insurance marketplace, which I know has been a hotly contested and politicized issue (so I won’t discuss it further here).

Oh, a free plug for my favorite HIMSS Chapter. Don’t forget to attend the CSO HIMSS conference this Thursday (yes Thursday) in Wilmington at the Roberts Center. See for registration and the agenda. See you there.

Healthcare Information Revolution

We are living through the information revolution and the amount of information we generate is phenomenal. How are we going to harness the power of this information for our benefit and how are we going to store this data in ever increasing amounts? Our parents and grandparents were products of the industrial revolution. We are in the middle of the data and information revolution.

Capturing and harnessing this data for effective clinical and operational use by our provider organizations is part of the future of our healthcare ecosystem. Leveraging the power of predictive analytics that is already being used in the areas of retail and marketing to mine such areas as social media data is transforming our everyday lives.
As a new generation of healthcare IT dawns, individuals who have never been in healthcare before now are entering in from other verticals and sharing what is achievable in our healthcare ecosystem by using technologies that have been in use elsewhere for years, but are now, new to healthcare. This is the new healthcare world we live in.

Interoperability Odyssey: 2024

The final frontier….the search for healthcare utopia where your records follow you seamlessly across the continuum of care without incident. It seems to be fantasy, but that might be what the office of the Office of the National Coordinator for Health Information Technology came out with a paper and a call for collaboration among stakeholders to share with them ideas and suggestions that would help in the achievement of this goal of interoperability over the next decade and the road beyond.

In their vision of the future, they want individuals, healthcare providers, communities, and healthcare researchers to be able to have many healthcare IT products and services that are interoperable and allow the healthcare system to learn on a continuous basis and be able to move the goal of “improved health care.” Patient engagement between care provider and patient would be constant and patients would be well informed as to their care roadmap and be able to be partners in their wellness.

I was excited on the encouraging news in that all 50 US states have a sort of health information exchange and that 50% of hospitals can electronically search for patient information from sources beyond their own organization and over 50% of office-based professionals and more than 80% of hospitals “are meaningfully using electronic health records which will require them to electronically exchange standardized patient information to support safe care transitions.”

In how they envision the nation getting there, they mentioned their focus on certain “Guiding Principles” for the future of the “health ecosystem, namely:

  1. Build upon the existing health IT infrastructure.
  2. One size does not fit all.
  3. Empower individuals.
  4. Leverage the market.
  5. Simplify.
  6. Maintain modularity.
  7. Consider the current environment and support multiple levels of advancement.
  8. Focus on value.
  9. Protect privacy and security in all aspects of interoperability.

The document followed up with a focus on a 3 year agenda with the paragraph titled “Send, Receive, Find, and Use Health Information to Improve Health Care Quality” that discussed  the development of an “interoperability roadmap as articulated in HHS Principles and Strategy for Accelerating Health Information Exchange.” The focus was on ensuring that the population as well as healthcare providers leveraged the basic set of health information across the continuum of care so that care coordination is enhanced and give us the ability to improve the quality of care.

It continued with a 6 year agenda that covered, aside from what was in the 3 year agenda, such things as a “multi-payer claims databases, clinical data registries, and other data aggregators will incrementally become more integrated as part of an interoperable technology ecosystem“.

Finally, in the 10 year agenda to take us to 2024, 4 building blocks are envisioned on how we achieve a state of initial interoperability:

  1. Core Technical Standards and Functions
  2. Certification to support adoption and optimization of Health IT products and services
  3. Privacy and security protections for health information
  4. Supportive business, clinical, cultural, and regulatory environment

In addition, it mentions a focus on data quality and reliability as part of the foundations for interoperability. The ability to engage with stakeholders and focus on operationalizing a common framework in order to grow trust by addressing issues such as privacy, security, business policy and practice challenges to move forward the ability to have secure and authenticated health information exchange through the care continuum.

The plan envisages working with all stakeholders and hone the use of healthcare IT infrastructure that was enabled through the HITECH Act in order to support the paradigm shift in healthcare towards a more patient centric, “less wasteful and higher quality system”.

In closing, they realize that it will take some time to be able to build an interoperable system that will improve the quality of care across the continuum, but say that HHS is committed to the cause of interoperability across all care settings through a roadmap that makes incremental changes that calls upon a collaborative focus to achieve the opportunities presented to all of us to improve the health and well being of our communities.


EHR implementations – A walk in the park…right?

Successful EHR implementations…is that an oxymoron? Can anything be called successful when there are so many stakeholders with so many differing opinions on what “successful” actually is? Ultimately in my mind, if the patient is served in the way that can help their care provider efficiently manage their care in way that aids in the recovery process, I would believe that the medical record has done it’s job and therefore the provider has had a successful group of initiatives.

Hearing of yet another CEO of a healthcare provider who has resigned in Georgia over the poor rollout of the EHR only emboldens critics of the move towards electronic health records. With the reluctance by many physicians to make this change, leveraging a CMIO will allow for an individual that exudes empathy towards their challenges. Building a strong strategy and having a good working relationship with a vendor or a set of vendors will help your chances of success greatly. Realizing that this will be a collaborative organizational endeavor is the first step in the road to success. Reaching out to organizations that have done this before and being able to “not reinvent the wheel” will greatly assist your team.

Many IT and provider organizations seem to think that reaching out is a weakness. It is actually, in my opinion, shows strength of character as show you want to make sure that your patients have the best possible care through efficient processes and use of resources. I heard of an organization in one of the Carolinas recently that refused assistance from another provider who had completed their EHR implementation. I wondered what would possess them not to take them up on their offer. I’m proud that our Ohio organizations collaborate and I have personally seen instances of positive information and best practices sharing that I know this to be true.

Defining an implementation time line that is realistic, but also does not drain your resources and allowing for risks, both negative and positive that could affect it. Leveraging outside groups to give you an understanding of budgeting for your initiative (such as attending HIMSS conferences, both chapter and national) would help in this task. Being able to get the appropriate stakeholders and clinical personnel to document clinical workflow requirements, both in terms of software requirements and hardware or infrastructure needs. Many forget the budget for hardware and will need to work with operational and administrative staff to understand the full extent of their current workflows that require such things as bar code scanners, medication dispensing stations, zebra printers and the requirements for PC or laptop distribution and deployments along with the needs of authentication due to comply with their states board of pharmacy requirements.

Understanding the needs of Revenue Cycle and not setting go lives around such things as, for instance the new date for ICD-10 go live (now October 1st, 2015) is crucial in being able to appropriately utilize as much of the same resources for a single initiative as possible.

Being good change managers and training the practices in as many aspects of the initiative as possible, keeping in mind that it is easy to forget the functionality of the new system and having patience during the cutover process are keys to this long, but in my opinion, ultimately needed endeavor.