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Work IT! Optimize Health Technology with EHR Adoption – Breakaway Thinking

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The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
workout
Investing in an electronic health record (EHR) is largely based on the decision to improve patient safety, align with clinical guidelines, enhance revenue cycle times, and capture government-based incentives. But without a proper EHR adoption plan in place, healthcare providers risk never optimizing their investment and achieving their intended goals.

Once an EHR is implemented, healthcare organizations must continue striving toward their goals to optimize their systems. Improving workflows, establishing best practices and increasing overall proficiency of end-users in this application are all components of optimization. Healthcare organizations that are able to maintain this level of focus will see improved clinical and financial outcomes.

This process isn’t easy and requires a commitment to the initial performance metrics that drove the healthcare organization to purchase the new system. Today, nearly half of all healthcare organizations use an EHR, but many struggle to ensure it provides clinical value across the organization. They carefully select and implement systems but fail to make the tool work as originally envisioned. Just because they bought a new EHR doesn’t mean it is serving their patients, providers, or bottom line.

A parallel comparison can be made with buying a high-end, a mobile exercise device to track aerobic and anaerobic steps. Individuals seeking a healthier lifestyle invest in these devices, hoping it will help them achieve their personal health goals. After making the initial investment and adapting daily habits to wear the device, one can begin to adopt the technology to achieve improved health goals. But realizing these goals takes work and commitment. If performance is not monitored, results can plateau and, in some cases, regress. This could result in a growing waist line for the person trying to lose weight, an ironic and unfortunate twist. For healthcare organizations, their growing waistline is unhealthy organizational performance, visible through increases in adverse drug events, recurrent admissions, revenue cycle times and government penalties, all symptoms of goal misalignment. The more healthcare organizations look away from their initial performance goals and utilize EHRs for data storage only, the more noticeable the symptoms become. Both individuals and healthcare organizations can benefit from the process of system optimization to make the tool work for the betterment of the individual or organization.

Extensive research has been conducted by The Breakaway Group (TBG), A Xerox Company, to identify elements that lead to optimization. TBG reports the key adoption elements exhibited by healthcare organizations that optimize their EHRs:

Engaged and Clinically Focused Leadership
Healthcare organizations must demonstrate engaged and clinically focused leadership. Clinical leaders must align their EHR by refining workflows, templates, utilization, and reporting to meet their organizations’ clinical and financial goals. The Chief Medical Information Officer (CMIO) is well suited for this venture.

Targeted Education and Communication
Healthcare organizations must provide targeted education and communication.  When system upgrades are released, organizations must effectively and efficiently educate end users to alleviate reductions in proficiency and productivity.

Comprehensive Metrics
Healthcare organizations must be able to use EHR data.  Organizations must move past the superficial use of an EHR and begin to analyze what is entered. The EHR is of little value, if the data is neither clinically valuable nor used.

Sustained Planning and Focus
Healthcare organizations must sustain planning and focus. Change occurs frequently in healthcare, so system optimization requires preparation, adjustment and real-time communication.

With these adoption elements, healthcare organizations can make their technology work as originally intended—to improve patient and financial outcomes. To overcome the EHR implementation plateau, they must focus on their original performance goals to truly optimize health information technology systems. This process isn’t easy. It requires endurance, but the payoff is worth it. It’s time to “Breakaway” from the status quo and work IT– by optimizing use of HIT systems!

Carrie Yasemin Paykoc
Xerox is a sponsor of the Breakaway Thinking series of blog posts.

August 20, 2014 I Written By

Can We Start Being Human?

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Excuse a moment of somewhat personal commentary, but this story in the New York Times has been making the rounds. Basically, the boards full of smiling babies in a doctor’s office are considered a privacy violation. Here’s an excerpt from the article:

Under the law, the Health Insurance Portability and Accountability Act, baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services. Even if a parent sends in the photo, it is considered private unless the parent also sends written authorization for its posting, which almost no one does.

When I read stories like this, I ask myself “Have we lost all common sense? Can’t we be human?” I get how privacy is important. I’ve written this blog for 9 years and so I know the consequences of HIPAA breaches. Although, I think Dr. Moritz covers my view really well:

“I think we have to have some common sense with this HIPAA business,” Dr. Moritz continued. “To leave medical records open to the public, to throw lab results in the garbage without shredding them, that makes sense” to prohibit. “But if somebody wants to post a picture of something that’s been going on for a millennium and is a tradition, it seems strange to me not to do that,” he said.

I know there are ways to comply with the law and preserve the baby board. Have the parents sign a release form when they drop off the picture. I think you could also add this note in your HIPAA notice that the patient signs before their first visit. However, I think this is missing the point. Isn’t it common sense that someone who sends a picture of their baby to the office isn’t afraid of having that picture shared?

Certainly this change is not life or death stuff. Although, I think the baby boards did provide some humanity to an otherwise sterile office. However, I hate the trend of where this leads. In far too many things we can’t be human anymore. Common sense is missing in so many areas of life and instead of giving people the benefit of the doubt we’re too easy to condemn people who had no ill intent.

I realize there are bad people out there that do bad things. However, they’re the minority and its sad when the minority is able to have such an impact on the majority.

August 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Chinese Hackers Reportedly Access 4.5 Million Medical Records

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The headline of a tech startup blog I read pretty regularly caught my attention today, “Another day, another Chinese hack: 4.5M medical records reportedly accessed at national hospital operator“. The title seems to say it all. It’s almost like the journalist sees the breach as the standard affair these days. Just to be clear, I don’t think he thinks breaches are standard in healthcare, I think he thinks breaches are standard in all IT. As he says at the end of the article:

Community Health Systems joins a long list of large companies suffering from major cybersecurity breaches. Among them, Target, Sony, Global Payment Systems, eBay, Visa, Adobe, Yahoo, AOL, Zappos, Marriott/Hilton, 7-Eleven, NASDAQ, and others.

Yes, healthcare is not alone in their attempt to battle the powers of evil (and some not so evil, but possibly dangerous) forces that are hacking into systems large and small. We can certainly expect this trend to continue and likely get worse as more and more data is stored electronically.

For those interested in the specific story, Community Health Systems, a national hospital provider based in Nashville reported the HIPAA breach in their latest SEC filings. Pando Daily reported that “Chinese Hackers” used a “highly sophisticated malware” to breach Community Health Systems between April and June. What doesn’t make sense to me is this part of the Pando Daily article:

The outside investigators described the breach as dealing with “non-medical patient identification data,” adding that no financial data was stolen. The data, which includes patient names, addresses, birth dates, telephone numbers, and Social Security numbers, was, however, protected under the Health Insurance Portability and Accountability Act (HIPPA).

I’m not sure what they define as financial data, but social security numbers feel like financial data to me. Maybe they meant hospital financial data, but that’s an odd comment since a stack of social security numbers is likely a lot more valuable than some hospital financial data. The patient data they describe could be an issue for HIPAA though.

As is usually the case in major breaches like this, I can’t imagine a chinese hacker is that interested in “patient data.” In fact, from the list, I’d define the data listed as financial data. I’ve read lots of stories that pin the value of a medical record on the black market as $50 per record. A credit card is worth much less. However, I bet if I were to dig into the black market of data (which I haven’t since that’s not my thing), I bet I’d find a lot of buyers for credit card data tied to other personal data like birth date and addresses. I bet it would be hard to find a buyer for medical data. As in many parts of life, something is only as valuable as what someone else is willing to pay for it. People are willing to pay for financial data. We know that.

We shouldn’t use this idea as a reason why we don’t have to worry about the security and privacy of healthcare data. We should take every precaution available to create a culture of security and privacy in our institutions and in our healthcare IT implementations. However, I’m just as concerned with the local breach of a much smaller handful of patient data as I am the 4.5 million medical record breach to someone in China. They both need to be prevented, but the former is not 4.5 million times worse. Well, unless you’re talking about potential HIPAA penalties.

August 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Telemedicine A Critical New Approach To Primary Care

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Telemedical treatment has been a tantalizing possibility for many years, for reasons including a failure of health plans to pay for it and too little bandwidth to support it, but those reasons are quickly being trumped by the need for quick, cheap, convenient care.

In fact, according to research by Deloitte, 75 million of 600 million appointments with general practitioners will be via telemedicine channels this year alone.

While one might assume that this influx is coming from traditional primary care practices which are finding their way online, that doesn’t seem to be the case.

Instead,a growing number of entrepreneurial startups are delivering primary care via smart phone and tablet, including Doctor on Demand and HealthTap, which offers videoconferences with PCPs, and options like Healthcare Magic and JustAnswer, which offer consumers the opportunity to get written responses to their healthcare queries from doctors.

Primary care doctors going into direct primary care are also joining the primary care telemedicine revolution; a key part of their business is based on making themselves available for consultation through all channels, including Skype/Facetime/Google Hangout meetings.

To date, most of the thinking about telemedicine have been that it’s an add-on service which is far to one side of the standard provision of primary care. However,with so many consumers paying out of pocket for primary care — and virtual visits typically priced far more cheaply than on-site visits — we may see a new paradigm emerge in which victims of  high-deductible plans and the uninsured rely completely on telemedical PCPs.

Rather than being merely a new technical development, I believe that the delivery of primary care via telemedical channels is a new form of ongoing primary care delivery.

It will take some work on the part of the telemedicine companies to sustain long-term relationships with patients, notably the use of an EMR to track ongoing care. And telemedicine PCPs will need to develop new approaches to working with other providers smoothly, as coordination of care will remain important. Health IT companies would be wise to consider robust, unified platforms that allow all of this to happen smoothly.

Regardless, the bottom line is that primary care telemedicine isn’t an intriguing sideline, it’s the birth of a new way to think about financing and delivery of care. Let’s see if traditional providers jump in, or if they let the agile new virtual PCP companies take over.

August 15, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The Eligibility Verification Time Suck

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The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts.
Vishal Gandhi
Eligibility verification has always been a challenging part of running a healthcare business. However, that challenge has become even more difficult as the Affordable Care Act has caused a wave of newly insured patients along with patients who are switching insurance carriers flooding into physician offices. Verifying and learning the details of the patients’ new insurance policies has created a lot of new work for a clinic’s staff.

In the perfect world, there would be an automatic verification system that would easily look up a patient’s insurance policy and the details of their plan. While some companies are trying to make automatic insurance verification a reality, it’s currently very weak and still requires a lot of human intervention and interpretation. Maybe one day the payers will fix that, but until then it’s important that a practice creates a smooth process for verifying a patient’s insurance. In many cases this includes hours browsing insurance company websites and internet payer portals or waiting on hold for hours a day on automated voice systems or insurance company call trees. Is that the best use of your staff’s time?

I don’t think I need to describe in detail why having the insurance eligibility and plan details as early as possible is important. If you don’t have this information, your ability to get paid by the patient for the services rendered goes down and your claims denials go up. Plus, many of these new insurance policies are high deductible plans where you’ll need to collect a lot more money than usual from the patient. One way to solve this problem is to know how much the patient owes before or at least while they are in the office. The best opportunity to collect from a patient is when they are standing in front of you.

While internal staff can do a great job verifying insurance eligibility and obtaining benefits summaries, this can be a challenging job while handling all of the other front desk or billing duties as well. One solution to this problem is to outsource the eligibility verification task. A list of scheduled appointments is supplied to the outside company and after verifying insurance coverage for the patients they put the coverage details directly into your appointment scheduler. Obviously the key business question here is to compare the cost, timing, and quality of an outside service against the cost, timing and quality of your current staff doing it.

One related challenge that many practices are facing with all of these new and changing insurance policies is the time staff spend educating the patients. Most patients did not spend time really understanding the insurance policy they were buying. They looked at the price and largely bought without reading the fine print. This often means your staff are tasked with sharing the details of the policy and dealing with any fallout. In some ways, this isn’t a new task. However, the volume has increased.

Another solution offices should consider is doing the eligibility verification well before their appointment. Then, using a secure messaging solution the practice can share a patients’ eligibility and plan details including any co-pays and deductibles with the patient before they even arrive at the office. This early communication gives the patient time to call their insurance provider instead of your practice for all the details. Plus, it makes the patient payment expectation clear before the patient even enters your office.

How much time is your office spending verifying insurance? What solutions are you using to improve your eligibility checking and communication workflow?

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Their Eligibility verification service is a great way to leverage technology and people to solve the eligibility verification problem. ClinicSpectrum also offers a secure messaging product called MessageSpectrum.

August 14, 2014 I Written By

Why You Should Stage Patient Portal Implementations

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In response to a discussion I started on LinkedIn about the 4 Things Your Patient Portal Should Include, Travis Moore, MBA, RN, VP at MEDSEEK, added some really great insight into how to have a successful patient portal implementation:

I agree with your assessment on trying to do too much. While many portals on the market, including MEDSEEK’s Empower Patient Portal offer a variety of features, what we at MEDSEEK have found is that it is best to roll out with a subset of features vs. the “big bang” approach for two major reasons. One, you don’t want to overwhelm patients with too many features, as they don’t end up using the “essential” ones appropriately to better activate them in their care. It’s like buying the SLR camera that does 100 things. Reality is, you use 3 of the features for a period of time to get the job done, but then over time, you get comfortable and want to take on more because you take a class, a friend teaches you, etc., and your photos become even better. Same for patient portals, you have to have the features available for future use to further enhance the experience, but roll them out methodically.

And two, many organizations just can’t handle the “do everything at once” deployment, operationally speaking. It’s not a technology “thing”, it’s an operational and cultural issue. I can say from first hand experience as Nurse on both the usage, and deployment end, you have to deploy these patient engagement tools in chunks because if your front line personnel, nurses, aren’t able to clearly articulate to the patient what value it will bring to them when they access it, patients are less likely to use the variety of features in a patient portal. And to Mike’s point about a comprehensive view, that’s exactly why an Enterprise solution is required to bring all of that data together into one view for the patient….and with ACOs, the importance of the enterprise access is even more critical. Patient’s don’t know or care what EMRs, scheduling, or billing systems an HCO has, they just want the “Expedia or Banking-like” experience to see and act upon the information regardless of the source system. It is also critical moving forward that interactive plans of care are accessible and actionable for the patients, and / or their family members, to better engage and activate patients in their care where they spend most of their time, outside the four walls of the organization.

I like the idea of a staged portal implementation. Unfortunately, sometimes that’s not possible since some patient portals are an all or nothing exercise. Plus, meaningful use has accelerated so many implementations. It’s too bad, because there’s real value in staged deployments. The beauty of staged deployments is that once you roll out a few features, then people are interested in what else you can roll out. I’ve seen this same principle work in staged EHR implementations as well. Of course, that provides the added challenge of being ready to roll out the rest of the features as well. Otherwise, you end up with unhappy end users.

August 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

What Can We Learn from Robin Williams

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“You treat a disease, you win, you lose. You treat a person, I’ll guarantee you’ll win.” – Robin Williams

One of the best quotes from the amazing movie Patch Adams. Maybe it was naive of me, but when I got my first job in healthcare I thought a lot about the movie Patch Adams. Besides being a great movie, it illustrated so well the impact great healthcare can have on people’s lives.

I realize that as an IT person I only have a tangential impact on patients, but that’s ok with me. I still know the impact I can have on many people’s lives and that’s exciting to me. Sitting in board rooms or IT offices, we could use more people thinking about the patient and not just the bottom line. I think that’s the message of Patch Adams that’s portrayed so well by Robin Williams.

Here’s another clip from one of my favorite Robin William’s movies: Read more..

August 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Complete Health IT Security is a Myth, But That Doesn’t Mean We Shouldn’t Try

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As I mentioned, last week I had the opportunity to attend the Black Hat conference in Las Vegas. There were over 9000 attendees and 180+ speakers sharing on the latest and greatest IT security and privacy topics. Black Hat is more appropriately called a hackers conference (although Defcon is more hardcore hacker than Black Hat which had plenty of corporate prensence) for good reason. You turn off your devices and be careful what you do. There’s a certain paranoia that comes when one of the vendor handouts is a foil credit card cover that prevents someone from stealing your credit card number. I didn’t quite have my tin foil hat on, but you could start to understand the sentiment.

One of the most interesting things about Black Hat is to get an idea of the mentality of the hacker. Their creative process is fascinating. Their ability to work around obstacles is something we should all learn to incorporate into our lives. I think for most of these hackers, there’s never a mentality of something can’t be done. It’s just a question of figuring out a way to work around whatever obstacles are in their way. We could use a little more of this mentality in dealing with the challenges of healthcare.

The biggest thing I was reminded of at the event was that complete security and privacy is a myth. If someone wants to get into something badly enough, they’ll find a way. As one security expert I met told me, the only secure system is one that’s turned off, not connected to anything, and buried underground. If a computer or device is turned on, then it’s vulnerable.

The reality is that complete security shouldn’t be our goal. Our goal should be to make our systems secure enough that it’s not worth someone’s time or effort to break through the security. I can assure you that most of healthcare is far from this level of security. What a tremendous opportunity that this presents.

The first place to start in any organization is to create a culture of security and privacy. The one off efforts that most organization apply after a breach or an audit aren’t going to get us there. Instead, you have to incorporate a thoughtful approach to security into everything you do. This starts at the RFP continues through the procurement process extends into the implementation and continues on through the maintenance of the product.

Security and privacy efforts in an organization are hard to justify since they don’t increase the bottom line. This is another reason why the efforts need to be integrated into everything that’s done and not just tied to a specific budget line item. As a budget line item, it’s too easy to cut it out when budgets get tight. The good news is that a little effort throughout the process can avoid a lot of heartache later on. Ask an organization that’s had a breach or failed an audit.

August 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Comprehensive Patient View, Social Media Time, and Linking Millions of EMR

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You don’t really need to click on the link above. The answer is no. The answer is that it probably won’t ever happen. There are just too many source systems where our health data is stored and it’s getting more complicated, not less.


If the social media maven Mandi has a challenge getting her social media on, now you can understand why many others “don’t have the time.” It takes a commitment and many don’t want to make that commitment. It doesn’t make them bad people. We all only have so many hours in a day.


No need to read this link either. Although, I found it great that they described the challenge as linking millions of EMR. Let’s be generous and say there are 700 EHR vendors. Unfortunately, that doesn’t describe what it takes to make EMR interoperable. To use a cliche phrase, if you’ve connected with one Epic installation, you’ve connected with one Epic installation. I know it’s getting better, but it’s not there. If you want interoperable EMR data, you need to connect a lot of different installs.

August 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Some Friday HIPAA Humor

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It’s Friday after a long week for me and I imagine many of you. So, let’s keep today post short and simple and hopefully give you a little laugh. Nothing like humor to help make any day better.

HIPAA Cartoon

Thanks to Practice Manager Solutions for sharing it with me.

August 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.