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Don’t Yell FHIR in a Hospital … Yet

Posted on November 30, 2016 I Written By

The following is a guest blog post by Richard Bagdonas, CTO and Chief Healthcare Architect at MI7.
richard-bagdonas
The Fast Healthcare Interoperability Resource standard, commonly referred to as FHIR (pronounced “fire”) has a lot of people in the healthcare industry hopeful for interoperability between the electronic health record (EHR) systems and external systems — enabling greater information sharing.

As we move into value-based healthcare and away from fee-for-service healthcare, one thing becomes clear: care is no longer siloed to one doctor and most certainly not to one facility. Think of the numerous locations a patient must visit when getting a knee replaced. They start at their general practitioner’s office, then go to the orthopedic surgeon, followed by the radiology center, then to the hospital, often back to the ortho’s office, and finally to one or more physical therapists.

Currently the doctor’s incentives are not aligned with the patient. If the surgery needs to be repeated, the insurance company and patient pay for it again. In the future the doctor will be judged and rewarded or penalized for their performance in what is called the patient’s “episode of care.” All of this coordination between providers requires the parties involved become intimately aware of everything happening at each step in the process.

This all took off back in 2011 when Medicare began an EHR incentive program providing $27B in incentives to doctors at the 5,700 hospitals and 235,000 medical practices to adopt EHR systems. Hospitals would receive $2M and doctors would receive $63,750 when they put in the EHR system and performed some basic functions proving they were using it under what has been termed “Meaningful Use” or MU.

EHR manufacturers made a lot of money selling systems leveraging the MU incentives. The problem most hospitals ran into is their EHR didn’t come with integrations to external systems. Integration is typically done using a 30 year old standard called Health Level 7 or HL7. The EHR can talk to outside systems using HL7, but only if the interface is turned on and both systems use the same version. EHR vendors typically charge thousands of dollars and sometimes tens of thousands to turn on each interface. This is why interface engines have been all the rage since they turn one interface into multiple.

The great part of HL7 is it is standard. The bad parts of HL7 are a) there are 11 standards, b) not all vendors use all standards, c) most EHRs are still using version 2.3 which was released in 1997, and d) each EHR vendor messes up the HL7 standard in their own unique way, causing untold headaches for integration project managers across the country. The joke in the industry is if you have seen one EHR integration, you’ve seen “just one.”

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HL7 versions over the years

HL7 version 3.0 which was released in 2005 was supposed to clear up a lot of this integration mess. It used the Extensible Markup Language (XML) to make it easier for software developers to parse the healthcare messages from the EHR, and it had places to stick just about all of the data a modern healthcare system needs for care coordination. Unfortunately HL7 3.0 didn’t take off and many EHRs didn’t build support for it.

FHIR is the new instantiation of HL7 3.0 using JavaScript Object Notation (JSON), and optionally XML, to do similar things using more modern technology concepts such as Representation State Transfer (REST) with HTTP requests to GET, PUT, POST, and DELETE these resources. Developers love JSON.

FHIR is not ready for prime time and based on how HL7 versions have been rolled out over the years it will not be used in a very large percentage of the medical facilities for several years. The problem the FHIR standard created is a method by which a medical facility could port EHR data from one manufacturer to another. EHR manufacturers don’t want to let this happen so it is doubtful they will completely implement FHIR — especially since it is not a requirement of MU.

And FHIR is still not hardened. There have been fifteen versions of FHIR released over the last two years with six incompatible with earlier versions. We are a year away at best from the standard going from draft to release, so plan on there being even more changes.

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15 versions of FHIR since 2014 with 6 that are incompatible with earlier versions

Another reason for questioning FHIR’s impact is the standard has several ways to transmit and receive data besides HTTP requests. One EHR may use sockets, while another uses file folder delivery, while another uses HTTP requests. This means the need for integration engines still exists and as such the value from moving to FHIR may be reduced.

Lastly, the implementation of FHIR’s query-able interface means hospitals will have to decide if they must host all of their data in a cloud-based system for outside entities to use or become a massive data center running the numerous servers it will take to allow patients with mobile devices to not take down the EHR when physicians need it for mission-critical use.

While the data geek inside me loves the idea of FHIR, my decades of experience performing healthcare integrations with EHRs tell me there is more smoke than there is FHIR right now.

My best advice when it comes to FHIR is to keep using the technologies you have today and if you are not retired by the time FHIR hits its adoption curve, look at it with fresh eyes at that time. I will be eagerly awaiting its arrival, someday.

About Richard Bagdonas
Richard Bagdonas has over 12 years integrating software with more than 40 electronic health record system brands. He is an expert witness on HL7 and EDI-based medical billing. Richard served as a technical consultant to the US Air Force and Pentagon in the mid-1990’s and authored 4 books on telecom/data network design and engineering. Richard is currently the CTO and Chief Healthcare Architect at MI7, a healthcare integration software company based in Austin, TX.

Vendor Study Says Wearables Can Promote Healthy Behavior Change

Posted on November 28, 2016 I Written By

Anne Zieger 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.

A new study backed by a company that makes an enterprise health benefits platform has concluded that wearables can encourage healthy behavior change, and also, serve as an effective tool to engage employees in their health.

The data from the study, which was sponsored by Mountain View, CA-based Jiff, comes from a two-year research project on employer-sponsored wearables. Rajiv Leventhal, who wrote about the study for Healthcare Informatics, argues that these findings challenge common employer beliefs about these type of programs, including that participation is typically limited to young and healthy employees, and that engagement with these rules can’t be sustained over time.

The data, which was drawn from 14 large employers with 240,000 employees, apparently suggests that wearable adoption and long-term engagement is possible for employees of all ages. The company reported that among the employers offered the wearables program via its enterprise health platform, 53% of employees under 40 years old participated, and 36% of employees over 50 years participated as well.

Jiff researchers also found that employee engagement had not measurably fallen for more than nine months following the program rollout, and that for one employer, levels of engagement have been progressively increasing for more than 18 months, the company reported.

According to Jiff, they have helped sustain employee engagement by employing three tactics:  Using “challenges,” time-bound immersive and social games that encourage healthy actions, “device credits,” subsidies that offset the cost of purchasing wearables and “behavioral incentives,” rewards for taking healthy actions such as walking a minimum number of steps per day.

The thing is, as interesting as these numbers might be — and they do, if nothing else, underscore the role of engaging consumers rather than waiting for them to engage with healthier behaviors on their own — the story doesn’t address one absolutely crucial issue, to wit, what concrete health impact are companies seeing from employee use of these devices.

I don’t think I’m asking for too much here when I demand some quantitative data suggesting that the setup can actually achieve measurable health results. Everything I’ve read about employee wellness initiatives to date suggests that they’ve been a giant bust, with few if any accomplishing anything measurable.

And here we have Jiff, a venture-backed hotshot company, which I’m guessing had the resources to report on results if it found any. After all, if I understand the study right, with their researchers had access to 540,000 employees for significant amount of time.  So where are the health conclusions that can be drawn from this population?

And by the way, no, I don’t accept that patient engagement (no matter how genuine) can be used as a proxy or predictive factor for health improvement. It’s a promising step in the right direction but it isn’t the real thing yet.

So, I shared the study with you because I thought you might find it interesting. I did. But I wouldn’t take it too seriously when it comes to signs of real change — either for wearables used for employee wellness initiatives. At this point both are more smoke than substance.

A Thankful Look at Healthcare Scene

Posted on November 22, 2016 I Written By

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

I’ve been recently working on the Healthcare Scene media kit (still being edited as we speak) and a presentation that illustrates the influence of Healthcare Scene. As part of that slide deck I gathered the numbers for this slide:

healthcare-scene-overview

As I look at any of these numbers, I have to admit that it’s really hard for me to comprehend any of them. We’re approaching the 11th anniversary of Healthcare Scene and it’s really hard for me to imagine how far we’ve come since that weekend I got bored and started blogging about EMR.

This week of gratitude, I’m particularly grateful for those people who trust Healthcare Scene for their daily cup of what’s interesting in healthcare IT. Amidst all the noise that exists in this world, it’s quite humbling to think that so many people look to this network of blogs to stay informed.

Just as humbling is the hundreds of companies that have sponsored the work we do at Healthcare Scene. What’s best is that most of our sponsors started out as readers. It’s gratifying to know that they valued the work we do enough to support our sites. A big thanks to our current crop of sponsors: The Breakaway Group, Stericycle Communications Solutions, HIPAA One, Kareo, Iron Mountain, Intel Health, Samsung, HIM on Call, Central Learning, Greythorn, Innovative Consulting Group, Cumberland Consulting Group, EMR Staffing Partners, UCSD Master in Health Informatics (Online)Galen Healthcare Solutions, and 4MedApproved. As sponsors, I’ve gotten to know each of these organizations quite well and they are all working hard to improve healthcare.

This Thanksgiving Week, I just wanted to take a minute to celebrate and show gratitude to all of you. Thanks for reading. Thanks for commenting. Thanks for sponsoring. Thanks for sharing on social media. Thanks for the private messages and responses. Thanks for the likes and hearts and favorites and retweets. I feel blessed to be part of such an amazing community. I can’t wait to see what happens with healthcare IT over the next decade.

Are Healthcare Data Streams Rich Enough To Support AI?

Posted on November 21, 2016 I Written By

Anne Zieger 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.

As I’ve noted previously, artificial intelligence and machine learning applications are playing an increasingly important role in healthcare. The two technologies are central to some intriguing new data analytics approaches, many of which are designed to predict which patients will suffer from a particular ailment (or progress in that illness), allowing doctors to intervene.

For example, at New York-based Mount Sinai Hospital, executives are kicking off a predictive analytics project designed to predict which patients might develop congestive heart failure, as well as to care for those who’ve are done so more effectively. The hospital is working with AI vendor CloudMedx to make the predictions, which will generate predictions by mining the organization’s EMR for clinical clues, as well as analyzing data from implantable medical devices, health tracking bands and smartwatches to predict the patient’s future status.

However, I recently read an article questioning whether all health IT infrastructures are capable of handling the influx of data that are part and parcel with using AI and machine learning — and it gave me pause.

Artificial intelligence, the article notes, functions on collected data, and the more data AI solution has access to, the more successful the implementation will be, contends Elizabeth O’Dowd in HIT Infrastructure. And there are some questions as to whether healthcare IT departments can integrate this data, especially Internet of Things datapoints such as wearables and other personal devices.

After all, O’Dowd notes, for the AI solution to crawl data from IoT wearables, mobile apps and other connected devices, the data must be integrated into the patient’s medical record in a format which is compatible with the organization’s EMR technology. Otherwise, the organization’s data analytics solution won’t be able to process the data, and in turn, the AI solution won’t be able to evaluate it, she writes.

Without a doubt, O’Dowd has raised some important issues here. But the real question, as I see it, is whether such data integration is really the biggest bottleneck AI and machine learning must pass through before becoming accessible to a wide range of users. For example, healthcare AI-based Lumiata offers a FHIR-compliant API to help organizations integrate such data, which is certainly relevant to this discussion.

It seems to me that giving the AI every possible scrap of data to feed on isn’t the be all and end all, and may even actually less important than the clinical rationale developers uses to back up its work. In other words, in the case of Lumiata and its competitors, it appears that creating a firm foundation for the predictions is still as much the work of clinicians as much is AI.

I guess what I’m getting to here is that while AI is doubtless more effective at predicting events as it has access to more data, using what data we have with and letting skilled clinicians manage it is still quite valuable. So let’s not back off on harvesting the promise of AI just because we don’t have all the data in hand yet.

Quality Reporting: A Drain on Practice Resources, New Study Shows

Posted on November 17, 2016 I Written By

The following is a guest blog post by Steven Marco, CISA, ITIL, HP SA and President of HIPAA One®.
Steven Marco - HIPAA expert
If time is money, medical practices are sure losing a lot of both based on the findings in a new study published in Health Affairs. The key take-a-way, practices spend an average of 785 hours per physician and $15.4 billion per year reporting quality measures to Medicare, Medicaid and private payers.

The study, conducted by researchers from Weill Cornell Medical College, assessed the quality reporting of 1,000 practices, including primary care, cardiology, orthopedic and multi-specialty and the findings are staggering.

Practices reported spending on average 15.1 hours per week per physician on quality measures. Of that 15.1 hours per week, physicians account for 2.6 hours with the rest of the administrative work divided between nurses and medical assistants. About 12 of those 15.1 hours are spent logging data into medical records solely for quality reporting purposes. Additionally, despite a wealth of software tools on the market today, about 80 percent of practices spend more time managing quality measures than they did three years ago and half call it a “significant burden.”

Aside from the major drain on administrative resources, there are heavy financial ramifications for such lengthy and cumbersome reporting as well. The report found practices spend an average of $40,069 per physician for an annual national total of $15.4 billion.

The findings of this study clearly demonstrate the need for greater reporting automation in the healthcare industry. By embracing technology to manage labor-intensive, error-prone and mundane tasks; practices free up their staff to focus on patient care. In the past few years, we have watched electronic medical record (EMR) companies do just that by embracing cloud-based software solutions.
physician-and-administrator-growth-over-time
This overwhelming administrative bloat and financial burden can be addressed by implementing software tools and solutions designed to streamline reporting and compliance management. For example, if your practice or organization is still conducting your annual risk analysis through spreadsheets and other manual methods, it is time to embrace automation and a Security Risk Analysis software solution. Designed to control costs, a cloud based Security Risk Analysis solution automates 78% of the manual labor needed to calculate risk for organizations of all size.

There’s no time like the present to embrace best practices for your quality reporting. Allow technology to do the heavy lifting and free up your resources.

About Steven Marco
Steven Marco is the President of HIPAA One®, leading provider of HIPAA Risk Assessment software for practices of all sizes.  HIPAA One is a proud sponsor of EMR and HIPAA and the effort to make HIPAA compliance more accessible for all practices.  Are you HIPAA Compliant?  Take HIPAA One’s 5 minute HIPAA security and compliance quiz to see if your organization is risk or learn more at HIPAAOne.com.

What Would A Community Care Plan Look Like?

Posted on November 16, 2016 I Written By

Anne Zieger 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.

Recently, I wrote an article about the benefits of a longitudinal patient record and community care plan to patient care. I picked up the idea from a piece by an Orion Health exec touting the benefits of these models. Interestingly, I couldn’t find a specific definition for a community care plan in the article — nor could I dig anything up after doing a Google search — but I think the idea is worth exploring nonetheless.

Presumably, if we had a community care plan in place for each patient, it would have interlocking patient-specific and population health-level elements to it. (To my knowledge, current population health models don’t do this.) Rather than simply handing patients off from one provider to another, in the hope that the rare patient-centered medical home could manage their care effectively on its own, it might set care goals for each patient as part of the larger community strategy.

With such a community care strategy, groups of providers would have a better idea where to allocate resources. It would simultaneously meet the goals of traditional medical referral patterns, in which clinicians consult with one another on strategy, and help them decide who to hire (such as a nurse-practitioner to serve patient clusters with higher levels of need).

As I envision it, a community care plan would raise the stakes for everyone involved in the care process. Right now, for example, if a primary care doctor refers a patient to a podiatrist, on a practical level the issue of whether the patient can walk pain-free is not the PCP’s problem. But in a community-based care plan, which help all of the individual actors be accountable, that podiatrist couldn’t just examine the patient, do whatever they did and punt. They might even be held to quantitative goals, if the they were appropriate to the situation.

I also envision a community care plan as involving a higher level of direct collaboration between providers. Sure, providers and specialists coordinate care across the community, minimally, but they rarely talk to each other, and unless they work for the same practice or health system virtually never collaborate beyond sharing care documentation. And to be fair, why should they? As the system exists today, they have little practical or even clinical incentive to get in the weeds with complex individual patients and look at their future. But if they had the right kind of community care plan in place for the population, this would become more necessary.

Of course, I’ve left the trickiest part of this for last. This system I’ve outlined, basically a slight twist on existing population health models, won’t work unless we develop new methods for sharing data collaboratively — and for reasons I be glad to go into elsewhere, I’m not bullish about anything I’ve seen. But as our understanding of what we need to get done evolves, perhaps the technology will follow. A girl can hope.

The Impact of the 2016 Election on Healthcare IT

Posted on November 9, 2016 I Written By

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

Today it’s pretty obvious that the Presidential is on everyone’s mind. While I don’t plan to discuss the details of the election and the specific results, it’s worth thinking about what Donald Trump in the white house will mean for healthcare IT.

Let’s start off with the easy one: Meaningful Use/MACRA. One doctor tweeted me that now that Trump is President, MACRA will be gone. I don’t think that’s further from the truth. In fact, I really can’t imagine any scenario where the EHR Incentive program (Meaningful Use, which still applies to hospitals and Medicaid) and the MACRA program would be gone. I think they’re here to stay and won’t be altered at all by this election.

The biggest reason for this belief is that Trump is going to have so many other things on the agenda. Not the least of which is ACA (Obamacare), which we’ll get to later in this post, but also a whole suite of other things that he’ll make a priority. Why would Trump want to take on a relatively bipartisan thing like healthcare IT, EHR and MACRA? I don’t think he’ll waste a second on the subject.

Plus, even if Trump wanted to go after the MACRA and EHR incentive legislation, I can’t imagine the Senate and House passing something to replace those programs either. Remember that Trump can propose all he wants, but the Senate and House have to pass it too and both of those groups seem to be firmly behind both efforts. Add this to the previous point and why would Trump go after health IT when it’s unlikely to pass and isn’t a strategic goal of his? Short Answer: He won’t.

My opinion: we’re unlikely to see any change to MACRA and other healthcare IT initiatives.

The trickier part to assess is the impact a Trump presidency will have on the Affordable Care Act (ACA or Obamacare). I live in Vegas and I wouldn’t even want to offer odds on what’s going to happen there. The rhetoric out there is to “repeal and replace Obamacare.” What’s not clear to me is if this concept is even practical and possible. There are so many issues with the idea of repealing Obamacare, that I can’t imagine it ever happening. I could see parts of it being repealed, but not the whole thing.

I also think it would be seen as very unfavorable for Trump to roll back things like the pre-existing condition exemption that allows those with pre-existing conditions to get insurance. There are probably a dozen other things like this that would likely be hard to take back without some major backlash and so I think they’ll have to preserve many of these things in whatever they do with Obamacare. Maybe that means a full repeal, but then rolling back in some of the popular pieces of the legislation so they can say they repealed it.

All of this said, I think that Trump will evaluate all options to undermine many of the things that were implemented by Obamacare including the insurance mandate and the insurance exchanges. Most people don’t realize that there’s so much more to Obamacare than just the mandate and exchanges. How he’ll undermine Obamacare and the impact it will have is anybody’s guess. I’m not sure anyone really knows and it’s certainly beyond my political punditry.

Long story short on Obamacare, I have no idea. I know that something’s going to happen because of the strict “Rip and Replace” rhetoric. I just think it’s really hard to predict which parts they’ll be able to rip out at this point and what they’ll replace it with going forward.

No doubt this will keep many in healthcare on edge. Unknowns are always a challenge. While I think the Trump Presidency will likely have a big impact on healthcare, I don’t see it having a big impact for good or bad on healthcare IT. I think the path to healthcare IT is happening and he won’t do anything to really stop it.

Side Note: Check out this interesting lessons learned post by Mr. H at Histalk which talks about the challenge of relying on data. As healthcare enters the world of data in a big way, it’s important to make sure we have a good understanding of what the data really tells us and what it doesn’t.

Health Plans Need Big Data Smarts To Prove Their Value

Posted on November 2, 2016 I Written By

Anne Zieger 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.

Recently, Aetna cut a deal which suggests a new role for health insurers in big data analytics and population health management. In partnership with Merck, the health insurer is launching a new program using predictive analytics to identify target populations and provide them with health and wellness services. AetnaCare will start by targeting patients with diabetes and hypertension in the mid-Atlantic U.S., but it seems likely to go national soon.

In its press release on the matter, Aetna says the goal of the program is to “proactively curate various health and wellness services… to support treatment adherence, ensure that critical social support needs are met, and reinforce healthy lifestyle behaviors.” That in and of itself isn’t a big deal. We all know that these are goals shared by providers, employers and health plans, and that most of the efforts health plans make on this front are pie in the sky, half-baked initiatives featuring cutesy graphics and little substance.

But then, Aetna’s chief medical officer gives away the real goal here — to power this effort by analyzing patient data being spun out by patients in varied care settings.  In the release, Dr. Harold Paz notes that patients are getting care in a wide variety of settings, including retail clinics, healthcare devices, pharmaceutical services, behavioral health, and social services, and that these services are seldom coordinated well, and implies that this is the real problem Aetna must solve.

If you listen to this with the ears of a health IT chick like myself, you hear Aetna (and Merck, actually) admitting that they must engage in predictive analytics across all of these encounters – and eventually, use these insights to help patients make good healthcare choices. In other words, they have to think like providers and even offer provider-like services fulfill their mission. And that means competing with or even beating providers at the big data game.

The truth is, health plans are in the same boat as providers, in that they’re at the center of a hailstorm of data and struggling with how to make use of it. Also, like providers they’re facing pressure from health purchasers to slow healthcare cost growth and boost patient wellness. But I’d argue that they’re even less prepared, technically and culturally, to improve health or coordinate care. So jumping in now is critically important.

In fact, I’d argue that health insurers are under greater pressure to improve population health than even sophisticated health systems or ACOs. Why? Because while health systems and ACOs can point to what they do – they make people better, for heaven’s sake — insurance companies are the eternal middleman who must continue to prove that they add value to the healthcare equation.

It remains to be seen whether programs like AetnaCare succeed at helping patients find the resources they need to improve and maintain their health. But even if this concept doesn’t work out, others will follow. Health plans need to leverage their unique data set to boost quality and reduce costs. Otherwise, as providers learn to work under value-based payments and accept risk, employers will have increasingly good reasons to contract directly — and leave the insurance industry out of the game entirely.

Locking Down Clinician Wi-Fi Use

Posted on November 1, 2016 I Written By

Anne Zieger 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.

Now that Wi-Fi-based Internet connections are available in most public spaces where clinician might spend time, they have many additional opportunities to address emerging care issues on the road, be they with their family in a mall or a grabbing a burger at McDonald’s.

However, notes one author, there are many situations in which clinicians who share private patient data via Wi-Fi may be violating HIPAA rules, though they may not be aware of the risks they are taking. Not only can a doctor or nurse end up exposing private health information to the public, they can open a window to their EMR, which can violate countless additional patients’ privacy. Like traditional texting, standard Wi-Fi offers hackers an unencrypted data stream, and that puts their connected mobile device at risk if they’re not careful to take other precautions like a VPN.

According to Paul Cerrato, who writes on cybersecurity for iMedicalApps, Wi-Fi networks are by their design open. If the physician can connect to the network, hostile actors could connect to the network and in turn their device, which would allow them to open files, view the files and even download information to their own device.

It’s not surprising that physicians are tempted to use open public networks to do clinical work. After all, it’s convenient for them to dash off an email message regarding, say, a patient medication issue while having a quick lunch at a coffee shop. Doing so is easy and feels natural, but if the email is unsecured, that physician risks exposing his practice to a large HIPAA-related fine, as well as having its network invaded by intruders. Not only that, any HIPAA problem that arises can blacken the reputation of a practice or hospital.

What’s more, if clinicians use an unsecured public wireless networks, their device could also acquire a malware infection which could cause harm to both the clinician and those who communicate with their device.

Ideally, it’s probably best that physicians never use public Wi-Fi networks, given their security vulnerabilities. But if using Wi-Fi makes sense, one solution proposed by Cerrato is for physicians is to access their organization’s EMR via a Citrix app which creates a secure tunnel for information sharing.

As Cerrato points out, however, smaller practices with scant IT resources may not be able to afford deploying a secure Citrix solution. In that case, HHS recommends that such practices use a VPN to encrypt sensitive information being sent or received across the Wi-Fi network.

But establishing a VPN isn’t the whole story. In addition, clinicians will want to have the data on their mobile devices encrypted, to make sure it’s not readable if their device does get hacked. This is particularly important given that some data on their mobile devices comes from mobile apps whose security may not have been vetted adequately.

Ideally, managing security for clinician devices will be integrated with a larger mobile device management strategy that also addresses BYOD, identity and access management issues. But for smaller organizations (notably small medical groups with no full-time IT manager on staff) beginning by making sure that the exchange of patient information by clinicians on Wi-Fi networks is secured is a good start.

What to Expect When You are Expecting: The Challenges of Technology Adoption Across A Dispersed Organization – Breakaway Thinking

Posted on October 26, 2016 I Written By

The following is a guest blog post by Mark Muddiman, Engagement Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Mark Muddiman
Imagine you have just installed your new clinical information system. Everyone has been waiting for months and excitement has peeked; the big day is right around the corner. Go live is coming and all the organizational sites are prepared for the new workflows and application. The application goes live and suddenly everyone needs help, support is inundated, and it becomes apparent that the expectations were not aligned to the reality of preparedness.

All too often this is a common scenario for organizations that are dispersed over large geographic areas. Adopting healthcare technology is difficult in a singular location, but certain challenges are uniquely amplified when an organization is dispersed. What challenges can you expect related to adoption and learning, and what can you do to ensure you are prepared?

Expect a greater emphasis on change management
As HIMSS reports, individual sites may fight the loss of autonomy as everyone is brought to a standard application or workflow. Each location has developed their own way of using the legacy application, and they must now learn new procedures and processes in addition to a new application. Multiple locations present multiple groups to manage at a distance, without the ability of physical project team members to be present at all locations throughout the adoption process.

Expect deviations from best practice and follow-up learning
Medical Economics recommends that learning continues beyond the initial go live. Staff will deviate from the best practice workflows as they forget less common tasks, and learn to navigate and use the application in different ways. Deviation from workflows introduces inefficiencies, dependency for support, and impedes the ability of staff to rotate between locations because the experience differs. Anticipate a need to provide follow up learning that reinforces best practices and helps avoid poor use of the application.

Expect each location will need onsite support
During go live, staff will often forget where to start and need a source to turn to when they forget a step in the new application and workflow they are using. However, it is very expensive and likely impractical to have a project team available at each location. Instead, providing assistance through super users and clinical champions along with easily referenced education materials will provide accessible onsite support for most issues.

What can you do?

Bring local leadership into decision making
Regional and local leaders can clarify the unique needs and constraints of their site when selecting applications and designing workflows. Whether equipment varies at each site or there are different service offerings, there are multiple benefits of involving local leadership. It allows leadership to determine the appropriate level of standardization that still respects the unique needs of each site, consequently removing the necessity to deviate from the standard workflow. Involving local and regional leaders engages them, provides a sense of ownership and cooperation in the project, and will help reduce resistance to change. It is imperative leadership is aligned at all levels, engaged in the adoption process, and supportive of the approach if adoption is to succeed.

Implement and ensure metrics are utilized
Metrics serve as key indicators to progress, knowledge retention, and proficiency, but in dispersed locations metrics also serve as indicators that would otherwise be filled with in-person observation. Metrics show whether a location is developing poor workflow practices or struggling with the change; subsequently metrics indicate whether a site needs additional support or learning. New metrics may be employed, such as surveys to gain feedback from multiple sites that could otherwise be obtained from a meeting or observation.

Follow up with each location often
Some sites will likely be more vocal in their need of support than others. It’s important to follow up with all sites and provide remedial education if metrics indicate a need to do so. Staff may need refresher training if inefficiencies arise, but there may be a root cause such as an educational or workflow gap that was previously unknown. Because adoption is a long-term commitment, it is important to provide continuous availability of learning while sustaining content to support changes to the application and learning needs.

Employ communication from leadership effectively
Effective communication goes a long way in reducing resistance to change. It also provides a channel for feedback and continuous collaboration. Communication should come from executive leaders to show their support of the adoption initiative, but also from local leaders. Staff can’t stop operations in a healthcare setting to join conference calls, and emails aren’t always read, but local leaders are able to directly communicate with staff. A comprehensive set of communications ensures an aligned message at all leadership levels and improves the ability of messages to reach staff.

While these suggestions may help, there is a proven methodology to comprehensively address challenges. At the Breakaway Group, we work with leadership to support engagement and change management at all levels while providing comprehensive sets of communication. Our experienced teams can provide workflow recommendations and develop education directly from the application that is sustained through the life of the partnership. Real-time data and metrics provide indicators of how each location is performing and undergoing change. Regardless of the organizational structure or of what to expect, we employ a methodology to help any organization achieve successful technology adoption and value realization.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.