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Healthcare CIOs Focus On Optimizing EMRs

Posted on March 30, 2017 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.

Few technical managers struggle with more competing priorities than healthcare CIOs. But according to a recent survey, they’re pretty clear what they have to accomplish over the next few years, and optimizing EMRs has leapt to the top of the to-do list.

The survey, which was conducted by consulting firm KPMG in collaboration with CHIME, found that 38 percent of CHIME members surveyed saw EMR optimization as their #1 priority for capital investment over the next three years.  To gather results, KPMG surveyed 122 CHIME members about their IT investment plans.

In addition to EMR optimization, top investment priorities identified by the respondents included accountable care/population health technology (21 percent), consumer/clinical and operational analytics (16 percent), virtual/telehealth technology enhancements (13 percent), revenue cycle systems/replacement (7 percent) and ERP systems/replacement (6 percent).

Meanwhile, respondents said that improving business and clinical processes was their biggest challenge, followed by improving operating efficiency and providing business intelligence and analytics.

It looks like at least some of the CIOs might have the money to invest, as well. Thirty-six percent said they expected to see an increase in their operating budget over the next two years, and 18 percent of respondents reported that they expect higher spending over the next 12 months. On the other hand, 63 percent of respondents said that spending was likely to be flat over the next 12 months and 44 percent over the next two years. So we have to assume that they’ll have a harder time meeting their goals.

When it came to infrastructure, about one-quarter of respondents said that their organizations were implementing or investing in cloud computing-related technology, including servers, storage and data centers, while 18 percent were spending on ERP solutions. In addition, 10 percent of respondents planned to implement cloud-based EMRs, 10 percent enterprise systems, and 8 percent disaster recovery.

The respondents cited data loss/privacy, poorly-optimized applications and integration with existing architecture as their biggest challenges and concerns when it came to leveraging the cloud.

What’s interesting about this data is that none of the respondents mentioned improved security as a priority for their organization, despite the many vulnerabilities healthcare organizations have faced in recent times.  Their responses are especially curious given that a survey published only a few months ago put security at the top of CIOs’ list of business goals for near future.

The study, which was sponsored by clinical communications vendor Spok, surveyed more than 100 CIOs who were CHIME members  — in other words, the same population the KPMG research tapped. The survey found that 81 percent of respondents named strengthening data security as their top business goal for the next 18 months.

Of course, people tend to respond to surveys in the manner prescribed by the questions, and the Spok questions were presumably worded differently than the KPMG questions. Nonetheless, it’s surprising to me that data security concerns didn’t emerge in the KPMG research. Bottom line, if CIOs aren’t thinking about security alongside their other priorities, it could be a problem.

VA May Drop VistA For Commercial EHR

Posted on July 12, 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.

It’s beginning to look like the famed VistA EHR may be shelved by the Department of Veterans Affairs, probably to be replaced by a commercial EHR rollout. If so, it could spell the end of the VA’s involvement in the highly-rated open source platform, which has been in use for 40 years. It will be interesting to see how the commercial EHR companies that support Vista would be impacted by this decision.

The first rumblings were heard in March, when VA CIO LaVerne Council  suggested that the VA wasn’t committed to VistA. Now Council, who supervises the agency’s $4 billion IT budget, sounds a bit more resolved. “I have a lot of respect for VistA but it’s a 40-year-old product,” Council told Politico. “Looking at what technology can do today that it couldn’t do then — it can do a lot.”

Her comments were echoed by VA undersecretary for health David Shulkin, who last month told a Senate hearing that the agency is likely to replace VistA with commercial software.

Apparently, the agency will leave VistA in place through 2018. At that point, the agency expects to begin creating a cloud-based platform which may include VistA elements at its core, Politico reports. Council told the hearing that VA IT leaders expect to work with the ONC, as well as the Department of Defense, in building its new digital health platform.

Particularly given its history, which includes some serious fumbles, it’s hardly surprising that some Senate members were critical of the VA’s plans. For example, Sen. Patty Murray said that she was still disappointed with the agency’s 2013 decision back to call of plans for an EHR that integrated fully with the DoD. And Sen. Richard Blumenthal expressed frustration as well. “The decades of unsuccessful attempts to establish an electronic health record system that is compatible across the VA in DoD has caused hundreds of millions of taxpayer dollars to be wasted,” he told the committee.

Now, the question is what commercial system the VA will select. While all the enterprise EHR vendors would seem to have a shot, it seems to me that Cerner is a likely bet. One major reason to anticipate such a move is that Cerner and its partners recently won the $4.3 billion contract to roll out a new health IT platform for the DoD.

Not only that, as I noted in a post earlier this year, the buzz around the deal suggested that Cerner won the DoD contract because it was seen as more open than Epic. I am taking no position on whether there’s any truth to this belief, nor how widespread such gossip may be. But if policymakers or politicians do see Cerner as more interoperability-friendly, that will certainly boost the odds that the VA will choose Cerner as partner.

Of course, any EHR selection process can take crazy turns, and when you grow in politics the process can even crazier. So obviously, no one knows what the VA will do. In fact, given their battles with the DoD maybe they’ll go with Epic just to be different. But if I were a Cerner marketer I’d like my odds.

“Blended” Super User Team

Posted on December 31, 2014 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.

At a conference I attended this Fall, I heard one person describe the “blended” super user team that they used during their EHR implementation. This is such a valuable idea for any EHR implementation. Having each areas input can really improve your probability for success. The various viewpoints will help you avoid major issues that could hijack or derail completely your EHR implementation.

The key thing you have to do with a blended super user team is to make sure you don’t demean the feedback, comments, and suggestions of anyone on the team. If you demean or belittle many of the people mentioned (technical, front desk, HIM, nurses, etc), then they’ll shut down and end up being a thorn in the side of your EHR implementation as opposed to a support. However, if you thoughtfully listen to, consider, and appreciate the feedback from all of these people, then you’ll be able to benefit from their ongoing support and insights in the process. I’ve seen both things happen and it’s not pretty for anyone when the staff feel alienated. It can get really ugly.

It turns out these “blended” super user teams are also what you need to optimize your EHR implementation as well. Sometimes that can be the same people that were part of the EHR implementation super team, but you also want to integrate other voices to the conversation as well.

Many doctors love to just pour as much work as possible on their staff. Indeed, you want to have everyone in your organization working to the highest level of their license. You also want to make sure you’re utilizing your most expensive resource (usually the doctor) in the most effective way possible. However, if you only focus on optimizing the doctors time and not the rest of the staff, that will eventually catch up with you. Once it catches up with you, the doctor will be doing work they don’t want to do, the other staff will feel overworked and no one will be happy.

You have to optimize the entire EHR spectrum to get the most value out of your EHR investment.

Eyes Wide Shut – January, 2014 Meaningful Use Stage 2 Readiness Reality Check

Posted on January 13, 2014 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Happy New Year?

As I begin the 2014 Meaningful Use measures readiness assessment and vendor cat-herding exercises, I’m reflecting on this portion of CMS’s Director of E-Health Standards and Services, Robert Tagalicod and the ONC’s Acting National Coordinator Jacob Reider’s statement regarding the Meaningful Use timeline modification: “The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2.” (Previously published on EMRandHIPAA.com.)

I call BS.

If the “goal” is a “successful implementation”, then CMS failed miserably by not addressing the START of the quarterly attestation period for Stage 2, which is still required in 2014. CMS and the ONC need more time to successfully implement the measures, and they are bureaucratic agencies that don’t directly deal with patient medical care. Why wasn’t the additional time required to truly succeed at this monumental task extended to the healthcare provider organizations? Because the agencies want to save face, and avoid litigation from early adopters who may be already beginning their 2014 attestation period amidst heroic back-breaking efforts?

Here’s a reality check for what a large IDN might be going through in early January, in preparation for the start of the 2014 quarterly attestation period. Assume this particular IDN’s hospitals’ fiscal year runs October-September, so you MUST begin your attestation period on July 1. You have 6 months.

As of December 31, 2013, only 4 of the 8 EMRs in your environment completed their 2014 CEHRT certification.

Each of those 4 EMRs has a different schedule to implement the upgrade to the certified edition, with staggered delivery dates from March to July. The hospital EMR is not scheduled to receive its certified-edition upgrade until April. You pray that THIS implementation is the exception to your extensive experience with EMR vendor target timelines extending 6-8 weeks beyond initial dates.

The EMR upgrades do not include the Direct module configuration, and the vendor’s Direct module resources are not available until 6-9 weeks after the baseline upgrade implementation – if they have knowledgeable resources, at all. Your hospital EMR vendor can’t articulate the technical infrastructure required to implement and support its own Direct module. Several vendors indicate that the Direct module configuration will have to be negotiated with a third-party. Your clinicians don’t know what Direct is. Your IT staff doesn’t know how to register with a HISP. Your EMR vendor doesn’t support a central Direct address directory or a lookup function, so you contemplate typing classes for your HIM and clinical staff.

The number of active patient problems requiring manual SNOMED remediation exceeds 60,000 records in your hospital EMR. You form a clinical committee to address, but they’re estimating it will take 6 months of review to complete. You’re contemplating de-activating all problems older than a certain date, which would whittle down the number and shorten the timeframe to complete – but would eliminate chronic conditions.

There are still nagging questions regarding CMS interpretation of the measures, so you ask for clarification, and you wait. And wait. And wait. The answers impact the business rules required for attestation reporting, and you know you need any help you can get in whittling down the denominator values. Do deceased patients count in the view/download/transmit denominator? If records access is prohibited by state/federal law, does that encounter count in the view/download/transmit denominator?

Consultant costs skyrocket as you struggle to find qualified SME resources to blaze a trail for your internal staff. Their 60-to-90-day assessments inevitably end with recommendations for “proof of concept” and “pilot” approaches to each of the 2014 measures, which don’t take into account the reality of the EMR upgrade timelines and the looming attestation start date. Following their recommendations would delay your attestation start by 9-12 months. So, your internal staff trudges forward without expert leadership, and you throw the latest PowerPoint deck from “Health IT Professionals-R-Us” on the pile.

Who needs testing, when you can go live with unproven technology the day it’s available in order to meet an arbitrary deadline? Healthcare.gov did it – look what a success that turned out to be!

But wait, this is real clinical data, generated by real-world clinical workflows, being used to treat real patients, by real healthcare providers. By refusing to address the start of the 2014 attestation period, CMS and the ONC are effectively using these patients and providers as lab rats.

I did not give permission to be part of this experiment.

ROI for EMR: Does It Even Make Sense Now?

Posted on December 20, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

There’s a new data point to add to the debate over EMR return on investment.

Norton Healthcare Inc. in Louisville, Ky., has experienced a $12 million increase in federal reimbursement since it started using Epic, Louisville Business First reported. The health system, which operates five hospitals and a network of outpatient sites, is three years into a five-year, $200 million implementation.

Sounds like the beginning of some pretty good ROI. Or does it?

It’s hard to say.

ROI for records systems is notoriously hard to pin down. The word is that many hospitals don’t even try. And they might be onto something.

A revenue boost is a good sign. It’s often a result of improved coding and lower claims denial rates, as Colin Konschak of health care consulting firm Divurgent and Garrett Blair of Norfolk, Va.-based health system Sentara Healthcare recently wrote. And of course, there are the federal incentives for using an EMR — for hospitals, as much as $11 million over four years.

There’s also the rise in productivity that EMRs are expected to cause. At first, an EMR can slow down clinicians’ workflow and cost them and their organization money. But in time, the system could increase productivity.

But revenue is only part of the equation. Cost savings are the more important — and harder to calculate — factor.

Here are a few ways, as described by Konschak and Blair, that EMRs can help hospitals to save:

  • Less need for transcription.

  • Reduced use of staff time for copying and filing.

  • Reduced — often by 50-70 percent — use of preprinted forms.

  • Potentially lower malpractice premiums because of more complete documentation.

Many other potential benefits are probably real but are even less straightforward to measure. Features such as clinical decision support and electronic medical administration records, for example, could lead to reductions in medical errors — the types of mistakes the federal government no longer pays for. But measuring the money you saved from the errors you didn’t make is fairly abstract.

Many hospitals do little if anything to measure the return on their EMR investment, according to a study released by Beacon Partners last year. Healthcare Scene’s John Lynn wrote a few months ago that CIOs likely view the systems as a “necessary requirement of being a hospital today,” somewhat like cleaning supplies. So they don’t see the need to measure ROI.

To me, the “investment” part of ROI suggests that you have a choice. You put money into something now with the hope — but no guarantee — of a payoff later.

Building an imaging center on the edge of town or buying a surgical robot would probably be considered investments. Maintaining your buildings or upgrading your phones would not.

Doing something the government is making you do is not an investment. Given the reimbursement penalties that will eventually kick in for organizations that stick with paper, it’s hard to imagine that many hospital executives see EMR adoption as a matter choice.

The idea of ROI for EMR is probably outdated, a holdover from the days when having a system was optional. Hospital leaders are shopping for EMRs with an eye toward getting the best value for their money — just the way they shop for cleaning supplies, furniture or legal services.

You could say that as a society we’ve invested in the idea of EMRs and that we’re hoping for a payoff in terms of better outcomes and lower costs. But that doesn’t predict much about whether any particular hospital or doctor will see a dollar-and-cents ROI.

At Norton in Louisville, it sounds like they’re happy just to be recovering some of what they’re spending.

“It really does improve the continuity of care,” Norton’s chief medical officer, Dr. Steve Heilman, told Business First.

For now, it sounds like Norton is on track.

(Note: I work for Business First as a freelancer but didn’t write the story linked here.)

It’s Not The Health IT You Choose, But The Way You Talk About It

Posted on December 13, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

With system upgrades taking shape across the country, IT is no longer just another another department in the hospital. More than ever, it’s integral to how healthcare organizations work and get paid.

But you don’t always see this shifting landscape reflected in hospitals’ leadership structures or practices.

That’s unfortunate. Getting the most out of  the billions being spent on health IT will require clear vision and skillful communication at the top levels, according to a December article in the Journal of the American Health Information Management Association.

Doctors, nurses and other team members “must understand the nature of the changes—what the result of the changes will be, how their roles and work will be different, and why change is important,” author Tiankai Wang wrote.

Thoughtful language can go a long way toward minimizing staff resistance and making an implementation successful, explained Wang, a professor of health information management at Texas State University.

Leaders should practice “framing” by promoting the benefits of the technology, such as improved outcomes, lower costs and greater efficiency, Wang wrote. They should also use “rhetorical crafting” by using stories, analogies and other devices to make their message resonate.

Rhetorical crafting, according to Wang, “leverages a ‘show, don’t tell’ approach to frame leaders’ message in a form that will connect more easily with staff and help them to embrace the possibilities of the coming change.”

He also advises using words such as “we” and “should” rather than “you” and “must” when talking about IT changes.

At a more fundamental level, though, IT leadership isn’t always valued in healthcare to the extent that other roles are. In 2013, average total cash compensation for chief information officers was eighth-highest of all hospital titles at about $316,000, Modern Healthcare reported.

And despite the growing importance of health IT, it’s also uncommon for hospital CIOs to be promoted to the roles of chief operating officer, president or CEO.

It does happen, though, as David Raths wrote in Healthcare Informatics. In perhaps the best known example, Cincinnati-based Mercy Health, which operates several hospitals, earlier this year named Yousuf Ahmad, who had previously served as CIO, to the chief executive role. Ahmad had also held other management roles, including president of the system’s physician group.

It’s likely a sign of the front-and-center role that IT is now taking at healthcare organizations everywhere.

Outfitting for the ICD-10 Voyage – Breakaway Thinking

Posted on November 19, 2013 I Written By

The following is a guest blog post by Laura Speek from The Breakaway Group (A Xerox Company) and Honora Roberts from Xerox. Check out all of the blog posts in the Breakaway Thinking series.
ICD-10 Boat
These are challenging times for healthcare providers in every imaginable vessel – and the whitewater ride is not over yet. Just around the bend looms the transition to ICD-10, scheduled for October 1, 2014. Most providers know the wisest course is to start preparing now, yet few have dared to navigate these uncharted waters.

For many, a major problem is not knowing where to start. Others may be suffering from protracted procrastination. And still others may be well on the road to ruin via the path of good intentions.

An effective way to put some wind in your ICD-10 sails is to get real about the serious costs of noncompliance. After October 1, 2014, claims must be submitted using ICD-10 coding to be eligible for reimbursement. In other words, if you don’t bill with ICD-10 codes, you simply won’t get paid. And that’s the cold, hard truth.

The transition to ICD-10 will affect every facet of healthcare, but it begins with understanding the basic differences between ICD-9 and ICD-10. First and foremost, ICD-10 is not just a simple expansion of ICD-9. There is no reliable one-to-one mapping system. Some ICD-9 codes equate to multiple ICD-10 codes, while some do not correspond to any.

ICD-10 codes include much greater specificity; care providers must document etiology, laterality, exact anatomical site, and other information. Patient encounter documentation must include proper detail to enable coders to locate the correct ICD-10 diagnosis and procedure codes. Physicians and mid-level providers should begin to assess their documentation today to identify where ICD-10 coding requirements are already being met and where improvement is needed.

Because clinical documentation is at the core of every patient encounter, it must be complete, precise, and accurately reflect the scope of care and services provided. Assuring depth and consistency of documentation represents a challenge for many organizations.

ICD-10 encompasses a huge increase in accessible codes. The ICD-10-CM diagnostic code set, used in all healthcare settings, increases from roughly 13,000 to 68,000 codes. The ICD-10-PCS procedural code set, used within inpatient settings only, expands from roughly 3,000 to 87,000 codes. It should be noted that ambulatory settings will continue to use CPT (Current Procedural Terminology) procedural codes.

Given this massive growth in coding scope, the importance of detailed clinical documentation becomes even more pronounced. Physicians and other healthcare providers typically are not trained to develop proper documentation skills in medical school or residency; nurse practitioners (NPs) and physician assistants (PAs) generally do not receive such training during graduate school or clinical rotations. Hospitals and healthcare systems need to compensate for this training deficiency by instituting educational programs and tools that align healthcare providers with proper documentation practices to clear the decks for successful transition to ICD-10.

ICD-10 requires physicians, NPs, and PAs to thoroughly document each and every patient encounter to a much greater level of specificity than is needed in ICD-9. Nonspecific or incomplete documentation within ICD-10 will cause delays, claim denials, cash-flow interruptions, and inaccurate quality reporting. Definition and terminology changes inherent in ICD-10, particularly for surgical procedures, will also require focused education and training.

At the end of the day, providers aren’t coders. They are far less concerned with ICD-10 codes than they are with improving quality of care. This is where ICD-10 can be viewed as a welcoming beacon on a rocky shore. It gives healthcare providers an incentive to establish a clinical documentation improvement (CDI) program. In fact, implementing and sustaining an effective CDI initiative should be a top priority for all healthcare organizations preparing for ICD-10. For those with no CDI program in place, the time to begin is now. Consider improved clinical documentation as essential equipment for maneuvering through the twists, turns, and churns that accompany the voyage to ICD-10.

Honora Roberts - Xerox
Honora Roberts is Vice President of Healthcare Provider Services at Xerox.

Laura Speek  - The Breakaway Group
Laura Speek is a Learning and Development Specialist at The Breakaway Group (a Xerox company).

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

CA EMR Adoption Up, But Other Health IT Use Is Behind

Posted on November 18, 2013 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.

While California providers are stepping up their use of EMRs, they’re still behind on some other measures of health IT adoption, according to a new report by the California HealthCare Foundation.

First, the positives. California physicians who use EMRs grew from 37 percent in 2008 to 59 percent in 2013. The report also concluded that 50 percent of California hospitals used EMRs in 2012, compared with 13 percent in 2007, and that 65 percent of community health centers used EMRs in 2011, compared with 3 percent in 2005.

All that being said, California providers are behind when it comes to Meaningful Use. While 58 percent of them said in 2012 that they planned to participate in Meaningful Use, only 30 percent of California providers with EMRs had a system that met all of the program’s 12 objectives, notes iHealthBeat.

What’s more, California hospitals’ use of clinical support systems fell from 77 percent in 2010 to 71 percent in 2012, a pretty low number given that the national average of 97 percent use of such tools. Also, the state ranks 49th in the country for e-prescribing rates.

The researchers also note that providers seem less interested in health IT than consumers. The 57 percent of state residents who had access to their EMRs  used them to view their health records, e-mail physicians and schedule care appointments, iHealthBeat reported.

All told, the report comes as something of a surprise, given that over time, California has traditionally been at the leading edge of many healthcare industry trends. And it suggests that many California providers are missing out on increasingly well-documented opportunities to improve productivity. So let’s hope that traditionally cutting-edge providers take the nudge provided by this report seriously.

Factors that Influence Healthcare Information Technology Adoption – Breakaway Thinking

Posted on October 16, 2013 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.

The following is a guest blog post by Laura Speek, learning and development specialist at The Breakaway Group, a Xerox company. Check out all of the blog posts in the Breakaway Thinking series.
Laura Speek  - The Breakaway Group
Healthcare organizations of nearly every variety are heavily involved in analyzing a smorgasbord of choices in electronic health record (EHR) technology. While some care providers still face the challenge of transitioning from paper to digital records, others are already moving to next-generation electronic systems.

Clearly, the cornerstone benefit of EHRs is improved patient care. However, that objective is best achieved when healthcare organizations look beyond software implementation (the installation phase) and orchestrate true technology adoption (overall integration for clinical benefit).

Consider the analogy of a wedding and a marriage. Software implementation is a momentous, finite event, similar to a wedding ceremony, that marks the beginning of a long-term partnership. The ensuing marriage demands that couples work diligently to learn how to live together in a way that is harmonious and meaningful. True technology adoption requires an extended commitment, comparable to a marriage. Over time, the organization coordinates efforts to seamlessly integrate a software system into daily workflows, procedures, and processes. The result is an enduring, measurably beneficial marriage with technology.

The Breakaway Group (TBG) is a company that works in healthcare and has conducted extensive research to identify elements of successful EHR adoption. Studies have shown that certain strategies can significantly contribute to the integration process. Referred to as the “four corners of adoption,” here are our research-based recommendations for successful EHR conversion.

Four Corners of Technology Adoption
The Breakaway Group Four Corners of Technology

Engaged Leadership: Leaders must possess the insight, will, and ability to direct and inspire teams throughout the adoption process. Engaged leadership begins with communication of a common vision and purpose that permeates the organization from the top down. Informed and enthusiastic healthcare leaders set the tone for creating a culture of adoption, which research has proven is vital for successful EHR integration.

Speed to Proficiency: TBG’s research indicates that targeted, streamlined education can significantly reduce training time and associated costs, while rapidly building user proficiency and confidence. The goal of developing proficiency to perform common daily tasks – as opposed to requiring mastery of multitudinous software bells and whistles – can be achieved in very short order. Brief, role- and scenario-based online courses that are relevant, self-paced, and accessible on demand appeal strongly to adult learners. Motivated learners generally complete assigned courses, score well on review tests, and rapidly assimilate new technology into routine workflows.

E-learning is a financially attractive alternative to instructor-led education. However, some healthcare organizations supplement online courses with carefully developed in-person instruction about unique or complex workflows that are not well suited to electronic formats. Our research confirms the effectiveness and efficiency of a “blended” educational approach that combines digital and personal delivery systems.

Performance Metrics: Positive change nearly always emanates from constructive, quantitative examination. In other words, “what is measured will improve.” Studies prove that rigorously tracking and analyzing performance metrics can uncover opportunities for adjustments that substantially bolster technology integration. The key is to establish reliable systems for collecting performance metrics early enough to yield meaningful results and to prescriptively analyze that data on a regular basis.

Adoption Sustainment: True EHR adoption requires a plan for accommodating software updates, new medical discoveries, and changes in workflows – a process referred to as “optimization.” Optimization addresses post-implementation issues involving best practices, workflows, and related educational revisions. This key adoption element requires continuous effort, examination, and the willingness to make mid-course adjustments to fine-tune the relationship between an organization and its technology.

The Breakaway Method™

TBG’s intensive research led to the publication of Beyond Implementation: A Prescription for Lasting EMR Adoption, a book that has inspired many hospitals to re-examine their approach to technology integration. Careful analysis of our research data led to the development of The Breakaway Method™, a comprehensive EHR-adoption solution. To date, our methodology has helped nearly 1,000,000 healthcare staff members rapidly embrace new HIT software. Our method reliably accelerates bona fide adoption while minimizing organizational stress and disruption.

In the course of working with hundreds of medical organizations, using EHR systems from vendors of all varieties, we have acquired valuable insights. TBG has identified some common HIT adoption issues and helped clients envision and implement successful resolution strategies. Over the coming months, we have the opportunity to share our experience, observations, and recommendations concerning adoption challenges successfully met by different types of care providers. Stay tuned.

Laura Speek is a learning and development specialist at The Breakaway Group, a Xerox company. She can be reached at: laura.speek@xerox.com. To learn more about TBG, go to: http://www.thebreakawaygroup.com.

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

Eyes Wide Shut – Inflicting Agile On The Waterfall World of Healthcare

Posted on October 8, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

In a recent hangout with John Lynn discussing Healthcare Big Data and Meaningful Use Challenges, he asked me why incorporating more agile development practices into healthcare software and business practice is so hard. In my fumbling attempt to articulate a pithy answer, and I bumbled into an insight: health IT mandates are inflicting agile methodology onto the waterfall world of healthcare, and demanding adoption at an unprecedented pace. It’s creating an uncomfortable, and in many ways untenable, situation for the healthcare system as a whole.

For quick reference, here’s a diagram explaining the difference between the traditional waterfall approach to software development, and the newer agile methodology.

waterfall_v_agile

What immediately jumped out at me about this visualization of waterfall versus agile: doesn’t this inverse-triangle comparison look a bit like a diagram of the “flipped clinic”? “Flip the clinic”, as defined by the Robert J. Woods Foundation project, has become a rallying cry to reinvent the patient-provider interaction, empowering patients and providers to increase the value of each encounter through technology-enabled improved engagement opportunities.

flip_clinic

This “flipping” approach is considered a disruptive concept, with great power to accelerate insights and empower patients. However, currently, it is far from mainstream, and likely to take a decade or more to enjoy widespread adoption.

Health IT mandates are, effectively, demanding that healthcare “flip the systems”: move from a conservative, quality-deliverable “plan-driven” model to an aggressive, loosely-defined-deliverable “vale-driven” model – on an ambitiously aggressive schedule, on a massive scale.

As an industry, healthcare follows a very slow progression through the Waterfall development cycle. A commonly-cited statistic states that it takes 17 years for a single clinical discovery to become commonly applied practice. In the beginning, there is an idea with fixed requirements: a specific clinical trial is designed, with narrowly-defined scope to control variables and insure the highest quality results. The results of the trial are analyzed, published, considered for expansion. Patents are pursued. FDA approval is obtained. Over a decade later, the discovery makes its way into accepted treatment protocols, and eventually becomes part of the attending’s lecture to residents on rounds.

Contrast that slow progress through development and adoption with what’s happening under ACA, specifically with Meaningful Use objectives.

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Now, if it takes 17 years for a clinical discovery to make it to mainstream practice, and that specific type of clinical function is what the healthcare industry is designed to DO, does anyone else see anything wrong with the schedule presented here? Notice there are only 11 years on that timeline, from inception of the certification program to the last year to receive an incentive payment? Only 5 years between program inception and penalties for non-conformance?

Another key differentiator between Agile and Waterfall: the criticality of quality. Quality is defined as “conformance to requirements”. Because Waterfall methodology places emphasis on explicitly-defined requirements, it also demands high-quality deliverables; there is traceability between each requirement and the specific feature/function that is designed to meet that need. Agile methodology places emphasis on flexible deliverables, as requirements are not clearly defined prior to starting work; the scope of the feature/functions that will be delivered varies, according to the results of the development effort and the time left to execute.

In one of my first posts on EMRandHIPAA.com, “Yes, Healthcare IT Adoption is Expensive AND Painful”, I ranted:

Haven’t we all heard the adage, “You can only have things done two of three ways: fast, cheap, or well”? Considering that the “thing” we’re trying to do is revolutionize the healthcare industry, the effects of which may be felt in each and every one of our lives at some point, don’t you want to include “well” as the bare minimum of what is required? After all, this is YOUR electronic health record, YOUR data, YOUR treatment plan and effectiveness measurements. So, what’s the other way we want this “thing” done: fast or cheap?

Now that I’ve spent more time working in the trenches with clinicians, detailing the operational challenges they’re facing with the rate of change the health IT mandates are demanding they absorb, I’ve come to the conclusion that I was wrong.

Health IT adoption must ONLY be done well. No other constraint matters.

Quality is of the utmost importance. Arbitrary deadlines are only increasing the cost required to implement half-baked product and process solutions that meet only the bare minimum “letter of the law” stipulations of the mandates.

The current focus on adopting health IT fast is only incenting corner-cutting measures from both IT vendors and healthcare providers. As a patient, I’m not ready to sign off on User Acceptance Testing of the nationwide implementation of Meaningful Use.