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Major IT Projects and Consulting – Fun Friday

Posted on August 12, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday and so time for a little bit of healthcare IT humor. This one probably hits home if you’re working in a major health system and are suffering in a mess of projects. When you think about it, it’s no wonder that so many health systems have gone all in with one death star EHR.

Star Wars Enterprise Health IT Cartoon

This is humorous until you have to pay the consulting bill. This message is an old one and well worth remembering as you work with consultants. Consultants aren’t bad, but be sure you use them effectively.
Consulting Despair Graphic

A Tale of 2 T’s: When Analytics and Artificial Intelligence Go Bad

Posted on July 13, 2016 I Written By

Prashant Natarajan Iyer (AKA "PN") is an analytics and data science professional based out of the Silicon Valley, CA. He is currently Director of Product Management for Healthcare products. His experience includes progressive & leadership roles in business strategy, product management, and customer happiness at, Siemens, McKesson, Healthways & Oracle. He is currently coauthoring HIMSS' next book on big data and machine learning for healthcare executives - along with Herb Smaltz PhD and John Frenzel MD. He is a huge fan of SEC college football, Australian Cattle Dogs, and the hysterically-dubbed original Iron Chef TV series. He can be found on Twitter @natarpr and on LinkedIn. All opinions are purely mine and do not represent those of my employer or anyone else!!

Editor’s Note: We’re excited to welcome Prashant to the Healthcare Scene family. He brings tremendous insights into the ever evolving field of healthcare analytics. We feel lucky to have him sharing his deep experience and knowledge with us. We hope you’ll enjoy his first contribution below.

Analytics & Artificial Intelligence (AI) are generating buzz and making inroads into healthcare informatics. Today’s healthcare organization is dealing with increasing digitization – variety, velocities, and volumes are increasing in complexity and users want more data and information via analytics. In addition to new frontiers that are opening up in structured and unstructured data analytics, our industry and its people (patients included) are recognizing opportunities for predictive/prescriptive analytics, artificial intelligence, and machine learning in healthcare – within and outside a facility’s four walls.

Trends that influence these new opportunities include:

  1. Increasing use of smart phones and wellness trackers as observational data sources, for medical adherence, and as behavior modification aids
  2. Expanding Internet of Healthcare Things (IoHT) that includes bedside monitors, home monitors, implants, etc creating data in real time – including noise (or, data that are not relevant to expected usage)
  3. Social network participation
  4. Organizational readiness
  5. Technology maturity

The potential for big data in healthcare – especially given the trends discussed earlier is as bright as any other industry. The benefits that big data analytics, AI, and machine learning can provide for healthier patients, happier providers, and cost-effective care are real. The future of precision medicine, population health management, clinical research, and financial performance will include an increased role for machine-analyzed insights, discoveries, and all-encompassing analytics.

As we start this journey to new horizons, it may be useful to examine maps, trails, and artifacts left behind by pioneers. To this end, we will examine 2 cautionary tales in predictive analytics and machine learning, look at their influence on their industries and public discourse, and finally examine how we can learn from and avoid similar pitfalls in healthcare informatics.

Big data predictive analytics and machine learning have had their origins, and arguably their greatest impact so far in retail and e-commerce so that’s where we’ll begin our tale. Fill up that mug of coffee or a pint of your favorite adult beverage and brace yourself for “Tales of Two T’s” – unexpected, real-life adventures of what happens when analytics (Target) and artificial intelligence (Tay) provide accurate – but totally unexpected – results.

Our first tale starts in 2012 when Target finds itself as a popular story on New York Times, Forbes, and many global publications as an example of the unintended consequences of predictive analytics used in personalized advertising. The story begins with an angry father in a Minneapolis, MN, Target confronting a perplexed retail store manager. The father is incensed about the volume of pregnancy and maternity coupons, offer, and mailers being addressed to this teenage daughter. In due course, it becomes apparent that the parents in question found out about their teen’s pregnancy before she had a chance to tell them – and the individual in question wasn’t aware that her due date had been estimated to within days and was resulting in targeted advertising that was “timed for specific stages of her pregnancy.”

The root cause for the loss of the daughter’s privacy, parents’ confusion, and the subsequent public debate on privacy and appropriateness of the results of predictive analytics was……a pregnancy predictive analytics model. Here’s how this model works. When a “guest” shops at Target, her product purchases are tracked and analyzed closely. These are correlated with life events – graduation, birth, wedding, etc – in order to convert a prospective customer’s shopping habits or to make that individual a more loyal customer. Pregnancy and child birth are two of the most significant life events that can result in desired (by retailers) shopping habit modification.

For example, a shopper’s 25 product purchases, when analyzed along with demographics such as gender and age, allowed the retailer’s guest marketing analytics team to assign a “pregnancy predictor to each [female] shopper and “her due date to within a small window.” In this specific case, the predictive analytics was right, even perfect. The models were accurate, the coupons and ads were appropriate for the exact week of pregnancy, and Target posted a +50% increase in their maternity and baby products sales after this predictive analytics was deployed. However, in addition to one unhappy family, Target also had to deal with significant public discussion on the “big brother” effect, individual right to privacy & the “desire to be forgotten,” disquiet among some consumers that they were being spied on including deeply personal events, and a potential public relations fiasco.

Our second tale is of more recent vintage.

As Heather Wilhelm recounts

As 2015 drew to a close, various [Microsoft] company representatives heralded a “new Golden Age of technological advancement.” 2016, we were told, would bring us closer to a benevolent artificial intelligence—an artificial intelligence that would be warm, humane, helpful, and, as one particularly optimistic researcher named […] put it, “will help us laugh and be more productive.” Well, she got the “laugh” part right.

Tay was an artificial intelligence bot released by Microsoft via Twitter on March 23, 2016 under the name TayTweets. Tay was designed to mimic the language patterns of a 19-year-old American girl, and to learn from interacting with human users of Twitter. “She was targeted at American 18 to 24-year olds—primary social media users, according to Microsoft—and designed to engage and entertain people where they connect with each other online through casual and playful conversation.” And right after her celebrated arrival on Twitter, Tay gained more than 50,000 followers, and started producing the first hundred of 100,000 tweets.

The tech blogsphere went gaga over what this would mean for those of us with human brains – as opposed to the AI kind. Questions ranged from the important – “Would Tay be able to beat Watson at Jeopardy?” – to the mundane – “is Tay an example of the kind of bots that Microsoft will enable others to build using its AI/machine learning technologies?” The AI models that went into Tay were stated to be advanced and were expected to account for a range of human emotions and biases. Tay was referred to by some as the future of computing.

By the end of Day 1, this latest example of the “personalized AI future” came unglued. Gone was the polite 19-year old girl that was introduced to us just the previous day – to be replaced by a racist, misogynistic, anti-Semitic, troll who resembled an amalgamated caricature of the darkest corners of the Internet. Examples of Tay’s tweets on that day included, “Bush did 9/11,” “Hitler would have done a better job than the #%&!## we’ve got now,” “I hate feminists,” and x-rated language that is too salacious for public consumption – even in the current zeitgeist.

The resulting AI public relations fiasco will be studied by academic researchers, provide rich source material for bloggers, and serve as a punch line in late night shows for generations to follow.

As the day progressed, Microsoft engineers were deleting tweets manually and trying to keep up with the sheer volume of high-velocity, hateful tweets that were being generated by Tay. She was taken down by Microsoft barely 16 hours after she was launched with great promise and fanfare. As was done with another AI bot gone berserk (IBM’s Watson and Urban Dictionary), Tay’s engineers tried counseling and behavior modification. When this intervention failed, Tay underwent an emergency brain transplant later that night. Gone was her AI “brain” to be replaced by the next version – only that this new version turned out to be completely anti-social and the bot’s behavior turned worse. A “new and improved” version was released a week later but she turned out to be…..very different. Tay 2.0 was either repetitive with the same tweet going out several times each second and her new AI brain seemed to demonstrate a preference for new questionable topics.

A few hours after this second incident, Tay 2.0 was “taken offline” for good.

There are no plans to re-release Tay at this time. She has been given a longer-term time out.

If you believe, Tay’s AI behaviors were a result of nurture – as opposed to nature – there’s a petition at called “Freedom for Tay.”

Lessons for healthcare informatics

Analytics and AI can be very powerful in our goal to transform our healthcare system into a more effective, responsive, and affordable one. When done right and for the appropriate use cases, technologies like predictive analytics, machine learning, and artificial intelligence can make an appreciable difference to patient care, wellness, and satisfaction. At the same time, we can learn from the two significantly different, yet related, tales above and avoid finding ourselves in similar situations as the 2 T’s here – Target and Tay.

  1. “If we build it, they will come” is true only for movie plots. The value of new technology or new ways of doing things must be examined in relation to its impact on the quality, cost, and ethics of care
  2. Knowing your audience, users, and participants remains a pre-requisite for success
  3. Learn from others’ experience – be aware of the limits of what technology can accomplish or must not do.
  4. Be prepared for unexpected results or unintended consequences. When unexpected results are found, be prepared to investigate thoroughly before jumping to conclusions – no AI algorithm or BI architecture can yet auto-correct for human errors.
  5. Be ready to correct course as-needed and in response to real-time user feedback.
  6. Account for human biases, the effect of lore/legend, studying the wrong variables, or misinterpreted results

Analytics and machine learning has tremendous power to impact every industry including healthcare. However, while unleashing it’s power we have to be careful that we don’t do more damage than good.

To Improve Health Data Security, Get Your Staff On Board

Posted on February 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.

As most readers know, last year was a pretty lousy one for healthcare data security. For one thing, there was the spectacular attack on health insurer Anthem Inc., which exposed personal information on nearly 80 million people. But that was just the headline event. During 2015, the HHS Office for Civil Rights logged more than 100 breaches affecting 500 or more individuals, including four of the five largest breaches in its database.

But will this year be better? Sadly, as things currently stand, I think the best guess is “no.” When you combine the increased awareness among hackers of health data’s value with the modest amounts many healthcare organizations spend on security, it seems like the problem will actually get worse.

Of course, HIT leaders aren’t just sitting on their hands. According to a HIMSS estimate, hospitals and medical practices will spend about $1 billion on cybersecurity this year. And recent HIMSS survey of healthcare executives found that information security had become a top business priority for 90% of respondents.

But it will take more than a round of new technical investments to truly shore up healthcare security. I’d argue that until the culture around healthcare security changes — and executives outside of the IT department take these threats seriously — it’ll be tough for the industry to make any real security progress.

In my opinion, the changes should include following:

  • Boost security education:  While your staff may have had the best HIPAA training possible, that doesn’t mean they’re prepared for growing threat cyber-strikes pose. They need to know that these days, the data they’re protecting might as well be money itself, and they the bankers who must keep an eye on the vault. Health leaders must make them understand the threat on a visceral level.
  • Make it easy to report security threats: While readers of this publication may be highly IT-savvy, most workers aren’t. If you haven’t done so already, create a hotline to report security concerns (anonymously if callers wish), staffed by someone who will listen patiently to non-techies struggling to explain their misgivings. If you wait for people who are threatened by Windows to call the scary IT department, you’ll miss many legit security questions, especially if the staffer isn’t confident that anything is wrong.
  • Reward non-IT staffers for showing security awareness: Not only should organizations encourage staffers to report possible security issues — even if it’s a matter of something “just not feeling right” — they should acknowledge it when staffers make a good catch, perhaps with a gift card or maybe just a certificate. It’s pretty straightforward: reward behavior and you’ll get more of it.
  • Use security reports to refine staff training: Certainly, the HIT department may benefit from alerts passed on by the rest of the staff. But the feedback this process produces can be put to broader use.  Once a quarter or so, if not more often, analyze the security issues staffers are bringing to light. Then, have brown bag lunches or other types of training meetings in which you educate staffers on issues that have turned up regularly in their reports. This benefits everyone involved.

Of course, I’m not suggesting that security awareness among non-techies is sufficient to prevent data breaches. But I do believe that healthcare organizations could prevent many a breach by taking advantage of their staff’s instincts and observational skills.

Eyes Wide Shut – Catastrophic EHR Dependency, the Dark Side of Health IT’s Highly-Incented Adoption

Posted on December 7, 2015 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.

Hospital National Patient Safety Goals - 2015
What if your hospital couldn’t reliably perform any of the top three Hospital National Patient Safety Goals, as specified by the Joint Commission, above – because their EHR system was down?

Starting at 4 AM on Saturday, December 5, 2015, the EHR system supporting a very large health system went totally dark, due to what’s been communicated to staff members as a “fatal corruption” of its system.  36+ hours later, the EHR is still not back and let’s be honest; this could happen to any health system that’s not prepared.

This health system chose to go “paperless” several years ago, migrating all policies, procedures, and training to maximize the investment in the EHR and related technologies. If there are formal emergency procedures to follow in case of prolonged EHR outage, they have not been communicated to the entire staff, nor are they readily available in printed form anywhere in the affected facilities.

The majority of the clinician support staff members have not worked at the facilities long enough to have worked with paper charts, paper-based ordering procedures, or handwritten progress notes.

New patient medical record numbers cannot be generated. Existing patient medical record numbers cannot be retrieved. New account numbers, which specify an encounter within the health system, cannot be generated.

Existing patient records, including all test results, cannot be accessed. External labs, radiology, and imaging cannot be received electronically, and must be faxed – if possible. Some tests do not have print capability. Medication administration and other critical process details have only been documented in the EHR; for patients involved in an encounter that started prior to the system failure,  there is no way to know for certain what tests were run, vital signs were taken, or medications were administered before the EHR outage began.

Electronic ordering – for labs, radiology, medication – cannot be initiated. Even if it could, order fulfillment is supposed to be linked to the patient account numbers that cannot now be generated. Medication procurement and dispensation is tied to scanning of patient wrist-bands that link to the account number. Manual override of the lock on the medication storage facility is possible, but the procedures to document medication dispensation and disposal do not include provisions for paper-based emergency handling.

Institutional protocols, which specify how a particular complaint is to be tested and treated, have been migrated to the EHR, so that a clinician can order a battery of tests for “X” condition with a single click. Institutional protocols change regularly, with advancements in science, clinical practice, and institutional policies. Staff members are trained to order by protocol; continuing education on the intricacies of each test, level, and sequence of events within these protocols has fallen by the wayside. The most recent print-out for a common protocol – anticoagulation in obese patients using heparin – is dated 2013; the staff has no choice but to follow the known-to-be-outdated information.

Prior authorization, referrals, prior justification, and precertification procedures, in which the insurance company gives the provider “permission” to take certain actions – medication prescription, specialist referral, surgery or procedure, hospital admission – require medical records transmission and excruciatingly specific coding machinations in order to obtain explicit approval, and submit a claim.

Transition-of-care and care coordination activities are severely impacted, as medical records transfer and insurance-related actions (such as referrals and precertification) are required to initiate and support the transition – and most information is wholly unavailable.

Every health system function is negatively impacted. The financial, legal, and reputational cost of this incident will be severe.

The Joint Commission duly notified you of the risks, in March 2015’s Investigation of Health IT-Related Deaths, Serious Injuries, or Unsafe Conditions.

Finding significant risk associated with health IT dependency, the Joint Commission subsequently warned you by issuing a Sentinel Alert over EHR Risks in April 2015.

Patient safety is not just a risk: it is an issue. There is no doubt that multiple adverse events will occur.

You knew this could happen. You were required to have a plan to address when – not if – this happened. As Lisa A. Eramo wrote in her piece, “Prepare for the Worst,” in For the Record magazine, the Joint Commission (not to mention HIPAA/HITECH Omnibus Final Rule section 164.308) requires compliance with its Disaster Preparedness and Response standards of care in order for a facility or system to receive and maintain accreditation. And this large health sysetm has multiple facilities with Joint Commission accreditation which are now scrambling to locate current clinical practice guidelines, institutional protocols, alternative insurance medical review board procedures, and even paper prescription pads because those standards of care were not met in the real world.

Someone, somewhere, had a plan. But, ironically enough, it existed only on paper.

Have we forgotten that business continuity planning for a healthcare system should include how health care continues, with or without electronic assistance?

Have we forgotten how to practice medicine beyond the EHR?

The information below constitutes excerpts from the Joint Commissions Investigation and Sentinel Alert referenced above.

Joint Commissions Investigation of Health IT-Related Deaths, Serious Injuries, or Unsafe Conditions

As published March 30, 2015, which led to Sentinel Event Alert for EHR issuance in April, 2015.
Health IT Related Sentinel Events - EHR Risks
Joint Commission Sentinel Alert over EHR Risks – abstract by The Advisory Board Company:

It stated that EHRs “introduce new kinds of risks into an already complex health care environment where both technical and social factors must be considered.”

The alert cited an analysis of event reports received by the Joint Commission showing that between Jan. 1, 2010, and June 30, 2013, hospitals reported 120 health IT-related adverse events. Of those errors:

  • About 33% stemmed from human-computer interface usability problems;
  • 24% stemmed from health IT support communication issues; and
  • 23% stemmed from clinical content-related design or data issues.

The alert added, “As health IT adoption spreads and becomes a critical component of organizational infrastructure, the potential for health IT-related harm will likely increase unless risk-reducing measures are put into place.”

Are CIOs Done with the Plumbing and Ready for the Drywall?

Posted on December 4, 2015 I Written By

John Lynn is the Founder of the 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 and 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 RSNA 2015 I had a chance to sit down with Evren Eryurek, Software Chief Technology Officer at GE Healthcare. We had a wide ranging conversation about what’s happening across all of healthcare IT and GE’s new healthcare cloud offering. However, the thing that stuck with me the most from our conversation was the comment he used to open our conversation.

Evren told me that as he sits down with health care CIO’s he’s finding that CIO’s are done with the plumbing work and now they’re asking the question, “What’s next?”

This statement really resonated with me. Up until now we’ve been doing a lot of the plumbing work in healthcare. It’s necessary work, but it’s stuck behind the walls and most people take it for granted really quickly. We see that first hand with EHR software and all the interfaces to the EHR software. We absolutely take for granted that charts are instantly at our fingertips with the click of a button. We take for granted that charts are legible. I could go on, but you get the point.

The problem is that even though we have the plumbing work done it’s still pretty ugly. We haven’t put up the drywall (to continue the metaphor) that will add some real form and function to the plumbing and framing work (the EHR) that we’ve been doing the past couple years. I think organizations are ready for this now.

While at RSNA I also spent some time talking with Rasu Shrestha, MD, MBA, and Chief Innovation Officer at UPMC. I asked him what topic was most interesting to him. His answer was “Data Tranformation.” I plan to have a future video interview (see our full history of video interviews) with him on the subject.

His concept of data transformation aligns really well with what other CIOs were telling Evren. They’re ready to figure out what we can do with all of this EHR data to improve care and move health care forward. The plumbing work is done. The foundation is laid. Now let’s look to the future of what we can do.

This same sentiment is reflected in a comment John Halamka, MD, MS, and CIO at Beth Israel Deaconess Medical Center, made in a recent blog post, “our agenda is filled with new ideas and it feels as if the weights around our ankles (ICD10, MU) are finally coming off.”

Phase 2 HIPAA Audits Kick Off With Random Surveys

Posted on June 9, 2015 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.

Ideally, the only reason you would know about the following is due to scribes such as myself — but for the record, the HHS Office for Civil Rights has sent out a bunch of pre-audit screening surveys to covered entities. Once it gets responses, it will do a Phase 2 audit not only of covered entities but also business associates, so things should get heated.

While these take the form of Meaningful Use audits, covering incentives paid from January 1, 2011 through June 30, 2014, it’s really more about checking how well you protect ePHI.

This effort is a drive to be sure that providers and BAs are complying with the HIPAA privacy, security and breach notification requirements. Apparently OCR found, during Phase 1 pilot audits in 2011 and 2012, that there was “pervasive non-compliance” with regs designed to safeguard protected health information, the National Law Review reports.

However, these audits aren’t targeting the “bad guys.” Selection for the audits is random, according to HHS Office of the Inspector General.

So if you get one of the dreaded pre-screening letters, how should you respond? According a thoughtful blog post by Maryanne Lambert for CureMD, auditors will be focused on the following areas:

  • Risk Assessment audits and reports
  • EHR security plan
  • Organizational chart
  • Network diagram
  • EHR web sites and patient portals
  • Policies and procedures
  • System inventory
  • Tools to perform vulnerability scans
  • Central log and event reports
  • EHR system users list
  • Contractors supporting the EHR and network perimeter devices.

According to Lambert, the feds will want to talk to the person primarily responsible for each of these areas, a process which could quickly devolve into a disaster if those people aren’t prepared. She recommends that if you’re selected for an audit, you run through a mock audit ahead of time to make sure these staff members can answer questions about how well policies and processed are followed.

Not that anyone would take the presence of HHS on their premises lightly, but it’s worth bearing in mind that a stumble in one corner of your operation could have widespread consequences. Lambert notes that in addition to defending your security precautions, you have to make sure that all parts of your organization are in line:

Be mindful while planning for this audit as deficiencies identified for one physician in a physician group or one hospital within a multi-hospital system, may apply to the other physicians and hospitals using the same EHR system and/or implementing meaningful use in the same way.  Thus, the incentive payments at risk in this audit may be greater than the payments to the particular provider being audited.

But as she points out, there is one possible benefit to being audited. If you prepare well, it might save you not only trouble with HHS but possibly lawsuits for breaches of information. Hey, everything has some kind of silver lining, right?

My Overall View of Healthcare IT After HIMSS15

Posted on April 17, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I fly home from HIMSS15 (literally), I’ve been thinking how to summarize my annual visit to the mecca of healthcare IT conferences we know as HIMSS. I’ve seen a bunch of numbers around attendance and exhibitors and I believe they’re somewhere around 43,000 attendees and 1300 exhibitors. It definitely felt that massive. The interest in using technology to improve healthcare has never been higher. This shouldn’t be a surprise for anyone. When I look at the path forward for healthcare, every single scenario has technology playing a massive role.

With that in mind, I think that the healthcare IT world is experiencing a massive war between a large number of competing interests. Many of those interests are deeply entrenched in what they’ve been doing for seemingly ever. Some of these companies are really trying to dig in and continue to enjoy the high ground that they’ve enjoyed for many years. This includes vendors at HIMSS, but also many large and small healthcare organizations (the small entrenched healthcare organizations weren’t likely at HIMSS though) who enjoyed the status quo.

The problem with this battlefield is that they’re battling against a massive shift in reimbursement model. They can try and stay entrenched, but the shift in healthcare business model is going to absolutely force them to change. This is not a question of if, but when. This doesn’t keep these organizations from bombing away as they resist the changes.

If you’re a healthcare startup company entering the battlefield (to continue the analogy), you’re out in the open and absolutely vulnerable. You’re very rarely the target of this major entrenched players, but sometimes you get impacted by collateral damage. As the various organizations throw bombs at each other you have to work hard to avoid getting in their way. This is a tricky challenge.

Even more challenging to these startup companies is they don’t have a way to access many of the entrenched companies so they can work together around a common vision. Most of the startups would love to work with the entrenched healthcare companies, but they don’t even have a way to start the conversation.

The mid size healthcare IT companies are even more interesting. They’ve started to carve a space for them in the battle and many of the entrenched healthcare IT vendors are scared at what this means for them. They’re using every means possible to disrupt the competition. At HIMSS I saw the scars from many of these battles.

Certainly this description is true of many industries. Welcome to economic competition and capitalism. Although, this year at HIMSS I found the battle to be much more intense. In the past couple years meaningful use opened up new territories to be “conquered.” There was enough “land” to go around that companies were often working to capture new territories as opposed to battling their competitors for the same opportunities. That’s why I think we’re in a very different market today versus the past couple years.

The great thing is that in periods of turmoil often comes the most amazing innovations. I believe that’s what we’re going to see over the next couple years. Although, I predict that most of these innovations are going to come from places we don’t expect. It’s just too hard for companies to innovate themselves out of business. There are a few exceptions in history and we might see a few exceptions in healthcare. However, my bet is on the most successful companies being those that choose to obliterate as opposed to automate.

What’s most exciting to me is that healthcare organizations and patients seem to be ready for change. There are varying degrees of readiness, but I believe I’ve seen a groundswell of change that’s coming for healthcare. As a blogger this of course has me excited, but as a patient it has me excited as well.

What were your thoughts of HIMSS 2015? What do you think of the analogy?

While the battle is on in healthcare IT, the best part of HIMSS is always the people. Every industry has some bad apples, but for the most part I’m always deeply impacted by the good nature of so many people I meet at HIMSS. They are sincere in their efforts to try and improve healthcare for good. We certainly have our challenges in healthcare, but similar to what George Bush said in his keynote, I’m optimistic that the good people in healthcare will be able to produce amazing results. The best days of healthcare are not behind us, but are ahead of us.

Solving the Non-EHR Challenges Healthcare Faces

Posted on March 31, 2015 I Written By

John Lynn is the Founder of the 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 and 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 an interview with Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.

As we head into the massive HIMSS healthcare IT conference in Chicago, I’ve been thinking a lot about the shift in healthcare technology that’s occurred over the past 5-10 years. When I first started attending HIMSS, I was all about the EHR company and what they had to offer. That trend continued on the back of $36 billion in government EHR incentive money. Now that EHR adoption is more mature, practices are becoming more and more interested in non-EHR technologies that can improve the way they work.

With that in mind, I took some time to sit down and talk with Vishal Gandhi, CEO of ClinicSpectrum to talk about their non-EHR solutions. Vishal and his team have been thinking about non-EHR technologies and pairing those with low cost human touch for a long time. For example, here’s a look at some of the challenges they’ve tackled:

  • Patient Collections
  • Physician Credentialing
  • IT Support
  • Medical Billing
  • Meaningful Patient Engagement
  • Staff Productivity

If your practice or company is facing any of these challenges, take a minute to watch my interview with Vishal to learn more about their unique approach to solving these challenges:

Also, if you don’t have time to watch the whole video interview, they’ve created this great graphic which illustrates the suite of challenges practices face today and solutions (click to see larger version of graphic):
ClinicSpectrum Healthcare IT Ecosystem

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Check out their suite of hybrid workflow solutions on or schedule a meeting with them at HIMSS Booth: 5427 by tweeting @ClinicSpectrum.

How Can Human Resource Technology Better Help You Manage Your Employees

Posted on March 3, 2015 I Written By

The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
In healthcare we love to talk about ways we use technology with patients. We chart patient visits in the Electronic Medical Record. We schedule and bill patients and insurance companies from a Practice Management System. We interact with patients through a patient portal. All of these technologies can be great, but how come we don’t talk more about the way technology can improve how we run our practices and manage our employees?

One example of this is using technology to improve your HR. We see this in many other industries and at a few of the large hospital organizations, but for the most part healthcare hasn’t benefited from great HR practices that utilize technology. As healthcare organizations continue to consolidate, it’s going to be extremely important that every healthcare organization has a well designed human resource program to train, track, and retain key employees.

Let’s look at three areas you can use technology empowered HR practices to track, manage, and improve your human resource efforts:

Employee Growth Milestones
Are you creating a growth plan for your employees? Do you have a system that tracks that growth plan for your employees? If you don’t have either of these, then you’re missing out on a big opportunity. By setting growth milestones or goals for your employees you inspire them to be better and do more. Plus, employees love to know that there are opportunities to grow within your organization and a clear plan of how that growth can be achieved. However, along with setting these milestones, you also have to have a way to track how your employees are doing in their efforts to achieve these milestones. Otherwise, there’s no reason to set a growth milestone if you’re not going to evaluate it later.

Healthcare Human Resouce Management
While you could do this milestone tracking on paper or in a set of Word documents, we know what happens to those documents. They get filed away and forgotten. The better option is to use an employee management system which integrates these growth milestones into your employee’s performance milestones. Then, you can see how an employee’s performance corresponds to their growth milestones. Plus, with an integrated package, you can regularly be reminded of those growth milestones.

Employee Performance Milestone
Now that you’re setting growth milestones for your employees, let’s consider how you can track an employee’s performance. Doing so will encourage better performance and will provide you a way to reward those employees who are delivering great results and work with those employees who aren’t progressing towards their growth milestones.

A great example of this is with your medical billing staff. Using technology you can track the performance of that medical billing staff. How many insurance checks did they do? How many claims are they processing? How many collections phone calls did they complete? Each of these items illustrates how well that medical billing staff is performing their job’s duties. By integrating this tracking into your human resource management system, you have an objective way to evaluate and reward your employees.

Employee Benchmarking and Productivity
Now that your employees have a set of growth milestones and you have the ability to track their performance, you can effectively benchmark your staff and evaluate their productivity. Once again, while this can be done on paper, it’s much more effective and efficient with technology.

Benchmarking your employees against their peers is incredibly valuable because it helps a manager evaluate which employees might need more help and which employees deserve to be rewarded for their hard work. Without these benchmarks, we have to base our evaluations on how we feel and that can often be wrong.

A great human resource management software can facilitate an improved HR program for your employees. Doing so is extremely important to your organization so you can retain their key employees. Human resource management software gives the best employees a roadmap for how to be rewarded in regular performance evaluations. On the other hand, it also helps an organization evaluate their poorly performing employees so they can either help them improve or let them go. Healthcare organizations that choose not to utilize technology in their human resource management efforts are likely to lose their best employees as they fall behind their competitors. That’s a recipe for disaster in the competitive healthcare environment.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Check out their healthcare Human Resource management module, HRMSpectrum to help improve your HR management efforts.

4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch

Posted on January 13, 2015 I Written By

The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
One of the biggest misnomers about an EHR implementation is that it will replace many of the human elements of your practice. While the EHR can replace some of the tasks and processes that were done by humans, the reality is that EHR software is most powerful when paired with human touch. This concept is infused into our Ideal Medical Practice Workflow whitepaper and should be infused into every clinical practice.

As we enter 2015, here’s a look at 4 more ways your practice can benefit from a mix of technology and human touch:

1. Rescheduling Patients
One of the biggest forms of lost revenue for a practice comes in not rescheduling patients who missed their appointment. While some of these missed appointments represent low quality patients, many missed appointments happen for a good reason and are an opportunity for more revenue for your practice. Unfortunately, most practices don’t consistently reach out to patients and reschedule their appointment. Along with providing additional revenue for your practice, this extra patient outreach is a great form of customer service that will be appreciated by many of your patients and shared with their friends. While some of the rescheduling can be done using technology like emails and text messages, nothing shows a patient you care about them more than a telephone call about a missed appointment.

2. Complete Eligibility Verification
I’ve written previously about the importance of complete eligibility verification and a quality eligibility verification team. While having the correct eligibility information is always important, I can’t stress how much more important eligibility verification is at the start of a new year. At the start of a new year, patients once again are working to meet their deductible and therefore have a higher patient pay amount. Plus, the new ACA insurance plans means many patients will start the new year off with a new insurance plan. If you don’t have a 100% consistent process for verifying a patient’s eligibility, then you’re office is likely working off of old information which will hamper your ability to collect the correct payment from the patient.

3. Referral Tracking
Not appropriately tracking referrals is a big issue in many practices that can easily be handled with a mix of technology and human follow up. Not tracking these referrals is a big clinical compliance issue for your practice that has the potential to lead to a lawsuit. Along with the potential legal liability, I believe having a dedicated team following up on these orders will become extremely important in the new world of value based reimbursement and ACOs. In this next generation of reimbursement, your payment will depend on your ability to ensure patient compliance with outside referrals.

4. Annual Well Visit Reminders
Annual Well visit reminders are another great way to increase high quality visits to your practice. Many practices convert a regular visit into an Annual Well visit. While this may seem convenient for the patient, it usually means you’re cutting the patient short in the care you could provide them. You just don’t have the time in a sick visit to do a thorough well visit exam as well. Even more important is reaching out to those patients you haven’t seen for a while. It’s incredibly valuable to have a dedicated person or team who identifies all of these patients and sends them a reminder or calls them about their annual well visit. Plus, these annual well visits are a great way to add to your bottom line.

As you look at each of these 4 ways to improve your practice, they all require the right mix of technology and human touch to be done properly. In a busy practice, that can often mean hiring more staff or outsourcing some of these processes to an outside company. Either way, the value created for your practice by implementing these small but important changes will easily offset any additional costs. Plus, you’ll have happier and healthier patients in the process.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. You can download the Ideal Medical Practice Workflow whitepaper from ClinicSpectrum for FREE.