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Optimization Dominates CHIME17 Discussions

Posted on November 8, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

“Our EHR Implementation is done”

“We completed our EHR roll-out last year”

“The last EHR module has gone live”

With these words, CIO presenters at the recent CHIME Fall CIO Forum (CHIME17) ushered in a new era in Healthcare IT. Instead of EHR implementations dominating the discussion, optimization was the hot topic of discussion at the event.

“It’s clear to us that CIOs are dedicating more time and energy towards optimizing their systems rather than just implementing them”, says Ed Rucinski, Senior Vice President Worldwide Healthcare Sales at Nuance and CHIME17 attendee. “Our clients, for example, are looking for ways to simplify the documentation physicians have to do in their EHRs so that they can focus their attention back on helping patients.”

Finding ways to better utilize the EHR infrastructure was the subject of many CHIME17 sessions. In one, Sallie Arnett, Vice President Information Systems and Chief Information Officer at Licking Memorial Health Systems, presented how her organization is leveraging EHR and patient monitoring data to detect the early signs of sepsis. Over 62 lives were saved through the work of Arnett and the staff at Licking Memorial.

These results would not have been possible without the investments made in EHR implementations and other digitization efforts.

Several sessions at CHIME17 were centered on the changing role of CMIOs. For the past several years CMIOs have been synonymous with EHR implementations. Now with EHRs up and running, CHIME presenters spoke about how CMIOs were morphing into CHIOs – Chief Health Information Officers – charged with extracting clinical value from the data within the hospital’s systems. This shift in focus is further evidence that healthcare is beginning to move beyond implementation and that we are entering a time of EHR optimization.

The new focus on optimization is a welcome development. It signifies that we are finally near the end of the road-building phase of the inudstry’s EHR journey and we are getting to the phase where we start building things to make the roads useful (like gas stations, diners and cars).

Personally I am looking forward to what the next few years will bring. It will be exciting to see how decision support tools, predictive analytics, artificial intelligence, personalized medicine applications and population health systems will leverage the data that is accumulating in EHRs. The next few years will be truly interesting for CIOs.

A Vision for Why and How We Make the Science of Health Care Shareable

Posted on October 30, 2015 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 recently heard Stan Huff, CMIO at Intermountain, talk at the Healthcare IT Transformation Assembly about the Healthcare Services Platform Consortium. As he presented what they’re working on he highlighted so well the challenges that I’ve been seeing in healthcare IT. I’ve long be asking people how healthcare IT innovations that happen in one hospital or practice are going to get shared with all of healthcare. Turns out, Stan has been thinking a lot about this problem as well.

In his presentation, Stan framed the discussion perfectly when he said, “No matter what you do, you can’t teach people to be perfect information processors.” I’d also mentioned in a previous post that the human mind can’t detect the difference between something that causes errors 3 in 100 versus 4 in 100. However, with the right data, computers can tell the difference. Plus, computers can assist humans in the information processing.

These points illustrate why building and sharing clinical decision support is so important. The human mind is incredible, but medicine is so complex it’s impossible for the human mind to process it all. Ideally all of the work that Stan Huff and his team at Intermountain are doing on clinical decision support should be “plug n play interoperable” with the rest of the healthcare system. That seems to be the goal of the Healthcare Services Platform Consortium.

Many might wonder why Intermountain would want to share all the work they’ve been doing with the rest of healthcare. Isn’t that their proprietary intellectual property? It’s actually easy to see why. Stan described that Intermountain has implemented or is currently working on ~150 decision support rules or modules. Given their organization’s budget and staff constraints he could see how those 150 could be expanded to 300 or so, but likely not more. That sounds great until you think that there could be 5000+ decision support rules or modules if there was enough time and budget.

The problem is that there was no path for Intermountain to go from 150 to 5000 decision support rules or modules on their own. The only way to get where they need to go is for everyone in healthcare to work together and share their findings and workflows.

Stan and the Healthcare Services Platform Consortium are building the framework for creating and sharing interoperable clinical decision support apps on the back of FHIR and Smart Apps. This diagram illustrates what they have in mind:
HSPC for 2015 Healthcare Transformation Assembly 151026
I think that Stan is spot on in his assessment of what needs to be done to get where we need to go with clinical decision support in health care. However, there are also plenty of reasons for being cautiously optimistic.

As Stan told us at the event, “If everyone says that their workflow is the only way, we won’t get very far.” Then Stan passionately argued for why physician independence allows the opportunity for doctors to take improper care of patients. “If we allow physicians to do whatever they want, we’re allowing them the right to take improper care of patients.”

Obviously Stan isn’t saying that there shouldn’t be rigorous debate about the best treatment. By putting these algorithms out to other organizations he’s actually inviting criticism and discussion of the work they’re doing. Plus, I have no doubt Stan understands where health care is an art and where it’s a science. However, I believe he rightly argues that where the science is clear, proclaiming the art of medicine is a poor excuse for doing something different.

In my mind, the Healthcare Services Platform Consortium should be focused on making the science of health care easily shareable and usable for all of health care regardless of EHR system. That’s a vision we should all get behind.

Can Patients Be Trusted?

Posted on August 14, 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.

“Pay no attention to that man behind the curtain!”  This was how Dr. CT Lin, CMIO at University of Colorado Hospital & Health Sciences Center, opened his talk at the Healthcare Forum.  Dr. Lin’s premise was that we have kept healthcare information hidden from patients for far too long.  Giving patients access to their medical record does not create confusion and extra work for providers, but instead there is strong evidence in Dr. Lin’s research that patients are highly engaged and satisfied with access to their record and it does not create added burden on providers.

While the mystique of the all knowing, all powerful doctor is a strong one, healthcare is changing.  We’re quickly moving from the all knowing, no mistake doctors, to a more realistic paternal collaboration between doctors and patients.  No doubt this change is a hard shift in medical culture.  Take a simple look at the 5th century BC Hippocratic Oath [emphasis added]:

“I will impart a knowledge of this art…to pupils who have signed the covenant, and have taken an oath according to the medical law, but no one else.”

In the 70’s we started to see the very first shift away from closed records and medical knowledge when patients were allowed to access their paper records.  In the 80’s and 90’s we started to see the first patient portals.

Dr. Lin described the old healthcare mentality as follows:

  • Knowledge is power.  Respect my studies.
  • I am too important for clerical tasks.
  • Patients do best when they do what I say.
  • There is nothing wrong with the way I work.

Then, he suggested where we are headed in healthcare:

  • Collaboration is powerful.
  • Communication improves safety.
  • Connection fosters participation.
  • Change requires a burning platform.

This shift requires us to move from a physician centered healthcare system to a patient centered healthcare system.  Is it any wonder why physicians feel threatened?  However, Dr. Lin has studied how this shift impacts both doctors and patients and the results are profound.

Dr. Lin discussed these results during his presentation at the Healthcare Forum (embedded below):

His presentation focused on studies he conducted on: online messaging, online release of test results, and online release of doctor notes.  In each case, Dr. Lin presents the fears many doctors have of connecting with patients in this manner and also the many doctors who see potential benefits of pulling back the curtain.  Some of those fears include: “This is a crazy idea; the phone will ring off the hook” and “Patients will be more anxious.”  One doctor only agreed to participate in his study because he thought that Dr. Lin was doing a “rigorous study” and he was certain that the study would validate his fears.

The results from his research consistently showed that the “floodgates” of patient requests didn’t open and where studied there was a dramatic improvement in patient satisfaction.   The irony of people’s reaction to the study was that it varied based on the clinic’s perspective.  For example, a busy clinic that has more patients than it can handle was happy to reduce the number of patient calls while a slower clinic was not happy with that result.  An even more surprising result was doctors who found they were better doctors after the change.

Plus, there were plenty of anecdotal examples of patient benefit that were not captured in the qualitative portion of the study.  For example, one patient who had been given access to their physician’s notes reported this experience: “I lost my luggage while traveling.  I went to a local doc and said: ‘If you have Internet Explorer, I can show you my chart.  Could I have a few days of my meds?”  Access to the physician notes changed the entire experience.

Dr. Lin’s research has also been confirmed by a 250 doctor initiative called OpenNotes which came to similar conclusions.  When you involve the patient, the world does not come to an end.  Patients are happier, more satisfied, more connected, and more empowered.  Dr. Lin concluded, “Patient centered information technology is fast moving, often out of focus, but always exciting.”

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

What Information an HIE Should Pass?

Posted on March 23, 2012 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 had a post by Dirk Stanley, MD recently pointed out to me where Dirk discusses the challenge of deciding which information an HIE should pass. Dirk is the CMIO at a hospital and also a genuinely nice guy. He frames the answer to the HIE data passing question really well:

And after a rousing discussion, the answer I heard was this :Everyone has a different opinion.

I guess it’s entirely understandable… ICU docs, PCPs, surgeons, specialists, hospitalists, and everyone else has a common goal – making the patient healthier – but they have different training and thus they all have different needs. This is why when I hear docs say “I just need the important information!“, I smile because ultimately, all of the information in a chart is important – It just depends on your context and clinical needs.

So I’m left with the ultimate Informatics challenge – How can we get the right information to the right person in the right place in the right time in the right way? Especially when everyone has a different opinion on what the right information is?

He then offers this zinger which describes the real core of the problem: “Looking at the current buffet table of documentation, it’s no wonder that every doctor has a differrent opinion of what they need. There aren’t really any hard standards for clinical documentation.”

Dirk then goes on to describe his solution to the problem which essentially revolves around the idea of a new type of note that can be transferred. You can read all the details in his post.

Reading through Dirk’s thoughts on the subject I’m reminded of the conversations that surrounded the creation of CCR back in the day. They seem to have taken a very similar approach to what Dirk describes. I wonder what Dirk thinks of the CCR (now basically merged with CCD) standards that are already out there. Do they not cover what he has in mind? Are their gaps in the CCD standard that don’t cover his “new note?” Could we just improve the CCD standard to cover those gaps? I’ll ping Dirk and hopefully he’ll join the conversation.

The real challenge when looking at what data should an HIE pass is that computers aren’t very good at understanding context. I’d be interested to hear people’s thoughts about this and how we’ll solve this problem going forward. My gut feeling is that we need to start with something that will solve a lot of problems for a lot of people. We don’t need something that will solve all things for everyone from day one. We can incrementally improve the exchange of data as we go forward.

Health Tech Next Generation Conference – See You in San Francisco

Posted on July 30, 2011 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 haven’t been to a healthcare IT conference in a little while. Mostly, because I hadn’t seen one that I really wanted to attend. So, I’m excited that August 12th I’m going to the Health Tech: Next Generation Conference in San Franscisco, CA.

I’m actually going to be there the whole weekend since there’s a WordPress conference happening that weekend as well. Plus, there are a number of people I’m planning to meet with while I’m there. If you’re in San Francisco that weekend, let me know so we can get together. I always love meeting readers of this site.

I’m really excited for this healthcare IT conference. They have the amazing Guy Kawasaki as one of the keynote speakers. He’s a dynamic person and I can’t wait to see him speak in person for the first time. Plus, I’m sure he’ll offer an interesting “outsiders” perspective on healthcare IT. I believe every attendee gets a free copy of his book “Enchantment: The Art of Changing Hearts, Minds, and Actions.”

I’m going to be moderating a panel about EMR 101. Most long time readers of this site won’t likely want to attend. Although, hopefully it will be a great session for those doctors who are diving into the EMR and EHR world. So, if you’re a doctor near San Francisco, come and learn. Nice thing is that it’s only a one day event so it’s not a huge ordeal. Plus, there are some other really smart people that will be at the event as well.

Here’s the full description of the Health Tech healthcare IT conference from their press release:

HealthTech:NextGeneration will host it’s first upcoming Conference & Exposition at the Hilton San Francisco Airport Bayfront Hotel, Burlingame, CA on August 12th 2011. This one day comprehensive event will assimilate leaders & professionals in Healthcare & Information Technology under one roof. It will showcase up-and-coming strategies and technologies to tackle today’s healthcare delivery obstacles, shaping and advancing the healthcare industry forward into tomorrow’s paradigm of patient controlled environments.

HealthTech:NextGeneration will feature expert speakers from both the Healthcare and IT industries, including renowned author Guy Kawasaki & Dr. Mattison who is CMIO at Kaiser Permanente. The track sessions will address crucial topics such as Data Privacy and Security, Meaningful Use of Electronic Health Records, Role of Social Media, Cloud Computing In Healthcare, Health Information Exchange, Funding Opportunities for Healthcare Businesses and Global Healthcare Systems. The conference is designed for Healthcare & IT Executives, Consultants, Entrepreneurs and Professionals. Attendees will also include Policy Makers, Vendors, Insurers, Medical Administrators, Directors, Managers and VCs.

I hope to see a number of my readers at the event. If you can’t make it to the event, but are in San Francisco, definitely drop me a line and I’d love to meet up with others as much as possible. If enough are interested we could do a dinner event or something one of the nights I’m there.