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Clinical Optimization Effort and ROI Matrix

Posted on September 6, 2017 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.

Over on Hospital EMR and EHR, Galen Healthcare Solutions has been providing some really practical and detailed information on optimizing an EHR as part of their EMR Clinical Optimization Series and they’re just getting started. Along with the EMR Optimization blog posts, they also have published a FREE EMR optimization whitepaper that dives into tips, tricks, and perspectives on how to approach driving a tangible return on your EMR investment.

I love that we are finally moving past the discussion of EMR implementation and moving towards EMR optimization. As David Chou, CIO at Children’s Mercy Kansas City, recently said in the CXO Scene podcast, “Hospitals have invested at minimum $100 million on their EHR and that doesn’t include all the consulting and training services required to implement the EHR on top of it.” Given this massive investment, it is more than time to optimize our EHR implementations and ensure we’re getting a great ROI from the investment.

In Galen’s EMR Optimization Whitepaper, they shared this really impressive matrix that looks at the clinical optimization effort required against the benefits an organization will receive from those efforts:


(Click on the above image to see the large version of the matrix)

There’s a lot to chew on in this matrix, so feel free to spend some time looking over the details. In fact, it would be beneficial to do a deep analysis of this matrix with your organization. No doubt you’ll uncover ways that your organization can benefit from better clinical optimization and it will help you evaluate areas where you should focus your initial attention.

While there’s a lot of detail in this matrix, I was struck by how few levers had an impact on costs. This is a tremendous insight to consider when it comes to EHR and clinical optimization and their impact on healthcare costs. No doubt there are other more important drivers of cost that need to be considered.

On the other hand, I was also struck by how many of the opportunities in the matrix were able to directly maximize revenue while also improving quality. Sometimes I think we look at the care we provide and see our efforts to improve quality as counter to our efforts to maximize revenue. This chart clearly illustrates how you can focus on improving the quality of care your patients receive while still maximizing your organization’s revenue.

I also like to look at the outliers in these matrices. In the matrix above, they’re found in the middle of the matrix. They require less effort, but the monetary ROI is high. I’m talking about “Keeping Patient in Network” and “Driving care delivery and managing acute and chronic diseases by evaluating the patient’s problem list in clinical documentation.” These are both things that can be done much more effectively on the back of the data found in the EHR. Are you maximizing these opportunities? I know many organizations that have barely begun the work of reducing volume leakage and improved clinical decision support. Those might be great places for your organization to start in your EMR optimization efforts.

What stands out to you when you look at the EMR optimization matrix above? Would you change any of the values in the matrix? Are there areas that are missing from the matrix that you would add? How many of these optimization efforts are you working on in your organization? We look forward to hearing your thoughts and perspectives in the comments and on social media.

Note: Galen Healthcare Solutions is a sponsor of Healthcare Scene and the EMR Clinical Optimization Series of blog posts.

Legacy Health IT Systems – So Old They’re Secure

Posted on April 21, 2017 I Written By

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

I’ve been thinking quite a bit about the ticking time bomb that is legacy healthcare IT systems. The topic has been top of mind for me ever since Galen Healthcare Solutions wrote their Tackling EHR & EMR Transition series of blog posts. This is an important topic even if it’s not a sexy one.

I don’t think we need to dive into the details of why legacy healthcare IT systems are a security risk for most healthcare organizations. Hospitals and health systems have hundreds of production systems that they’re trying to keep secure. It’s not hard to see why legacy systems get forgotten. Forgotten systems are ripe for hackers and others that want to do nefarious things.

Although, I did hear someone recently talking about legacy health IT systems who said that they had some technology in their organization that was so old it was secure again. I guess there’s something to say about having systems that are so old that hackers don’t have tools that can breach such old systems or that can read old files. Not to mention that many of these older systems weren’t internet connected.

While I find humor in the idea that something could be so old that it’s secure again, that’s not the reality for most legacy systems. Most old systems can be breached and will be breached if they’re not considered “production” when it comes to patching and securing them.

When you think about the costs of updating and securing your legacy systems like you would a production system for security purposes, it’s easy to see why finding a way to sunset these legacy systems is becoming a popular option. Sure, you have to find a way to maintain the integrity of the data, but the tools to do this have come a long way.

The other reason I like the idea of migrating data from a legacy system and sunsetting the old system is that this often opens the door for users to be able to access the legacy data. When the data is stored on the legacy system it’s generally not used unless it’s absolutely necessary. If you migrate that legacy data to an archival platform, then the data can be used by more people to influence care. That’s a good thing.

Legacy health IT systems are a challenge that isn’t going to go away. In fact, it’s likely to get worse as we transition from one software to the next. Having a strategy for these legacy systems which ensures security, compliance, and extracts value is going to be a key to success for every healthcare organization.

5 Tips When Implementing a Secure Text Messaging Solution

Posted on December 20, 2016 I Written By

The following is a guest blog post by Matthew Werder, CTO, Hennepin County Medical Center. Thanks to Justin Campbell from Galen Healthcare Solutions for facilitating this guest post for us.

Now twelve months into our secure messaging implementation, and it’s safe to say our transition to a secure-messaging application with the aspiration to eliminate pagers has been quite a journey.  Recently, I answered a couple of reference calls on the selection process from some of my healthcare colleagues and determined it was time to share 5 (of many) tips for implementing a secure messaging solution.  Like most healthcare technologies, what may appear to be simple isn’t and even with the best of the best implementation plans, project manager, and leadership support – the road to implementing a secure messaging solution contains many challenges.

To start, here are five tips that have left me with scars & memories:

#1 – Define Your Strategy.  Are you just adding another technology, enhancing an existing, or just buying into the hype of secure text messaging applications?  In his post dated January 26, 2016, Mobility Solutions Consultant, Jason Stanaland from Spok stated, “secure text messaging should be implemented as a workflow solution, and not simply a messaging product.”  Before putting ink to paper, ensure that your goals are aligned, providers are supportive, and a measureable outcome has been identified.  Just because you can implement a technology doesn’t mean you should.

#2 – Beware of the Pager Culture.  In the words of Peter Drucker, “culture eats strategy for lunch,” and the same can be said for the pager culture.  This was impressed on me last summer when a physician stopped me in the hallway and had questions about the new text messaging solution we were implementing.  She was very excited and encouraged to hear that we were taking communication, mobility, and security seriously.   What I wasn’t prepared for was her question, “What is your plan to address the 4, 5, and 9-digit callback needs?”

In many institutions, a pager Morse code exists.  Telemediq’s Derek Bolen wrote in December last year that the, “Pager culture’ is real, and extremely persistent, in healthcare.” Judy Mottl, of Fierce Mobile Healthcare, talks about “Why the pager remains a viable and trusted tool for providers.” She wrote that the pager has been a resilient tool and in order for new technologies to replace it, they must overcome the benefits of such a simple mobile device – the pager!  Don’t underestimate #PAGERPOWER!

#3 – Text Administration and Etiquette Policy.  If your goal is to replace your paging system or add a secure text messaging solution in addition to pagers, your paging and messaging policy will need to be archived and a new text messaging/secure messaging policy will need to be authored.  Who authors the policy will be a collaborative effort between the medical staff, legal, IT, nursing, compliance, and operations.  Gentle reminders as written by Dana Holmes, Family Lifestyle Expert of the Huffington Post, in her 2013 blog, “A Much-Needed Guide to Text Etiquette”, highlights the necessary rules and guidelines of texting. Many of these are well known, yet good reminders in the adoption of secure text messaging in healthcare.

#4 – Think Beyond Text Messaging.  Regardless of your strategy, text messaging alone will provide minimal value.  Organizations implementing secure text-messaging solutions should think beyond the implementation and think in terms of “Connection Point” or “Communications Hub” opportunities with the patient/customer in mind.  On August 19, 2015, Brad Brooks, TigerText Co-Founder and Chief Executive Officer, stated that secure texting not only fosters a collaborative environment, but it also enables users to quickly communicate and coordinate with other colleagues while eradicating the need for multiple devices and tedious communication channels. Unlike emails, secure texting is instantaneous and avoids outside threats or hackers. Secure texting encompasses everything we love about mobile messaging, but with built-in features and tools to help one work faster and more easily with his or her team.  Does the vendor have a roadmap to take you where you want? Intersect it with patients, and make for texting amongst patients and provider. Include the patient, how can they take advantage of the texting platform?  Turn it into an engagement tool.  Drive collaboration and improve the patient experience and family experience.

#5 – Enjoy and Have Fun.  I am amazed at times when technologists don’t embrace the adoption of a new technology that could have a significant impact on their organization.  The secure text messaging industry is rich and deep right now with countless options and innovative solutions at every corner.  You run into unforeseen obstacles and workflows, and despite the promise of a short implementation multiple it by two.  We all know that change in healthcare is challenging and exhausting so enjoy the ride!

Of course there are many more. At last count, about 37 additional lessons and tips should be considered when implementing your new secure-messaging solution, so feel free to comment and share your experiences.

About Matthew Werder
Matthew Werder brings over 20 years of healthcare experience in his position as Chief Technology Officer at Hennepin County Medical Center, a 477-bed Level 1 Trauma Center and Academic Medical Center in Minneapolis. In his role, he is responsible for advancing HCMC’s technology vision and strategy to enable the organization to achieve its critical priorities.  Currently, Matthew is leading the development of an enterprise telemedicine strategy, migration to a new data center, and leading the execution of the organization’s technology strategy.

Prior to his role as CTO, Matthew was the Director of Supply Chain at HCMC, where over the course of 4 years achieved over $12M in cost savings while transforming the supply chain organization whom received recognition by Supply & Demand Chain Executive as Pros to Know.  He also worked as a Supply Chain Manager for Medtronic, Inc. at their Physiological Research Laboratories and in the Global Strategic Sourcing group. Matthew is a certified Master Lean instructor and previously worked as a Lean Consultant with Operational Excellence, Inc. 

Matthew holds a Master’s Degree in Health and Human Services Administration from Saint Mary’s University and graduated from Concordia University with a degree in natural science.  He has presented and been published on several topics focusing on operational excellence, cost management, technology and the patient experience, and strategic sourcing for services in healthcare.

Security and Privacy Are Pushing Archiving of Legacy EHR Systems

Posted on September 21, 2016 I Written By

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

In a recent McAfee Labs Threats Report, they said that “On average, a company detects 17 data loss incidents per day.” That stat is almost too hard to comprehend. No doubt it makes HIPAA compliance officers’ heads spin.

What’s even more disturbing from a healthcare perspective is that the report identifies hospitals as the easy targets for ransomware and that the attacks are relatively unsophisticated. Plus, one of the biggest healthcare security vulnerabilities is legacy systems. This is no surprise to me since I know so many healthcare organizations that set aside, forget about, or de-prioritize security when it comes to legacy systems. Legacy system security is the ticking time bomb of HIPAA compliance for most healthcare organizations.

In a recent EHR archiving infographic and archival whitepaper, Galen Healthcare Solutions highlighted that “50% of health systems are projected to be on second-generation technology by 2020.” From a technology perspective, we’re all saying that it’s about time we shift to next generation technology in healthcare. However, from a security and privacy perspective, this move is really scary. This means that 50% of health systems are going to have to secure legacy healthcare technology. If you take into account smaller IT systems, 100% of health systems have to manage (and secure) legacy technology.

Unlike other industries where you can decommission legacy systems, the same is not true in healthcare where Federal and State laws require retention of health data for lengthy periods of time. Galen Healthcare Solutions’ infographic offered this great chart to illustrate the legacy healthcare system retention requirements across the country:
healthcare-legacy-system-retention-requirements

Every healthcare CIO better have a solid strategy for how they’re going to deal with legacy EHR and other health IT systems. This includes ensuring easy access to legacy data along with ensuring that the legacy system is secure.

While many health systems use to leave their legacy systems running off in the corner of their data center or a random desk in their hospital, I’m seeing more and more healthcare organizations consolidating their EHR and health IT systems into some sort of healthcare data archive. Galen Healthcare Solution has put together this really impressive whitepaper that dives into all the details associated with healthcare data archives.

There are a lot of advantages to healthcare data archives. It retains the data to meet record retention laws, provides easy access to the data by end users, and simplifies the security process since you then only have to secure one health data archive instead of multiple legacy systems. While some think that EHR data archiving is expensive, it turns out that the ROI is much better than you’d expect when you factor in the maintenance costs associated with legacy systems together with the security risks associated with these outdated systems and other compliance and access issues that come with legacy systems.

I have no doubt that as EHR vendors and health IT systems continue consolidating, we’re going to have an explosion of legacy EHR systems that need to be managed and dealt with by every healthcare organization. Those organizations that treat this lightly will likely pay the price when their legacy systems are breached and their organization is stuck in the news for all the wrong reasons.

Galen Healthcare Solutions is a sponsor of the Tackling EHR & EMR Transition Series of blog posts on Hospital EMR and EHR.

EHR Data Extraction and Clinical Conversion

Posted on July 5, 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 think it’s quite easy to predict that 3-5 years from now, one of the top topics on this blog and in the EHR world as a whole is going to be around EHR data extraction or if you prefer EMR data conversion. I’ve previously predicted that by the end of the EHR stimulus money we’re be lucky to achieve 50% EHR adoption. So, you’d think that in 3-5 years we’d still be talking about EHR selection and implementation. Certainly, that will still be a topic of discussion. Not to mention, which EHR vendor they should go to for their second EHR. However, I am certain that 3-5 years from now we’re going to see a mass of doctors switching EHR vendors.

As part of my EHR blog week challenge (if you’re a blogger, you should participate too), today I’m going to highlight one of the foremost EHR professional and technical services company’s blog, Galen Healthcare Solutions which focuses on EHR data conversion.

I know I’ve written about EMR data conversion a number of times before. Although, I haven’t written about it much for quite a while. I guess meaningful use and the EHR incentive money has kind of dominated the conversation. However, there’s much that can and should be said about EHR data conversion.

The first thing anyone should know about EHR data conversion is that it’s not easy. In fact, it’s quite frankly an incredibly painful experience in almost every regard. Just take a look at this blog post summary of the EHR Clinical data conversion process by Justin Campbell of Galen Healthcare Solutions. He summarizes the steps as follows:
* Data Extraction
* Data Analysis: Cross-Referencing
* Design: Data Filtering, Matching (Provider, Patient Item), and Exceptions/Errors
* Testing
* Go-Live

I believe the most challenging item on this list is likely the Data Extraction. Sure, the data analysis and design are a pain to do and do well. However, the data extraction is often the most difficult part of an EHR data conversion, because you’re often working with an unfriendly EHR vendor that has lost you as a customer. Unfortunately, many EHR vendors haven’t heeded my call for EHR data independence, and so it can be a miserable experience trying to get the information and access you need to do an EHR data conversion. In some cases the EHR vendors will try and hold that data hostage.

The key for those selecting an EHR software is to be sure that the process for exporting your data from the EHR is part of your EHR contract. If it’s not, then add it to your contract. If they won’t add it to your contract, there are 300+ EHR vendors to choose from. Certainly it’s a part of the EHR contract that you hope to never have to use. Don’t take that risk.

Justin Campbell has also posted a few different data conversion success stories on the Galen Healthcare Solutions blog. Obviously, Galen has a lot of experience with the Allscripts Professional EHR software and so you’ll note this bias throughout the blog. However, the experience of the conversion is very interesting.

Here’s a paragraph from one of their data conversion success stories: Azalea Orthopedics.

To facilitate this conversion, flat-file extracts were obtained from MedManager for dictionaries, demographics and appointments. However, instead of using these extracts to import into Allscripts PM, an alternative approach was taken in which real-time appointment and demographic interfaces were deployed from the client’s existing Allscripts Enterprise EHR to the new Allscripts PM environment. This offered the flexibility of having the PM data populate real-time. Interfaces were also required from Allscripts PM to Allscripts Enterprise EHR. Thus as part of the go-live, existing reg/sched interfaces from MedManager to Allscripts Enterprise EHR needed to be deployed.

I have to admit that this kind of complexity in healthcare is what drives so many doctors nuts. I’m sure there were some functional reasons that they had to do all these interfaces between the systems. What I don’t understand is why the interfaces need to stay in place after the conversion is complete (at least if I understand it correctly). Did Galen really have to implement an interface between Allscripts PM and Allscripts Enterprise EHR? I’m sure there’s some long history for why this has to happen, but it’s such a terrible design. Certainly this isn’t Galen’s fault, but Allscripts. Interfaces are really great….when they work. When they don’t work, they drive a clinic, the IT person and even the EHR vendor absolutely nuts. I’ll be interested to learn more from Galen about why they did what they did.

I did find their report on the number of transactions processed fascinating:
Demographics: 156,900 processed in 491 minutes (8.18 hours)
Appointments; 313,280 processed in 1570 minutes (26.17 hours)

That’s a lot of data being processed. Can you imagine having to run the 26 hour data conversion twice if you messed it up the first time? Yep, data conversion is a tricky thing and can be very time consuming if you’re not really thorough in the process.

Imagine how much data will be collected 5 years from now with all these EHR implementations happening. Plus, the above data was only appointments and demographics. It doesn’t even include the physicians charting and other clinical data.