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Are You Wasting your EHR Investment? – Breakaway Thinking

Posted on August 31, 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.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Heather Haugen
Healthcare leaders and clinicians continue to be disappointed with the value Electronic Health Record (EHR) technology provides in their organizations today. The challenges are real, and it will take some time and effort to improve. The technology will continue to evolve at the pace we set as leaders, vendors and healthcare professionals.

When Free Is Expensive
Several years ago, a reputable IT vendor offered us free use of their software, which provided monitoring of equipment that would be valuable to us. Initially, we were excited; the functionality perfectly aligned with our needs, and the application was robust enough to grow with us. We had a need and the software fulfilled the need. We couldn’t wait to have access to the dashboard of data promised by the vendor.

Months after the implementation, we were still waiting. The “free” price tag was alluring, but we quickly recognized the actual maintenance costs and labor required to make the application truly valuable to our organization were far from free. This story drives home a concept that we all understand, but often overlook. Underestimating the “care and feeding” required to maintain a valuable investment puts the entire project at risk. We all need to remember the importance of sustainability even when we are initially excited about a new investment.

EHR systems are expensive and require tremendous resource investment, but the effort is ongoing and we need to plan accordingly.

The Key to Long Term Behavior Change
The difficulty of moving from implementing an EHR to maintaining high levels of adoption over the life of the application is strikingly similar to weight loss and weight management efforts. The percentage of overweight adults in the U.S. is staggering and continues to rise. Today, over 66 percent of adults in the United States are overweight and 59 percent of Americans are actively trying to lose weight. But the problem isn’t weight loss – it’s weight maintenance. Many of us have successfully lost weight, but can’t keep the weight off. As a matter of fact, we regain all the weight (and often more) within 3-5 years.

This isn’t a complex concept: dieting doesn’t incent long-term lifestyle change, thus we re-gain weight after we settle back into old habits. To be successful in the long-term, we need to practice weight management behaviors actively – for years, not months.

We’ve taken the dieting approach to implementing new software solutions in healthcare for too long. We prepare for a go-live event, but fall back into our comfortable old habits afterwards – resulting in work-arounds, regression to ineffective workflows, insufficient training for new users, poor communication and errors. The process of adoption requires a radically different discipline, and the real work begins at go-live.

Instead of checking the project off your to-do list after a successful implementation, you need to create a plan to sustain the changes. A sustainment plan addresses two critical areas:

  • It establishes how your organization will support the ongoing needs of the end users for the life of the application. This includes communication, education and maintenance of materials and resources.
  • It establishes how and when your organization will collect metrics to assess end user adoption and performance.

Lack of planning and execution in these two areas will lead to a slow and steady decline in end user adoption over time.

Effective sustainment plans require resources – time and money. Keep in mind that adoption is never static; it is either improving or degrading in the organization. A series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for the investment and fund it to achieve improved performance.

Most organizations only achieve modest adoption after a go-live event, and it takes relentless focus to achieve the levels of adoption needed to improve quality of care, patient safety and financial outcomes. Sustainment plans are most successful when they are part of the initial budgeting and planning stages for EHR.

Metrics Make the Difference
Metrics are the differentiating factor between a highly effective sustainment plan and one that is just mediocre. End user knowledge and confidence metrics serve as a barometer for their level of proficiency, providing the earliest indication of adoption. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining or regressing in their adoption of the system. If we get an early warning that proficiency is slipping, we can react quickly to address the problem. These metrics ensure the organization is progressing toward high levels of adoption, overcoming barriers and gaining the efficiencies promised by EHR adoption. Metrics act just as the scale does in long-term weight management; they are the first indicator that we are falling back into old behaviors that are not consistent with sustainable adoption.

Metrics also keep us on track when performance does not meet expectations. Two potential scenarios in which the go-live event is successful but performance metrics fail to reach expectations help illustrate this idea. For instance, performance metrics could not be achieved because the system is not being utilized effectively. This may be due to inadequate training and therefore lower proficiency, or a problem with the actual performance by end users in the system. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and make sure they receive the education needed. Once users are proficient, we can refocus our attention on the performance metrics.

A second scenario is less common but more difficult to diagnose. Users could be proficient, but specific performance metrics are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be a delay in achieving certain metrics, especially if the measurements are examining small changes. A normal delay can wreak havoc if we start throwing quick fixes at the problem. In this situation, staying the course and having confidence in the metrics will bring desired results.

Like sustained weight loss, EHR adoption is hard work.  Commit to a sustainment plan and a measurement strategy to ensure your EHR continues to provide the long-term value that was promised at go-live.

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

Is Your Organization Ready for EHR Adoption? – Breakaway Thinking

Posted on July 20, 2016 I Written By

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Heather Haugen
What is the most significant barrier to Electronic Health Record (EHR) adoption for clinicians?  This question was the foundation of our research published in Beyond Implementation: A Prescription for Lasting EMR Adoption in 2010. The answer wasn’t surprising then and won’t surprise you now, but let’s consider how your leaders are doing in the face of enormous change in healthcare (think telemedicine, high pharmaceutical costs, rising medical costs, medical ID theft). It’s more important than ever to focus on technology adoption in today’s healthcare climate.

The one factor that formed a pattern across every organization struggling with EHR adoption was a lack of engagement by those leading the effort, and this still holds true today. For many reasons, this is a hard pill to swallow. First, it places responsibility back on the earliest champions: those who decided to fund and move the entire organization into an EHR implementation or upgrade. Second, it requires already overworked executive and clinical leaders to make adoption a daily priority. Effective leadership is an antecedent to adoption.

There is no greater barrier to the adoption of a complex IT application in an ever-changing healthcare environment than believing we can simply pile this effort on top of the other priorities and expect success. Organizations with disengaged, part-time, and/or overworked leaders at the helm of an EHR effort will struggle and may never achieve full adoption. In contrast, organizations with leaders who are fully invested in the daily march toward adoption will not only reach the early stages of adoption, but will enjoy a reinforced cycle of meaningful clinical and financial outcomes. Leadership must take five steps to succeed in moving their organization toward EHR adoption.

Develop a “stop doing” list: Establishing a new leadership agenda requires freeing up time for those leading and working on the effort. Without reprioritizing daily tasks, EHR adoption receives inadequate time and attention. Leaders currently in charge of EHR adoption need to understand what they are going to stop doing and focus on maintaining the courage to follow through on their decision.

Create a positive tone at the top of the organization: One of the most challenging aspects of leading an EHR adoption is transforming the project into a compelling and meaningful effort for everyone. When people, especially clinicians, believe in a cause, they will go to extraordinary lengths to ensure a successful outcome. Creating a common message with purpose and constancy is not easy, and sustaining the message is even more difficult. But when leaders create the right tone for the EHR adoption message, it will be powerful and help maintain momentum to create change.

Connect to clinical leadership: The key to provider adoption of EHRs is engagement. A governance system will engage clinicians through responsibilities and accountabilities and create clinician champions – the most highly-respected and well-networked clinicians. A high level of provider engagement can ameliorate or even overcome the common barriers to adoption, including resistance to abandoning the previous charting method, the investment of time required to learn the new system and the initial drop in productivity until users attain proficiency.

Empower decision-makers and reinforce their spheres of influence: Implementing or upgrading an EHR requires thoughtful consideration of the policies and procedures that will govern the use of the system.  There are many stakeholders with a myriad of opinions and often competing interests that can dramatically slow adoption of the EHR. Adhering to a well-defined governance process ensures that the right people are involved at the right time with the right information. The lack of governance allows the wrong people to endlessly debate decisions, ignore standards and often conclude by making the wrong decisions. Leaders must establish strong governance processes that define expectations around adoption of the EHR, involve the right stakeholders to make decisions, establish policies and best practices and ultimately evaluate performance against expectations. Governance must also be flexible enough to evolve over time.

Relentlessly pursue meaningful clinical and financial metrics: The payoff for adopting an EHR comes in the form of clinical and financial outcomes. If results are neither tracked nor realized, the effort is truly a waste of time and money. Our expectations need to be realistic, but it really is the leaders who are accountable for the relentless pursuit of positive outcomes. Leaders must incent the right people to collect, analyze, and report on the data. Similar to engaging clinicians, this requires some finesse. The good news is that clinicians are generally interested in these metrics and may find the numbers compelling enough to change processes enough to impact the outcomes. Identify several key metrics that are easy to collect, work to improve them and then measure again.

Now is the time to create a new leadership agenda to drive EHR adoption and ultimately improve patient care – which is the goal we all share!

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

Top 10 Healthcare CIO Budget Priorities

Posted on September 22, 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.

For those on the email list that can’t see the image that Charles Webster, MD shared, here are the list of top technology priorities:
1. BI/Analytics
2. CRM
3. Digitalization/Digital Marketing
4. Legacy Modernization
5. Industry-Specific Applications
6. Enterprise Applications
7. Infrastructure and Data Center
8. Application Development
9. Architecture
10. BPM
11. Cloud
12. Collaboration

Sure makes the life of a CIO look pretty easy, doesn’t it? (That was my sarcasm font in case you don’t have that font installed on your computer)

As I chew on this list, I’m processing Will Weider, CIO at Ministry Health Care’s response to me asking him what would he consider the 3 key focus areas for healthcare CIO’s:

Applying Technology to Healthcare Workforce Management

Posted on June 10, 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 mentioned before that at HIMSS this year I made a shift in focus from EHR technology to a look at what’s next after EHR. In most cases, the technology has some connection or tie to the EHR, but I was really interested to see where else a healthcare organization can apply technology beyond the EHR software.

I found one such case when I met with Ron Rheinheimer from Avantas. For those not familiar with Avantas, they’re a healthcare scheduling and labor management solution. In most cases, their workforce solution is something the nurses choose and often the CNO. I imagine that’s why it’s not talked about nearly as much as things like the EHR. It takes a pretty progressive CIO at a hospital to be able to see through all the noise of other regulations and work with the CNO on a workforce management solution. Or it takes a pretty vocal CNO who can make the case for the solution.

Ron Rheinheimer from Avantas made a pretty good case for why workforce management should have a much higher priority for hospital CIOs. He noted that about 60% of a hospital’s budget is labor expenses and 50% of the labor budget is for nursing. It’s no wonder that nurses take it hard when a hospital goes through layoffs thanks to an EHR implementation. However, given those numbers, optimizing your workforce could save your organization a lot of money.

I think this is particularly true as hospital systems get larger and larger. We’ve all seen the trend around hospital system consolidation and as these organizations get larger their staffing requirements get much more complex. Most of them start moving towards a centralized nurse staffing model. They start working on a floating pool of nurses in the hospital. While humans are amazing, once things get complex, it’s a great place for technology to assist humans.

Ron Rheinheimer also told me about the new incentive models that many hospitals are employing to be able to incentivize nurses to take the hard to fill shifts. Night shift differential has long been apart of every workforce, but with technology you can use analytics to really understand which shifts are the hardest to fill and reward your nurses appropriately for taking those hard to fill shifts. My guess is that we’re still on the leading edge of what will be possible with technology and managing the schedule in a hospital. Real time dynamic pricing for shifts is something that only technology could really do well.

As you can tell, I’m new to this area of healthcare technology. However, I find it fascinating and I believe it’s an area where technology can really improve the current workflow. I look forward to learning more.

The Fundamental Challenge of Building a Healthcare-Provider Focused Startup

Posted on March 6, 2015 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

Over the past few years, the government imposed copious regulations on healthcare providers, most of which are supposed to reduce costs, improve access to care, and consumerize the patient experience. Prior to 2009, the federal government was far less involved in driving the national healthcare agenda, and thus provider IT budgets, innovation, and research and development agendas among healthcare IT vendors.

This is, in theory (and according to the government), a good idea. Prior to the introduction of the HITECH act in 2009, IT adoption in healthcare was abysmal. The government has most certainly succeeded in driving IT adoption in the name of the triple aim. But this has two key side effects that directly impact the rate at which innovation can be introduced into the healthcare provider community.

The first side effect of government-driven innovation is that all of the vendors are building the exact same features and functions to adhere to the government requirements. This is the exact antithesis of capitalism, which is designed to allow companies to innovate on their own terms; right now, every healthcare IT vendor is innovating on the government’s terms. This is massively inefficient at a macroeconomic level, and stifles experimentation and innovation, which is ultimately bad for providers and patients.

But the second side effect is actually much more nuanced and profound. Because the federal government is driving an aggressive health IT adoption schedule, healthcare providers aren’t experimenting as much as they otherwise would. Today, the greatest bottleneck to providers embarking on a new project is not money, brain power, or infrastructure. Rather, providers are limited in their ability to adopt new technologies by their bandwidth to absorb change. It is simply not possible to undertake more than a handful of initiatives at one time; management can’t coordinate the projects, IT can’t prepare the infrastructure, and the staff can’t adjust workflows or attend training rapidly enough while caring for patients.

As the government drives change, they are literally eating up providers’ ability to innovate on any terms other than the government’s. Prominent CIOs like John Halamka from BIDMC have articulated the challenge of keeping up with government mandates, and the need to actually set aside resources to innovate outside of government mandates.

Thus is the problem with health IT entrepreneurship today. Solving painful economic or patient-safety problems is simply not top of mind for CIOs, even if these initiatives broadly align with accountable care models. They are focused on what the government has told them to focus on, and not much else. Obviously, existing healthcare IT vendors are tackling the government mandates; it’s unlikely an under-capitalized startup without brand recognition can beat the legacy vendors when the basis of competition is so clear: do what the government tells you. Startups thrive when they can asymmetrically compete with legacy incumbents.

Google beat Microsoft by recognizing search was more important than the operating system; Apple beat Microsoft by recognizing mobile was more important than the desktop; SalesForce beat Oracle and SAP because they recognized the benefits of the cloud over on-premise deployments; Voalte is challenging Vocera because they recognized the power of the smartphone long before Vocera did. There are countless examples in and out of healthcare. Startups win when they compete on new, asymmetric terms. Startups never win by going head to head with the incumbent.

We are in an era of change in healthcare. It’s obvious that risk based models will become the dominant care delivery model, and this is creating enormous opportunity for startups to enter the space. Unfortunately, the government is largely dictating the scope and themes of risk-based care delivery, which is many ways actually stifling innovation.

Thus is the problem for health IT entrepreneurship today. Despite all of the ongoing change in healthcare, it’s actually harder than ever before to change healthcare delivery things as a startup. There is simply not enough attention of bandwidth to go around. When CIOs have strict project schedules that stretch out 18 months, how can startups break in? Startups can’t survive 18 month cycles.

Thus the is paradox of innovation: the more of it you’re told to innovate, the less you can actually innovate.

Healthcare CIO Mindmap

Posted on April 8, 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.

During HIMSS, Citius Tech put out this great image they called the Healthcare CIO Mindmap. It’s a beautiful display of everything that’s happening in healthcare IT. Although, it’s also an illustration of the challenge we and hospital CIOs face. Is it any wonder that so many hospital CIOs feel overwhelmed?

Enjoy the Healthcare CIO Mindmap in all its glory below (Hint: Click on the image to see the full graphic):
Healthcare CIO Mindmap

I think that image is enough for anyone to chew on for one day. I’d love to hear your thoughts on it.

Healthcare Data Centers and Cloud Solutions

Posted on March 4, 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.

As a former system administrator that worked in a number of data centers, it’s been really interesting for me to watch the evolution of healthcare data centers and the concept of healthcare cloud solutions. I think we’re seeing a definite switch by many hospital CIOs towards the cloud and away from the hassle and expense of trying to run their own data centers. Plus, this is facilitated greatly by the increased reliability, speed, and quality of the bandwidth that’s available today. Sure, the largest institutions will still have their own data centers, but even those organizations are working with an outside data center as well.

I had a chance to sit down for a video interview with Jason Mendenhall, Executive Vice President, Cloud at Switch Supernap to discuss the changing healthcare data center and cloud environment. We cover a lot of ground in the interview including when someone should use cloud infrastructure and when they shouldn’t. We talk about the security and reliability of a locally hosted data center versus an outside data center. We also talk a little about why Las Vegas is a great place for them to have their data center.

If you’re a healthcare organization who needs a data center (Translation: All of you) or if you’re a healthcare IT company that needs to host your application (Translation: All of you), then you’ll learn a lot from this interview with Jason Mendenhall:

As a side note, the Switch Supernap’s Innevation Center is the location for the Health IT Marketing and PR Conference I’m organizing April 7-8, 2014 in Las Vegas. If you’re attending the conference, we can also set you up for a tour of the Switch Supernap while you’re in Vegas. The tour is a bit like visiting a tech person’s Disneyland. They’ve created something really amazing when it comes to data centers. I know since a secure text message company I advise, docBeat, is hosted there with one of their cloud partners Itrica.

A CIO Guide to Electronic Mobile Device Policy and Secure Texting

Posted on January 6, 2014 I Written By

The following is a guest blog post by Cliff McClintick, chief operating officer of Doc Halo. Doc Halo provides secure, HIPAA-compliant secure-texting and messaging solutions to the healthcare industry. He is a former chief information officer of an inpatient hospital and has expertise in HIPAA compliance and security, clinical informatics and Meaningful Use. He has more than 20 years of information technology design, management and implementation experience. He has successfully implemented large systems and applications for companies such as Procter and Gamble, Fidelity, General Motors, Duke Energy, Heinz and IAMS.
Reach Cliff at cmcclintick@dochalo.com.

One of the many responsibilities of a health care chief information officer is making sure that protected health information stays secure.

The task includes setting policies in areas such as access to the EMR, laptop hard drive encryption,  virtual private networks, secure texting and emailing and, of course, mobile electronic devices.

Five years ago, mobile devices hadn’t caught many health care CIOs’ attention. Today, if smartphones and tablets aren’t top of mind, they should be. The Joint Commission, the Centers for Medicare and Medicaid Services and state agencies are scrutinizing how mobile fits into organizations’ security and compliance policies.

Be assured that nearly every clinician in your organization uses a smartphone, and in nearly every case the device contains PHI in the form of email or text messages. That’s not entirely a bad thing: The fact is, smartphones make clinicians more productive and lead to better patient care. Healthcare providers depend on texts to discuss admissions, emergencies, transfers, diagnoses and other patient information with colleagues and staff. But unless proper security steps are being taken, the technology poses serious risks to patient privacy.

For creating a policy on mobile electronic devices, CIOs can choose from three broad approaches:

  • Forbid the use of smartphones in the organization for work purposes. This route includes forbidding email use on the devices. Many companies have tried this approach, but in the end, it’s not a realistic way to do business. You may forbid the use of the technology and even have members of your organization sign “contracts” to that effect. But even for the people who do comply out of fear, the organization sends the message that it’s OK to violate policy as long as no one finds out.
  • Allow smartphones in the organization but not for transmitting PHI. This approach acknowledges the benefits of the technology and provides guidelines and provisions around its use. This type of policy is better than the first option, as the CIO is taking responsibility for the use of the devices and providing some direction. In most cases there will be guidelines regarding message life, password format, password timeout, remote erase for email and other specifics. And while the sending of PHI would not be allowed, protocol and etiquette would be in place for when the issue comes up. Ultimately, though, this approach can be hard to enforce, and the possibility remains that PHI will be sent to a vendor or out-of-IT-network affiliate.
  • Create a mobile device strategy. This option embraces the technology and acknowledges that real-time communication is paramount to the success of the organization. In healthcare, real-time communication can mean the difference between life and death. With this approach the technology is fully secured and can be used efficiently and effectively.

Recent studies have shown that more than 90 percent of physicians own a smartphone. Texting PHI is common and helps clinicians to make better decisions more quickly. But allowing PHI to be transmitted without adequate security can compromise patient trust and lead to government penalties.

Fortunately, healthcare organizations can take advantage of mobile technology’s capacity to improve care while still keeping PHI safe. In a recent survey of currently activated customers of Doc Halo, a secure texting solution provider, 70 percent of respondents using real-time secure communication reported better patient care. Seamless communication integration and a state-of-the-art user experience ensure that the percentage will only rise.

Doc Halo, a leading secure physician communication application, is a proud sponsor of the Healthcare Scene Blog Network.

Study: Doctors Favor Integrated EMR, Practice Management System

Posted on September 13, 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 large institutions may not be jumping onto cloud-based technologies — or admitting it, in any event — the majority of doctors in a new Black Book survey are gung-ho on cloud solutions to their revenue cycle management dilemmas, according to a new piece in Healthcare IT News.

A new Black Book study, “Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors,” surveyed more than 8,000 CFOs, CIOs, administrators and support staff for hospitals and medical practices.

The research has concluded that 87 percent of all medical practices agree that their billing and collections systems need to be upgraded, HIN reports. And the majority of those physicians are in favor of moving to an integrated practice management, EMR and medical software product, Black Book concluded.

According to Black Book rankings, the revenue cycle management software and services industry just crossed the $12 billion mark, pushed up by reimbursement and payment reforms, accountable care trends, ICD-10 and declining revenues.

Forty-two percent of doctors surveyed said that they’re thinking about upgrading their RCM software within the next six to 12 months. And 92 percent of those seeking an RCM practice management upgrade are only planning to consider an app that includes an EMR, Healthcare IT News said.

It’s no coincidence that  doctors are trading up on financial tools. Doctors are playing catch-up financially in a big way, with 72 percent of  practices reporting that they anticipate declining to negative profitability in 2014 due to inefficient billing and records technology as well as diminishing reimbursements. (On the other hand, it’s not clear why doctors aren’t still seeking best-of-breed on both the EMR and PM side.)

While selecting an integrated PM/EMR system may work well for practices, it’s going to impose problems of its own, including but not limited to finding a system in which both sides are a tight fit with practice needs. It will be interesting to see whether doctors actually follow through with their PM/EMR buying plans once they dig in deep and really study their options.

Do Hospitals Need an EDW to Participate in an ACO?

Posted on July 29, 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 Dana Sellers, Chief Executive Officer of Encore Health Resources. Dana’s comments are in response to my post titled, “Skinny Data Solves Specific Problems While BIG DATA Looks for Unseen Problems.” For more context, also check out my post on Skinny Data in Healthcare, and my video interview with Dana Sellers.
Dana-Sellers-Encore-Health-Resources
You did a great job of nailing down the kinds of problems our industry can tackle with BIG DATA on the one hand and smart, skinny data on the other in your blog last Thursday, “Skinny Data Solves Specific Problems While BIG DATA Looks for Unseen Problems.” We here at Encore Health Resources were particularly intrigued when you asked whether skinny data would be enough for ACOs, or whether hospitals will need full enterprise data warehouses – EDWs – to meet the demands of ACOs.

I’d love to take a shot at that. As I’m sure lots of your readers know, an EDW is a collection of enterprise data based on the best guess of what an organization thinks it will need over the long run. So it’s bigger than skinny data (only what we know we need now) but smaller than Big Data (every bit of data available). So now we get to your question…do hospitals need an EDW to meet the demands of participating in an ACO?

If you’ve got one, great! In large part, we know what measures ACOs want a hospital to report. If you already have a mature, well-populated EDW — fantastic! Pull the needed data, calculate the required measures, and go for it.

If not, start with skinny data. Many organizations find that they are jumping into ACOs before they have a mature EDW. So this is a great example of where skinny data is a great idea. The concept of skinny data lets you focus on the specific data required by the ACO. Instead of spending a long time trying to gather everything you might need eventually, focus on the immediate needs: quality, readmissions, unnecessary ED visits, controlling diabetes, controlling CHF, etc. Gather that quickly, and then build to a full EDW later.

Think about a skinny data appliance. One of the problems I’m seeing across the country is that organizations are rarely talking about just one ACO. These days, it’s multiple ACOs, and each one requires a different set of metrics. I talked with an organization last week that is abandoning its current business intelligence strategy and seeking a new one because they didn’t feel the old strategy was going to be able to accommodate the explosion of measures that are required by all the ACOs and commercial contracts and Federal initiatives coming down the road. The problem is that you don’t have to just report all these measures- you actually need to perform against these measures, or you won’t be reimbursed in this new world.

One way to deal with this is to establish a sound EDW strategy but supplement it with a skinny data appliance. I doubt that’s an official term, but my mother never told me I couldn’t make up words. To me, a skinny data appliance is something that sits on top of your EDW and gives you the ability to easily extract, manipulate, report, and monitor smaller subsets of data for a special purpose. As the demands of ACOs, commercial contracts, and Federal regulations proliferate, the ability to be quick and nimble will be critical — and being nimble without an army of programmers will be important. One large organization I know estimates that the use of a smart skinny data appliance may save them several FTEs (full time equivalents) per year, just in the programming of measures.

Bottom line – I believe skinny data will support current ACO requirements. Eventually, an EDW will be useful, and skinny data is a good way to get started. Many large organizations will go the EDW route, and they will benefit from a skinny data appliance.

John, as always, I love talking with you!