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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!

Bring Your Own EHR (BYOEHR)

Posted on July 23, 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.

Nerd Doc recently offered a new term I’d never heard called Bring Your Own EHR (BYOEHR). Here’s the explanation:

As a tech nerd doc, the best advice I can give to CIOs/CMIOs is to find a framework for ambulatory practices that embraces a BYOEHR (Bring your own EHR) in the same vein of BYOD (Bring your own device). What I mean by that is allow providor choice in purchasing and implementing their own EHR while insuring that a framework is set up for cross communication to interlink records.

This is to fend off the trend to a one size (Epic) fits all approach in which no one is happy. C-level management needs to realize that if users (providers) are not happy, the promises of savings via efficiency simply will not happen.

I think we’re starting to hear more and more examples like this. We saw evidence of this in my previous post called “CIO Reveals Secrets to HIE.” That hospital organization had created an HIE that connected with 36 different EMRs. Think about the effort that was required there. However, that CIO realized that there was a benefit to creating all of those connections. The results have paid off with a highly used HIE.

I’m sure we’ll still see hospitals acquiring practices and forcing an enterprise EHR down their throats for a while. However, don’t be surprised if the cycle goes back to doctors providing independent healthcare on whatever EHR they see fits them best. Those hospitals that have embraced a BYOEHR approach will be well positioned when this cycle occurs.

CIO Reveals Secrets to HIE

Posted on July 3, 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.

Inspira Health Network is a community health system comprising three hospitals in southern New Jersey, with more than 5,000 employees and 800 affiliated physicians. It is an early adopter of health information exchange technology. In this Q&A-style paper their CIO and Director of Ambulatory Informatics share secrets to their successful Health Information Exchange implementation.

One of the most impressive numbers from their HIE implementation is that they were able to get 600 providers using the portal and 36 EMRs connected. Plus, they were able to get their HIE up and running in 4 months while many of the public HIEs were still working on their implementations. As I’ve written about previously, I see a lot of potential in the Private HIE. So, it’s great to see a first hand account from a CIO about their private HIE implementation.

Here are some of the other benefits the CIO identifies in the paper:

  • Ties the Physician Community to the Organization
  • Helps Meet the Meaningful Use Patient Engagement Requirements
  • Helps Address Care Coordination Requirements
  • Paper, Postage, and Staff Resource Savings
  • Improve Patient Length of Stay

Check out the full Q&A for a lot of other insights including rolling out the HIE to doctors who have an EMR and those who don’t. I also love that the CIO confirmed that the biggest technical challenge is that every EHR vendor has interpreted the HL7 standard differently based on the technical limitations of the application. This is why I’m so impressed that they were able to get 36 EMRs connected.

I hope more CIOs will share their stories of success. We’ve heard enough bad news in healthcare IT. I want to cover more health IT success stories.

EMR Success Depends on Proper EMR Access

Posted on March 1, 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.

With all of the focus being on all the various regulatory requirements (meaningful use, ACOs, ICD-10, 5010), I think there’s a real issue brewing in healthcare IT because we’re not focusing on other IT issues. As a hospital works on their EHR implementation strategy, it’s easy for them to focus a lot of time and effort to make sure that they meet the meaningful use attestation requirements. This is important, because if they don’t focus on meaningful use, then they’ll never meet the meaningful use measures. However, in the process I’m starting to see many institutions that short change the IT part of the EMR equation.

This point was really driven home to me when I was reading “Tips for Ensuring EMR Access = Success” on the Point of Care Corner blog. Here’s a great paragraph from that blog that highlights the challenge:

An effective access-point strategy must also support a safe, ergonomic workplace that enables caregivers to focus on patients rather than “hunting and gathering” the tools and information they need. Most nurses walk many miles per shift. With good planning, they will not need to add to that total looking for an open computer to enter or view patient information.

Unfortunately, in the rush to implement meaningful use of a certified EHR by the deadlines, many institutions aren’t spending the time required to make sure that EMR access is available when and where it’s needed.

The good part of this story is that you can still correct this problem after the fact. Plus, it’s not that hard once a hospital CIO places focus on it. However, it does take a focused effort. Ideally you would have worked through the EMR access issues during your EMR implementation, but it shouldn’t be any surprise that you weren’t able to plan for all of your unseen EMR access needs. So making sure you plan a review after your EMR has been in place is essential.

There is nothing more demoralizing to a user of an EMR than to not be able to get into the EMR when they need it. Although, many times EMR users won’t know what they need until after they’ve been using the EMR for a little while. There’s nothing more valuable than experience to inform decisions. Plus, technology is constantly changing, so you’ll want to consider how new technologies can make your EMR users’ lives better.

This issue reminds me of a comment Will Weider, CIO of Ministry Health Care, made in this interview. When asked what project he thought didn’t get enough attention in the hospital, he answered that it was the need to abandon Windows XP by the time Microsoft ends support. Evaluating EMR access points is another issue that I think doesn’t get enough regular attention. It’s unfortunate, because it can make an extremely big difference in what your EMR users think about their EMR experience.

Full Disclosure: Metro is a sponsor of EMR and HIPAA