Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

2018 Practical Innovation Award Winner: ENGINUITY

Posted on July 25, 2018 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 the vision for the Health IT Expo came into view, we realized how valuable it was for the Health IT Expo community to learn about and share practical innovations that were happening in healthcare IT. As part of that effort, we announced the 2018 Practical Innovation Awards. Being the first year, we only had a short time to promote it and get the word out about it. With that said, we’re extremely pleased with the practical innovations that the 2018 Practical Innovation Award Winner has brought to the healthcare IT community and we’re excited to share those with you.

So, without further ado, we’re excited to announce the 2018 Practical Innovation Award Winner is ENGINUITY run by Kelly Del Gaudio, Principal Consultant, Galen Healthcare Solutions and was implemented at Freeman Health System, Valley Health System, and Canton – Potsdam Hospital System. This is a well-deserved honor for Kelly Del Gaudio and the team that worked on this project. Congratulations!

While awards and recognition are great, they don’t mean much if we don’t share the details of the practical innovations that won the award. In order to share more details about ENGINUITY (originally named Project Claire[IT]), we thought an interview with Kelly Del Gaudio would be a great way to share what they accomplished and hopefully help to spread their experiences, insights, and innovations.

Tell us about Project Claire[IT].  How was it started and who was involved?

Project Claire[IT] was what we originally called ENGINUITY. It was a project in honor and memory of my friend and Rule writing mentor at MEDITECH, Claire Riemer. Claire was the original pioneer of the MEDITECH rules engine and led the Clinical Content group there for many years.

The idea for this project started about a few months after I came on as the Principal Consultant for MEDITECH at Galen Healthcare Solutions. Since I had a lot of experience with the MEDITECH Rules engine from people like Claire, and working on a Clinical Optimization Performance Team during my 10 years at the “Tech”, I decided to host a free “Rule Writing 101” webinar that would give users a basic understanding of the MEDITECH Rules engine and offer tips and tricks on how to write some basic rules. We were surprised when we saw the signup list the day of the webinar (which ended up being our highest attended to date), and soon after, the flood gates opened with questions from MEDITECH users asking for help with Rules they’ve been stuck on for weeks, months and sometimes years!

Many of the questions we received were similar (people needing help with calculations, VTE compliance, Problem List Management etc) so we thought maybe we could streamline the process and write the complex rules that everyone seems to need for them; or as we call it: Doing their NerdyWork. Galen was no stranger to this as we have been successful in creating and delivering a similar solution to our Allscripts clients called eCalcs.

I knew I had the unique skill set to write the Rules that these customers needed, but not being a nurse or clinician by trade (although I can occasionally fake it til’ I make it) I knew I needed their help to understand exactly what their frustrations were from both a clinical and IT perspective. The only logical conclusion was to host a focus group, and so our first Galen Focus Group: Operation NerdyWork was born.

Operation NerdyWork was a group of nine MEDITECH hospitals all running MEDITECH’s 6.x/6.1 or higher platform. They represented various areas of the country, from cities to rural/remote, from large Health Systems to small Critical Access satellites. It seems that no matter how big (or small) your IT staff was, the Rules Engine was a bit of a black box for everyone.

Here is our elite nine:

  • Catholic Health Initiatives
  • Salinas Valley Medical Center
  • Randolph Hospital
  • Uvalde Memorial Medical Center
  • Freeman Health System
  • Canton-Potsdam Hospital
  • Peterson Reginal Medical Center
  • Calvert Memorial Hospital
  • Parkview Medical Center

These groups offered their time on Thursdays during the winter of 2016 and provided us with valuable insights into the world of a MEDITECH doctor, nurse, care provider, or pharmacist. From their list of frustrations, we got to work building better, rule driven workflows that will save time, reduce clicks, increase compliance and patient safely and present users with much needed clinical decision support.

We decided to call our platform ENGINUITY because we use the MEDITECH Rules Engine to code a lot of our custom content. It’s also a derivative of the word ingenuity which is the quality of being inventive, clever, resourceful; thinking outside of the box. We pride ourselves on coming up with really clever ways to achieve something that may otherwise be “Working as Designed”. ENGINUITY continues to be crowdsourced and we receive suggestions every day from users of our content. MEDITECH customers drive the future direction of this product because hey, they’re the one that have to use it right?

What have been the practical benefits of this project?

Practical Innovation is all about solutions that can be implemented now that bring value to an organization. We think we are doing just that.

By streamlining the lengthy design process that many of these rules take to write and creating a plug and play solution that has been tested, validated, and thoroughly researched, we can confidently help hospitals achieve optimal compliance, increased patient and provider satisfaction, EMR confidence, realize revenue gains and so much more. If you wanted to implement some of these complex tools outside of ENGINUITY, not only would you need at least one full time dedicated FTE on these projects, but that person would need to have an advanced Rule writing skill set which is not easy to find. You would also need to keep those people on staff to troubleshoot Rules that are subject to change during much needed updates or future workflow changes.

I actually spoke with a client at last year’s MUSE conference who told me that their resident “Rules” person was about to retire so they stopped optimizing their system because she was the only one who could support it. I used this anecdote the next day at our official launch presentation and realized that this was more common than I thought. Rules are complex and there are a lot of unknowns but they are far and away the most efficient way to optimize the your MEDITECH system which is why everyone should have them!

ENGINUITY makes these options an affordable reality for many organizations that simply don’t have the time, capital or resources. The Galen team supports all of our content post-implementation, so our clients can worry about daily system support and education.  ENGINUITY customers also determine “what’s next” in our dev cycle and are always receiving the fruit of our development efforts keeping their system optimized, refreshed and functional for years to come.

What were the keys to success with this project? 

I attribute the success of this project to 5 main things.

  1. First, having a deep understanding of the technical underpinnings of the MEDITECH Rules Engine is crucial to the success of ENGINUITY. I have always been fascinated with trying to figure out this puzzle and I continue to learn more about it daily. For me, it’s fun; for most, its frustrating. Thank you Claire Riemer, Ginny Jacques and Nancy McGowan for teaching me this craft.
  2. Second, having the support of the Galen Healthcare Solutions team. They let me run with this idea to design, develop and mass deliver content to clients who need it and they’ve fully supported it through its infancy to now. We are KLAS ranked and on Modern HealthCare’s Best Places to Work for a reason and I know working at Galen was one of the best decisions I have ever made. I firmly believe that autonomy, support and confidence is really what helps innovation to thrive.
  3. Third, our focus group. They are the ones who brought the ideas to the table and got the ball rolling. Thank you Operation NerdyWork!
  4. Fourth, our ENGINUITY clients who push us and challenge us with new puzzles every day. Their challenges (though sometimes daunting) make us better in the long run.
  5. Finally, getting the word out in major healthcare IT publications! Having published articles that recognize our unique approach to customer collaboration and feature our MU3: Measure 3 content really help to spread the word about what we’re doing.

How does this project impact patients?

We put a lot of effort in the design process of a workflow to make it easy for the doctor/user to use. Many of our tools are “single-click” meaning that as soon as I “click” on something (a query or order) then the algorithm will “fetch” necessary data and bring that to the providers attention immediately. We can suggest, require, suppress or automate responses based on preexisting information which makes ENGINUITY very patient centric. This added clinical decision support is embedded directly into the MEDITECH system (not 3rd party) which significantly increases the confidence that users have in the messages they are receiving. We can then use a combination of hard stops, soft stops, alerts and audit trails to increase patient safety across the board.

We’re currently working on a case study of before and after Implementation of our VTE Compliance protocol, which was designed using the AHRQ’s Best Practice recommendations for VTE Prophylaxis compliance. It is estimated at increasing organizational compliance to over 90% which will significantly impact the lives of many surgical inpatients.

I also worked with some of our product development folks from our VitalCenter Online Archival team to create a way to have Rules evaluate patient Problems and drive care off the Problem List. From my research, this is not just a MEDITECH problem, (pun intended) but it spans across all EMRs leaving most Problem Lists “static”. We are changing that for our MEDITECH clients by driving and automating care off the Problem List making it a truly “dynamic” list.

You call the effort “Operation NerdyWork”.  What’s been your experience getting “nerds” together to collaborate on a solution like this?

Operation NerdyWork was all about bringing a diverse group of people together with some commonalities (trades, users of MEDITECH) and working together toward a common goal. Listening to each other’s pain points and sometimes even solving each other’s problems without my help at all (which was really fun to see). Everyone brought a unique voice to the table. As innovators, the best we can do is shut up and listen, hear what people want and develop what they need.

What practical advice would you give health IT professionals that will help them be more successful in their work?

Find something you’re good at, something you’re passionate about, something that keeps you up at night but also helps you rest easy knowing you could be a part of the solution. When you’ve found it then surround yourself with supportive people and get busy on the Nerdywork.

A big Congratulations to the 2018 Practical Innovation Award Winner: ENGINUITY

Physician Burnout, a Healthcare Issue Unique to Our Healthcare Providers

Posted on May 25, 2018 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Strategy, at Galen Healthcare Solutions.

I Can’t Get No Satisfaction…but I try, and I try, and I try, and I try – Rolling Stones

Justin CampbellIn a 2018 Medscape survey exploring the professional satisfaction of providers, 42 percent of 15,000 survey respondents reported feeling burnt out with their jobs, up from an overall rate of 40 percent in 2017. In recent years, physician burnout has become a serious industry issue, with national policy discussions ensuing on how to best combat the problem. Researchers have drawn correlations between physician burnout and higher medical error rates, lower overall quality of care, and increased clinical staff turnover. Year after year, the underlying drivers of dissatisfaction have remained consistent: overwhelming charting requirement, long work hours, and cumbersome EHRs.

As health IT leaders, one question we should be asking ourselves is how we can best apply our EHR expertise to help reduce physician burnout. To answer this question, let us look to the doctors we aim to help. When physicians are at the bedside, they analyze a patient’s condition and formulate a care plan accordingly. They look to diagnostic test results, review trended vitals, pain scores, and nursing assessments, and consult with specialists in a massive data gathering exercise all aimed at quantifying the problem and crafting a treatment plan.

Providers are telling us there is a problem, and they are consistently identifying the primary underlying causes. IT department leaders have a direct influence over many of the drivers of physician burnout, so it is time for us to dig into the details, measure the problem, and craft a treatment plan. How do we measure and manage physician burnout?

There’s Gold In Those EHR Audit Logs

The Office of the National Coordinator’s EHR Certification Requirements mandate that all certified EHRs be capable of generating an audit log detailing all user activity, stored in a database alongside user credentials and a date and time stamp. At first glance, these unassuming audit logs appear to provide little actionable insight, but buried in the data there is value. When audit logs are compiled across several months, data analysts will quickly see that they have a rich dataset that can be sliced and diced to expose the EHR navigation and module utilization trends of key physician populations.

Analyzing patterns within EHR audit logs will allow savvy data analysts to determine the average length of time providers spend working in the EHR. This information can be calculated at the individual level or aggregated across all providers.

Source: Galen Healthcare Solutions

Knowing how long providers are spending on administrative tasks in the EHR is valuable information for a number of reasons. First and foremost, this information can be used as a benchmark to measure the impact of future software updates or optimization projects. Any significant changes to provider workflow should be retrospectively reviewed to understand how it impacts the average time providers spend in the EHR. First, do no harm.

Analyzing user activity logs at the individual level also helps identify highly efficient EHR users within each specialty. The EHR workflow patterns of these EHR champions can be modeled. Peers can be educated on how to adjust their own workflows to mirror specialty-specific champions, reducing their own daily EHR burden. These “quick win” workflow adjustments are changes that can be adopted by clinical staff immediately, before extensive EHR optimization efforts are undertaken.

Audit log analysis can also highlight which EHR modules providers spend the most time in. In most cases, updating user preferences and optimizing the information displayed on EHR screens can expedite chart navigation. Simplified documentation templates and macros training can expedite the documentation process. A library of evidence-based order sets and targeted clinical decision support algorithms can minimize time spent entering orders.

Analyzing utilization trends at the EHR module level exposes the workflow tasks that are consuming a disproportionate amount of provider time.

Don’t. Stop. There.

EHR audit log analysis can reveal how much time providers are spending in the EHR, and where specifically they are spending that time. It can identify physician champions, and highlight those that are struggling. Audit log analysis can be used to measure EHR-induced physician burnout and support system-wide optimization efforts aimed at improving satisfaction.

Beyond this, EHRs offer a wealth of additional datasets that can help highlight inefficiencies in clinical workflows. Traditional health IT data analytics typically aims to uncover problems in care quality or revenue cycle management, but analysis focused on EHR workflow improvement is just as noble an effort, and one providers have long been seeking.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement & data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and Gold sponsor of Health IT Expo. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on TwitterFacebook and LinkedIn.

 

Practical Applications of EMR Optimization Through Clinical Decision Support – #HITsm Chat Topic

Posted on May 15, 2018 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.

We’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 5/18 at Noon ET (9 AM PT). This week’s chat will be hosted by Justin Campbell (@tjustincampbell) from @GalenHealthcare on the topic of “Practical Applications of EMR Optimization Through Clinical Decision Support”


As a primer for the upcoming Health IT Expo, we will be discussing practical applications of EMR optimization through clinical decision support. Optimization dominates Health IT leaders’ list of priorities as they seek to rationalize EMR investment and harness its capabilities for improving efficiency, care and outcomes. However, boil-the-ocean approaches to EMR optimization can be counterproductive and stifle progress. Instead, Health IT leaders would be best served to focus on practical applications of optimization – specifically through clinical decision support, which serves as a lynchpin to clinical quality improvement initiatives.

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.

CDS has a number of important benefits, including:

  • Increased quality of care and enhanced health outcomes
  • Avoidance of errors and adverse events
  • Improved efficiency, cost-benefit, and provider and patient satisfaction

CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include:

  • Computerized alerts and reminders to care providers and patients
  • Clinical guidelines
  • Condition-specific order sets
  • Focused patient data reports and summaries
  • Documentation templates
  • Diagnostic support, and contextually relevant reference information

The majority of CDS applications operate as components of comprehensive EHR systems, although stand-alone CDS systems are also used. Many modern EMRs contain CDS capabilities such as rule engines, predictive modeling languages, and alert and order set authoring. However, the development and use of effective CDS within the EMR requires significant clinical, IT, and knowledge management resources that many organizations do not possess. This has led an increasing number of organizations to use compartmentalized decision support platforms other than EMR to drive portions of their CDS programs.

Ideally, CDS tools will be readily accessible to a wide array of caregivers where and when they need them, irrespective of what electronic health record they’re using. One such initiative emerging to share CDS resources is the AHRQ-funded CDS Consortium Project, which has demonstrated successfully that CDS from Partners Healthcare could be delivered to disparate EMRs across the country.

In an age of overwhelming data access and rapid technological development, ensuring clinicians have the clinical decision support tools to sift through a sea of information to find what is most relevant to their patient’s needs is vital to optimizing health outcomes.

In this tweetchat, we will discuss types of CDS (including sepsis surveillance, risk calculators, drug interaction, among others), mechanisms to deliver CDS to the point of care, workflow and alert fatigue implications, and methods for sharing proven CDS libraries.

Resources and Other EMR Optimization & CDS Reading:

  1. EMR Optimization Whitepaper
  2. EMR Optimization Infographic
  3. HealthIT.gov Clinical Decision Support
  4. CDS in the Cloud: Deploying a CDC Guideline for National Use
  5. Almost 20 Percent of CDS Alert Dismissals May Be Inappropriate
  6. EHR vendors, AHIMA push use of clinical decision support to prevent patient falls
  7. EMR Sepsis Surveillance – Achieving Optimal Sepsis Sensitivity & Specificity
  8. Integrated Health Calculators Whitepaper

Join us for this week’s #HITsm chat where we’ll discuss the following:

T1: What experiences do you have with CDS implementation? What impacts (positive and negative) did it have? #HITsm

T2: How can CDS best be deployed to the point of care without exacerbating alert fatigue? #HITsm

T3: How are different types of CDS initiatives (VTE, sepsis detection & prevention; clinical pathways implementation; risk calculation) prioritized? #HITsm

T4: Is CDS best suited to be managed by EMR vendors or can CDS be shared across vendors? How? #HITsm

T5: What are strategies to manage to CDS code and clinical peer review and rating? #HITsm

Bonus: What are mechanisms for making knowledge artifacts for CDS shareable? #HITsm

Upcoming #HITsm Chat Schedule
5/25 – TBD
Hosted by Amanda (@LALupusLady)

6/1 – #HITExpo Hiatus
The #HITsm chat will be on hiatus this week with the Health IT Expo happening in New Orleans. Please join in on the conversation happening on the #HITExpo conference hashtag.

6/8 – TBD
Hosted by Jeanne Bliss (@jeannebliss)

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

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.