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Written by Ahmed Mori at Care Cloud:

You wouldn’t know it from the overwhelming amount of positive press it receives, but amplified use of technology in healthcare could be one of the driving factors behind the high cost of healthcare in the United States.

However, it’s not the technology that you’re thinking of.According to a new study from the Commonwealth Fund, the U.S. healthcare system is fraught with high obesity rates, higher prices and more extensive use of medical technology like MRIs and CT exams.

So, despite the fact that the U.S. system spends more on healthcare than 12 other industrialized countries included in the study, why doesn’t it provide notably superior care? Or better yet, why is it spending so much?

High obesity rates and their associated medical costs represent a significant spike in healthcare costs. However, the country’s young population and considerably smaller percentage of smokers relative to the other countries in the study could offset the obesity spending.

Higher prices are more difficult to tackle. If you compare the U.S. healthcare system to Japan’s model – which controls healthcare costs via a government budgeted fee-for-service system that doesn’t restrict access to patients to contain costs – you’ll notice a rather stark contrast between the ways both systems operate, suggesting that the U.S.’s problems may lie at the procedural level.

When suggesting a remedy for America’s backwards system, Commonwealth Fund president Karen Davis points to the Affordable Care Act.

“The United States must use all of the tools provided by [the ACA], including new methods of organizing, delivery and paying for healthcare that will help to slow the growth of healthcare costs, while improving quality,” said Davis.

Things get a little murkier with technology, however, because much of the exorbitant spending in the sector is tied in to the fluctuating price of healthcare services. So in other words, an MRI in one clinic may be very differently priced in another. Your insurance plan also plays a prominent role.

While some of the abovementioned holes in the system are to blame, there is also the way in which technology-reliant healthcare services are delivered. However daunting the regulation of medical technology may seem, it’s not a procedural impossibility.

After examining the results of the study, disorganization seems to be a major contributing factor.

Enter healthcare information technology. Sure, sometimes electronic health records and revenue cycle management systems are too readily touted as the panacea to healthcare’s most pressing issues. But it’s tough to deny that they’re a huge step in the right direction, and they’re built to keep doctors tidy.

These systems are improving the way healthcare is delivered, improving patient safety, ensuring higher precision in the medical billing cycle to ensure less money slips between the cracks at practices and hospitals, providing better access to imaging test results, and making medical offices virtually paperlesswhich could save the system over $150 billion yearly.

Tack on another $140 to $240 billion in healthcare savings and improved health outcomes over the next ten years directly as a result of ePrescriptions, and the outlook is vastly different.

A SureScripts study saw a 10% increase in first-fill medication adherence and higher prescription delivery rates, which translates to fewer doctor visits and reduced risks of hospitalization. Oh, and decreased healthcare costs, naturally.

Information technology in healthcare means the same work is performed with fewer resources, equating to efficiency savings. According to a RAND study, the potential savings for both inpatient and outpatient care could total in the hundreds of billions if most hospitals and doctors’ offices adopted health IT.

So why not fight tech with tech?


Written by our advisory board member, Kara Nance, MD, FACP

No one can deny that healthcare is at a crossroads.  Current thought leaders like Atul Gawande and Richard Baron have proposed that history will label our current time period as the “healthcare revolution”. The introduction and adoption of electronic medical records will have an impact no less powerful than the cotton gin had during the industrial revolution.

If you are working in the medical field, you have felt the tension between the “change-makers” and the “change-resistors”.  Depending upon which camp you are in, you either love or hate what’s happening in the field of medicine.  If you talk to anyone in healthcare these days about EMR, mobile health, payment reform or ICD-10, you’re bound to get a passionate response – sometimes positive, sometimes negative.  Much like our political system, the two camps sometimes face a gridlock.

To help me understand the conflict going on in healthcare right now, I’ve looked to Dr. Helen Fisher’s Personality Type Study which describes four broad basic personality types.  She uses her data to help people find love on her internet dating site Chemistry.com.  I propose that this same framework can help those working in healthcare to find common ground as well.  After all, like marriage, we’re all in this field for better or for worse, so we might as well figure out how to live together so that we can navigate these choppy waters and not overturn the ship!

Per Dr. Fisher, the two most basic personality types are “Explorers” and “Builders”.  Explorers are driven by the neurotransmitter dopamine which fills these individuals with enthusiasm, heightened energy, curiosity, creativity, spontaneity, optimism and the propensity to seek novelty and take risks.  Builders, on the other hand, are calm, social, cautious, persistent, loyal, fond of rules and facts and orderly.  These individuals are driven by the serotonin system.  Given these biologic facts, it’s obvious that Explorers are more likely to be “change-makers” and Builders are more likely to be “change-resistors”.  Asking an Explorer to be more like a Builder or vice-versa is like asking a zebra to change its stripes to spots – it’s not going to happen.

Dr. Fisher’s study shows that in the romantic world, Explorers are attracted to other Explorers and Builders are attracted to other Builders.  We see this in the world of healthcare too.  Explorers are the ones driving the healthcare revolution, and the Builders, given their much more calm and cautious nature, are putting on the breaks.  Evolution has shown us that both character sets are important.  Without the Explorer’s impulsivity, tendency to value rewards more than fear consequences and propensity to try new things, we would not continue to evolve.  Although it is true that Explorers often win big, they are also much more likely to suffer disastrous consequences.  Explorers are the group most likely to come up with revolutionary ideas that lead to big changes or big business rewards, but a much higher percentage of Explorers than Builders may lose big too.  We need the Builder’s caution to balance the Explorer’s impetuousness, but at the same time, we can’t let the Builder’s sometimes excessive caution and fear of change allow us to stagnate.

I’ll reveal that I’m an Explorer that lives and works in a Builder’s world.  This unique, but sometimes lonely position, has given me the ability to truly understand what motivates both camps.  A “radical academic” by nature, I came to the suburbs at the beginning of my child bearing years thinking I wanted to focus on motherhood and just be a “regular doctor”.  This suited me well when high levels of estrogen, prolactin and oxytocin induced by my four pregnancies suppressed my drive to explore new territory.  But when my hormonal-induced fog began to clear, the “change-maker” area of my brain reactivated, and healthcare IT became my new drug and obsession.

What I’ve learned during my time in the suburbs is that most private practice physicians, especially primary care doctors, are Builders, which makes perfect sense.  Builders tend to be affable, tactful, careful, orderly, precise, detail-oriented, persistent, patient, conscientious and have exceptional managerial skills.  This absolutely sounds like the skillset I’d like my doctor to have!  But this same group of people, while amazing providers can be a nightmare to those trying to encourage healthcare reform or the broad-scale adoption of HIT because they like routine, predictability, tend to be frugal and are wary of fast changes.  Builders are more likely to hold tightly to the “right” way of doing things and can be closed-minded and stubborn.  The Builder’s realism and caution can also sometimes morph into deep pessimism or fatalism, which leads them to strongly believe that nothing will ever change for the better.

As I began to see the revolutionary changes EMR would bring to healthcare, I initially suffered from many delusions.  I believed that with the right product and optimized workflow scenarios, any physician office could successfully implement the new technology.   I mistakenly thought that the ability to do away with paper, collect structured data and ultimately reduce costs while improving outcomes would automatically appeal to everyone!   As I reflect on my actions during that time period, I can only laugh at my naiveté.  I was completely oblivious to the fact that many of my fellow physicians were NOT exhilarated by this opportunity for change, and actually dreaded it.  But like a bull in a china shop, I was going to prove how wonderful it was.  Needless to say, my first big exercise in change management could have gone better.

An entire industry of “implementation specialists” has evolved to help manage the pain that comes from transitioning from a paper-based to an electronic healthcare system.  What many of these experts forget though is that effective change only happens when the system is ready to embrace it.  Large corporate organizations have recognized this and actually employ many people in full time “organizational readiness” positions.  But with healthcare being so strapped for financial resources, this critical piece of the journey is not often put in place even when monumental changes are anticipated.

The stages of change are often described as pre-contemplative, contemplative, preparation, action and maintenance.  I think many working in healthcare these days are frustrated because attention is not being given to the necessary elements for successfully navigating each stage.  So much has been written about change management, but I’ve gained my deepest knowledge of the process from the Harvard MBA professor Dr. John Kotter who wrote Leading Change.  It’s a great place to start for those trying to steer healthcare innovation.

The inspiration for this posting came from watching my 12-year-old daughter experience the turmoil of a middle school girl.  Adolescents are so awkward because they are changing so rapidly.  We’re seeing the same in healthcare.  Some days are exhilarating, and some days everyone wants to regress and throw tantrums.  As a mother and a healthcare “change maker”, my hope is to continue to study, learn and help others develop the skillsets to navigate this choppy time.

Contact Kara Nance, MD:

Twitter @How2BeHealthyMD

About Kara Nance, MD, FACP:

Kara currently works in private practice in Rolling Meadows, IL. Dr. Nance approaches the care of her patients with a very holistic attitude that targets the many factors that contribute to overall wellbeing. In addition to her clinical practice, Dr. Nance is passionate about electronic medical records and the establishment of electronic health exchanges. She consults with local physicians, hospitals, and medical groups about transitioning over to electronic medical records. Kara also participates in advocacy activities relating to primary care. As a Fellow in the American College of Physicians and a member of the ACP’s Northern Illinois Council, Dr. Nance frequently travels to Washington to lobby for important issues in health care reform.

epic_logoPartner’s Healthcare, the state’s largest healthcare provider in Massachusetts is currently in negotiations with Epic Systems to replace it’s existing number of various electronic health record systems that was built in-house with a single EHR solution. The transition is expected to cost over $600 million over 10 years will move Partners in the right direction towards a more integrated, statewide system for sharing medical records. Epic Systems will allow each patient a single up to date record that is accessible by all Partners providers.

The majority of Partners current systems was developed starting in the 1980s at Massachusetts General Hospital and Brigham and Women’s Hospital before the two institutions formed Partners and when there were no products on the market that could meet the hospitals’ needs. The hospitals have separate but related inpatient systems, distinct from those used by many of their affiliates.

Dr. David Blumenthal, Partners chief health information and innovation officer states, “The result is, when patients move from one place to another, their information often does not follow them in a complete form or as promptly as we’d like. Under the new system, data for a patient who is referred from a primary care office to an orthopedist, has surgery, and later is discharged with home care would be contained “all in the same record and all available in real time.’’ Blumenthal also stated,”the Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than different “docking stations’’ for data.”[pullquote] “the Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than different “docking stations’’ for data.”[/pullquote]

The potential move to Epic shows the commitment Partners is making towards information exchange; however, the move to Epic does not come with some key challenges. The transition to a new electronic health record system will not be easy for physicians and others who are already accustomed to their current systems. Physicians who have their own homegrown operation may also lose some of their control being forced to use Epic for a more streamlined system.

For Epic Systems, this would be a huge win that would make them the most dominant EHR vendor in Massachusetts further displaying the domination of Epic in the market.

Yesterday HIMSS released their very first infographic highlighting some of the key metrics associated with this year’s event. HIMSS is claiming this year’s HIMSS12 broke the world record for tweet volume at a healthcare  conference. Some of the highlights of the following infographic include:

  • HIMSS12 averaged 167 tweets per hour
  • Biz Stone’s keynote alone generated 7,595 tweets – with Farzad Mostashari not far behind at 7,047 tweets
  • 26.5% of all HIMSS12 attendees were senior execs
  • 20.9% were IT professionals Patients, cloud computing and ONC (oh, Meaningful Use) were hot topics of mention in tweets

Guest interview post from our media partners, iHT2′S blog:

Christopher Paidhrin, Security Compliance Officer at PeaceHealth Southwest Medical Center in Vancouver, Wash., took part in the panel discussion “Securing Electronic Personal Health Information (ePHI): From the Data Warehouse to the Point of Care,” at IHT2’s Health IT Summit in San Francisco.

Paidhrin has worked for many years in IT and business operations, in higher education, the private sector and entrepreneurial environments, where he has held numerous director-level positions. Christopher has received recognition, nominations and awards for IT service excellence (Information Security magazine’s 2011 “Security 7” Award, NetworkWorld, ISE, SC Magazine), and has presented at numerous events across the U.S. during the past six years. Christopher is an advocate of IT Service Management (ITSM) best practices and process improvement, such as ITIL and COBIT, learning organizations and knowledge management.

In advance of the HIT Summit, Paidhrin shared some of his thoughts and views on health IT security issues with IHTEditor Joseph F. Jalkiewicz.

How did you get into Health IT?
About 12 years ago I was transitioning from the entrepreneurial sector as a consultant for hire and when PeaceHealth Southwest needed a new firewall and its IT security posture reviewed, a 90-day contract turned into an 11-year position, and it’s worked out well for both of us.

Can you share a bit more about your role at PeaceHealth?
I don’t think my role is common in the industry, because I’m responsible for IT security, which includes governance, operations monitoring, auditing—the works—but I also have compliance responsibility. It’s more than just HIPAA high-tech, but also PCI, Red Flag rule, hospital accreditation, and a bit of corporate compliance. I also support many project and strategy design technical teams. In my spare time, I support our continuous improvement initiatives, using COBIT, ITIL, maturity model and organizational learning models to help our division move up the service quality and maturity scale.

As SCO, do you find your time dedicated more toward technical challenges or more toward user interaction?
I would say my time is moving toward the user interface side, both internal and external. I have tools that leverage my eyes and ears across the organization and the layers of services, so the risk and vulnerabilities I see are disproportionately on the human element side. It’s the “not trained,” the neglectful, the unmindful, the inattentive individuals doing things they shouldn’t be doing. And this has been shown in lots of surveys that the human factor is costing organizations billions of dollars. One recent survey showed that $6 billion in costs in 2010 could be attributed to poor training and humans not complying with policies and protocol standards. That’s where I can effect the most business value; reduce the most risk and close up those vulnerabilities.

Do the Meaningful Use criteria play a significant role in your responsibilities?
Meaningful Use is huge, but I wouldn’t say it has a significant role in my responsibilities. The risk assessment aspects are a priority for me. We have a program for assessments and remediation and tracking and ownership. For the most part I support the medical records group and the EMR analysts, who have the vast burden of getting our organization to the various milestones and criteria. I support them, but they do the heavy lifting.

In what area of EMR implementation are you expending the most resources, financially and in man hours?
It’s project oversight and technical compliance. I’m the point of contact for validation and confirmation of those efforts and I support the team that ensures we meet those requirements. But at PeaceHealth as a whole, we have several teams—analytical, clinical informaticists, project, informational strategy. There are many teams working on Meaningful Use. Last year we really ratcheted it up. It’s a strategic goal of the organization, up in the Top 3, and it’s a big deal across PeaceHealth Southwest.

Any unexpected obstacles people should look out for?
The biggest ones are with the EMR vendors. Can they bring their applications up to the MU requirements and how quickly? I know there are 1,500-plus certified applications out there, but there are thousands more that are not ready. Internally, we’ve had to craft a supergovernance team to align our technical-level initiatives, and we have an extra layer of unified communications plan to keep it all straight and clear. We’re having to be careful with that communications plan as well because we’re getting pushback from customers saying, “You’re sending us too much information. We can’t parse it all. We don’t know what we’re doing yet.” They’re going through months and months of training to get ready for these new ways to interface with the application. So organizationally, an obstacle could be training; having enough time to do the day-to-day work and also train for the new major upgrades and changes that are coming over the next couple of years.

With cloud and mobile technologies coming online at breakneck speed, how can security teams keep pace and stay in compliance with HIPAA?
That is a huge issue, both from service delivery and customer satisfaction perspective and a security perspective. The technology for access and the expectations for access far exceed the security controls that most health care providers have in place. Cloud security itself is a Top 3 topic at almost every conference. I’m a strong advocate for controls and having them in place before releasing the services, but the demand for remote patient services and remote access and mobile access and bring-your-own device, the whole mobile explosion is catching many of us off guard. And we have to get the controls in place beforehand because the pain for the provider and the customer afterwards is huge.

It’s almost like you have to predict the issues that arise before they happen.
Organizations are moving from the old paradigm of perimeter networks. We didn’t have tools in place [that we have today] but we had a perimeter. Now that perimeter is breaking down, through HIES, through bring-your-own-device, through mobile access. At PeaceHealth Southwest more than half of the providers who access our EMR are not employees. They are partners; community clinics. We have so many diverse needs for access, it really changes the dynamic.  It’s really exploded and that’s foreign territory to most health care organizations. That is a huge challenge, and we do have to be proactive. So many people are saying, “How do I get out in front of this?”

Do you have any advice for groups trying to prepare for a HIPAA compliance audit?
Every security officer should have an IT security plan, and by that I mean, a governance plan and a programmatic plan.  Have a program for security efforts and initiatives, and it then constitutes the governance plan ——here’s why we’re going to do it—and the operational plan—here’s how we’re going to do it. It’s then definable in terms that executives understand. We have to have security, we have to have protocols, we have to have ownership and assignments of accountability and responsibilities. Otherwise, too many negative outcomes will occur and we’ll react to them one off with point solutions and individual response solutions.

I’ve had a plan I update every year. My CIO gets to see it, our IT oversight committee gets to see it, our directors in IT get to see it. They know if they can’t reach me, everything and anything I’m doing gets clarified in this large, programmatic scope document.  It’s necessary for me, because I can’t be everywhere answering all questions at all times. It’s a measure of maturity to have that in place.

As for your other point, about how to prepare for an audit, just like the Boy Scouts: “Be prepared.” HHS and CMS have provided us with their expectations, and very shortly we’re going to hear back from the first batch of audit sites. We should all be prepared to answer that main list of questions. We need to have, and be prepared to give, an answer to each one of those questions when they’re asked, even if the answer is, “We don’t have a solution for that, but here’s our action plan, and who’s responsible for handling it.” If every security officer can do that, that then will address the core concerns of the auditors. [But] if you say, “I don’t know and I’ll have to get back to you,” you can expect a mandated and monitored remediation plan from Price Waterhouse Cooper. If you can’t answer those basic questions, then you’re really going to get caught in a really awful place.

If you could share one final piece of advice with your fellow leaders in health IT, what would it be?
I’ve been speaking and talking and interviewing for 6 years now, and it can all be distilled down to one statement: It’s all about waking up. Awareness is the key. Security teams must know the scope of their risks, what their vulnerabilities are, and what their plan is to address them. But the workforce awareness must also be increased if the security controls are going to amount to anything. You can have all the security controls in the world, but if you have someone who’s not paying attention, not following the rules, or has the authority or the ability to do something different, there’s the possibility they will, and the organizational leadership needs to wake up. They need to have the awareness of those risks—what’s involved, what the costs are for not being ready. We all need to be more mindful day to day and we need to be more aware of our responsibilities, what we’re accountable to, and what is our posture? Are we at 100 percent, or are we at 80 percent and what are we going to do about the remaining 20 percent?

iStock_000018939372XSmallGuest post from Irene Froehlich, Director of Marketing at DrFirst:

Adopting an electronic health record (EHR) increases practice efficiency which translates to a profitable, organized practice that can focus on the quality of care provided to it’s patients. Here are six considerations for practices researching EHRs to improve efficiency and patient care:

  1. Where’s The Chart? Not quickly locating a patient’s paper chart can be  frustrating and time consuming for everyone. A typical scenario might involve: Could it be in the lab? Is it in the physician’s office, waiting to be annotated? Is it with a nurse awaiting a call to the patient? Is it at the front desk, because the patient has an appointment tomorrow? By using an EHR, anyone in the office needing the patient’s information can log in to immediately access it from anywhere in the office.
  2. Access Control - With an EHR, anyone with valid login credentials will be able to electronically access the patient record. No more misfiling of papers or shuffling through a large chart looking for one particular prescription. The staff can simply log in and perform a search for the required information.
  3. Adding Notes - When can a physician or nurse find time to add notes to the chart? It is difficult for a physician to remember what happened in an exam room, yet many doctors stack up patient charts until the end of the day and do all their charting at once. It is much more efficient to type up notes in the EHR system within the exam room. The EHR also makes it easier to quickly review a patient’s history, saving time to examine the patient and address any problems or concerns.
  4. Simultaneous Access - What if two people need the chart at the same time? With an EHR, a nurse can be in another room electronically transmitting a prescription to the patient’s pharmacy, ordering labs or sending a referral while the doctor continues an exam.
  5. Allergies and Drug Interactions - The EHR can alert a physician to past medication allergic reactions. Additionally, most EHR applications rely on a drug database and the patient’s record of active medications to alert the provider of potential dangerous drug interactions.
  6. Reminders - What about exam and vaccine reminders? An EHR can remind staff when it is time to set up patient appointments, such as wellness exams, mammograms and colonoscopies as well as adult and child immunization reminders.

Have you implemented an EHR yet? What other efficiency benefits have you experienced? Let us know in the comments!

About Irene Froehlich:

Ms. Froehlich has been with DrFirst since its inception in 2000. In her role as Director of Marketing, she oversees the planning, directing, and coordinating all marketing and public relations efforts at DrFirst. Ms. Froehlich has a B.S. in Communications from the University of Illinois, Champaign-Urbana.

Very interesting infographic that was created by Capterra solutions from examining the EMR software companies listed in their EMR Software Directory. From there, Capterra narrowed down the list by looking at web data for each of the vendors, including Alexa rankings, Compete traffic, and Google searches. While none of these are perfect indicators of popularity (particularly for B2B websites), the data gave them a way of narrowing down the list from 325 to the top 50 most visited EMR sites on the web. One major caveat for this infographic is companies that do not publicly release their user, customer, or revenue data are bumped down in the popularity due to the lack of data. No surprise to see the dominance of Epic and eClinicalWorks in the number of users.

The Top 20 Most Popular EMR Software Solutions

Recently the Cyber Security and Information Assurance Division of Kroll Inc. released their annual top 10 security trends for 2012 highlighting the key areas of risks and trends that will impact how organizations and governments combat and respond to cyber threats.  In this interview, Alan Brill, Senior Managing Director at Kroll dives deeper into their forecasted security trends in 2012 providing his insight on how healthcare organizations can effectively minimize their threat of security breaches, monitor your network, and optimize incident response times. In volume 2 of this interview/podcast, Alan discusses:

  •  Kroll’s Risk Assessment Approach
  • Cloud Adoption in Healthcare
  • Cloud Contract Negotiations
  • How to Secure Data from Mobile Applications
  • Making Security A Priority
  • Healthcare Social Media Security Implications
  • Creating an Effective Incident Response Plan


    About Alan Brill: Alan Bill is the Senior Managing Director of Secure Information Services at Kroll. The author or co-author of seven books and dozens of articles, he is frequently quoted in the media in his field of expertise. He has conducted analyses of security for a wide range of global companies and led incident response teams handling a wide range of incidents involving personal, health, proprietary, and classified data. He has served as an expert witness in federal and state courts and as a special master for the federal courts. He has provided expert testimony before Congress, having been invited to do so by the majority and minority leaders of the committee.

    About Kroll: Kroll, the world’s leading risk consulting company, provides a broad range of investigative, intelligence, financial, security, technology and supplier management services to help clients reduce risks, solve problems and capitalize on opportunities. Headquartered in New York with offices in 52 cities in 29 countries, Kroll has a multidisciplinary team of approximately 2,800 employees and serves a global clientele of law firms, financial institutions, corporations, non-profit institutions, government agencies and individuals.