http://www.healthcare-informatics.com Latest Articles from Healthcare Informatics http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=085ECE9C3FC549988B626669F2D00B6D by David Raths  A pair of interesting talks about state and federal health IT efforts led off the Feb. 3 National Government Health IT Summit in Washington, D.C.  A presentation, by Alan Weil, executive director of the National Academy for State Health Policy, served to remind people who work in health IT to keep their eye on the programmatic priorities of state government health agency leaders. From a 2009 survey of state health policy leaders, Weil summarized their five main goals: Connect people to needed services Promote coordination and integration in the health system Improve care for populations with complex needs Orient the health system toward results Increase health system efficiencies. He described one example of how health IT could help in improving care for populations with complex needs: approximately 40 percent of the people on Medicaid are “dual-eligible” with Medicare. One negative side-effect of Medicare Part D is that now people in nursing homes on Medicaid get prescription drugs through Medicare. Those systems, one state-run and the other federal, don’t readily share data, so providers don’t get a single view of those patients’ care. Health IT solutions could eliminate silos between those (and other) systems to improve that information flow. Vendors, consultants and federal officials also must understand that working in state health agencies “is pretty miserable right now,” Weil said. For example, one of the greatest challenges he has in planning meetings with state officials is working around all the people on furlough. States do not have the capacity to do everything they’d like to do in updating antiquated legacy systems, so they must take their top few priorities and build an infrastructure to support them. The HITECH Act has created an imbalance, Weil said, where beleaguered officials see the health IT funding as their salvation. “But that’s the tail wagging the dog,” he said. “It’s an underfed dog, and that tail is pretty big.” States must pull back from the allure of all that money and do the hard thinking about health system improvements. The bottom line, Weil said, is that any health IT strategic plan has to derive its goals from specific tasks agencies have identified, rather than working to create a broad health IT infrastructure for its own sake and then applying it. In an earlier presentation, an enthusiastic Todd Park, chief technology officer of the Department of Health and Human Services, talked about some ways that he is trying to get HHS to look at its own data in new ways. Park, who co-founded athenaHealth, is pushing HHS to do “smart targeting” to apply the type of analytics that national intelligence agencies use across HHS agencies, looking at structured and unstructured data, to elucidate patterns in healthcare delivery and outcomes. He also talked about harnessing the power of social networking and Web 2.0 technology to share best practices. Park gave an example of a food safety widget that can feed safety alerts over Twitter, but said that is just a beginning. He said he is “working startup hours again” to make HHS a catalyst to leverage the power of data and networking to build collaboration across communities. Both Aneesh Chopra, U.S. chief technology officer, and David Blumenthal, MD, national coordinator for health information technology, are scheduled to address the conference on Feb. 4. Wed, 03 Feb 2010 00:00:00 EST 085ECE9C3FC549988B626669F2D00B6D http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=0626D3F337B9420E91388F7E5342B209 The Landscape: Because HIPAA enforcement previously lacked teeth, many healthcare organizations haven't developed the policies and procedures required to prevent data breaches. The ARRA-HITECH Act is about to change all of that. The Future: HITECH's security provisions and heightened enforcement may force hospitals and their business associates to spend more on training and security features such as encryption and audit trail systems, and to hire consultants to conduct audits. Lisa Gallagher Most of the attention paid to HITECH's impact on hospitals has focused on overcoming clinical hurdles to meeting meaningful use guidelines. But many CIOs seem more relaxed discussing CPOE and data exchange than they do changes to HIPAA regulations. That's because HITECH's changes to privacy and security regulations and enforcement could force them to devote considerably more resources to audits, policy reviews and relationships with business associates. And it may require re-evaluation of the relationship between IT security and compliance officials.   In brief, the biggest security changes in the HITECH Act involve: Business associates: Effective Feb. 17, 2010, business associates, such as claims processors or benefit management firms of HIPAA-covered entities, are directly responsible for complying with HIPAA security provisions. Breach notification: HITECH creates the first national data breach notification law. Covered entities have 60 days from when they reasonably should have known about a breach to report it. If the breach involves more than 500 records, it must be reported to prominent local media; states such as California have even more stringent notification laws. This could put hospitals under greater public scrutiny. HIPAA enforcement: The Department of Health and Human Services Office for Civil Rights is getting more tools (and staff) to enforce HIPAA, and states' attorneys general can bring civil actions. If there is a breach of protected health information (PHI) through “willful neglect,” it could cost $25,000 per incident if the hospital moves to fix the security weakness and $50,000 per incident if it doesn't, up to a maximum of $1.5 million per year.   The health IT provisions of the stimulus bill present other security concerns as well. “The biggest changes aren't the laws and penalties, it's that HITECH is all about sharing data and making it more accessible to outside entities,” says David Finn, former CIO of Houston's 639-bed Texas Children's Hospital and current health IT officer for Symantec Corp. (Mountain View, Calif.). “It's relatively easier to secure your own house. But as you move toward exchange, it adds many layers of complexity.” A recent Healthcare Information and Management Systems Society (HIMSS, Chicago) security survey points to some troubling trends, according to Finn. “There is more awareness of the issue, but as far as budget numbers, creation of formal security positions, or tools being integrated, there has not been much change. That's what most concerns me,” he says. “They know HITECH is coming down the road, but they are not doing the assessments necessary.” Lisa Gallagher, HIMSS' senior director of privacy and security, cites one statistic from a survey in which 60 percent of respondents say they've alloted less than 3 percent of their IT budget to data security. “That is very concerning to me,” she says, pointing out that less than half say they have a chief information security officer or chief security officer in their organization, and a quarter say they don't do formal risk analyses. “They aren't doing these risk analyses because they don't have the experience or the resources to conduct them,” Gallagher says. “That's why that budget number is significant.” Information Privacy and Security Consultant Chris Apgar says that when Portland, Ore.-based Apgar and Associates is asked to audit a hospital, it usually finds the same five problems: No risk analysis has been completed Up to that point, the hospital hasn't conducted any security audits The hospital may do an initial training, but doesn't offer refreshers and doesn't train temps, contractors and volunteers, who are all part of their work force There's little documentation of any policies and procedures The disaster recovery/emergency management plan is limited in scope and/or out of date.   So what should hospital security teams be concentrating on first? Apgar says one focus should be sending out addendums to their business associate contracts. After prioritizing their business associates by which access the most PHI and mission-critical data, “I would ask those high-risk business associates to give me a list of their policies and procedures, and a copy of their last risk analysis and compliance documentation,” he says. “Some hospitals are doing full-blown audits of their business associates.” However, experts say the field is not level. Indeed, HIMSS' Gallagher suggests that if upon review, the business associate is “wildly out of compliance, you need to consider terminating that contract.” Taking an active stance Some CIOs have already taken proactive steps to ensure compliance with the new provisions. Gerald Greeley, CIO of 229-bed Winchester Hospital in Massachusetts, says he is working with the director of legal affairs “on a re-evaluation of what needs to be done internally and in terms of business associate agreements. Besides the changes in ARRA, there are some new stringent regulations going into effect in Massachusetts on protecting personal information from identity theft, so we are going to work on a new round of training for staff,” he says. Another focus at Winchester is better encryption for things like USB drives, Greeley adds. “And anywhere there is protected health information, we need to move that to a secure server.” Some consultants say that getting a better handle on data breaches will require a change in cultural attitudes. Healthcare is already highly regulated, and the mindset is often about doing just enough to pass the next audit, says Glen Day, a principal in Booz Allen's Los Angeles office. “But a better approach is to develop a breach prevention policy that puts tools in place to alert them in a proactive way. Unless they take a proactive monitoring stance, they will be further penalized,” adds Day, the former chief privacy officer for Los Angeles County. Hospitals must also delve into clinical and financial departments to see how data is actually being used. “A chief security officer may have drawings and diagrams of the IT architecture and where PHI data is supposed to reside,” Day explains, “but what this doesn't recognize is all the ways data is actually used.” Digital information, he says, is often copied from databases into laptops or e-mailed or put on USB drives. “So there's the policy and then the reality of how it's used. My experience is that in 100 percent of cases, it's in many more places and used in more ways than they can imagine.” Analysts and consultants expect that the HITECH changes will bring more patient data breaches to public attention. Often the discovery of a serious breach forces an organization to re-evaluate its security stance and identify and address weaknesses. For instance, after an admissions employee was accused of selling the data of 2,000 patients in a 2008 identity theft scheme, New York-Presbyterian Hospital initiated an organization-wide information security enhancement project to improve coordination among institutions, and reduce personally identifiable information. In written testimony presented to the HIT Standards Committee, Soumitra Sengupta, Ph.D., New York-Presbyterian's information security officer, notes that the 2,242-bed multi-hospital system has since worked to improve its audit log alerting mechanisms. “We had to do a better job of using our audit logs to determine which access of patients' records is legitimate and which is illegitimate,” he says. “We learned from our breach that the simple set of rules we had in place was not enough. We had to do a better job of understanding how employees actually access data to create better rules.” The audit log system now triggers alerts on specific conditions, such as number of consecutive medical record numbers accessed by a user, or a sudden significant change in number of records accessed by a user as compared to past practice. New York-Presbyterian has 30 applications reporting about 700,000 log records for about 65,000 patients each day in its audit log server. It also is working to encrypt all institutional laptops, requiring purchase of encrypted USB drives, and ensuring encryption of all tape backup, says Sengupta. One recent change that may have a significant impact involves accounting of disclosure, he notes. Under HITECH, if an individual requests an accounting of their EHR information, covered entities must be able to provide disclosure information for the prior three years if the disclosures were made for “treatment, payment or health care operations.” It may take considerable resources, Sengupta says, to round up explanations for why each hospital employee accessed an individual's record during a hospital stay. Does Your Organization Need a CSO? Fewer than half of respondents to the 2009 HIMSS Security Survey indicate that their organization has either a formally designated chief information security officer or chief security officer. And some analysts say that will become more of a problem as the HITECH changes unfold. “Not having a CISO or CSO title says something about an organization,” says David Finn, health IT officer for Symantec Corp. (Mountain View, Calif.). HIPAA requires that an individual is designated to that role - and that individual should not be the CIO, according to Finn. “It's good that CIOs are engaged, but a CIO has a lot of things to think about.” When he held the position at Texas Children's Hospital in Houston, Finn had a privacy office within IT that worked hand in hand with a security group in the technical infrastructure department in IT. Another question is whether the CSO should report to the CIO. “In an ideal world, I believe the CSO should not report to the CIO, because if there is too much of an IT focus, so you lose sight of the issues on the business side, such as training,” says Chris Apgar of Apgar and Associates (Portland, Ore.). “I would tell CIOs that if the CSO is reporting to you, make sure you take a broader view of the whole organization and issues other than technology. Make sure their role is expanded to look at all the policies and procedures, not just the tech issues.” Lisa Gallagher, senior director of privacy and security at Chicago-based HIMSS, agrees that while the best arrangement is for a CSO to report elsewhere, “in most cases, they do report to the CIO, so the CIO needs to stay in the loop on what needs to be done.” Unfortunately, she says, many lose track of security issues because they are focused on the day-to-day mission of running the IT shop. ‘The boy who cried wolf’ There is skepticism among some health IT security executivies as to whether enforcement will actually be any more rigorous than it has been historically. “HIPAA never had a lot of teeth,” says Joe Granneman, who is both chief technology officer and chief security officer at Rockford (Ill.) Health System, which includes the 396-bed Rockford Memorial Hospital. “I have to ride that line between security and efficiency, but if it's not enforced, who's backing me up? I end up looking like the boy who cried wolf.” Granneman says some physicians tell him they think the focus on protecting patient data is all blown out of proportion and shouldn't be a big deal. “So there is still a lot of education that needs to be done to get the importance of this across,” he adds. “Privacy is the number one patient concern around the use of electronic health records.” Granneman, who reports both to the CIO and the audit subgroup of the hospital board of directors, says he believes Rockford is on the right track. “But of course, you're never done with security,” he says. “There's always something you could do better.” Healthcare Informatics 2010 February;27(2):20-23 Fri, 29 Jan 2010 00:00:00 EST 0626D3F337B9420E91388F7E5342B209 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=A15256E687484B6994A28246C31E27B8 The Landscape: It's not just the push to obtain federal funding under the ARRA-HITECH legislation that's driving a burst of CPOE implementation of late; it's the realization on the part of CIOs and other organizational leaders that CPOE really is foundational for progress in improving care quality and efficiency. The Future: The image of CPOE is rapidly being transformed. Clinician leaders and CIOs see the technology as a vital tool in eliminating unnecessary and problematic variation in care, and in spurring data analysis for quality and patient safety improvement going forward. The challenge, as many hundreds of hospitals move towards CPOE in order to qualify for meaningful use under ARRA-HITECH: can they all implement successfully? Tim Zoph When computerized physician order entry (CPOE) was first rolled out in hospitals, it was frequently derided by many as “turning doctors into order entry clerks,” and criticized for adding precious minutes to physicians' daily tasks. But more and more, hospital leaders are recognizing the true value of CPOE - as a foundational technology for data analysis, the standardization of physician practice, and quality and patient safety improvement initiatives. In addition, in the past several years, the technology itself has steadily improved. So with hospitals nationwide scrambling to achieve meaningful use under the ARRA-HITECH Act, CPOE - a technology famously difficult to implement - is becoming an industry-wide litmus test for clinical IT implementation. And CPOE-pioneering CIOs are urging their colleagues forward.   David Liebovitz “I think that computerized physician order entry has become an emblematic term and milestone for electronic health record adoption,” says Tim Zoph, vice president and CIO at the 873-bed Northwestern Memorial Hospital in Chicago. “That's been shored up by the Leapfrog standard, which has long maintained CPOE as a core patient safety measure. That was one of the first signals. And now Leapfrog has a measure around effective use of CPOE, such as sufficient dose-range and drug-allergy checking, to make sure you're using your system safely. So we're at one of these inflection points in the adoption of electronic records that says you've arrived.”   According to David Liebovitz, M.D., medical director for clinical information systems and associate chief medical officer at Northwestern, the benefits of CPOE are becoming clearer as hospitals move beyond implementation. “For hospitals that have successfully implemented CPOE, very little will happen without an electronic order that is very specific, with elements completed,” he says, noting that the technology has been in place at Northwestern for several years. “So already, this standardizes the entering of orders for nursing, lab, pharmacy, and so on. And once that's in place is when the real potential benefit becomes possible.” He says that involves using clinical decision support and alerts intelligently, and drilling down to enrich the features embedded in CPOE at deeper levels. “One potential pothole along the path is assuming that if something is used, it will actually be used,” Liebovitz says. “For example, he says, an organization could develop a community-acquired pneumonia order set, while maintaining a scenario in which that order set has to be explicitly looked up. “In that situation, the physician would have to search for the specific community-acquired pneumonia (CAP) order set rather than defaulting to ad hoc ordering. So CPOE might exist, but we have to get to the next step.” So, he says, if a patient has an elevated white blood cell count from a chest X-ray, “the system should serve up the CAP order set as a first choice. The power of the system is in making sure the right orders are entered at the right time.” The path to that level of order entry optimization is inevitably challenging, Liebovitz says. However, he notes that resources are becoming increasingly available to help facilitate the path, including Web sites offering free downloadable order sets. Specialty medical societies and numerous other groups have made order sets available in a variety of care areas as well. What the trailblazers learned Ed Marx Leaders at hospitals and health systems that have successfully implemented CPOE say there are several lessons they've learned that can benefit those in the early stages of deployment. One piece of advice is to make sure senior executives are closely involved, says Ferdinand Velasco, M.D., vice president and CMIO of Texas Health Resources, a 14-hospital, 3,700-bed system based in Dallas-Fort Worth. “Another major lesson has to do with the manner in which you engage physicians,” he says. “In a community hospital setting like ours, unlike an academic setting, you simply can't dictate to physicians to use the system. So it really involves getting the physicians on board, finding champions, and getting physicians to be partners with us.”   Todd Rothenhaus Once that's done, says Ed Marx, Texas Health Resources senior vice president and CIO, the challenge is to derive real benefit from the implementation. For Marx, this means harnessing the power of automated order entry to help fuel clinical business intelligence and transform care delivery. Organizations are usually very proud when they reach 30 percent of standardized order sets, Marx says. His, he adds, is somewhere north of 60 percent. “The higher that number goes, the higher the clinical quality and efficiency in the utilization of implants and other supplies.”   As for the difficulties involved in implementing CPOE in a community hospital setting, Todd Rothenhaus, M.D., senior vice president and CIO of six-hospital Caritas Christi Health System in Boston, says those may be a bit exaggerated in some people's minds. “Fundamentally, community hospitals really aren't that different,” says Rothenhaus, who in addition to his CIO duties, still devotes a small number of hours a month to practicing as an emergency physician at Caritas Christi. The bigger challenge, he says, is the variability of results when implementing commercial CPOE products in different community hospitals. “CPOE potentially has the ability in a community hospital setting to have an even greater impact on patient safety and quality,” he says, adding that having an electronic hospital allows physicians to be more attentive to the needs of the patients. “They can be in the office, and looking at the patient's chart, without having to drive into the hospital.” The same kind of logic has become apparent in the PACS space over the past two decades, he notes. Quality improvement, turbo-charged Like most CIOs who have implemented CPOE, Rothenhaus extols its benefits for data analysis and quality improvement. “We're looking at metrics for patients whose medications have been barcoded, and we've been looking at CPOE-entered orders and have been tracking adverse events,” he says. At Summa Health, a five-hospital, 2,060-bed health system based in Akron, Ohio, System Vice President and CIO Greg Kall says, “CPOE is indeed a platform, and it allows you to do things you can't do as easily in a paper-based world. We view it here at Summa as a tool: there's this great marriage between information technology and quality that allows us to help move our quality agenda forward.” Charles Ross, M.D., Summa's vice president and CMIO, says that while there are some technical aspects that are important in successful CPOE implementation, the vast majority of elements are process changes that lead to the end-point, which improved care quality. “That, to me, is much more important than checking a box and saying you've done it, and now you want your money from ARRA-HITECH,” he says firmly. The pioneers say in the end, ARRA-HITECH legislation is only accomplishing what should have already been happening - an industry-wide acceleration in CPOE adoption. Caritas Christi's Rothenhaus says one day in the future, leaders across healthcare will understand that CPOE is an infrastructure that allows for serious and continual process improvement. “I think if you flash forward just five years from now, using paper to write orders will be an anachronism.” Healthcare Informatics 2010 February;27(2):16-18 Fri, 29 Jan 2010 00:00:00 EST A15256E687484B6994A28246C31E27B8 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=4F70BE1CB4244E9B892017F45E20FBFC It's 2010 and a new day has dawned in the healthcare IT job market. You can feel the difference between where we are today and where we have been for the last year or so. It's been a strange time for some, and a stressful one for others, as we've all absorbed a steady diet of negative news regarding the job market. But somehow, it feels much better now. The phones are ringing again. Clients and candidates alike seem to have the same cautious enthusiasm as they look ahead to the New Year. As we embrace 2010, we also are seeing a major shift in the employment marketplace in the health IT space. Companies are beginning to build bench strength and upgrade their talent pools as we all prepare for a hiring frenzy in our space that I suspect will rival or exceed the demand for talent that we experienced in the dot-com boom of the late '90s. While it's exciting to stop and think about what is forecast to happen in our marketplace, it's also important to begin to formulate strategies to attract and retain the talent we will need for the opportunities ahead. I strongly suggest that you examine your human capital needs very carefully. With increased demand for human capital, we all have greater execution risks. The methods we used for hiring and retaining talent must change. Here are a few ideas you may want to consider and implement in your own environment: Talent Assessment: Do you have all “A” and “B” players on your team? If the answer is yes, that's good. If you still have “C” players, it's probably time to give them a chance to step up their game or find a new employer. The demands of this market will be too great, and you only want top tier talent on your team. Place them on a 60 to 90 day improvement plan and give them your support and enough run-way to succeed. Be honest with yourself as to their capabilities to get the job done, and check your emotions at the door. Talent Acquisition: With a shortage of qualified candidates in the marketplace, the competition for top-shelf talent will be fierce. How do you sell the value in your organization over other options top candidates will have? What is your competitive advantage when it comes to giving future employees a true career path? Why would someone want to work for you and your organization? Develop a clear message as to what you have to offer and be ready to articulate it to candidates. How do you sell the culture you are building, and why is that important to a new recruit? Everyone in the hiring process needs to be on the same page when it comes to talent acquisition. On-Boarding: The day the employee walks in the door, an impression is made forever. How do you set the right expectation and quickly get new employees productive? How do you welcome them and embrace them as new members of your team? Do you have their laptop, voicemail, and e-mail set up, and benefit and other key information available when they walk through the front door? Do you have a mentoring program in place to allow experienced employees to transfer skills and domain knowledge about your organization on day one? Remember - you get one chance to make a first impression. Make it count! Retention: The demand for HIT talent is going to be extremely strong for the next five years and beyond. What are you doing to make sure your employees are happy and not seeking greener pastures? Do you have a formal retention strategy to retain your “A” players? Remember, employees always create their value - either internally or externally. If you don't recognize their value, show your continued appreciation and have a formal retention plan in place, you may have a bigger problem - attracting and retaining human capital during an explosive high growth job market. Tim Tolan is senior partner at Sanford Rose Associates Healthcare IT Practice. Tolan can be reached at tjtolan@sanfordrose.com , or at 843-579-3077, x 301. His blog can be found at http://www.healthcare-informatics.com/tim_tolan . Healthcare Informatics 2010 February;27(2):59 Fri, 29 Jan 2010 00:00:00 EST 4F70BE1CB4244E9B892017F45E20FBFC http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=4DFCE538B7474B3E8433131927F7D571 Two industry leaders made the headlines 20 years ago in the first issue of “Healthcare Informatics.”   Editorial: Bill Childs chronicles the HIS-story of this publication in particular, and of HIS magazines in general: Computers in Healthcare - In 1980, Childs left Technicon Data Systems (acquired many times, eventually becoming part of Eclipsys) to start this magazine, the first to specifically target the HIS industry. After six successful years, Childs sold it to the Cardiff Publishing Company, and then founded: Healthcare Computing and Communications - Formed by Childs in 1986, which competed with Cardiff. The name was a mouthful but the magazine competed well, and after a few years, Childs changed the name to: U.S. Healthcare - Childs graciously gave credit for this moniker to his good friend and marketing maven: Art Randall of McAuto. Although short and sweet, the name ran afoul of the copyright of an HMO in Blue Bell, Pa., so Childs had to change the name again, this time to: Healthcare Informatics - The perfect name to describe the content, and it has stuck for the past 20 years.   HBO News: Walt Huff announced his retirement as Chairman of the Board of HBO (Huff, Barrington and Owens), a major player in the HIS industry in 1990. Few people know the saga of Huff and HBO, so here's a capsule version: OSF - Huff built a pioneering shared system for the Third Order Regular of St. Francis (OSF), a multi-hospital system in Peoria, Ill. Shortly after the advent of Medicare in 1965, Huff designed a system to automate the complicated 1453, 1483 and 1554 bills that Medicare mandated. He hired a consultant named Chuck Barlow to advise on the commercial feasibility of selling the system to other hospitals besides OSF, and when Barlow wrote a glowing report, the airplane company hired him to head up the venture, known as the “Health Services Division” (HSD) of their computer division, McAuto. HFC - Chuck hired Huff away from OSF to be the chief techie at HSD, and they named his shared system Hospital Financial Control (HFC), which proceeded to sell like proverbial hot cakes. Ever the futurist, Huff soon got involved in a new technical project at HSD: HDC - Hospital Data Control was the name of a pioneering turnkey mini-system McAuto was developing in the early '70s using minicomputers to build an affordable order entry system to compete with Lockheed's “MIS” running on costly mainframes. MedPro - Huff quit HSD in a huff (sorry…), along with Bruce Barrington and David Owens, which is where the initials HBO came from. They bought a Four Phase, installed it in the garage of Huff 's home in St. Louis, and proceeded to program the Four Phase Data 4/40 with only 40K bits of memory (yes, that's a K as in thousand, not meg or gig!) for ADT and order entry, spitting out charges to shared systems like HFC. They later upgraded to a Model 4/70 (with 70K of memory!), and proceeded to sell the system called MedPro to hospitals on McAuto or SMS. ACTIon - So successful was HBO in selling MedPro that Harvey Wilson struck a deal garnering SMS the rights to market it themselves under the acronym of All Communications Transmitted Immediately, or ACTIon for short. It didn't take we wise guys in King of Prussia long to come up with “or never” for the meaning of the last two letters!   HBO proceeded to grow exponentially, riding the turnkey mini-wave, and making its three founders wealthy men. So for Huff to finally retire a second time was indeed big news in 1990. Wonder if he ever dreamed his garage start-up would grow to be the number one HIS vendor, and gross over $3 billion today under McKesson's ownership? Vince Ciotti is founder and principal at HIS Professionals, LLC. His blog can be found at http://www.healthcare-informatics.com/vince_ciotti . Healthcare Informatics 2010 February;27(2):64 Fri, 29 Jan 2010 00:00:00 EST 4DFCE538B7474B3E8433131927F7D571 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=3D067EAAEE624CD0A6BA5ED6EDBDD0B2 New Protection and Retention Product is Introduced Woburn, Mass.-based BridgeHead Software (BH) has launched a hospital administrative data protection system. According to the company, its new BH OfficeStore solution suite provides a single, unified platform for long-term data management of administrative content generated from office productivity applications. The new software, it claims, can simultaneously manage e-mail, unstructured files and information contained within Microsoft's collaboration system. Bed Management Solution Gets Enhancements TeleTracking Technologies Inc. (Pittsburgh) is unveiling the Bed Management Suite powered by TeleTracking XT, the next generation of its patient flow application. The solution joins TransportTracking, which has been live on the TeleTracking XT platform since 2007 at more than 100 hospitals, to create a patient flow automation software package, says the company. The new application includes enhanced visual alerts and timers to improve the monitoring and management of patient admission criteria; user-defined clinical and physical attributes; isolation indicators to help minimize cross contamination during transfers, patient transportation and bed turnover; a single platform; and multi-campus deployment for centralized placement capabilities, according to the company. Iasis Deploys Single Sign-on Iasis Healthcare (Franklin, Tenn.), owner and operator of 15 acute care hospitals in six states, is implementing Andover, Mass.-based Sentillion's enterprise single sign-on (SSO) solution to facilitate access to its EHR system. Seven of Iasis' facilities are currently live with SSO. Since deploying the solution, Iasis' IT department has reported a 60 percent reduction in help desk calls related to password resets, according to the company. Iasis expects SSO to be fully deployed in all of its facilities by the end of the year, after which it will begin rolling out Sentillion's identity management solution to automate the user administration process of managing, creating and terminating accounts, it says. ICD-10 Translation Tool Unveiled Salt Lake City-headquartered 3M Health Information Systems released its ICD-10 Code Translation Tool. The Department of Health and Human Services has set Oct. 1, 2013 as the implementation date for ICD-10, the new national coding standard that will replace ICD-9. The product contains menu-driven features to convert existing systems and software applications to ICD-10, or to create customized mappings for specific business needs. 3M says its new software identifies all reasonable ICD-10 alternatives for the ICD-9 codes held in an information system, and performs automated mappings where a simple one-to-one map exists. The software then isolates the remaining complex codes and provides the user with reference data to assist in fine-tuning the final conversions to ICD-10, it says. Codes based on the International Classification of Diseases (ICD) are used throughout healthcare to record, store, and retrieve diagnosis and procedure information for clinical, epidemiological and quality purposes, and for reimbursement. Baxa Workflow Software Upgrades Pharmacy Capabilities Baxa (Englewood, Colo.) is upgrading its IntelliFlowRx workflow management software to include Preparation Modes, FormularyPlus and TPN processing capabilities. The addition of Preparation Modes, says the company, provides a user-defined set of standards that control how the workstation behaves during dose preparation so that IntelliFlowRx Workstations can filter and control the dose queue. This, say Baxa, allows pharmacies to track oral dose prep, extemporaneous compounding, telepharmacy and manual additions as well as IV dose prep. New Audiopoint Solution Automates Patient Follow-up Audiopoint, a Rockville, Md.-based provider of voice data solutions, has introduced NotifierRx, a suite of automated patient management services. NotifierRx is designed to help hospitals improve care and reduce readmissions by automating outpatient follow-up with interactive voice-controlled services, says the company. With this solution, patients receive a series of personalized reminders and queries. Their spoken responses are then automatically captured via Audiopoint's Automatic Speech Recognition technology, it touts. New Solution Looks to Improve Public Health Reporting Orion Health Inc. (Santa Monica, Calif.) and Cisco (San Jose, Calif.) have introduced Rhapsody AXP, a solution designed to address challenges in public health reporting and to improve the detection, tracking and response to disease outbreaks such as seasonal or H1N1 flu. According to the companies, the solution integrates the Cisco Application Extension Platform (AXP), Cisco Integrated Services Routers (ISRs) and the Orion Health Rhapsody platform to provide a pre-configured and secure public health reporting solution. Rhapsody AXP automates reporting by enabling the secure exchange of data, routing it within the hospital or clinic as well as between organizations, including the Centers for Disease Control. TeleTracking Enhances Patient Transfer Pittsburgh-based TeleTracking Technologies Inc. has acquired transfer center software technology designed to be used as either a standalone product or to be incorporated into its Avanti Patient Flow consulting division's Transfer Center, it says. TeleTracking is now selling this product in its current form, and will begin integrating the new technology into its patient flow software solutions, according to the company. The TeleTracking Avanti Patient Flow consulting division developed a specialized process model to help hospitals design a centralized Transfer Center that it says helps hospitals better manage referral and transfer admissions, increase transfer volumes, improve physician satisfaction, analyze and respond to referral patterns and provide patients with rapid initiation of life-saving care. The addition of this software will further streamline and track the flow of communications necessary to smoothly and efficiently accept transfers and referrals, it touts. MedeAnalytics Introduces Patient Access Services Emeryville, Calif.-based MedeAnalytics, a provider of healthcare performance management solutions, announced the launch of its Patient Access Services (PAS) solution. The solution is a Web-based workflow application that provides real-time intelligence during the patient registration process, says the company. Directly integrated with key hospital information systems, PAS includes patient payment estimation, charity care screening, address validation, risk segmentation and insurance eligibility verification capabilities combined into one interface designed for front-end staff, it adds. PAS also leverages a variety of third-party data sources and predictive modeling techniques to automatically segment patients prior to service and prompt registrars for appropriate action using customized business rules and logic, it says. Healthcare Informatics 2010 February;27(2):54-56 Fri, 29 Jan 2010 00:00:00 EST 3D067EAAEE624CD0A6BA5ED6EDBDD0B2 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=0CF67A6D6133410492F869D4F4F50EE8 Enhanced PACS Aims to Improve Nuclear Medicine Image Processing Mortsel, Belgium-based Agfa HealthCare has inked an agreement with Segami Corporation (Columbia, Md.) to integrate the Oasis workstation software into IMPAX 6, its sixth generation PACS. According to Agfa, the solution is designed to enable nuclear medicine physicians to review, process and report studies using processing software on their IMPAX workstation. The software will provide users with a uniform reading and processing environment for all their planar nuclear medicine, SPECT and PET studies, and deliver a full spectrum of clinical nuclear medicine and multi-modality applications, it touts. Oasis is a vendor neutral application for gamma cameras and PET scanners that adheres to standards such as DICOM, IHE and HL7 for a consistent and predictable workflow. ProSolv Upgrades CVIS Indianapolis-based ProSolv CardioVascular is unveiling Synapse ProSolv cardiovascular version 4.0.2, the latest release designed to enhance clinical workflow, help improve patient care, and reduce the potential for errors by automating the exchange of data with U.K.-based Philips Healthcare. The updated version is designed to deliver workflow and diagnostic benefits by providing access to the advanced quantification capabilities of QLAB, including state-of-the-art 2D and 3D ultrasound, into the echocardiographer's everyday clinical practice, says the company. With version 4.0.2, users performing image review and reporting can launch the full QLAB application directly from the image in the Synapse ProSolv cardiovascular application for greater efficiency, it touts. Laser Imager Gets FDA Clearance Rochester, N.Y.-based Carestream Health Inc.'s Dryview 5850 laser imager has been approved by the FDA. The machine, according to the company, is designed for digital mammography and general radiography applications. Featuring 508 pixels-per-inch output, the Dryview 5850 addresses the need for affordable laser-quality film output from full-field digital mammography and CR-based mammography systems, the company claims. The product, which has two online film trays, supports DICOM printing for mammography and general radiography, Carestream says. The company says its laser imagers are available in three models that range from tabletop systems designed for imaging centers to units designed for high volume, multi-modality output for hospitals of all sizes, and offer output from PACS, CT and MRI. New Solution Aims to Ease Image Sharing TeraMedica Healthcare Technology (Milwaukee) is partnering with Sun Microsystems (Santa Clara, Calif.) to offer a pre-configured solution for viewing and managing clinical images at the point of care. According to TeraMedica, the Evercore Enterprise Imaging Interchange combines Sun's Master Patient Index and Enterprise Services Bus with the Evercore Univision and Smartstore modules to capture and aggregate digital images from multiple diagnostic sources, assemble them into a logical single patient view, and deliver the images directly to the caregiver through the Evercore viewer. The solution is built with the Sun Java Composite Application Platform Suite and the TeraMedica Evercore Clinical Enterprise Suite, says the company. Healthcare Informatics 2010 February;27(2):52 Fri, 29 Jan 2010 00:00:00 EST 0CF67A6D6133410492F869D4F4F50EE8 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=0AD08762063046109FE44BA1574FCBF9 ClaimTrust Unveils Revenue Cycle Suite Murfreesboro, Tenn.-based ClaimTrust is launching the InSight Revenue Cycle Solution, a suite of fully hosted, Web-based products designed to target the key inflection points in the hospital revenue cycle. According to the company, the solution offers all-payer edits down to the fiscal intermediary and plan level, as well as the ability to deduce unbilled charges and generate net new revenue. All of the products in the suite work with InSight Workflow and Claim Editor, a workflow platform providing editing tools and intelligent routing of claims, and InSight Reports, a reporting and analytics module with a range of report and dashboard options, it touts. New Solution Available for Audit Assistance Chicago-based Care Communications Inc. has rolled out a RAC software tracking solution, Audit Manager. According to Care Communications, the tool, powered by Northbrook, Ill.-based Cobius Healthcare Solutions, has been approved by the VHA for its member hospitals nationwide to help hospitals and health networks prepare for Centers for Medicare and Medicaid Services RAC audits. Care Communications claims Audit Manager can help minimize RAC risks and costs by: Detecting error patterns to avoid repeating mistakes; Minimizing the need for additional staff; Ensuring deadlines are met by using work lists and e-mail reminders; Allowing authorized users to access documentation, appeals templates and other tools; and Providing information in real-time reports. DocSite PQRI Approved as Qualified CMS Registry Raleigh, N.C.-based DocSite announced today that its PQRI solution has been selected for the second year by Baltimore-based CMS as an approved Qualified Registry for the 2009 Physician's Quality Reporting Initiative (PQRI) Registry Program. According to the company, DocSite PQRI provides physicians with a way to qualify for incentive payments up to $4,000 from Medicare. It adds that the PQRI process that used to take an entire year to complete can now be completed in as little as two days with DocSite PQRI. For selection as a Qualified Registry for 2009, DocSite says it participated in a detailed approval process. Ingenix Revenue Manager Launches Eden Prairie, Minn.-based Ingenix has introduced Ingenix Revenue Manager, a suite of new software applications that it says enables hospitals to proactively track, manage and automate revenue cycle functions, improve billing accuracy and reduce claims denials and administrative processes. These tools can also be combined with Ingenix Consulting services to identify root causes for claims denials, prevent denials from happening, automate appeals and improve profitability. The company says Ingenix Revenue Manager is comprised of three modules - Denials Prevention, Appeals Automation, and Denials Analytics - that can be applied separately or as a suite to automate, update and monitor billing processes, reduce the number of days claims are delayed in accounts receivable, prevent denials and minimize collections costs. Greencastle Unveils ARRA Readiness Assessment Malvern, Pa.-based Greencastle Consulting introduced a new service offering: ARRA readiness assessment. According to the company, hospital and health system customers can use the new service to assess how ready they are with regards to the variables associated with “meaningful use” of the American Recovery and Reinvestment Act (ARRA), as well as their ability to comply with the HITECH Act. Greencastle says its four-week readiness assessment evaluates technology certification, clinician adoption of technology, quality data captured by that technology, and HITECH security and privacy factors that contribute directly to the ability to achieve ARRA criteria. Healthcare Informatics 2010 February;27(2):50 Fri, 29 Jan 2010 00:00:00 EST 0AD08762063046109FE44BA1574FCBF9 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=61FCF90FF33644D1AFCC299C2330602B Sterilizable RTLS Tag Earns Certification San Diego-based Awarepoint Corporation's T2S RTLS tag has been independently certified by SPSmedical (Rush, N.Y.), making it the first and only clinically validated sterilizable active RTLS tag available, according to the company. The solution was tested for decontamination and mechanical cleaning, Cytotoxicity, steam pre-vacuum efficacy, and Sterrad Sterilization Systems, including use in wrapped trays and Tyvek Peel Pouches, it says. GetWellNetwork Introduces Discharge Planning Tool GetWellNetwork Inc. (Bethesda, Md.) has released PatientLife System 3.5 (PLS 3.5), the latest version of GetWellNetwork's interactive bedside system, which includes tools focused on accelerating the discharge planning process and reducing average length of stay in hospitals. New capabilities offered in PLS 3.5 include: The “Countdown to Discharge” Pathway, which delivers timely information about discharge through the in-room television monitor. A series of automated, interactive messages guides patients through a discharge checklist and readiness assessment, which includes medications, transportation, education completion and setting of follow-up appointments. Discharge Readiness Dashboard, which provides nurses and discharge planners with a real-time view of patient and unit progress within a Web-based Management Console. Enhanced Usability and Reporting, which offers improved usability, utilization and reporting capabilities, Pathways in PLS 3.5 now deliver on-screen prompts that are more visually engaging and less intrusive. WebMD Launches Free Mobile App. for Docs New York-based WebMD Health Corp. has rolled-out Medscape Mobile, a free medical application for physicians. According to the company, the product provides physicians with Medscape's medical information in a mobile format that can be accessed on demand on the iPhone and iPod touch, and later this year, on the BlackBerry. Medscape Mobile includes drug information, clinical reference tools, medical news and continuing medical education (CME) information, the company says. The product also includes CME activities organized by specialty and is designed for use on a mobile device. The company says features include: a drug database of over 6,000 generic and brand name drugs, plus hundreds of herbals, supplements and antidotes, as well as a drug interaction checker that shows interactions. To download Medscape for iPhone and iPod touch, search for ‘Medscape’ in the Apple iTunes App Store or look under ‘free apps’ in the Medical category. An interactive demo is available online. Ambulance Provider Goes Wireless Bell Ambulance, a provider of emergency and non-emergency medical services based in Milwaukee, has selected NetMotion Wireless (Seattle) to enable seamless roaming and data connectivity for its mobile emergency medical technicians (EMTs) and paramedics. According to the company, Bell Ambulance uses tablet PCs in its ambulances to complete patient care reports, which are then synchronized with dispatch and billing applications. Bell's EMT staff uses NetMotion's mobile Virtual Private Network software, Mobility XE, to stay connected to critical applications, roam between multiple wireless networks, and maintain applications when moving in and out of wireless coverage areas, it touts. Bell Ambulance responds to an average of nearly 5,000 ambulance calls per month, employs nearly 200 EMTs and paramedics and has a fleet of more than 40 ambulances. Tempsys Develops WiFi Gateway for Temp Monitoring San Francisco-based Tempsys Inc. says that its computerized Checkpoint Wireless Temperature Monitoring System can now be utilized on hospitals' existing WiFi wireless networks. According to the company, hospitals will be able to use either wireless WiFi or a hybrid system utilizing both the wireless WiFi and hard-wired LAN to install the wireless temperature monitoring system. The Checkpoint Wireless Temperature Monitoring System is designed to continuously monitor temperature-sensitive equipment throughout the hospital, from the pharmacy to the blood bank, nurses' stations to research laboratories, it touts. New Patient Portal Monitors Diabetes San Diego-based Entra Health Systems has unveiled an enhanced version of the MyGlucoHealth Patient Portal for diabetic monitoring. According to the company, the portal provides an easy-to-use interface for automatic collection and evaluation of test results from the MyGlucoHealth blood glucose meter. Readings can be interpreted and charted in different ways to analyze, evaluate and visually present patient data. Test information from the MyGlucoHealth meter is wirelessly transmitted to individual patient sites on the portal using a Bluetooth-enabled mobile phone or PC, it says. The newest version of the portal enables users to manage data on blood pressure, weight, nutrition, exercise and medication. It also features a scatter plot that charts blood sugar readings by time of day and a new timeline that displays all blood tests for a selected time period, touts Entra Health. Service Uses Text Messaging to Recruit for Studies New York-based Axiom Accelerated Patient Recruitment is introducing a text messaging service designed to help healthcare researchers enlist patients. The company says it is using the service for patient recruitment and retention programs for clinical research studies, says the company. Text messages can be used to directly communicate with pre-qualified audiences to gauge interest in participating in a clinical study that may help minimize symptoms or treat a disease. The tool can also retain participants through support services like appointment reminders and treatment instructions, it touts. Allscripts Unveils BlackBerry Solution, EHR 9.0 Chicago-based Allscripts is introducing two new products: Allscripts Remote for BlackBerry smartphones and Allscripts Professional EHR 9.0. Allscripts Remote provides to access the Allscripts Professional and Enterprise EHRs from the BlackBerry, enabling physicians to make critical medical decisions when they are away from the office, says the company. Capabilities include access to real-time patient summary information; communication to local hospital emergency rooms; ePrescribing to any pharmacy; and real-time access to patient information including medical history, lab results and medications, it touts. Designed for small and medium-sized physician groups, Professional 9.0 delivers a graphical user interface (GUI) designed to streamline navigation and common tasks. It includes a physician dashboard that highlights the patient's care management plan, providing graphing of health measures such as blood pressure and cholesterol, says Allscripts. Healthcare Informatics 2010 February;27(2):46-48 Fri, 29 Jan 2010 00:00:00 EST 61FCF90FF33644D1AFCC299C2330602B http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=93FDC39884384DBBA75B0A766021D7E8 Tool Offers Alabama Medicaid E-Prescribing Headquartered in Dallas, Affiliated Computer Services Inc. (ACS)'s Web-based EHR record and clinical support tool, QTool, now has new e-prescribing functionality, it says. According to ACS, it actually developed QTool to support Alabama Medicaid's initiative to build a statewide electronic health information system. The company says approximately 150 Medicaid-enrolled physicians are pilot testing QTool in nine Alabama counties including Calhoun, Houston and Tuscaloosa. In addition to e-prescribing, physicians can view information on patients' ER, hospital and doctor visits, lab tests, and medications, the company says. ACS touts QTool's built-in alerts that notify the physician when asthma and diabetes patients need special tests or care. athenahealth EHR Earns CCHIT Certification The Certification Commission for Healthcare Information Technology (CCHIT, Chicago) has approved the software component of Watertown, Mass.-based athenahealth Inc.'s service-based EHR, athenaClinicalsSM Version 9.15.1, as a conditionally CCHIT Certified 08 Ambulatory EHR pending advanced electronic prescribing verification. According to CCHIT, athenahealth's EHR service meets the Certification Commission's EHR criteria for physician office-based use. MedCentral Launches Data-Mining Solution The Commission - a private, nonprofit organization - is the recognized certification body for certifying health information technology products. MedCentral Health System (Mansfield, Ohio) launched Malvern, Pa.-based Siemens' knowledge-driven healthcare data-mining tool, Soarian Quality Measures. According to the company, the application will help MedCentral streamline its quality improvement process by automating chart abstraction and helping expedite the submission of quality measures. Soarian Quality Measures replaces manual chart reviews with accurate and automated chart abstraction of quality measures, says the company. It analyzes and draws conclusions from all available electronic patient data from both Siemens and non-Siemens IT systems, and the results of the analysis are presented in a simple, intuitive interface, it touts. MedCentral Health System is an independent, not-for-profit organization comprised of two general, acute care hospitals: Mansfield and Shelby, with a combined total of 351 beds and 44 bassinets. The system offers complete cardiac care, comprehensive neurological services, a walk-in medical center, industrial health and safety services and the MedCentral College of Nursing. Initiate Systems Links to Federal CONNECT Gateway Chicago-based Initiate Systems Inc. has successfully integrated its software with the Federal Health Architecture's CONNECT Gateway. According to the company, Initiate's patient registry, part of the Initiate Interoperable Health solution, is among the first products to demonstrate interoperability with the Gateway. Its patient registry technology integrates with the open-source architecture, using Web service technology and HL7 standards, says the company. Initiate successfully completed tests with the CONNECT Gateway's Subject Discovery Service, which locates patients based on demographic information, and completed interactions needed to locate and return patient information requested by a peer from the NHIN network. According to the Department of Health and Human Services, the CONNECT Gateway is designed to enable public and private health information technology systems to communicate with each other through health information exchanges using Nationwide Health Information Network specifications and conventions. The CONNECT software was released as open source technology by the Office of the National Coordinator in April 2009, it says. Healthcare Informatics 2010 February;27(2):44 Fri, 29 Jan 2010 00:00:00 EST 93FDC39884384DBBA75B0A766021D7E8 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=D950E47F3AD74DA99D5A6DB6D97DD30D Each day, the editors at Healthcare Informatics select a number of newly introduced products and services to highlight in the news section of our Web site. In this, the third edition of the Healthcare Informatics Platinum Products & Services Guide, we offer readers a compilation of those new and innovative offerings. The products highlighted here span five general categories: clinical information systems, such as EMRs, CPOE and e-prescribing; financial systems, like revenue cycle management tools and enterprise resource planning applications; administrative systems, which include scheduling, asset and supply chain management; wireless technologies, including network management and handheld devices; and imaging/PACS IT. No matter what you're in the market for, this guide will help you identify some of the major players in each area. TABLE OF CONTENTS Clinical 44 Wireless 46 Financial 50 Imaging 52 Administrative 54 Healthcare Informatics 2010 February;27(2):43 Fri, 29 Jan 2010 00:00:00 EST D950E47F3AD74DA99D5A6DB6D97DD30D http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=FCD0758D4722444EAB6EEA8FB2A3668A Now, more than ever, healthcare professionals need to stay on top of IT trends. HCI asked our readers to vote for the trends that will most significantly impact healthcare CIOs in the coming year. In Top Tech Trends 2010, page 10, we highlight areas our readers feel will be important as they try to move their organizations ever further into the digital age. It's a roadmap produced after much deliberation and research - and a desktop companion for the entire year. The ARRA-HITECH Act has made CPOE a household word (well, almost). But if docs won't use it, hospitals will never make the grade. Some organizations are layering on third party applications to help, but all need to take this seriously. It's not just the push to obtain federal funding under HITECH that's driving a burst of CPOE implementation of late; it's the realization on the part of CIOs and other organizational leaders that it truly is foundational for progress in improving care quality and efficiency. Read CPOE, page 16, to see how the technology is being transformed into a vital tool in eliminating variation in care, and in spurring data analysis for quality and patient safety improvement going forward. The challenge, as many hundreds of hospitals move towards CPOE in order to qualify for meaningful use under HITECH: can they all implement successfully? However, with its focus on clinical IT implementations such as EMR and CPOE, HITECH has forced every other IT need in hospitals to the back burner. This means overdue upgrades to financial systems and adoption of clear-ROI projects like asset tracking on expensive biomedical equipment are no longer a top priority. Many say hospital-IPA integration is key. In HITECH, page 39, we'll examine what will happen once work on CPOE, quality reporting and data sharing are on track, and how you can expect IT leaders to refocus their attention to topics such as clinical-financial integration, business intelligence, and asset tracking. Find out why savvy CIOs are pushing their organizations to integrate with the largest IPAs in the area, recognizing that electronic interconnectivity is a guaranteed way to solidify an important revenue-generating relationship. Healthcare Informatics 2010 February;27(2):8 Fri, 29 Jan 2010 00:00:00 EST FCD0758D4722444EAB6EEA8FB2A3668A http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=18AD319C7F83411AB2719359D16B63BC To the Editor Re: The Dismal Failure of Informatics in Healthcare Let's face it. Anyone who says Informatics has done for healthcare what it has done for the financial, entertainment and retailing industries either would have a hard time keeping a straight face or is delusional. “Bar codes” that were introduced 50 years ago are being hailed as the recent “big advance” in bedside health care. This is occurring while everyone else is going to RFID! And, HIT hasn't lowered costs as promised (HCI Jan 2010). There are two major problems in healthcare delivery that make healthcare informatics almost impossible. First, everyone is unique and second there are no “laws” in medicine. Lawyers have the same problem with uniqueness of every client but they have standards, i.e., laws that they must abide. There are no such standards in medicine. The paper medical record was declared useless for research, documentation, etc in the 1970's. So, what makes a useless paper record worth anything just because it is digital? In fact, “macros” that produce page after page of “medical documentation” at the click of a single button have made it impossible to discern what the clinician really did. More has not been better! Free text has been the Achilles heel of healthcare informatics. Free text is not easy to index and search and there are billions of megabytes of it in healthcare. Synonyms and medical abbreviations are rampart and impossible to automatically interpret. Dyspnea, shortness of breath and its abbreviation -“SOB”(!) are used interchangeably to mean the same thing. Healthcare standards were started in the days when a T-1 line was more than anyone could ever want or use and not relevant today. The bitways, middle ware and applications are obviously there for informatics systems. Just look at the other industries cited. What is lacking in healthcare informatics is critical thinking. The W3 organization (e.g., semantic Web) and National Library of Medicine (e.g., Unified Medical Language System) are working on projects that could streamline healthcare informatics and possibly make it work. Yet, I don't see or read anything about them in the healthcare information literature. Healthcare is still in the days of Prolog, Dialog and AOL instead of the World Wide Web, Internet and beyond era. Why? Best Regards, Fidel Davila, MD, MSMM, FACPE, CPE VP for Medical Affairs QualChoice Little Rock AR Healthcare Informatics 2010 February;27(2):7 Fri, 29 Jan 2010 00:00:00 EST 18AD319C7F83411AB2719359D16B63BC http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=A59B68E6AC8F461A941D7986289A6F58 The Landscape: After conducting “ARRA readiness assessments,” many CIOs are juggling their project priorities to work toward achieving the definition of meaningful use. As a result, some financial and infrastructure projects are put on hold. The Future: Once work on CPOE, quality reporting and data sharing are on track, expect IT leaders to refocus some of their attention to topics such as clinical-financial integration, business intelligence, and asset tracking. When the Office of the National Coordinator for Health IT rolled out its meaningful use matrix last year, most people thought first and foremost about how close their institution already was to achieving those goals. Hospital executives set out to do gap analyses and accelerate projects such as CPOE implementation and interoperability with community physicians. But what has received less attention is the impact it has had on financial and other non-clinical IT projects, some of which could be put off indefinitely due to the double-whammy of HITECH and the recession. “When they do this reprioritization, something has to fall to the bottom of the list,” says Sharron Finlay, a regional manager with Beacon Partners Inc. (Weymouth, Mass.). “I would expect that things like biomedical asset tracking would be put off. If they are not contributing to patient safety and the overall goals of meeting meaningful use, they might be delayed,” she adds. “Things that are clinically outcome-focused now have the weight of the institution behind them, where three years ago they might not have.” Paul Pitcher, director of financial systems for KLAS (Orem, Utah), has heard much the same from both vendors and hospital executives. “My impression is that other projects are being put on hold in order to achieve the definition of meaningful use,” he says. “Patient accounting projects are being done if they are tied to clinical, but otherwise, people are not going to replace financials right now.” Of course, the level of change to the overall IT plan will depend on a hospital's situation. CIOs who realize they need huge capital outlays for new clinical systems to meet meaningful use guidelines will see a greater impact on how much can be spent on other projects. David Briden, CIO of the 100-bed Exeter Hospital (N.H.), says his organization has accelerated work already underway on physician e-prescribing, CPOE and interoperability with the EHRs of community physicians. On the non-clinical side, Exeter is in the third and final year of an upgrade to its Lawson (St. Paul, Minn.) payroll and human resources implementation. “Because we already own the clinical software, we weren't looking at a big capital expenditure,” Briden says. “But if you had a big purchase of CPOE competing for dollars with something like a Lawson system upgrade, then absolutely the non-clinical work would take a back seat right now. You just can't afford not to be focused on the meaningful use guidelines,” he adds. “CFOs understand it is not just the bonuses in the first three years, but the penalties that kick in for not meeting it that extend out forever.” It may be difficult to separate out the impact of the economic downturn from the looming HITECH guidelines, according to Harry Greenspun, M.D., CMO for Dell Perot Systems (Plano, Texas). “Many hospitals have frozen most discretionary spending and frozen hiring,” he says. “They are cutting costs everywhere.” Both because CIOs wanted some more specificity and also because of the economic shock, there was initially a real pause in spending on either clinical or non-clinical solutions, Greenspun says. “Now that is breaking loose. People feel a little more confident about what the meaningful use will mean to them and they are moving forward.” Greenspun says he believes that hospitals will soon have to turn their attention to integration. “With the overall health reform focused on public reporting, transparency and value, there is going to be much greater emphasis on integration of clinical and financial systems,” he says. “How do you demonstrate value other than cost per quality? So those that are best able to demonstrate value are going to be leaders in the market and gain market share.” A juggling act Some CIOs say they can't afford to put off non-clinical projects, such as enterprise scheduling and charge capture using handheld devices. “We haven't put anything financial on the back burner,” says Mike McTigue, CIO of 645-bed Saint Barnabas Medical Center (Livingston, N.J.). “If something like denials goes through the roof, that kills us,” he says. “As important as clinical systems are, the financial side is also critical and drives our business strategy.” In Arizona, as the 345-bed Phoenix Children's Hospital ramps up its work on eMAR and bidirectional pharmacy ordering, Vice President and CIO Bob Sarnecki says he has decided that development of financial systems must keep pace. “If CPOE lets us understand physician ordering practices 10 times better, the idea is in the long run to deliver more efficient healthcare, and that means identifying and providing financial incentives for best practices,” he says. “So we have to tie that into our financials.” Sarnecki's team defined a set of challenges involving charge auditing across the hospital to look at losses. “We thought these important enough to hire four FTEs in the business systems group to tie the clinicals tighter to the back-end financial systems,” he says. Taking a lower priority in the short term, says Sarnecki, are infrastructure projects. For instance, a new hospital tower under construction has a more sophisticated network than the one in the older tower. “We are going to make due with that older network until 2011 rather than doing both at once,” he says. Other CIOs tell similar stories of trade-offs. Charles Colander, vice president and CIO of 427-bed Elmhurst Memorial Hospital (Elmhurst, Ill.), is preparing to move to a new 866,000-sq.-ft.-hospital building while also working on meeting meaningful use measures. Moving to the new building was a catalyst for creating a new IT strategy, and that series of IT initiatives fits nicely with HITECH, Colander says. “But there are certain things that are just not getting as much attention, both because of HITECH and because of our IT strategy that we put in place to coincide with our move to the larger facility,” he says. “We have a homecare and hospice system that has been clamoring for a new billing system for a few years now, but we are just not in a position to do those projects now.” Staffing Strains Besides limiting some other IT projects, CIOs say, all the work toward meaningful use will put a strain on the health IT work force. Recognizing how serious an issue it is, the Office of the National Coordinator is launching an $80 million community college work force training program. “We are working with our independent physician community helping them with their billing systems on a consulting basis,” says Elmhurst (Ill.) Hospital CIO Charles Colander. “Everything is under stress because of the financial crunch. Even if you do find the financial resources, where do you find the talent?” Phoenix Children's Hospital Vice President and CIO Bob Sarnecki has found an interesting solution to that problem. “People are reluctant to locate here unless we purchase their existing home,” he says. “We came up with a solution of using a distributed work force. I have people in places like Tucson, Minnesota, and New Jersey telecommuting, so I don't have to buy their houses.” Although he hasn't felt the worker shortage yet, Winchester (Mass.) Hospital CIO Gerald Greeley says, with eClinicalworks and Partners HealthCare close by, he's sure it will be an issue. “We have been extremely fortunate to date to be able to hire and retain good staffers, but I am sure the crunch point will come.” IT projects at 580-bed University Hospital (Augusta, Ga.) have to compete with all of the hospital's other capital projects, says William Colbert, vice president and CIO. Though some projects may need to be postponed, Colbert says many of his earlier investments align quite well with the meaningful use matrix. “We will do basic investment in infrastructure such as replacing servers that are at the end of life,” he says, “but we are putting off buying a radiology information system, and we are not planning to do RFID or ultrasound for locating medical equipment. That is expensive and we just can't cost-justify it.” Winchester Hospital, a 229-bed facility in Massachusetts, did a reprioritization after HITECH passed, and found that most of the meaningful use guidelines appeared to be in line with what it had already been working on, including a widespread CPOE implementation and connecting to physician office EHRs, says CIO Gerald Greeley. “One thing we do need is a business decision support tool for business analytics,” he says, adding that it would likely be a need that goes unmet for the next few years. “For years we have been concentrating on the clinical over the business side, and that is not going to change. The trend of focusing on clinical applications is only going to get stronger.” Healthcare Informatics 2010 February;27(2):39-41 Fri, 29 Jan 2010 00:00:00 EST A59B68E6AC8F461A941D7986289A6F58 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=DFB41945B31741A3B76A0048DDDA23F3 DiagnosticPRO® Advantage VIDAR's DiagnosticPRO Advantage film digitizer has achieved the highest reliability, image quality, consistency and best overall productivity of any digitizer on the market. It offers flexibility and can be used in facilities supporting both PACS and low-volume mammography applications.   Visit us at HIMSSBooth #2565 VIDAR Systems Corporation (703) 471-7070 http://www.vidar.com/film/diagnosticpro-advantage Sunquest: Driving the Future of Diagnostic IT You deliver quality healthcare. Sunquest delivers confidence. At Sunquest, we believe meaningful use depends upon meaningful laboratory information. With Sunquest, our customers have confidence. Confidence that the laboratory will enable their organizations to optimize the patient experience, take the guesswork out of therapeutic planning, and drive safe, effective healthcare.   Please visit us at HIMSS, booth #1345, to learn more about Sunquest innovation! Sunquest Information Systems, Inc. (520) 570-2000 http://www.sunquestinfo.com LINKMED® ToolsDynamic HL7 Mapper Real time converts DICOM, GDT, and Report Files to HL7 and Vice Versa Medical Devices, EMRs/EHRs Interfaces Interface with: McKesson, Meditech, Epic, Misys, Cerner, GE Centricity Bi-directional HL7 Interface for ADT/Orders/Billings/Results Can Include Base 64 or Hex Format inside HL7 Messages Build Table Data, User Delimited, Transcription Interface Easily Absolutely No Software Programming Skills Needed   Visit us at HIMSSBooth #2823 LINK Medical Computing, Inc. (888) 893-0900 http://www.linkmed.com There's No Meaningful Use Without Meaningful Data Is the data in your electronic health records complete? Can it be shared by the people who need it? Find out how the 3M Healthcare Data Dictionary can help translate and integrate your patient data into a standard language, regardless of where it originates.   Visit us at HIMSSBooth #5817 3M Health Information Systems (800) 367-2447 http://www.3Mhis.com/MeaningfulData Software for Connected Healthcare InterSystems is the world's #1 vendor of database and integration technologies for healthcare applications. InterSystems products are used by thousands of hospitals and labs, including all 21 hospitals on the Honor Roll of America's Best Hospitals as rated by U.S. News and World Report. Learn more at http://InterSystems.com .   Visit us at HIMSSBooth #5315 InterSystems Corporation (617) 621-0600 http://www.InterSystems.com eCura Information System InfoMC provides enterprise software solutions for behavioral healthcare Payors. InfoMC's eCura® solution allows EAP/Work-Life programs, Managed Behavioral Healthcare and Disease Management Organizations to enroll and track member eligibility; manage provider networks; do referrals, authorizations and care coordination; and process and pay claims. It also links Providers and Payors to streamline communications.   InfoMC, Inc. (484) 530-0100 http://www.infomc.com Virtual Examiner Without automated pre-payment review of claims, there is constant risk of losing massive amounts of premium dollars. Virtual Examiner® empowers organizations to contain costs without the huge upfront investment. With 15 percent savings off every check run, return-on-investment is guaranteed. Turn your claims department into a profit center.   PCG Software, Inc. (887) 789-1291 http://www.pcgsoftware.com Universal Imaging Utility (UIU) at HIMSS The Universal Imaging Utility (UIU) is the only application able to create ONE hardware-independent hard drive image that can be easily deployed to any laptop or desktop, regardless of manufacturer. Visit Booth 9137 to see how ONE Windows image will work on every PC in your hospital/healthcare organization.   Visit us at HIMSSBooth #9137 Big Bang LLC (414) 225-9075 http://www.bigbangllc.com Moving Money at Net Speed IPayX Online Billing and Payment is The Best Way To: Accelerate Cash Flow Reduce Invoicing Costs Contain Customer Service Expense Improve Customer Satisfaction   Put the Power of IPayX to work for You, now! Contact sales@ipayx.com or call us. Internet Payment Exchange, Inc. (800) 530-7095 http://www.ipayx.com SCC Soft Computer With thirty years experience, SCC Soft Computer is the first name in LIS performance and reliability. New generation technology and tools produce the highest outcomes in productivity, efficiency and R.O.I. SCC offers information systems suites for Laboratory, Genetics, Outreach, Blood Services, Radiology, and Pharmacy.   Visit us at HIMSSBooth #4731 SCC Soft Computer (800) 763-8352 http://www.softcomputer.com Ask us about HCC and P4P - EMR Integration! Ascender Software is a national leader in healthcare analytics with comprehensive solutions designed to meet the demands of healthcare organizations needing to improve their P4P, HEDIS, PQRI, and HCC outcomes. With over 15 years of experience, Ascender has empowered many organizations to reduce costs and improve patient satisfaction, while increasing revenue.   Ascender Software (619) 955-7847, ext. 110 http://www.ascendersoft.com SIERRA Advantage The SIERRA Advantage film digitizer provides an affordable solution for teleradiology and low-volume digitizing, and overcomes the most common barriers to digitizer use - quality, cost, and size. It allows you to increase report turnaround time and integrate outlying clinics for a fraction of the cost of low-end CR products.   Visit us at HIMSSBooth #2565 VIDAR Systems Corporation (703) 471-7070 http://www.vidar.com/film/sierra-advantage.html Find the Right Solution for WLAN Security and Performance Doctors, nurses and staff need mobility while remaining connected to clinical information systems - a natural environment for wireless LANs. AirTight's SpectraGuard assures both wireless LAN security and performance with protection against all wireless threats.   Learn: Why encryption is not enough to secure sensitive EHR How wireless intrusion prevention (WIPS) ensures patient data privacy   Visit us at HIMSSBooth #8661 AirTight Networks, Inc. (877) 424-7844 http://www.airtightnetworks.com/home/products Complete Revenue Cycle Management Solutions ZirMed is the complete, web-based, revenue cycle management solution designed to revolutionize the way you work. Created to streamline every aspect of the healthcare revenue cycle, ZirMed's innovative technology and experienced service staff can ensure that you are paid faster and more completely from payers and patients alike.   ZirMed, Inc. (877) 494-7633 http://www.zirmed.com Health Information Exchange - It's About Time Connect to and provide physicians with clinical information from any information system. Physicians receive data directly into their existing EMRs or into Axolotl's Elysium EMR, a CCHIT certified SaaS solution. They can also access a complete “hybrid-federated” record of patient data via the Elysium Virtual Health Record. Implementation is quick, providing for full HITECH reimbursement for meaningful health information exchange.   Visit us at HIMSSBooth #502 Axolotl Corp. (888) 296-5685, ext. 5 http://www.axolotl.com HCS INTERACTANT HCS has provided fully integrated clinical and financial software solutions to leading healthcare providers nationwide for 40 years. Our product, INTERACTANT, is specifically designed to support acute, long-term care, and outpatient providers. INTERACTANT integrates healthcare delivery networks through registration, census, billing, and clinical and financial applications on a single database.   Visit us at HIMSSBooth #1524 Health Care Software, Inc. (HCS) (800) 524-1038 http://www.hcsinteractant.com Include your company in our next Product Watch! For information, contact: Alexandra Bonanno(212) 812-1415 abonanno@vendomegrp.com Pro-Filer Electronic Health Record (EHR) UNI/CARE's Pro-Filer is the only http://Microsoft.net certified Electronic Health Record enabling organizations to service multiple domains within a connected continuum of care environment. Pro-Filer seamlessly converts the consumer paper record and diverse HHS functions into an enterprise solution supporting clinical data management (CCD/CCR), revenue cycles, CPOE, PHRs, and HIE.   UNI/CARE Systems, Inc. (941) 954-3403, ext. 310 http://www.unicaresystems.com InnovaTV Patient Infotainment HCI makes hospital-grade televisions and patient infotainment solutions. HCI made the industry's first IPTV, which lays the foundation for HCI's networked solutions. HCI's innovaTV IPTV technology includes built-in thin client and media player capabilities to: increase patient satisfaction increase staff efficiency decrease readmissions improve HCAHPS scores   Visit us at HIMSSBooth #2153 HCI (800) 783-8105 http://www.hci-tv.com Healthcare Informatics 2010 February;27(2):60-62 Fri, 29 Jan 2010 00:00:00 EST DFB41945B31741A3B76A0048DDDA23F3 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=1BCC14779F4E42E0A928A5F5238EC805 At Cincinnati Children's Hospital Medical Center, leaders - including (from left) Marianne James, senior vice president and CIO; Tony Johnston, CTO; and Uma Kotagal, M.D., senior vice president for quality and transformation - have built a data reporting infrastructure to support intensive quality and patient safety improvement For a second year, Healthcare Informatics is presenting our readers with a package of Top Tech Trends that has been vetted by you, our audience. Like last year, after compiling a preliminary list of trends nominated by the editorial team, we once again put our list to a vote, by you. And how our readers voted confirmed a lot of what has emerged in the current Zeitgeist - above all, a fascination with the technologies and facilitative elements that will help hospitals and health systems create the kinds of high-quality, efficient, transparent and accountable delivery systems that policymakers, purchasers, payers and consumers demand.   In that context, it shouldn't be surprising that the need for data reporting infrastructures to support the advancement of future healthcare led our list this year, followed by a focus on CPOE. In fact, virtually every trend this year either relates primarily to clinical information system evolution, or includes clinical IS as one of its direct or implied elements. And with such a strong clinical IT focus, it is equally unsurprising that readers would be particularly interested to learn more about the role of clinical informaticists in helping to lead transformation nationwide. Indeed, there is a sense of connectedness among all trends this year that is clearer than ever before. To a large extent, the industry-wide concentration on the meaningful use requirements of the ARRA-HITECH federal stimulus legislation - and the high level of interest in the outcome of the healthcare reform legislative process - is helping to shape that focus. And with the industry moving forward rapidly to transform itself to meet the new demands, a clear understanding of the most important industry-changing trends will be crucial for every CIO and healthcare IT executive. In that spirit, we hope that this package of stories will add to your sense of clarity and purposefulness going forward. Please enjoy these articles, and best wishes in forging ahead into the new era of healthcare in your own organizations. - The Editors Healthcare Informatics 2010 February;27(2):10-11 Fri, 29 Jan 2010 00:00:00 EST 1BCC14779F4E42E0A928A5F5238EC805 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=3FA8AFF07964440FAB54BADC51F2F70E The Landscape: CIOs are realizing that everything they and their fellow executive and clinician leaders want to accomplish in hospital-based organizations - improving patient safety and care quality; enhancing efficiency and clinician workflow; delivering evidence-based patient care; creating outcomes transparency for purchasers, payers, and consumers; and participating in value-based purchasing initiatives, not to mention snagging federal funding under the ARRA-HITECH legislation passed last year - will require robust data infrastructures. And as pioneers are learning, creating those infrastructures is challenging and complex, but immensely critical. The Future: Experts say the need for robust data infrastructures to support performance improvement and transparency will only intensify. The time is now to put the needed technologies into place. No one needs to explain to Marianne James, senior vice president and CIO at Cincinnati Children's Hospital Medical Center, or Uma Kotagal, M.D., senior vice president for quality and transformation, the importance of a robust data infrastructure to the pursuit of performance improvement. Cincinnati Children's, a leader in the development of evidence-based guidelines for inpatient pediatric care, has been zooming ahead with patient safety and quality improvement progress for the past few years. Some of the many positives, says Kotagal, have included increased compliance with guidelines for the administration of antibiotics to avert surgical-site infection, from 56 percent a few years ago to 98 percent; and a greater than 70 percent reduction in opiate over-sedation of patients. “We've been using a rapid-cycle process involving daily and weekly failure reports to clinicians to examine care delivery practices and improve them,” she reports. “Physicians very much respond to data, but the data has to be timely, actionable, and reliable.” The secret to such rapid advances? A robust, enterprise-wide data infrastructure that can produce such reports day in and day out. And that has been job number one for James and her colleagues in IT. “In the past,” she says, “the success we had had with evidence-based care and quality improvement had required us to go through some heroic efforts in IT to make sure things have happened, as we've had to pull together all the disparate data. Now that the data sits together in one place, with common data definitions, it should further empower our clinical informaticists to work even more fully with our clinicians.” Like their colleagues nationwide, James and Kotagal recognize that the ability to pursue the new, evidence-driven healthcare depends strongly on the strength of the organization's core data backbone. And that means having EMR, CPOE, eMAR, and advanced pharmacy applications implemented, along with an advanced data warehouse, and sophisticated reporting capabilities. Chief Technology Officer Tony Johnston and the rest of the Cincinnati Children's team are working to upgrade and implement the systems needed to support such clinical transformation. A confluence of factors What the IT team at Cincinnati Children's is doing mirrors efforts nationwide to upgrade the core computing infrastructures as organizations push ahead into the emerging operating environment. Industry experts see tremendous challenges and opportunities alike in the current landscape. “For years, we've been talking about the need for robust data warehouses as a fundamental element in hospital IT plans, but there always seemed to have been more urgent things to take care of,” says Jane Metzger, principal researcher in the Waltham, Mass.-based Emerging Practices group at CSC (Falls Church, Va.). “But several things have happened,” she says, “and the performance management challenges for hospitals and their business and operating environment have radically changed.” In addition to the push from organizations like the Joint Commission that have been demanding documentation of quality improvement, Metzger says pay-for-performance programs, the potential for broader value-based purchasing, and the push for greater safety have all awakened CIOs to the need for stronger data structures. On top of all that, the drive to fulfill the meaningful-use requirements under ARRA-HITECH in order to obtain federal stimulus funds has really jump-started the discussion around data infrastructure. Indeed, a strong awareness of the need for robust infrastructure has been top of mind among the CIOs of those hospital organizations that are pioneering the most dramatic innovations in patient safety, care quality, evidence-based care, and clinical transformation. At 20-hospital University of Pittsburgh Medical Center, Senior Vice President and CIO Daniel Drawbaugh says, “As you move in the direction of an integrated electronic health record, what occurs on the reporting side is that the requirement and demand for reporting for clinical analytics and financial analytics just skyrocket.” As a result, he notes that 91 data marts - subcomponents of the health system's broader data warehouse - have burst forth, up from 55 just a few years ago. And, as UPMC's clinicians pursue more and more patient safety and care quality improvements, the demand for data and reports will only continue to intensify, he says. Presently, there are already 25,000 clinical reports of all types available for the appropriate clinicians and managers to use. Similarly, at the 44-hospital Trinity Health system in Novi, Mich., Vice President and CMIO J. Michael Kramer, M.D., says, “By having a unified data warehouse, we can put critical data into the hands of our executives, our financial leaders, our clinician leaders, and our doctors. And we couldn't do that if we didn't have a single standardized architecture.” Kramer and his team have created more than 300 evidence-based clinical order sets, which are used across the majority of its facilities as part of its core EMR/CPOE system. Kramer says he believes Trinity Health has moved further than any community hospital-based, multi-hospital system in the country in such work. And without the core foundation of EMR, CPOE, eMAR, advanced pharmacy, and a robust data warehouse, such advances would not be possible, he emphasizes. For Aurelia Boyer, R.N., senior vice president and CIO at the five-site New York-Presbyterian Hospital in Manhattan, moving forward to unify and integrate her organization's data infrastructure is a constantly moving target, particularly given its ongoing acquisitions of facilities in the New York City area. She and her colleagues are all live on EMR, CPOE, eMAR, and nursing documentation, and will soon be live with physician documentation. Still, a diversity of products and technologies remains a challenge. As a result, her organization is using the Amalga product from the Redmond, Wash.-based Microsoft to perform data analysis enterprise-wide. The use of such tools, she notes, is propelling organizations like hers forward, even as they continue to work toward more unified data platforms. Other CIOs are following similar paths. Catherine Szenczy, senior vice president and CIO at the nine-hospital MedStar Health system in Columbia, Md., has also turned to the Amalga product, even as it is a commercialized version of a program first developed in-house (and then called Azyxxi) at MedStar. “We are moving towards greater consolidation, but that is obviously a long-term project,” Szenczy says, adding that Amalga will continue to help her and her colleagues improve clinical performance as they build a stronger core data infrastructure. “It's becoming more and more critical for hospitals to move toward robust infrastructures, especially as we aim toward meaningful use,” she reflects. “It's not enough just to use systems, it's necessary to demonstrate that you've improved the quality and safety of care. And without data, how do you accomplish that?” Accelerating the future Deborah Gash, vice president and CIO of Saint Luke's Health System in Kansas City, Mo., says, “There is a lot of work industry-wide that still has to be done to get the needed data into electronic form in a discrete way, in order to perform effective analytics. So in the next one to two years, there will be a lot of focus on putting that infrastructure in place. And after that happens, things will move forward very quickly.” Adds Keith Figlioli, senior vice president of health care informatics at the Charlotte-based Premier Inc. alliance, “We're still very early in terms of robust data infrastructures in individual provider organizations, let alone across communities. In fact, we're still basically putting in a lot of what I would call proprietary, transactional warehouses right now. But vendors will inevitably have to move towards more open data platforms, as hospital organizations go through mergers, connect disparate systems, and become involved in HIE initiatives,” he says. Greg Walton, CIO at the 542-bed El Camino (Calif.) Hospital, says that infrastructure challenges will inevitably persist as hospital organizations evolve toward clinical IS tools, and their performance improvement initiatives. “Some vendors and some CIOs believe that you can design a data model that's complete or almost complete. I don't believe that's possible,” says Walton. “My entire career, the data model has continued to grow broader, because the technology has continuously expanded what is possible, and medicine has moved forward.” The bottom line is simple: the future is already here. And as healthcare accelerates toward a new environment of continuous quality improvement, value-based purchasing, and demands for patient safety and quality documentation, the pressure to implement the most robust possible data infrastructures will only intensify. Those CIOs and their colleagues who heed the call will find themselves on the right side of history - not to mention reimbursement. And those who don't, need to rethink their concept of ‘future.’ Healthcare Informatics 2010 February;27(2):12-14 Fri, 29 Jan 2010 00:00:00 EST 3FA8AFF07964440FAB54BADC51F2F70E http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=4B30D97EA87E4E1B9001D0D2FA52142F The Landscape: Physician use of handhelds is by no means a new concept. But as the devices - particularly the RIM BlackBerry, Apple iPhone and Google Android - become more sophisticated and more applications become available, the game is changing, quickly. And with so many hospitals upgrading their infrastructures to offer ubiquitous wireless coverage, clinicians are using smartphones in the hospital setting to access online tools such as drug references, and communicate with colleagues. For CIOs, it's a no-brainer - physicians and nurses are already carrying these devices, so why not capitalize on the trend by enabling users to access clinical information and link to patient records. A number of organizations have adopted this thinking and are on the road to enabling EMR access via mobile devices. And while there are certainly sticking points, it's an area that many say is poised for significant growth in the next few years. The Future: Many innovative organizations are looking to provide access to electronic records and other clinical data through smartphones. Plans are already being formulated to leverage the devices to facilitate patient handoff and sign-out, as well as to link charge capture with quality measures. Cutting-edge organizations are looking to create actionable information for clinicians through software that can analyze data, track patients' progress, and send out alerts when conditions worsen. When it comes to cutting-edge technology, sometimes the implementations that fail are the ones that end up having the greatest impact. A few years ago, Children's Hospital Boston launched an initiative to plug clinical data into smartphones - the result was disappointing. According to Daniel Nigrin, M.D., CIO and senior vice president of information services, the IT team at the 396-bed hospital linked smartphones to the Cerner (Kansas City, Mo.) EMR system, enabling physicians to view patient information online. But the project never quite took off, says Nigrin, who believes it was primarily because the technology “wasn't quite up to the degree that it is now. In order to secure the devices to the degree that we thought was required, clinicians had to enter a clunky password each time they logged on,” he says. “It was enough of an obstacle that it led to providers just not bothering to log in. That was one of the places we stumbled.” Making it too difficult for users to access electronic records was a critical mistake, he says, but it was one that Children's certainly learned from. And with the organization now looking to get back into the smartphone space, Nigrin says he feels he and his team are at a distinct advantage. “As we consider redeploying similar types of things, we know what we really have to focus on,” he says. “Things like, how are we going to secure the information to the degree that we need to, while also making it streamlined and easy enough for the clinicians that they'll log in and use the tool.” Presently, clinicians at CHB are using smartphones for tasks like searching for drug information through applications like Epocrates, and are accessing Web-based tools through the hospital's Intranet. But in the next few years, Nigrin's team is looking to leverage the technology to facilitate patient handoff and sign-out by creating an application that extracts data from the Cerner EMR system and feeds it into the handheld device. Children's is also working to link charge capture with quality measures. “We've got a significant effort underway to try to collect clinical quality outcomes from the providers at the time of care,” says Nigrin. The function will be available both through the EMR system and via the handheld, he adds, letting clinicians choose the method most convenient for them. For many, that option is the handheld. “I think there is more and more of an interest” in accessing patient data via smartphones, he says. “Clinicians aren't banging down my doors asking for it, but there are enough comments being made that I think as we start to roll these things out, the uptick will be better than the last time around.” Craig Brandis, a principal at mHealth Consulting based in Portland, Ore., says this reflects what he is noticing across the industry. “I've seen an enormous surge of interest in smartphones,” he adds, estimating that 70 percent of physicians carry the devices. “The amount of reference information available is constantly going up, and people are looking for more integrated, more actionable information.” Healthcare Informatics Research Series: Trends in Point-of-Care Technologies Perhaps the biggest appeal of smartphones, he says, is the fact that clinicians are already using them as personal communication devices. “That's the number one thing - it's a ubiquitous platform. And I think the expectation is that if your regular data is available on your smartphone, then why isn't the clinical data there?”   Quiet, please According to Brandis, the two areas CIOs are looking to improve by rolling out smartphones are patient safety and communications. At Sarasota Memorial Hospital, easing communication between staff members was the key objective when Apple (Cupertino, Calif.) iPod Touch devices were piloted at one of the Med/Surg departments in 2009. And while Vice President and CIO Denis Baker was confident that the deployment would be successful, he admits he was surprised by one of the outcomes. During the trial run, the staff quickly discovered that corresponding via text messaging meant that the overhead paging system was used much less frequently, which made for much quieter hallways. “In any hospital environment, noise is always an issue. So while it wasn't an initial goal, it was certainly one of the more positive benefits that came out,” says Baker. “You'd think voice-to-voice over a phone would be optimum, but it turns out that people don't always necessarily want to answer the phone while they're doing something. With texting, they still get that communication.” Taking IT Home: Smartphones' Role in Telehealth While hospitals are starting to see a significant surge in use of smartphones in the clinical setting, one area where adoption is already high is chronic disease management, according to Stan Schatt, vice president and practice director, Security and Healthcare, ABI Research (New York). Applications that assist with glucose and cardiac monitoring or checking for irregular rhythms are commonly used in the patient home, he says. “And what's really spurring it is the iPhone. There are a lot of health-related applications available now, and there is a definite trend toward giving patients equipment and having them use the smartphone to monitor themselves.” Schatt says the appeal for hospitals is that clinicians can spend their time more productively. “Instead of having the patient come in for a periodic check-up to see how it's working, they can have the information sent over a network.” The problem, he says, is that it costs hospitals money upfront to buy the equipment in order to be able to receive this information. Schatt says whether manufacturers can convince hospitals to invest in the servers and software to interpret the metrics is a big debate. And, he says, whether insurance will pay for it is of concern. “But the idea itself makes a lot of sense.” The devices, he says, will be rolled out incrementally to critical care units and other areas throughout the organization. One factor that helped make the pilot successful, according to Baker, was the staff's willingness to provide feedback to Voalte (Sarasota, Fla.), the developer who worked with the hospital during the implementation. Nurses regularly offered input on issues like which orders they wanted on their task lists, and how they wanted to be notified when action needed to be taken, he says. The next frontier for Sarasota is to enable clinicians to access its Atlanta-based Eclipsys EMR system using iPhones. The IT team, says Baker, has begun discussions with the vendor to develop a format that will enable optimal use by clinicians. Scoping out the market While several EMR vendors are beginning to offer smartphone applications, the issues that should be top of mind for CIOs are data integration and creating actionable information, according to Brandis. For example, software from companies like San Francisco-based Keane can analyze multiple data streams, signal a patient is deteriorating, and send out alerts - it's this type of smart trending that can really usher smartphones into the next frontier, he says. “Clinicians are drowning in data. They need actionable information. You want them to have all of the clinical alarms from the monitors, all of that history and all of the event information in their hand.” Look Before You Leap The decision to implement a new technology is one that can't be taken lightly, says Daniel Nigrin, M.D., CIO and senior VP at Children's Hospital Boston. “I love new technology and new devices, but I don't necessarily just jump and try to implement them unless I know exactly what problem it's solving. We've sort of had a cautious deployment approach.” That philosophy, he says, applies to rolling out smartphones. So while applications that enable users to view imaging studies or real-time waveforms might seem attractive, Children's has its sights set on initiatives “that we think will solve a real need and not necessarily just ‘wow’ people,” he says. “We're thinking about using smartphones for those instances when it's not convenient to log on to a full workstation,” says Nigrin. With the handheld device decision, or any other one, Nigrin says he asks two questions. “First, will this solve a need? And second, once we implement it, can we justify its use? As far as the support and ongoing maintenance requirements - can we justify it in terms of the benefit that it's going to bring, compared with all the other tools that we provide for completing that task now.” According to Brandis, Welch Allyn (Skaneateles Falls, N.Y.) is also establishing itself in the smartphone space with a solution that “integrates lethal arrhythmias and all the parameter information and puts it, in real-time, in your hand.” The tool also has a feature that lets clinicians automatically escalate alarms when they are busy and review patient alarm histories, he says. Brandis says he believes that improving workflow and eliminating bottlenecks should be top priorities, particularly as technologies like smartphones become more prevalent in the hospital setting. “I think the CIOs are being driven bottom-up, increasingly, by the end users,” he notes. “And so I think this is a very good time for them to step back and understand their end-user needs better and look at central solutions.” And while CIOs need to be conscious of which new technologies should get the green light, particularly in these economic times, Brandis believes that “when everyone is carrying a platform like a smartphone all the time, it's a golden opportunity to help clinicians get access to information they need when they need it.” Healthcare Informatics 2010 February;27(2):24-27 Fri, 29 Jan 2010 00:00:00 EST 4B30D97EA87E4E1B9001D0D2FA52142F http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=BB1F9142E1674E3CBDF4016BEFFB7879 The Landscape: As the U.S. population ages and the number of patients with chronic conditions continues to rise, hospitals are beginning to leverage remote technology to improve care post-discharge and cut down on avoidable hospital readmissions. In addition, rural areas with increasingly limited access to specialists are using telemedicine to provide care without transporting patients from small, critical care hospitals into the larger cities. The Future: As healthcare reform begins to change the payment structure, episode of care reimbursement will provide the push for hospitals to increase their chronic care management programs. The cost of technology for in-home monitoring is rapidly dropping, and patients will begin to play a greater role in managing their own care. In addition, Washington's pledge to increase the national network infrastructure means that rural areas will have better, faster connections to link specialty services to the cities, and the use of telemedicine for specialty services like telepsychiatry, telestroke and wound care may rise. Gregg Malkary Changes from Washington are coming. Though many areas of telehealth, like e-ICUs, have seen steady growth in recent years, many believe a slew of different initiatives lumped under ARRA are going to provide the push to make these technologies more mainstream.   In rural areas, for example, Rural TECH (Telemedicine Enhancing Community Health) Act of 2009 aimed to increase the use of telehealth technologies like video conferencing to connect medical experts with providers, facilities and patients, and provide critical health services and education. The Act created three telehealth pilot projects to analyze clinical health outcomes and the cost-effectiveness of telehealth systems in medically underserved communities. Marc Holland “We do not have a shortage of specialists, we have a disproportionate distribution of specialists,” says Gregg Malkary, founder of Menlo Park, Calif.-based Spyglass Consulting Group. “They're all in the cities.” Today, telemedicine systems such as Netherlands-based Phillips Visicu e-ICU - already in use in many small critical care hospitals - are linking city-based specialists to rural areas and allowing patients to receive care without leaving their communities. And most say that as infrastructure improvements abound, the trend will continue to grow.   According to Marc Holland, principal in the New City, N.Y.-based System Research Services consulting firm, ARRA provisions state that by 2011, the National Coordinator for Health IT (currently David Blumenthal, M.D.) is obliged to present recommendations to the Senate in this area. “There's a billion dollars for improving the broadband infrastructure in this country,” says Holland, “and telemedicine was cited as part of that push.” In total, the USDA has awarded more than $1.5 million in Rural Utility Service (RUS) grants to hospitals around the country to fund expansion of e-ICU critical care services to rural communities. ICU telemonitoring programs are closing the coverage gap as physicians and critical care nurses, staffed 24/7 at an e-ICU hub, can now assist bedside caregivers in the diagnosis, treatment and management of critically ill and trauma patients. “We're seeing an increased demand for specialists and certainly not a growing supply,” says Ken Lawonn, senior vice president and CIO at Alegent Health in Omaha, Neb. “What we're seeing is building out a better network infrastructure for higher speed connections between the smaller communities so we can do some things that are above and beyond what you can do on low speed connections.” Ken Lawonn Alegent is currently using Visicu's e-ICU technology to monitor 120 beds in eight locations, and Lawonn says the plan is to expand further. “We're working on a plan to offer it to non-Alegent small critical care hospitals,” he says. “We think it would provide not only better care and some revenue, but also provide a connection with the community and help with referrals - we do have some competition in the area.”   While e-ICUs have experienced early popularity, the scarcity of rural specialists is having an effect on other telemedicine initiatives as well. The Atlanta-based Centers for Disease Control, for example, recently awarded a three-year grant to the Louisiana Department of Health and Hospitals Heart Disease and Stroke Prevention Program to build a telestroke network in collaboration with Ochsner Health System and the American Heart Association. Ochsner, a seven-hospital system based in New Orleans, plans to utilize Reach Call's (Augusta, Ga.) telestroke and telehealth services to improve stroke care in urban and rural areas throughout the state by connecting neurologists with patients. The aim? To develop a regional TeleStroke Network in southeastern Louisiana that will address the lack of access to stroke neurologists and availability of stroke-treating hospitals in the state. It starts at home And while telemedicine solutions geared toward specialty services continue to grow, many feel that chronic disease monitoring in the home will see some of the most explosive growth in the years to come. Many say broadband penetration into homes, coupled with the emergence of more sophisticated portable medical devices, will push the point of healthcare delivery to the home. According to a report from New York-based PricewaterhouseCoopers, the remote medical care market for telehealth services is expected to top $1.8 billion by 2013, up from $77 million in 1995. Broadband expansion has also caused telecommunications giants like ATandT and Verizon to enter the market with home health offerings (see sidebar). And as legislation changes transform the reimbursement model with bundling and preventable readmissions penalties, many expect home monitoring for patient management to spike. Warm and Fuzzy Data Telecommunications companies are rushing to get a piece of the telehealth pie by developing wearable health devices that connect with home health networks. Dallas-based ATandT, for example, recently unveiled a prototype for foot-signature telemetry in the in-sole of slippers to detect or even prevent falls. These “smart slippers” have embedded pressure sensors to help prevent falls in elderly patients by relaying messages to a doctor if the wearer starts walking erratically. ATandT hasn't yet set costs for either the product itself, or the accompanying wireless service needed to deliver notifications. Another research project is a networked pill-minder that provides a voice reminder to take a pill when required, and also sends information on which pill was taken and when, to a database that can be examined by physicians. Currently, however, most agree that reimbursement presents a knotty situation. According to Malkary, the real return is for IDNs that are both payer and provider, such as Oakland, Calif.-based Kaiser Permanente and Rochester, Minn.'s Mayo Clinic. “When a hospital is part of an IDN, the goal is to keep the diabetic patient out of the hospital,” he says. “For the non-IDN hospitals, they want the diabetic who needs his leg removed.” Holland agrees that changes in the reimbursement model will drive change. “If you can perform all the services and meet the quality, you get to keep the difference,” he says. “There will be a restructuring of the reimbursement system first with Medicare - which will require validation through pilots - and all the private insurers will follow suit.” And regardless of how things play out with Medicare, Holland says the price of the technology itself is decreasing, which is enabling hospitals - and patients - to purchase it more easily. “That is going to drive this market even absent a change in reimbursement,” he says. Alegent, like many health systems, is using in-home monitors for its home health division, says Lawonn. “We have some pretty crude ones that connect to the telephone, but there are exciting new technologies coming out. It's an increasing area but hasn't gotten critical mass yet.” He believes changes and incentives in reimbursements to keep patients healthy will drive the change. “It's the right thing to do anyway.” Many of the newer home monitoring technologies are also less invasive, and can include devices like GPS tracking for Alzheimer's patients and even medication compliance tools. But the biggest problem with home monitoring is managing the data. “It's like home security monitoring - home security is like the burglar alarm in the house, and the physician is like the police that's only notified if the situation warrants it,” says Holland. “The question is ‘who is going to be ADT?’” “When a hospital is part of an IDN, the goal is to keep the diabetic patient out of the hospital,” he says. “For the hospitals, they want the diabetic who needs his leg removed.” A sound strategy, believes Malkary, is a call center that would monitor the data transmitted from the home-based patient. “The care is only as good as the data you have,” he says. “If the home health nurse only takes vitals when they're there for a visit, you're operating in the dark.” Though call centers may be on the horizon, they are not commonly used today. At University of Illinois Medical Center, for example, CIO Rose Ann Laureto says the home telemanagement model includes an advanced-practice nurse who works with a cardiology fellow and an attending cardiology physician. Clinical goals are set as desired ranges for blood pressure, heart rate, weight, and laboratory values specified in each patient's individual medical plan. The advanced-practice nurse evaluates the data transmitted by the patient, conducts telephone assessments, titrates medication therapy, and conducts patient education as needed to achieve the goals of the medical plan. Patients with heart failure use trans-telephonic home monitoring devices to measure their weight, blood pressure, heart rate, and oxygen saturation level, says Laureto. But many say the missing link is getting all that telemedicine information into the patient's EMR. “What would be ideal is when it connects into the clinical system so the alert goes right into the patient's chart and a nurse responsible for the patient is notified,” says Lawonn. “That way you don't need a separate monitoring system.” Many believe the missing links may fill up fast due to the shortage of caregivers with the right skill sets. “As Medicare approves more and more telemedicine modalities, the floodgates are going to open,” says Holland. “It will be a trickle in the beginning but it's going to be a pretty steady flow.” Healthcare Informatics 2010 February;27(2):28-58 Fri, 29 Jan 2010 00:00:00 EST BB1F9142E1674E3CBDF4016BEFFB7879 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=A3CDC36258CB4B16B4C50416D6E408BA The Landscape: Whatever the controversies around health insurance reform on Capitol Hill, there's a strong bipartisan consensus as to the need for reimbursement reform, including a shift towards value-based healthcare purchasing under Medicare. For healthcare CIOs who will need to implement data reporting and sharing systems that can facilitate new reimbursement arrangements nationwide, the implications are huge. The Future: CIOs and other leaders who have been involved in advocacy work say the time is now to prepare for the reimbursement reform changes to come. Blair Childs There are two things we know about reimbursement reform: it's coming, and it'll rock your world. First, let's differentiate from health insurance reform, which would seek to restructure how health insurance is provided and paid for in the United States. That policy and political issue is being hotly debated in the U.S. Congress. At the same time, lost amid mainstream media coverage has been the consensus on the part of policymakers from both major political parties on the need to move healthcare towards value-based purchasing.   Mike Smith And when value-based purchasing under Medicare - as well as some other potential reimbursement innovations, including bundled payments and accountable care groups (ACOs) - becomes a reality, hospital and health system CIOs will have to have put in place the kinds of information and data reporting systems required both for complex clinical data reporting schemas, and for care delivery spread across multiple organizations. What's more, some of these reimbursement changes, particularly value-based purchasing under Medicare, could go into effect far faster than many might think.   “Hospitals, and for that matter all healthcare providers, are going to have to deal with substantial changes in the way they're paid,” says Blair Childs, senior vice president for public affairs at the Charlotte, N.C.-based health alliance Premier Inc. The system, Blair says, will transition from one that is based on volume to one “where they're at least partially paid on value, with the portion of payments coming from value ramping up over time.” He says, referring to bundled payments and ACO arrangements, “if you're trying to communicate among hospitals, post-acute care and long-term care, there need to be ways to transmit information easily and efficiently.” Change, however, may be unavoidable. “Reimbursement reform is inevitable, because in the absence of that, healthcare costs will bankrupt this country,” says H. Stephen Lieber, president of the Chicago-based Healthcare Information and Management Systems Society (HIMSS). Lieber says he believes CIOs need to pay close attention, “because they've got to put the systems in place to handle that knowledge, and understanding why they have to do that will be as important as actually putting the systems in place.” CIOs who have been involved with advocacy, whether through Premier, HIMSS, or CHIME (Ann Arbor, Mich.-based College of Healthcare Information Management Executives) agree that change is inevitable, and that they and their peers need to be involved in advocacy work, and to be prepared to lead the implementation of information systems to support new healthcare reimbursement arrangements. “I think the days of fee-for-service healthcare are numbered,” says Mike Smith, CIO of four-hospital, 1,500-bed Lee Memorial Health System (Fort Myers, Fla.). The challenge, he says, is for CIOs to be involved in advocating for reimbursement changes that make sense for hospitals and for patients, while also preparing for the inevitable changes to come. “Clearly, all the reimbursement innovations being talked about, including bundled payments and ACOs, will require good information to operate effectively,” says Smith. CIOs, he urges, must begin to implement the information systems needed to prepare for reimbursement changes, even as they talk to policymakers about what issues are important and what strategies work. “If you believe in the kinds of activities we've talked about and believe in healthcare reform, you have to believe that information is key, and that the CIO is in a good position to inform on these issues,” he says. Of course, knowing that reimbursement reform is coming doesn't necessarily mean that one is totally prepared for it. For example, says Dennis L'Heureux, senior vice president and CIO at the 396-bed Rockford (Ill.) Health System (which includes an employed physician group and long-term care), “Our legacy hospital patient billing system is not very flexible, so a switch to bundled payments would force me to replace that system sooner rather than later.” L'Heureux says he is going to have to make changes based on the shift to ICD-10, while he's already replacing his EMR to help qualify for meaningful use. “And I hardly have sufficient resources to do what needs to be done now.” Inevitably, reimbursement reform will force CIOs to make tough choices in terms of technology upgrades and implementation options, L'Heureux says. Still, he says he believes that value-based purchasing, along with other payment innovations, is unavoidable. “We're going to be reimbursed by the results of care, and probably no longer simply by unit of care provided. Instead, did we make the patient better?” In the end, Premier's Childs predicts that many areas involving the proposed federal reimbursement changes will need testing, such as bundled payments and accountable care organizations. “There's no question that the testing will lead to changes,” he says. “And all of these new quality measures that are going to be coming down the pike, as well as comparative effectiveness research, need to be integrated into the electronic record.” As a result, he says he thinks it's an opportunity for CIOs to make themselves less technicians and more integral players in strategizing for their organizations. “I would encourage CIOs to help create a vision of where technology can help a hospital get to the next level. It's really a significant opportunity.” Healthcare Informatics 2010 February;27(2):32-34 Fri, 29 Jan 2010 00:00:00 EST A3CDC36258CB4B16B4C50416D6E408BA http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6F66A6CCF50E4E0B9674519C0238A186 The Landscape: With hospitals scrambling to implement EMRs and demonstrate meaningful use through CPOE in order to meet HITECH requirements, CIOs will need embedded clinical informaticists with medical, nursing, and pharmacy backgrounds on their IT teams. At the highest level will be CMIOs and VPs of clinical informatics; but permanent teams of clinical informaticists will be needed. The Future: Though the clinical informaticist staffing model is fairly common in large academic medical centers, its use will rise in smaller hospitals. In addition, the short timeframes for qualifying for HITECH dollars mean that hospitals will have to employ skilled clinical informaticists to ensure fast and reliable implementations. However, with these double-skilled clinicians at a premium, many hospitals will come up short in the talent department unless they recruit or grow from within. In addition, once systems are implemented, these clinicians will be needed to help grow the value of the EMR through data mining and other quality initiatives. It's nothing new for hospitals to have IT staff skilled in fields other than IT. Indeed, when hospitals began automating their financial functions two decades ago, it happened more often than not. “We saw this years ago with finance, but it's the nature of where IT investments are being made today,” says Linda Hodges, vice president and IT practice leader at Oak Park, Ill.-based Witt Keiffer. “Having physicians, nurses, and pharmacists who are subject matter experts, but who are very much involved with IT is becoming critical with the implementation of clinical systems and the EMR.” Projects, she says, are more than just IT; they are a transformation in how care is delivered. “It's the death knell for most organizations if it's perceived as purely an IT project,” she adds. Having experts who have credibility and can speak the language of the clinician and the language of IT is important, she says. Daniel Martich, M.D., CMIO at Pittsburgh-based University of Pittsburgh Medical Center (UPMC), says, “It's the natural progression of IT as it relates to healthcare.” The best approach, he says, is a collaboration between clinical staff and IT, and should be used for design, deployment, support, and training. But many say that the collaborative approach hinges on having clinical informaticists. “There's a need to have someone who understands the clinical world and enough about IT to help clinicians,” says Jackie Willis, R.N., vice president of clinical systems and chief clinical informatics officer at 26-hopital Adventist Health System based in Winter Park, Fla. “That's critical.” Adventist is just one of the larger and more advanced hospitals that have embraced that model. However, for smaller hospitals, many of which have yet to implement an EMR, the clinical informaticist staffing model can also be key. “My observation is that leadership hospital systems think this staffing model is routine,” says Michael Shrift, M.D., CMIO and vice president of clinical knowledge management at Minneapolis-based Allina Hospitals and Clinics. Being clinically-oriented is part of the Allina culture, Shrift says. In fact, Susan Heichert, Allina's CIO, is also an RN. But orientation does not necessarily dictate where the clinical informaticist sits. “Whether they are actually part of the IT organization or partner with it, Hodges says in essence they are all part of the IT organization. “Even though the CMIO might have a direct line to the CMO, their office is located right next to the CIO,” she says. That's the UPMC model: James Venturella, CIO of UPMC's Hospital and Community Services Division, uses the matrix approach. “We have multiple physician groups and combined nursing, physician, pharmacy groups,” he says. “There's a lot of crosswalk and cross talk.” Some hospitals have dedicated clinical informatics teams, which Willis says she created four years ago at Adventist. Reporting directly to the CIO, the team is divided to support the system's multiple hospitals by region. “We also have physician liaisons at each hospital supporting the physicians and working with the clinical informatics lead,” she says. “Our informatics team facilitates both of them.” And there is more than one model. “Our team is a rich amalgam of 35 RNs and advanced clinicians, pharmacists, and physicians, among others, who combine to make it easy for the caregivers to do the right thing, and hard for them to do the wrong thing,” says Shift of his team at Allina. “We are now separate but very closely linked.” And once the go-lives are finished, many say the need for clinical informaticists to be part of IT will only increase. “A lot of the larger places have implemented the systems, and are now trying to tap the data and move more to knowledge-based medicine and really do some true informatics with the data,” says Hodges. “It's sort of like an evolution.” Shrift agrees that once hospitals and IDNs are fully implemented on an EMR, the next step is to focus on achieving a return on investment. “It takes a rich skill set of IT, and of data and content, business and human factors, and especially workflow redesign to fully extract clinical quality and safety value from an EMR investment,” he says. And that skill set, as Willis points out, will be especially valuable when hospitals begin trying to qualify for any dollars flowing from Washington. “As a part of meaningful use, we see lots of opportunity to optimize what we already have in place,” she says. “It's the way that information is used; understanding and optimizing the workflow of the clinician and how they interact with that system and enter and retrieve that information in a meaningful way, at the time they need it.” Willis says though Adventist has already rolled out its Kansas City, Mo.-based Cerner system to all of its hospitals, it is looking into some redesign and will be working closer with clinicians to make sure their needs are addressed, especially now that Adventist is about to implement CPOE. “We recognize that the clinicians need a better understanding of how to use the system, and that's why the use of informaticists is growing.” A Novel Source of Inspiration Developing an embedded informatics program can be tough. Cooley Dickinson Hospital, a 142-bed community hospital in Northampton, Mass., implemented an EMR system from Atlanta-based Eclipsys in June 2008. To help smooth the clinical, financial and policy issues that can arise from EMR implementation, CIO Wayne Freeberg and CMIO Dirk Stanley, M.D., partnered with ED Informaticist Isaac Bromberg, M.D. to develop this pioneering role for front-line clinicians. Says Stanley, “The hardest part was figuring out a cultural model for how these clinicians should function. You need them to help smoothly bridge the IT and clinical worlds, to meet our hospital's clinical informatics demands. So training can be difficult, especially when so few people understand what clinical informatics is.” In a life-imitates-art scenario, Stanley and Bromberg looked for novel sources of inspiration to help solve this problem. “One day it occurred to us that we, like many Generation X'ers, were at least partly shaped by the mythology of the George Lucas Star Wars movies,” says Stanley. “We then realized that the mythological Jedi Knight culture - including their fictional culture of self-improvement, political neutrality, and serving others rather than ruling over them - was a great role model for this new position in healthcare.” Since then, the two have adapted the fictional movie culture to a more real-world clinical culture and code of conduct that helps them implement patient-focused embedded clinical informatics solutions. The result: 20 front-line clinicians interested in serving this new role and meeting regularly to discuss embedded clinical informatics. Adds Stanley, “We can only thank George Lucas for the inspiration and for helping shape a future generation of leaders, even if they work in healthcare.” With CPOE adoption growing and competition increasing from both inside and outside the hospital space, some are wondering if a shortage is on the way. Hodges says the number of people looking for physicians and clinicians to lead informatics or to fill the CMIO role has gone up dramatically. And while hospitals are trying to fill positions, so, too, are vendors and consultants. “These people are in demand.” When it comes to experienced people, Hodges says today the demand is greater than the supply. So with such great demand, do credentials, such as a degree in informatics, matter? “Credentialing is important, but I think experience is equally if not more important,” she says. And in addition to experience, most agree that clinical informaticists must possess a unique skill set. “It requires the person to have some clinical background and a broad background of clinical practice,” says Willis. “It's hard to find someone that has the right mix of skills that we're looking for.” Willis doesn't exclude candidates without a degree in informatics, but does request that they continue their education. Many say the best place to build the team and to find clinical informaticists is right at home. Venturella says UPMC has been growing from within, “but it does take a unique individual to be able to walk both sides.” Martich says if he were a CIO and hadn't started building his team he would be scared. “Clinical informaticists have the experience of walking both sides of the fence and providing translation for their colleagues,” he says. “We have a handful of people skilled in doing that. If we lost any of them, it would be a challenge.” Healthcare Informatics 2010 February;27(2):34-36 Fri, 29 Jan 2010 00:00:00 EST 6F66A6CCF50E4E0B9674519C0238A186 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=06C85476E4624F2E82E64870A58C23CD I see social networking as an extension of my IT department's wholesale efforts over the last two and a half years to improve our hospital's online presence.   During an executive leadership meeting about three years ago, our chief of surgery asked us to consider how we could increase marketing to give the hospital a global presence. From his perspective, the hospital's Web site was the first spot we needed to target. So the IT department took complete control, dramatically improving the site's design, and a little over a year later, giving it another level of improvements. When we began looking at social networking, it was with this same concept in mind - to increase the power of the hospital's online global presence. But we knew going in that there were potential barriers. First, we needed to convince hospital leaders that social networking could be a positive thing - that we wouldn't lose control of our brand and we weren't opening up the proverbial floodgates to negative comments. We also had to convince them that opening up the firewall to make social networking sites available to staff could be a positive thing. It helped that our CEO was on board with this plan from the beginning. We were also able to demonstrate how our peer hospitals were already capitalizing on this functionality. In addition, our team worked closely with human resources to communicate facts like, “HIPAA rules still apply online as well as offline,” and provide some governance. It was very important, from my perspective, to have this in place before we opened up the network firewall to these sites. To date, the improvements to our entire online presence, including social networking activities, have fundamentally changed the way that we reach out to the world. One place where we've realized a significant ROI is our fundraising department. Since the team upgraded our site more than two years ago, we've seen approximately $3 million in donations come in through the Web site. I attribute this to the impact of having our information readily accessible online, and integrated with our social networking presence. Our purpose in this is to allow those who support us to feel like they are an integral part of our mission. For example, prior to the go-live of our new Web sites (and more recently, the launch of social networking), we didn't have a centralized online repository for personal accounts of how our hospital lives out its mission. A list was kept by our fundraisers, who would ask patients to share their stories at community events, but the stories weren't accessible to the average person. Now that we have improved our online presence, we can reach the entire globe with our story and connect everyone, both inside and outside of our hospital. Being able to leverage social media compounds the impact we are able to have. For instance, prior to launching a dedicated YouTube channel, individuals in our community had to go to our site and search for our videos. Now, they can search YouTube or Google to find our videos - and not only can they watch them, they can embed them in their own Web sites to share with others. Through these capabilities, our reach has become phenomenally larger. Another area where we've seen ROI is through recruiting of patients, nurses, doctors, and administrative staff. We've had individuals find us on Facebook and, without prompting, tell others that because we had become a preferred employer because of our social media sites. And several of these individuals live in other countries, which tells me that we are getting the international reach we want to have. I can't foresee a time in the future where new media won't be an integral piece of any marketing push. I also can't foresee a time where we won't be reaching out to online communities just as strongly as we might reach out to our various audiences through traditional means. Steve Garske is vice president and CIO at the 286-bed Children's Hospital Los Angeles. Healthcare Informatics 2010 February;27(2):57 Fri, 29 Jan 2010 00:00:00 EST 06C85476E4624F2E82E64870A58C23CD http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=F4452C4541374EFEB5295C11E31FE5A8 As the health care industry undergoes a period of dramatic transition and change, every sector, including health care IT, is looking to industry-leading publications that can help identify the issues facing executives and clinicians, and suggest paths forward. Fortunately, the readers of Healthcare Informatics can rely on the broad range of experience and expertise of its editorial team. This is a team with deep roots in health care, and a commitment to using its individual and collective expertise to bring our readers the best in reporting, writing, and analysis.   Our goal is to provide you with information that is objective and responsive to your needs. In short, that means we are masters of the editorial agenda. We depend upon the team's collective intelligence, as well as interaction and feedback from our readers to develop our stories and coverage. Although we have embraced new ideas and channels of communication, we remain dedicated to what is known among journalists as the “separation of church-and-state.” This means simply that we neither plan nor publish articles based on who buys an advertisement. We know that many other business publications blur the lines, but we work hard to keep that “wall” in place. (Did you know that we have a standing rule that if a story should mention a company that has purchased an ad in that issue, the ad can't be next to the article?) Much of our coverage focuses on the practical-what works and what doesn't, but we can also tap the rich results reported in any of the Healthcare Informatics Research Series. In addition, each editor aims to be a thought leader and, as such, identify opportunities and introduce ideas that create the kind of nurturing environments in which “ah-ha” moments emerge. Allow me to introduce you to the lineup, each of whom actively participates in developing and carrying out editorial strategy. Editor-in-Chief Mark Hagland is a nationally recognized healthcare journalist with more than 20 years' experience as a writer, editor, and speaker. He has written articles on a broad range of topics, won numerous national awards for his writing, and authored two books on quality and efficiency in healthcare delivery. Managing Editor Stacey Kramer keeps the print and online publications on track and on time. Senior Associate Editor Daphne Lawrence has worn many hats working for hospital CIOs and CFOs. She covers clinical and financial developments for the magazine, and manages all submitted articles. Associate Managing Editor Kate Huvane Gamble gained writing and reporting experience in medical and healthcare IT-related topics before joining the publication. She currently focuses on wireless and administrative issues, and is instramental in compiling Healthcare Informatics' Extra, the weekly e-newsletter. Contributing Editor David Raths is a journalist with rich understanding and expertise in healthcare information technology, behavioral healthcare, and healthcare policy for HCI, as well as for other Vendome Group publications. Individually, each member of the HCI team is excellent; collectively, they're outstanding. Charlene Marietti, Executive Director of Editorial Initiatives Healthcare Informatics of Vendome Group Healthcare Informatics 2010 February;27(2):6 Fri, 29 Jan 2010 00:00:00 EST F4452C4541374EFEB5295C11E31FE5A8 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=582DEDCAED6B4813B8113F17544648FA On Tuesday, Jan. 26, I attended the eHealth Initiative’s Annual Conference in Washington, D.C., which was quite lively and thought provoking. Here are five quick observations: 1. Won’t Get Fooled Again This is the third time I have gone to a conference at which someone from the Office of the National Coordinator for Health IT was scheduled to speak, and it is the third time I have come away somewhat disappointed. I don’t think I’ll bother making an extra effort to go to their conference presentations anymore. Don’t get me wrong, ONCHIT’s staff members seem to me earnest, hard working, and intelligent. But their presentations at conferences like this one strike me as too basic and very cautious. It’s sort of like listening to President Obama’s press secretary, Robert Gibbs. I always get the impression he’s trying to answer questions without really saying anything. This crowd didn’t need to hear a rehash of what the basic components of meaningful use are or what a regional extension center is, but that’s about all they got from Joshua Seidman, acting director of the meaningful use division (nice title, huh?). 2. States: Revenues Down, Uncertainty Up During a panel about state health information exchange efforts, Ree Sailors of the National Governors Association noted that in 2010 many state governments are facing a double-whammy of sharp revenue declines and the prospect of turnovers in the governor’s mansion. On the financial side, overall state revenues are down 17 percent from a year ago, forcing cuts in critical services at the same time there’s going to be an influx of HITECH funding to foster eHealth improvements. Meanwhile, in this fall’s elections, there’s the potential for a 50 percent turnover in governors, said Sailors, director of health IT in the NGA’s Health Policy Division. Those changes in administration are bound to disrupt or slow work on HIEs as new governors, staffers agency heads and legislators struggle to get up to speed, she said.  3. You’re Never Done Building Trust People in regions that don’t yet have functioning health information exchanges may look jealously at places like Cincinnati, where the HealthBridge HIE is seen as a model of success, with links to 24 hospitals and more than 5,000 physicians in three states. Yet even for advanced HIEs, the organizational work is still challenging. Rodney Cain, HealthBridge’s CIO, expressed some frustration when asked how HIEs could move from just being a medium for exchanging data to getting involved in more advanced projects like quality initiatives. As HealthBridge recently began work on a project to consolidate regional data for reporting to CMS, it found it needed to go back to some providers for missing data elements, he said, and met with resistance. “It felt like we were starting over,” Cain said. “Sadly the same old issues of trust between institutions popped up.” The issue of building trust is ongoing, he said, and is constantly evolving due to the pressures of the marketplace, meaningful use, and interoperability. 4. Can HIEs Be Done on the Cheap? At the conference, the eHealth Initiative announced winners of its 2010 eHealth Awards. One was Larry Garber, MD, the medical director for informatics of the Fallon Clinic in central Massachusetts. After hearing other state-level health IT leaders give their take on how HIEs might achieve financial sustainability, Dr. Garber said the key is to keep the overhead as low as possible. He said the software for the SafeHealth HIE he has helped establish in Massachusetts was written in-house. There is no legal entity set up, so they avoided attorneys’ fees. The annual operating expenses so far, he said, are just $7,000 per year. Is that a model others could replicate? 5. Trying to Tackle Too Much at Once During the wrap-up of a panel on transforming patient-provider relationships through eHealth, two prominent physicians expressed some doubts about the expansive scope of the meaningful use push. While expressing their support for the overall goals, both Steven Stack, MD, a member of the board of trustees of the American Medical Association, and J. Leonard Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the Stage 1 MU guidelines are putting way too much on the table at once. Stack said an approach he would prefer would be to first tackle a smaller list of projects to solve specific problems about making e-prescribing and lab and radiology data ubiquitous. Lichtenfeld said the expansive nature of the MU guidelines could be problematic for many physicians who believe they don’t have the time, money or expertise to comply. One last bit of news from the conference: Harry Totonis, president and CEO of Surescripts, announced that his company would begin working to make prescription history information available to HIEs as well as to patients’ personal health records. Wed, 27 Jan 2010 00:00:00 EST 582DEDCAED6B4813B8113F17544648FA http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=661B2A1CE81548BBAA1A2E2C4A7A5DC6 On Jan. 13, the Ann Arbor, Mich.-based College of Healthcare Information Executives (CHIME) named William Spooner, senior vice president and CIO of the San Diego-based Sharp HealthCare, the recipient of the 2009 John E. Gall Jr. CIO of the Year Award. Spooner, who has been CIO at the five-campus, 2,000-bed Sharp HealthCare, oversees over 400 IT professionals at the integrated health system. Spooner spoke recently to HCI Editor-in-Chief Mark Hagland regarding the CHIME honor and his perspectives on the evolution of the CIO role.   Healthcare Informatics: What was your reaction to receiving the honor of being named CIO of the Year? What do you think it means for you? Bill Spooner: Even though I’d had the opportunity to present the CIO of the Year award a few years ago, when I was CHIME board chair, I hadn’t really been all that familiar with the nomination and selection process. So I was excited when I learned I’d been nominated; and once I realized I had won the award, I was totally overwhelmed. To be mentioned on the same list as the past recipients and to have been chosen for the award, was rather humbling. I think it’s a recognition for my team; because my team has done a lot of great work. I take the credit for leading my team, but my team has done a lot of great work. And Sharp has been an innovator for a long time, in various niche areas, whether it be information technology or medicine. We were the first hospital to do open-heart surgery in San Diego County, in 1958.   HCI: So Sharp has long had a culture of innovation? Spooner: Yes, Sharp has had a culture of innovation. And my boss came to recognize through all of our conversations that we have to look at it in a global sense. So he, our CEO, has been very supportive, and the board has been very supportive, in the last several years. And that’s really been the key to fostering success in enabling us to do what we’ve been able to do. So the award is as much a reflection on the organization as on me. And because I’ve got a really good team, I’ve been afforded the time to do some things outside, at CHIME and in other venues.   HCI: We seem to be at a very pivotal point in the evolution of the CIO role within the health care field. More and more CIOs are becoming, and need to become, senior leaders in their organizations. While retaining some technical knowledge will be important, for most CIOs, being a part of the executive management team and helping to steer their organizations forward on a far broader level than in the past seems to be what's called for. Your thoughts? Spooner: That’s right, and the other piece of it is the role of the CIO on the executive team. The question is still being asked. I remember five years ago at CHIME, everyone was asking, how do we get the CIO in the c-suite, at the executive table? And I don’t think there are many CIOs who aren’t there at this point; there may be some. But certainly, there’s the recognition that they need to be there at the table. So I think you’ve got the transition of the title from director of IT to CIO; you’ve got the participation at the executive level; and you’ve got the reporting relationship upward in the organization. And there are more CIOs reporting to the CEO and COO than before.   HCI: And what the CIO does is more strategic than it was a few years ago? Spooner: I couldn’t configure a server if my life depended on it. And I really don’t very often get down into the technical details; I get into the high-level architecture discussion; and into the hot-topic issues. But I rely more and more on a team with diverse skills while at the same time trying to understand what the direction of the organization needs to be, and trying to prod it forward in the right ways, including into the community, and in the position, I’ve been taking on more of a community role. In fact, more of us are taking on advocacy roles. I testified at a hearing of the California state Senate Health Committee a few weeks ago, regarding California’s position and progress regarding health information exchange. That wouldn’t have been common a few years ago.   HCI: What do you see as the biggest few challenges facing hospital and health system CIOs in the US right now? What are the biggest opportunities?   Spooner: There are near-term issues and longer-term issues. We all have the challenge of making our EHRs hum and qualify for the stimulus. And some of the meaningful use requirements, particularly around reporting indicators, may end up being trickier than we might have thought. But we have more and more opportunities for using automation to make it easier to do our jobs; and it’s a real challenge how to decide where to apply the resources. That’s the ‘today’ thing. I think down the road, it’s all of healthcare reform. And we know that there will be changes in reimbursement, towards such things as changes in reimbursement. We really have most of the infrastructure in place here at Sharp for ACOs [accountable care organizations]. And we don’t know exactly how healthcare reform will impact us. But it’s really the fact that, like it or not, and whether it’s this year or five years from now, we have to bend that cost curve, and that’s got to be top of mind for all of us. And we’ve got a board-level committee devoted to IT issues; I’d say only about 10 percent of hospital organizations have that so far. Now, we’ve got a couple of CIOs from for-profit corporations on our committee. And in healthcare, it’s more complicated; they seem to have the ability to move things along faster; there’s not as strong a drive to produce a more cost-effective, higher-quality widget, in healthcare. But as we’re sitting close to 17 percent of GDP, we’re going to have to think about how to bend that cost curve. It’s just a different culture. But it is kind of exciting as well. You’re being asked to do things in totally different, new ways.   HCI: What are the biggest challenges and opportunities facing you in your own organization?   Spooner: We’re striving forward on a lot of initiatives; we’ve got a lot of things on our plate. And we changed direction in terms of EMR four years ago; we decided to eliminate some of our best-of-breed products in favor of moving mainly towards Cerner. And in managing what had become pent-up demand, and with a high focus on some of our organizational initiatives, including Cerner and Allscripts in our medical group, the whole prioritization issue is a challenge.   HCI: How do you view the current situation with regard to the ARRA-HITECH legislation and federal stimulus funding?   Spooner: I’ve been following it fairly closely since the legislation was passed and the initial outline was drafted. I’ve probably taken a somewhat divergent view about certain things. I think we’ve protested, as an industry, more than is appropriate, in terms of some of the demands around CPOE. I think we spent a lot of time trying to fend off CPOE, to the point where we were only at 10 percent of implementation; but the functional and quality indicators have come out a little bit stronger than expected; but we might have achieved a slightly better balance if we’d been more aggressive or optimistic in terms of our ability to move CPOE. One of the things that’s been kind of interesting here at Sharp, and I’m pretty pleased with the outcome, but it wasn’t easy, is that when we decided to move to our new EMR with Cerner, there wasn’t room for paper charts anymore, so CPOE became a directive. We didn’t make it mandatory, but we had 50-55 percent CPOE adoption in the first month. And we went through the typically rebellion and pushback from the medical staff. Then we moved into the new hospital, and after 16-17 months, we were in the mid-80 percent range, and we’re now at about 90 percent. We brought Cerner up in November, and by December, we were at 83 percent CPOE utilization at our second hospital. And we’re not an academic medical center, we have community physicians doing CPOE.   Meanwhile, overall, I’d say that those involved in the HITECH work have done their job in terms of the meaningful use requirements. I think they’ve been pretty thoughtful. They’ve outlined some requirements that will raise the bar; I think they will challenge us, but in a good way.   HCI: What should your generation, the established generation, of CIOs be doing to help newer CIOs and those who are not yet CIOs, become effective leaders and executives?   Spooner: There are a number of things that we can and should be doing: clearly, helping to encourage up-and-coming leaders to get the right kind of education and experience. The CHIME CIO Boot Camp is an awesome training ground, because it not only gives them some very practical methodologies, proven by some very experienced CIOs, but it also establishes some networking and mentorship that you just can’t get anywhere else. I wish I’d had that available to me years ago. I’ve not heard anyone come out of that and not say it was outstanding. And give opportunities and challenges to people in your organization, so that they can grow, so that they have the opportunity to succeed, or to fail with forgiveness once in a while.   HCI: How do you see CIOs' relationships and interactions within their hospital organizations changing, particularly with regard to clinicians and clinician leaders?   Spooner: That’s absolutely true, we need to be able to speak the language of the clinicians. Still, try as we might, we’ll never understand clinician workflows in the ways that clinicians do. So we have to have clinicians coming into the dialogue. We have a CMIO. And in any significant interaction, you need a CMIO and you need system-level nurse informaticists involved. We’re recruiting for a system-level nurse informaticist now, and we’re looking for other nurse informaticists as well. They need not only to be involved in changing workflow, but also to drive change in the clinical setting. I’m a former CFO, and I could go in and say those things, and they’d look at me as though I’ve lost my mind. So partnering with clinician leaders in informatics will become more and more important going forward. And though the CIO more and more is out there as a change agent, more and more, the initiatives must be led be clinician leaders who are sponsors. So more and more, being a change agent means persuading the change leader to create the change.   HCI: How do you see the CIO role changing and evolving in the next five years?   Spooner: I think some of the conversation we’ve had so far leads to that, as far as being a change agent and agent of transformation is concerned. And among some of the skills we’ll need in the future, vendor management, for example, will become a skill set in itself. And just plain business leadership. And there’s the whole concept of sourcing. I have very little contract help in my department; I use some consultants. But we may find ourselves using some external, contracted support; or we may have people who are contractors or who are employees of offshore contractors who are doing development or support for you. So the focus will be not only on recruiting and retaining the best staff, but also the best contract resources. In other words, how do I get the job done? And that ties back to the conversation, as well, around pulling costs out of the organization. There have been articles in the local newspapers here about the City of San Diego changing its help desk, because they in their IT help desk can use an outside contractor. They use contractors for nighttime staffing. So as CIO, you’ll still have the responsibility for service, but you’ll be delivering it through different vehicles, and you need to keep good relationships between your own staff and outside contractors. So I think more and more flexibility will be required.   HCI: Any closing thoughts?   Spooner: It’s a tremendous honor to receive the award. And I had an e-mail from Bill Childs this morning. His message was, congratulations on winning the John Gall Award. In fact, Bill Childs knew John Gall for years. And it’s pretty exciting to be included on the list of accomplished leaders who have preceded me in this honor.       Wed, 20 Jan 2010 00:00:00 EST 661B2A1CE81548BBAA1A2E2C4A7A5DC6 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=50D8C1AA87854272A992834966580275 With HITECH making physician acceptance of CPOE more important than ever, getting the user interface right is paramount. Unfortunately, most HIS vendors have spent the last few decades optimizing their products to capture transaction and store data. Thus, physicians are often left wanting when trying to navigate green screens using function keys. To address this need, those same HIS vendors have gone back to the drawing board in an effort to make the docs happy. But third-party vendors have also been working to fill the breech, including PatientKeeper. To learn more about how this vendor is making core HIS offerings palatable for physicians, Healthcare Informatics Editor-in-Chief Anthony Guerra recently caught up with CEO Paul Brient. (Part I)   GUERRA: The timelines for HITECH seem quite aggressive. What are your thoughts? BRIENT: Well, that’s an interesting question. Certainly, I think from how meaningful use has been described so far — putting aside the timeline — it’s very consistent with where just about every hospital system was going with their automation. And at some level, I think healthcare IT gets a bad rap. People say, “Well, gee, we don’t spend enough money on technology,” so as a technology provider, I can’t help but agree with that, but I’ve been in this industry for 20 years, and there’s been a tremendous amount of automation in hospitals, a little less so on the physician practice side, but I point out that every single practice in the country basically has a practice management system all by themselves. Why? Because they had an ROI. The ROI on ambulatory EMRs been a little questionable so adoption’s been slow. But on the inpatient setting, the core clinicals are all automated, people are doing bar code administration, and PACS is almost 80 percent penetrated. So a lot of work is already done, and everyone knew that eventually we would do CPOE and we do physician documentation. So, at a conceptual level, I think meaningful use is very congruent with the direction the industry was already heading. The timing, obviously — and the point of stimulus is to change things — is very different than where people were going. CPOE was very much on the “later” category. Almost every one of our customers were saying, “Hey, we know we have to do it, but that’s not even next year’s project, that’s down the road.”   The question is how far forward do we bring it? If they put it out too far away, everyone’s going to just keep ignoring it, and no one wants to do that. If they make it, “Hey, you’ve got to have it all in next October,” which they’ve kind of threatened to do a little bit, that’s just too soon. It’s taken them almost a year to come up with a definition of meaningful use. It’s not reasonable to say, “In six months, you’re going to have to implement it.”   GUERRA: That’s a good point. BRIENT: I think, just from discussions I’ve had, they’ll recognize that. So there’s a balance there. You’ve got to make it urgent and yet you’ve got to make it somewhat doable. My general view is that one of the disconnects is CPOE has largely not worked in the community setting. In the academic settings, yes, in places where you own your doctors, okay, but in the traditional community setting where there are no residents and only the admitting physicians, it has not been successful. We’ve got a lot of clients that have tried to deploy it and have failed. So just saying, “Go do it,” isn’t going to solve that. We’ve got to figure out a different way to do it, and PatientKeeper, as a company, has a very different approach. We’ve got to do it differently in the community setting, and I think that’s the real rub. I don’t have a great solution for it, but what really needs to happen is several rounds of innovation in the community hospital space to get community-based CPOE to work before we can really be guaranteed of success as an industry. I think that’s the rock and the hard place, and if I were king for a day, I’m not sure I would necessarily change the trajectory, but that is a real rock and a hard place situation.   GUERRA: Let’s say they come in on the aggressive side, do you think the greater likelihood is that people will just, as you said, possibly ignore it and say it’s too hard, or do you think there could be instances of trying to do this before people are ready, resulting in some major disasters? BRIENT: I think there are definitely going to be both, and some of our clients have already explicitly said, “Hey, we’re not going to go try to do the ARRA thing. CPOE is already part of the plan, documentation is already part of the plan, we’re going to keep that plan but we’re not going to change the plan to meet the ARRA deadlines because we don’t want to be in the second category of trying to do this before we’re ready and failing.” The folks writing the legislation are pretty clever, they haven’t said that you have to go try, they’ve said you have to succeed to get the money. So you could be in a really bad situation where you spend $15 million to put in your CPOE system, have it fail, and not get the ARRA money. Even worse, if you look at the math on hospital revenue, if it goes down by 1 percent, it wipes out all their ARRA money. I f you make your doctors angry or just slow them down by a couple percentage points and do less volume, then all of the money you might have gotten from ARRA is eviscerated . And so there are a lot of hospitals out there looking at it and saying, “That’s just too big a risk. I want to avoid the penalties, so let’s make sure we get this in eventually, but we’re not going to change the timeframe that we had. Maybe we’ll move it up a year or two, but we’re not going to try to do a ‘pull out all the stops sprint’ to make it work.” I think that’s a very real possibility for a lot of organizations around the country.   GUERRA: I interviewed a CIO who said, “If it’s between blowing up my surgery business or losing some HITECH money, I’ll lose the HITECH money.” BRIENT: Absolutely. I mean, when you look at the steps that hospitals take around revenue-producing physicians, I mean they go to great lengths to make them productive and happy and successful, and if this goes in the face of that, well, that’s a real problem. I do think, though, that the program is having a very high level of the desired effect. CPOE was not part of the dialogue a year ago. Now it is very much part of the dialogue. So they’ve achieved that, frankly, without spending a single dollar of taxpayer money — yet.   GUERRA: Let’s talk a little bit about the core HIS vendors. How dependent is your success on those companies playing nice with PatientKeeper, and do some play nicer with you than others? BRIENT: Very interesting question. So the other part of the discussion in the healthcare IT world is there’s no interoperability, and the more interoperable systems are, the less anyone needs to play nice with anyone else because they just communicate. The reality, of course, is that the major HIS systems go out of their way to not be interoperable, despite what they might say in public. We have developed expertise and knowledge around each one of those systems and we know the nuances of them, we know what works well with them, we know what doesn’t work well with them, we know how to get the data out of them, and how to get the data into them. In some cases, we do that with pretty amazing cooperation and support from the vendors, in some cases, begrudging support and, in some cases, active hostility and no support. At the end of the day, it’s more about the technology than the support necessarily. Our preference would be to work closely with them. I think our customers don’t view us as competitive with the HIS systems, our customers very much view us as helping solve a problem that they have which the HIS systems have not. We really view them as a necessary party. If the HIS system wasn’t there, our software wouldn’t work. You must have all this automated, and our strategy on order entry is we’re the physician part of physician order entry. We’ve got to be able to send that work to a departmental system that can do all the complex processing which the core HIS vendors do really well. So we need them and our customers need them, and our stance is that we love to partner with and work with all of them, but each one has a different view and stance towards us.   GUERRA: So you’re still able to go into a hospital that’s using a “hostile” HIS and do you what need to do to be successful? BRIENT: Absolutely, and we’ve already developed the integrations to every one of the major ones and several of the minor ones, including some homegrown ones.   GUERRA: If you have a company with proprietary software, and they’re not interested in working with you, how do you integrate with their software? BRIENT: Well, remember that the software is, for the most part, installed in a customer site. Their customers have deep knowledge of those systems. There’s a whole infrastructure of people who will do the integration work who know the systems well, and we either employ those people or we leverage the expertise of our customers. Most systems have ways of getting some of the data out pretty nicely, and you get a lab feed out of every one of those systems pretty easily. When you get to some of these advanced clinicals and stuff like that, it’s a little different. The systems need to communicate with other systems. So it’s not completely proprietary, but in the case of the most proprietary system out there — MEDITECH Magic — we hired people who know the Magic programming language. We wrote Magic software to pull data out of MEDITECH Magic, and now we can do that. The McKesson systems have a very nice set of HL7 interfaces that we leverage. Cerner; we partner with on a thing called Millennium Objects and pull their data out to their published APIs and Web service. We partner with them very closely. So for every HIS system, we have a story and a lot of experience and, you know, a lot of bruises for the most part. We can walk into the hospital and it’s not a science project anymore. Six years ago or seven years ago, it was.   GUERRA: What is the main thing you’re hearing from CIOs? BRIENT: Well, the side effect of the stimulus program has not been great for CIOs. So every CIO in the country is being asked by their CEO, “How am I going to get the whatever millions of dollars I’m eligible for from HITECH.” They’re all trying to deal with that within their own organizations either saying, “We’re going to go aggressive into this,” or, “It doesn’t make sense to do this,” but that is a very big theme on every CIO’s mind. Most of them, by now, have sorted this out, but it’s a board-level kind of discussion. The second thing that’s on their minds is resurrecting plans that were put on hold during the recession . That is being done in the context of making sure they’re driving revenue to the hospitals because, at the end of the day, that’s what it’s all about. They have to figure out how you do that in this new context, and how don’t you let the ARRA stuff get in the way of that. So I think it is probably the most challenging time to be a hospital CIO there has ever been. I don’t envy many of my clients, but there are some great CIOs out there doing some really cool stuff.   Tue, 05 Jan 2010 00:00:00 EST 50D8C1AA87854272A992834966580275 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=159DF716E2D04B5FA4DBE2A334A8E75E With HITECH making physician acceptance of CPOE more important than ever, getting the user interface right is paramount. Unfortunately, most HIS vendors have spent the last few decades optimizing their products to capture transaction and store data. Thus, physicians are often left wanting when trying to navigate green screens using function keys. To address this need, those same HIS vendors have gone back to the drawing board in an effort to make the docs happy. But third-party vendors have also been working to fill the breech, including PatientKeeper. To learn more about how this vendor is making core HIS offerings palatable for physicians, Healthcare Informatics Editor-in-Chief Anthony Guerra recently caught up with CEO Paul Brient.   GUERRA: From my vantage point, PatientKeeper seems to occupy a unique position. I don’t quickly come up with three to four companies that do what you do. Obviously, you compete with the core HIS vendors because you’re supplementing what seems to be a deficiency in those systems. Would you describe it that way? Tell me a little bit about the hole you’re filling in the market. BRIENT: That’s really a good question, and I think your observation is exactly correct. We actually have a (PowerPoint) slide that we use when talking about the competitive landscape for us, we look at each of our applications and there are a variety of point-solution vendors for each one. My observation’s always, “Well, we compete with all of them, but they don’t compete with each other.” We really look at the world a little bit differently than just about anyone has, and our shtick is very much around how you automate a physician, how do you get a physician technology that they will adopt, embrace, love, use, and that’ll make a difference for them. There are people in the core HIS vendors who look at us as a competitor. They say, “We have a hospital information system, and we have a place for physicians to go look at the stuff that’s in it. If PatientKeeper provides a way for physicians to look at information, they must be competing with us.” We take a different view. Our view is that looking at the results from one hospital information system is only a very small piece of what physicians do. We all know the challenges that the HIS systems have had with physician adoption, and people always say, “Well, gee, the user interface isn’t good,” or this isn’t good or that isn’t good. The concept that you can automate a physician at the same time you’re automating the individual hospital — which might be just one of the hospitals or physician practices where they do business — is just flawed. If you want to automate a physician, let’s automate what that person does. If I want to find you a technology to automate your day and I said, “Well, I’m going to take on 15 percent of it because that’s what I do,” how is that going to produce a great result for you? So the thing that’s unique about us is that we have said, “Let’s take everything a doctor does and automate it,” which isn’t necessarily the easiest task in the world, but we’ve been at it for 11 years now, and we’re just about done. Thanks to the folks in Washington with the stimulus program and meaningful use and all that, I think we are going to be done much faster than we would have been.   GUERRA: Right. So you automate the doctors’ workflow. You make life easier for them, but the doctors aren’t typically buying your solution. It’s the hospitals that want to strengthen that relationship with their physicians. Is that accurate? BRIENT: Yes. About 70 percent of our customers — the people that buy — are hospitals, 30 percent are physicians themselves. So some physicians do buy our solution. But in many cases, in most cases, when hospitals buy our software, they buy it because they want to make their physicians happy with technology. No one goes out and buys a hospital information system to make the doctors happy, but they buy our system to make the doctors happy.   GUERRA: Having a nicer CPOE interface can give competitive advantage to one hospital over another. BRIENT: That is the thinking, yes, and to some extent in practice. Obviously that plays out in some pretty interesting ways over time in a community, because physicians who practice in hospital A will go to hospital B and say, “Why don’t we have this here,” and that creates some interesting opportunities for us. We’ve seen communities emerge around the use of PatientKeeper. I think you talked to Jeff Cash from Mercy — they play a lead role in Cedar Rapids, but their competitive hospital also has PatientKeeper. That was the result of a person saying, “Hey, we liked it so much we want it over here too.” At the end of the day, most communities have both competition and collaboration, and we sometimes get to sit in the middle of that dynamic.       GUERRA: So your thinking is that no matter how nice a hospital makes its information system, you have a role because doctors have to deal with more than one hospital. BRIENT: Correct. And there’s a whole bunch of workflow that physicians have, like signing out coverage and even knowing the phone numbers of the people they need to call. I mean, silly stuff in some ways, plus real deep stuff like charge entry and accessing results from their EMR, if they have one. Those things are really outside anything that a HIS would want to tackle. GUERRA: The 30 percent of your customers that are docs — are these very, very large practices or do you scale down to the smallest of the small? BRIENT: We do both. The ones that buy direct are generally large practices. That’s the way our company is setup, but we partner with both GE and Sage and they resell our products to small practices. So we actually have some solo physicians using our technology. From a business model perspective, that’s not something we could do directly, just because of cost issues, but our software scales nicely. We run it out of a hosting center and have turnkey integration to both GE’s Centricity Physician Office as well as the Sage Intergy product. GUERRA: You’re obviously partnering with some ambulatory vendors there, where does your product end and the electronic medical record begin? What’s the difference? BRIENT: Well, in some ways an ambulatory EMR is very similar to the HIS discussion we just had. So for some physicians, take a dermatologist for example, they only go to their office, they should just buy an EMR and they don’t really need us, right? All their workflow is there because they go to their office every day, and that’s where they work. You get physicians, surgeons, cardiologists, or orthopedics, all the physicians that go to hospitals and also their practice, well now going into an EMR makes matters even more complex, because I’ve got an EMR and let’s say I practice in two different hospitals. So now, I’ve got two HIS systems that are different. I’ve got my EMR, I’ve got probably three or four different kinds of PACS systems I need to deal with, maybe an ED system or two. So I’ve got all the different systems that have some of my patient data in them. There’s no place that I can consolidate a patient list. So a PatientKeeper comes in and can provide a consolidated patient list across the ambulatory settings that are in two hospitals, access to all that data at a click of a button. In situations like that, we will link directly to the physician’s ambulatory EMR in our portal. So one of the tabs in the portal will be their EMR. Then if they want to work within the EMR context for those patients that are just ambulatory, we’ll provide linkages so they can send data from their EMR to the hospital. So it just becomes another system that we’re going to work with, and I obviously point out the fact that we really only service about half of the physicians out there — those that go across different settings of care. GUERRA: How much can these physicians handle financially? I wonder if there is frustration that getting an EMR doesn’t mean they are going to function smoothly. You’re saying they may also need a product like yours. BRIENT: Well, at some level you probably have to look at the world before and after ARRA. Before ARRA, most doctors were not purchasing EMRs, really small physicians were not. In the ARRA world, you get your EMR mostly for free, so that’s helpful; physicians like that price point a lot. We haven’t experienced a lot of frustration there. It’s more of a ‘thank God.’ The EMRs, people understand why they’re buying them for the most part. Our product, they buy for two reasons: one is it saves them time — doctors love to save time — and it makes them more money, specifically our charge capture application, because they’re losing charges on the inpatient side almost universally. So it’s really more about the benefits.   GUERRA: I would imagine you need a tremendous amount of physician engagement. Do you have focus groups and panels and plenty of doctors that work for you? How do you make sure you’re continually refining that interface for what physicians need? BRIENT: We do all of the above. One of the things that’s neat about the physicians that work for us is they almost all still practice medicine. We put a lot of stock in what they have to say, but the people that we care about the most — in terms of feedback — are the physicians that are taking care of patients and using our software. And so, before we build any product, we work with at least two sites for co-development. We have formal physician usability panels and we go through an iterative agile methodology from a software-development perspective. We work very closely with the physicians in mock workflows, take those observations and walk them through the system to get that real physician feedback. We do that because, even if you’re a doctor, if you come work for software company, you get stale and you don’t really appreciate what’s going in direct patient care. So I probably spend half of my week every week out in the hospitals running around the country talking to as many doctors that are using our software, or want to use our software, as possible. We’ve got product managers and formal product advisory boards comprised of physicians that provide us feedback, because it is so critical. The whole thing falls apart if the software’s too hard to use or it’s not solving the problems of the doctors. Since the use of our system is always voluntary, people would stop using it very fast. GUERRA: They would just cut you out and go back to their HIS? BRIENT: Yes. I mean, this is supposed to be better. If it isn’t, they won’t use it. So the fact that we have 15,000 physicians using the system every day and, in about four months, that’ll be about 30,000, is a testament to the fact that we’re solving a problem that isn’t currently solved.   GUERRA: You do a lot of physician engagement. What is your advice to CIOs on how they can better engage physicians? BRIENT: Well, let me give you my opinion since you asked. If you look at physicians today, you have to put yourself in their shoes, right? They feel they are being asked to do more and more and more, get paid less and less and less. They are also blamed for a lot of things that aren’t right in the healthcare equation. And then you enter things like CPOE for example, and the first thing they do is ask all doctors to change the way they practice medicine. That’s a pretty difficult pill to swallow. Physicians believe that they practice medicine well today, rightly or wrongly, that’s their belief, and a lot of the changes that we ask physicians to make, as part of CPOE projects, are fairly arbitrary things about the way they practice, not evidence-based things, because most of the things they do aren’t driven directly by evidence but relatively arbitrary physician reference things. So why take so long to get them to agree with everything? Probably not the right way to engage a doctor, right? A better way to engage a doctor is, “I am here to make your life better. I’m not here to turn you into a clerk. I am here to help you take care of more patients, better, faster.” It benefits everybody, and therefore you’ve got to be very, very careful about what you ask them to change, and how you ask them to change . And so if you just think about any change management exercise — and adopting technology is change management, even if it changed for the better, it’s still change management — this is a tough one. You’re essentially saying, “Come to this three-day training session, change the way you practice medicine, do this thing that is going to slow you down.” You should be saying, “Let’s tailor the system to the way you practice. Let’s focus on a few key change management issues that we’ve all bought into, let’s provide you extra assistance or support.” If you do that, I think you’ll have a lot more success. Part II Sun, 03 Jan 2010 00:00:00 EST 159DF716E2D04B5FA4DBE2A334A8E75E http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6718DED936204DB2B7CA2786A2D26799 Consistently earning top marks in KLAS’ small physician practice EMR category, Greenway Medical Technologies seems to prove the point that a limited focus equals increased quality. But will the Siren’s call to tackle larger quarry be succumbed to? And would such an expansion of focus lead to diminished results? To learn more about this quiet but capable vendor, HCI Editor-in-Chief recently caught up with President Tee Green to find out how HITECH is effecting small practice EMR providers.   (Part I)   GUERRA: We were talking about how some vendors are operating on outdated technologies. Is that because you inevitably lose some customers during a major upgrade?   GREEN: Well, that can be a component of it, but it’s also very expensive to rewrite and retrain an R&D team. T here are some of our competitors whose whole business has been built around buying a bunch of different products and try ing to cobble them together. Well, now they have all these different R&D teams, they’ve got all the different domain experience, so to take all these people and say, “Stop what you’re doing. Rewrite this thing in Web architecture, but make sure it still has all the rich functionality and all the workflow,” is not practical. That’s a difficult process for a company to take on.   We were fortunate enough to come along at a time when we understood the technology platforms and the difference between the interior architecture systems versus a client/server system. I’m not saying we’re any smarter than anybody else, but we arrived at a different time.     GUERRA: When you re -wrote the app in .NET, was it painful?   GREEN: Well, the main thing for us is we spen t the first four years in R&D. I didn’t have hundreds of customers whose workflow I had to disrupt. We were at a different time in our evolution than some of these other companies that ha ve grown through purchases.   GUERRA: The one negative comment in the KLAS mid-year report was that you didn’t have the most timely enhancement releases.   GREEN: I’m not sure what the question was that got that response. We do three major releases a year, so maybe that’s not fast enough for some people. I don’t know. We’re pretty methodical on how we do it. Some of that can be how the question was asked.   GUERRA: How many employees do you have?   GREEN: I think we’re around 320 today and growing quite rapidly. We’re partnering with universities for a pretty neat incubator program. We have a pretty big consulting program that can help deliver these technologies , mainly from an implementation and training perspective. As our backlogs continued to grow, we recognized two years ago there’s no way we’re going to be able to hire and train this many people. That’s why you see these regional extension centers coming out. But we did start building a consulting program that has really almost increase d our abilities by 100 percent. You’ve got to make sure you’re managing the quality and the training because they’re not your team, so you need to understand and manage that.   GUERRA: We’ve been talking about the HIT worker shortage, so how are you going to keep your people from being lured away?   GREEN: I think you have to create a work environment where people can thrive and be successful and provide for their families , and we’ve tried to create a long-term business plan here at Greenway. So we’ve passed the first 10-year mark in our history and now we’re preparing for the next 10 years. So our business model is if we can find the top talent in the United States and attract them, they can be a part of the organization, be part of extreme innovation in the healthcare industry, provide some really life- saving technologies to the industry. If that excites you, we’re going to reward you, we’re going to compensate you, and we’re going to allow you to be part of this very unique team. If you’re that type of person, you can probably build a career here. So we’ll have to be more attractive than our competition and compete with the regional extension centers.   There are also some people that don’t fit our model. Some people aren’t cut out to work in one business for the next 15 or 20 years. You know, they like to spend three years here, three years there. That’s not the person we look for.   GUERRA: How do you feel about competing against a center that’s got ten $8 million from the government?   GREEN: Some of those will be interesting challenges or hurdles. It will be interesting in communities where taxpayer dollars are going to compete against you , but hey , that happens in other business as well.   GUERRA: Essentially, your tax money is going to fund your competition.   GREEN: Right. Just imagine being Ford. [Laughing] I just think that’s bizarre.   GUERRA: A lot of bizarre things are happening these days.   GREEN: Yes, correct.   GUERRA: How do you engage hospital CIOs and make them aware of your product and make them understand that you should be on their Stark shortlist?   GREEN: First of all, it starts with our customers. Our customers are the number one lead generator for this organization, and our customers are the ones that bring us into the hospital systems in their communities.   I would imagine the worst thing you can do as a CIO is to recommend an EHR platform to your community physicians and see them struggle mightily during deployment because then it effects the whole relationship between the hospital and the physicians. And so one of the things that we bring to the table is a track record that our customers are more successful, typically, than our competitors because of our technology platform and our implementation process es. That way, you as a CIO can be assured that not only can you offer sta te-of-the-art technology, but you can offer a platform that your physicians are going to be successful using. And that means t hey’re more likely to electronify faster than the competition.   We think there’s a difference between electronifying information and liquefying information. There’s a lot of electronification tak ing place today in the country. There’s not much liquefying of information, and that means you’re going to have to be able to exchange information very efficiently and very securely in any format , in a ny security protocol.   So point-to-point interfaces don’t work, and that’s how we built our exchange portal. It allows us to take information from our customers, route it to any hospital, any lab, registry, clinical trial and do that automatically, managed by Greenway, rather than having to write point-to-point interfaces that create havoc in the industry.   GUERRA: Speaking of liquefication, what are your thoughts on CCHIT , the Drummond Group , and certification in general?     GREEN: It is a challenging environment for any of the vendors. The way I look at it, I have to have twice the amount of R&D budget that I normally would have , and I’m going to need X dollars to develop what Washington wants and X dollars available to develop what my customers need. So it’s whatever you would normally spend on R&D times two.   I’m going to make sure that I clear the hurdles of CCHIT and anything that comes from HHS, whether it’s interoperability or meaningful use. Those are the things that are requirements. Those aren’t optional things for us. So I have to be prepared for that, but I’ve also got a huge customer base that has needs in their business exchange, and they’re expecting innovation. So you’ve got to look at your project plans. I mean, half of it goes to Washington and half of it goes to customers. So you really got to have some resources to do that.   And then going back to the certification bodies themselves, it will be challenging for the industry if there’s multiple certification bodies. In my opinion, there needs to be one. It needs to be CCHIT; they’re the ones with experience. Believe me, just running test scripts is one thing, implementing these tests is highly complex. It takes a tremendous amount of intellectual property to actually conduct these tests. They have to be extremely smart. They must have done this a number of times to be any good at it. You can’t just hire some people off the street and say, “G o test some products.” So I would encourage us as a country to get behind one certifying body. Hopefully, CCHIT will continue to be the gold standard. Fri, 01 Jan 2010 00:00:00 EST 6718DED936204DB2B7CA2786A2D26799 http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=28D3119ECF4749B8B43F171BE6D8A2EE Demand for Healthcare IT Professionals Will Exceed Supply! War on Talent About to Begin in Healthcare IT! Healthcare IT Effort to Create Thousands of New Jobs! Currently, headlines like these are ubiquitous and unrelenting. Whether you believe the conservative estimates of 50,000 new healthcare IT-related jobs, or the more optimistic (pessimistic?) numbers that exceed 70,000-plus, there's simply no escaping the fact that you will most likely need to add new players to your healthcare IT team this year. Generally, you can approach this often-daunting task in one of two ways: Keep the hiring process in-house, using the skills, expertise, and resources of your hospital's internal sourcing department, or enlist the help of a recruiting or executive search firm that will help you find the right people to fit your organization and needs. Both approaches certainly have their share of pros and cons, and since healthcare IT positions are highly specialized and often uncharted territory for hospital hiring managers (whose internal resources are already stretched beyond capacity), more and more hospitals are choosing to partner with search firms that specialize in sourcing and/or recruiting healthcare IT professionals. “Asking individuals to uproot themselves and their families without any type of assistance … forces many excellent candidates to decline offers.” If you do decide to go the external sourcing route, there certainly is no guarantee you will attract and land the “perfect” candidate, but experienced healthcare IT recruiters seem to agree that your odds will greatly improve if certain protocols are followed and courtesies are extended. Therefore, here are five secrets to landing the best candidates: 5. Offer relocation assistance - Times are tough, and hospital budgets are tight. According to recruiters, these circumstances become painfully apparent when it comes to relocation assistance, or more specifically, the lack thereof. In fact, top recruiters state that 90 percent of their hospital clients refuse to contribute anything toward the candidates' relocation expenses. “Asking individuals to uproot themselves and their families without any type of assistance, especially when you add the challenge of selling a home in this market, forces many excellent candidates to decline offers,” states Christine Kalmbach, vice president of Parker HealthcareIT (Seattle). “If a hospital can craft a fair and creative relocation package to attract candidates, they will quickly spring to the top of the list in terms of attractiveness to candidates for their regional market.” 4. Provide a concise job description - On the surface, this request seems obvious. But if you've ever had to sit down and craft a comprehensive job description, you know it's much more difficult than it appears, which is probably why this critical step is often shortchanged. The trouble is, if you don't know what or who you want, how can you expect a recruiter to know? Cherie Lester of Intellect Resources (Greensboro, N.C.) explains, “We need detailed descriptions of the responsibilities and required skill sets of the position we're recruiting for. Without them, we won't be able to find the ideal candidate.” And without the ideal candidate? You're right back where you started! 3. Provide feedback to recruiters - Have you ever been in the frustrating position of having an idea or project or promotion shot down without a hint of an explanation? Imagine, then, what it's like to be a recruiter, who, after spending countless hours and considerable resources, submits a candidate they believe to be a strong contender, and then receives no feedback whatsoever as to why their applicant was deemed unsuitable. Apparently, in the frenetic world of a typical hospital hiring manager, this scenario occurs quite frequently. Christi O'Brien, senior recruiter at Santa Rosa Consulting (Southfield, Mich.), offers this insight: “I think the single thing that sets my favorite clients apart is their willingness to keep an open dialogue. When they interview a candidate who they feel is not a good fit or review an applicant they decide to pass on, it enables me to do a much better job on their behalf if they take the time to tell me why.” “We need detailed descriptions of the responsibilities and required skill sets … Without them, we won't be able to find the ideal candidate.” “Expect and be happy to find an 80 percent match, perhaps offer a lower salary, and then offer training and mentoring to bring that individual up to speed.” 2. Prepare to be flexible - These are challenging times in healthcare IT, and certainly the ideal situation is to quickly attract and hire new “plug and play” team members who are experienced, certified, and ready to get down to business the moment orientation is over. But with the potential upcoming shortage of professionals, this idyllic scenario is becoming less and less realistic. And hospital HR departments aren't the only ones losing sleep over this situation. Parker Healthcare IT, which focuses on recruiting and placing experienced technology talent into hospital projects, “has been working to identify and present solutions to its clients regarding this issue,” according to Kalmbach. Some of the potential solutions the company has presented include the following: “Expect and be happy to find an 80 percent match, perhaps offer a lower salary, and then offer training and mentoring to bring that individual up to speed. You'll save a bit in your budget, and earn the gratitude and loyalty of a sharp team member who just needed someone willing to give them some guidance and training. Additionally, offer certification programs to otherwise qualified applicants. This is a huge plus for our candidates who are extremely eager to get certified. The cost to do so can be prohibitive to the individual, and should be taken into account as part of their total compensation package.” The number one secret? 1. Communicate, please! - According to each and every recruiter who provided their thoughts and insights for this wish list, well … what we've got here is a failure to communicate. This failure manifests itself in several ways - lack of follow-through by the hospitals in communicating desire to interview submitted candidates, lack of feedback following the interviews (as mentioned above), and finally, a lack of communication regarding their desire to make an offer. As Lester states, “We explain to the hiring managers that the candidates we send to them are time-sensitive. If their application sits in the hiring manager's inbox for weeks, there's a very good chance that the candidate won't be available for an interview.” Kalmbach echoes these sentiments, “We sometimes wait for over a week to hear if they wish to interview, then wait for feedback from the interview, and then often the offers take up to a month. In the meantime, the candidates have moved on.” But Kalmbach, like many others, can understand the demand on the hospitals' resources: “We know everyone in our industry is slammed with projects, deadlines, and decisions, but professional courtesy and respect (on both sides) goes a long way in attracting the best of the best talent to your team.” CONTINUE THE CONVERSATION Wiki-fy this story at http://www.healthcare-informatics.com by posting comments, listing relevant resources and linking to associated events. Gwen Darling is CEO of HealthcareITCentral.com . She also writes a blog at http://www.healthcare-informatics.com/gwen_darling . Healthcare Informatics 2010 January;27(1):41-42 Thu, 31 Dec 2009 00:00:00 EST 28D3119ECF4749B8B43F171BE6D8A2EE http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=01B21612BA7F455FBCEA5B4750BB34FB A look back 20 years ago to “U.S. Healthcare” magazine from January 1990: Featured Ad: “HL7 and Open Systems Architecture” - a two-page ad graced the inside cover, touting this breakthrough in an era when interfaces were almost as difficult as an Act of Congress (well, almost). To quote HL7's claims: “It allows for multiple kinds of hardware and software to function together on one network without the restrictions of a central mainframe system architecture. This is particularly beneficial in the healthcare industry, because no single vendor solution can accommodate an entire hospital's functional requirements.” Couldn't have said it better myself in 2010! Fun part is the list of HL7 founders, which reads like a “who's who” of HIT 20 years ago: Professional Hospital Systems - created by hospital chain American Medical International to market their DG-based turnkey mini system featuring a revenue cycle systems called “PatCom.” It's running today at Johns Hopkins, Massachusetts General, and other customers of Keane, Inc., who still sells it as part of “Optimum.” Simborg Systems - formed by Donald Simborg to market “StatLAN,” his pioneering patient care system, later taken public as Oacis. Digital Equipment Corporation - as big in minis as IBM was in mainframes, from their PDP line right through to 64-bit VAXes; eaten up by Compaq and later swallowed by HP. Compucare - a Reston, Va.-based HIS vendor formed by Ron Apprahamian in the '70s, eventually bought by QuadraMed for its “Affinity” HIS. Ernst & Young - hard to imagine how dominant these “Big Eight” firms were back then; E&Y itself was formed by the merger of Ernst & Whinney and Arthur Young. MegaSource - a Michigan-based pharmacy system vendor running on PCs; acquired by Cerner, who eventually sunset it. Arthur Andersen - amazing how the then-small consulting arm survived the Enron accounting debacle, thriving today as Accenture. First Consulting Group - formed by Jim Reep and some ex-Andersen friends, FCG grew to over $100 million in revenue before being gobbled up by CSC. Peat Marwick & Main - Main was eventually replaced by Mitchell; PM&M was another Big Eight back then, eventually gobbled up by KPMG and spun off to Bearing Point, which went defunct this year. Enterprise Systems Inc. - offered one of the least-expensive and most functional ERP suites in HIS-tory, running on IBM PCs under DOS. Some say ESI is still better than its “Horizon” successor … Digimedics - an early RX vendor eventually bought by Mediware along with competitors Continental and Pharmakon. Community Health Computing - a leading LIS vendor back then, later bought by ADAC, which was eventually bought and sunset by Cerner. Coopers & Lybrand - another Big Eight monster, merged with Price Waterhouse, nicknamed by insiders as “Pricey Coopers.” A dominant HIS consulting firm in the '80s and '90s, totally out of healthcare today. Space Labs - literally started by monitoring early astronauts' vital signs, the firm dominated patient monitoring and cardiology markets back then. Data General - another mini monster back then, DG had the largest product names in HIS-tory: the MV 10,000 and 20,000 series. Must have been a lot faster than IBM's puny 360 or 370 series, right? Lesson for today: Only one of these 15 firms above survives (Ernst & Young). HL7 is still with us, but with so many founding firms defunct, we can only hope interoperability is not a fatal disease. Vince Ciotti is founder and principal at HIS Professionals, LLC. His blog can be found at http://www.healthcare-informatics.com/vince_ciotti . Healthcare Informatics 2010 January;27(1):48 Thu, 31 Dec 2009 00:00:00 EST 01B21612BA7F455FBCEA5B4750BB34FB