We congratulate Bill Childs for his imminent receipt of yet another HIT industry accolade. The 50-in-50 award, rightfully conferred this evening,  will appropriately adorn his home’s mantel, sharing space with last fall’s CHIME Lifetime Achievement Award. Of course, he’s far from resting on his laurels as he has been networking throughout the HIMSS ‘11 this week. You might run into him at our Booth (#3070, see photo) where you can discuss in detail any one of the eight topics he’s summarized so far here on the blog.

Today wraps up his series with the 9th and 10th issues he sees as paramount to HIT/HIS market in the upcoming year. So, without further blabbing, here’s Bill -

9. Sharing of patient medical information outside the traditional walls of provider organizations

ARRA requires the sharing of patient information on a patient-directed guideline to other need-to-know (with permission) entities. The rules are complex and even ominous when it comes down to specific permissions. Enter CHIN’s and a whole host of other secured operating systems. At this time, providers, vendors, states, and the federal government either have a hand out or a hand in (or both!) in developing rules and ways. Some participants do not add value to the solution. Security issues can and will bite the hand that feeds them in this process. Buyer Beware!

10.  Adoption of social media capabilities

The world is becoming one giant social network. Danger lies in the unknown. Social networks have been developed for all kinds of healthcare maladies, procedures, and other specialties. Several CIO’s have recently reported an increasing demand for application and system help in healthcare social media. This is just another area fraught with security issues when it comes to disclosing patient information.

Thanks, Bill and again, congratulations. We’re VCS grateful to and proud of you.

So, if you sidle up to Bill at HIMSS or catch him after a future keynote speech, you have 10 topics upon which to strike up a conversation, add your opinion, or merely joust ideas with the godfather of HIS/HIT.

However, if reading HIT/HIS insight is more your cup of tea, you can delve into VCS’ resource library, its on-line newsletters (still available in hardcopy at HIMSS ‘11), and archives.

For a creative, literary jaunt  read Jeanette Borzo’s “visualization” of an EMR’d physician’s office circa 2015 at The Medical Blog.

The VCS troops have departed for the Orlando theatre of engagement at HIMSS ‘11. We’re packed to the gills with ideas, optimism, not a few thcotchkes, and copious amounts of goodwill (like raising awareness to and funds for Central Florida’s Second Harvest Foodbankand celebrating Bill Childs for collecting his 50-in-50 “HIMSSY” Tuesday evening).

Leading up to that, here’s Bill’s next two issues that he anticipates will affect the HIT/HIS market during 2011.

5. Implementation and integration of new technology (including devices, procedures, and the cloud) demand Information Systems Support

Improved efficiency, new and better technology, remote access, more/better information, decision support, and inter-related security issues will command increased systems support.

6. Dealing with reduction in elective procedures and Medicare & Medicaid reimbursement

“So much to do; so little time, talent, budget, and understanding.” Everyone wants to cut the cost of healthcare and everyone has a plan that probably won’t work. Because of the moribund economy, healthcare providers have felt a bottom-line pinch because of reduced demand for elective procedures. In addition, random cuts in Medicare and Medicaid payments will result in less money for the healthcare providers and more to do. It doesn’t make sense to me!

Tomorrow, Bill expounds upon 2 more issues: Providing for the exploding needs of the physician community and the direct employment of many new physician groups; and Acquisitions of new provider organizations.

Bill is not the only VCS’er with wisdom to share; you can visit our Vital Knowledge Library , our knowledge archive, and our practice newsletters at this very website to read white papers and articles written by our consultants. Of course, you can always comment below.

HIMSS ‘11 is only three days away. Today, Bill Childs’ third and fourth topics address the federally-mandated propulsion behind Meaningful Use of electronic health (medical) records, and the security that must be ensured so as to allay patients’ fears about personal data being breached.

Take it away, Bill -

3. Accelerated Movement Toward Meaningful Use

More and more CIO’s are beginning to wonder if they can satisfy Meaningful Use (MU) criteria in order to reap all the incentives and avoid all the penalties. Far too much remains unfinished. Dollars are often scarce or unavailable, and attaining MU exceeds many organizations’ resources. However, getting incented to make dates will be less stringent than getting penalized for missing dates. Both providers and their vendors are rushing to meet deadlines, but not all vendors can meet the needs of all their customers and not all providers can afford or manage the requisite, obligatory tasks to attain meaningful use. However, few refute that automating healthcare will produce more benefits for patient and, ultimately, provider.

4. Information Systems’ Security Issues

ARRA, HIPAA 5010, the HITECH Act and a whole host of existing and new rules and regulations are inundating Information Systems departments with (in many cases) ominous portents. At a recent I.S. Security conference hosted by Southern California HIMSS, several provider I.S. security officers detailed their efforts of trying to keep up. Their top laments? Budgets were inadequate. They were getting a mere 2% to 6% of the total I.S. budgets but needed more like 10%, which most never expected to get. Addressing proliferation and subsequent encryption of hand held and remote devices plus demands from physician groups clogged security teams’ “TO DO” lists. But the entire list reached far beyond those two issues.

Take the liberty to comment below.

Tomorrow:  Implementation and integration of new technology including devices, procedures, and the cloud demand Information Systems Support; and Dealing with reduction in elective procedures and Medicare & Medicaid reimbursement

Editor David Merritt’s Paper Kills 2.0 explains in its third chapter about Patient Centered Medical Homes (PCMH) which has nothing to do with convalescent facilities, and all to do with individual control of one’s healthcare. The topic is being addressed tomorrow, January 14, at the Delaware Valley HIMSS event at the Lehigh Valley Hospital in Allentown, PA.

In the book, Sarah T. Corley, MD FACP and Charles W. Jarvis FACHE propose  PCMH as an “environment based on evidence, driven by data, founded on wellness, and centered on patients’ needs.” They go on to say that PCMH is a team-based virtual network of doctors, nurses, and involved clinicians who share patient  information to better coordinate patient care. Central to the team is the patient and all decisions about care begin with the patient and doctor and radiate outward. However, Corley and Jarvis caution, because of glacial adoption of healthcare IT/EHR – widespread use of PCMH is distant; but progress should not be abandoned. Better healthcare will be realized when it can be put into the individual patient’s hands and guided by professionals. Examples of PCMH’s potential can be found at WellStar Health System in Atlanta, CHC Collaborative Ventures in Arizona, and Crystal Run Healthcare in New York. PCMH is championed by the NCQA.

Corley and Jarvis recommend that the healthcare market take the following actions to abet swifter PCMH adoption: understand that healthcare transformation is essential and inexorable, validate data gleaned from federal and private payers who should commit to openly promoting PCMH, educate patients as to PCMH’s value and doctors as to its business and clinical benefits, and adopt healthcare IT and its inherent advantages for all involved. Consider the above a primer to PCMH.

If you’re heading to the DV HIMSS event tomorrow (here’s agenda and directions), you are now prepared. If you’re not, you’ve learned something good here. If you want to read more about HIT issues you can access VCS’s vital news library of white papers and newsletters.

What’s that low thrum? It’s the sound of the “meaningful use” definition” fading in the distance as healthcare providers now scramble away to put pieces of the EHT compliance puzzle into position. But wait! What’s that shrieking bleat ahead? “EHR PRIVACY,” the next issue du ARRA. The DHHS-convened Tiger group will command the headlines and attract legitimate attention over the next few months especially as the public comment period for proposed modifications to the HIPAA Privacy & Security Rules ends September 13, 2010.

The latest from the Tiger Group’s progress is succinctly captured by Modern Healthcare.com and Healthcare IT New.com. Follow these links to learn the most recent developments.

Tiger Group's EHR Privacy Conundrum: Modern HealthCare News

Privacy and security recommendations approved: Healthcare IT News

Below are two links to substantive accounts of the latest MU evolution. The first, released yesterday, is an explication by HHS National HIT Coordinator Dr. D. Blumenthal & CMS deputy administrator M. Tavenner. Given tables summarize new Core and Menu Set objectives.

The second link takes you to HISTalk’s Inga, who had by early morning today, compiled a straight-forward contrast, sort of a “then-and-now,” as regards MU after yesterday’s announcement by HHS.

You’ve probably spent the last 24 hours squinting at as many websites & sources as we have. Trying to keep you up-to-date while avoiding information overload & repetition, the blogmasters extend what we’d like to call a representative sample of our latest research done for you by our agents in the field.

Meaningful Use Regulation for EHR

Inga's Comparison

The recently published PriceWaterhouseCoopers Health Research Institute report, Ready or Not: On the Road to the meaningful use of EHRs and health IT, has circulated through the blogmasters desk, and in our continuing effort to keep you informed, we’ve produced the following abstract…

After surveying 120 CIO’s and another handful of healthcare executives, the PwC report adds heft to the impact of the ARRA’s Meaningful Use (MU).

The report makes many keen assertions including:

• “Health systems will need to transform the way they deliver care, so they can sustain performance and grow revenue in the future.”
• Successfully achieving meaningful use “hinges on closer integration with key constituents” (physicians, health insurers, patients).
• Health systems that already have connected with physicians, patients, and health insurers around MU are “more likely to be applying for government incentives” than those that haven’t. But only half of respondents expected to apply for incentives in 2011. (By 2014, 90% expect to be applying).
• Health systems that have included patients in the planning are “more confident about meeting MU standards.”
• “Implementing MU can enhance hospital-physician alignment.”
• Most health systems are failing to connect with health insurers around MU.
• 80% of CIO’s are more than concerned about meeting MU requirements by deadlines. (An American Hospital Association survey reports that 55% of hospitals expect to incur penalties.)
• “The benefits of achieving MU outweigh the challenges.” Those benefits include improve healthcare quality, disease management, coordination of care, improved alignment with physicians, increased productivity, market advantage, and improved alignment with payers.

But PwC identified four barriers to attaining MU: Lack of MU standards clarity, shortage of skilled IT staff, vendor readiness, limited capacity of existing infrastructure . . .

and proffered five benchmarks to achieve compliance: Establish governance, balance compliance against competing priorities, forge new public-private ventures, make the patient the purpose, collaborate with physicians and health insurers.

Another popular discussion point at HIMSS2010 is the intrinsic need for workflow change when practices move to an EMR. Simply installing a new solution will not necessarily fix process issues and inefficiency. As our brand new EVP of Sales stated “EMR is, and should be, more than just a pretty screen.”

You are introducing a new element that must change the way you work. For instance the process of a nurse putting a folder on an exam room door, to notify the doctor that a patient is ready (sometimes accompanied by a little green flag on the door frame), will be unnecessary and redundant. The number of these processes and workflows that need to be reviewed, and adjusted accordingly, will greatly depend on each practice’s current state of documentation, but everything should be evaluated.

This massive evaluation isn’t in vain, every change should be an improvement and every improvement, great or small, will have a ripple effect that at the end of the day will improve patient care and patient safety. Ultimately, that is the overriding goal. (Oh, and cost savings…but that’s understood, right?)

More Reading:

www.emrandhipaa.com (don’t miss the comments here)

"Workflow of the Workflow"

Dr. Greiver: Workflow is King

HIMSS wrapped up today and as a recap I thought I’d post some interesting conversation topics. First up is a conversation with some good folks at Henry Mayo Newhall Memorial Hospital (HMNMH).

How important is it to have a Physician Champion for your EMR projects? According to the two doctors and the Physician Project Manager from HMNMH, there was no doubt that it’s essential. I gleaned from that conversation that one of the overriding concerns of doctors, who have yet to adopt a certified EMR, is that many don’t want to change a system they are already comfortable with. Those doctors need a colleague who have seen the benefits of an EMR; an expert who can optimize the project, provide education, champion the project, mentor staff, and generally be a guide who garners support.  A role that was once defined simply as a “subject matter expert” has evolved into a position of critical importance integral to the success of ERM adoption.

This is no longer a one-way street with the IT department handing down process changes and the Champion promoting them, a good Physician Champion is involved in the entire redesign of processes and workflows, ensuring that changes align with how a clinician thinks and works. (Digitized Medicine).  The goal is to use the Physician Champion’s expertise to structure the project and optimize the way the EMR is used. From structured document templates to order sets and support tools, the Champion is a key player in strategic decision making. Selecting and installing an EMR is just one half of the battle. Participating doctors need to be on board and ready to use their newly adopted systems. A Physician Champion can rally the support needed to bring the whole thing full circle on the Information Superhighway (you know that speedway we were warned about?).

Projects that do not commence with a Physician Champion can experience problems on a variety of levels resulting from a lack of insight and general usage. A Champion is the person who can make a new EMR implementation a win-win for doctors, patients, and IT administrators (maybe a win-win-win?).

Stay tuned for more conversations from HIMSS.

More Reading:

The Healthcare Blog

EMR Selection: The Physician Champion

Are Physician IT Champions Necessary?