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

Will tonight’s State of the Union recharge the fight to reform healthcare?

“Congressional leaders are taking healthcare legislation off the fast track as rank-and-file Democrats, wary of unhappy midterm election voters, look to President Barack Obama for guidance in his State of the Union address.

House and Senate leaders said Tuesday they need time to determine the best way forward on healthcare in the wake of last week's special election loss in Massachusetts, which cost Democrats their filibuster-proof Senate majority”…read more on ModernHealthcare.com.

Will lawmakers come together to finally finish the job?

Just in case you haven’t been able to find it one of the other dozens of sites publishing the link here is the HITECH: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology and here’s how you get paid (warning 556 pages).

Mr. HISTalk summarized the finer or most relevant points here. And over at HealthcareITNews.com “Stakeholders have mixed reviews on proposed requirements” while Government HealthIT profiles groups that aren’t happy with the definition.  

We all knew it’d be a mixed bag right? What do you think of the proposal? Have you (are you) going to read it or will you just look for an effective summary? Let us know what your thoughts and questions are in the comment section.

By: Mary Pat Fralick, COO

I am convinced that we would not need healthcare reform if each of us agreed to a personal reformation. “Huh?” Let me explain…

Recently, while listening to NPR (it was a Friday, so Howard100 was playing reruns) I heard a gentleman talk about four changes in everyday life that he believes would save the country more money and result in a healthier population than any healthcare reform proposal currently being considered. While I can’t remember the show I was listening to or the name of the author of these ideas, I do remember the four changes. The facts to support his ideas are ones that I found through research; he used others that were equally compelling.

#1 – Everyone who smokes should quit now. According to the American Cancer Society , the average lifetime medical costs for male smokers are 32% higher than for men who never smoked and 24% higher for female smokers. The ACS also estimates that smokers make about six more visits to healthcare facilities per year than non-smokers.

#2 – Everyone should ALWAYS wear seatbelts. According to the Division of Motor Vehicles , for every 1% increase in seatbelt usage, close to $100 million in annual injury and death costs could be saved.

# 3 – Severely overweight people need to lose weight. According to the Centers for Disease Control, 10% of the cost of healthcare in the US is related to obesity.

#4 – Women who are pregnant must seek prenatal care. Lack of prenatal care is the #1 cause of preterm births. According to the March of Dimes , in 2005, the cost of medical care for preterm births in the US was at least $16.9 billion. The average first year medical costs, including inpatient and outpatient care, were about 10 times greater for preterm infants than full-term infants.

I wasn’t a math major in college, but I was a mathlete in high school and it sounds to me like this guy is on to something! What would you add to this list? Here’s my suggestion:

Everyone who rides a bike should wear a helmet. According to the New England Journal of Medicine, bicycle safety helmets are highly effective in preventing head injury. It’s estimated that anywhere from 45-88% of brain injuries could be prevented by wearing a helmet and that every $1 spent on a bike helmet is estimated to save $30 in direct medical costs. Sounds like a good ROI to me!

By: John Smaling, Executive Vice President

As the final definition of various ARRA related requirements take shape, financial incentives and impending penalties will most assuredly lead to an upswing in ambulatory software implementations. A number of those initiatives, sponsored by acute care organizations, will be large-scale implementations that involve large numbers of practices, and lots of physicians, spanning multiple specialties. With heavy participation by the acute care IT organization, these types of initiatives will introduce a number of complexities that I believe will challenge both vendors and customers, while exposing the differences in approach adopted by the ambulatory software vendors, and those typically employed during acute care implementations.

Historically, ambulatory software vendors have dealt with physician practices ranging from single practitioners, to large, multi-specialty group practices. In the course of deploying their solutions to this customer base, vendors have developed planning, implementation and support strategies that have worked for this profile of clients. I believe that this dynamic will oftentimes differ from the typical hospital customer in many ways, among them:

1. Acute care customers will have different goals and objectives than the typical physician practice in the areas of standardization, data normalization, reporting, and outcomes. For example, a common goal of the acute care organization is to achieve a comprehensive medical record that encompasses both practice and hospital based episodes and the level of integration required to accomplish this will likely be atypical for many ambulatory vendors.

2. Acute care enterprises will generally have larger and more experienced IT teams who have stronger views on infrastructure, security, project management, process and systems management than that found in physician practices.

3. There will be differing views from the acute care customer with respect to the level of individuality required from practice to practice. Many acute care organizations will feel that one physician practice operates essentially like every other practice, and their vision of standard workflows, process, and customization may be far different than the desires and perceptions of their constituent practice groups. The ambulatory vendor needs to understand this potential conflict in views and understand how to arbitrate these differences to meet their customer’s goals and objectives.

4. Acute care software vendors generally hold similar views with respect to the transition from install mode to support mode, and the manner in which they structure their support arrangements with customers. Ambulatory vendors, given their physician practice orientation, oftentimes adopt vastly different approaches than acute care vendors.

5. Decision-making and dealing with complex organizational dynamics, even in a relatively large physician practice is far different than can be found in an acute care organization. The importance of well defined governance, change control, and related process is not something that ambulatory software vendors have had to address to the extent that they will encounter in the future as they engage more acute care organizations.

While this listing is by no means comprehensive, it amplifies some of the key areas that will require adjustment by both parties. Taking the time to dialogue during the sales cycle to understand the many key elements of such initiatives is warranted. Understanding differences such as those mentioned above early in the relationship will help to either promote mutual respect and workable solutions, or to avoid an unproductive relationship and ill fated technology investment.

By: Eric Egnet, CIO

Over the past few months, I’ve been talking with Hospital CIOs about HITECH. I wanted to hear it from the horse’s mouth rather than from all the politicians, firms, and agencies who have been hyping it to no end. In my discussions, a clear pattern has begun to take shape. Hospital CIO’s fall into three different camps when it comes to their HITECH efforts and concerns. I’ll detail the three types of campers over the next three days…

Camp Not Concerned or the “NCs”

These guys aren’t going to camp yet, so they aren’t too worried about the implications of changing their routine.

The Hospital CIOs in this camp have read a few articles on HITECH but have not had any meetings or discussions internally on the topic. They feel that things need to shake out before they take any serious action. With the number of projects already on their plate, HITECH is not something NCs plan to lose any sleep over. They are aware of the $44k incentive for their physicians, and how they will need to demonstrate “meaningful use” by 2011, but these campers are not worried about it. In the future the NCs plan on becoming better informed and educated on HITECH, but they are going to wait until there are definitive answers and definitions.

These CIOs feel good and are confident about their existing IT infrastructure and their current HIS systems, both on the inpatient and ambulatory side. There are no plans to switch HIS vendors and they are confident they will be able to close any gaps identified once a thorough analysis is performed. If an ambulatory solution is needed, NCs will select one of the major vendors, after some proper due diligence, and then either manage the project in-house or outsource it. In fact, they may even opt to have the system “hosted.”

Hospital CIOs in this camp are also confident that they have enough or can hire enough full-time IT staff to commit to these projects and they certainly don’t need a third-party firm to come in and provide them with a HITECH assessment. Funding will not be problem, as working capital has been promised, and will be provided by the Hospital Board to address HITECH initiatives that are required.

Are you concerned yet, or are you still feeling safe at home?

The scheduled meetings for the HIT Policy Committee and the HIT Standards Committee are August 14^th and August 20^th, consecutively. While we’re all waiting with bated breath for their updated recommendations, let’s figure out what the difference is between the two committees.

According to the official HIT for HHS site (healthit.hhs.gov):

The Policy Committee “will make recommendations to the National Coordinator for Health Information Technology (HIT) on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information.”

The Standards Committee “is charged with making recommendations to the National Coordinator for Health Information Technology (HIT) on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information.”

The meaning is in their names (how clever): Policy equals recommendations for government policies and Standards equals recommendations on certification.

What does make an EHR user friendly? From nine basic principles (such as simplicity, consistency, forgiveness and feedback) to methodologies behind evaluation and rating systems, the HIMSS EHR Usability Task Force produced an easy to follow guide: Defining and Testing EHR Usability.

In the interest of full disclosure, and to exercise our well deserved bragging rights: one of our Project Managers was on the task force and lent a hand behind the scenes for this much anticipated publication.

Do you want to know what's going on behind the scenes as the HIT Standards Committee refines their initial recommendations so that the ONC and CMS can include them in the interim final rule? Read this post by John Halamka, MD, CIO, CareGroup Health System, Harvard Medical School.

By: Marlene McCurdy PhD, PMP®, Practice Manager

A brief review of the HITECH Act of ARRA:

• February, 2009, President Obama signed the ARRA to improve the nation’s health care through HIT by promoting meaningful use of electronic health technology
• On July 16, 2009 the HIT Policy Committee (a part of DHHS) adopted a definition of “meaningful use” and recommended high level criteria for the certification process. On July 21, 2009 the HIT Standards Committee met and discussed the differences between the requirements for “meaningful use” and for “certification.” Now, the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) will consider the recommendations from both committees and draft regulations that will be released in December, 2009.
• As part of the President’s Stimulus Plan, funding for those providers (hospitals and individual providers) will become available beginning in 2011 through 2015 for those who are able to demonstrate meaningful use for a year prior to eligibility for funding. For example, to obtain funding in 2010, the provider must show meaningful use in 2009.
• It is estimated that an average of $4M to $6M will be available for hospitals; and $44,000 per individual provider in a provider practice (excluding the care provided primarily in hospital). Funding will be front-loaded, meaning that more dollars will be provided to eligible hospitals/providers in earlier years, with decelerating payments through 2015. If providers/hospitals are not compliant with meaningful use by 2015, CMS (Centers for Medicare and Medicaid Services) will impose financial penalties by reducing reimbursements. (Chart credited to John Lynn at www.emrandhipaa.com).

Example of Individual Physician Reimbursements Available Per Year

Example of Hospital Reimbursements Available Per Year

More details on the comprehensive act can be reviewed at www.cms.hhs.gov.

Financial Incentives for Acting Now

There is a financial incentive for hospitals and physician practices to move ahead now to establish meaningful use of their HIT well ahead of the 2010 deadline. You may be curious, though, of how providers can move forward with information technology while the definition of meaningful use is still in flux. Although the definition is not final, the HIT Policy Committee published initial recommendations, identifying 22 objectives that will qualify as meaningful use. (Source: www.HealthIT.hhs.gov) Among those recommendations are several broad areas that can be acted upon immediately, regardless of the final definition since it is clear that aspects of these must be implemented and in use to be eligible for ARRA funding.

• Use of a Certification Commission for HIT (CCHIT) Electronic Medical Record (EMR) application. Many vendors are upgrading their releases to meet certification standards.
• Ability to share information outside of the hospital/physician practice (referred to as Health Information Exchange – HIE – technology). For example, funding will be considered based on the organization’s ability to send information to national registries for quality comparisons.
• Ability to measure and report on patient safety, quality and outcomes. Although the ruling is not yet available on how healthcare providers obtain funding, it will likely be based on these factors.
• Full implementation of CPOE, with which many of us are very familiar. Seemingly, an obvious prerequisite given patient safety and quality thought to be inherent in CPOE environments, hospitals are still slow to adopt the practice. According to the HIMSS Analytics™ Database^© 2009, only 2.5% of hospitals have adopted CPOE and Clinical Decision Support as of 2008, primarily leaving ancillaries (lab, radiology, pharmacy), data repositories, medical vocabularies, document imaging and, to a lesser extent, minimal clinical documentation, accounting for most of the clinical automation statistics.

How Can Vitalize Consulting Solutions Create Value Now for Hospitals Who Wish to Take Advantage of ARRA Funding? Contact us at vcs@getvitalized.com or 610.444.1233 to find out.