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.

By Linnea McNair, Senior Consultant

Once upon a time, CIO’s suspected that the fairy-tale-ending go-live was just that. Fortunately, because of several common characters (regardless of the vendor or the scope of the activation), “happily ever after” go-lives are possible. 

Prince Charming comes in the form of abundant planning. Skimping on this will put a poisoned apple in the hands of all involved -- from end-users to support staff.

The following tried and true go-live advisories have been used to slay activation dragons and resuscitate entire IT kingdoms:

•    Training should occur no more than 3 weeks prior to the planned activation.  Should go-live date be delayed after education has occurred, review education must take place no further than 3 weeks prior to the new date.
•    Crib-sheets, helpful for both staff and the super-users, readily identify the accepted protocols that staff should follow.  Handy crib-sheets can curtail “creative” solutions that might not follow facility policy.
•    Staffing & Support:

o    Identify super-users in every unit for all shifts. 
o    Super-users should be available 24 x 7 for a minimum of two weeks for all shift and all floors. 
o    During the first go-live week super-users shall not be utilized as care-givers. 
o    After the first week (or once staff is fairly confident) super-users may take call or share floors for support.  If a unit is struggling, full-time support should be sustained.  Assess each unit and provide for its needs.  Thou shall not pigeon-hole all units’ support needs.
o    IT staff shall support 24/7 super-users and multiple floors during the first two weeks of go-live. 
o    The entire IT staff shall carry a beeper.  If possible all super-users should also carry a beeper or mobile phone.
o    Config guidelines for IT support staff.
o    Staff a config person on the helpdesk that knows what’s configured, understands ramifications of changes, and has authority to make changes.
o    4 magic words: Third-party support staff.  Use to enhance your staffing or free up IT staff.  One caveat: Educate any third-party staff so each knows house processes, guidelines, and policies.

•    Furnish a dedicated helpdesk and command center to give users a break area and support staff a food service and idea report/exchange area. Stake out ample space for tables and comfortable chairs.
•    Grease the gears of inter-shift communication by notifying the go-live coordinator (GLC) of any arising issues and solutions, emerging challenges, discovered expedients. Having a single point of contact -- the GLC -- works best. 
•    If possible, set up computers on each floor with the training DB.  This will provide a location where staff can “play” and reinforce their training.
•    Supply Food!!!  Hot food (other than pizza) for the night staff; snacks for breaks. 
•    “Happily Ever After” go-live – continue support and communication in the form of weekly to monthly rounding.  This should last forever!

Of course, fairy godmothers can merely make suggestions about the path to success not guarantees. Merriweather warned Sleeping Beauty about the spinning wheel, after all. And while hindsight best determines what could have been improved during any go-live tale, the following five ogres will most assuredly devour your quest for a successful activation:

•    Errant, inaccurate handouts
•    Absent or gnarled communication
•    A bound Helpdesk, unauthorized to fix problems
•    A plodding Helpdesk, unable to remedy problems on the fly
•    A remote and/or miniscule Command Center

More powerful than a wish, a prince and a squad of fairy godmothers working in concert, abundant planning will get your activation beyond the tolling bells of midnight and into “happily ever after.”

For more information on VCS's Allscripts/legacy Eclipsys solutions, contact us at 610.444.1233, email vcs@getvitalized.com, or visit www.getvitalized.com.

McKinsey Quarterly recently reported on the effect of competition on delivery of quality healthcare. Finding that a “judicious use of provider competition can produce desired results” in healthcare delivery, McKinsey authors Penelope Dash, MD and David Meredith nevertheless caution that some socialization (read: governmental oversight) of the system is necessary and constructive.

Sifting empirical evidence through economic theory, Dash and Meredith provide “a framework that health systems can employ to decide” the best use of competition to “drive access to high quality, efficient care.”

With a Republican Congress ascending to House rule in January and cleaving to its mantra that competition creates a “virtuous cycle of innovation, high quality, and efficiency,” the McKinsey report might prove if not clairvoyant in terms of healthcare reform, then at least instructive.

Sink your teeth into the report. (free registration may be required).

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.

VCS representatives are headed to the Lone Star state for this year’s International MUSE Conference in Dallas. We’ll be in booth 719 all week handing out cowboy hats and taking pictures with one of America’s favorite country music stars (sorry…we could only get the cardboard version).

Look out for some wild pictures on our Facebook page soon!