Healthcare Talent Transformation

Summary: 12 Best Practices for Health IT

Kel Mohror

Government HealthIT also published from Oregon Health- Network Leveraging The 12 Best Practices For Health IT To Improve Care And Reduce Costs Working together to do more – and better – with less, By Kim Lamb, Executive Director, OHN.

"Health care is in a painful transition from being a delivery system that is designed and managed within a silo to one that needs to communicate in real time to the rest of the policy-making continuum."

"The new emphasis on patient-centered care requires collaboration and coordination at the federal, state and regional level, as well as full interoperability at the hardware, software, payer system and patient care levels."

"In this multi-variate environment, health IT is truly the best means to not only survive, but to thrive."

"1. Strategy and vision – Form follows function

2. Collaboration – Don’t reinvent the wheel

3. Connectivity –  Building the infrastructure needed for success

4. Implementation – Answering the question of “how”?

5. Information – Quality improves outcomes

6. Support – Making it work every day

7. Measurement –  Access real-time information for improved decision making

8. Education – Shortening the divide from “have” to “use”

9. Recruitment and retention –  Increase and then meet demand

10. Credentialing and privileging – Care without borders

11. Reimbursement – Ensuring payment for the next generation of care

12. Policy – Top-down collaboration and support of the continuum."

"The Federal Communications Commission (FCC) Rural Health Care Pilot Program (RHCPP) is building the next-generation health care delivery broadband telehealth network  infrastructure.”

"The key, as a health care provider business, is to consciously determine what you can feasibly address on your own, and where you need to look to others for assistance."

"Information on:

• lessons learned
• cultivating new strategic partnerships and referral patterns and
• investments poised to be leveraged at a state level to benefit the greater community good

are all areas that benefit from a strong health IT network."

Health Wonk Review: Looking at the Future

Here on Health Wonk Review, our last issue included some recaps of the prior year, so in this issue (hosted by Workers' Comp Insider), we are looking to the future and what the coming year might hold for healthcare. Check it out: Health Wonk Review: Looking at the Future  

Our blogger, Dr. Michael Koriwchak is featured as he discusses why Doctors are Unenthusiastic about Obamacare Geeks.

HIT, Part 3: Connectivity

Kel Mohror

OHN's 12 Health IT Best Practices, Part 3: Strategic Checklist for Connectivity, January 09, 2012, Brian Ahier and Kim Lamb, Executive Director, Oregon Health Network

 "Health information exchange is a key enabler of improving our health care system. The future of health care [and the livelihoods of providers] will depend on the effective incorporation of digital technologies to help streamline the practice of medicine and to lower costs.”

"The new nationwide health care model that is developing will force us all to think about how our facility, community and state will connect to the health care delivery system via information technology. Reliable, high-speed, high-quality connectivity is the crucial, but often overlooked, component for success. OHN (Oregon Health Network, an FCC Rural Health Care Pilot Program) and other pilot programs are working to bring such connectivity out of the shadows and into the lime-light."

High-speed, high-quality connectivity enables:

• "The ability to share diagnostic images is an important component to a telemedicine initiative. A vigorous robust broadband infrastructure is required for the high-bandwidth requirements for sharing  consult x-rays and other diagnostic images."
• "Provision of specialized services over long distances (e.g. telepharmacy)"
• "Delivery of critical health care services to remote and home-bound patients, which could facilitate incredible cost savings."

"Providing the right information, in the right place, at the right time requires robust connectivity."

"Strategic checklist for connectivity general how-to’s" include:

• "Support a health IT strategy and plan in the context of Federal/State initiatives, mandates, incentives and funding streams."
• "Gain knowledge of local and neighboring networks or HIEs."
• "Build with the end in mind."

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HIT, Part 2: Collaboration

Kel Mohror

OHN's 12 Health IT Best Practices, Part 2: Collaboration, October 17, 2011, Kim Lamb, Executive Director, Oregon Health Network and Dawn Bonder, O-HITEC and Chris Tamarin, Oregon Economic and Community Development Department.

"Once viewed as a friendly means to gain a strategic and competitive advantage, collaboration is the means to effectively address transitioning a broken health care delivery system to that of a new and improved patient-centered care system."

"If we pool our knowledge, resources and experience, we can develop a solution with unique perspectives and can address how to rebuild our systems to serve the common good together."

"How to build and connect to the next generation of health care systems is up to us. All of us."

"The first step is to embrace the first Health IT Best Practice area of having an HIT strategy or plan that serves a commonly shared community (state or federal) such as the Triple Aim.”

“Having a clear strategy enables us to narrow the universe significantly in determining where, how and if we can collaborate."

"Identify, create, support and introduce yourself to existing HIT network communities, agencies and organizations such as-

• HIEs
• Private Community Networks
• EHRs
• Regional Extension Centers (RECs)
• Accountable Care Organizations (ACOs), Coordinated Care Organizations (CCOs) and  
• ·Primary Care Health Homes (PCHHs)
• Broadband/Connectivity Infrastructure Deployment and development programs through the Federal Communications Commission (FCC) and Department of Agriculture (USDA)

HIT, Part 1: Strategy and Planning

Kel Mohror

Government HealthIT posted a three-part series titled OHN's [Oregon Health Network] 12 Best Practices for HIT, Part 1: Strategy and Planning, September 19, 2011, Vanessa McLaughlin, MPH and Christopher Thoming, MD.

This post excerpts “food for thought and action” from the series, which emphasizes telemedicine HIT.

"The emergency physician, upon seeing the child, contacted the local pediatrician who suspected Meningococcemia, a disease that could have caused the child’s death within six hours."

"An  immediate consultation via live video connection, with a Pediatric Emergency physician who diagnosed and provided treatment recommendations immediately."

"Proprietary programs, equipment and technology networks that often lack compatibility, standardization and common clinical protocols are hurdles that may be overcome through the Patient Protection and Affordable Care Act (PPACA) and CMS’ Triple Aim* goals."

 *simultaneous pursuit of three aims:

• Improving the experience of care
• Improving the health of populations and
• Reducing per capita costs of healthcare.

"Five essential elements in the strategic growth and development of telemedicine programs are:

1.  Telemedicine and telehealth delivery strategies must be in the context of the organization’s mission, vision and goals and plan) and championed by senior leadership.

2.  Structure telemedicine as a business line that will enable any provider to incorporate telemedicine in her / his ongoing practice.

3.   Resist the temptation to call an individual telemedicine program your enterprise level solution, because it is not.

4.  ‘Who are you going to call?’ Groups like Oregon Health Network, HIE initiatives and Beacons are conveners of regional health care initiatives that provide the secure connectivity needed to answer the ‘who are you going to call?’ question.

5.  Money in your pocket. Increasingly health plans are paying when billed for remote patient consults. Medicare/Medicaid continues to support rural access, which fits well with health system outreach strategies."

"Telemedicine and telehealth delivery is no longer about-

• testing to see if the gadgets, technology and networks work or
• surveying providers and patients to measure their satisfaction with the convenience."

"Telemedicine and telehealth delivery is about using technology innovations to enhance the clinical moment, enabling-

• patients to receive continuous care in their home or local community and
• health care systems to discharge patients to a transition team that will follow their care for the next stage of returning to health."

“Telemedicine and telehealth delivery is also about connecting across the distance to build collegial relationships that enables providers to trust one another and upgrade the acuity of care in a remote community so patients are appropriately triaged and transferred to an emergency department."

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Doctors Unenthusiastic About Obamacare Geeks

Dr. Michael Koriwchak, www.wiredemrdoctor.com

Despite the success of information technology (IT) in transforming many parts of the economy, the health care sector has proven itself immune to the seduction of smart phones and iPads.  This is puzzling at first glance.  It is certainly not due to any shortage of health IT products.  The problem appears to be on the demand side.

A recent article by Olga Khazan in The Washington Post provides some explanation. She reports on the third annual mHealth Summit, held earlier this month in Washington D.C.  The event has attracted such notables as Bill Gates and Ted Turner, according to the mHealth website.  The piece laments the “enthusiasm gap” between Health IT startup companies offering dozens of miracle products and those darn stick-in-the-mud physicians who just can’t get with the program.   But meetings like the mHealth Summit actually hurt the movement of Health IT that they profess to support.

The poster child for Ms. Khazan’s article is Dr. Eric Topol, one of the Summit’s keynote speakers.  HHS Secretary Kathleen Sebelius joined Dr. Topol behind the podium.  Together they offered Health IT Utopia – where “you can take a video of a rash on your foot and get a diagnosis…without making a doctor’s appointment.”  Then they criticized practicing physicians using the same old Obamacare propaganda.  Ms. Sebelius continued, “Americans still live sicker and die sooner than many of the people in other nations…Healthcare has stubbornly held on to its cabinet and hanging files.”  Dr. Topol called the medical community “ossified” regarding the adoption of health information technology.  The author starts the online post-article comment thread herself with the question, “How do we encourage doctors to be more open to these technologies?”

This kind of meeting is common in the Health IT (HIT) community.  A bunch of self-described HIT experts get together, pump each other up about the absolute perfection of their products, and then start bashing physicians because - literally and figuratively – we aren’t buying it.  At similar meetings I have heard HIT people brag about walking out on their doctor the minute he pulled out a paper prescription pad.  Doctors are called fearful, stupid, or rich fat-cats protecting their turf.  Now thanks to our “colleague” Dr. Topol we can add, “ossified” to the list of unflattering terms.  It comes as no surprise that the government is happy to join in the sing-along.  It is a free opportunity to serve Obamacare Kool-Aid.

I am a dedicated supporter of HIT.   Our practice’s EMR implementation reached a reasonable level of maturity long before Obamacare, HITECH incentives, and Ms. Sebelius came along.  We became Meaningful Use – compliant the first of October.  I believe in the potential of HIT to revolutionize the practice of medicine by reducing costs and improving efficiency and quality of care.  But I do not believe the HIT community is on a course that will take us to that vision. 

The IT community has indeed done great things for other parts of the economy – without government incentives.   They have yet to offer similar value to practicing physicians.  Health care is different from banks, grocery stores, and airlines.  It would take an entire book to fully explain the differences, but for now consider 2 indisputable facts that distinguish health care:  1)  In health care there is no tolerance for errors and unexpected outcomes, and 2)  In health care the beneficiary of a service is not the one who pays for it.

Consider Ms. Sebelius’ example of a rash on the foot.  In her utopian world you don’t need to see the doctor.  Instead you just take a picture of your rash, send it via the Internet (oops, I meant “The Cloud”) to a provider who looks at your photo, makes a diagnosis and sends you the treatment.  The job is done for less cost and with more efficiency…right?

Well, maybe…but what if the patient with an apparently simple rash is a brittle diabetic…and right next to the rash, beyond the photograph, is a near gangrenous toe?  Or perhaps this patient recently changed laundry detergents, or maybe went camping and had a tick bite.  Of course the clinician (who is probably not a doctor, in Sebelius-utopia) has no way of knowing; in this example the picture is the only information available.  Will we expect clinicians to make a diagnosis with so little data?  If not, then what additional information should be made available?  How will it be made available?  How should the standard of care for remote service be defined?  Doctors cannot be expected to spend precious dollars on IT products until we establish how they should be used.

Then comes the daunting task of paying the provider.  If patients paid for their own care they would be glad to pay a fair price for remote service in order to avoid losing time at work and save on gas, parking, etc.  This in turn would make it attractive for doctors to offer the service, and everyone would quickly buy in.  But third party payers have no incentive to give doctors more ways to provide service and get paid.  And in the health care regulatory environment doctors would take a huge legal risk if they attempted to bill insured patients directly for remote services.  Ms. Khazan mistakenly lays the blame at the doctor’s feet, accusing us of having no interest in saving money.  She also brings out the same old propaganda regarding the quantity-not-quality payment system.  Those arguments are complete nonsense.  Neither the HIT community nor the government knows the first thing about how to provide quality health care while at the same time making payroll for staff, getting the office rent paid, and still putting bread on your own table.

To address Ms. Khazan’s question, here are some ideas for the HIT community that will make doctors more receptive towards HIT:

First, stop insulting your target audience.  It’s hard for us doctors to do business with folks that call us fearful, stupid, greedy, “set in our ways,” “stubborn,” or “ossified.”  If you think so little of us physicians, why should we work with you?  Why should we trust our patients’ welfare to your products?  As the saying goes, you get more bees with honey.

Second, through your success digitizing other parts of the economy you have earned our respect.  But you need to admit that doctors know more about patient care than you do.  To us your health care products are the technological equivalent of black-and-white vacuum tube TV sets and brick-sized cell phones.  They reflect your lack of understanding of how to practice medicine.  Physicians will not get interested until you spend less time rubbing elbows with famous people and globetrotting academicians and spend more time working in the clinic with regular docs to learn how patient care works in the real world.

We docs are indeed set in our ways to some extent, and with good reason.  In our years of training we were repeatedly taught that even small changes in patient care could adversely affect treatment outcomes in unpredictable ways.  You don’t make changes in a cavalier fashion when patients’ lives are at stake.  There is more to lose than there is to gain.

Third, stop letting Kathleen Sebelius and her Obamacare cronies play you for fools.  They are giving you the time of day for only one reason – to make you dependent on government for survival.  Getting in bed with them may feel great now, but the morning after will be ugly.  Their goal is not to jump start your industry, but to control you forever.  Meaningful Use incentives were the first step.  Witness the fate of the American Medical Association.  For decades they have financially benefited from government support of the AMA-copyrighted CPT coding system.  But, faced with the prospect of Obamacare “reforming” CPT out of existence, the AMA chose to abandon its physician constituency, supporting Obamacare to preserve its CPT revenue stream.  The government owns the AMA.   Now they want to own you.

The government should not be your customer.  Doctors and patients should be.  It is not too late to change strategy.  Among regular docs there are plenty of early adopters willing to work with you.  Let’s talk.

2012 The Year of Improved Communication

Jonena Relth, TBD Consulting

I received this cartoon from Diane Zuckerman, a fellow member of Society for Participatory Medicine (SPM). 

May 2012 be the year of improved communication between patients and their physicians!  We're on our way and so appreciative of medical professionals and patients for helping to change medicine in the US.

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the communiation needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

Deep Thoughts from the Meaningful Use Mountain Top

Dr. Michael Koriwchak, www.wiredemrdoctor.com

In some ways I am grateful to see 2011 end.  Several extracurricular projects have drained the life out of me, including our Meaningful Use (MU) project.  As near as I can tell we survived.  Our 90 days of compliance for Phase 1 / Year 1 are completed.  Last night I completed my attestation online uneventfully.  We will get attestation completed for the rest of our physicians within a couple of weeks.  Then we will join the few (1%) of “eligible providers” that have complied with MU.  One would think that folks would be breaking down the doors of these “one-percenters” to learn the secrets of their success.  Yet a brief Internet search reveals no doctor testimonials on MU success beyond the second hand accounts offered by EMR vendors and consultants.  These are of little value.  So I am writing my testimony.

Over the past several months I have repeatedly criticized MU, with good reason.  But perhaps now that I have climbed the MU Mountain and my check will soon (hopefully) be on its way, I should soften my view a bit.  Sort of like final exam week…exams looked awful before you took them, but when you got done and you were somehow still alive, well, maybe it wasn’t so bad.

Well, sorry, it’s still that bad.  It took about 150 man-hours of work to complete this project.  And our EMR use, our quality of patient care and our practice efficiency is for the most part no better.  In some ways it is worse.  As a result of MU:

1. We now take blood pressures on children.  This is almost never medically relevant in an ENT practice.  We can’t exempt ourselves from this requirement because of our adult patients, in whom blood pressure is often relevant.
2. We waste volumes of paper printing clinical visit summaries that no one reads.  While the concept of a visit summary is OK, the document itself must include so much extra data, it is useless.  Our web portal, which we are in the process of replacing, does not support this requirement so we have to use paper visit summaries for now. 
3. Patient waiting time is increased while we process data on pneumovax status, smoking status and body mass index on every patient.  In our practice, these data are medically relevant for many patients, but not everyone.  Doing it for everybody is a waste.

To be fair, a couple of good things did happen:

1. Use of EMR-based prescriptions and true e-prescribing (e-Rx) improved with those physicians that were still hanging on to paper scripts and/or were not using e-Rx.
2. We were not maintaining true ICD-coded problem lists in the EMR before MU.  We had problem lists and diagnoses of course, and we were using ICD codes for billing.  But we had never combined the two processes before.

The entire process is complicated, confusing and intimidating.  Not only are the guidelines themselves a mess, but also there is a surprising amount of inaccurate and misleading information out there.  Even the CMS publication Attestation User Guide is missing a page compared to the actual attestation website.  After reading the User Guide I lost an entire night’s sleep thinking that the “children with pharyngitis” quality measure had been deleted because it is missing from that document.  I have 17 years of medical practice experience and 37 years of IT experience.  If I can’t figure this out, there is something wrong.

The view from the top of the MU Mountain looking down is no better than the view from the bottom looking up.  Meaningful Use remains an expensive distraction that forces the true benefits of EMR to be overlooked in favor of regulatory compliance.  MU also creates an unhealthy alliance between government and the health IT community.  The government wants to own health IT just like it wants to own the rest of health care.  Don’t fall for it.

Related Posts:

Meaningful Use Will be on Life Support by the End of 2012

2012 - Year of Leadership Growth in Healthcare

May 2012 be the year for positive changes in healthcare leadership in the US and all around the world! Unlike the picture, we don't want to "wash away" all our leadership practices replace them with all new, but a good "cleaning" will be a good thing!

• May our leaders grow themselves while they help those around them grow.
• May our leaders learn how to lead - not manage. 
• May our leaders learn to trust and delegate, not dictate.

Here's to everyone who is working to make our healthcare the best quality and most affordable possible. We are a blessed nation with smart, talented people who want to make positive improvements in our system.  Let's LISTEN more and gain improvements from the contributions of all concerned!

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena Relth. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

Happy New Year Blessings - Pay-It-Forward

Jonena Relth, TBD Consulting

As I was reflecting on my many blessings going into 2012, I easily assembled a list and started to write my blog posting.  However, before I finished, I received the message below from a dear friend -- a repeat of one I had read long ago, that is much more profound that the "dribble" I was putting to paper.  So, I hope you will appreciate my sharing the profoundly, wise words of someone else.  

My new year's resolution is to practice being more positive everyday in my work and my personal life.  With each positive encounter, kinda' like a pay-it-forward, I hope the people I bless will in turn bless others around them by doing the same thing.  Please hold me accountable 'cuz New Years' resolutions have a dismal implementation rate!  I want this to be the beginning of a whole new me and whole new world around me.

"GOOD THOUGHTS ANYTIME, ANY DAY, ANYWHERE" 

"There was a blind girl who hated herself because she was blind.

She hated everyone, except her loving boyfriend. He was always there for her. She told her boyfriend, 'If I could only see the world, I will marry you.'

One day, someone donated a pair of eyes to her. When the bandages came off, she was able to see everything, including her boyfriend.

He asked her, 'Now that you can see the world, will you marry me?' The girl looked at her boyfriend and saw that he was blind. The sight of his closed eyelids shocked her. She hadn't expected that. The thought of looking at them the rest of her life led her to refuse to marry him.

Her boyfriend left her in tears and days later wrote a note to her saying: 'Take good care of your eyes, my dear, for before they were yours, they were mine.'

This is how the human brain often works when our status changes.

Only a very few remember what life was like before, and who was always by their side in the most painful situations.

Today before you say an unkind word -

• Think of someone who can't speak.
• Before you complain about the taste of your food, think of someone who has nothing to eat.
• Before you complain about your husband or wife, think of someone who's crying out to GOD for a companion.
• Today before you complain about life, think of someone who went too early to heaven.
• Before you complain about your children, think of someone who desires children but they're barren.
• Before you argue about your dirty house someone didn't clean or sweep, think of the people who are living in the streets.
• Before whining about the distance you drive, think of someone who walks the same distance with their feet.
• And when you are tired and complain about your job, think of the unemployed, the disabled, and those who wish they had your job.
• But before you think of pointing the finger or condemning another, remember that not one of us is without sin and we all answer to one MAKER.
• And when depressing thoughts seem to get you down, put a smile on your face and thank GOD you're alive and still around."

Author: Unknown

Happy New Year! Jonena