When my wife forwarded me the following heartwarming link to a tender, but powerful presentation about leadership and teamwork, and later in the day I came across a piece titled “5 Facts that Top Teams Learn From Geese,” I figured it was some sort of sign so thought I’d share with the readers of Electronic Health Reporter.
The link to the presentation is here, and it’s worth a look. Even though it’s a slide show, I understand if you don’t have the time or the desire to follow a link. As such, I’ve included the piece, from HR Pulse (thanks to writer Charles Lubbe for compiling this post, his in full below).
Is it about health IT? No. But, it’s about leadership and taking common sense steps to help improve your teams and your organizations. These are simple tips that apply to every business and should be embraced by every leader — and, who doesn’t like an animal story?
Fact #1: As each bird flaps its wings, it creates a “current” that lifts the bird following it. By flying in a V formation, the whole flock adds 71 percent more flying range than if one bird flew alone.
Lesson learned: People who share a common direction and sense of community can get where they are going quicker and easier if they travel on the strength of one another. The clearer the vision or certainty of a team, the more courage they demonstrate in achieving their results and the less they concern themselves with individual effort.
Fact #2: Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone and quickly gets back into formation to take advantage of the lifting power of the bird immediately in front of it.
Lesson learned: If we have as much sense as geese, we will stay in formation with those who are ahead of where we want to go and be willing to accept their help and give ours to others. Top teams encourage discipline and look forward to opportunities for positive criticism, ensuring that the entire team reaps the reward.
Fact #3: When the lead goose gets tired, it rotates back into the formation and another goose flies at the point position.
Lesson learned: It pays to take turns doing the hard tasks and sharing leadership. Teams that are focused on their vision understand situational leadership and don’t need to be micro managed.
Fact #4: The geese in formation honk from behind to encourage those up front to keep up their speed.
Lesson learned: We need to make sure our “honking” from behind is encouraging, and not something else. Teams that place a value on regular check in and feedback hold their shape.
Fact #5: When a goose gets sick, is wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again, or dies. They then launch out on their own, with another formation, or they catch up with their flock.
Lesson learned: If we have as much sense as geese do, we too, will stand by each other in difficult times as well as when we are strong.
I’d love to know your thoughts and if you think the previous points are worth the read, and more importantly, if they are worth implementing.
Guest post by Kim Lennan, Director of Healthcare Markets at Sensage
Healthcare organizations of every size face a growing number of threats and regulations associated with patient data management. Pharmacies must be on the lookout for falsified prescriptions issued to employee family members. Hospitals must track access to patient records, from both inside and out, to identify individuals trying to gain health details about a celebrity, a neighbor or family member. Network connections must be analyzed to pinpoint situations when passwords have been compromised or mobile devices have fallen in the wrong hands. Finally, meaningful use Stage 1 requires the identification of devices, systems and applications that are dormant or redundant.
To address these scenarios, IT teams must establish monitoring capabilities around a disparate set of systems and activities. This leads to incredibly manual, risk-prone event data collection, correlation and analysis processes across clinical and non-clinical sources, which discourages most IT teams from even taking the first step.
A successful event data management initiative provides three important benefits, which are often overlooked:
The ability to understand patterns and establish baselines by which risk can be measured against. When you know what “secure” activities look like, you can create alerts when an unusual activity exceeds acceptable boundaries or thresholds. For example, if you know a set of workstations are not used during the hours of 11 p.m. to 4 a.m., you can easily set up a notification when a flurry of activity takes place on one of them during that period.
The much-needed context to drive better policy creation and compliance. If you are able to demonstrate events that create risk, you are more likely to drive understanding with users and influence appropriate behaviors. For example, correlate data from your time management system with log-out details on a shared workstation to identify high-risk individuals who fail to log out when they go off duty, leaving that system open to compromise.
The valuable insight needed to investigate a breach or establish compliance with internal or external regulations and policies. All too often, the data that can tell the story was either not collected or is impossible to analyze after the fact. In cases where an incident or breach spanned more than 90 days, most organizations have no historical perspective to review, which could prove a non-event.
For greatest success, security practitioners, auditors and compliance teams will need to align around processes that aid their shared efforts and actions. Here are some must-haves that need to be in place — or at minimum discussed:
Collect and centrally store all event data, even if you don’t think you need it. This is especially important since you don’t always know what you have—or what you will need—in the way of historical data analysis.
Establish basic measurements, understand them, then expand. Start somewhere … anywhere … to establish a metric and then work to make that metric useful or replace it with a better one that you’ve discovered in the process. Don’t just poke around or take a whack-a-mole approach to your discovery process — prioritize your effort so that you can accumulate and maintain a portfolio of metrics that maximize the value of your initiative.
Be consistent or face the consequences. Don’t spend a month on analysis then move on if nothing pops up. Maintaining consistent vigilance is the key to spotting trends or variance. Erratic monitoring and analysis leads to a false sense of security and reduces your ability to continuously reflect and refine based on known patterns.
Be ready to change. There is a tendency to take a finding, create a counter-measure around it, and then never look back. Be intellectually honest when you make new discoveries, particularly if they show a need to change an established rule, alert or policy. While flexibility and change seemingly conflict with “be consistent,” get comfortable with the idea that you will often learn something new which will require a policy or process change.
Engage experts and ignite managers. The dynamic nature of attacks may also lead you to integrate data from systems you didn’t initially consider using to drive critical correlations. As you think about what data to analyze, solicit input from teams who know the systems, devices, people or information associated with all areas of infrastructure. They may shed light on interdependencies or relationships that are critical to better metric definition. Leverage “the truth” established with the experts to ignite the support needed from managers.
A healthy, sustainable data management initiative starts with a single version of the truth. When everyone is looking at the same data, there is an increased likelihood that anomalies will be spotted and risks can be detected more rapidly. Here are some of the capabilities to look for:
A data management solution that makes event data collection from any source a simple task.
A scalable system that gives you the ability to collect and store vast amounts of data without ever-increasing hardware or maintenance costs.
Correlation capabilities that leverage a standards-based event taxonomy so analysis is possible across all data, regardless of source, without additional work from you.
Flexible analysis options that address the needs of every user – from standard reports to customizable dashboards and ad-hoc querying.
There is much we are learning every day when it comes to protecting patient data, and – to evolve – we must adopt new disciplines and continuous improvement around risk monitoring. We applaud Cerner, our innovative partner, and customers like Adventist Health Systems, who are breaking new ground with the “science of risk management” and developing a centralized approach to the systematic inspection across their clinical and non-clinical landscape.
HIMSS is one of the most exciting events on the health IT calendar. An annual parade of the pomp and circumstance, the mighty and the meek; the somewhat great equalizer for everyone in attendance (perhaps not measured by booth size but by mere participation).
HIMSS is the place to be seen as it holds a certain stature, like being invited to the hottest party in town or attending an industry’s red-carpet event. As such, there’s a level of elitism for those that make the journey as all that enter the grounds can claim that they’ve reached a certain stature in their careers.
There are the parties and toasts, educational and informational, evangelists and doomsdayers walking the same halls, shaking the same hands, seeking the same solutions and securing similar aspirations. As if a city of its own, HIMSS thrives upon its own economies and its communities, its own crooks and its own saints; it is the world in which we live, and great things tend to happen here, despite the few inevitable hiccups that happen along the way.
From the sessions to the show floor, the whole thing is a carnival. Like in the real world, everyone in attendance has their tribe and the land in which they’ve staked is the land in which they occupy.
I’ve done my time in the booth; standing at the edges of the territorial carpet, scanning the horizon, taking in the tourists and judging the competition for their various faults — from the poorly dressed sales folks to the vendors vying for supremacy from the land of the largest booth.
Sometimes, we cross the isle, make nice and say hello to a neighboring tribe. Others times we invade, stealing chachkis, and water and the occasional free massage.
We smile and make nice, and for a minute we’re friends, but then we remember that we come from the other side of the isle so we slither back to our tents and to our carnival barker duties. After all, it’s the show they love — the folks walking by – who window shop their way through the maze of capitalists.
We’re their entertainment, in our pressed shirts, standing in our corner smiling. We make passersby pass the time between sessions, but we understand our role. Even though we’re there to show some product and educate some minds, it’s a time for us all to come together and to celebrate the best that is healthcare, its technology and all its related parts.
For a few short days, we’re united and (somewhat) sincere with each other. Like a high school graduation party where everyone can come together even after years of disagreement or opposing views and think grand things about the future even though we know the roads we’ll travel will take us down very different paths.
And when it’s all over and life settles down, after the tent cities are razed and we’re back in our offices, we’ll remember the time we had where we came together and we’ll long for those time once again.
“There’s always next year,” some of us will say to ourselves, but we know it will never last forever.
Despite the good times we had round the hotel bar, in the ballroom or conference center board room, we realize that even the best of times must end and, ultimately, we pretend to know “it” (read: interoperability) could never work in the “real” world so we settle for and embrace the short-term relationships we’ve made knowing “we’re just not right for each other.”
Truth is, in the end, when the show is over, we’ll simply return to our silos and shut the door. Lights out, and once again we’ll be alone.
By the time the market is ready to move, the technology they’ve been told to move to won’t exist as it has been depicted.
This is much the same thing as technology that has been developed that upon its arrival has been pronounced dead. An example of this was the iPad. Before it hit the market analysts and naysayers said the technology – which I don’t have to tell you is essentially a hand-held, touch screen computer – was worthless. No one had a need for PC that one could carry about wherever they went; we had laptops after all. But they failed to see the upside.
For example, iPads are the ideal technology for busy physicians (as you well know) making rounds jumping from patient to patient throughout a practice, as well as have had a profound effect on the treatment and education of individuals with autism and other developmental disabilities.
For example, tablet devices have opened the door for children with special needs, many of whom use them easily and effectively. Not only have they become a learning tool for many of these children, they have also become communication devices. According to Mashable, students using an iPad advance more quickly than those who did not use them. Even in education, there are currently more than 2 million tablets, like iPads, being used and the number will increase dramatically as the technology becomes more accessible and affordable.
As of December 2012, there are more than 20,000 apps for mobile devices that teach communication, speech, language, motor skills, social skills, academic skills, behavioral skills and more than 900 apps for students with disabilities, including autism.
I believe something similar will happen to the patient portal market. Heavily pushed on physicians by EHR vendors for the last three years, this has led to their increased popularity. Meaningful use hasn’t hurt either.
However, by the time the market adjusts to their availability and the reasons for their existence – bill administration, appointment scheduling, viewing records (in some cases) and communicating securely with physicians – the technology as we now know it will no longer exist.
Monique Levy, vice president of research for Manhattan Research recently made an interesting point about the future use of patient portals and I think it’s hard to disagree with her: Today, patient portals are most commonly used for scheduling appointments, viewing medical results and sending messages to doctors or nurses, Levy says. But many more advanced features are not only possible, but are available and waiting to be implemented. This includes access to video chat with a healthcare professional, pre- or post-operative care instruction videos and consolidation of all of a patient’s medical data from multiple sources in one place.
For instance, mobile health technologies will feed patient data directly to the patient portal to improve care and treatment options.
In a lot of ways, this sounds a lot like a Hootsuite interface that used to collate and track all of our social media channels. For example, I can track my Twitter feeds and Facebook pages as well as can interact, post and broadcast content through it. Patient portals are likely moving in this direction and will end up being so much more than the base model systems currently being implemented.
Most likely, the standard bi-directional portals that current vendors produce are likely going to be passé in short order and new systems and interfaces are likely to crop up and take over the market, changing the landscape once again.
Simply stated, perhaps it’s best not to believe all that we’re being told. It may benefits us to think about where our decisions regarding technology investments take us.
To follow the belief that the stale portals of today will match what in the future will most likely be vibrant interfaces may be similar to denying the viability and importance of devices like tablet PCs in healthcare and beyond, though, many thought them worthless at the point of issue.
In a recent conversation with Steve Ferguson, vice president of Hello Health, he described how the company is identifying new revenue sources for practices while working to engage patients. Even though the company’s business model is one that sets it apart and helps it rival other free EHRs, like Practice Fusion, I left the conversation with him wondering why more venodrs weren’t trying the same thing as Hello Health: trying something no one in the market is trying to see, if by change, a little innovation helps pump some life into the HIT market.
Along the same lines, myself and thousands of others in HIT have wondered why systems are not interoperable and, for the most part, operate in silos that are unable to communicate with competing systems.
Certainly, there’s a case to be made for vendors protecting their footprints, and for growing them. In doing so, they like to keep their secrets close; it’s the a business environment after all and despite the number of conversations taking place by their PR folks, improving patient health outcomes comes in only second (or third) to making money.
However, let’s move closer to my point. Given the recent rumors that Cerner and McKesson are working on a joint agreement to enable cross-vendor, national health information exchange, I’m wondering: Why don’t other vendors partner now and begin to build interoperable systems.
According to the rumors, the deal, if completed, could shift the entire interoperable landscape for hospitals, physicians and patients. It would position Cerner, which has more EHR users, and McKesson, which has a strong HIE product in RelayHealth with a loyal user base, to take on Epic Systems, a leading EHR vendor.
An announcement is expected at HIMSS13.
Here’s why this is important news: Interoperability mandates are coming. Like most things, it’s really just a matter of time. Systems will be forced to communicate with other, competing systems. They should already. It’s actually a bit shocking that given the levels of reporting required of care givers, the push for access to information through initiatives like Blue Button and patient’s access to information through mobile technology that there’s not more openness in the market.
The Cerner/McKesson news is incredibly refreshing and worth a look. Two major competitors may be realizing that by partnering they’ll be better able to take on each company’s biggest competitor: Epic.
Imagine connected systems exchanging data. The thought alone would be marketable across several sectors of the healthcare landscape and the move worthy of reams of coverage, which would lead to great brand awareness for each and the change to do what all EHR companies aim for: To create thought leaders; to stand out; to set the market on its heels.
If nothing else the partner vendors would stand ahead of the pack when future interoperability mandates are enacted and will be seen as experts in the exchange game. Tongue and cheek aside, the idea really is a good one and with no one currently doing it, it’s a great opportunity for a couple of HIT companies to actually move change forward and create an environment where information can be easily exchanged across practices, across specialties and across borders.
Then, perhaps, we’ll see a real commitment to improved patient health outcomes rather than them simply trying to improve bottom lines.
According to a recent report issued by KLAS Research, “Patient Portals 2012: The Path of Least Resistance,” published by HIT Trends health systems and practices are turning to patient portals more than ever before. Meaningful use is an obvious reason, but convenience and “the ease of integration that comes from having an established relationship with an EHR vendor are the primary factors providers use to choose a patient portal.”
In light of the expanding need of patient portals, the KLAS study focused on solutions that providers use, and what role the portals play in the long-term strategies each organization for patient engagement. The report included respondents from a mix of health systems, hospitals, and clinics.
“Providers are feeling increased pressure to engage with their patients at deeper levels than ever before. About one-half of interviewed providers already had a portal in place, primarily from their current EHR vendor. Providers needing to connect a number of disparate EHRs were the only group more likely to opt for a best-of-breed solution.”
“The existing EHR vendor relationship appears to be more important than any other factor when choosing a patient portal,” said report author Mark Allphin. “While functionality and ease of use are important to providers, they take a backseat compared to providers’ desire to manage fewer vendors and interfaces.”
Although many providers are choosing to stay with incumbent EHR-based patient portals, KLAS did report significant interest and engagement with third-party vendors.
Access to the patient clinical record is the most implemented function. Other functions in place or planned include: appointment scheduling, provider messaging, bill pay, online registration and patient education.
Of those interviewed for the report, 57 percent of providers surveyed report a patient portal in place.
According to Michael Lake, publisher of the monthly healthcare IT newsletter, HIT Trends sums up the report this way: “Providers are putting patient portals in place to meet meaningful use requirements for access and messaging. Some are looking at kiosks and mobile solutions, too. In single EHR organizations, using portals from their current vendor makes tactical sense. Niche solutions may fare better when providers look at long-term strategies and required functionalities.”
From my perspective, and probably yours, serious portal conversations have taken place for about the last three years, and with the mandates of meaningful use, it was only a matter of time before they started to proliferate the market.
Even as practices look to engage their patients more, portals will likely be the first tool considered to do so. As the report suggests, the biggest question here may be whether to add a portal from your current vendor or to find a third-party solution.
Are you going through a portal implementation? What’s your strategy going to be?
Guest post byDaniel Castro, senior analyst with the Information Technology and Innovation Foundation.
Although we are only a month into it, 2013 is already shaping up to be an important year for health information technology (IT).
Two recent developments have increased pressure on the health care community to deliver results from government investments in health IT systems. First, concerns about the federal budget are causing policymakers to take a close look at programs with a large budget. As of July 2012, the U.S. Centers for Medicare and Medicaid Services (CMS) reports that the government has spent almost $6.6 billion in incentive payments for electronic health record (EHR) systems, and the amount of money spent on health IT will only continue to grow.
Second, policymakers are taking an extra critical look at any program that appears to be under performing. Whether fair or not, health IT will likely fit this profile as well because of recent concerns that have been raised about the effectiveness of some of these investments. In particular, earlier this month, the RAND Corporation released a report backtracking on its earlier assertion that health IT could save the United States more than $81 billion annually. This claim in the original RAND study played an important role in helping to quantify the potential impact of health IT for policymakers.
The authors of the latest RAND report have raised doubts about the accuracy of that prediction. More importantly, however, they have pointed to a number of factors that have contributed to the lower-than-expected performance of health IT in the United States. In particular, they argue that current performance is the result of slow adoption of health IT systems, the selection by health care providers of EHR systems that are not interoperable or easy to use, and the failure of health IT providers to adapt their processes to the technology.
Many of these problems were somewhat expected. For example, it is not too surprising that healthcare providers adopted systems that are not user friendly since those purchasing the systems are a relatively unsophisticated customer-base. We’ve seen the same type of problems in other areas of government. In the early-2000s, the Help America Vote Act gave out millions of dollars to state and local election officials to purchase new voting systems. Although there was (and is) a strong need to procure more sophisticated voting systems, many of these officials made poor decisions on what types of systems to purchase. We’ve seen the same type of problem in health care.
It is also not too surprising that healthcare providers are experiencing interoperability concerns since the federated, bottom-up approach to building health information exchanges does not properly incentivize data sharing or consumer access to data. The Department of Health and Human Services (HHS) has included some top-down mandates on meaningful use around these issues, but that is no replacement for consumer-driven competition. Still, while the United States may be taking the long route to data portability, at least projects like the VA’s “Blue Button” initiative to give consumers access to data are generally moving us in the right direction.
That is why, even with these minor setbacks, we should still have a positive outlook on the potential of health IT. True the RAND report is a bit discouraging, but it’s also come at an ideal time when healthcare practitioners and policymakers still have time to refine their efforts to implement the HITECH Act. After all, implementation is far from over and there is still time to have a course correction.
For example, HHS was tasked with defining three stages of meaningful use for EHR systems where each stage reflects an increase in complexity and utility. We have passed stage 1, where the criteria focused on capturing important data and reporting clinical quality measures, and we have moved into stage 2, which focuses on exchanging and transferring health information in different settings. The third stage, which focuses on improved outcomes, is not set to occur until 2016, so there is still time to get this right.
And the key to maximizing benefits is to encourage healthcare organizations to meet high performance metrics through the adoption of advanced technologies. A few years ago I co-authored a report on maximizing the benefits of IT. I wrote “Policymakers should recognize that IT is a means and not an end—it’s unreasonable to expect that simply using IT to perpetuate existing analog processes will lead to better solutions. Existing problems shouldn’t just be digitized; IT should be used to find new solutions to old problems.” These same words hold true today in healthcare where providers do not always understand that innovation takes a combination of people, process and technology.
This is why we need to be thinking long-term about how to maximize the benefits of health IT, not only in delivering more effective and efficient care, but also in rethinking how we use IT to innovate in healthcare. There are countless possibilities where IT can lead to radically new solutions in healthcare, from using IT to monitor health in the home to using health data for new types of medical research. But the reality is that we won’t get there unless we constantly evaluate where we are falling short and implement policies to address these problems so we can successfully move forward.
Daniel Castro is a senior analyst with the Information Technology and Innovation Foundation.
Guest post by Chris Giancola, principal consultant at CSC.
Looking into what’s ahead, 2013 will be another year of compliance activities dominating the healthcare landscape. Mandates on the industry, from both the ARRA and ACA, are fully underway and stretching the financial and intellectual resources of healthcare providers and insurers across the country. Here are three major compliance pressures facing the industry this year:
ICD-10 – Though the U.S. Office of Health and Human Services delayed the ICD-10 compliance deadline to October 2014, it did so back in August 2012. This early action by HHS acknowledges the enormous scope of the challenge facing providers, HIT vendors and insurers that stands to impact every administrative process and workflow. Far beyond simply recoding claims, any process involving a diagnosis will materially change because of the higher degree of clinical specificity described by the ICD-10 code set, such as obtaining referrals and lab tests for patients, providing clinical decision support and e-prescribing.
Insurers and providers also will face the challenge of understanding how the code changes may impact their bottom line by determining the financial neutrality of any potential change in diagnoses and payment for treatment of those conditions. Providers relying on vendors with fixed or appointment-style upgrade schedules should consider as early adoption as possible to reduce the potential negative impact of these changes. There also will also be a period of overlap where both ICD-9 and ICD-10 code sets will need to be supported by all participants involved, increasing the complexity of the problems looming on the horizon.
Organizations that are late on their remediation timelines will increasingly look for solutions, like selective outsourcing and alternative technical solutions that will allow them to minimize the implementation risk and operating costs of achieving necessary compliance. But, if the ANSI X12 4010 to 5010 conversion was any indicator, these alternative solutions will be offered at a premium price.
Meaningful Use Stage 2 – Stage 2 makes much of the optional menu set of objectives in Stage 1 a part of the mandatory core set, meaning that those providers who deferred as many of the optional objectives as possible now face challenges in Stage 2 they can no longer avoid. Also, in 2014, penalties for noncompliance with Stage 2 will begin to take effect, and so 2013 will be the year for many providers to buy or build new capabilities, such as web-based and device-accessible portals to satisfy patient engagement objectives and to change clinical workflows to meet Stage 2’s objectives and gather new mandated quality measures.
In Stage 2, Eligible Physicians (EPs) must complete 17 core and three of six menu objectives for a total of 20 objectives. Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) must complete 16 core and three of six menu objectives for a total of 19 objectives. Though Medicare or Medicaid incentive payments will offset some of the financial impact of implementing electronic health records, the impact to administrative and clinical staff, as well as to previously paper-based workflows, will be nontrivial.
Payment Reform – Many providers have already felt the financial impact of changes to their contracts with insurers that are implementing alternatives to the fee-for-service reimbursement models of the past. Bundled payments to providers for disease-state management will require higher degrees of care coordination and information sharing not only within delivery systems but across disparate organizations and affiliations.
Effectively managing referral networks will be a key success factor in the coming year. New payment contracts also typically require greater degrees of reporting to the insurer to ensure that quality of care is not being compromised, further increasing the burden on providers to gather, harmonize and report on clinical data previously written on paper or buried in unstructured text.
Compliance with these mandates, though not imposed by federal or state regulations, will grow to be a larger challenge as these new payment models mature and they represent a larger portion of providers’ revenue streams.
Chris Giancola is a principal consultant at technology consulting company CSC with a combination of technical skills, project and product management experience, business development successes, and healthcare domain expertise.
According to a recent report issued by KLAS Research, “Patient Portals 2012: The Path of Least Resistance,” published by HIT Trends health systems and practices are turning to patient portals more than ever before. Meaningful use is an obvious reason, but convenience and “the ease of integration that comes from having an established relationship with an EHR vendor are the primary factors providers use to choose a patient portal.”