In just the past few weeks, we saw several major healthcare merger announcements – Dignity and CHI, Advocate and Aurora, Ascension and Providence St. Joseph Health on the provider side. And then there’s CVS Health and Aetna – a potential disruptor in the healthcare market. And we don’t yet know what other market disruptors like Amazon or Google might do in the healthcare space.
There have been predictions in recent years that eventually there would be just 10-15 major healthcare systems in the U.S. Are we on our way to that prediction with the latest merger announcements? The combined Advocate and Aurora system would create a 27-hospital healthcare system in Wisconsin and Illinois with projected annual revenue of $11 billion. The Dignity and CHI merger would include 139 hospitals in 28 states. If Ascension and Providence St. Joseph Health merge they would create the largest hospital chain with 191 hospitals in 27 states and annual revenue of $44.8 billion.
What is driving these mega mergers? The announcements about them talk about improved access to care, improved outcomes, lower costs, sharing best practices and overall being more prepared for success in the changing healthcare market and landscape.
Jane Sarsohn-Kahn, health economist, wrote a great piece earlier this month – “Will Getting Bigger Make Hospitals Get Better?”. She talked about the value that matters to patients — the trust that is needed between hospitals and patients.
And what are the IT implications of these mergers? If markets don’t really overlap, what degree of system integration is needed? Is one seamless patient record needed as it is for large regional systems with a lot of patient movement between community hospitals and specialists at academic medical centers? Continue reading
This week, I participated in another HIMSS Analytics Acute Care EMRAM Stage 7 review team as the CIO reviewer. During the opening presentations by the organization’s leadership, I leaned over to the
full-time HIMSS reviewer to say, “They are hitting it out of the ballpark”. By the end of the day, our three-person review team had indeed reached that conclusion. The full-time reviewer said, “Some organizations barely clear the bar but this one far exceeded it.”
Only 6.1% of hospitals have achieved Stage 7. What does it take?
On review day, the review team is presented with information that includes a system overview, including governance, clinical and business intelligence, health information exchange, and plans for disaster recovery and business continuity.
The review team has been given a 17-page document that includes checklists for each major clinical area.
Several case studies are presented that demonstrate how the organization has used the system to improve clinical care.
The organization prepares for this visit for months, developing the case studies and verifying they have met every specific criterion. The full-time reviewer spends time on the phone reviewing their readiness.
Achieving Stage 7 takes teamwork throughout the organization to fully leverage all aspects of the vendor’s product. It takes engagement and passion from executives and clinicians.
The organization we were reviewing implemented their EMR according to these guiding principles: Continue reading
We have watched with sadness as Hurricane Harvey has flooded first southeast Texas and now Louisiana. We have seen the spirit of the American people at its best. Volunteers from around the country have brought their own boats to rescue residents while thousands have donated money and supplies. As of Thursday morning, there had been over 25,000 water rescues.
Hospitals are meant to operate and care for patients 24/7 through a disaster. But they too were impacted by the rising waters. I took a break mid-day yesterday to watch the news. I saw in that 15-minutes the evacuation of patients from Baptist Hospital in Beaumont, Texas after the city lost its water supply. Without clean water, the hospital had to close and transfer 190 patients.
Patients, many in wheelchairs, needing dialysis treatment were being boarded onto Black Hawk helicopters by teams of doctors and nurses. They were being handed over to military medics to be flown to a hospital in Jasper, Texas – 70 miles away.
The last step in the transfer process was a clinician giving a folded-up paper to the medic. She had stuffed it under her shirt until that point so it didn’t blow away in the wind from the helicopter propellers. We know that this critical paper handoff probably happened over and over this week as patients were transferred to other facilities.
In this age of electronic medical records (EMRs) and health information exchanges (HIEs), we hope that piece of paper is a backup document. Transfers within a health system with a common EMR should be able to rely on the system for access to critical patient information. Health systems that participate in HIEs should be able to rely on some level of data exchange and access between health systems and their disparate EMRs.
I was encouraged to see two health IT articles this week – “As Harvey Devastates Houston, HIE Leaders Move in to Help” in Healthcare Informatics, and “What’s Next for Health Information Exchanges?” in Healthcare IT News. The first article describes the power of the HIE in Texas; portals have been set up in the many shelters so clinicians can access critical health information as they care for people in need of medical attention. The second article talks about the future needs that HIEs could meet and their potential benefits as healthcare continues to evolve. Continue reading
What is a “frenemy”? According to Dictionary.com: “person or group that is friendly toward another because the relationship brings benefits, but harbors feelings of resentment or rivalry”.
Within health care organizations, there is a lot of history between the people who support the medical devices that touch patients and those who support the information systems used by clinicians. It has not always been positive and collaborative. In fact, there are such differences in the culture of each group that they don’t always get along. Maybe they are even “frenemies” in some organizations.
In your hospital, you may know the function as Biomedical Engineering, Biomed, Clinical Engineering or Health Technology Management (HTM) as it is now called as part of elevating the profession within healthcare. Those in the field now refer to themselves as “HTMs”.
AAMI (Association for the Advancement of Medical Instrumentation) is a standards development organization and the professional society for HTMs. AAMI is celebrating its 50th anniversary this year. Its mission is to advance safety in healthcare technology.
Four years ago, I was the first CIO ever to be elected to the AAMI board when AAMI leaders recognized the trend towards HTM and IT convergence and integration. I have provided the IT perspective to the AAMI board as the HTM profession continues to evolve. Continue reading
I recently participated as the CIO reviewer on a HIMSS Analytics Stage 7 validation. The long travel to the West Coast aside, I was happy to contribute my time and expertise to be exposed to an advanced
Source: HIMSS Analytics
organization and to meet a wonderful group of leaders. The review team also included a Chief Medical Information Officer and the HIMSS Analytics Regional Director for North America.
As of the 3rd quarter this year, only 4.6% of hospitals have achieved Stage 7 while 30.5% have achieved Stage 6. Just over a third of hospitals are currently at Stage 5.
All three hospitals I’ve served as CIO have achieved Stage 6. Getting from Stage 6 to 7 is a significant leap. There is a greater focus on analytics and using the data from the electronic health record to improve patient outcomes.
From the HIMSS Analytics website, here is how Stage 7 is described: Continue reading
This past weekend we did another major upgrade – this time the ambulatory EMR. It went extremely well and was met with smiles and kudos from our senior executives. While we’ve done several major upgrades recently including revenue cycle and acute EMR, this one had a lot of eyes on it. Those same senior executives have been rightly concerned about the performance of our ambulatory EMR while we worked through some significant issues during the past several months, including software, hardware and infrastructure. So, kudos to the team that turned the corner on those issues and pulled off a very successful upgrade with minimal issues and disruption to our physician providers and operational practice teams.
We called our 200+ physician practices before the upgrade to make sure they felt prepared. A few actually said “what upgrade?”. Apparently they had not read the any of the advance communications. So we worked with each of them to make sure they were ready.
The command center was open all week and will close early today as we have fewer and fewer calls. Over 62% of the reported issues had been resolved as of late yesterday. Our users gained a lot of new functions and features which has made everyone happy.
In addition to a strong and collaborative relationship with your vendor, here are some critical success factors for any major software upgrade: Continue reading
In August 2014, I posted “Beyond the core Electronic Health Record” about our primary integrated vendor strategy at UMHS. We have already implemented the core suite of products from Epic. We continue to be committed to this strategy and it continues to serve us well.
We are in what we call MiChart Stage 4 which includes radiology, home care, and part of cardiology. We had agreed that anesthesiology and transplant would be in a future stage. As we plan for those future stages, we’re also considering ambulatory pharmacy, care management, infection control and other specialty areas.
Outside these major stages, there are ongoing needs to support strategic initiatives in capacity management, patient engagement and telehealth. We are planning for the Bed Management module to replace an existing third party product, Bedside in the hospitals that don’t already have a solution, and telehealth functions.
We are also discussing another critical area where Epic is building out functionality. Continue reading
I spent the better part of a day this week at the annual meeting of the Epic Michigan Users Group (we call it eMUG). But I don’t want to focus on Epic. I want to talk about the value of learning from your peers. It could be any vendor or any user group.
This was our fourth annual eMUG conference. Given space limitations, we had 200 attendees last year and with the venue this year we were able to accommodate 400, a significant increase. With 11 health systems in Michigan on Epic, that’s a good size group from each organization.
When asked for a show of hands on how many had been to Epic’s national user group meeting (UGM) before, only 25-30% of the attendees raised their hands. Local user group meetings like eMUG give many more staff a chance to attend and connect with their peers. National user group meetings are costly with airline and hotel expenses for a couple days.
This eMUG meeting was a content rich day: Continue reading
We make all kinds of decisions every day. Some are small yet seem difficult at the time. One I sometimes joke about is ordering off a restaurant menu that has too many good choices. When I finally make my order, I tell the server that I have made my “major life decision” for the night.
Sometimes a group makes a decision after weeks or months of lengthy deliberation: many groups have weighed in, expressed their concerns, asked their questions, refined the plan or recommendation, and only then ultimately provided their support.
And then there are the potentially very impactful decisions that must be made in a matter of minutes with the best information you have available after a very quick weighing of the risks. I had to make one of those decisions last Friday.
We had scheduled our Epic version 2014 upgrade for the weekend. The plan was to bring down the production system at 12:30 AM Saturday. The system would be down until 5:00 AM while the final conversion tasks were completed. IT and operations staff were scheduled in the command center to monitor the upgrade and address any problems. Leadership calls were scheduled daily to review issues starting Saturday.
At 11:51 AM on Friday, I got a text Continue reading
I had the opportunity to talk about lessons learned from EHR implementations as part of the faculty for the “Leadership Strategies for Information Technology in Health Care” course at the Harvard School of Public Health (HSPH) last week. And yes, I was fortunate to make it in and out of Boston between snowstorms for the one day I was there.
The course is part of Executive and Continuing Professional Education at HSPH. It is a two week course with 4 modules. The first week covers Module 1 on IT Strategy and Governance and Module 2 on the EHR.
The faculty lineup for the first week is impressive. John Glaser, CEO Health Services at Siemens Healthcare and former CIO at Partners HealthCare System, lectured on “IT Strategy Considerations.” John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston covered “The National Perspective and IT in the Era of Health Care Reform.” Vi Shaffer, Research Vice President and Global Industry Services Director at Gartner, provided an “Overview of the IT Industry.” Meg Aranow, Senior Research Director and Health Care IT Advisor at The Advisory Board Company, discussed analytics. New care models including telehealth, retail clinics, and accountable care organizations were also covered by various faculty members. Mary Finlay, Professor Simmons School of Management and former Deputy CIO at Partners, discussed IT Governance. Mary is the program director for the course and does a terrific job.
Students come from various roles in health care. The course has also become well known internationally at this point – with about 30% from other countries. For this session some students came from as far away as Australia and India.
I was happy to be part of the faculty and get a chance to hear a few other lectures that day as well as interact with the students over lunch. Here are some of the EHR implementation lessons I shared in my talk:
- The CIO and executive leadership in health care organizations have many priority initiatives at any given time. The EHR implementation will become a primary focus, especially as it gets closer to the go live date. As the CIO, you need to know where and when to be deeply involved vs. maintaining an overall awareness of the project’s progress, being ready to address issues as they are escalated.
- Engaged executive sponsors are needed throughout the life of the project. If the CIO is the only one worrying about the project, there’s something wrong. At the same time, the CIO should avoid saying “it is not an IT project”. To be successful, it has to be a true partnership between clinicians, operations, and IT.
- An EHR implementation has a significant impact on your entire organization and all staff members. A robust change management program is critical given the multi-disciplinary effort that EHRs require.
- Many decisions get made through the life of the project. Establish early on very clear decision rights. Know which group makes what decisions and define the escalation path when issues can’t get resolved at lower levels of the project governance structure.
- Your plan should include a “Go Live Readiness Assessment” at 120, 90, 60 and 30 days prior to go live. All teams are expected to report out their progress and open issues in detail. Project leadership then creates a readiness scorecard. This allows leadership to focus on the areas that are behind schedule and address issues to ensure an on-time, successful go live.
- Contingency planning needs to be part of the overall plan. Any major system implementation needs a back-out plan if something goes wrong. But you also need to account for the operational impact. You can’t stop the flow of patients into the emergency room but do you reduce your surgical or clinic schedules? Each organization has to determine what’s right for them. And then there’s the unrelated and unanticipated crisis that you have no control over – it could be a major facility issue like a power outage, a weather incident like the snowstorms we’ve seen the past few weeks, or a mass casualty incident in your area. Be sure to include your organization’s emergency management team in your activation and contingency planning.
- At go live, it’s all hands on deck in the command center and throughout the organization. Everyone has their specific roles. Leaders need to be present. The CIO may not be running the project but maintains a very visible presence in and around the command center. It’s a 24/7 operation for the first few weeks after go live. And be sure to round – find out how things are going for front-line staff and thank them for their work.
- Once the system is up and running, you have to recognize that optimization is ongoing. Don’t minimize the requests. Listen carefully to your users. At the same time, manage expectations about how much will get done and by when. Help shape the message. Multiple communications channels are important. Structured processes for intake of requests and a formal prioritization process with agreed upon criteria are critical. While optimization for your organization and the unique workflows is needed, don’t get stuck there. Learn from others how they have leveraged the product. Reach out to your colleagues and learn from them. Many have gone before you at this point.
And when you’re ready, be sure to share your own lessons with others.
Harvard School of Public Health’s Executive and Continuing Professional Education program, “Leadership Strategies for Information Technology in Health Care”
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