What keeps you up at night – the wrong question

What do healthcare CIOs have in common as they start off 2018? And how can they get the additional bandwidth they need to achieve all their objectives?canstockphoto13538474 question

When I talk with CIOs. I want to understand their current priorities and challenges. Our team of advisors at StarBridge Advisors can be an extender for a CIO – partnering with them to accomplish key initiatives that they or their leadership team don’t have the time to do.

When I meet with CIOs that I don’t know or who serve organizations I’m not familiar with, I try to get as much background in advance as I can.  It’s easy to do these days. You look at the organization’s website, press releases, and online profiles of individuals and their career history. When I was a CIO, I remember when new vendors would call on me and they’d eerily seem to know a lot about me. I realize now that they were just doing their basic homework.

But as consultants, we don’t know until we talk with a CIO what their priorities and areas of need are.

I stay away from that standard question I heard so many times as a CIO – what keeps you up at night? I like to just sit down with a CIO and learn about their agenda and challenges. Through dialog we can mutually identify potential gaps that StarBridge Advisors might fill.

Based on recent conversations with several CIOs, there are common themes. Are they AI, machine learning, or blockchain? Continue reading

The other end of the highway

This morning I was looking out my window at a new 3 inches snowfall while making conference calls. Tonight, I’m driving past palm trees. This afternoon I was on I-95 driving to the Providence airport for a canstockphoto25609566 (002) highwayflight to see a new client. Tonight, I’m exiting a Florida airport in a rental car and merging onto I-95 heading south.

With google maps piped through the car rental audio, I am confident I will get to the hotel 50 minutes away. I have done all the initial lane changes and merging, so now I’ve got a 19 mile stretch before the next turn. It’s safe to call home on speed dial and chat with my husband. I do the ritual “woe is me” that my flight was delayed, the airport was busier than I expected, and there was a long wait for the car rental center shuttle. But I’m finally on the road to my hotel much later than expected and very hungry. I am aware that these all are first world problems.

We have the “I’m still on I-95 but with palm trees” conversation. When I exit I-95, it is crystal clear that I am 1,500 miles south of the I-95 I’m used to. The “lady” in the car audio is telling me to merge onto Dolphin Expressway. No road in Rhode Island is called Dolphin Expressway!

I dislike busy unfamiliar expressways, driving at night (especially with lane changes) and driving in the rain (in that order). Fortunately, this was only 2 of the 3 – it was dry, with no rain (or snow). In these situations, lane management is critical, and the navigator system can only help so much. And good signage is critical or as my daughter says, “use your eyes”.

What does this have to do with healthcare and IT? Continue reading

Merger mania – is it good for the patient?

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’scanstockphoto18678854 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

HIMSS Stage 7: what does it take?

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 theHIMSS EMRAM 2018

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

HIEs matter

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 countrycanstockphoto30688369 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

8 tips for telehealth success

Telehealth or connected health as some call it, takes different forms depending on the provider organization and their strategy. The primary driver may be extending geographic reach by providing canstockphoto40754495telehealth services to rural areas. Or it may be largely a focus on consumer engagement.

Regardless, there are common themes for successful initiatives. Based on my experience in several healthcare systems in recent years, I offer these tips for success:

Strategy is key – The organization must first determine what the key drivers are for the initiative. Is it to extend reach or provide an easier patient experience or a combination?

Tactics and specific programs will follow – Once the strategy is clear, which specific clinical services and offerings are needed the most will become clear.

Physician leadership is needed – If the focus is on extending reach of certain clinical services, physicians are at the center and must provide overall direction. For consumer-focused services, ambulatory services or strategic planning leadership may play a more central role.

Operational issues and decisions must be considered early on – There are legal and billing factors along with workflow issues for clinicians and staff to work out before any implementation. Continue reading

HTM and IT: frenemies or collaborators?

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”.canstockphoto5722510

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

Walking in a nurse’s shoes

National Nurse Week begins tomorrow. I’m fresh off a 4-hour shift shadowing a nurse on a busy inpatient unit with cardiac surgery patients. I was taking part in the “Walk in My Shoes” program at Stony Brook Sue in scrubs cropped (2)Medicine where I currently serve as interim CIO.

All the executives were asked to block out 4 hours this week to shadow a nurse. I looked forward to my shift despite the other work on my desk. And as I told the nurse I shadowed, spending time on their unit was more fun than some of the problems I deal with as a CIO.

But I wasn’t there to have fun. I was there to understand what a nurse’s day is like and find ways that administration can help. And as the CIO, I wanted to understand how they use the systems we support and to find opportunities to improve them.

I donned a pair of scrubs, the universal hospital uniform and a fashion neutralizer. It’s amazing how different it feels to be on a nursing unit in scrubs compared to being a “suit” who periodically does rounds with a bunch of other “suits”. The staff seemed more willing to just tell it like it is when I encouraged them to be candid with me.

As soon as got to the unit a nurse realized I was from IT. His first thought was that I was there about a system problem that had been reported in the patient safety system. I introduced myself and my role as interim CIO. I told him that while I was there to shadow another nurse, I wanted to hear about their IT issues.  This was my “gemba” walk with a group of nurses. Continue reading

What to expect from your vendors

You are past the big go live. You and your team are focused on optimization, enhancements, ongoing support issues, and upgrades. So, what should you expect from your vendor in this ongoing relationship?canstockphoto10856287

I have worked with all the major EHR players and many other IT application and infrastructure vendors over the years. I have worked with three of the major EHR vendors just in the last 18 months given my interim CIO engagements.

My post “Keys to successful vendor management“ covered the importance of the product roadmap, service, total cost of ownership, reputation, contract, implementation, and escalation.

It’s time to look at the ongoing vendor relationship that clients should expect. Vendors, take note. I assume most of your clients would share this view. There’s a reason that the KLAS Research reports carry a lot of weight for CIOs, they are vendor evaluations from their peers.

Whether it is a large, proven vendor or a small start-up, here’s what you should expect: Continue reading

Aspiring to Stage 7

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

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