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

What upgrade?

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 canstockphoto13469755recently 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

The journey continues

What better time than year end to reflect on our collective progress as an IT team. You will see a lot of “top 10” type stories in December – top trends, breakthroughs, stories, and even top predictions for the coming year. I’ll leave those to people with far more time to research and write. What I’d like to share is the progress my incredible IT team has made in partnership with our many internal customers at UMHS in 2015. These are common journeys for health care CIOs around the country. Continue reading

Evolving into the future

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