On Best Practices

Looking ahead – the “new normal” post COVID-19

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It’s hard to think about anything good coming out of this pandemic. Every story of a life lost is heartbreaking. Like you, I have shed many tears in the past month as I read and heard their stories.

And yet, it is encouraging to consider some of the positive changes we may see when we get to the other side of this crisis and are living and working in the “new normal”. We don’t yet know when that new normal time will come. But there are changes in healthcare and how we work that will hopefully be long lasting. I’m not talking about the overall healthcare system or macro societal and economic changes – I’ll leave that to others.

From a health IT lens, here’s my take on some of the positive changes:

Telehealth – There is no question that this crisis has led to a huge increase in telehealth and new use cases. Some organizations are seeing 50+ times the number of telehealth visits compared to before. With regulations relaxed and no alternative, telehealth is being used in many different scenarios. Training, broad deployment and adoption has accelerated as clinic visits are cancelled and telehealth becomes the primary means to connect with your physician. And on the frontlines of COVID-19 hospital care, leveraging it with inpatients to protect staff and reduce the amount of PPE used has also become common. We’ve reached the tipping point for telehealth and I expect we’ll see it continue to grow in the future. A recent article in NEJM Catalyst by Judd E. Hollander, MD, and Frank D. Sites, MHA, BSN, RN, titled “The Transition from Reimagining to Recreating Health Care Is Now”, covers how organizations need to look at expanded telehealth use post COVID-19.

Rapid deployment – From an IT perspective, supporting the effort to stand up a field hospital or alternate care site such as the 1000 bed Boston Hope Medical Center is like a “greenfield” hospital compared to rolling out a new EHR and the associated infrastructure at an existing hospital. What lessons can be learned and applied from these rapid deployments when it comes to getting all hospitals in a healthcare system on a common platform? Does it have to take years?

Interoperability – I use this term loosely here. New York considers all hospitals statewide as one system to share resources and staff. The Hospital for Special Surgery (HSS) in New York City quickly transitioned from an orthopedic only hospital to take other surgical cases and COVID-19 patients, credentialing physicians and providing access to systems. While state and regional Health Information Exchanges (HIEs) have varied in their successes over the years and physician credentialing is one of the slowest and most tedious administrative processes in healthcare, it gives me hope to see how effectively and quickly hospitals are working together in a time of crisis.

Workflow changes – With EHR systems it can often take weeks or months to identify requirements, reach consensus, make the changes, test, train, and implement. Those changes are now measured in hours or days if it’s needed for COVID-19. IT teams and their clinical partners should ask what processes can be streamlined when we are in the new normal. Continue reading →

How daily life has changed

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Whether you live in a state with strict stay at home orders from your governor or are still going about your life with few adjustments other than social distancing and more frequent hand washing, your life has changed.

You may be an essential worker reporting to your workplace each day or adapting the best you can to working from home or fearing a layoff or already out of a job at this point.

You may have elder parents living with you or other family members with health issues that make them high risk.

Regardless, your life has changed. The fears, uncertainty, anger, sadness, exhaustion, confusion, and so many other emotions and feelings are real. We all have them.

Self-care is important for all of us. As a CIO/CMIO colleague keeps telling his team, it’s a marathon not a sprint. The image I used this week is one of my favorites shared on Facebook by Brooke Anderson, a photographer in California. It’s a good reminder of how we need to take care of ourselves..

Here’s what my daily life looks like now:

  • Staying at home: My husband and I haven’t been anywhere in 2 weeks except for when I picked up takeout at a local restaurant over a week ago.
  • Working from home: Splitting time between our StarBridge Advisors business and work with a health system client on a variety of projects.
  • Exercise: Walking our two little dogs and trying to get 10K steps each day keeping appropriate social distance with all the other walkers. There is a joy in seeing the spring flowers and buds on trees change each day – gives me hope!
  • Family connection: Talking to my sister in Minnesota where I grew up and where all my three siblings and their families live. Keeping in touch with my daughters and their changed lives. One daughter is a Nurse Practitioner who will soon be caring for COVID-19 patients while her husband adapts to working full-time from home and their 3 and 5-year-old kids play together. The other daughter was already working from home; her husband is adapting to working from home while their first grader is doing the eLearning school program and their 5-year-old plays.
  • Sharing resources: It’s hard to not be in the thick of it knowing what healthcare organizations are going through and how IT teams are working hard to support them. I’m channeling that energy into supporting Bill Russell and “This Week in Health IT” with a growing number of free COVID-19 resources for health IT teams.
  • Social media with a purpose: I try to share what is most informative and useful as well as positive and motivating.
  • Managing how much news I watch: On my busiest workdays I only watch at night. On more flexible days, I get snippets mid-day. In the spirit of being positive, I will say that the leadership demonstrated by New York Governor Andrew Cuomo is the leadership we need at all levels of government – fact based, informed, action oriented, and empathic.

And as the days blend together, the weekly routine now includes a couple new things. We gratefully receive grocery delivery that our nearby daughter has helped coordinate. We do a weekly family video call where the four grandkids stick their face right up to the camera and call out to their cousins then eventually go play so the six adults can talk and check in with each other. And we make a quiet moment to do Sunday online church which are YouTube messages from our ministers that we can watch anytime.

No matter what your days look like now, practice self-care. There are many resources out there to support you. The latest This Week in Health IT podcast – “Mental Wellness During Crisis” with Dana Udall PhD, Chief Clinical Officer at Ginger is definitely worth listening to.

Whatever you might fear or feel inconvenienced by during this pandemic, think about the healthcare workers who like firemen run into the burning building, not away from it. They are going to work so we can stay home. They and all the essential workers who are keeping things running are the true heroes. To them I say thank you, be safe and well. To all of you, take care of yourself and those you love. We will get through this – together.

COVID-19: Health IT collaboration and best practices

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We are an industry that shares best practices and continually learns from one another. As we all deal with uncharted territory, that sharing is needed more than ever before. In conversations with healthcare CIOs it

Message from Brigham and Women’s Hospital OR nurses: #StayHome

is obvious that the amount of work currently being undertaken by health IT teams is extraordinary.

In that spirit, this week I’m highlighting several resources that might be useful to health IT teams:

Through ThisWeekInHealthIT Bill Russell has produced valuable podcasts for health IT professionals for the past two years, interviewing healthcare executives and IT leaders across the country. Last week he pivoted to focus on COVID-19 with two new services:

COVID-19 Resources is a page dedicated to COVID-19 resources during this time. It’s a resource site for health IT teams when they are asked to stand up a relevant technology or implement a technology enabled process. Visit the page now to see what’s already been shared. And you can help him help others. Just forward any resources for health IT that you are willing to share to Bill at hello@ThisWeekinHealthIT.com

Podcast interviews with health IT leaders on the front lines of the pandemic who are willing to share some of their preparedness challenges, lessons and best practices:

COVID-19 Prep with Baptist Health KY

  • Standing on the lessons of the past
  • Protecting the care providers during COVID-19

COVID-19 Prep with Asante Health OR

  • Establishing communication in crisis
  • Preparedness huddles
  • Prioritization of IT work
  • Leadership skills needed

Continue reading →

Healthcare providers on the front lines of Covid-19

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In my blog last week, I consciously decided to avoid the Covid-19 topic. The situation was evolving day to day and I asked myself what useful insights or comments I could possibly have.

Just 11 days ago, the cancellation of HIMSS20 conference was announced. Many of us were hoping for this as we worried about being in a convention center with 45,000 people from not just around the country but around the world. With the cancellations of major sports, Broadway, closure of Disney, limits on the size of large gatherings, and school closings, the times have changed drastically in a matter of days.

We are being encouraged to practice “social distancing”. People who can are working from home.

But hospitals remain open for business as they must. Our nurses and doctors are on the front lines. IT teams and all the hospital staff who support the clinicians are doing what is necessary to ensure that they can deliver care.

While all healthcare organizations have emergency preparedness plans in place for a variety of incidents, this is uncharted territory that tests the limits of those plans. There will be much to learn and share when we get to the other side of it. But in the spirit of we’re all in this together and the culture of sharing best practices we have in healthcare, here are a few links that might be of value in the days ahead.

UW Medicine CIO’s advice: Prepping IT systems for COVID-19 – by Eric J. Neil published in Health IT News, March 12. UW Medicine was one of the first health systems on the front lines of the pandemic in the U.S. Their insight and advice are invaluable to IT leaders around the country.

While you may question the value of Twitter, it is yet another forum where lessons are being shared from the front lines. Dr. Kira Newman has worked in the ICU in Seattle the past week and posted a 10 part thread:

In one part Dr. Newman provided the link to their Covid-19 Resource Site for other hospitals to use.

17 Coronavirus (Covid-19) Actions for Healthcare CIOs – by John Lynn in Healthcare IT Today, March 11. John is continuing to collect info from IT leaders and will share as he does.

Healthcare IT News is maintaining a list of trusted resources that can be found here: Key resources to keep track of the coronavirus pandemic.

Most of my readers probably work in healthcare organizations and fully understand the magnitude of this pandemic. For those of you who don’t and need some convincing, remember that science and math do matter. Here are two of the best articles I’ve seen:

Why Outbreaks Like Coronavirus Spread Exponentially and How to Flatten the Curve – by Harry Stevens in the Washington Post, March 14.

Coronavirus: Why You Must Act Now – Politicians, Community Leaders and Business Leaders: What Should You Do and When? – Tomas Pueyo, first written March 10 and updated on March 13. The author closed with this message: “This is probably the one time in the last decade that sharing an article might save lives. They need to understand this to avert a catastrophe. The moment to act is now.” So, I share with all of you.

And if working from home is new to you, here’s a good resource to check out:

Work in the time of Corona – a blog by Alice Goldfuss on March 11th.

My paternal grandfather died in the 1918 flu pandemic. He was young but married with three small children. My father and uncle were sent to an orphanage and my grandmother and aunt went to live with friends. Yes, it’s not 1918. Healthcare has advanced significantly. But we are an even more global and mobile society. The most important lesson from 1918 is the impact of social distancing which is shown in this graph:

In closing, I want to express a huge thank you to all who work in healthcare. The strain on our healthcare system is real. The stress on our healthcare workers is real. Let’s all do our part to #SlowTheSpread and #FlattenTheCurve.

Practicing SODOTO with a new system

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I know that “see one, do one, teach one” is common in the training of medical professionals. But until I googled it, I didn’t realize it was a known method with an acronym – SODOTO.

With our new implementation of Salesforce at StarBridge Advisors, I am in the SODOTO mode. We are a small team. We recently hired a consultant to help us get it configured and designed the way we need it. My mantra as I worked with the consultant was KISS – keep it simple.

We are in the training, practice, and start to use it everyday phase. While we have a ways to go on data cleanup from our previous version, the new system is in production.

I’ve watched several short videos on how to create lists, reports and dashboards – literally “see one”. Then I made time to set up a few of each before I forgot what I’d just learned – the “do one” part. I think that would be considered “just in time” learning. I will show my colleagues how to do the same encouraging them to watch the videos as well – the “teach one” part. I still need to watch some videos on key features we may want to use so I can advise our team and make decisions together as we optimize the system.

Granted, our system is very small scale compared to the major EHR and ERP implementations I’ve overseen at many healthcare organizations. But here are my key takeaways applicable to any new system implementation:

  • Out of the box – Another way of saying don’t customize unless you really can’t work with the standard system.
  • Decision making – Key stakeholders need to be part of design decisions to ensure all use cases and workflows are identified and there is buy-in and adoption once the system is up and running.
  • Minimum data fields – Between what is available “out of the box” and custom fields you might think you need, be cautious. You can always add something later if you need it.
  • Workflow – Consider all your common use cases and basic workflows to design a simple, streamlined system that meets your unique needs.
  • Reports and dashboards – Data fields and workflows are too often the primary focus, but you need to be able to get the data out of the system in a usable format.
  • Adoption and consistent use – With any new system, all users need to understand what’s expected of them.

Major system implementations typically have optimization phases post go live. As much as the project team tries to account for everything, there are always changes requested once users start to actually use the system. It’s fair to say that I’ll be working with our own small-scale optimization phase of Salesforce in the next few weeks.

Related post:

Something new every day

 

It’s handoff time again

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This week I will do a handoff to the new Chief Technology Officer (CTO) at the University of Vermont Health Network (UVMHN), Seth Maynard. I’ve been serving as interim CTO since late May of last year. Seth recently served as CTO at Yale New Haven Health System and is ready to take over from me. We have already had several transition conversations, but we have plenty more to cover in the coming days as part of the handoff.

Anyone who has relocated to join an organization at a senior management level knows there is much to learn. It’s a new market, a new organization, a new set of leaders, a new team, a new culture, a new set of projects, and new issues. Yes, there is much similarity between health care organizations, and you have your experience and knowledge to draw on from the past. But the learning curve in a new organization is still a steep one.

My overarching goal for this week is like my previous interim to permanent handoffs – provide as smooth and comprehensive a handoff as possible. Ultimately, I’m there to ensure the permanent leader gets off to a good start and is successful. That means:

  • Sharing background information that is most critical and useful passing along as much needed knowledge and insight as possible
  • Conducting the meetings that are a critical part of the handoff including focused time with the management team, an introduction at the monthly all staff meeting, as well as initial discussions with key partner departments
  • Ensuring that together we don’t miss a beat on current issues that need leadership direction
  • Stepping back and letting the new leader start making decisions and address issues providing support as needed

When I started this interim, Continue reading →

Struggling to get (or stay) organized? You are not alone

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When I wrote my “Value of podcasts for professional development” blog a few weeks ago, I asked readers for their favorites podcasts. One of my directors at UVMHN suggested the GTD podcast series. I’ve known since I met Greg Van Buren at the start of this interim CTO engagement back in May that he was a big fan and proponent of the Getting Things Done (GTD) approach from David Allen. I told Greg early on that I’d like to take some time to learn how he applies it in his work.

There are many personal productivity systems and methodologies out there. I’m familiar with GTD concepts but have never really gone deep with it. So why not learn from someone who has? After all, what’s not attractive about the idea of “stress free productivity”?

Greg is paperless from all appearances – how he shows up at meetings and in his office. He uses a mobile device to capture all his notes and to dos. If he does momentarily have paper with handwritten notes, he scans it and copies it into the appropriate note for future reference. And as I have more recently seen he appears to have mastered an organization system for all his notes and tasks within OneNote.

After listening to a few GTD podcasts, I realized again that none of this is rocket science. It’s basic organization of your ideas and work at all levels – from the macro long term goals, to the house and family tasks of today and everything in between. And I realize that I could make a lot of adjustments to improve how I work. That sounds better than saying I’ve realized I’m out of control! Continue reading →

Value of podcasts for professional development

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The start of a new year is often a time to establish or renew professional and personal goals. There are common myths that it takes 21 days to form a new habit though researchers who have studied this say it could take from 2 to 8 months to build a new behavior into your life. The end of January marks the first 30 days of the new year. I’m not going to ask how you are doing with your gym goals and whether you are on the road to changing your behaviors about regular workouts. Rather, I’ll ask you if you have a professional development goal for this year.

With tight budgets and busy schedules, finding time to fulfill professional development goals can be challenging. You may or may not be able to get to a training program or conference. And finding time to read publications or electronic newsletters may be wishful thinking given how much work email and reading you already have to do.

I highly recommend the practice of listening to podcasts as part of your ongoing professional development and learning. You can even mix it in with your workout goal. Listening to a 20-30 minute podcast while working out, walking the dog, or on your daily commute is easy and it’s free!

I have subscribed to many different podcasts but my “go to” in order to learn from health IT industry influencers and keep up on industry news and analysis is “This Week in Health IT”, launched by Bill Russell two years ago. Bill has served on executive teams in healthcare, higher education and Fortune 500 consulting practices including serving as Chief Information Officer for St. Joseph Health, a 16 hospital $5 billion system, for nearly five years.

With his podcast series, Bill uses his extensive experience to help leaders, innovators and organizations share their stories in a conversational style to capture the wisdom of the industry and share it with his listeners.

After a successful year one of his weekly podcast, Bill listened to his audience and greatly expanded his offerings. Continue reading →

Major implementations need experienced leadership

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What CIO hasn’t worried about a major EHR or ERP go live? Despite the years of work by your dedicated and talented team alongside your software vendor and possibly an implementation partner consulting firm, you still worry. The Go Live Readiness Assessments (GLRA) at 30-60-90 days have level set all involved on what is complete/ready, what is on track to complete, and what needs help.

It’s that last piece – what needs help or is significantly behind schedule – in bright red on the status report that requires attention. There could be many reasons it’s red, but bottom line it is red. Do you have enough of the right resources and enough time to get it done? Do you have to adjust scope? Do you have to put more money into it? You certainly don’t want to sacrifice quality. And with the scale and complexity of most major implementations, you don’t want to move the go live date. Any good project manager knows that those are the only four levers you have – scope, quality, money, and schedule.

Everyone who has done this before tells you that there will be some yellow and red areas yet at the 30-day GLRA. But they should be minimal and able to be addressed in time for the go live.

If you have a major implementation in 2020 and don’t have an implementation partner or lack full, unbiased confidence in your implementation partner, you might consider a little more help in those final 90-120 days. And not just more staff resources. As the CIO, you may need to bring in an experienced senior IT leader who can assist you by doing a quick project review and risk assessment. Someone who can identify the key areas you need to focus on and if needed bring the expertise and leadership to address them in time for a successful go live. Someone who, at a modest cost, will help you sleep better at night.

At StarBridge Advisors, we have a team of senior IT leaders serving as advisors who have significant experience leading successful implementations in all sizes and types of healthcare organizations. We know what can go wrong and how to avoid it. We know what it takes to be successful. And we will tell it to you straight. Our approach is practical, unbiased, open, and plain speaking. We offer you frank and honest opinions based on real-world experience.

If you have a major implementation in 2020 that you are worried about, let’s talk.

Related Posts:

Plans, processes, people: lessons from a successful EHR implementation

Epic Go Live – report from the field

9 Tips for Go Live support success

10 best practices for project success

10 Go Live Command Center lessons from the field

Crunch time and why IT matters

Most popular blogs in 2019

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It’s the new year and time for top 10 lists and countdowns so I’m adding mine to the mix. These are my most read blog posts in 2019. If you missed any of them first time around now is your chance to check them out.

I am a practitioner and always willing to share experiences pulling lessons from everything that I do. I continue to cover a range of topics from leadership to women and work to technology and healthcare. It looks like my readers appreciate the variety. Here are the top 10 as measured by total views:

A passion for health care – a classic one from previous years about why we do what we do

6 tips for successful huddle boards – another classic from previous years that doesn’t go out of style

“We’re at meeting norms” – this one is about best practices I learned from my IT colleagues during my interim CTO engagement at University of Vermont Health Network (UVMHN) this past year.

10 best practices for project success – another one from my experience at UVMHN as we approached the November Epic Go Live.

Where do new ideas come from? – another back to the classics from a previous year.

Develop women leaders, transform leadership – at StarBridge Advisors, we launched a new service early in 2019 call C-Change focused on developing women leaders in health IT. Continue reading →