On EHRs

The power of your network and learning from others

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Healthcare is one of the most collaborative industries I know. Granted, my entire professional career has been in health IT so maybe that’s a bold but uninformed statement. Healthcare organizations are very canstockphoto12450988 (1) networkingopen, transparent and willing to learn from one another. Whether it’s sharing best practices, hosting site visits, or the many collaborative groups that leaders participate in, we are constantly learning from one another.

Our upcoming Epic go live at the University of Vermont Health Network is no exception. Of course, we rely on the experience that our implementation partner and vendors have had at other similar organizations. That’s why organizations utilize their services.

But there’s also the professional networks that we develop and nurture over the years to draw on. When our CIO, Adam Buckley, asked me to look at an area that he was concerned about as we approach the go live, I did what I do. First, learn from the people doing the work and find out their concerns and what they think we need to do to ensure success. Then, turn to colleagues who have gone before us.

While I wasn’t close to this specific area when I was CIO at University of Michigan Hospitals and Health Centers and we implemented Epic, I knew I could talk to someone who was. I reached out to my CIO successor and one of the executive directors there to get a contact to talk to. Within an afternoon I had gotten a good sense from them of how they handled that function and insights from colleagues at two other large healthcare organizations. And then a follow-up call to drill down further with someone who manages the function. That’s the power of having a strong network and being able to learn from others. I owe them one! Continue reading →

12 tips for effective vendor management

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An EHR implementation involves more than just the EHR vendor. As we approach the November 1st Epic go live at the University of Vermont Health Network, the interfaces and interdependencies with other canstockphoto26237556 (1) VRMvendors become more critical. As we review issues and risks that need executive level attention, multiple vendors are involved. Whether it’s ensuring their system implementation and interfaces are ready on or in advance of November 1st, or it’s a product that we already use that just needs to work in a new environment, we are counting on them to share our sense of urgency and deliver as expected.

As I assist with some of these vendor relationships and escalations, I’m drawing on many years of experience with IT vendors – both software and infrastructure. We are fortunate to have a strong supply chain management team that partners with IT. They are involved from early on in vendor evaluations through contracting. They stay connected to IT and step in to lead or assist when we have vendor issues after implementation.

Two of my previous blog posts provide guidance on creating win-win relationships with vendors. In “Keys to successful vendor management” I outlined some key success factors:

  1. A good product roadmap: It should be clear what core solutions are available now and what their path forward is for the next several years.
  2. More service than sales – a strong service culture should be evident in the sales cycle and demonstrated throughout the duration of the relationship. A focus on service should be engrained in every one of their employees.
  3. Total Cost of Ownership (TCO) – you and the vendor should develop this together. It should include initial one-time fees, ongoing costs for their products and services, all required 3rd party products, and your internal staff. There should be no hidden costs or “gotchas” later.
  4. Reputation – be sure to do your in-depth reference checks. Colleagues in similar organizations are a great source of honest, candid information and experience – good and bad. If your vendor is going to host or manage the application/service for you, check on the change management and operational maturity with colleagues and references. Resources like KLAS, Gartner and others can be leveraged as needed.
  5. Solid contract – once it is negotiated and signed, you may never have to look at it again. But if you do, ensure you are protected.  There is growing market consolidation among larger vendors; start-ups are often acquired by larger firms. Ensure you are protected under these scenarios. Ideally you have someone in your Legal or IT department who focuses on technology contracts and knows the common issues and standard terms.
  6. Implementation – your vendor should provide onsite resources that are integrated with your internal team. Issues tracking and resolution is a joint effort. Status reporting should be a shared effort with a very objective, accurate view.  It should include an executive dashboard on status, milestones, issues and budget.
  7. Escalation – problems will inevitably occur. Escalation process should be clear from the start with a point person for both the vendor and your organization.

Continue reading →

10 best practices for project success

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It’s the final few weeks before our major Epic go live at the University of Vermont Health Network on November 1st. Yes, we have some parts of the project still in yellow or red status as of our 30 day Go Live canstockphoto19779100 (1) gearsReadiness Assessment (GLRA). But the majority are green (on track) or blue (complete).  I’m seeing many best practices that have us on a path towards success. Individual and team behaviors and practices that are worth sharing:

Flexibility – On any given day, you don’t know what issues you might need to deal with or what meeting you’ll have to add to your calendar.  Be willing to adjust as needed throughout the day and know what can wait for another day.

Raising issues – Don’t be afraid to raise issues that need resolution. Don’t assume someone else has more time or knowledge to handle the issue – be willing to take ownership if you can.

Utility players – You need generalists who can be put into a variety of situations to temporarily help. If you are one of these people, don’t hesitate to raise your hand when you see gaps.

Step up and lead – Leadership takes many forms. Even if you may feel unready, don’t be afraid to step in and fill a leadership gap if needed.

Cross coverage – Being dependent on one person’s knowledge and skills can create delays when that person is unexpectedly unavailable. Knowing who you can hand off to and having confidence in that person stepping in is critical to projects staying on schedule. Continue reading →

Press 1 for… Press 2 for…

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Does hearing this cause anxiety and impatience? Or do you think, great, I’ll soon be talking to the right person to help me? I am usually impatient when it comes to getting help with something. I find it frustrating canstockphoto20456258to listen to a long list of phone options, to wait for someone to be available, then get bounced around between call center staff and repeat my information multiple times.

But call centers and automated attendant systems are our new reality. There will be more use of artificial intelligence (AI) and Chatbots in the future. If designed properly, the customer experience can be a positive one.

I admit that I quickly forget the experiences that are smooth and positive. But I remember the ones that aren’t. I had one of those not so positive experiences this week.

While driving on the freeway last Friday, something flew off a truck and hit my windshield creating a crescent like crack the size of an orange. Not something to ignore and put off.

Making the call to my insurance company and being routed to the auto glass service they partner with involved getting redirected to different numbers, providing the same information multiple times, and still not getting the result I needed. In the end, I got it worked out when I contacted the service provider directly.

This not so positive experience reinforced how important it is for us to design the optimal flow and support structure for our command center (a call center on steroids) during our upcoming Epic go live at the University of Vermont Health Network. Customer service encounters in some form are an everyday experience. They should be easy, quick, and have a positive outcome. Continue reading →

IT takes a village

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GLRA is an acronym recognized by anyone who has been through a large-scale system implementation. Spelled out it is Go Live Readiness Assessment. It is typically done at the 90, 60, and 30-day mark before canstockphoto16594838 (1) hands puzzlea go live. At the University of Vermont Health Network (UVMHN), our 90-day GLRA for Epic Wave 1 was this week.

Dr. John Brumsted, UVMHN CEO, kicked the day off with a powerful message on how important the Epic project is to the network and our patients. He talked about why we are doing this for the region that includes six hospitals, a medical group, many ambulatory locations and home health and hospice in both Vermont and New York. He set realistic expectations saying it wouldn’t be perfect and there would be issues. But he expressed confidence in the project, and everyone involved in making it a success. His presence for a good portion of the morning spoke volumes about his support for this massive initiative and appreciation for all involved. The network CFO and the University of Vermont Medical Center (UVMMC) president, CNO, CMO and VP for Medical Group Operations were also there for a good portion of the morning.

Dr. Adam Buckley, UVMHN CIO, followed Dr. Brumsted by talking about how the journey to a common, fully integrated EHR began back in 2013.  A journey that included a Certificate of Need (CON) review and approval by the Green Mountain Care Board. He too set realistic expectations about how many tickets we’ll have at go live just like every other major EHR implementation around the country and thanked the interdisciplinary team involved.

Lori Boisjoli, UVMHN VP Application Portfolio, then framed the day for everyone. The morning would be focused on the UVMMC with revenue cycle and the full suite of specialty modules going live. The afternoon would be focused on the three affiliate sites where ambulatory clinical and revenue cycle are going live. She highlighted that GLRA is the time to raise any significant issues and risks so project leadership can capture them for follow-up. Continue reading →

Not so secret shopper

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If you work at a healthcare system, most likely you get your care there as well. As IT professionals we have an opportunity to be “not so secret shoppers”. In other words, if we tell the clinical and administrative canstockphoto28401496 (1) good or badstaff we have contact with as a patient that we are in IT, we will probably get an earful – both good and bad.

I always make a point of being a not so secret shopper. I want to hear what our users think of the systems we provide and support – good or bad. If I hear about actionable items, I follow-up with the right people afterwards.

This week, I had the chance to be on the patient side of systems. Believe me, I would rather have not been. After a severe toothache all weekend, I called my dentist back home Monday morning. I was hoping to get a prescription for an antibiotic (assuming the pain was due to infection) and something for pain stronger than the over-the-counter ibuprofen and Tylenol I’d been taking. But their protocol was no prescribing unless they saw me. Being hundreds of miles away at my interim engagement, I said that didn’t work for me. So, what was I to do? They said to call my PCP (also hundreds of miles away) or go to an urgent care center.

So, Monday night, I headed off to the University of Vermont Medical Center Urgent Care.  New patient check-in, registration, nurse triage and then to the exam room to wait for a physician to see me.

The wait was minimal at each step and everyone was extremely friendly. At registration I heard enthusiasm about the Epic system coming November 1st and that they would no longer have to use two different systems. The registration clerk said it will be a change and take time getting used to, but that having just one system would be so much better.

With the triage nurse, I realized I didn’t have my medication allergies stored as a note in on my iPhone as I thought I did. I rely on the fact that they are in my medical chart at my healthcare system back home. Continue reading →

Crunch time and why IT matters

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It’s crunch time. Every day counts. Can’t miss a deadline. All hands-on deck. Go live readiness assessments (GLRA). If you work in health IT and have been through a major EHR implementation, canstockphoto60328456 (1) EHR UVMHNyou’ve heard all these phrases.

At the University of Vermont Health Network (UVMHN), the Epic Wave 1 go live is less than 5 months away. The University of Vermont Medical Center (UVMMC) has been on Epic for inpatient and ambulatory core clinicals for years. Wave 1 includes the full revenue cycle, lab and anatomic pathology, radiology, OR and anesthesia, cardiology, ophthalmology, orthopedics, behavioral health, rehab, wound care, infection control, and predictive analytics at UVMMC.

Wave 1 also includes the first Epic implementations at three Vermont and New York hospitals in the network starting with ambulatory systems for billing and clinical functions. Waves 2 (2020) and 3 (2021) will be the full suite of inpatient systems at those same hospitals – Central Vermont Medical Center in Berlin, Vermont; Porter Medical Center in Middlebury, Vermont; and Champlain Valley Physicians Hospital in Plattsburgh, New York. Yet to be scheduled are Elizabethtown Community Hospital in Elizabethtown, New York; Alice Hyde Medical Center in Malone, New York; and Home Health and Hospice.

The core infrastructure is largely in place to support the November 1st go live though we have more to do at the device level. Over 10,000 users will be trained in a 6-week period. The first GLRA at 120 days pre go-live is coming up soon.

When I saw Epic on the agenda for the UVMMC quarterly leadership meeting, I assumed it was a project status update. How wrong I was. Continue reading →

Partnering for your health

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You go to a conference, hear many great speakers, take some notes, learn about some new firms, make new connections, and catch up with colleagues. There are usually one or two key takeaways. Those btn_epatient_spm (002)stories or presentations that make a significant impression on you.

At the New England HIMSS Chapter Annual Spring Conference this week, that moment came during the session by Dave DeBronkart, known as e-Patient Dave, and Dr. Daniel (Danny) Sands, his primary care physician and faculty member at Beth Israel Deaconess Medical Center. Together they were two of the twelve founders of the Society for Participatory Medicine and the inaugural co-chairs.

Prior to the conference, I knew who e-Patient Dave was and had seen him on social media, but I had never heard his personal story nor met him. Their session demonstrated the power of storytelling at its best. Now I understand why Dave is so passionate about patient engagement.

Their session, “Hot or Not? A Doctor and Patient Role-Play the Archaic and the Modern Way to Engage” was a combination of role play and presentation. Dave started by describing the moment when he was diagnosed with a stage 4 cancer in 2007 following an incidental finding from a shoulder x-ray. He learned early in his journey that the median time left for a patient with his diagnosis was 24 weeks. He thought then that he had at most 6 months to live. That got my attention!

Their role play illustrated what may be the typical patient – physician interaction vs what should be a true patient – physician partnership. They covered communications (email, texting), patients doing their own online research and sharing information with their physician, timely access to results on a patient portal, and disease specific online support groups.

The Society for Participatory Medicine focuses on the power of partnership between patients/families and clinicians. They describe “Participatory Medicine” as a movement in which patients and health professionals actively collaborate and encourage one another as full partners in healthcare. They believe this leads to improved health outcomes, greater satisfaction, and lower costs. Continue reading →

IT matters – why I work in healthcare

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42,000 steps later and HIMSS19 is behind me. Heard insightful and moving speakers at the CHIME CIO Forum. Co-presented with Pam Arora on the relationship between IT and HTM. Sponsored the networking breakfast at the career fair. Facilitated a roundtable at the mentor meetup. Interviewed by Bill Russell for his This Week in Health IT podcast HIMSS series. Walked the exhibit hall. Had many great conversations with new and old colleagues. And promoted our new StarBridge Advisors service, C-change, receiving lot of positive feedback and enthusiasm.

Did I meet my HIMSS19 goals? Yes. Now it’s time for all the follow-up.

In the first two days I was reminded numerous times why I work in healthcare. The CIO Forum planning committee made some bold speaker decisions this year and I applaud them for it. The day included some very personal and touching stories. Continue reading →

Physician satisfaction with EHRs

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I am a huge fan of Dr. Atul Gawande. Who isn’t? He is a surgeon, an author and one of the most insightful and influential physicians of our time. His books are best sellers and his articles in The New Yorker canstockphoto3914104 (1) physician computermagazine are widely read. He was recently named as CEO of the non-profit-seeking health care venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase to deliver better outcomes, satisfaction, and cost efficiency in care. He will be the opening keynote speaker at HIMSS19 in Orlando this coming February.

His books include Better, Being Mortal: Medicine and What Matters in the End, Complications: A Surgeon’s Notes on an Imperfect Science, and The Checklist Manifesto. I gave one of his early books to all my IT leaders one holiday season. My tradition was to give them an insightful and inspiring book each year. Gawande’s books are clearly some of the best for health care leaders.

Gawande has been a staff writer for The New Yorker since 1998. His latest piece was titled “The Upgrade: Why Doctors Hate Their Computers”. It’s a long read but worth the time if you work in health IT and care about your physicians. Gawande describes the challenges of EHR’s from the front lines of medicine. He talks about the significant amount of time spent doing documentation after a patient visit and the loss of physician to patient connection with the computer competing for attention in the exam room.

In discussing physician burnout, he referenced Berkeley psychologist Christina Maslach’s work studying occupational burnout where she defined burnout as a combination of three distinct feelings – emotional exhaustion, depersonalization and a sense of personal ineffectiveness. He noted that in 2014, 54%% of physicians reported at least one of the three symptoms compared to 46% three years earlier. He shadowed a scribe and talked with surgeons and primary care physicians on the impact of the EHR on their work and their time. He learned from a patient who works as a construction supervisor that others are also challenged in their work to make the necessary human connections. Continue reading →