On Technology

Knocking on the digital front door

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Health systems are learning many lessons during this pandemic that they will need to carry forward into the recovery and “new normal” phases. One of them may be the need for an integrated digital health strategy, and more specifically a patient focused “digital front door”. The almost overnight shift from in-person ambulatory visits to virtual visits during this pandemic highlighted the need for a more integrated approach for many health systems.

An integrated strategy for a patient centered digital front door has many components including the core website, the patient portal linked to the electronic health record, improved access and scheduling capabilities, call centers, and care delivery through virtual visits. The goal is to meet patients where they are and guide them along the right care pathway with efficient, consistent, and easy processes in the background.

However, these multiple components and functions are often led and directed in an uncoordinated manner by different senior leaders within the organization. The core website is typically owned and directed by Marketing and Communications with technical support from IT. The patient portal is often managed by the ambulatory team in IT partnering with the Chief Medical Information Officer, Ambulatory Services, and Marketing. Improved patient access and scheduling initiatives are often directed by Ambulatory Services or in an academic medical center by the Physician Practice Group leadership. The call center may be managed by Marketing or Ambulatory Services leadership. And telehealth may be provided by a specialized team either connected to or part of IT but be directed by physician leadership.

A successful patient centered digital health strategy needs to involve all these components in a coordinated, comprehensive manner. In some respects, who leads this strategic initiative does not matter. What does matter is that there is buy-in and collaboration from all leaders involved with a common overarching goal to meet patients where they are at and provide an easy, consistent experience to access services. Continue reading →

IT requests increase while budgets decrease

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As hospital systems develop their COVID-19 recovery plans, the financial impact of this pandemic is deep and far reaching. IT budgets are no exception. IT leaders are being asked to take salary cuts, furlough staff, and deal with a capital freeze for the rest of the year. This comes at a time when the demand for technology solutions is only increasing. And at a time when IT teams have performed at their peak in providing and supporting new solutions with agility and in record time.

In a recent Becker’s Hospital Review article, Hospital IT Spend Pivots to Mission Critical Projects: 7 Leaders on the Key Focus for the Next 12 Months, IT leaders covered telehealth, digital transformation, analytics, informatics, and of course the reality of cost reduction facing them and their organizations.

IT leaders have long faced the supply vs demand challenge. And they have long faced the need to reduce their budgets while meeting a growing user base and increased demand for technology solutions. The days of significant year to year budget and staff growth in IT are a distant memory.

As we look to the future after the COVID-19 recovery, some people talk about the “new normal” phase and others refer to it as the “re-imagine” phase. The latter certainly encourages us to think differently. Regardless, it will be with far less resources. So how does IT manage and ensure success in this ever more constrained environment? Continue reading →

What next for health IT?

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Two weeks ago, I wrote about looking ahead to the “new normal” post COVID-19. Since then some states have started slowly re-opening while other states are defining what their phased re-opening approach may look like. Hospitals have started to develop plans to expand their services beyond emergencies and COVID-19 patients – performing elective surgeries and opening outpatient clinics. All of this is new territory. Patient scheduling, workflow changes, and appropriate staffing and PPE to provide safe care must be accounted for and planned for very carefully. This will happen over the coming weeks and months.

Given the financial impact COVID-19 is having on healthcare systems, executives also need to be looking at how to position their organization for not just recovery but long-term success. One of the articles that I have seen on this is a white paper published by the Chartis Group – “After the Surge: Five Health System Imperatives in the Age of COVID-19”. In it they discuss how COVID-19 has fundamentally changed the care delivery landscape. They outline what they consider to be the five imperatives for future health system success:

  1. Engage consumers and other referral sources to recapture patients
  2. Fundamentally reduce the cost base
  3. Restructure the physician enterprise
  4. Transform the clinical operating model
  5. Closely evaluate partnerships, both horizontal and vertical, traditional and non-traditional

Other management consulting firms that work with healthcare providers most likely have a similar analysis and framework. Regardless what they may look like, all of these long-term efforts will require IT support. Continue reading →

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 →

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 →

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

 

HIMSS20 – are you ready?

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If you work in health IT, you know that the annual HIMSS conference is the biggest industry event each year whether you are headed to Orlando in three weeks or not. The number of emails, blog posts, social media posts, and articles providing guidance and recommendations on HIMSS20 grows with each passing day.

In the next two weeks I’m wrapping up my current interim CTO engagement at University of Vermont Health Network and handing off to the new CTO. If like me you are super busy at work, making your game plan for HIMSS20 is probably low on your priority list. With so much info out there, I decided to pull together some resources that might help in your preparation.

Whether you are attending in person or following the happenings from a distance, the Official HIMSS20 Hashtag Guide will help you focus in on your areas of interest. My top picks this year are #WomenInHIT, #HealthcareStartup, #HealthcareInnovation, and #PatientEngagement. And of course, you’ll want to follow all the HIMSS digital influencers. You can follow and engage with them using hashtag #BeTheChange. If you’re looking for who the 2020 social media ambassadors are, the digital influencers have replaced them with a new and more expansive program.

Several recent blog posts are worth checking out for more previews and tips:

With my focus on developing women leaders in health IT, I’m looking forward to the Women in Healthcare and Tech: Closing the Gap to Strategic Leadership session on March 10 from 10:30AM-11:30AM. A panel of trailblazers with backgrounds in healthcare and technology will discuss empowering women and closing the gap to strategic leadership. Continue reading →

Getting ready for 2020 – 10 steps for health IT leaders

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One of my greatest joys when we started StarBridge Advisors back in 2016 was to be able to partner with someone as smart and insightful as David Muntz. He has a long career history as a healthcare CEO, a CIO and as a senior leader in the Office of the National Coordinator. I continually learn from David and appreciate his provocative thinking,

David’s advice for 2020 is no exception. In his recent post, “10 Steps to Prepare for 2020 – Big Challenges – Bigger Opportunities” on our StarBridge Advisors blog “View from the Bridge”, David starts off by challenging CIOs to begin thinking of themselves as CDSOs – Chief Digital Services Officer. He goes on to highlight the importance of encouraging innovation, embracing AI, addressing governance issues, physician burnout and more. And ever mindful of how leaders must take care of themselves to be at the top of their game, he closes with a message on self-care.

Here’s David’s blog post in its entirety:

10 Steps to Prepare for 2020 – Big Challenges – Bigger Opportunities

It’s that time of year again when prognosticators and futurists compile a top 10 list for the upcoming year. Please joining me in welcoming 2020 with a call to action for our wonderfully challenging and opportunity rich healthcare IT environment.

Before starting the list of recommended actions, I suggest that we IT professionals change the way we refer to ourselves — now, even before the turn of the year. Please join me in a self-directed evolution by shifting our reference from IT to Digital Services. That change would suggest using the title CDSO instead of the familiar CIO. The rationale for doing so, though relatively obvious, will be suggested in another blog.

Digital Service (DS) leaders will need a steady hand on the rudder to lead their organizations through some rough waters. Some of the themes below are repeated from last year…they still deserve your attention and efforts. Continue reading →

Conducting project “lessons learned” as continuous improvement

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As I caught up on my industry reading this past weekend, I saw several implementation best practices articles – advice from experts on EHR, Telehealth, Pop Health, and Medical Device implementations. These kinds of resources are always helpful to think beyond your organization’s experience, get a different perspective, and learn from others.

At the same time, conducting lessons learned sessions internally after major projects is critical. While it’s still fresh in your mind, being able to look as a team at what worked well and what didn’t work well over the life of the project is an important step before moving on to the next project or next phase of a multi-year project. This should be done in the spirit of continuous improvement. Ask yourself, what can be learned from this project that can be applied to future projects. And be sure to document that in a way that is referenceable in the future.

We are just over 3 weeks post go live for Wave 1 of our Epic project at the University of Vermont Health Network (UVMHN). We start a series of lessons learned/debrief sessions this week. IT managers have been asked to think about three questions and submit them in advance so they can be compiled for review and discussion:

  • What worked well?
  • What didn’t work well that we should modify?
  • What didn’t work well (or was unnecessary and we should no longer do)?

As we planned for the sessions, I suggested that we have a few guidelines – no blame, assume positive intent, and ensure everyone is heard. UVMHN has a very collaborative and team-oriented culture so that shouldn’t be difficult.

Often, it’s easy to go right to what didn’t work well. Those examples may be top of mind. But there is so much in a project of this magnitude that is done well. Capturing those points and making sure you repeat them in the future is important.

Wave 2 planning started before the Wave 1 go live. Certain lessons have already been looked at as part of that planning. But the upcoming sessions will be an opportunity to look more broadly and get the input of all areas involved. Given I’ve been interim CTO since late May, my involvement did not span the entire project but rather certain aspects in the last few months including the go live. I look forward to hearing everyone’s perspective on how we can do better and build on the successes to date.

Related posts:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

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

9 Tips for Go Live support success

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My first blog post published back in 2014 was called “Three Days and Counting…” written as we approached a major Epic go live at Michigan Medicine. This week’s post could be called “Five days and canstockphoto15204222 (1) keep calmcounting….” as we approach our Wave 1 Epic go live at University of Vermont Health Network on Saturday 11/9.

We were originally scheduled for a 11/1 go live. But in mid-October after much deliberation with operations and IT leadership, our CEO, Dr. John Brumsted, made the decision to move the go live back one week. As he said in his communication to the entire organization, “This decision is in the best interests of our patients, our people and our Network. It gives us the time we need to get to a place where we are confident to go live and it allows users additional opportunities to prepare”.

Planning for the two-week 24/7 command center and support structure started a few months ago. With just five days to go, the plan is pretty much finalized. Highlights and some tips to share based on our game plan:

  • Physical setup/location – Where your command center is located will depend on space available but ideally it will be in the hospital. We are fortunate to have primary and secondary locations at the University of Vermont Medical Center where we’ll have approximately 80 people. We will also have a triage team (to review and route the tickets entered online) and trainers (to answer “how to” questions) co-located offsite. In addition, we’ll have local support centers at each of the hospitals involved in Wave 1.
  • Overall call flow and phone setup – We have a documented decision tree/call flow starting with the super users reporting issues they can’t address. Phones are programmed to route calls to the appropriate support staff depending on user role and/or application involved.
  • Reporting issues – When you are dealing with thousands of issues, you need to use a common tool and standard process. We use ServiceNow and all tickets will be entered and tracked through this tool. Dashboards have been created for leaders to monitor ticket volume and trends.
  • Staffing – A command center operating 24 hours a day for two weeks means people are scheduled for 12.5 hour shifts including time for handoff to the next shift.
  • Leadership roles – Multiple leadership roles have been defined and scheduled for these same shifts. Roles include a physician and nurse leader from IT, someone to monitor ServiceNow tickets and trends, and someone to be overall command center leader.
  • Huddles – There are huddles scheduled throughout the day for each operational area to review broad issues and trends that will then role up to the executive huddle at the end of the day.
  • Communications – This is a critical function to embed in any command center. As high impact issues are resolved and trends are identified, communications staff will work closely with command center leadership to push out daily updates and specific tip sheets.
  • Reference documentation for support staff – Wwith the intensity and pace of a major go live like this, you can’t rely on personal knowledge. Documentation will be available to all support staff and will be reviewed in advance to ensure everyone is comfortable with the plan and what is expected of them.
  • Logistics – And last, but not least, don’t forget about food, parking and transportation arrangements.

Our command center and support plans for go live are well defined. They may not be perfect, but a lot of thought and preparation has gone into them. The key is to be flexible and adaptive as the days go by.

As I always tell my IT teams, we are part of the extended care team. While we don’t touch patients directly, the staff who do depend on the systems and support services we provide. This is never truer than at go live time!

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Crunch time and why IT matters

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Three Days and Counting…

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