Tag Archives: EHR

Amplifying the voice of nurses

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May 6-12 is National Nurses Week. Nursing has been the most trusted profession for the past 20 years according to a Gallup Poll. That’s no surprise when you think about the nurses you have interacted with as a patient or as a colleague.

I’ve written a post about nurses almost every year since I started this blog. Do I have anything truly new to say this year? Yes, in that I want to highlight how the past three years has taken a toll on all our clinicians, in particular nurses. The public health emergency is expiring. Health care providers are adapting their policies as they continue to deliver care. We have entered a new phase for healthcare organizations, staff, patients, and families.

Staffing challenges are at the top of the list of concerns for many health executives – staff shortages and clinician burnout. There are no easy solutions. The toll of the past few years on our nurses was highlighted in a May 2nd NPR article by Jaclyn Diaz – “Nearly a third of nurses nationwide say they are likely to leave the profession“. The article starts with some sobering findings from the 2023 Survey of Registered Nurses conducted by AMN Healthcare. The survey examined the impact of COVID-19 on the career plans, job satisfaction, and mental health and wellness of more than 18,000 RNs. Key findings:

  • Close to 1/3 of nurses nationwide say they are likely to leave the profession for another career due to the pandemic. This level is up 7 points since 2021.
  • 89% of RNs said the nursing shortage is worse than five years ago, 80% expect that to get much worse in another five years.
  • Younger generations of nurses are also less satisfied with their jobs compared to their older counterparts.
  • 80% of nurses experience high levels of stress at work, an increase of 16 points from 2021.
  • 77% of nurses reported feeling emotionally drained, up from 62% in 2021.

Of all the blog posts I’ve written about nurses, this one from five years ago has the strongest message – “Celebrate nurses, but more importantly listen to them”.  This is true now more than ever. From the bedside to the boardroom we need to listen, amplify, and prioritize the voice of nurses.

IT leaders won’t solve the staffing challenges. But we have a role to play. The systems and solutions we provide and support as health IT leaders and vendors must help nurses do their job more easily and efficiently, not make it harder. We need to reduce the burden on nurses and ensure they are integrally involved in decision making, prioritization, and design processes.

Celebrating, collaborating with, and learning from HTM – part 2

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This week is Health Technology Management (HTM) Week celebrating and honoring all those who work in the HTM/Clinical Engineering/Biomedical department at provider organizations across the country. Regardless of the department name, you know who they are. If you are a nurse, you know the HTM staff by name. HTM professionals make a difference every day ensuring safe patient care.

Over the past 9 years as an AAMI board member, I’ve developed a greater appreciation for this critical part of our health ecosystem and all the players involved. From HTM leaders to clinicians to educators to device manufacturers and government representatives. AAMI is an organization that brings all of them to the table. As described on their website, the Association for the Advancement of Medical Instrumentation® (AAMI), a nonprofit organization founded in 1967, is a diverse community of more than 10,000 professionals united by one important mission—the development, management, and use of safe and effective health technology. AAMI is the primary source of consensus standards, both national and international, for the medical device industry, as well as practical information, support, and guidance for healthcare technology and sterilization professionals.

The timing of my first This Week Health Townhall interview published last week was perfect. I spoke with Pamela Arora, AAMI’s new President and CEO. I have gotten to know Pamela as a CIO colleague and fellow AAMI board member the past 6 years. She will bring new perspectives and experiences to AAMI. Not the least will be a recognition that HTM and IT teams need to work more closely together at the micro level in provider organizations and at the macro level with professional health IT organizations. Closer collaboration will have a positive impact for the patients and communities we collectively serve. Continue reading →

On the other side of the digital front door – part 3

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Two different procedures. Two different specialties. Two different patient communication approaches. Yet both practices use the same EHR and patient portal.

Prep for surgery instructions. Paper. Branded folder to put the paper in. More paper on next visit. A call from practice confirming specific surgery time and then get transferred to recorded message with specific pre-surgery instructions. Day of surgery sent home with post-op instructions – more paper.

Prep for procedure instructions. Available on the patient portal under letters. Texts and emails sent with specific prep information. Timed texts and emails for each major step along a defined prep timeline. Post procedure summary and instructions given to me on paper and available on the portal.

Practice variation is real. At times, it’s required and makes sense given different specialties. But not always.

So how were these two different experiences from a patient communication perspective? For me, there is a comfort having paper – can easily refer to it when needed. That is, if you know where you put it – hence the branded folder they give you. In the other situation, there was a very prescribed set of timed pre-procedure steps so the texts/emails at specified times telling me what to do was helpful.

What wasn’t such a good patient experience? Continue reading →

Thoughts on the Oracle acquisition of Cerner

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Without question, the announcement yesterday that Oracle is acquiring Cerner for $28.3 billion is the biggest health IT story of the year. I won’t speculate on what I don’t know. I’ll leave that to others. But I can

source: www.hitconsultant.net

speak from experience as a CIO who has worked with all the big EHR vendors over the years including Cerner, Epic, Allscripts and Meditech. I’ve talked with and at times commiserated with many CIO colleagues who have experience with some or all of these EHR vendors.

While Cerner clients are trying to figure out what this acquisition will mean for them, good or bad, I’ll go back to the basics. Over the years I’ve written several blog posts on vendor management. They all seem pertinent and good reminders for health IT leaders trying to sort out how to work with Cerner going forward and how to manage within their organizations as they are faced with questions this week that they probably can’t answer.

12 tips for effective vendor management outlines what to look for in your current and future vendors. If I were a Cerner client or contemplating a switch to Cerner, I’d pay particularly close attention to these tips:

  • A good product roadmap
  • More service than sales
  • Excellent customer service
  • Executive level relationship
  • Long term value for the investment

There will be much speculation and commentary in the coming days on what this acquisition means to Cerner clients and the health IT industry overall. At the end of the day, we must keep the Quadruple Aim in mind in all we do to serve our patients and our communities: enhance the patient experience, reduce costs, improve healthcare outcomes, and improve the clinician experience. That has never been more important than during this pandemic. Will Oracle’s acquisition of Cerner help or hinder? Will Cerner provide a superior, more reliable, more integrated EHR in 2022 and well into the future? Only time will tell.

Related Posts:

12 tips for effective vendor management

Keys to successful vendor management

What to expect from your vendors

Vendor relationship management revisited

 

On the other side of the digital front door – part 2

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My health journey continues with multiple focuses. And my journey through digital front doors continues as well. I wrote part 1 on this topic in early November when I was in the middle of various health and dental appointments and scheduling more. I also wrote about what I thought was an awesome example of how technology has evolved in “Patient friendly testing – yes, a positive story!” in September.  The end of that story was not so positive. More on that later.

Here are a few anecdotes from my recent experience:

Cataract surgery – I had my initial consultation appointment the end of November and have surgery scheduled for mid-February. Specialized eye drops were prescribed to start taking a few days in advance of the surgery. As soon as I left the doctor’s office, I received a text message that my eye drop prescription from my doctor was pending payment with this special pharmacy – for immediate delivery to my home I should click the link to pay $82.50. I was a little suspicious of a text asking for payment like that and knew I didn’t need to have the eye drops until February, certainly not immediate home delivery. I called the doctor’s office to confirm the text was legitimate and asked how to handle the timing of delivery. I was told I could just text back regarding delivery timing which I did and got a reply that they could do that. I thought great, there’s a person on the other end. But then I received several more automated text reminders to click the link so they could ship right away. Then they called me. I talked through the timing and gave them my payment info. Their proactive communication (and persistence) was a plus, but I was more comfortable with real-time communication to coordinate specific delivery schedule and payment.

Bone health – I had a virtual visit with a Nurse Practitioner from the Bone Health clinic at my primary hospital. This was part of follow-up from my fall and pelvic bone fracture in August. The virtual visit was easy to get into and very thorough. I learned that more and more elders are asking to be seen in person – not this one unless there is a reason to “lay hands on me”. Continue reading →

On the other side of the digital front door

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Being on the other side of health care delivery is always an eye opening experience as to the progress we’ve made with technology and making it easy for our patients, and how far we have yet to go.

Now that I have more flexibility in my work schedule and we’re past the house move, I’m taking time to prioritize my own health. The newest health issue I’m addressing is cataracts in both eyes. I was pleasantly surprised when I saw that the ophthalmic practice in the area who my eye doctor referred me to has a patient portal link on their website. As I waited on the phone to make an appointment, I perused the website. I thought it was odd that the portal had the same name as my health system’s portal. When it was my turn to talk to someone, they told me my new address asking me to confirm it. I had just updated it with my health system on the patient portal last week. So I asked how they, a separate ophthalmic practice knew. They said the patient portal showed it based on my phone number. Turns out it is the very same portal as my health system. I asked if they were part of the system and they said no but they share the portal. Guessing there is more to the story – possibly an Epic Community Connect relationship?

We scheduled the initial consultation appointment at a location reasonably close at the end of November vs one at an even closer location at the end of January. But my positive response to this encounter quickly took a step backwards. As they described my next steps pre-appointment it included writing down two fax numbers. One to give my eye doctor so they could send a report from my last eye exam. And a different one to give my PCP so they could send a referral. When will healthcare finally retire fax machines??

The fact that I can remember my patient portal password means I’ve become a regular user. And that means I’m taking care of my health. Due to my injury in August, I have multiple ortho appointments and now weekly physical therapy visits.

I was late to my first physical therapy appointment due to mistakenly thinking the e-checkin on the portal would be quick. Continue reading →

Time to pass the baton

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It has been an honor to serve Boston Children’s Hospital (BCH) as their interim SVP and Chief Information Officer for the past 7 months. At the start of 2021, I told myself I wasn’t going to do another interim CIO engagement. But how can you say no to the #1 children’s hospital in the country? While they tell me they are grateful for what I have accomplished during this period, I too am grateful. Grateful for the opportunity to work with such fine people and be part of such an incredible mission – as they say, “Until every child is well”. I’m proud to have been part of an organization with a culture that values their staff and is committed to equity, diversity and inclusion.

From the start, BCH leadership knew I didn’t want the interim engagement to be prolonged. One of my priorities was to assist the search firm in finding the best candidate to be the next SVP and CIO. Goal accomplished! Heather Nelson starts on October 11. She has served as CIO at UChicago Medicine since 2017.

This last week before the official handoff begins, I focused on annual performance reviews for my leadership team, finishing up my work on the EHR strategy so Heather can move forward with the next phase, and compiling everything I will go over with her in our one-week transition/handoff.

Why would an interim do performance reviews? I strongly believe that people should not miss a review cycle because of a leadership transition above them that they have no control over. Collecting input from others in an informal 360 manner along with my experience working together for seven months is enough to have a constructive conversation and provide guidance on future development opportunities. Of course, Heather will need to work with each of them on specific goals for the coming year.

The EHR “path for the future” as we’ve called it has been the primary focus of my time at BCH. Continue reading →

Resources for your digital health journey

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My StarBridge Advisors colleague, David Muntz, wrote an excellent blog series on Digital Health over the past year. His latest in the series is titled, “Digital Health – Planning for the Virtual Campus”. David’s ability to define digital health and provide a blueprint for organizations is impressive. This most recent post does not disappoint. He describes the changes that health systems have made in care delivery during the pandemic and poses the question – where do we go from here? He outlines 12 steps organizations should take. Here is a partial list just to whet your appetite:

  • Embrace the same discipline and framework to create the virtual campus as for a traditional campus
  • Query a broader representative sample of stakeholders than you have in the past
  • Plan for the underserved and those who might be excluded because of the digital divide
  • Personalize the experience for providers, patients, and families
  • Use augmented intelligence (AI) and machine learning (ML) during the data collection process

I encourage you to check out the entire post. If you are interested in any future posts in David’s digital health series, subscribe to View from the Bridge to get notifications of new posts. Our team of advisors regularly contributes posts on a wide range of topics relevant to today’s healthcare executives and IT leaders.

The New England HIMSS 2021 Annual Spring Conference: “Empowering People to Impact Health Through Information and Technology” was this week. Continue reading →

Ensuring go live success for large scale IT projects

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Since the pandemic, major system implementations at health systems have continued with successful go lives supported by virtual or hybrid remote/onsite teams. Many organizations have “go live” success stories in this new world of remote work. While virtual support may change some things and certainly presents new challenges, the core work of a successful go live is still the same.

In late 2019, I published several blog posts on successful go lives based on firsthand experience with a major Epic implementation. Here they are again with basic lessons and tips:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

I welcome your comments on any virtual or hybrid go live experiences you have been involved in during the past year. If I get enough new lessons and tips, I will write a new blog so all can benefit. After all, continual learning and sharing best practices is at the core of what we do in healthcare.

Why this topic this week? I am currently working with a client who is less than six weeks out from an ERP go live so it is on my mind a lot. We are doing what we refer to as an Independent Verification and Validation (IV&V), a framework that facilitates audits of major IT projects regardless of area and complexity.  We explore 11 categories in-depth.  The topics range from governance and budget to training and QA.  The detailed analyses for each area involve document review and interviews to ascertain the status of the project.  A risk score is assigned in each of the 11 areas and mitigations are suggested based on the findings.  Ideally, over the life of the project there are three IV&V sessions conducted prior to go live and one session after go live to ensure that projects stay on course, make corrections as necessary in a timely manner, and achieve the defined objectives.

If you think an IV&V from my advisory firm, StarBridge Advisors, is something that your organization can use, please contact us to discuss.

Vaccine rollout – it takes a village, part 2

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Last week’s blog post on vaccine rollout took longer than expected to write as I compiled multiple resources and articles to comment on and share. With the vaccine rollout as massive an undertaking as it is and so many stories (good and bad), I decided to do part 2 this week highlighting best practices, technology challenges, and health disparities.

Best Practices

Last week, I mentioned Atrium Health and their local partnership to do mass vaccination events. It was encouraging to see their update on vaccinating over 20,000 people had a special emphasis on underserved communities.  We need more focus on underserved communities – more on that in a bit.

Another health system doing drive thru vaccination clinics at scale is Memorial Hermann in the Houston area. They are getting calls from health systems across the U.S. asking for guidance on how to design similar large-scale vaccination events and are more than willing to share their blueprint for others to replicate according to Binita Patel, Vice President of Pharmacy Services for Memorial Hermann Health System. The location (NRG Park) and staffing (700 people including many volunteers) were key to their success.

We cannot forget that there are many people leery of the vaccine, sometimes referred to as “vaccine hesitancy”. Education and public health messaging campaigns will be key as the vaccine rollout continues over the next several months. Based on the Kaiser Family Foundation’s latest COVID-19 Vaccine Monitor report, there are key messages that resonate with people. They are listed in this short article from Becker’s Health IT : “8 most convincing messages to promote COVID-19 vaccines”.

Many health IT vendors pivoted their products and services to support COVID-19 over the past year. Vaccine scheduling is the latest focus area for vendors like Kyruus which shared best practices and insights from their customers in their recent blog: “Eight Best Practices for COVID-19 Vaccine Scheduling Online: Insights From Our Health System Customers”. A great transition to the next topic.

Technology Challenges

I mentioned the Vaccine Access Management System (VAMS) in my post last week as a system provided by CDC to states and other organizations for pre-screening, registration, scheduling and tracking. Not surprisingly, a software solution developed quickly and made available for many different but similar situations and workflows has experienced problems as captured in this article from MIT Technology Review. I would hope the problems can be resolved so organizations using it do not have to switch systems midstream with vaccine rollout already in process and moving rapidly. Continue reading →