@UConnHealth appoints Dirk Stanley, MD as First CMIO

by Gregg A. Masters, MPH

Dirk Stanley MD CMIO Uconn HealthA first at UConn Health aka @Uconnhealth, maybe first ‘win’ is to get Twitter handle on home page?

Per Healthcare IT News:

We are pleased to have Dr. Stanley on our team, given his high-level of experience and success in a similar role,” Jon Carroll, CIO at UConn Health said in a statement. “What he has accomplished, and experienced, in his eight years at Cooley Dickenson will be vital to us on our EMR journey.”

In his role as CMIO, Stanley will play an important role implementing the Epic EHR and also will head the health system’s Epic Physician Steering Committee.

Bravo to one of our founding members and supporters at #CMIOchat!

Blab the Blockchain: Healthcare Implications?

by Gregg A. Masters, MPH

 

Today, at 4PM Pacific/7PM Eastern we gather to deploy another innovative platform that enables collaboration via the Blab Beta platform.

For an overview of ‘Blockchain’ see: ‘Understand the Blockchain in Two Minutes‘.

Join your peers and colleagues as we dive into this distributed system of secure transactional accountability.

For full screen and social streams, click here.

 

 

A HiMSS16 Primer

by Rasu Shresthra, MD, MBA 

 

rasu_headshot_cmiochatThe annual HIMSS conference is seen as the “Superbowl” of the Health IT industry. The conference brings together over 40,000 health IT professionals, clinicians, executives and vendors from around the world, hungry to learn from one another, with an appetite to connect, collaborate and learn. The conference is seen as an annual pilgrimage for many – a “must attend” event due primarily to the high value that can be attained in a condensed period of time. Whether this is your first HIMSS conference or whether you are a regular, the one hallmark of a successful conference is planning.

 

So let’s chat about what you may expect from #HIMSS16. And let’s together plan to make this a particularly meaningful one.

 HIMSS16_home

HIMSS promises to offer a showcase of cutting-edge health IT products and services, remarkable networking opportunities and world class educational content with an inspiring line up of sessions, talks, keynotes and workshops.

 

And then, there are the announcements and press releases, each trying to one up the other. The news of the demise of Meaningful Use may have been premature. This was sparked by a comment last month at the JP Morgan Conference made by a top CMS official (Andy Slavitt) when he said that “the meaningful use program as it has existed will now effectively be replaced by something better.” Will HIMSS16 attendees be able to get more clarity around what this “something better” really means for them? Or will we come back with an alphabet soup of questions on how MU will be integrated with PQRS (Physician Quality Reporting System) and MACRA (the Medicare Access and CHIP Reauthorization Act), which in turn will be based on the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs)?

 

Will we see large strides in vendors and providers scaling the interoperability mountain? What about patient engagement? Is cloud, analytics or information security going to be top of mind for most? Will there be interesting innovations around wearables, sensors, big data and the IoT?

 

Keynotes are always a big draw at HIMSS. The secretary of the U.S. Department of Health and Human Services, Sylvia Mathews Burwell, and Michael Dell, chairman and CEO of Dell, are both set to deliver keynote speeches at the HIMSS 2016 conference. Super Bowl Winning Quarterback & Five-Time NFL MVP Payton Manning will be coming in fresh off of a real SuperBowl 50 win and will be providing the closing keynote. I wonder if this will be a touchdown of a keynote!

 

Also featured, amongst many other things will be the HIMSS Interoperability Showcase, and the HX360 Innovation Pavilion. The Intelligent Health Pavilion is also always a big draw.

 

With all this and more, HIMSS16 promises to be busy. So let’s fire up your favorite Twitter application (TweetDeck, Tweetchat, Tweetchat.io) and let’s get chatting! Here are the topics:

 

T1:  Why are you attending #HIMSS16? What are your priorities for the conference?

T2:  What ONE thing are you most excited about for #HIMSS16?

T3:  Do you fear that we will be blinded by buzzwords? How do you separate the wheat from the chaff?

T4:  Population Health means many things to many people. What does this mean to you?

T5:  What tips do you have for fellow HIMSS attendees?

 

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Rasu Shrestha MD MBAChief Innovation Officer

UPMC & EVP UPMC Enterprises

AMDIS 2015: A Look Back and Peek Forward?

by Gregg A. Masters, MPH

In this non-stop 24/7/365 tsunami of data overload, taking time to look back and see where we’ve been is often a rewarding if not grounding experience.AMDIS15

In June the Association of Medical Directors of Information Systems (AMDIS) met in the awesome surroundings of Ojai, California to consider their agenda for the year.

AMDIS describes itself as:

..the premier professional organization for physicians interested in and responsible for healthcare information technology.

AMDIS Members are the thought leaders, decision makers and opinion influencers dedicated to advancing the field of Applied Medical Informatics and thereby improving the practice of medicine.

With our symposia, blogs, on-line forum, journal, presentations, sponsored and co-sponsored programs, and networking opportunities, AMDIS truly is the home for the “connected” CMIO.

[Editor’s Note: AMDIS 2016 information and registration page is here.]

Here is a list of and access to symposium presentations from the June gathering, while a twitter transcript of the meeting is available here.

Always ground zero for clinical informatics innovation, best practices and real world experience beyond vendor marketing hype, AMDIS sessions are rich and current. Here are the titles and presenting faculty at the event:

As we continue down the merry path of HealthIT or tech fueled if not enabled accountable care or better yet the holy grail of the triple aim, may we continue to be mindful of the limits of technology to make up for tired if not mis-aligned business models in healthcare delivery today.

Bridging the volume to value gap is a complex task. Enterprises and health systems navigating a mid-flight transformation need operate in a sea of conflicting incentives. As one of our colleagues John Mattison, MD opines on occasion: ‘we get what we incent’.

Today we have toes in the ‘risk water’ via a complex mix and range of government and privately fueled change initiatives mostly codified in drawers of healthcare contracts and/or service agreement ranging from bundled payments to global (PMPM) capitation.

While some health plans or their host integrated delivery systems (IDNs) have been in the value space for quite some time, most remain in a production oriented fee-for-service operating mindset and culture.

Yet as Don Berwick opined some time ago, we’re in an ‘all hands on deck, full court press’ to meet the challenges of the triple aim. Clearly absent the tech central spine enabling many to act as one, we can not get there. So, let’s get on with and get this done!

 

 

 

Informatics Domain and Clinical Workflow

by Dirk Stanley, MD, MPH

After my last post, some people asked me if I could put it into a video form, to help share with other people.

I was able to condense it into this 7-minute, 23-second video below:

CMIOchat_dirk_imageFor anyone who has ever struggled to explain the Informatics domain, how it is related to clinical workflow development, and how it can help create smooth, predictable, reliable, and non-disruptive workflows – this is my offer.

Hope it was helpful! Leave your comments and feedback in the comments section below!

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Source of blog post and video originally posted here.

Author’s note: Need a CMIO, temporary CMIO, or physician informaticist? Need someone to help coach your new CMIO or CNIO? Or need someone to help analyze your workflow challenges? I am available for consulting! Feel free to email me at DlRKSTANLEY@GMAlL.COM or look me up on LinkedIn!

2nd CMIO Tweetchat

by Luis Saldana, MD

luis saldana headshotOur inaugural #CMIOchat was a great success, and thoroughly engaging with the skillful facilitation of Dr. Nick van Terhyden aka @DrNic1.  I have the distinct pleasure of facilitating the next #CMIOchat this Thursday October 22nd at 7 PM Eastern Time.

cmiochat_analytics1

So, the ICD-10 ‘GoLive’ date has come and gone without much ruckus, and the Stage 3 Meaningful Use Final Rules were released with a bit more fanfare, and certainly more to come.  So, how do these events impact the journey to the holy grail destination of interoperability.

I think we have all experienced the challenges associated with the current state of interoperability, or lack thereof, of various systems that support our health system.  We want to delve bit in our next #CMIOchat into this and related topics.  We would love to hear all perspectives on this topic and welcome anyone with interest in exploring and discussing this.

So here are the topics for Thursday evening’s Tweetchat.  I look forward to seeing you there,

Luis @lsaldanamd

T1. What are the challenges we encounter as patients and informaticists in the road to interoperability?  Are you optimistic that we will get to true interoperability?

T2. What would a truly inter-operable, unified patient medical record look like from a functionality, user interface and operational perspective?

T3.  How would such a unified medical record support patient engagement or activation, or facilitate self management of one’s own health?

T4.  How would physicians and other clinicians engage with the data from such a record to enable both personalized medicine and population health?

 

CMIOchat Thursday September 24th 2015

by Gregg A. Masters, MPH

We’ve been baking this idea for a while, and at long last here it is!

CMIOchatThe inaugural chat is moderated by social media savvy and clinical informatics thought leader Nick van Terheyden, MD Dell Health and Life Sciences (@DellHealth) Chief Medical Officer aka @DrNic1 on twitter.

For a list of founder members of CMIOchat, click here, and the ‘why’ question is answered here. For context on the chat, checkout ‘Process matters as much as technology, especially when treading new ground‘ proffered by @DrNic1.

The hashtag is #CMIOchat and you have several ways of participating Thursday, September 24th, 2015 at 7PM Eastern/4PM Pacific Time.

Simply find your way to our home page here, or check out the TweetChat room here, or the Twubs page here (enter #CMIOchat). In the later two instances, you need be logged into your twitter account to access the ‘rooms’.

The value of Tweetchat or Twubs participation is you can pause and resume the #CMIOchat tweetstream.

Of course you can also follow on your smart phone, tablet or even Tweetdeck via the hashtag.

The theme is ‘Emerging Technologies’ and the topics to be parsed to the community are as follows:

T1: What technology is critical for near-term and future clinical and financial success? (Analytics? Telehealth? Mobile Apps? Social media listening?)

T2: What factors to consider in prioritizing tech adoption: Impact? Cost? Effectiveness? Ease of adoption? Current tech platform?

T3: How do you ensure that the IT department prepares for future technology?

T4: What ancillary factors should be considered when adopting technology? (Training, support, physician leadership, integration of data, etc.)

The process will begin with a round of introductions, followed by each topic and it’s discussion.

We’ll run for 60 minutes and hopefully engage the health data and clinical informatics community is key issues many of us are  grappling with on a daily basis.

Cheers!

 

 

Process matters as much as technology, especially when treading new ground

By Nick van Terheyden, M.D. Chief Medical Officer, Dell Healthcare and Life Sciences

Dr Nick Dell HealthIt’s an exciting time to be a chief medical information officer (CMIO), especially at a hospital or health system with forward-thinking leadership. New technologies are emerging that will help us make huge strides toward truly effective, precise and personalized medicine.

That said, it’s also a very complex time. New technology comes with a host of challenges, and the biggest lie not so much with the technology but with the people involved. New clinical technology inevitably disrupts established workflows, and while it can be a big improvement, it has to be handled carefully if you want the project to succeed.

Over the past five years, as EHR adoption has soared, we’ve seen spectacular successes and spectacular failures in technology adoption. The difference between the two often lies in the process, training and the implementation services used.

So what makes for a good process? Discipline, for a start. You want to move forward with all deliberate haste, but you don’t let yourself be pushed into taking shortcuts or unjustified leaps of faith. Too many projects have gone down in flames because a good process was circumvented in the haste to meet an arbitrary deadline or at the behest of an impatient leader. As the strategic technology leader for your organization, you set the standard for how projects are planned, implemented and measured. If you are disciplined, others will follow your lead.

No matter what the technology, there are a few key factors to focus on to increase your chances of success. Below are the ones that I think make a big impact. Some are obvious, but there are organizations that have ignored the obvious and lived to regret it. Take heed.

Know where you are

Before you launch a project (before your even plan a project), know your organization and its capabilities. Don’t assume you know what’s happening on the nursing units just because you meet regularly with the nursing leadership. They may not know what’s happening and impacting day to day work on the nursing units. People get very creative with workflows when time is short and they feel the pressure to do too much. If you are introducing technology that will affect a particular area, take the time to talk to front-line staff, with a particular eye to understanding the process variations that exist.

Same thing for the technology. Don’t base all your knowledge on what the CIO reports. Talk to the data center manager and the front line IT staff to learn the variations that occur to the set protocols. They will also be aware of how well their end users are following security protocols, which is knowledge you should have before you introduce new technology.

Think carefully about all the stakeholders, and take the time to understand how those stakeholders currently do their jobs.

Know where you are going

Make both a clinical and business case for any technology you want to adopt. Have clear and realistic goals. Avoid the temptation to oversell the merits of the new tools, because if the results fall below the expectations, things will get very uncomfortable for you and anyone else who has championed a project. Don’t undersell, but be sure to set achievable goals.

Also, get the metrics for a full year of operations prior to the adoption of the new technology, to have a reliable baseline for monitoring performance. Why a year? Because that will show any seasonal variations as part of a continuum. If you use a shorter window, you might inadvertently have data that is either on the top end or the bottom end of a variation, which could skew your view of results.

Gain from lessons learned

If others have blazed the trail before you, talk to them – use social media or join a TweetChat like #CMIOChat for example. Find out what mistakes they made, what challenges they saw and what factors were most important in making things work. Were there unintended consequences or unanticipated benefits?

Plan carefully

As you start the process, get all the key stakeholders at the table. Make sure you have input from the people who will use the technology most. That means frontline staff as well as leaders. Make your timeline reasonable, and do a pilot launch of the technology in parallel with your usual operations. That will allow you to test and refine before you go live. Even seemingly small changes can have big impact, and testing will uncover all those unintended consequences that could trip you up.

Don’t forget the business operations in your planning. One large system saw a huge drop in revenue when they implemented a new EHR in 2013, because it changed where and how charge capture occurred. Millions of dollars were lost over several months while they tracked down the problem and retrained staff. So if your new technology changes charge capture in anyway, you’ll need to plan for that. Your colleagues in the business operations arena must be involved.

Get the right resources

Don’t assume that you have all the expertise in-house to plan and implement a new technology. You can often save money in the long run by investing in consulting services and short-term staff augmentation to assist your people with the planning and implementation. Your staff have to keep the business running, while these contracted experts can focus solely on the project. If you choose your vendor wisely, you will have access to knowledge gained from hundreds of other engagements. And they will bring a disciplined process to the project, one that has been refined over many iterations and in widely varying environments.

But don’t just hire folks and walk away. Stay involved. Treat the consultant as a partner, and work together. Take advantage of the experts’ knowledge, and offer your own knowledge of the organization to improve the planning and implementation.

Choose your champions carefully

Physician and nursing leadership are often critical to successful technology adoption. The right champions can make or break a project. Choose these people based on their influence with their peers; their ability to be enthusiastic without being unrealistic; and their ability to take a disciplined approach to a project. An enthusiastic champion with no follow-through abilities can create cynicism and distrust. Conversely, don’t choose people who are so nit-picky that they slow things down over unimportant details. Common sense and an optimistic frame of mind are the key attributes you want. Plus a thorough-going knowledge of the clinical issues involved.

Start small and be both willing to fail and persistent

New technology inevitably requires trial and error. Failure is okay, if it happens small and early and is well documented. Do pilot projects before you take on a big one with new technology. Test, learn and test again. Don’t abandon a project without knowing exactly what went wrong and why. That process of examination can often identify a new approach that will lead to success.

cmiochat_TEDx_HarfordIn a TED talk on the subject of trial and error, Tim Harford (@TimHarford) notes that all really good complex systems are the result of trial and error. But it has to be disciplined trial and error, with results carefully documented and each failure examined for lessons that guide the next attempt.

Don’t be on the tail end of technology

In 2005, Blockbuster dominated video rentals. By 2010, the company filed for bankruptcy, its business model disrupted by Netflix’s streaming video and Redbox’s rental kiosks. Other brick and mortar businesses also declined, their profits eroded by Amazon, e-Bay and other virtual markets that offered responsive service and convenience.

Healthcare faces a similar turning point, in which the delivery of healthcare is radically changing. With the emergence of disruptive technologies like telehealth and retail express clinics, consumers want a different healthcare experience, one in which they have greater control, engagement and convenience.

So don’t be Blockbuster. You don’t have to be Netflix, but you don’t want to stick your head in the sand and wait to see what happens. If you are disciplined in your research, planning and expectations, and you have a well-thought-out business and clinical case for a new technology, move forward. The alternative is to fall behind and become irrelevant. And our patients can’t afford for us to give them half-measures.

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Follow Dr Nick on Twitter via @DrNic1 and Dell Healthcare and Life Sciences via @DellHealth