@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.

 

 

The Identity Problem

by Nick van Terheyden, MD aka @DrNic1

Dr Nick Dell HealthI struggle to keep my contacts in order and synchronized, not just across devices but across ecosystems and channels. How do you keep your old style digitized version of the “rolodex” in sync with your twitter followers and LinkedIn connections? How do you know when your friends join a new social media channel that you are member of so you can connect there?

I’ve tried many tools and techniques and had been using Brewster (which recently was acquired by FullContact) and the transition offered me 3 months of premium access to their service. The free version offers backup and some syncing across limited accounts – the premium version expands to multiple accounts and includes business card scanning.

The early results were surprising – in my contact database the system was offering me updates to over 40% of my contacts. I was suspicious but as I investigated I discovered that using some clever back end algorithms it was revealing updates too many of my connections including some I validated manually that good friends revealed were early forays into social media including a blog on Ice Cream and a corresponding Pinterest account.

So in social media and the commercial world we can link data and people. In fact the commercial organizations do this very effectively that Target collected enough information on individuals linked through a unique identifier to identify a high school student was pregnant and mail her maternity adverts before the “news” had leaked to her father:

“Target assigns every customer a Guest ID number, tied to their credit card, name, or email address that becomes a bucket that stores a history of everything they’ve bought and any demographic information Target has collected from them or bought from other sources”

The healthcare system is rife with enough challenges – why is it we have one that is of our own making? Why is there so much resistance to the idea of uniquely identifying a patient so we can attach the correct medical data to the correct person and deliver the correct medical treatment to that same individual?cmiochat_ patientID

In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law and it specifically called for:

“a standard unique health identifier for each individual”

But in 1998, Congress eliminated that requirement and even prohibited the use of federal funds to develop a unique identifier. Anyone who knows me will know my passion for privacy and individual rights but in this instance the harm and cost foisted on the system, providers, payers and ultimately the patients is gargantuan!

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Figure: The Percentage of Waste by country spent on Healthcare Administrative and Insurance

The Social Security number has become the de facto universal (and most valued) US national identifier. Created in 1935 for the purposes of tracking social security benefits it has been hijacked and subsumed into multiple other uses. The gathering and use of this placed a large target on the back of healthcare data and as of the end of last year over 112 Million healthcare records were breached.

As far back as 2009 HIMSS issued a Patient Identity Integrity White Paper making the case for identity management and in 2010 the recently retired Gartner Analyst and Research Director Barry Hieb and now Chief Scientist at Global Patient Identifiers wrote this piece in e-Journal of Health Informatics: A Cost Effective Method to Create a Universal Healthcare Identifier System (full PDF here) advocating the need and a path to the creation of a universal patient identifier:

“The prohibitive cost associated with creating a universal healthcare identifier has been one of the primary barriers to the creation of such a system. The Voluntary Universal Healthcare Identifier (VUHID) project takes a radically different approach to solving this problem compared to previous proposals. This article examines the economic impact of this approach and discusses why the unique VUHID approach permits implementation of the system at a small fraction of previously estimated costs”

Despite a rational approach that enabled individualized control and security it has not taken off. We continue to waste resources, duplicate tests, decrease the overall safety and increase errors in our healthcare system that according to the RAND study: Identity Crisis; An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System could offer a saving of $77 billion per year if implemented with sufficient penetration – they cite 90% level of adoption.

Have a I raised your heckles advocating for a unique identifier – is it as Adrian Gropper Chief Technology Officer for Patient Privacy Rights stated (@agropper):

“Implementing a unique patient identifier would add nothing to our health care system beyond coercive surveillance”

Or, as Twila Brase, RN, Co-founder and President of Citizens’ Council for Health Freedom, says its important not to have it to prevent the creation of a “nationalized” healthcare system (I’d interpret this as a single payer system like the VA and Medicare?):

“The most important reason is our opposition to building a national health care system. Without a national identification card for patients, it would be difficult to nationalize health care”

Or do you side with Douglas Fridsma, MD, PhD, is President and CEO of the American Medical Informatics Association who says people care a lot about the privacy and security of their medical data but want immediate access and transferability with control over who can see and use their medical data and believes that:

“Giving every American a unique patient ID could help address all of those issues”

Join me and your clinical informaticist colleagues this Thursday April 28 at 7pm Eastern/4PM Pacific for #CMIOChat.

Here are the topics we’ll be considering:

T1 Why does the US not have a Unique Patient Identifier?

T2 Is it possible we can come up with agree and use a Unique National Patient Identifier and if so how?

T3 What alternatives are practical and cost effective to a Unique patient identifier?

T4 How do we protect patient confidentiality and privacy in a world with a unique patient identifier?

 

HiMSS16: Separating the Wheat from the Chaff

by Dirk Stanley, MD MPH

Very happy to report that I’m back from HIMSS16 in Las Vegas this year, renewed and re-energized with new information!

Dirk Stanley MD MPH HiMSS13
Dirk Stanley MD MPH HiMSS 2013

What a great learning experience HIMSS always is – And not just at the conference! This year, I even learned a lot about what HIMSS really means when a non-healthcare, non-technology person sitting next to me in the plane asked me, curiously: “What is your conference all about? What can 40 thousand people possibly have to talk about for five days?”

For many healthcare technology and Informatics professionals, HIMSS is not only a great showcase of what’s going on in the industry, but it’s a great opportunity to connect with other people who are facing the same challenge : How to make technology work to successfully help improve patient careHIMSS16_home

In general terms, some technologies focus on improving clinical operations for the doctors, nurses, pharmacists, and other ancillary staff providing care on the front-line. Other technologies focus on harnessing quality data and analytics to streamline care and reduce costs, or connecting patients with their care and caregivers. And finally, some vendors are looking to improve all of these areas, together.

But when budgets are tight, and the clinical stakes are high, it can be very challenging to predict the success of a investment in a new technology or human capital. How exactly does one best do this? What factors should a health technology professional look for to know if the investment will be both helpful and cost-effective?

And so I’m very happy to report that in addition to the new technology and talent showcases, HIMSS also attracts a priceless group of real-world healthcare IT, Informatics, and patient care advocates and professionals who are faced with the same challenges, and asking the same questions.  Many of them can be found on Twitter following the #HealthIT and #HITsm hashtags.

So when I was trying to explain my purpose for attending HIMSS to this curious person sitting next to me on the plane to Vegas, it dawned upon me that one of my major reasons for going was not only to better understand the answers, but also to better understand the questions.

So now after returning from HIMSS16, I’m glad to say that I learned a tremendous amount from the vendor showcases, education sessions, and the after-hours conversations with these other HealthIT, Informatics, and patient engagement advocates. Together, they help me develop clarity through better questions about investments in technology and/or human capital. It’s that clarity and deeper understanding that helps to effectively separate the wheat from the chaff. After all, if at the end of the day, it doesn’t help improve patient care, provider satisfaction, or efficiency – or all three – why make the investment?

T1 : What factors do you consider in a technology to know if the investment will be helpful?

T2 : What factors do you consider in a vendor to know if the investment will be helpful?

T3 : What factors do you consider in human capital to know if the investment will be helpful?

T4 : What factors help you determine whether an organization will see a good return on investment from their investments in technology or human capital?

T5: What are your sources of research when exploring & vetting products, services & solutions? Why?

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Dirk Stanley, MD, MPH  is a board-certified hospitalist, informaticist, workflow designer, and former CMIO who lives in Northampton, MA. For more information, click here.

#HiMSS16: The CMIO Then and Now

by Gregg A. Masters, MPH

I love this quote:

Leadership has always been a complex calculus and is specific to the domain/environment/population being led. – William F. Bria, MD, FCCP ‘The CMIO Survival Guide

So are we willing to be led? And by whom?

As we all know perhaps all too well, ‘healthcare is local‘, in fact hyper-local as the case often is, and not immune from indigenous geo-political and market structural considerations. Whether from a market dominance or top of mind share perspective, healthcare infrastructure carries a considerable amount of political currency – if not outright ideology driving the organization, governance and equity (business model) considerations of local operators. For instance, the State of Texas and it’s commitment to the preservation of independent physician practice is a stark contrast to the practice of Medicine (risk tolerance) in the State of Florida (no Corporate practice of medicine doctrine) or even California for that matter.

cmio_jama_article
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Yet in the still emerging space of ‘applied medical informatics‘ whether informed purely by market or even organic forces, before factoring in the material incentives presented legislatively via ARRA/HITECH and it’s aftermath, the space has been in a constant state of dis-equilibrium if not sector chaos as we look for and settle on some market or industry homeostasis if you will.

This narrative has been developing for some time. In 2006 JAMA published: The CMIO—A New Leader for Health Systems wherein it posited physician:

leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined

IT and teh Executive Team (CMIO)
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While a tad dated, this perspective was further informed last year when HiMSS released its Annual Leadership Survey (see: ‘About‘ post for results). What this author found of interest then and perhaps still so today with the degree to which the CMIO role penetrated the C-suite culture particularly given the importance of the role as acknowledged by both references above. In 2015 the CMIO was considered part of the ‘executive team’ in only 39% of the sample.

While this is a static picture and therefore not instructive on the relative growth rate of this participation (and standing) in the health system enterprise, it none-the-less follows on the heels of the rise of the CIO as a full fledged member of the C-suite team. Here the evolution from DP Manager or Director (often seen as staff position with an overhead label) to the CIO of a materially staffed operation tasked (or co-tasked) with revenue, market share and business intelligence objectives may offer some insight.

In 2016 the CIO role is well established. Yet, can the same be said of the CMIO? For an excellent post by one of our founding colleagues Nick van Terheyden, MD (@DrNic1), see: ‘Process matters as much as technology, especially when treading new ground‘.

And ‘treading new ground’ is arguably a constant for our colleagues and the vendors who hope to engineer their enterprise success!

Follow the action from HiMSS 2016 via the hashtag #HiMSS16. The digital dashboard is here.

 

 

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