Another popular discussion point at HIMSS2010 is the intrinsic need for workflow change when practices move to an EMR. Simply installing a new solution will not necessarily fix process issues and inefficiency. As our brand new EVP of Sales stated “EMR is, and should be, more than just a pretty screen.”

You are introducing a new element that must change the way you work. For instance the process of a nurse putting a folder on an exam room door, to notify the doctor that a patient is ready (sometimes accompanied by a little green flag on the door frame), will be unnecessary and redundant. The number of these processes and workflows that need to be reviewed, and adjusted accordingly, will greatly depend on each practice’s current state of documentation, but everything should be evaluated.

This massive evaluation isn’t in vain, every change should be an improvement and every improvement, great or small, will have a ripple effect that at the end of the day will improve patient care and patient safety. Ultimately, that is the overriding goal. (Oh, and cost savings…but that’s understood, right?)

More Reading:

www.emrandhipaa.com (don’t miss the comments here)

"Workflow of the Workflow"

Dr. Greiver: Workflow is King

By: Bill W. Childs

I had the honor of meeting with David Blumenthal at HIMSS last week along with selected CIO’s, physicians, and vendor representatives. Our discussions centered on the costs and benefits of the ARRA and Meaningful Use criteria.

My Concerns:

1. Time lines for ARRA, Meaningful Use, HIPAA 5010, and ICD-10 are too tight. Some providers (with anywhere from one to ten facilities)who have been working on these efforts for years, can easily reach meaningful use criteria. However, there are many large and small providers who will not be able to meet the time lines as established.  “Too many guidelines; too little time”.
2. The cost of these efforts is beyond the ability for 80% of providers. It will take a great deal to implement and prove the needed requirements to reach meaningful use and history shows that it will cost much more than most people expect.
3. There is not enough industry experienced talent to get these projects implemented. As an industry observer for more than 30 years, I can already see providers hiring bodies that are not talented enough to get the job done. Implementing these systems is a very difficult task, and many of the most talented are already on the assignment.

My Peers' Concerns (in addition to those listed above):

1. The board and “C” suite lack of understanding the full impact of the effort (time, cost, talent, change, security, and interactions with entities not under their control).
2. The cost of sustaining these Herculean efforts.
3. The cost and effort to report to all of the new agencies and on all of the new data requirements.

My session with Blumenthal was enlightening. Not only were some of my concerns confirmed, but I was also made aware of other aspects to be apprehensive about.  Here is one silver lining though: The effort and direction is a good thing. HIT, if built properly, implemented properly, and maintained the right way with updates as necessary, is the only technology introduced to healthcare delivery systems that has the potential to reduce costs and eliminate errors, thus improving quality.

What are your major concerns? What efforts and ideas would you like to applaud? 

HIMSS wrapped up today and as a recap I thought I’d post some interesting conversation topics. First up is a conversation with some good folks at Henry Mayo Newhall Memorial Hospital (HMNMH).

How important is it to have a Physician Champion for your EMR projects? According to the two doctors and the Physician Project Manager from HMNMH, there was no doubt that it’s essential. I gleaned from that conversation that one of the overriding concerns of doctors, who have yet to adopt a certified EMR, is that many don’t want to change a system they are already comfortable with. Those doctors need a colleague who have seen the benefits of an EMR; an expert who can optimize the project, provide education, champion the project, mentor staff, and generally be a guide who garners support.  A role that was once defined simply as a “subject matter expert” has evolved into a position of critical importance integral to the success of ERM adoption.

This is no longer a one-way street with the IT department handing down process changes and the Champion promoting them, a good Physician Champion is involved in the entire redesign of processes and workflows, ensuring that changes align with how a clinician thinks and works. (Digitized Medicine).  The goal is to use the Physician Champion’s expertise to structure the project and optimize the way the EMR is used. From structured document templates to order sets and support tools, the Champion is a key player in strategic decision making. Selecting and installing an EMR is just one half of the battle. Participating doctors need to be on board and ready to use their newly adopted systems. A Physician Champion can rally the support needed to bring the whole thing full circle on the Information Superhighway (you know that speedway we were warned about?).

Projects that do not commence with a Physician Champion can experience problems on a variety of levels resulting from a lack of insight and general usage. A Champion is the person who can make a new EMR implementation a win-win for doctors, patients, and IT administrators (maybe a win-win-win?).

Stay tuned for more conversations from HIMSS.

More Reading:

The Healthcare Blog

EMR Selection: The Physician Champion

Are Physician IT Champions Necessary?

We will donate $1 for every new follower, fan, commenter, and visitor from now until March 3^rd 2010. If you have no idea why --- read this.

Don’t forget to leave a comment on this post and if you would like to donate on your own please do so here: ACFB.

Thank you,

The VCS Team

Will tonight’s State of the Union recharge the fight to reform healthcare?

“Congressional leaders are taking healthcare legislation off the fast track as rank-and-file Democrats, wary of unhappy midterm election voters, look to President Barack Obama for guidance in his State of the Union address.

House and Senate leaders said Tuesday they need time to determine the best way forward on healthcare in the wake of last week's special election loss in Massachusetts, which cost Democrats their filibuster-proof Senate majority”…read more on ModernHealthcare.com.

Will lawmakers come together to finally finish the job?

By: Mary Ann Ciccone

As part of ARRA, Medicare and Medicaid will provide reimbursement incentives to physicians and hospitals who become “meaningful users” of EMR. This effort will begin in 2011 and end by 2015 at which time all providers will be expected to utilize EMR. Changes will be implemented in stages and include data sharing, compliance with HIPPA and state laws, evidence based order sets, the engagement of patients and families, and care coordination. The final draft recommendations that will define meaningful use were published by the ONC for Health IT in December 2009. Eligible facilities and providers can incorporate these guidelines into projects currently in progress to meet the requirements.  

The result of following the meaningful use guidelines for all stages will be improved and more efficient patient care through the use of disease prevention and reduction of medication errors, greater communication between providers, efficiency in meeting reporting mandates and claims submissions, and lower healthcare costs.

 The recommendations for Stage 1 are listed below.

Source: HHS website for meaningful use.

It is time for the House and the Senate to reconcile the healthcare bill, but finding common ground on major sticking points may prove tricky.

Among the differences is cost and how to pay for reform. The Senate’s plan is projected to cover 94 percent of Americans with an estimated cost of $871 billion over the next ten years while the House’s plan guarantees converge for 96 percent of Americans at a rate that exceeds $1 trillion over the next ten years according to the Congressional Budget Office.

To pay for these plans CNN details the House and Senate’s plans: “The House plan pays for health care reform with a 5.4 percent surtax on incomes for those making more than $500,000 a year, as well as families earning more than $1 million. It also includes a 2.5 percent tax on medical devices sold in the United States. The Senate plan increases the Medicare payroll tax on individuals earning more than $200,000 and couples earning more than $250,000 from the current 1.45 percent to 2.35 percent. The Senate bill also imposes a new tax on insurers that provide so-called Cadillac health plans valued at more than $8,500 for individuals and $23,000 for families.”

As a mini – conversation starter: check out this article about “Cadillac Care” from FORTUNE.

How would you finance healthcare reform?

Just in case you haven’t been able to find it one of the other dozens of sites publishing the link here is the HITECH: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology and here’s how you get paid (warning 556 pages).

Mr. HISTalk summarized the finer or most relevant points here. And over at HealthcareITNews.com “Stakeholders have mixed reviews on proposed requirements” while Government HealthIT profiles groups that aren’t happy with the definition.  

We all knew it’d be a mixed bag right? What do you think of the proposal? Have you (are you) going to read it or will you just look for an effective summary? Let us know what your thoughts and questions are in the comment section.

Healthcare Reform in … five, four, three, two, one.

We are counting down to a Christmas Eve vote on the healthcare bill that’s in front of Senate right now. Familiarize yourself with the details with an article from the Wall Street Journal that looks at specific changes some democrats included, new taxes that will be implemented, and other included provisions.

If you are more of a visual learner and are interested in the three (most likely) alternatives to our current healthcare system check out "Healthcare Napkins" for insight into the core issues of the complex debate.

How knowledgeable are you on the proposed bill? Share your insights in the comment section.  

Throughout the healthcare debate I’ve heard a lot about the French healthcare system and the British system and occasionally someone will throw Germany in there too. In September one of my good friends visited from England and we had the chance to chat about her personal experiences with healthcare back home. Helen wasn’t all that satisfied with the British system, in fact, she wasn’t happy with it at all. Obviously, no system can be perfect, but it did get me thinking...beyond broad generalizations how do other countries handle healthcare?

France’s La Couverture Maladie Universelle                                                  

Described in detail Medical News Today has a basic run down of how the French healthcare system works. Dr. Yann Meunier reviews medical training in France and how it differs from the United States on KevinMD.com. And finally, an interesting comparison here.  

Britain’s National Health Service

Time get’s a few opinionated digs in, in this article, but if you can read through it with a discretionary eye it is a good overview of the NHS. Here are two quick opinion pieces that summarize some pros and cons on CBS.  And here’s one more article that goes into further detail about NHS from a site hosted in Europe.

And to bring it all full circle (well almost) here’s an article out of the UK about the German healthcare system. 

If you had to pick a country to live in based solely on healthcare, where would you go? (Not limited to the countries mentioned in this post.)