Elearning makes sense economically more than ever today. It is the cheapest way to get a clear, consistent message to the most people in the least amount of time. In healthcare, even moreso. What better way to educate healthcare workers on the use of IT than to use technology to deliver the message?  We’ve been using elearning to train workers across all industries in some skills, particularly manufacturing line workers in processes or transactional workers in soft skills. But just lately this trend is accelerating and spreading beyond the workforce and reaching to the upper echelons of the corporate hierarchy.  

Today, we are using elearning modalities to educate, inform and transform at all levels of the organization – webinars, online courses, videos, e-modules, pdfs, list servs – the list goes on and on and on.  Any type of computer-based learning from your laptop or your smart phone, anything you can grab from the web, download, participate in virtually, log onto or phone into, is elearning. Healthcare workers are being asked to change their work processes to seamlessly incorporate the use of information technology to provide better patient care. It only makes sense that one of the ways to migrate these workers to the effective use of technology is to also educate them using those same modalities.

I wrote an article last year for eLearning Guild’s emagazine Learning Solutions called  “Leveraging the eLearning Advantage in Healthcare.”  At the time, I felt like a voice in the wilderness. Now, I am beginning to see the training market tap into this efficient way to meet an acute need for knowledge transfer and culture change as the healthcare system moves from mom-and-pop doctor offices and prescriptions scribbled on paper pads to fully integrated health systems with patient information online and computer  physician order entry mandatory.

Let the medium be the message.

The federal government first firmly insinuated itself into the payment and regulation of modern healthcare in 1965 when it passed the Medicare and Medicaid acts as part of the Great Society programs of the Lyndon B. Johnson administration. From there, people have looked more frequently to Uncle Sam for guidance and reimbursement on healthcare decisions.

In the last year, health reform and electronic medical record requirements for meaningful use have changed the face of healthcare forever. Expect care to be more tightly regulated, more closely scrutinized and probably less generously reimbursed. Of all the changes coming out of DC, providers are most concerned about health care reform. Some want to play the new ball game, some are just confused, some are concerned, and others are angry. With some exceptions, very few are pleased as punch.

In the meantime, analysts from all types of organizations and across the political spectrum are scrutinizing what health reform is going to mean to doctors, patients, hospitals, drug companies, medical device manufacturers, researchers, insurance companies, small employers, large industry, unions, retirees – or, put more succinctly, just about anybody taking a breath. And after all the analysis is in, there still are naysayers on both sides of the political aisle talking about “de-funding” the whole shebang and starting over.

We hear that it is pretty hard to rip up a huge piece of legislation after it has passed through the serpentine legislative process. It is far more than likely that some pieces of health reform, at the very least, are going to be put in place permanently.

I want to be a spoiler in this discussion. Yes, it matters which pieces are adopted, when and to what degree. But because we don’t know, and because it is out of the hands of the average healthcare provider, my fallback position is to control what you can. And the one sure thing that will occur over the next decade, health reform notwithstanding, is that healthcare organizations will adopt information technology with or without encouragement from the feds.

In the long run, technology marches on. Newly minted medical school grads, nursing school grads and people swarming out of medical coding technical schools are living in the age of technology. When they get to work, they will expect to use all the great technology that makes their lives easier everywhere else.

The federal government is just making it easier by putting a mandate on it, setting standards and guidelines for meaningful use, and providing funding to get it moving. Realistically, even with lots of help and money from the government, the process of integrating health IT into the workflow of many environments will present challenges.

A little education and training can go a long way toward helping the integration of health IT move more smoothly, quickly and toward a common goal. Of course, first we need technology that is easy to use for providers, secure for patients and easy to integrate for the IT staff that has to implement it. Education and training are only part of the answer, but they are an important part of the answer.

If education and training are the answer, we need to frame the question.

The question is: how are we going to get tens of millions of healthcare providers all on the same page by 2014?

People are not usually anxious to embrace change, that is, unless the existing situation has become so uncomfortable that they imagine things can only get better.

Healthcare providers who want to adopt electronic health records into paper-based practices are finding themselves in that predicament. Unless things are terribly unworkable right now, staff and physicians might not think that another way of doing business will measurably improve the status quo. Add to that resistance the fact that the change is virtually mandated by the government, will cost money and disrupt workflow, and you can end up with a lot of unhappy campers during an IT implementation. Unless, somehow, the providers and staff believe that electronic patient records will improve the current situation.

Electronic patient records could make patient care better, and done well, will certainly address lots of problems with accuracy, availability and useability of patient information. We all know that is possible.

We also know that in their current form, some electronic patient record systems implementations are falling short of the goals of ease of use, workflow improvement, faster claims submission and fulfillment, more accurate patient data resulting in higher quality care, etc. Studies have even shown that, when fully functional, electronic patient records will save money for the individual providers and the entire system, meaning there should be a trickle-down effect in price containment.

No, we aren’t even close to there yet. But we are getting closer everyday.

The government has implemented mandates, incentives, deadlines and processes to advance the pace of the uptake and interoperability of health IT. The official effort pushed down from the top is a catalyst to advance the process ahead of its natural pace. And that assumes there would be a natural pace of the eventual adoption of electronic patient record systems resulting in a national database of patient information for care and research.

Because information technology and the Internet, in particular, dominate our world, it is more than likely – almost certain – that over time we will achieve full uptake, integration and interoperability of electronic patient records, and all the efficiencies that other industries have already realized. And this would probably happen even without government influence.

Knowing the inevitability of information technology for healthcare, the only question left is whether we push through the change now – at the massive cost and effort involved in the push – or we wait for the natural evolutionary pull to occur. For those who advocate pushing through the change now, we’ll need to prepare the way for a whole group of healthcare workers who might not – yet – be convinced that the current state of affairs is undesirable.

I usually blog about healthcare and frequently its relationship to training and performance. Today, however, the subject is pure training. For healthcare afficianados, be assured it was inspired by a blog about table etiquette for doctors that was featured on Kevin MD, one of my favorite healthcare blog aggregators.

See www.kevinmd.com to sign up.

Table Etiquette Rule #7

Table etiquette rule #7 is “Put napkin on lap to unfold. When leaving the table temporarily, place the napkin on the chair. At the end of the meal, place napkin to the left of the plate.”

I know this. I had learned virtually every one of the 30 rules, and most of them ingrained to he point that if I violate one, my conscience nudges me. Well, that is until lately.

I have been placing my napkin on my chair when I temporarily leave the table almost all my life; it’s one of those instinctual things. Not everyone does it; many people who demonstrate good table manners put their napkin on the table when they excuse themselves momentarily. Over time, somewhere deep down inside, I started to wonder if I “remembered it wrong.” After all, maybe the rule had changed.

The table etiquette article affirmed my instincts and, since I tend to see things through the eyes of a trainer, reminded me about a few things regarding training as well.

1. Reinforcement. Even if we learn something well, we can get sloppy over time, cut corners, or begin to question ourselves when people around us don’t apply the learned behavior. Occasionally, we may need a refresher or a job aid placed at our work station to reinforce the learning.

2. Learn it well the first time, apply it often. The original learned behavior “stuck” because it was repeated many times with correction for failure. The ingrained behavior is automatic and deviation causes a little subconscious nudge.

3. Teach everyone the same rules and processes for consistency. We don’t like to be different than our peers. If someone does it differently, long enough, we may start to emulate them to fit in. Make sure all, or at least the majority, of your employees know the correct way to do something and it will spread to others who may not have learned it as well, or at all.

The Stickiness of Training

The Learning, Education and Training group on LinkedIn has a hot trending topic this week on “In 10 Words or Less…Why do you think learners forget what they’ve learned so quickly?” This topic has garnered over 1,000 comments, akin to going viral. Just about everyone agrees stickiness is all about having the learning be relevant to your job, using it soon and frequently.

We all know this. But after we write and implement training, how often do we go back to reinforce what we’ve delivered? Sure, maybe we don’t have the time or resources. Or the managers back on the job don’t know the new learned behavior or don’t reinforce it. Or something.

If we’re going to stop wasting training dollars, we need to put in the time and effort to follow-up to make sure what we’ve taught is reinforced in the workplace and relevant to the job at hand. Then our employees will always place their napkins on the chair when they temporarily dismiss themselves from the table, just the way they learned it the first time.

KSAs? For my readers who are healthcare people, you may ask, “What are KSAs?”

For readers who are training people, you know that KSAs are Knowledge, Skills and Atttitude. You can teach KSAs.

Here are some examples of teaching KSAs in Health IT:

• Knowledge training includes compliance training. Health IT learners need to know the laws that govern the use of electronic health information such as HIPAA regulations regarding the use of personal health information. Some trainers I’ve worked with call this “head knowledge”.
• Skills training includes the actual, hands-on software training. Learners experience how to sign on to an application, which fields must be filled in, and how to access, save and send information. Providers learn how to use a laptop or tablet in patient interactions so the device does not interfere with the relationship.
• Attitude training includes what are known as “soft skills” in the parlance of human resources. Soft skills include things like leadership, empathy, management of self/others/projects. In health IT, attitude training includes change management techniques such as finding champions of an IT implementation and sending them out on the floor to make sure people are on board with the implementation. Soft skills health IT training includes managing the people, timelines and workflow, making sure there is a smooth transition.

You can lead an HCP to health IT, but can you make them think? Think what? This is where attitude training enters:

• Think about the value of gathering the correct patient information for high-quality care
• Think about the overall efficiency of gathering information to be disseminated to other caregivers who might be outside your immediate care team – say the dentist and the ophthalmologist
• Think about the value of patient data to researchers in the fields of cardiology, oncology and neurology (just as examples) based on the accurate information you have entered about the patient in front of you
• Think about the correct clinical protocol returned to you when you enter patient information into the system

Question: Are you employees trained in essential soft skills related to health IT? Would it help?

The Borg in Start Trek said, “Resistance is futile.” In health IT, resistance is probably futile in the long run. But in the short and medium run, resistance has probably slowed progress.

I would appreciate your feedback on whether you are doing soft skills training for your health IT implementation.

Please leave a comment or email me at peggysalvatore@healthsystemed.com. I am very interested to hear your thoughts on this issue.

by Peggy Salvatore

The story about Ebola has been dominating the news, and I didn’t feel any particular need to weigh in on it since there is plenty of information out there. Then a few little bits of information hit my inbox and I feel compelled to discuss the seriousness of it because the electronic patient record system has been implicated.

According to a story in HealthLeaders Media on the morning of October 3 by Cheryl Clark (who writes accurately and prolifically for HealthLeaders), Patient Duncan’s travel itinerary was tucked into a note in the nurse’s record which was not connected to the physician’s workflow. The way the unnamed electronic patient record software is set up, different caregivers can enter notes that are not cross-posted to other caregivers.

You can read the full article at: http://www.healthleadersmedia.com/page-3/TEC-309001/Hospital-EHR-Flaw-Obscured-Ebola-Patients-Travel-Note

If we stop and digest this for even half a New York minute, the flaw in this design is obvious and egregious.

That night, this tidbit hit my email alert by Joseph Goedert (also an accurate and prolific reporter) 10:25 p.m. October 3 in HealthData Management, “Friday evening, the hospital issued another statement:

“We  would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic patient record (EHR), including within the physician’s workflow.

“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event. [end of statement]

“Emails to two Texas Health Resources spokespersons late Friday asking what changed so that the hospital now believes there was no fault in the workflow of the EHR, or if the attending physician simply missed the travel history, were not quickly answered.”

Huh?

You might imagine for a minute the panic at the up-until-then unnamed software vendor. Since then, I have seen the name, and I choose not to mention it here. But there are only a few biggies in hospital systems today, and it is one of them.

The truth is important. It really is.

Where You’ve Been Matters

At first, I was moved to put keyboard to screen when I read this story because I had an experience before the proliferation of electronic patient records that further supports the fact that our travel is a critical piece of information when we present with symptoms. About 20 years ago, I began to have serious gastrointestinal problems. I couldn’t keep anything inside me – solid or liquid. When it was clear that no matter how much I put into my body, I was losing it all immediately and starting to slip away, my primary doc sent me to a gastrointestinal doc. The gastro guy asked me a few questions and within 10 minutes knew exactly what I had and where I got it: after hearing the symptoms, he asked specific questions about my vacation the previous summer. He knew the lake, he knew the bug. He prescribed a heavy duty antibiotic and within 10 days I was recovered. He probably saved my life.

Doctors are human, too. They don’t all know everything; they can’t. That’s why we have specialists. And that is why all the information in an electronic patient record needs to be accessible to every provider who touches the patient. You never  know what little gems in there may really be the golden key in the hands of the right physician.

A thorough history shared with providers all along the caregiving continuum is not a luxury. It is essential to providing efficient and effective care, as quickly as possible, at all points along the healthcare spectrum. And travel histories, especially when a patient presents with a mysterious illness, is critical information. Travel histories are critical information today, especially with the proliferation of bizarre viruses and flu epidemics popping up all over the country and the globe. Where you’ve been matters.

That is the beauty of the potential of electronic patient records. The case of Patient Duncan in Dallas highlights the importance of designing the record systems so we can extract the value they could provide when done right.

Points to ponder:

1. Electronic patient records need to be comprehensive and include travel histories, especially when the patient presents with a mysterious disease.

2. All providers need access to all patient information across all sites of care.

3. As to the disparate reports, it is worth repeating that the truth matters or the record is pointless.

By Peggy Salvatore

The ONC’s national meeting held earlier this month is cause for the greatest amount of optimism I have seen since the government decided to drive health information technology. Current and former national coordinators gathered on one stage, and their uniformity of purpose was representative of the movement toward interoperability.

The meeting was covered by Healthcare IT News in an article by Brian Ahier, director of standards and government affairs at Medicity.

The meeting came on the heels of a new Federal Health IT Strategic Plan released in December that calls for coordination of efforts among federal departments and agencies to advance the sharing of electronic health information.  Here in the cheap seats, there is a sense that the coordination of standards is finally ready for prime time (in deference to the great Saturday Night Live 40^th Anniversary).

In Ahier’s February 18^th article Entering a New Era of Population Health , he explains that the data sharing section of the ONC’s Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap lays out the following goals for the end of 2017:

1. Establishing a coordinated governance framework and process for nationwide health IT interoperability;
2. Improving technical standards and implementation guidance for sharing and using a common clinical data set;
3. Enhancing incentives for sharing electronic health information according to common technical standards; and
4. Clarifying privacy and security requirements that enable interoperability.

The big picture is that the roadmap, as well as proposed rules for Stage 3 meaningful use standards, will advance the use of population health data which will, in turn, support value payment structures such as accountable care organizations.

While this is all good news, I continue to be concerned about overly optimistic timelines that don’t account for real-world budget constraints, training times, and conversion of all relevant providers. If anything, I continue to be concerned that the laws don’t go far enough in recognizing how far we have to go.

And in the case of how very far we’ve come with health technology in just the last few years, I wonder about how the system will integrate consumer health electronics and the central role they can play in monitoring, maintaining and supporting health.

Technology is out in front of the regulatory environment, and government’s role is appropriately to guide and support, not control and require. The leadership at ONC is heading in that direction and dragging a cumbersome set of laws behind it. Let’s see if these enlightened leaders can manage to lose those laws as they gain speed.

Would you like to use HIMSS15 as a starting point to explore a topic, do research this year and create a white paper and do a presentation next year?

I am hoping to tap into a network of health IT people within organizations who are interested in this idea or who need a project writer to pull together work your team is already doing.

I am available to attend HIMSS15 for an organization that would like a writer onsite for their company. I have a lot of experience in healthcare and years of interest in health IT. I write books, white papers, articles. blogs, training programs, presentations, and more. I attended HIMSS10 and worked on the original change management task force. I think this year is a turning point in health IT and would love to be there but can’t justify going for my own curiosity and enrichment. Besides, I think it would be much more valuable for me to attend with a specific end goal or research question in mind to stay focused because the options are almost endless.

I can attend the event and work on a project basis, especially if a company or organization is interested in pursuing a particular topic at length beyond the event.

I have done year-long projects and other book length papers and presentations, and view this is an opportunity for an organization to explore an issue at this turning point in health IT and using the HIMSS event as bookends.

Your project would focus on your area of interest from your point of view.

I can be reached at peggysalvatore@healthsystemed.com

We are oh-so-close to there.

By Peggy Salvatore

For those of you who follow the Health System Ed blog, you know this doesn’t happen often. I am speechless.

I just got off the phone with Dr. Sandeep Pulim, the CMIO of @Point of Care, a company that developed an app that pulls together all the pieces of the patient puzzle into an informed treatment plan that can do nothing else except improve outcomes and lower costs.

The computer brain meets patient data.

The Vision

Here’s a synopsis of my vision for healthcare that I summed up in my first Health System Ed blog six years ago:

Let’s play John Lennon for just a second.

Imagine going into a doctor who already knows your medical history and won’t require you to fill out pages of information which you’ve done countless times before, and may have forgotten some or most of it because you’re worried about whatever is ailing you at the moment.

Imagine that doctor’s staff won’t have to re-input that inaccurate data.

Imagine if we could track whether prescriptions are filled, so we’d know which treatments worked in which patients and which ones caused a side effect.

Imagine having baseline mammograms, colonoscopies, x-rays, c-scans and more that were available to any healthcare provider at any time in your life to see if you have a condition, a change, or just an old scar.

Imagine the mistakes avoided, the conditions identified and treated early and effectively, the cost of duplicate paperwork and medical testing eliminated.

Imagine knowing what works in whom, why, for how long, and under what circumstances.

If you can imagine that, you can imagine the end game for electronic health records.

Not to pooh-pooh concerns about patient privacy, rationing and all the other hurdles. They are serious concerns, and are being taken seriously by serious people.  But for now, let’s just play John Lennon and imagine there’s no duplication, it isn’t hard to do.

@Point of Care Marries Watson

Yes, the Fitbit and the patient record can talk to each other right now, and that information can be combined with latest published medical studies available at the point of care to come up with the best treatment plan for the patient in front of you. Doctors and nurses can transfer de-identified patient data into the electronic health record to become part of the database of patient information to be parsed across health systems. The patient has a HIPAA-compliant smartphone or tablet app and can choose which providers receive their personal records and biometric data.

@Point of Care recently announced a relationship with IBM/WatsonHealth which IBM promoted as one of its partners at HIMSS15. Watson’s cognitive computing power is now being put to work on the patient in the treatment room to pull all patient and medical information together in an ascending spiral of knowledge.

The @Point of Care app and its interface with Watson is exactly the kind of technological advance that catapults healthcare technology into the future and leapfrogs over many of the plodding but necessary steps we’ve taken to put the infrastructure in place.

As Dr. Pulim explained, “Our work with Watson is…exciting because it lays the foundation for what the IOM (Institute of Medicine) calls a ‘Learning Healthcare System’.”

WIIFM?

Who should care about this? Everybody. Here’s why:

• What’s the incentive for the patient? Best practices applied securely to your current condition immediately for optimum outcome. Patients get better faster.

• What’s the incentive for the providers? Evidence-based medicine plus ultra. And @Point of Care has built in the ability to earn those pesky CME credits while researching and treating the patient in front of you.

• What’s the incentive for the health systems? Follow the money. New payment structures based on outcomes require implementation of best practices at the point of care to maximize reimbursement.

• What’s the incentive for the payers? Identifying the best treatment, first time, all the time. No guessing, no spending money on less than ideal treatment. Let’s imagine that we can lose the pre-authorization process and cost associated with it.

• What’s the incentive for the pharmaceutical companies? It’s the pharma mantra come to life: prescribe the right treatment for the right patient at the right time. An interface with health plan payers ensures that the treatment is included in the patient’s benefit package. The interface with the patient encourages compliance and persistency.

A few years ago I imagined the promise of health IT to deliver better outcomes, lower cost and improve access. I am here to report that we are oh-so-close to there.

Where are you and your organization in the Internet of Healthcare Things? Please post a comment below. 

By Peggy Salvatore

Yesterday, just as I was turning out the lights in my office, two breaking Health IT news stories came in over the proverbial transom. The Office of the National Coordinator of Health IT (ONCHIT) announced that it has readjusted its Meaningful Use plans and set more focused goals for interoperability. I must remember to close the transom before I shut down my computer. That was too much to digest at dinner time.

Meaningful Use Rules Modified

According to FierceEMR , HHS changed the requirements for MU from 2015 through 2017 and implementing Stage 3 of the program. Here’s the really good part:

The rules “shift the paradigm so health IT becomes a tool for care improvement, not an end in itself.”

Ponder that.

In other good news, CMS will no longer be financially punishing doctors who can’t meet MU by moving “physicians out of the Meaningful Use program into a new merit-based incentive payment system,” a story in Healthcare IT News  reports. Whew. Got rid of that stick and replaced it – apparently, at least – with a carrot called MIPS (merit-based incentive payment system).

The Interoperability Road Map

As for the new interoperability goals, HHS released its final interoperability road map that sets a 10 year timeline for with “the ultimate goal…of (building) a learning health system by 2014” based on data. Briefly, the roadmap has three milestones:

• 3-year milestone. By 2017, the nationwide health IT system should be able to enable the sending, receiving, finding and using of health data
• 6-year milestone between 2018 and 2020. Expand data sources and increase the number of users to create healthier populations at a lower cost
• 10-year milestone. We arrive at a “learning health system” requiring nationwide interoperability that puts the person at the center of system that continuously improves care, public health and science through real-time data access

So there you have it. By 2024, we should arrive.

There is a lot more to both of these documents. And, for those with long memories, you will recall that two weeks ago HHS released it Federal Health IT Strategic Plan. These two latest documents regarding MU and the interoperability roadmap are in service to meeting the four goals outlined in the strategic plan:

Goal 1: Advance person-centered and self-managed health

Goal 2: Transform health care delivery and community health

Goal 3: Foster research, scientific knowledge and innovation

Goal 4: Enhance the nation’s health IT infrastructure

If you are an interested party, HHS is taking comments on the updated MU rules for 60 days. According to the article , it is widely believed that MU 3 will be, at the very least, delayed. HHS has taken serious note of the fact that a Robert Wood Johnson study recently questioned whether a well-intended MU initiative has been all that successful. The new rules have significantly pared down the requirements for each stage and rolled back reporting requirements.

A Traumatized Healthcare System?

Meanwhile, this morning John Lynn makes a very astute observation about health IT implementation at his EMR & HIPAA blog . John suggests that U.S. healthcare organizations are experiencing a sort of “PTSD” around health IT requirements using Mayo Clinic’s definition of the syndrome. Here’s a link to his thoughts on the trauma that these continually changing rules have wrought on an already burdened healthcare system (remember, the whole point of the system is to take care of sick people which is a very difficult job). John guest blogged in this spot last year and I highly recommend his blog if you are interested in staying current on the state of the healthcare technology and implementations.

More to follow on all these developments as I get a chance to dig down into the guts of the documents.

Steve Anderson is seeing green at MedicareResources.org this week for his compilation of health wonkery. Read this week’s Money Changes Everything edition here.

By Peggy Salvatore

This is the eighth entry in a series of blogs for ePharma Summit 2016 to explore ways the pharmaceutical industry can maximize the promise of digital health.

A report put out by the California Health Care Foundation  last week chronicled the promise of digital health holding the key to holding down costs for low-income patients with chronic conditions. After all, it is the poor, those with poor literacy and health literacy, who are often the ones with the highest rate of chronic disease – and the highest cost – to the healthcare system.

Who pays? For patients who fit this description, it is often the states and federal government who end up footing the bill for medications, emergency department care (because they sometimes don’t have a home at all, let alone a medical home) and inpatient stays. The study states:

Some 90 million Americans have multiple chronic conditions (MCCs), with the prevalence of MCCs highest among people with the lowest incomes. Each additional chronic disease increases a person’s risk of adverse drug events, higher out-of-pocket expenses, impaired functional status, hospitalization, and mortality. Two-thirds of health spending is associated with patients managing MCCs. (p.3)

A series of pilot programs have shown that even the poorest of the poor in unstable living situations often have a cell phone or even a smart phone, and Internet access at a computer. With just those tools, a few low-cost, high-touch digital outreach programs have moved the needle with medication compliance, attending appointments and maintaining health regimens recommended by their providers.

Here are a few highlights from this February 2016 CHCF study which surveyed global healthcare leaders:

• Digital solutions use texting, customize language and communication style to the audience, uses portals, kiosks, video, telephone and cable, combines medical and social services, leverages a trusted human and collects data passively.
• One-half of low-income adults own a smartphone and 84% own a cell phone. Customized text messaging bolstered appointment adherence by 40% and medication adherence by 12%. One successful test program has been expanded to Medicaid care management programs in New York.
• Text4baby is a program in both English and Spanish that messages labor signs and symptoms, birth-defect prevention, prenatal care, urgent alerts, developmental milestones, immunizations, nutrition, safety and more. It also connects users to Medicaid and the CHIP program.
• Meducation targets community health centers and translates medication and discharge instructions into 18 languages as well as provides visual instructions.
• Kaiser Permanente implemented KP HealthConnect by mining retrospective data in the EHR and using HEDIS data sets to use electronic messaging to bolster outcomes for black patients managing diabetes and heart disease.
• In a North Philadelphia grocery store in a low-income area of the city, one kiosk with behavioral health information encourages people to get “a check-up from the neck up”.

Some programs leverage relationships with faith-based initiatives, federally qualified health centers and university programs. The promise of digital health to help, diagnose, treat and manage diseases and common conditions (like pregnancy!) are only limited to our imagination.

With the desire to serve those who cannot afford and do not have regular access to healthcare, and the limitations of state and federal budgets to do so, digital health solutions can bridge the gap between poor health outcomes and managing high-risk populations.

Last Friday, widely used websites like PayPal, Netflix and Twitter were unavailable due to a distributed denial of service (DDOS) attack . Hackers got into those systems through technical holes in hundreds of thousands of personal wifi-enabled devices like baby monitors and personal devices to bring down a website host, Dyn. For people in healthcare who are concerned about security, it brought a system vulnerability into sharp relief.

I am not a computer expert (disclaimer), but as I understand it, many of the consumer and even medical personal devices that we use to monitor our health and deliver data to the electronic patient record are pre-set with default passwords. Users don’t usually reset them to a private password so most of these IoT devices remain set with the factory default. Apparently, any hacker can guess the default passwords, hijack the devices and get them to log into a web host system like Dyn all at once which overloads the system with requests and causes it to fail.

Vulnerabilities to Healthcare Organizations and Individual Patients

These kinds of vulnerabilities pose risks to individual patients and healthcare systems.

Healthcare organizations have already sustained several debilitating attacks that have occurred in this way. In 2014, Boston Children’s Hospital was offline for several days after a DDOS attack by the group Anonymous that was protesting its treatment of a patient; other hospitals have sustained similar attacks. Computer experts say there are measures that hospitals and health systems can institute to prevent such attacks. This article broadly describes some of those precautions.

Concerns regarding the safety of individual patient devices such as heart monitors and insulin pumps fall into two broad categories 1) diverting data thus compromising patient privacy and 2) resetting dosing parameters thus endangering patient lives. The FDA, which regulates medical devices, is interested in the issue and has studied it, but so far has decided not to regulate the IoT of medical devices for several reasons. It is technically difficult to do, technology and security advance more quickly than threats, and the threat to individual patient health and safety is more theoretical than actual. A hacker could hack into an individual patient’s medical device to reset it, but that is very unlikely. It doesn’t mean that patients with consumer or medical devices cannot or should not take steps to protect themselves. Patients can reset default passwords. This article from TechTarget describes the pros and cons of patient access to device passwords in more detail.

Due Diligence

The attack last week wasn’t a state-sponsored attack from Russia as originally postulated, but came from non-state-sponsored vulnerabilities out of China . No matter where it came from, last week’s incident reminds everyone, including those in healthcare, that a damaging hack attack is not that hard to do. In fact, attacks like this occur all the time, all over the globe. For a little fun – or for a wake-up call – check out this website where you can watch cyberattacks in real time. There is usually a lot of activity into and out of the U.S., Russia and China.

The challenge for IT specialists in health care is to make sure these attacks aren’t perpetrated on your patients or your organization. This article from Modern Healthcare  describes Athenahealth and Allscripts outages that occurred during the DDOS attack last week. A Medical Group Management Association health information expert reminded individual physicians’ offices that their data, too, can be taken offline during an attack and he recommends backup plans that involve having a technician on speed dial.

An article out of the 2014 Black Hat hackers conference  explains that all attacks –even those not directly targeted at healthcare – should be of concern to health IT professionals.

All hacks and cyberattacks can expose your patients and organizations. The Dyn DDOS attack is a reminder to do your due diligence.

Technology is moving much faster than the snail’s pace of government and regulation. It is an exciting time to be – not just in healthcare – but to be alive.

I’ve been hanging around the virtual water cooler in healthcare for two decades, and now the promise of technology as it affects and improves our lives is beginning to come to fruition. With that, here is a roundup and just a few developments and their significance to the future of healthcare from a medical, business and financial perspective.

Med-Tech: At the head of the futurist pack is Dr. Peter Diamandis, known for oh-so-many things including a founder of the X-PRIZE, Singularity University and the Human Longevity Institute. In his May 19 Abundance Insider, he looks  at a bionic hand developed in the UK “capable of grasping objects without the wearer’s focused thoughts.  The researchers created a convolutional neural network training the hand and its algorithm on the images of over 500 objects in various orientation and lighting conditions with four programmed grasps that you might use to pick up things.”  Go to the link to see the video. Under that entry, you can read the next story about an 18-year-old Mexican student who designed a bra that detects breast cancer.

Health Biz-Tech: The business of healthcare is all about how we pay for medical services and the structure of the business model. Our current system is focused on an insurance-based payment model. Already, insurance companies are toying with issuing insurance policies in real time based on your current medical history that involves instantaneous analysis of your condition, the company’s risk and what it will cost you to be covered by them. This could blow all the regulations out of the water. It could also call into question the current model of trying to cover everyone with insurance and could instigate a movement to have us begin to look at a different business model completely, especially in light of the kind of Med-Tech advances in the pipeline that will completely alter our outcomes and lifespan.

Health Fin-Tech: How and why certain goods and services get paid keep many an insurance agent, claims administrator and government regulator up at night., not to mention the security people who need to lock down our data to maintain patient privacy. The blockchain has the promise of changing the financial world, and healthcare payments and security will be part of this revolution. I am attending a Meetup of blockchain people in my area this Saturday and I’ll report back at some point.

They say those in a movement need to either lead, follow or get out of the way.

At some point in the history of the evolution of healthcare, government was in a position to lead. In the past few years, it has been in the unfortunate position of having to follow as technical advances outpaced the ability of government to legislate and regulate at the pace of change. Now it is time for government to get out of the way. At some point, we’ll need to regulate for safety and security reasons. But this is not that time.

By Terry McGinn and Peggy Salvatore

We’ve been getting quite a bit of interest and feedback regarding our series on standard operating procedures, so we’ll continue writing about this topic this week.

After all, inherent in the word “expert” is the idea that something is done correctly. Correct procedures and best practices need to be captured and passed on. Sometimes, though, it seems the only people who care if the SOPs are followed are the experts who wrote them.

Truth is, everyone needs to care. Accountability right down to the last man or woman is absolutely the key essential ingredient in ensuring regulatory compliance.

Train for Accountability

Employees who are tasked with executing the many small, incremental steps are responsible only for their piece of the process. Sometimes in the laser-focus on one task, people may lose sight of the bigger picture. That bigger picture – a safe product going out the door – needs to be reinforced occasionally. Training usually steps in here for both reinforcement and correction. When that fails, the regulatory authorities will notice. Companies get slapped with government warnings and fines at a higher rate than the average person may realize. But if you are in a regulated industry, you know how often you are out of compliance.

Think about dialing the failure point back to its origin. The failure point is when the SOP is not correctly written, understood and applied.

Only then does the employee fail to perform to specifications.

Only then will training have to step in for often very expensive correction.

Only that will happen when an audit reveals you are out of compliance with your SOPs, and the Corrective and Preventative Actions (CAPAs) applied at that point of failure. That doesn’t need to happen.

In a perfect world, it should look like this:

If your current plant is not operating flawlessly as above, identify your points of failure:

1. How many people are asked to retrain personnel after a deviation or equipment issue?
2. How many SOPs do you have? Are they overwhelming or conflicting?
3. Are they easy to understand and do they follow a logical, stepwise process?
4. After a deviation, is the SOP reviewed?
5. Are people observing the CAPAs?

And, the big question…

Do your employees feel responsible and accountable for performing their jobs according to the SOPs in place?

Employees feel empowered when they are able to follow well-written SOPs, and when they are acknowledged for contributing to a well-run organization. Points of failure cannot be business as usual. Organizations that accept points of failure as the status quo have a company culture that unintentionally encourages non-compliance.

Maybe that is worth repeating:

Organizations that accept points of failure as the status quo have a company culture that unintentionally encourages non-compliance.

And the road to audit hell is paved with regulatory non-compliance.

The Solution

Dial back your points of process failure to the source.

Ask yourself:

• Are my SOPs well written?
• Do my employees feel a sense of responsibility for performing to specifications?

If your answer to either of those questions is, “No” or “I don’t know”, give us a call.

We would be happy to speak with you.

Unlike some problems in the universe, the problem of poorly-written and executed SOPs can be solved. Let’s do it.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection. To have a conversation, write to us at workingwithsmes@gmail.com to set up an appointment.  

Photo by Drew Hays on Unsplash

By Peggy Salvatore and Terry McGinn

Each company in a regulated industry is required to follow written procedures.  The written procedure describes how steps or tasks are to be followed to achieve the desired outcome or result.  Having these steps identified permits the distant or precise way to achieve the end of your process or practice. 

Knowing the critical nature of having written procedures, your standard operating procedures and best practices need to follow a few procedures of their own so you can replicate what you do across your organization.  In other words, your standard operating procedures need to be transparent and streamlined.

One of the many purposes of the SOP or best practice process is to ensure that the process flow can meet expectations. Done well, your standard process or procedure should result in a quality product or achieve the desired result every time.

Knowledgeable and trained  personnel must have the SOP available to follow because no matter how many years’ experience they may have, even experts get stuck for a variety of factors. In fact, some experts know their jobs so well that they think they can skip or modify steps, take shortcuts, or do it from memory. This is a red flag!

The SOP should be written in a logical process flow that will allow someone looking for the cause of a failure later can pinpoint where a difficulty arose. Reviewing the SOP with someone internally or externally who is checking or auditing your procedure should allow them to identify what and where things  went wrong.

When you have a point of failure, an examination of the SOP should indicate gaps or problems that can include one or more of a host of issues including materials, equipment, environment and much more. Often, a failure can point to the source of your complications by reading the SOP against practice.

A well-written procedure or best practice document will:

1. Be written to describe the flow clearly to anyone trained on it
2. Include every essential step without including extraneous steps or materials that can and should be accessed elsewhere
3. Always be followed by everyone from the new hire to the veteran employee using the current SOP

Expect you will have changes to your SOPs on occasion. Expect you will need to review your documents periodically according to your SOP. And expect that when you have a clean, clear, streamlined SOP process that your errors should be few and easily identifiable.

To summarize, standard operating procedures and best practices need to follow procedures of their own so you can replicate what you do across your organization.  In other words, they need to be transparent. If they are the opposite of transparent – opaque – they are hard to follow and may result  in errors.

If you would like to talk to us about your SOP process, give us a call for a no-obligation preliminary review of your procedures.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection. To have a conversation about writing your standard operating procedures, write to us at workingwithsmes@gmail.com to set up an appointment.  

Photo by Drew Hays on Unsplash

Last week was the most important annual convention for health information technology, HIMSS 2018. The Health Information Management Systems Society (HIMSS) provides a forum for thought leaders and a venue for innovative products.

The 2018 U.S. HIMSS Leadership and Workforce Survey provides some insights about the state of health IT today and where its efforts will be focused for the next 12 months. With input from 369 hospital/health system and vendor respondents, the survey revealed that privacy and security, process improvement and workflow as well as data analytics and business intelligence to inform clinical decision-making remain top of mind.

For a glimpse of the 2018 priorities of the HIMSS respondents, this chart shows the Top 10 concerns of hospital leaders and the correlating priorities of the vendors who serve them. While there tends to be agreement about the top 10 issues facing health IT today, vendors and their customers do not always have alignment about their relative importance.

TOP 10 HEALTH IT PRIORITIES FOR HOSPITALS AND VENDOR CORRELATION (click to enlarge)

A Saturation Point

One of the most telling discrepancies between hospital and vendor respondents was the fact that hospitals overwhelmingly either anticipated stagnation or reduction in hiring in 2018 while vendors are still showing aggressive hiring practices. Vendors may be responding to last year’s demand and this survey indicates a need for them to adjust their projections to align with their customers.

CURRENT WORKFORCE VACANCY (click to enlarge)

This trend may show a saturation point for hospitals regarding how much more change and expense they are currently willing to incur to play the expanding health information technology game to the level that the government, innovators and vendors would like to push them.

Willingness is only part of the equation. The next generation of health information products in development will move information and technology to further integration and greater utility for patients, providers and payers. This trend is a juggernaut that will take both hospital and vendors with it in the next few years. Guaranteed.

by Peggy Salvatore and Terry McGinn

This article is cross-posted at www.workingwithsmes.com

Sometimes expert knowledge isn’t really knowledge at all. In fact, if your data sounds too good to be true, it just might be.  Sadly, for reasons of human sloth, greed or carelessness, sometimes the experts who supply your data are giving you bad information – and they know it.

In Finding Your SMEs, we discuss times when you may be dealing with conflicting expertise or when you may be asked to ignore some information and favor other information in your documentation to please a stakeholder. In those cases, you aren’t dealing in bad data. Rather, you are dealing with differences of opinion.

That’s an honest debate of the relevant facts.

Falsifying data to purposefully mislead someone is different than simple disagreement among experts.

When you are dealing with falsified data, there are no facts. There is no honest debate. There is only an intent to deceive. In regulated industries that depend on quality data to remain in legal compliance, falsified data can have many bad outcomes including products that are substandard, dangerous or deadly. Your best defense is to know your regulations and how to work with them because, remember, you can be guilty simply by omissions.

Remember Volkswagen? What About Your Drugs?

In 2015, the U.S. Environmental Protection Agency discovered that many VW cars were outfitted with software programmed to falsify data during emissions testing showing the cars met carbon dioxide emission standards. The brand suffered substantial damage and the company was exposed to up to $18 billion in fines when it was discovered the cars actually emitted up to 40 times the allowable amount. This attempt to defraud the public resulted in massive car recalls and a loss of company credibility along with profits.

Money lost. Reputation lost. Environment damaged.

In biopharmaceuticals, clinical trial data is the stuff upon which the Food and Drug Administration makes decisions about the safety and efficacy of pharmaceutical products. Does data get falsified there, too? Unfortunately, yes!

A 2001 study showed that falsification of scientific data used in FDA evaluations of experimental drugs was not uncommon, and it ranged from falsifying the identities of clinical trial subjects and their physical exam results to creating duplicate records to achieve the desired number of trial subjects.

It still happens today.

Just a few weeks ago, a Kyoto University research group headed by Nobel laureate Shinya Yamanaka was found guilty of fabricating all six main data figures in a study published in Stem Cell Reports. The study claimed it had modelled the blood-brain barrier in vitro using pluripotent stem (iPS) cells. Yamanaka, who won the 2012 Nobel Prize in physiology or medicine for discovering iPS cells, reportedly was going to donate his salary to the university as a mea culpa but the damage to his reputation will live beyond his paycheck.

Bad data can hurt – or even kill- patients and it exposes the biopharma research companies who rely on quality data to potentially billions of dollars in fines and, at the end of the day, the delay or loss of up to a billion dollars in research and development for a product that can’t be supported by strong, reliable data sets.

Is Your Data Subject to Tampering?

One of the ways to ensure that your data is valid is to have strong processes in place for data collection and auditing. Long before an FDA or compliance inspector finds a problem with your product or process, you can lock down your documentation with well-written and faithfully executed standard operating procedures.

By taking some strong action today, you can implement steps to avoid harm to your brand reputation, delayed or denied product approval, heavy fines, jail time and, of course, harm to patients.

If you would like to discuss your process for developing and implementing standard operating procedures, write to us at workingwithsmes@gmail.com and schedule a no-obligation appointment for a review of your organization’s data integrity vulnerabilities.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection.

This article is cross-posted at www.workingwithsmes.com.

In aviation, safety is always the primary concern. In fact, aviation’s safety record is so stellar that it is considered a model for healthcare. That is quite a testament.

However, a retired pilot friend recently bemoaned that the emphasis on FAA rules and regulations has overtaken concern about safety, and aviation is not better for the change.

“Now we’re only concerned about compliance. We have a cast of thousands as support staff. When I started flying in 1964, Part 91 federal regulations were about 30 pages. You could memorize it. Today, it is hundreds, if not thousands, of pages and nobody can possibly know everything that is in there. We are less safe today than we were 50 years ago,” he complained.

Making and keeping track of all those regulations costs aviation a lot of money. It requires a boatload of federal regulators to oversee them, and costs private carriers a bundle of money to hire people to monitor every jot and tittle of the laws. One misstep, and they can shut you down. And, he concludes, neither the passengers nor the airline employees benefit from this over-regulation.

Will Healthcare Follow Aviation Again?

Just about everyone in healthcare knows about the vaunted aviation checklist, and how it has become standard procedure in many operating rooms today. Books are written and consultants make good livings just teaching the checklist approach to safety. The checklist is a great tool. Healthcare is better for following aviation down that path.

But is healthcare going to benefit by following the FAA down the road to over-regulation? We can trip on our path toward safety by using regulations as stumbling blocks instead of using some common sense rules to pave a smooth road to improved quality and performance.

So Many Rules They Can’t Be Followed

Just yesterday, I was observing a training class that I wrote for a major pharmaceutical company that shall remain nameless, but one that we all know and love. We were training hourly line employees on procedures that affect product safety. To a person, they had one complaint: standard operating procedures were becoming downright cumbersome and made it very difficult to follow, let alone implement, them.

One veteran employee said when an incident occurs, someone writes another procedure and adds it to the book of procedures. Nothing else in the book is deleted or changed, and so it is becoming nearly impossible to follow. In fact, the employee complained that SOPs are written in response to each incident, meaning that many new SOPs only relate to one isolated incident each. The SOPs are losing their meaning and rationale. It is just a jumble of unrelated knee jerk reactions to specific incidents.

The employee concluded the company was creating more problems than it was solving by having a procedure manual that could not be followed. There are now so many rules to follow, the rules can no longer be followed, the employee complained.

Is All of Healthcare Headed Toward Unwieldy SOPs?

With the passage of the Accountable Care Act, known colloquially as ObamaCare, many believe that we are headed down a path of over-regulation. Where common sense and good medical practice once dominated the industry, healthcare practitioners (formerly called nurses and doctors) are overwhelmed with rules regarding how they practice, to which the actual art and science of medicine is taking a backseat.

At a recent visit accompanying a friend to a physician’s appointment at a hospital center, we observed that we were two of only four people sitting in a new waiting room with 25 chairs, two large receptionist desks – one that seated four and another with 12 stations – and a physician accompanied by a nurse and a receptionist carrying around a brochure rack deciding where to place it. Let me say that again. A highly skilled specialist was carrying around a brochure rack with his nurse and receptionist trying to find a place for it.

In this brand-spanking-new facility where our doctor’s office had been moved since our last visit (from a very modern, extremely functional office building now sitting vacant in the parking lot), we also observed not one – but two – printers behind the one receptionist desk and a wall of file drawers. We filled out our medical information on a clipboard, which we have done for each of his visits for the last three years to have it inserted into his manila file folder.

Sigh.

The Trend Is…

By personal experience as well as professional observation, the trend is toward more regulation, more staff to assure compliance with the rules, and an ongoing steady stream of physical and electronic paperwork to track patients.

Instead of continuing to ramp up our regulatory oversight into the stratosphere, perhaps it is time to – if I can paraphrase my retired pilot friend – throttle back and re-evaluate what we are really trying to accomplish.

Photo by NeONBRAND on Unsplash

By Peggy Salvatore, MBA

About 8 years ago, I started Health System Ed as an educational portal about the value of health information technology. It started with a blog called “Imagine” that described the dream of having all relevant patient information, all the time, in real time, to make good decisions about the patient in front of you based on best practices that had been determined by measuring what treatments worked in which patients.

Lately, as I write about genomics and sensored medical devices, it is clear that we are oh-so-close to the dream. In 2010, I didn’t have a clue how long it would take to achieve lift-off. Today, all the pieces are in place for people (masquerading as patients to the healthcare system) to know what is going on inside their bodies even before they manifest illness sometimes.

• Scientists and researchers can peer inside the genetic code to see what has gone awry, and they can snip, delete and replace poor genetic codes.
• Doctors can measure results by getting information about the patient in real time – whether it is a glucose reading to track the efficacy of your medication dosage, a heart rate monitor looking for signs of trouble, or a sensored knee brace telling your orthopedic surgeon whether you are doing your rehabilitative exercises
• Patients can know how they are doing and adjust their behaviors
• Payers know what works, what to pay for, and when to implement resource utilization strategies to encourage best practices

The electronic patient record systems are mostly in place now to capture information. They may need to be tweaked, upgraded, or replaced with the next generation of software, but the infrastructure is in place today. Next, we will build the analytics to turn data into usable information.

One of the most beneficial aspects of capturing patient data – everywhere, all the time – is that ultimately people will get the most effective treatment first which will drive down costs to the system and extend the healthy human life span. When we know what works in whom, it is a much shorter trip from disease to health.

It is nothing but exciting. We aren’t there yet. But we can see “there” from here.

Peggy is an author and writer who specializes in healthcare.