I love CCHIT.  Having an independent body assess EHR functionality is a wonderful service for us buyers of that technology.  CCHIT gives the seal of approval to those vendors that that have comprehensive EHR functionality requirement.

Apparently someone involved with writing the Federal Stimulus bill loved it as well.  It is apparent to me that it is intended to be a mechanism for determining if a healthcare organization qualifies for EHR incentive payments.

However, assuming CCHIT can determine acceptable EHR functionality is based on the flawed assumption that an EHR is a single purchase from a single commercial vendor.  Organizations that have achieved EHR functionality through the use of multiple specialized applications don’t have a certified EHR in the eyes of CCHIT (and therefore in the eyes of the ARRA it appears).

Let’s say I have a vendor that meets all but one requirement, perhaps their ePrescribing is inferior.  In the past I would simply find someone with niche capabilities to fit that need.  Good for me since I don’t have to start all over just to address that one need.  Good for the start-up that saw a need and met it.

But, in the ARRA world this is no longer an option.  Instead I don’t qualify for EHR incentives because I am not using a qualified EHR technology.

This concern has reached the level of drama in the open source world.  The Open Source folks had an open forum with the CCHIT folks at HIMSS yesterday.  It kind of got ugly.  CCHIT is just tied to an old single vendor paradigm which cannot accommodate this legitimate approach.

The problem is that vendor functionality does not determine how well an EHR is implemented.  I could have a vendor that provided my organization the richest functionality one could imagine, and still implement it in a way that totally sucks.  Conversely, I could cobble together several applications, none of which could qualify on their own for CCHIT certification, but implemented in the right way create something more functional and beneficial to my patients than some CCHIT certified applications.

We should return CCHIT to a buyer’s guide and stop using it to determine government patments.  The goal is good EHRs.  Certification distracts from that more than it ensures it.

Let me be the first to announce the delay of the deadlines to qualify for EHR incentives.  Actually, there is no official announcement or even open discussion – yet.  But, I believe it is inevitable.  I believe this for two reasons:

1. In my experience, government mandates delays are the rule
2. This EHR deadlines are completely unreasonable

Remember APCs, the revised Medicare funding mechanism for outpatient procedures?  Remember the big push for the deadline followed by a last minute delay.  In fact can anyone think of any significant government deadline that did not change?  My favorite example is the recent cutover to digital television.  We gave American couch potatoes years to go buy a converter box (or get cable service).  Millions were spent on advertising, web sites and coupon giveaways.  If there was ever a deadline that should have stuck it was that one.  Still, it was delayed from February to June.

We are giving hospitals and medical groups less time to implement EHRs than we gave television stations to change their broadcast capabilities.  The EHR is at least two magnitudes of order more complex.  Integrated Delivery Networks, such as mine, have essentially one year to implement an EHR for doctors and another year to implement the hospital EHR.  Note: I am assuming the rest of 2009 will be used for planning and waiting for the definition of “meaningful use.”  I have been working on this my entire professional career.  It is not a two year effort.

So, a delay is inevitable.  That is not to say that CIOs and other healthcare executives should plan on a delay.  I don’t think that would be prudent.

The other pressure for us is that healthcare, like corporate America, is focused on belt-tightening.  I have a backlog of really good ideas to reduce the cost of care to our patients.  Our new focus on Electronic Health Records will reduce our ability to implement these ideas.  Then again, I think that was the purpose of the incentives.  Get healthcare organizations to make EHRs a top priority to get them implemented once-and-for-all.

Today we have unveiled a new IT self-service help site.  This site is based on new generation artificial intelligence that reviews and categorizes our database of closed incidents.  The result is a system that can anticipate the most likely resolution to a user’s problem, even before the system collects the details of the incident being reported.

While we have a huge investment in this proprietary technology, it is so revolutionary we are compelled to share it with the community.  Your feedback is greatly desired:

http://shurl.net/ch8

The EHR incentives in the American Recovery and Reinvestment Act (ARRA) will cause nearly every healthcare organization to tear up their IT strategy and plans.  The incentives are significant and the time lines are incredibly aggressive for most organizations.  We cannot simply overlay the new work on top of the existing plans.

Healthcare, like corporate America, is focused on belt-tightening.  I have a backlog of really good ideas to reduce the cost of care to our patients.  Our new focus on Electronic Health Records will reduce our ability to implement these ideas.

This is a game changer.  Time to rethink what you can get done and when you can do it.  Even the time to develop a new strategy is limited.  If we spend the rest of 2009 planning and waiting for the definition of meaningful use we have a year to implement an EHR in our medical group and a year to implement the hospital EHR.  Talk about all hands on deck.

Then again, I think that was the purpose of the legislation.  Get healthcare organizations to make EHRs a top priority to get them implemented once-and-for-all.

Is your organization looking at the ARRA this way?

I love traveling across the state of Wisconsin visiting the hospitals that I serve. But, I also appreciate those days when I get back to my desk. I tend to get a lot of deliverables completed on those days.

I try to make my self as accessible to our IT team. You may have seen that I regularly post my phone number on Twitter.  When I am at my desk I often answer my phone. So, on those days when I am at my desk, I will inevitably pick up a couple of cold calls in a day.  I cannot think of a less effective way to market.  The whole process is inefficient and leaves me completely closed to the idea of doing business with the caller even before I know what they are selling. I especially hate the obligatory chit-chat at the beginning of the call (I am super. Yes it is cold in Wisconsin…).

Email campaigns are nearly as bad.  Come on folks, that is so 2005.

In the 21st century you get 140 characters to pique my interest. That is how much time I have and that is the length of my attention span.

I am seeing more and more IT companies joining the social network sites, particularly twitter. Today alone I received follows from Perot Systems Healthcare, ThotWave HealthCare, and NextGen Healthcare.

I applaud their use of social networks, this is a much more efficient channel for me to receive messages.  Their imbedded in the stream that I am already reading and the messages are short.  However, I believe these messages would be much better if the twitterers were actual people that work there, not a corporate moniker.

Whenever someone follows me on twitter, I take a look at their profile.  If they don’t seem to be contributing anything interesting to me then I am unlikely to follow them.  If they are talking about topics I care about (technology, healthcare, running, good restaurants in Wisconsin) then they become part of my online community.  If they are only marketing and selling, or talking about what they ate for breakfast, then I am not interested in following them.  If I see stock phtography on the profile page and more news releases than genuinely interesting content I turn and run.

People are more interested in marketing message when you first establish a relationship based on mutual interest.  Oh, by the way, did you know that St. Elizabeth Hospital in Appleton is the first in the area to offer Barrx (pronounced BAR-x)? It is totally star wars.  It targets pre-cancerous Barrett’s esophagus condition, a complication of chronic GERD.  See what I did there?

What is really intersting to me now is how we can unleash 10,000 Ministry employees and 4,000 Affinity employees to use their social networks to talk about the work that they and their co-workers do.   There are alread 700 such folks on Facebook.  If they can help others in our communities (geographic) connect their healthcare needs with our services, without an advertisement, that would be awesome.  Hmmm.

Annually I work with Ministry’s IT Customer Advisory Board (our IT Steering committee) to identify the IT projects for the coming year.  Like all capital budgeting processes, we have a IT capital target that is based upon a number of factors like recent financial performance and competing capital projects (usually new imaging equipment and construction projects).

At Ministry we really have two targets, money and time.  As I have posted previously, we estimate how much time each IT employee has to work on projects (as opposed to support).  We add all of that time to determine the total project time for the year.  I am simplifying things, but you get the idea.

If we don’t spend as much capital as we had planned then we can save that money to spend in the future.  However, time is different.  Every hour that we had reserved for projects is lost forever if we are not using it that way.

We have such a great demand for IT projects, it is important to make sure we do not let that time go unused.  In past years we approved projects, then waited for those championing the project to bring them forward.  The problem with that approach is that our managers are so busy they tend to wait until the latter half of the year to get things going.  In the mean time that time set aside for projects is going unused.

This year we are encouraging our business leaders to getting things moving sooner and telling them the resources are available now.  This should better use scarce IT time and reduce the number of projects that carry-over into the next year (which ultimately reduces our capacity for a given year).

I will let you know how that works.

OK, here is what the last guy screwed up. If you are serious about interoperable health records for every American, this should get you started.

Firstly, treat the initiative like the moon shot that it is. It is complicated, it requires a great deal of planning and a great deal of money. Think of NASA, now you have an idea of what it will take.

Secondly, you will need a patient identifier for everyone in the country. This includes non-citizens, because they get care too. If you are worried about the privacy implications of that, then scrap the whole thing. If every provider can’t use a single number to correctly identify their patient then this doesn’t work.

Thirdly, this is a national project. Treat it as such. Americans don’t stay in regions – we travel; we relocate. Focus on a single national solution.

OK, now the important stuff. The first time I ever heard the phrase “standards harmonization” was from the first person that the existing administration put in charge of health records. It is a STUPID concept. The existing standards cannot be reconciled. They are apples and oranges. Even if they could be, we can’t waste time trying to add a layer of complexity on top of something that is already too complex, which brings me to my last point…

Don’t try to make everyone happy. There will be winners and losers. There will be technology companies and healthcare providers that made bets on the wrong technologies and standards. You are going to have to break some eggs to make this big omelet.

I shy away from openly discussing politics in my personal and professional life.  But I think it is fair to say that the current administration has abandoned what was once a significant agenda to advance health care information technology.

One could argue that the national defense issues rightly made healthcare IT less of a priority for the executive branch.  Add on top of that the recent national economic woes and I had little reason for optimism that electronic health records would surface as a top political priority for the new administration.

So, I was delighted when the president-elect recently served notice that healthcare reform remains a significant part of his plan:

“We’re also going to focus on one of the biggest long-run challenges that our budget faces, namely the rising cost of health care in both the public and private sectors. This is not just a challenge, but also an opportunity to improve the health care that Americans rely on and to bring down the costs that taxpayers, businesses and families have to pay.”

Moreover, electronic health records are a central component to his healthcare reform plan:

“If we do a smart job of investing in health care modernization — let’s just say, as an example, helping local hospitals and providers set up electronic billing and electronic medical records, that experts across the spectrum consider to be an important step towards a more efficient health care system.

Now, somebody’s got to help set those up. We’ve got to buy computer systems and so forth. That’s an immediate boost to the economy, in some cases working with state and local governments, but it’s also laying the groundwork for reducing our health care costs over the long term.”

Certainly we have a great story to tell in central and northern Wisconsin.  Ministry Health Care and Marshfield Clinic are implementing an EHR setting aside competitive interests to put patients first.  In doing so we will provide integrated care in such a way as to eliminate duplicate testing, actively manage preventive care and eliminate wasteful paper-work.  I believe we are doing exactly the kind of work that the president-elect has advocated.  I strongly support the direction he has described.

I also support president-elect Obama’s baseball affiliation.  Many of you know I am a long-time White Sox fan.  The best day of my life was the surprise 40th birthday party my wife threw for me at then Comiskey park.  So, I enjoyed this exchange between Obama and a Chicago reporter:

“I’m going to call on Steve Thomma. Where’s Steve? And the reason I’m going to call on Steve, I understand that, as a lifelong White Sox fan, you were placed in the Cubs section yesterday, and I want to apologize for that. This is also part of the new way of doing business. When we make mistakes, we admit them.”

I have never launched a point of care application on wireless devices that has not had immediate and ongoing problems.  Usually the problems are enough to be annoying but not severe enough to scrap the initiative.  Even the highly paid outside network engineers can’t seem to provide me the flawless wireless connectivity that the vendors and trade journals lead me to believe is possible.

Recently I spoke to a group of hospitals on behalf of a consulting friend of mine.  As part of that favor I reviewed a short assessment of each of the 4 hospitals.  All of them had three things in common with our 14 hospitals:

1. They all cited medication scanning at the point of administration as their top clinical priority.  Our three Affinity hospitals in the Fox valley have implemented this and the others want to join them.
2. They all cited frustrations with their Carts on Wheels (aka COWs).  I too have yet to find the perfect choice.
3. They all cited frustrations with wifi reliability in their clinical areas.

I suppose misery loves company.  How did we all buy-in to this enterprise wireless disappointment?

What is your experience?  Does anyone have the secret code?

Ministry’s approach to product updates has changed over the years.  Previously, we endeavored to take all upgrades as they became available.  Recently, we have taken a different approach.  Our IT resources are scarce and demand is high.  We have to have a compelling reason to commit resources to any effort.  We now postpone upgrades unless there is a compelling reason such as a new feature with a significant ROI; remediation of a painful problem; or end of support for the current version.

The existing version of any application has hundreds of features that we are not leveraging.  So, stating that newer is better is not sufficient rationale.

This philosophy applies to desktop software (Office, Windows) and enterprise applications (Meditech, GE Centricity, Picis).

What’s your approach?