Author Archives: hospitalcio

Don’t post your PHI on the Internet

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I was looking at cheap services to transfer large files (home videos) and I stumbled across the mailbigfile service.  I was checking out the FAQ, which is actually a forum.  The first entry I read was very scary.

If you don’t feel like following the link, I will summarize.  This user was asking how long the service would retain his file named “ Admission, Discharge & Transfers.doc ”  Yikes, this dude is sending his hospital patient data using this free service!

This service does not use any encryption or passwords.  It just puts the file in a publicly available web server using a funky web address like: http://www.mailbigfile.com/309744be27e1b1c2800553375d0ca99b/download/826733/will_bellin_2007.png

These are the kind of links that people believe are undiscoverable, but googlebots find them all the time, and then heads roll.

Project Governance

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When we organize medium to large size projects we like to create two main committees to ensure the success of the project.  The Project Leadership committee typically includes the IT Leader, the Project Champion (non-IT), and the project manager.  This committee meets regularly, at least 3 hours a week.  This group is charged with:

  • Tracking the project plan, taking corrective action where necessary
  • Tracking the budget
  • Reviewing the issues list
  • Planning what updates should be communicated to various audiences
  • Summarize all of this in a regular status report

The Project Oversight Committee is comprised of the Project Leadership team and senior leaders with accountability for the success of the project.  It is their job to:

  • Regularly review the project controls
  • Resolve issues that require senior leader decision making
  • Sign off on any decisions that have a significant impact on the goals of the project
  • Keep the project leadership team focused on achieving the project goals

This structure has worked well for me and I recommend using this approach as a starting point for your project governance.

How NOT to use Powerpoint

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Cute video regarding common PowerPoint mistakes.  Forward it to your favorite offender:

How NOT to use Powerpoint by David Airey of Creative Design

I would add my own presentation tips:

  • NEVER use animation – life is too short
  • Don’t use notes – they kill the spontaneity
  • Don’t over-rehearse – I don’t like robots
  • If you find yourself saying “again” you are being redundant, it is OK if the presentation goes quickly

Modern Healthcare Online – EHR and Physician Anger

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David Burda’s piece on physician anger with Electronic Health Records is interesting (Alexis Polles is the original presenter).  Modern Healthcare’s Daily Dose suggests these frustrations are related to poor design and poor training.  Of course excellent design would minimize the need for training.  I agree with that take.

However, the original speaker seems to indicate that some physicians are unable to adapt to this way of practicing medicine.  Our experience is that 1 to 2 percent of doctors may have trouble embracing clinical IT (regardless of design and training).  As you prepare to roll out your clinical IT systems I think it is critical to know how you will handle that 1 to 2 percent.  I hear a lot of people talk about a “lack of senior management support” with clinical IT efforts.  I think we put senior leaders in a tough position when the checks are signed and the physician problems beginning to pop up.  If you have that conversation in advance and agree on the course of action, we will find senior leaders more support.

It will be useful to discuss some real uncomfortable scenarios.  What if the one physician hold-out is your top admitter?  What if you are experiencing 10% physician resistance?  Too often we sugar coat these challenging projects.  That will really cause a lack of senior leader support when your EHR or CPOE effort turns out to be something other than the bed of roses it was portrayed.

I report to General Counsel

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Over the years there has been a lot of debate regarding where the CIO should report. Most of the noise comes from CIOs that determine their self-worth by reporting to the CEO. I know this, because I used to be this way. But, the CEO is not always the best person. I now strongly believe that this is dependent on the organization and the leaders. There are very few generalities one can apply to this topic. The best example is here at Ministry. I report to the General Counsel. Now, this is very mis-leading. Our General Counsel, Ron Mohorek, is a top executive that just happens to be lawyer by education. Because of that background he is naturally in charge of legal matters. But, his greatest contribution to the organization is his ability to be strategic and tactical. This is where he spends most of his time.

Legal and IT matters are very similar. In both disciplines there is a temptation to hand over a business matter to the lawyer or the IT guy. In both cases this usually results in disappointment, especially when the business leader is not clear on what they are trying to accomplish.  Ron’s understanding of this greatly advances my cause to keep the accountability for IT initiatives out of IT (except the technical stuff).

At Affinity I do report to the CEO. And, this seems to be the best fit for that organization. I would love to hear your thoughts.

Swapping Existing Headaches for New Ones

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Particularly in IT, the grass is always greener on the other side.  The bottom line is that complicated IT systems all have their flaws.  It takes a lot of effort to make sure you are not swapping out a set of existing frustrations for a new set that are different, but equally frustrating.  And, the cost of that swapping is enormous.

Healthcare Blogging and Web 2.0

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Bob Cofield has written an amazing summary on “Healthcare Blogging and Web 2.0” and posted it to his blog. I found it because he linked to this blog (thanks for the publicity). Unless he asks me not to, I intend to use the content to educate our leadership on these topics. In general, I think healthcare leaders lag behind the top of the technology adoption curve. I suggest other healthcare leaders consider using this content to improve the tech savvy of their leadership.

Tech Hiring Thoughts

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I am in the process of filling a position and it generated some thoughts about tech hiring that I wanted to share.

This position is a part-time position that can be done from one’s home. I have been overwhelmed by the quality of the candidates that this position has attracted. Many of these candidates are moms that are looking to adjust their work-life balance. It strikes me that there is a largely untapped market of talented women professionals that are looking for these part-time, telecommuting positions. With the invent of broadband Internet access, WebEx and other web 2.0 collaboration tools there is no reason for many of our employees to come into the office.

My other observation is about how candidates prepare for interviews. I cannot imagine going into an interview without doing my research on Google. It just speaks to the candidates proactive nature. When candidates tell me that they found this blog they get bonus points. If they are totally unaware of our organization it tells me that they didn’t even bother to go to our corporate web site. That would be hard for me to get past.

For future candidates that have found this blog, here are some tips for interviewing, especially me:

  • laugh at my jokes
  • be a good listener, most people will tell you what to say before they ask you the question
  • bring samples of your work such as copies of reports, presentations, writing samples, etc.
  • show me that you are technologically savvy.
  • show me you are a self-learner
  • be personable – people want to hire people they like

Better usability, not more training

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I have a vendor of HR and Time/Attendance software that does not have a clue when it comes to software usability.  Whenever we point out how difficult their software is to use, they are fond of telling us that these are “user training issues.”

Classic example: we were attempting to roll-out the first generation of their online employment application.  Employment candidates could not figure out how to save their entry.  It wasn’t apparent that the small floppy disk icon in the upper left corner was the submit button.  Firstly, the submit button should not be in the upper left.  Secondly, many of our candidates have never seen a floppy disk.

When we pointed this out they gave us response that has been programmed into their autonomic system since orientation: “That is a training issue.” Hello, these are people spread all across the country.  How do we train them to fill out a 5-minute application?

The fact is, you don’t need to train people on software that is designed well.  Nobody gets trained on eBay, or Monster, or Digg.  They are intuitive.  These organizations spend time watching how users interact with their tools and modify them based on what they learn.  If you are a software developer and you have the same people working on the presentation layer of the application as the logic layer you need to get a clue.  If you have an extra clue send it to me and I will forward it to my vendor.

This is an area where I have spent more evaluation time when considering a new purchase.  There is a huge cost to all of this user training that is completely unnecessary.  I would encourage IT leaders to make this a more heavily weighted portion of their evaluations going forward.

World Premier Video

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Making it easy for physicians to do the right thing is the hallmark of our EHR initiative. This includes practicing medicine as supported by medical research (Evidence Based Medicine). Some physician claim this is cookbook medicine. This video is our response. The video is the brainchild of Dr. Pete Sanderson, Ministry’s talented CMIO. He makes a cameo in the video along with his Affinity counterpart, Dr. Paul Veregge.