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.

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.”

This week a dear friend of mine passed away suddenly.  Jeanne Gittings ran the library at Trinity Regional Health System.  Jeanne and I worked together from 1995 to 2000.  A fraction of her career in the Trinity – she started in 1969 after receiving her degree from Augustana that same year.

Jeanne was dedicated to her role as a medical librarian.  It seemed more like a calling than a career.  She was selfless and constantly adopting with the times.  I got to work with Jeanne during the Internet revolution.  During that time I saw the library go from periodicals and books to PubMed and the web.

Jeanne and I taught a series of community classes on how to search for reliable medical information on the Internet.  She convinced me that I should be demonstrating Google searches (at the time I was an Alta Vista user).

After leaving Trinity I found that all medical librarians seem to demonstrate the traits of service and adaptability.  At Affinity I found that Michele Matucheski and Mary Bayorgeon were from that same mold.

Appreciate your medical librarians.  I can’t think of a better way to honor Jeanne’s memory.

There are a series of applications available that I call “extract-ware”.  These applications receive an extract of your data with the promise of allowing you to have the ability to analyze and monitor your data.  They are generally dealing with a niche like productivity, quality, provider benchmarking or market share.

I am very skeptical of these systems.  My experience is that they are typically 10 times more complicated than leaders expect and are often used much less widely than expected.

These systems are sold to business leaders that do not understand the underlying data.  The sellers of these systems leave the business buyers with the impression that these extracts are simple and every hospital has the exact same data.  In the end it turns into a huge exercise.  It is left to interpret some extract specification and deal with the following:

• Data is simply not available, which requires lengthy process changes.
• Data is not clean, leaders have used fields to store different data than intended.
• Data requires significant mapping, which is a huge ongoing burden for IT.

Usually the data issues can be conquered (with a significant and unanticipated amount of time and money).  But, in my experience, these systems still tend to fail.  They simple never get the widespread adoption originally anticipated.  Users, who want the data, never use it for a variety of reasons:

• Often these systems require additional credentials.  Since users access these systems infrequently they can’t recall their password when they go to use the system – and they don’t have the time to call the help desk.
• The systems lack the level of development needed to make them intuitive and easy to use.  If any training at all is required, they will fail.
• Complicating this is that they have multiple extract-ware systems, often with different credentials behaving and looking completely different.
• Time

There are actually other bloggers here (Ministry and/or Affinity).  I love this.  I work with so many bright people with something interesting to share.  I hope they inspire others to blog.

MD Leader is the blog I read most often, and am most close to.  It belongs to Pete Sanderson, MD.  He is Ministry’s CMIO.

Pete’s blog features both of his talents: healthcare IT and photography.  It is a surprising mix, but it really works.

Eric Haglund is on our IT leadership team.  His blog is called Appropriate IT.  I love his candor.

Michele Matucheski runs Affinity’s library.  She maintains a blog to update our staff and physicians regarding what is new at the library.  She also blogs to to communicate CME opportunities to the clinicians in our community, a great solution for reaching a lot of people outside of our network.  Michele also has a knitting and crafts blog which I do not visit as often.

Today, Governor Doyle announced our plans to create the largest patient database in the state of Wisconsin.  We appreciate the recognition from Madison and the inspiration we received from the governor’s e-health initiative.  Both efforts recognize that information silos are limiting quality of care and patient safety.

In April 2006 a group of key Ministry IT, Business and Clinical Leaders collaborated to develop an Electronic Health Record (EHR) vision that has served us well over the last two years as we developed our Clinical IT Strategy.

By the end of June 2006, using that vision as our foundation, we identified the need for a single Electronic Health Record to be shared across all of our Ministry Medical Group Clinics and hospitals in Central and Northern Wisconsin.  In addition to the need for a single, shared electronic health record we realized that our greatest clinical functionality gap exists in our medical groups.  We set out to find the best solution to provide us that single patient database and revolutionize how we care for patients in our clinics.

Ministry used a traditional system selection process to look at all of the established options in the market place.  Through our Request for Proposal process we developed a short list of options that included Epic, GE and a commercial product that the Marshfield Clinic was bringing to market: CattailsMD.

I was very hesitant about the notion of buying a new product, especially one that was developed by a company that has not traditionally sold software.  However, the opportunity to expand our vision for a shared patient database beyond our organization to include our largest patient care partners was too important not to consider.

I strongly believe that our selection process was very thorough.  we laid out the options to key leaders and medical staff members who challenged us to be very thorough in our analysis. A thorough selection of this magnitude requires a great deal of time.

In August 2007 I recommended to the Ministry board of Directors that we name CattailsMD as our Ministry-wide EHR vendor of choice.  I actually did not think this is where we would end, but we have been very surprised how well the CattailsMD offering has stacked up to the competition.  We are also very excited about their willingness to include Ministry as equal partners in the development of the product, even before the contract was signed.  We have identified 6 critical enhancements and developed details specifications.

However, we committed to the board a full business case.  We did not want to have the same experience as others that have had clinical IT projects that have run well over plan (schedule and cost).  I have half-jokingly reminded my team that our primary indicator of success will be CIO retention.  If I am still at Ministry at the end of this effort that means we did it properly.  The most important aspect of success is the preparation.

We spent 8 months developing detailed plans and testing the most technically challenging aspects of the project.  all of this was done in partnership with Marshfield Clinic without a committeemen to purchase their offering.  This level of collaboration would not exist with a traditional software vendor.  It is refreshing to have a partner with the same level of commitment to a mutually agreed upon definition of success.

This decision meant that over 1,000 doctors in our region of Wisconsin will share an Electronic Health Record.  They will jointly contribute to patient’s single medication, allergy, immunization and problem lists.  All patient care documentation will be accessible anywhere and immediately.  I believe that RHIOs (aka CHINS) have largely been a failure.  If we want real integration today, that is a quantum leap in patient care, it is clear to me that a shared electronic health record is the best way to accomplish this.

Of course I am the CIO at Affinity Health System as well.  They are observing Ministry’s progress as they look at their EHR options.

Today, many hospitals are extending the electronic records to their non-employed medical staff.  Ministry’s approach turns that model upside down.  Instead, we are purchasing an EHR from our physicians.

Now that this announcement is public I will have lots more to share.  It is my intention to use this forum to be very candid about our experience.  I believe part of our mission includes sharing what works and what was not ideal so others can improve their care, even our competitors.

I am so thankful for those that have made this happen.  Our planning project alone was 12,000 hours of effort.  It has been an incredible collaboration of medical group leadership, practicing physicians, senior leadership, Ministry’s project management office and IT.

When I was with APM I learned the phrase “pre-wire.”  A pre-wire is simply the meeting before the meeting.  As consultants it was important to share the meeting agenda with the customer and be aware of any concerns that they may have.  As a manager I still find pre-wires important.  For example, we always review the IT Steering Committee agenda with the chairperson a few days in advance of the meeting.  The better prepared I am for the pre-wire the better the Steering Committee meeting will go.

Whenever you are trying to get approval for an important decision it is always a good idea to have pre-wire meetings with all of the major decision-makers.  Often, just taking the time to meet with meeting attendees in advance is enough to make them sympathetic to your position.  A good manager will know the outcome before the meeting ever starts.

My goal here is to post original content.  I generally don’t like to use this space to comment on someone else’s work.  But this InfoWorld article quotes me.  So, in the interest of self-promotion I am linking to it here:

Guerrilla IT: How to stop worrying and learn to love your superusers

I have always embraced our tech savvy employees.  They are my people.  When others were writing Internet Access policies that restricted employees use to “business-related sites,” we were encouraging people to join the Internet revolution.

I realize that IT cannot meet every possible need.  With tools like QuickBase we can unleash our tech savvy employees to meet their own needs, while keeping them in a sandbox.

As a bonus, the story also talks about Maureen Vadini, a former Parma Community General Hospital nurse that moved to IT to implement the Vocera communicator.

Speaking of Parma, does anyone else my age remember the Ghoul.  I think he was local to Detroit.