October 21,2014

3:50
Gough, For getting rid of conscription (yes I was sucked in), providing major changes to health and education (yes I really benefited) and getting rid of the death penalty - many thanks! We won't see his likes again I believe. The meanness we now see in public policy just shows how badly we are presently led - IMVHO. We can care and fund things - but no one wants to try! Pity about that. David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
2:46

In a sidebar to the September cover story I did for Healthcare IT News, I reviewed some of the work of Scot Silverstein, M.D., who has long been chronicling problems with EHRs and other health IT systems. Unfortunately, he wasn’t available for an interview in time for that report, but he was last week, so I got him for a new podcast.

Silverstein, a professor of health informatics at Drexel University in Philadelphia, considers EHRs to be experimental and, sometimes, less safe than paper records and would like to see health IT subjected to the same kind of quality controls as aerospace software or medical devices. “Suboptimal system design could lead even careful users to make mistakes,” Silverstein said in this interview.

During this podcast, we refer to a couple of pages that I promise links to, so here they are. Silverstein writes regularly for the Health Care Renewal blog, a site founded by Roy Poses, M.D., a Brown University internist who runs the Foundation for Integrity in Research and Medicine. His definitions of good health IT and bad health IT appear on his Drexel Web page.

Podcast details: Scot Silverstein, M.D., on health IT safety risks. MP3, mono, 128 kbps, 33.8 MB. running time 36:59.

1:10 How this interest came about
3:05 His blogging
3:45 His 11 points demonstrating why he believes the FDA should be concerned about health IT risks
5:00 IOM, FDA and ECRI Institute statements on health IT safety
5:50 Comparing EHRs to medical devices and pharmaceuticals
8:35 Lack of safety testing in health IT
9:25 Issues with EHR certification
10:00 Safety validation of software
10:35 EHR’s role in Texas Health Presbyterian Hospital’s initial discharge of Ebola patient
11:50 EHR failure causing medical harm to a close relative
13:10 Poor design vs. poor implementation
14:35 Who should regulate?
15:55 Billions already spent on EHRs
16:45 Threat of litigation
17:40 “Postmarket surveillance” of “medical meta-devices”
18:50 EHRs now more like “command and control” systems
19:30 Movement to slow down Meaningful Use
20:17 Safety issues with interoperability
21:40 Importance of usability
22:30 His role at Drexel
24:18 “Critical thinking always, or your patient’s dead”
25:05 Lack of health/medical experience among “disruptors”
29:30 Training informatics professionals and leaders
31:15 Concept vs. reality of “experimental” technology
32:50 Advice for evaluating health IT
33:55 Guardians of the status quo
35:10 Health IT “bubble”
36:10 Good health IT vs. bad health IT

 

1:30
This appeared a day or so ago.CDC, ONC Target EHR-Based Ebola ScreeningGreg Slabodkin OCT 17, 2014 7:30am ETAn initiative launched last year by the Centers for Disease Control and Prevention and the Office of the National Coordinator for Health IT to help providers meet Stage 1 and 2 meaningful use public health objectives is now focusing its efforts on Ebola electronic screening tools.In August 2013, CDC and ONC established the Public Health Electronic Health Records Vendors Collaboration Initiative. However, with recently confirmed cases of Ebola in the United States, the initiative—which includes public health practitioners and EHR vendors—is currently aimed at trying to get vendors to configure EHR systems to support screening protocols for the deadly disease.“The overall goal here is for us to explore ways in which the electronic medical record can serve as a prompt to help our healthcare professionals around the country identify individuals that may be at risk for Ebola,” said...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

October 20,2014

18:00
PhilipsRoyal Philips (NYSE: PHG, AEX: PHIA) has reported Q3 sales of EUR 5.5 billion and operational results of EUR 536 million. Healthcare comparable sales grew by 1% year-on-year. The EBITA margin, excluding restructuring costs and various charges, was 12%, a decrease of 2.6 percentage points year-on-year.
18:00
Siemens HealthcareSiemens Healthcare introduces the Symbia Evo Excel SPECT system at the 27th Congress of the European Association of Nuclear Medicine (EANM). The system is a new version of the successful Symbia E. Symbia Evo Excel combines industry-leading SPECT image resolution and detector sensitivity with the smallest room size requirement in its class*.
17:21

On October 17, 2014, I posted a note discussing the usefulness of a reverse feed of clinical data from the EHR to the LIS (see: Reverse Feed" of Clinical Data from EHR to the LIS -- Will This Ever Happen?). I commented that I had first heard about the "reverse feed" from Dr. Ulysses Balis who is the Director of Pathology Informatics at the University of Michigan Medical School. He submitted an interesting comment to my note which I am now elevating to the level of a note. --BAF

Indeed, I proposed on the fundamental need for reverse feeds (and also reverse-federation, specifically) from the EHR back to the LIS as far back as 2007. This need is made obvious, when one considers the present state, where pathologists and laboratorians are being compelled to sift through one or more clinical systems, in addition to the LIS, in order to review all the underlying diagnostic data needed to make a full and complete report or diagnosis. In the absence of having convenient access to such information, the outcome is both predicable and obvious: reports are generated where the clinical information in foreign/disparate information systems has not been reviewed [by the pathologists generating surgical pathology reports], sometimes leading to glaring errors and inconsistencies (e.g. a bone biopsy not being clinically correlated with the radiographic impression, which itself might be the primary pathognomonic body of evidence) because the pathologist didn't bother to look up the case in the EHR or RIS.

At [the University of Michigan], we are actively developing workflow models that are purpose-built around reverse EHR-to-LIS interfaces and plan to use one such interface from the EHR to enable a pathologist's cockpit for the evaluation of medical liver biopsies. Other exemplars will hopefully come into being in logical succession. In time, as the number of use-cases grow and as the need becomes obvious to all, from a workflow perspective, the hope is that this construct will become commonplace. An important distinction of this type of interface, as opposed to a traditional LIS outbound results interface, is that the incoming clinical data from the EHR to the LIS is ephemeral. As soon as the pathologist or laboratorian is finished in their review of such clinical data, it is discarded. This is done to ensure that the EHR remains the referential single source of truth (SSOT) for all clinical information across the enterprise. Should the lab need subsequent access to clinical data, the reverse feed can again be utilized to refresh the view, with it always guaranteed to contain the most up-to-date data.

Ul raises an important point with regard to a proposed interface at the University of Michigan from the EHR to the LIS. He indicates that the clinical data copied to the LIS will be ephemeral. By this he means that it would be discarded after review in pathology so that the EHR would remain as the single source of truth (SSOT) for all clinical information. Here's a definition of SSOT from the Wikepedia (see: Single Source of Truth):

In Information Systems design and theory Single Source Of Truth (SSOT) refers to the practice of structuring information models and associated schemata such that every data element is stored exactly once (e.g., in no more than a single row of a single table). Any possible linkages to this data element (possibly in other areas of the relational schema or even in distant federated databases) are by reference only. Thus, when any such data element is updated, this update propagates to the enterprise at large, without the possibility of a duplicate value somewhere in the distant enterprise not being updated (because there would be no duplicate values that needed updating).

When test results are transferred to from the LIS to another system such as the EHR, the process is always prone to errors. Some of these errors will be caught during the periodic validation of the LIS-EHR interface but such validation is never foolproof. Ul Balis has referred to the HL-7 interface between two systems as a data shredder (see: The EMR as a Data Shredder: Implications of a Single-Source-of-Truth Policy). As one example, formatting errors are common in the transfer of microbiology test results that are often in tabular format.

The most important interface for the LIS is the one to the EHR because this latter database is usually the only source of lab test results for hospital clinicians. This interface should only be validated by lab professionals because only they are trained to understand lab data in terms of accuracy and correct formatting. Let's assume that, in addition to the EHR, a hospital has a clinical data repository or warehouse that contains lab data. Such a database can not be used for patient care unless the lab data stored there is supplied by the LIS with the interface validated by pathology personnel. Ul understands this SSOT principle because he states, with regard to the reverse feed to the LIS, that "the EHR remains the referential single source of truth (SSOT) for all clinical information across the enterprise." Another important reason for mandating that the clinical data that is copied from the EHR to pathology is ephemeral, as Ul point out, is that clinical data that is acquired later may be modified or updated.

16:57

I’ve been interested in the new “wearables” segment for a while. I reached out to Cameron Graham, the managing editor at TechnologyAdvice where he oversees market research for emerging technology, to give us some evidence-driven advice about wearables that entrepreneurs, innovators, healthcare providers, and payers can use for decision making. Specifically, what does the current research show and what are the actionable insights for how to incentivize patients to use them and figure out why patients might pay for them? Cameron thinks that wearable health technology could help improve patient outcome monitoring, if insurance companies and providers work together. He elaborated:

Wearable health technology (or mHealth as some call it) is one of the emerging frontiers in medicine. Fitness tracking devices could allow the healthcare industry to better measure patient outcomes, monitor patient populations for emerging trends, and give preventative healthcare advice based on quantitative measurements (such as daily step counts or heart-rate). We surveyed 979 US adults about their fitness tracking habits, in order to determine current the usage rate for this technology. We then further surveyed 419 of those adults, who identified as non-trackers, about what incentives would convince them to use wearable health monitors. Here are some of our takeaways for vendors and providers:

1. The wearable health market remains small, but is growing steadily

In order to gauge how many adults are currently generating personal health data that would be useful in either patient treatment or preventative medicine, we asked a random, nationwide sample of adults whether they currently tracked their weight, diet, or exercise using a fitness tracking device or smartphone app.

74.9 percent of respondents indicated they did not track any of those variables using either a fitness tracker or smartphone app. 25.1 percent reported tracking such stats.

Out of the roughly one quarter of adults who do track their fitness, 14.1 percent said they used a smartphone app, and 11 percent said they used a fitness tracker. There is currently little data on such demographics, although the Pew Internet Research Project conducted a survey in 2012 looking at similar trends. In their report, they noted that seven percent of adults tracked health indicators using an app. Combining these results, we can see that the market for health tracking applications has approximately doubled over the last two years.

As more consumers adopt such technology, and rely on it for monitoring their health, providers need to become involved in the discussion. There is limited data that can be draw from a sample of just 25 percent of a patient population. If providers can encourage adoption among a majority of their patients however, they will gain greater insight into current health habits, and be able to provide more tailored advice.

2. Physicians can play a large role in encouraging tracking but there are are few incentives in place for them to do so

Looking into what incentives could convince non-tracking adults to use such devices, we found great potential for healthcare providers to encourage tracking habits among their patients. It appears patients want their physicians involved more in monitoring but our healthcare system doesn’t have the right incentives or payment structures available to compensate providers.

48.2 percent of adults said they would use a wearable fitness tracker if their physician provided one. While this may be financially unrealistic for smaller practices, wearable activity trackers (like the FitBit or Jawbone UP) will likely become cheaper as more sophisticated, multi-purpose devices enter the market, such as the forthcoming Apple Watch.

If physicians were able to get half of the three-quarters of non-tracking adults to start measuring their fitness with wearable devices, it would create huge amounts of patient-generated data for the healthcare industry to analyze.

The infrastructure for handling this data is largely in place. The most popular electronic health record provider, Epic Systems, recently announced a partnership with Apple that will allow hospitals to easily integrate wearable data through Apple’s HealthKit platform into patient portals and records.

Promoting the use of such devices should now be a goal for physicians looking to gain greater insight into their patient population. The question would be why Physicians would do this without additional compensation either directly from their patients or indirectly through insurers.

3. Insurance companies and providers need to form partnerships

While a significant portion of adults would use physician-provided devices, health insurance companies may be the ultimate key to promoting widespread fitness tracker adoption.

A total of 57.1 percent of respondents said they would be more likely (or much more likely) to wear a fitness a tracker if they could receive lower health insurance premiums. In fact, this was a more compelling incentive than the possibility of receiving better healthcare advice from their physician (just 44.3 percent of respondents said that would make them more likely to use a tracker).

By agreeing to use a fitness tracker, insurance customers would become eligible for special discounts, perhaps for walking a set number of steps each day, or raising their heartbeat for a certain period of time. Discounts could be given out directly or through an employer.

Some companies are already experimenting with such systems. Humana insurance has a new Vitality program that allows employees to opt-in to fitness tracking in exchange for possible discounts. Car insurance companies have also found success by offering lower rates for safe-driving, as measured through in-car tracking devices.

If providers want to encourage fitness and health tracking among their patients, they should evaluate the possibility of providing devices to their patients, either for free or at a reduced cost. At the very least, they should make patients aware of the benefits of such devices, and encourage them to automatically share such data through their patient portal.

Long term, providers will likely need to collaborate with insurance companies in order to establish a data sharing system for such information, which can allow for physicians to better monitor their patient population, and provide more accurate, tailored diagnoses. A universal patient record system would be ideal, although given current interoperability standards, an insurance-provider arrangement is more likely.

13:12

Last week I had the chance to attend the Craneware Summit in Las Vegas. It was a really interesting event where I had the chance to meet and talk with a wide variety of people from across the spectrum of healthcare. I love getting these added perspectives.

One of the sessions I attended was an E&M session which provided some really interesting insights into the life of an E&M coder and how they look at things. There’s a lot more to their job, but I tweeted these comments because they made me laugh and illustrated part of the challenge they face in a new EMR world.


I thought these immediate responses to the question were interesting. They came from a crowd of HIM and coding professionals. Overall, they were quite supportive of EMR it seemed.


Many doctors don’t understand this. That’s why so many coders still have jobs.


Too funny.


Said like a true coder.

8:14

Whether you call it recruiting or staffing, the business of putting other people to work is full of all six basic emotions: anger, disgust, fear, happiness, sadness and surprise.

In the office, a theme that connects all of those feelings is "humor," as sometimes recruiters want to laugh from happiness - and other times from total desperation. Nowhere else is the art of knowing and communicating with people so valued, as seasoned recruiters have seen or heard it all. Whether you in the staffing industry need a laugh now - or are just saving one up for later, when you really, really need it - we present to you the humorous side of staffing, for a variety of situations you may encounter.

For when you have to heavily edit a resume...

staffing humor 1

For when you have to ask the "greatest weakness" question...

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

For when you have to answer questions about yourself...

staffing humor 5

The post Welcome to the Humorous Side of Staffing appeared first on Healthcare IT Leaders.

Categories: Influential , All
8:14

Whether you call it recruiting or staffing, the business of putting other people to work is full of all six basic emotions: anger, disgust, fear, happiness, sadness and surprise.

In the office, a theme that connects all of those feelings is "humor," as sometimes recruiters want to laugh from happiness - and other times from total desperation. Nowhere else is the art of knowing and communicating with people so valued, as seasoned recruiters have seen or heard it all. Whether you in the staffing industry need a laugh now - or are just saving one up for later, when you really, really need it - we present to you the humorous side of staffing, for a variety of situations you may encounter.

For when you have to heavily edit a resume...

staffing humor 1

For when you have to ask the "greatest weakness" question...

staffing humor 2

For when you hear excuses...

staffing humor 3

For when you just nail it...

staffing humor 4

For when you have to answer questions about yourself...

staffing humor 5

The post Welcome to the Humorous Side of Staffing appeared first on Healthcare IT Leaders.

Categories: Influential , All
1:30
Here are a few I have come across the last week or so.Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.General CommentAnother quiet and pretty news less week. Lots of private sector activity but the Government is just a black hole with no light or information escaping!Interesting to see Google Glass gradually becoming more mainstream. The impact of health is far from clear and we will only see what the outcome of the technology a good few years from now.-----http://www.computerworld.com.au/article/557291/epic-pharmacy-injects-1-5-million-into-flamingo-healthcare-vrm-software/Epic Pharmacy injects $1.5 million into Flamingo for healthcare VRM softwareEpic Pharmacy managing partner Cathie Reid to join Flamingo boardAdam Bender (Computerworld) on 14 October, 2014 13:48Epic Pharmacy has invested $1.5 million in...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

October 19,2014

18:00
PhilipsRoyal Philips (NYSE: PHG, AEX: PHIA) has acquired the CE mark for diagnostic use of its Philips Digital Pathology Solution. European pathologists will now be able to use the full digital solution as an aid in diagnosis for routine pathology, such as primary diagnosis of oncology.
18:00
CarestreamCarestream has been selected by the Union des Groupements d'Achat Public (UGAP), France's national procurement agency, to supply a range of radiology and IT solutions to the hospital sector. UGAP is the largest general public procurement agency in France whose role and procedures are defined by Le Code des marches publics, procurement rules laid down by the French Government that release its clients from prior advertising or competitive tendering.
1:00
There was a very interesting meeting that has considerable impact on where e-Health is heading globally held in the last few days.There are reports here:Interoperability's 'game-changer'Posted on Oct 17, 2014By Bernie Monegain, EditorCharles Jaffe, MD, CEO of standards organization HL7, came away from the joint meeting of the federal Health IT Policy and Health IT Standards committees earlier this week, thinking that the industry could move faster on interoperability. And HL7 has just the thing to change the game."I don't try to denigrate the success; I try to celebrate it," he told Healthcare IT News.He blames a stuck-in-the-past approach for the slow pace of progress."We embrace a lot of technology that is technology for the past and ways of doing things that were important in the past rather than understanding the ideas that fundamentally change the way we achieve interoperability."Top of mind for effecting that change is HL7's FHIR, he says. The acronym stands for Fast Healthcare...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

October 18,2014

18:42
Here are the results of the poll.Should Federal Government Agencies Simply Just Get Out Of E-Health In Australia? Yes 47% (141) Probably 6% (18) Neutral 1% (3) Probably Not 28% (86) No 18% (53) I Have No Idea 0% (1) Total votes: 302 The closest vote I have seen so far (53% to 46%) - with a small majority thinking the Feds should just leave it others to sort all this out. Interestingly the definite Yes vs No vote was 47% to 18%. Again, many, many thanks to all those that voted! David.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All
15:19

Via Medgadget

locked in detection New Technique Helps Diagnose Consciousness in Locked in Patients

Brain networks in two behaviourally-similar vegetative patients (left and middle), but one of whom imagined playing tennis (middle panel), alongside a healthy adult (right panel). Credit: Srivas Chennu

People locked into a vegetative state due to disease or injury are a major mystery for medical science. Some may be fully unconscious, while others remain aware of what’s going on around them but can’t speak or move to show it. Now scientists at Cambridge have reported in journal PLOS Computational Biology on a new technique that can help identify locked-in people that can still hear and retain their consciousness.

Some details from the study abstract:

We devised a novel topographical metric, termed modular span, which showed that the alpha network modules in patients were also spatially circumscribed, lacking the structured long-distance interactions commonly observed in the healthy controls. Importantly however, these differences between graph-theoretic metrics were partially reversed in delta and theta band networks, which were also significantly more similar to each other in patients than controls. Going further, we found that metrics of alpha network efficiency also correlated with the degree of behavioural awareness. Intriguingly, some patients in behaviourally unresponsive vegetative states who demonstrated evidence of covert awareness with functional neuroimaging stood out from this trend: they had alpha networks that were remarkably well preserved and similar to those observed in the controls. Taken together, our findings inform current understanding of disorders of consciousness by highlighting the distinctive brain networks that characterise them. In the significant minority of vegetative patients who follow commands in neuroimaging tests, they point to putative network mechanisms that could support cognitive function and consciousness despite profound behavioural impairment.

Study in PLOS Computational Biology: Spectral Signatures of Reorganised Brain Networks in Disorders of Consciousness

 

Categories: All , News and Views

October 17,2014

15:38

In a pathology informatics webinar delivered yesterday by Dr. Mike Becich and presented by API and Sunquest  (see: Free Informatics Webinar Tomorrow: IT Support for Pathology Research), I posed the question whether he knew of any cases of a "reverse feed" of clinical information from an EHR to an LIS. Ul Balis was the first informaticist who had used the term "reverse feed" in my presence but I am not sure if he originated it. A feed of clinical information to the LIS will be absolutely necessary for pathology to fulfill its evolving mission in molecular diagnostics and cancer genomics because it enables pathologists to refine their diagnoses and generate therapeutic recommendations. Pathologists obviously have manual access to the EHR but the volume of such data demanded by molecular and genomic pathology requires an electronic interface back to the LIS.

Dr. Becich said that he knew of no instances of reverse feeds of clinical information from the EHR to the LIS in any hospital. In my opinion, there are a number of reasons why such a reverse feed will never be allowed by EHR vendors. Here are some of the reasons for my statement:

  • The LIS, RIS, and PACS systems are viewed as "ancillary systems" with the sole purpose of sending diagnostic data to the EHR with which the clinicians interact. For an EHR vendor, there would be no rationale or justification for such a "reverse feed" to the LIS from a competitive or business point of view. They would never articulate such an argument, however. Instead they would say that there is no need for such an interface given the integrated nature of the EHR database. They would omit the fact that there are few available tools to perform "deep phenotyping" studies on the EHR. Below is a definition of deep phenotyping for precision medicine (see: Deep Phenotyping for Precision Medicine)
    • Deep phenotyping can be defined as the precise and comprehensive analysis of phenotypic abnormalities in which the individual components of the phenotype are observed and described....The comprehensive discovery of such subclasses, as well as the translation of this knowledge into clinical care, will depend critically upon computational resources to capture, store, and exchange phenotypic data, and upon sophisticated algorithms to integrate it with genomic variation, omics profiles, and other clinical information. 
  • An EHR vendor like Epic offers an enterprise-wide-solution with its own LIS and RIS. The company would thus not be inclined to participate in any process that enhances the functionality of a best-of-breed LISs like Sunquest, Soft, or Cerner and, in so doing, enhance their perceived value.
  • An EHR vendor will assume that any algorithms used for deep phenotyping would run on its own system. Although such processing would be very desirable, I don't personally think we will see the development of such algorithms in the foreseeable future for EHRs. Although EHRs store massive amounts of clinical data, they are destined to function primarily as archives of clinical data without advanced data processing features.

Dr. Becich went on to state that very sophisticated data integration and analysis (i.e., deep phenotyping) is now occurring within the Department of Pathology at Pitt. The clinical data that the department of pathology requires to support its clinical and research mission is obtained from medical center's clinical data warehouse or repository which is populated with data by the EHR (including lab data) and to which the LIS is interfaced.  At the end of the day, this may well be the best architecture for hospitals and medical schools because it spares the EHR the cycle burden of supporting interfaces back to the ancillary systems like the LIS and RIS. The downside of such an architecture is that the creation of a clinical data warehouse will probably be limited to the larger academic medical centers that are able to justify the expense by its research mission and the funds generated from it. Smaller hospitals will thus be deprived of the opportunity to integrate pathology test results with the relevant clinical data.

15:11

www.leiadisplay.com
www.facebook.com/LeiaDisplaySystem

Categories: All , News and Views
15:05

The people at online physician community, QuantiaMD, recently sent me a list of the top 3 “Crazy ICD-10 Codes” that they got from their community. It was quite interesting to learn that when they asked their community for these codes, they yielded double the participation the company typically sees. No doubt, physicians have globbed on to these funny and crazy ICD-10 codes. I’ll be honest. I’ve gotten plenty of laughs over some of the funny ICD-10 codes as well. Seriously, you can’t make some of this stuff up. Here’s a look at the top 3 crazy ICD-10 codes they received (and some awesome color commentary from the nominators):

1. W16.221 – Fall into bucket of water, causing drowning and submersion. I didn’t realize mopping the floor was so dangerous!
2. 7. Z63.1 – Problems in relationship with in-laws. Really, Who does not?
3. V9733xD – Sucked into jet engine, subsequent encounter. Oops I did it again.

While these codes are amazing and in many respects ridiculous, they’re so over the top that they’ve branded ICD-10 as a complete joke. For every legitimate story about the value of ICD-10 there have probably been 10 stories talking about the funny and crazy ICD-10 codes. You can imagine which story goes viral. Are you going to share the story that talks about improvement in patient care or the one that makes you laugh? How come the story about their being no ICD-9 code for Ebola hasn’t gone viral (Yes, ICD-10 has a code for Ebola)?

Unfortunately, I don’t think the proponents of ICD-10 have done a great job making sure that the dialog on the benefits of ICD-10 is out there as well. Yes, it’s an uphill battle, but most things of worth require a fight and can easily get drowned out by humor and minutiae if you give up. If ICD-10 really is that valuable, then it’s well worth the fight.

My fear is that it might be too late for ICD-10. Changing the ICD-10 brand that has been labeled as a joke is going to be nearly impossible to change. However, there are some key people on the side of ICD-10. CMS for starters. If you can get the law passed, then the ICD-10 branding won’t matter.

One thing I do know is that doing nothing means we’ll get more and more articles about Funny ICD-10 codes and little coverage of why ICD-10 needs to be implemented. I encourage those who see the value in ICD-10 to make sure their telling that part of the story. If you don’t have your own platform to share that part of the story, I’ll be happy to offer mine. Just drop me a note on my contact us page.

12:21

This is not a nice story at all now the the patient died and the resultant series of events that have followed.  The military is currently using the machine in Liberia so we have not heard the end of this one.  Perhaps in the panic everyone forgot they had this machine sitting around? 

From the Website about the FilmArray:

“The FilmArray is an FDA-cleared multiplex PCR system that integrates sample preparation,image amplification, detection and analysis. It requires just a few minutes of hands-on-time and its turnaround time is just about an hour, giving you faster results which may lead to better patient care.

The FilmArray now has three FDA-cleared panels – the Respiratory Panel, the Blood Culture Identification Panel, and the Gastrointestinal Panel. Together, these panels test for more than a hundred pathogens. Thus, FilmArray is not only the fastest way to better results; it’s the fastest way to more results.”

The FilmArray is FDA approved but perhaps not for use in the US for detecting Ebola?  Hospitals have to agree to use the machine specifically for research projects only…and here’s another clip worth reading from this article:

“The FDA rules in what are called “research use only” machines are far more lax than for machines that must provide clinical diagnosis. According to representatives from BioFire, even after the FDA approved the use of the machine for Ebola screening and allowed workers at the hospital to acquire the proper kit for Ebola testing, a 10-20 day “validation” procedure would kick in before they could change the machine’s use from diagnostics to research — and the results would have to go to the Centers for Disease Control for confirmation.

Dr. Luciana Borio, assistant commissioner for counterterrorism policy and acting deputy chief scientist at the FDA, recently told National Journal that the agency was looking to speed up evaluation of new drugs to treat Ebola.”

Stay tuned as I’m sure we’ll here more about this and perhaps this is why we have a lawyer as the Ebola Czar now?  BD 


It’s a toaster-sized box called FilmArray, produced by a company called BioFire, a subsidiary of bioMérieux and it’s capable of detecting Ebola with a high degree of confidence — in under an hour.

Incredibly, it was present at Dallas Presbyterian Hospital when Ebola patient Thomasimage Eric Duncan walked through the door, complaining of fever and he had just come from Liberia. Duncan was sent home, but even still, FDA guidelines prohibited the hospital from using the machine to screen for Ebola.

The FilmArray retails for about $39,000 per unit and can screen for the genetic markers of a wide number of respiratory, gastro-intestinal and other illness, including Ebola, but only with the right “kit” in place. Current FDA guidelines would not have allowed Dallas Presbyterian Hospital to get that kit. That’s despite the fact that it can provide results with higher than 90 percent certainty and it’s one of the machines that the military is currently using to screen for Ebola in Africa.

BioFire Diagnostics, a Utah-based firm that produces disease detection technology, confirmed that the Dallas Presbyterian Hospital did in fact have one of the machines (possibly for as long as two years) sitting on the shelf when Duncan came in.

Speaking before a congressional panel Thursday, CDC Director Dr. Tom Frieden acknowledged that airport screening for Ebola was extremely limited. He also said that he was open to any strategy to reduce risks to the general population from Ebola. Other witnesses at the hearing said the U.S. is rapidly speeding up the development and deployment of new diagnostic systems.

http://www.defenseone.com/threats/2014/10/dallas-hospital-had-ebola-screening-machine-military-using-africa/96713/?oref=d-mostread

October 16,2014

19:19

We all know or maybe should know by now that Texas did not extend Medicaid and would that have made aimage different in his treatment?  That’s a big question and his nephew wrote a letter explaining such.  As he stated certain drugs were not available and his test took days longer than someone else who had their results in 24 hours.  Also is this why he was initially sent away?  There’s a lot of questions here to be answered, that’s for sure.

We know we have a broken system for sure and will it take Ebola to wake folks up?  His nephew said he was also denied experimental drugs.  This makes a case perhaps of how care is delivered in the US to the poor and those without insurance. 

Sadly It’s Ebola That’s Bringing the US Kicking and Screaming, To Our Knees–We Must Deal With the Real World Solutions, Not Virtual World Values This Time as They Won’t Work…

Now the next part is awful, the family had to hear of his death from the press?  BD 


Thomas Eric Duncan could have been saved. Finally, what is most difficult for us — Thomas Eric’s mother, children and those closest to him — to accept is the fact that our loved one could have been saved. From his botched release from the emergency room to his delayed testing and delayed treatment and the denial of experimental drugs that have been available to every other case of Ebola treated in the U.S., the hospital invited death every step of the way.

When my uncle was first admitted, the hospital told us that an Ebola test would take three to seven days. Miraculously, the deputy who was feared to have Ebola just last week was tested and had results within 24 hours.

The fact is, nine days passed between my uncle’s first ER visit and the day the hospital asked our consent to give him an experimental drug — but despite the hospital’s request they were never able to access these drugs for my uncle. (Editor’s note: Hospital officials have said they started giving Duncan the drug Brincidofovir on October 4.) He died alone. His only medication was a saline drip.

http://crooksandliars.com/2014/10/ebola-victims-nephew-speaks-thomas-eric

18:56

I’m thinking I need to start a new healthcare reality TV show called “Healthcare Data Hoarders.” We’ll go into healthcare institutions (after signing our HIPAA lives away), and take a look through all the data a healthcare organization is storing away.

My guess is that we wouldn’t have to look very far to find some really amazing healthcare data hoarders. The healthcare data hoarding I see happening in comes in two folds: legacy systems and data warehouses.

Legacy Systems – You know the systems I’m talking about. They’re the ones stored under a desk in the back of radiology. The software is no longer being updated. In fact, the software vendor is often not even around anymore. However, for some reason you think you’re going to need the data off that system that’s 30 years old and only one person in your entire organization knows how to access the legacy software. Yes, I realize there are laws that require healthcare organizations to “hoard” data to some extent. However, many of these legacy systems are well past those legal data retention requirements.

Data Warehouses – These come in all shapes and sizes and for this hoarding article let me suggest that an EHR is kind of a data warehouse (yes, I’m using a really broad definition). Much like a physical hoarder, I see a lot of organizations in healthcare that are gathering virtual piles of data for which they have no use and will likely never find a way to use it. Historically, a data warehouse manager’s job is to try and collect, normalize, and aggregate all of the healthcare organizations data into one repository. Yes, the data warehouse manager is really the Chief Healthcare Data Hoarder. Gather and protect and and all data you can find.

While I love the idea that we’re collecting data that can hopefully make healthcare better, just collecting data doesn’t do anything to improve healthcare. In fact, it can often retard efforts to leverage healthcare data to improve health. The problem is that the healthcare data that can be leveraged for good is buried under all of this useless data. It takes so much effort to sift through the junk data that people just stop before they even get started.

Are you collecting data and not doing anything with it? I challenge you to remedy that situation.

Is your healthcare organization a healthcare data hoarder?

18:00
PhilipsRoyal Philips (NYSE: PHG, AEX: PHIA) and hospital Reinier de Graaf, Delft, the Netherlands, have announced the signing of a 15-year partnership to improve the delivery of care and the patient experience at the 622-bed Dutch hospital. The agreement covers the group's four hospital sites, including a new facility due to open in August 2015, which together serve a patient population of 251,000.
6:00

Cuisinart DesignIndustrial designer Marc Harrison suffered a brain injury while sledding when he was 11-years old. The injury and years of rehabilitation would provide Harrison with insight and inspiration for his future work in industrial design.

Harrison would go on to develop the philosophy of Universal Design – the idea that products should be developed for people of all abilities, not just for people of average size, shape, and ability.

Harrison’s study of people with disabilities led to the iconic design of the Cuisinart food processor, a design still relevant today after more than 40 years. The simple, clean design would also come to be a major influence for Steve Jobs in the development of the Macintosh computer.

If you put the original Mac in 1984 side-by-side with an early ’80s Cuisinart, the influence on the physical design of the Mac is immediately obvious. Not only is the Mac designed with software for accessibility and more universal design, but its physical design had this perhaps unknown influence as well. – Dean Karavite

Designing for the “extreme user” vs. the average user results in more innovative designs.

A Podcast for Everyone

Click Image to play the podcast

I learned about Harrison from an exceptional interview with Dean Karavite, a Human Interaction Specialist in Clinical Informatics at Children’s Hospital of Philadelphia. Dean was interviewed by Whitney Quesenbery, co-author of the book, “A Web for Everyone”.

The podcast available on iTunes covers Dean’s work on “Accessible Designs for PHRs”. He discusses healthcare interoperability in layman’s terms, and provides answers to some valuable questions:

The Accessible Designs project seeks to unite accessibility and usability to inform the future development of health IT that will be effective for all users.

POWER USERS

It is important to point out that people with disabilities are not all people in poor health.

People with disabilities use the health care system a lot and in many different ways. –Whitney Quesenbery

Among study participants with various levels of disability, Dean found that people with the highest level of needs – those also with many chronic conditions – were the source of “the most detailed, sophisticated, and innovative ideas on what an accessible PHR should do.”

JUST ASK

Understanding what users want and the problem the application will solve should be the first step in any development process. How does user-centered design firm IDEO find people to interview for needfinding? While it is great to speak with average users, the most interesting interviews come from “extreme users.” This idea of extreme users is also explored in “Just Ask: Integrating Accessibility throughout Design” by Shawn Henry.

As part of our project exploring accessible Personal Health Records, one of the methods we have applied was performing a survey with 150 people with different disabilities. In that survey, we had our participants rate over 20 health topics in two ways.

First, in terms of how important the particular topic was to their health and healthcare, and second, their current level of satisfaction with a particular issue or topic.

The number one, most highly rated issue in terms of importance was the ability to share medical information between different providers’ offices, and hospitals.

The real underlying issue here isn’t just the transfer of data, but care coordination, which is the collaboration, not just communication, but collaboration between multiple healthcare providers. – Dean Karavite interview with Whitney Quesenbery

Assessment of Three PHR Systems

Another part of the “Accessibility Designs” project looked to assess the current state of PHR systems for accessibility, functionality and usability.

Unfortunately, vendors were reluctant to participate.

These results came from systems project team members used to manage their own health including a hospital PHR, an ambulatory PHR, and a consumer PHR.

PHR Assessment

According to the project,  “The hospital PHR was the least functional and least usable, yet was the most accessible. Meanwhile the ambulatory PHR was the most functional and most usable, yet failed to meet basic accessibility standards. The consumer PHR was quite usable despite failing to meet accessibility criteria, and failed one crucial accessibility requirement: the entry of dates by people with visual and/or physical disabilities, a critical action required by almost every task managed by the system.”

Now We All Have It, and We Absolutely Love It

Many of the technologies used today are the result of work used to meet the needs of people with disabilities:

“For example, touch screens, on-screen keyboards with word prediction, zoomable displays, speech recognition, text-to-speech. Think about it. It took about 10 to 15 years, and now we all have it on our computers, our phones and other devices, and we absolutely love it.” – Dean Karavite

Dr. David Do, MD says, “The healthcare industry has much to learn around the design and usability concerns espoused by Silicon Valley.” Whitney Quesenbery suggests,

Get out of your little box and look for inspiration all over the place.

Good ideas can come from anywhere!

Categories: News and Views , All
5:05

From TIME

Based on Facebook and Twitter chatter, it can seem like Ebola is everywhere. Following the first diagnosis of an Ebola case in the United States on Sept. 30, mentions of the virus on Twitter leapt from about 100 per minute to more than 6,000. Cautious health officials have tested potential cases in Newark, Miami Beach and Washington D.C., sparking more worry. Though the patients all tested negative, some people are still tweeting as if the disease is running rampant in these cities. In Iowa the Department of Public Health was forced to issue a statement dispelling social media rumors that Ebola had arrived in the state. Meanwhile there have been a constant stream of posts saying that Ebola can be spread through the air, water, or food, which are all inaccurate claims.

 

Research scientists who study how we communicate on social networks have a name for these people: the “infected.”

Read full story

Categories: All , News and Views
4:06

Here’s yet another one and being a former developer myself I look at all of these such groups andimage realize right up front that developers can’t be serious about this unless they have some other source of income to get involved, it just is what it is.  You can read the press release below.  I think we are reaching the tipping point as well where developers too are starting to see through some of this as gosh knows there’s been enough of them out there.  I call it “Cash for Code” and other big companies such as Verizon have run these as well.   You can innovate your heart out here if you can afford to eat and pay your rent. 

One More “Cash For Code” Innovation Center From Ex United Healthcare Executive
Verizon Latest to Enter “Code for Cash” Prize Format With $1 Million Top Pay Out for Writing Healthcare Apps That Use Their Platform, Is This the New “Corporate Business Model” To Yield Inexpensive Code?

Read between the lines and they want more monitoring apps for folks over 50.  You have a choice of nine categories to where you might want to spend some time and it’s the same old thing with a new cover basically.  We do at 50 dwarf the younger population a we are older and have a lot more data to harvest, that part is correct.  It’s not like there’s a shortage of these types of applications by all means, we have a glut of them actually. 

AARP is always a willing partner as they get paid from United for marketing, link below. 

UnitedHealthGroup and AARP Get Cozier, AARP Still Gets Paid for Marketing Use of AARP Name As AARP Becomes an Optum Labs Data Selling Promoter Amidst Doctor Complaints Received Relative To United Firing of 5500 MDs–Subsidiary Watch

So again another “Cheap Code for Cash” it appears here for all the glory and minimal compensation you may desire to participate for the young folks to figure out how to create some apps for us plus 50 that will collect data and monitor us.  Many folks anymore see most of this up front and are headed for the exits as privacy concerns today are becoming a much greater concern and we know United Healthcare and AARP are both data sellers and make some pretty big dollars doing it as well as being such a strong mentor with CMS over the years with a lot of their quantitated business models.  BD  


SAN MATEO, Calif.--(BUSINESS WIRE)--AARP and UnitedHealthcare, two of the leading organizations in senior advocacy and health care, today announced the launch of “The Longevity Network” to promote innovations in health care that will improve the quality of people’s lives as they age.

“The Longevity Network will help foster innovations across the consumer and health care landscape that will improve the health and well-being of the 50+ population”

AARP and UnitedHealthcare have focused on nine innovation “frontiers” that offer a framework for distinct innovation pipelines so entrepreneurs can focus their attention on these high-need areas. The nine frontiers are: medication management; aging with vitality; vital-sign monitoring; care navigation; emergency detection and response; physical fitness; diet and nutrition; social engagement; and behavioral and emotional health.

The Longevity Network will promote innovation by focusing entrepreneurial attention on these large, high-growth market spaces. The goal is to drive a national dialogue about the longevity economy and ensure everyone driving innovation in this country is asking themselves, “What is our 50+ strategy?”

The Longevity Network will include focused research, success stories and discussion groups, and will regularly publicize significant achievements in this area and the best innovations in each of the nine frontiers. The innovations will be evaluated for recognition based on their potential impact, marketplace viability, business model, originality, quality of design and consumer appeal.

The two organizations unveiled the digital platform, www.longevitynetwork.org, at the 2014 HealthTech Conference in San Mateo. The platform is a central hub where entrepreneurs, advocates and consumers can share information and access ideas, press and other media, social feeds and event invitations about health care innovation for the 50+ community.

Breakthrough technologies, innovative services and disruptive business models are expected to represent $30 billion in cumulative revenue over the next five years and benefit more than 100 million people 50 and older, according to a study from health research firm Parks Associates.

http://www.businesswire.com/news/home/20141015005233/en/AARP-UnitedHealthcare-Launch-%E2%80%9CThe-Longevity-Network%E2%80%9D-Encourage#.VD91v2cUzKc

0:53

As you can read below, a lot of elective surgical procedures here, so this means orthopedic procedures. image The hospital closed down the surgery rooms after the JACO inspection.  There were 4 patients who had surgery in the same room that came down with infections.

Someone notified JACO and they came out and found some issues.  The hospital was given preliminary denial of accreditation which means no Medicare payments if they lose that. 

Well the hospital is also ready to open their big neuroscience and spine institute so the time is not good when you think of money as those rooms are not making any money while closed.  This is a a brand new wing added to the hospital with cutting edge technologies. 

It will include three operating rooms will equipped with technology to project images of patients’ brains on the walls and ceilings and transmit them in real time to other doctors around the country, so yes your brain can now be as big as the wall.  This is a pretty affluent area of the OC by the way. 

The hospital is cooperating and didn’t find any evidence of any infected equipment so I guess just may have been something in the room that day.  BD 


One of Orange County's largest hospitals has halted all elective surgeries after its accreditation came under review following an outbreak of surgical infections.

Mission Hospital performs about 7,000 surgeries a year, of which nearly 70% are elective.

Last week, the Joint Commission conducted an onsite survey at the hospital following reports that four patients who underwent orthopedic surgery had developed infections.

The accrediting body determined that there was an “immediate threat to health or safety to patients or the public,” and issued a preliminary denial of accreditation, Katie Looze, the commission’s spokeswoman, said in an email.

Last Thursday, the hospital voluntarily chose to postpone all elective surgeries at both its Mission Viejo and Laguna Beach locations out of an “abundance of caution,” said James Keany, the hospital’s associate director of emergency services.

http://www.latimes.com/local/lanow/la-me-ln-

October 15,2014

21:47

At the just completed ASCP annual conference in Tampa, Dr. Liron Pantanowitz discussed how he and colleagues in the pathology department at the University of Pittsburgh School of Medicine have developed a new type of pathology report for solid tumors and FNAs. It's called the comprehensive theranostic summary (CTS). Theranostic is a blend of the words therapeutic and diagnostic and is applied here to a report that incorporates both diagnostic and therapeutic features. Pathology generates the CTS as an addendum to its solid tumors and FNA reports, creating a useful summary for clinicians of all of the ancillary prognostic/therapeutic findings for a patient based on IHC, FISH and molecular testing.

As I have commented in previous notes and lectures, we need to aggressively pursue integration of information from all of the diagnostic specialties, particularly pathology and radiology (see: Integrated Diagnostics: Innovations for a Leaner, Greener Healthcare System; Revisiting Integrated Diagnostics and the Integrated Diagnostic ReportAdditional Discussion about Integrated Diagnostic Testing). However and in the short term, we should pay the most attention to the integration of test results from our own disciplines of surgical pathology, surgical pathology, and clinical pathology (see: Integrated Diagnostics and Its Relationship to Digital Pathology: A Strategic Analysis). Along these same lines, I have also previously proposed in Lab Soft News the development of integrated diagnostic centers (IDCs) staffed by both pathologists and radiologists and designed for the rapid analysis of undiagnosed tumor masses (see: A Call for the Development of Integrated Diagnostic CentersMore on Integrated Diagnostic Centers; Trend or Lukewarm Idea?). With the CTS, Pitt pathologists provide an integrated report to their test-ordering physicians for whom combing through the voluminous electronic record for a patient may lead to omissions and mistakes.

In my view, the CTS, as it stands now, is more of an integrated diagnostic report without much therapeutic information. However, this problem will soon be remedied as cancer genomics rapidly expands (see: IT Support for Cancer Genomics; Moving to Practical Clinical SolutionsIdentifying Therapeutically Relevant Genetic Abnormalities in Cancer Patients). Pathologists will soon be able to supply therapeutic recommendations about optimal cancer treatment and the CTR will be able to "grow into its name."

In order to product the CTS for relevant cases, Pitt currently uses a customized manual process based on the  synoptic reporting feature of CopathPlus by Cerner. In other words, the pathologists select the relevant ancillary test results for a patient and insert them into a synoptic template. To make this type of specialized report scalable in the future, Pitt intends to work with the CopathPlus developers to automate the process. I should note parenthetically that requiring pathologists to generate the CTS using a manual process has the salutary effect of raising to their highest level of consciousness all of the additional relevant information necessary to make a diagnosis including IHC, FISH, and molecular testing. A discussion of the concept and impact of the Pitt CTS reports has been published by Liron and colleagues in two abstracts:

Pantanowitz L, Yousem S, Piccoli A, Roy, Kelly S, Wiehagen L, Parwani AV. Evaluation of comprehensive theranostic reporting in Anatomic Pathology. Archives Pathology Laboratory Medicine 2013; 137(10): 1522.

Pantanowitz L, Wiehagen L, Monaco S, Yousem S, Piccoli A, Parwani A. Comprehensive Theranostic Summary (CTS) reports for thoracic cytopathology. Journal of the American Society of Cytopathology. 2014; 3(5):S83

10:50

People talk about client satisfaction as if it were a static thing—something that never blog-101314progresses or evolves. I believe the “action” in satisfaction means we must continually measure it and make adjustments as necessary. Our world is constantly changing; what made a customer happy three months ago may have nothing to do with his or her needs today. We must check in on a regular basis through a variety of channels in order to create a multi-dimensional living model of what our clients really want. Only then can we understand whether we are truly satisfying our customers. In order for any company to innovate, they must know what is important to clients today—as well as have a sense of what will be important tomorrow. Insights are discovered in many ways, and I believe we should use a variety of tools to determine the most accurate picture. Here are a few:

  • Industry Events – Be present to check the pulse of your industry, hear about issues and trends, and speak to others as an authority and a colleague. Events are already in place for these purposes, so get out there and learn.
  • Focus Groups – Drill down to specific insights that allow you to ask new questions and test ideas that may not yet be ready for a larger forum. Modern focus groups can provide nearly instantaneous feedback and insights at a very reasonable cost, so consider upping the frequency.
  • Social Media – Sometimes it’s the informal comment or question that can trigger a breakthrough innovation. Social media can be the next best thing to actually talking with clients—and sometimes even better, since it gives people a place to share their thoughts in real time.

If you’re really committed to knowing (instead of assuming) what your customers are thinking, why not create a whole experience dedicated to discovering just that? Right now I’m at our annual User Summit, where my team and I will be spending three days with our clients, listening to what only they can tell us. This is the ultimate forum for the pursuit of knowledge, and we look forward to learning how to continue to evolve our company to best serve our customers. Each customer interaction reveals different insights; enabling and acting upon that ongoing dialog is what we consider to be the action in customer satisfaction. It’s what allows us to innovate with purpose. The most significant question our clients ask right now is, “How can I successfully meet government requirements and achieve my practice’s goals without having to sacrifice one to serve the other?” I’ll be sharing more about our answer to that in my next blog post, so stay tuned . . .

9:53

The following is a guest blog post by Noelle Whang, Sr. Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Noelle Whang
Implementing an electronic health record (EHR) is a huge undertaking, but the work after go live can be even more demanding. Mapping and redesigning workflows is an important aspect of EHR implementation and optimization that is often overlooked, especially after the application has been live for a while.  This seemingly simple but complex task involves diagraming and analyzing all current work processes and adjusting them to include use of a new EHR system or upgrade, or to be more effective with a current system.

Workflow mapping and redesign should occur before implementation and regularly after go live to ensure end users truly adopt the EHR and organizational benefits are realized. Following these eight steps can ease the task of mapping workflows to identify any that should be adjusted to maximize optimization:

  1. Identify what workflows will need to be mapped in detail. “Understanding the full clinical context for health IT to the level of task, resources, and workflow is a necessary prerequisite for successful adoption of health IT,” according to a Perspectives in Health Information Management article. It’s helpful to first map out the entire patient care process at a high level, such as from registration to discharge in the inpatient setting and scheduling to check-out in the ambulatory setting. Documenting how business is performed at a high-level facilitates identifying the more granular tasks that need to be mapped in detail, such as scheduling a patient appointment or placing verbal orders.  It also helps in identifying all the roles involved in each workflow, as these can vary depending on the department or patient process.  For example, discharging a patient from Labor and Delivery may include roles, such as a lactation nurse and pediatrician, not found in other departments.  Remember to also consider departments or patient processes that are often overlooked, such as Materials Management and Respiratory Therapy. Other areas of concentration should be those with lower productivity or that relate to how the organization is going to determine return on investment.
  1. Identify teams to map out each process. After identifying what workflows need to be mapped, establish the team that will do the actual mapping. Usually, individuals who perform a particular workflow or those who are responsible for implementing any redesign changes are best suited to map workflows, as they have in-depth knowledge of the process. For example, select one registrar, one nurse and one physician to map out all workflows in the Emergency Department.
  1. Determine the process for mapping the workflows. Once the team has been identified, determine how information about workflows will be gathered, documented, and visually represented. The process for gathering information can be through interviews, observation, or meetings.  The information can be documented with tools such as Microsoft Word or Visio or simply on paper.  The data can be represented in formats such as a swim lane chart, a flow process chart or other process diagrams.   In my experience mapping out workflows, the most commonly used format is a swim lane chart created through Visio.  And remember: Internal staff will most likely need to be trained on how to gather the data and use the appropriate tools.
  1. Map the workflow as actually performed. After determining how information is gathered and documented, create the actual workflows diagrams.  Document all work as it is currently being performed, including any undesirable behavior such as workarounds or inconsistencies.  For a case study on how one organization created their workflow diagrams, see the following Journal of American Medical Information Association article.
  1. Analyze the workflow. Once the workflows are diagramed, begin the analysis. If a vendor has not been selected, use the diagrams to determine if a particular application fits the needs of your organization, with the caveat that it is neither feasible nor desirable to keep workflows exactly the same after an implementation.  If the application is already in place, the diagrams can be used to determine where problems are occurring, what the root cause is, and how to fix them.  The diagrams can also be used to determine where optimization or efficiencies may be gained.
  1. Document the new workflow. Once the analysis is complete and you have determined what workflows are currently not working for your organization, document the new and improved workflow.  It is a good idea to take the new workflows through a couple of use-case scenarios to ensure that the updates are not causing other problems or unintended consequences.
  1. Update or create policies and procedures. New or updated policies and procedures may be necessary to implement and support the new workflow. This can include determining consequences for any end users that do not adhere to the new workflows.  Note that this also requires thinking about how non-adherence will be identified, perhaps through routine application audits or quarterly in-department observation.
  1. Train staff. After all the hard lifting of creating the workflow diagrams, analyzing the processes and updating the workflows, the last step is to train end users on the new workflows, policies and procedures.  Remember to convey why the changes are occurring, and if possible, tie the reasons to big-ticket items such as increasing patient safety and satisfaction.

It’s easy to focus entirely on big tasks such as vendor selection and system configuration when implementing an EHR, but neglecting workflows can have serious negative impacts, including costly reconfigurations and operational inefficiencies.  It’s like building a house where each individual room is perfect, but the doors are all in the wrong place. With poor design you end up having to go through the closet to get to the kitchen, or even worse the foundation may begin to crack.  Similarly, with poorly designed EHR workflows, you can end up with duplicate documentation, activities that take more time than they should, and workarounds or shortcuts that can lead to negative consequences. Set your healthcare organization up for success and create a solid foundation by making workflow mapping and redesign a priority.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

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