InformationWeek Stories by Rebecca Armato

InformationWeek Stories by Rebecca Armatohttp://www.informationweek.comInformationWeeken-usCopyright 2012, UBM LLC.2013-03-14T12:25:00ZTechnology Alone Isn't Healthcare's SaviorAnyone who deploys tech "solutions" without reconsidering workflows and policies -- and doing other heavy lifting -- is in for a rude awakening.http://www.informationweek.com/healthcare/leadership/technology-alone-isnt-healthcares-savior/240150792?cid=SBX_iwk_related_mostpopular_Leadership_healthcareIf you believe everything you read and hear, technology is the Holy Grail of our industry. It will "fix" just about everything that's broken in healthcare. That's a presumption fueled by human nature: Gravitate toward simplicity and immediate gratification. Technology is tangible, something we can install, turn on and it works. But what exactly should we expect from this working technology? Have we done a thorough job of defining what we want to accomplish and then addressed all of the components that go into ensuring we succeed? Hospitals and physicians focused only on the Meaningful Use bull's-eye when implementing technology will experience a grave letdown when they turn "it" on and discover technology alone isn't their savior. Anyone who deploys technology without reengineering workflows, redefining job duties, readdressing policies, revisiting best practices and refining business arrangements could find that the cost exceeds the Meaningful Use incentive funds and that the technology will fall far short of delivering Meaningful Value. Unfortunately, these same organizations will be quick to point out that the technology "didn't work." "Right care, right place, right time, right quality at the right price" requires us to think differently. It requires a disciplined focus on the long-term goal while executing on the short-term tasks, all while avoiding the distractions that come with the hype around technological solutions. [ Want your patients to take more control of their healthcare? See <a href="http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137?itc=edit_in_body_cross">7 Portals Powering Patient Engagement</a>. ] Imagine an electronic health record (EHR) as you would an automobile. You must know what you'd like the automobile to do in order to know which ones to consider. A rancher doesn't buy a Porsche to haul hay. We expect carmakers to deliver vehicles that work when we turn them on. But from the moment we drive one off the dealer lot, if we don't know where we're going, or we haven't been trained to drive, or we drive distracted or impaired, or we're unaware of our surroundings, or we don't respond fast enough when a child or animal darts out in front of us, we're going to end up in the wrong place or in an accident. How far off course we end up and how much damage we cause will depend on the level of our neglect, incompetence and recklessness. <div class="inlineStoryImage inlineStoryImageRight"><img src="http://twimgs.com/informationweek/graphics_library/175x175/staples_eas y_button.jpg" alt="Staples Easy Button" title="Staples Easy Button" class="img175" /></div> When it comes to mishandling EHRs and other technology implementations, we're not completely to blame. Vendors are sending the message that their technology will solve all of our problems, and with all the challenges we face in our industry, we want desperately to believe them. I have a red Staples "Easy" button that I hit when I'm feeling particularly challenged, but I know that success with healthcare technology will never be as easy as installing it and turning it on. We must address head-on all of the other areas: redesigning workflows, reengineering thought flow, finding usability tricks, adopting business arrangements that understand our surroundings and adjust to our conditions. We must avoid the misperception that technology makes all things possible, requiring data and reports that aren't technically possible with the technology we've adopted. If we don't, we will set up our organizations with unsustainable processes that cost more than we can afford and don't deliver the outcomes and quality we've committed to delivering to our communities. The right way isn't always the easy way. Success requires leadership, vision, focus, drive and hard work -- all of which are within our control. With the right mix of people, process and technology, we will make tremendous advances and be able to focus on improving the health of our communities rather than just providing sick care. We must continuously monitor our efforts and develop better tools and smarter processes. By infusing clinical decision-making with instantaneous "smart information," physicians are better equipped to collaborate, diagnose, treat and accelerate the medical breakthroughs necessary to improve not just our industry, but our world. Have you ever experienced a time when you were driving and all of a sudden you looked up and for an instant had no idea where you were or how you got there? Is that the fault of the car manufacturer? Don't get complacent or distracted. Hard work pays off. Apply the right balance of people, process and technology necessary to succeed. As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/021813hc/?k=axxe&cid=article_axxt_os">Big Data Analytics</a> issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.) 2012-09-26T08:36:00ZIs IT Innovation Driving Physicians Out The Door?Recent health IT initiatives are forcing many frustrated clinicians to take early retirement. IT leaders need to realize that our national treasure is becoming an endangered species.http://www.informationweek.com/news/240007922?cid=SBX_iwk_related_mostpopular_Leadership_healthcareRather than face the perfect storm of decreasing reimbursement, increasing costs, legislative mandates, and penalties around technology adoption, information exchange, and <a href="http://www.informationweek.com/healthcare/policy/meaningful-use-stage-2-rules-finalized/240006128">Meaningful Use,</a> an alarming number of physicians are making the decision to "go quietly into the night" and retire early from practice. Some are leaving the profession as many as 10 years earlier than they had anticipated. Rather than consider change, physicians are placing a DNR on their practices, saying no to investing in tools necessary to efficiently manage their businesses. For some physicians, the hospital's own IT transformation activities are the tipping point driving them to retire. We need to do something about this problem before it's too late. Physicians are trained to make decisions, not ask questions--except of patients. The noble personality that gives them the confidence to heal also causes them to feel they have to be all-knowing and all-seeing on all topics. Many physicians are not comfortable publicly sharing their questions about technology selection, adoption, or optimization--fearing it will expose ignorance about topics on which they believe their peers have all the answers. Yet with so little time just to keep up with clinical research in their own specialties, when do physicians have time to become IT experts as well? Consider what happens when physicians experience an adverse outcome. Unless they're residents or are in a behind-closed-doors peer review, they're not encouraged to expose the troubling issue so they can brainstorm with their peers to improve their clinical decision-making. For fear of retribution by attorneys representing patients or grieving families, they have been trained to suffer in silence and guess at what might have happened and/or what they might do differently next time. Unfortunately, many physicians apply that same learned response to their selection, implementation, and adoption of EHRs. They don't openly discuss their questions, concerns, thought processes, and experiences as they evaluate technology. Nor do they share best practices or lessons learned while adopting and utilizing new health record tools and processes. Instead, they kick into "fight or flight" mode during EMR implementation, too often letting their practices quietly flat-line. [ Looking for a PACS platform to replace an outdated system? See <a href="http://www.informationweek.com/healthcare/clinical-systems/9-must-see-picture-archivingcommunicatio/240006960?itc=edit_in_body_cross">9 Must-See Picture Archiving/Communication Systems</a>. ] In my view, physicians fall somewhere between a national treasure and natural resource, and one that's becoming an endangered species. Fewer physicians are encouraging their children to go into medicine, unsure of the future reward for all the risk. Physicians are deciding to retire early, afraid to change, unwilling to learn something new, and unsure if they can. While your first instinct as an IT manager may be to push forward with your hospital's EHR implementation without them--don't. You may not realize exactly how much impact on care they are providing in your community. Hospitals have a license to house patients; physicians have the license to treat them. It is only by working together that we can continue to provide care in our community. If physicians go, who will step in to provide care to those patients? With empathy and the right engagement, these physicians will ensure the successful adoption and utilization of the technology needed to ensure your organization not only survives but also thrives during these turbulent times. <a href= "http://www.huntingtonhospital.com/Main/AboutUs.aspx ">Huntington Hospital,</a> where I serve as executive director, physician & interoperability services, is working with physicians in our community to help them consider their options, share their experiences, best practices, challenges, and missteps, and figure out how to create efficient workflows.Innovation by itself does not ensure success. Installment of innovative technology is happening at a dizzying pace. More important is the ability to scale innovation, blending creativity with the self-discipline to stay focused on the IT features that foster patient safety and quality care. My message to clinicians is straightforward: Don't end your practice prematurely because you fear the unknown, and don't be afraid to speak to your peers or reach out to us on the IT side. Most likely the physician you're speaking to has the same questions and feels the same uncertainty and confusion about the future that you do. If a doctor in solo practice is considering retiring within the next 3 to 5 years, investing in a full-blown EMR for his or her private practice may not be the best choice. There are other options available. Is he considering an EHR but not sure how to start looking, or what to ask vendors? Is she wondering what bells and whistles are really important, so the practice can get real value rather than waste time with unimportant "wow" features? Huntington Hospital works with physicians in our community by implementing a variety of services, resources, and technology designed to leverage a practice's technology investments. We have also started upgrading our own hospital electronic medical record to improve quality, outcomes, efficiencies, and cost of care, and to better integrate with Huntington Health eConnect. We provide educational tools that address the questions physicians should be asking. We also provide software they can use today as a transition to a full-blown EMR, helping them to improve patient outcomes and efficiencies. Two examples are HuntingtonRx, which provides medication history, electronic prescribing, and medication contraindications; and Huntington Health eConnect, which offers a physician portal, an in-box for patients' clinical results, secure communications with other physicians, and community virtual patient record combining inpatient and outpatient care. Clinicians don't need an electronic medical record to electronically receive their patients' results via Huntington Health eConnect or to e-prescribe using HuntingtonRx. Adopting technology for their practices doesn't have to be a heroic investigational treatment. Physicians can expect to see well-documented improvements to outcomes, practice expenses, and efficiencies, if they adopt the right technology for the right reasons, in the right way, and at the right time. Just as physicians don't expect patients to face health issues alone, our hospital is there so physicians don't have to face healthcare's "perfect storm" alone. We encourage physicians to resist their "fight or flight" impulses with the same attitude and strength they ask and expect of their patients. The Right Information, Right Time, Right Device Our staff works with physicians and other caregivers to help figure out when and how to use tablets and other mobile devices to view and document information supporting patient care; we perform readiness assessments of their practice. And as we implement new inpatient electronic medical records, we work closely with physicians to ensure we have the best workflow and thought-flow to improve patient care, cost, and efficiencies. Whether they're viewing or moving information from a private practice EMR to an outpatient imaging center, reference lab station, cardiac cath lab, inpatient surgery, outpatient rehab, or home care, our community patient record enables all clinicians to be engaged with and to collaborate with other caregivers, regardless of their technological capabilities. Even with multiple vendors involved, technology has progressed to support patient care workflow. But it takes discipline and physician engagement to determine the best workflows. We shouldn't place the burden of figuring it out only on physicians. Together, our clinicians see 11,000 patients a day--10,000 in private physician offices in our community. If we can convince each one of our physicians to stay in practice just one more day, in that one day 10,000 lives in our community will be touched, treated, and healed. Could the next Da Vinci or Einstein be among them? Don't let your IT transformation cause physicians to "go quietly into the night," or you may find your organization transformed completely out of doctors. Rebecca Armato is executive director, physician & interoperability services at Huntington Hospital in Pasadena, California. InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) 2011-01-29T00:00:00ZFor Doctors, EHR Adoption Isn't A Spectator SportSelecting and adopting an electronic health records system is critical to the health of a physician's practice.http://www.informationweek.com/news/229200031?cid=SBX_iwk_related_mostpopular_Leadership_healthcare  <div style="margin:0; padding:0; border-top:dotted 2px #56a643;"> <a href="http://www.informationweek.com/gogreen/013111HC/index.jhtml?k=axxe&cid=article_axxe_os"><img src="http://twimgs.com/infoweek/hc/004/smallcov.jpg" alt="InformationWeek Healthcare Feb 2011" width="65" height="88" hspace="0" vspace="0" border="0" align="left" style="margin:22px 33px 8px 15px;" /></a> <a href="http://www.informationweek.com/gogreen/011711/index.jhtml?k=axxe&cid=article_axxe_os"><img src="http://twimgs.com/infoweek/graphics_library/misc/Green_leaf_88x88.jpg" alt="InformationWeek Green" width="88" height="88" hspace="0" vspace="0" border="0" align="right" style="margin:8px 10px 8px 10px;" /></a> <div style="margin:10px 0 0 0; font-size:1.1em;" align="center"> <a href="http://www.informationweek.com/gogreen/013111HC/index.jhtml?k=axxe&cid=article_axxe_os">Download the entire February 2011 issue of InformationWeek Healthcare</a>, distributed in an all-digital format (registration required). (Registration required.) <div style="margin:6px 0 0 0; color:#56a643; font-weight:bold; font-size:1em;">We will plant a tree for each of the first 5,000 downloads.</div> </div> </div> <div style="clear:both; margin:0; padding:0 0 0 0; border-bottom:dotted 2px #56a643;"></div>    Just as the right medical treatment is critical to a patient's health, the right approach to selecting and adopting an electronic health records system is critical to the health, and even survival, of a physician's practice. And it's not just about the technology. Big problems can come from making the wrong EHR choice for the wrong reasons, and from expecting a software vendor to successfully implement an EHR system without the engagement of the practice's physicians. Those problems will cost much more than the federal stimulus funds being offered to encourage physicians to implement EHRs. For physician practices, EHR selection and adoption isn't a spectator sport: Doctors must be actively engaged. They must focus on evaluating features that support patient quality, safety, outcomes, privacy, and security. But they also must insist on features that improve the efficiency and viability of their practices. We've been working with the independent physicians in our area as they choose EHR systems. In order to be successful, physicians must keep in mind the following three ideas: 1. Deployment isn't the same as utilization. Technology makes it possible, but the art is in making EHRs personal to physicians and their staffs. One size doesn't fit all, so it's important to find a system that operates the way physicians in a practice think and work. 2. Functionality isn't the same as usability. It isn't about the number of bells and whistles an application has. Think in terms of number of screens and mouse clicks required to qualify not just for federal "meaningful use" requirements, but also to deliver "meaningful value" to you and your patients. Evaluate whether functions are supportive and not disruptive during clinical decision-making, patient care, and treatment. We're hosting a "vendor click-off" event so physicians can make side-by-side comparisons of how many mouse clicks it takes to perform key meaningful use criteria. ONC-ATCB certification shows only that an application can perform the required criteria, not how easily. 3. "Data" isn't the same as "information." Evaluate not only how the EHR captures information about care provided during a patient's treatment, but also how seamlessly the information is available and actionable during subsequent visits. Evaluate if it can securely and effortlessly receive and exchange information across national, regional, and local health information exchanges, in support of collaboration with physicians and caregivers in other settings. Focus On The Core First Physician practices we've seen succeed with EHRs are those that focused on core functionality first. Here are five areas to concentrate on: 1. Patient registration. This includes staff entry and patient entry through patient portals and kiosks. 2. Scheduling. This isn't just for patients, but also for physicians, equipment, and resources. 3. Clinical documentation. This includes physician, nurse, and medical assistant documentation; testing and treatment order templates; decision support alerts for key conditions and treatment; and quality/outcome reporting. 4. Accounts receivable. Analyze charge capture, claim submission, and insurance payment postings; patient statement and payment postings; and management reporting. 5. Communication and care collaboration. Consider the ability to support the consult, referral, and care transition among caregivers; patient communication (secure e-mail, telephone calls, remote monitoring devices); tracking and handling of paper communication, such as mail and faxes; handling of medication history, formulary, eligibility, and electronic prescribing; electronic exchange of reports and results; and secure access to EHRs from handheld devices. At Huntington Memorial Hospital, we're conducting seminars and providing educational resources, such as EHR selection toolkits. We're also offering an e-prescribing application that encourages physicians to take small steps into technology adoption, while providing them breathing room to evaluate and implement the right EHR systems for their practices. In addition, we're building IT infrastructure that supports information sharing among multiple sources in a variety of formats, and puts information into a uniform structure so it can be shared with other electronic health records, personal health records, and decision support systems. Our goal is to make sure collaboration among inpatient, outpatient, and private practice settings occurs in what we refer to as "high definition"--in terms of detail, contrast, and refresh speed. That's needed to support fast, informed decision-making at the point of care, to improve the quality and lower the cost of care. Hospitals have a license to house patients; physicians have a license to treat them. It's only by hospitals and physician practices working together, and adopting the right tools and processes, that we can meet the healthcare needs of our community. Together with physicians in our community, we care for more than 11,000 people a day--10,000 of them in the private physicians' offices. We consider community physicians somewhere between a national treasure and a natural resource and want to make sure they don't become an endangered species. Creating a collaborative virtual health community that improves quality of care begins with physician engagement as much as it does adopting the right tools and processes. We hope with our encouragement and assistance that community physicians don't just survive, but thrive. Rebecca Armato is executive director for physician and interoperability services at Huntington Hospital in southern California. Write to us at <a href="mailto:iwletters@techweb.com">iwletters@techweb.com</a>.