Overcoming IT Challenges for Community and Rural Hospitals

With Meaningful Use (MU) in full swing, healthcare organizations are fully involved in planning and completing their tasks to keep them moving down their MU roadmap.  As of January 30, 2013, a FierceEMR article reports that incentive payments top $10.6 billion dollars. With over 355,000 hospitals and eligible professionals with active CMS registrations, the community and rural based hospital is one segment of the healthcare industry that is severely underrepresented.

The backbone of our healthcare system is the smaller community and rural hospitals located in communities across our nation.  The American Hospital Association totals the number of community hospitals at 4,973 with a total of 797,403 staff beds.  These hospitals account for almost 35 million admissions. With that kind of impact on our healthcare system, the loss of any community hospital would have dire consequences on the country as a whole.  If, however, these hospitals are not able to meet the MU deadlines, the Medicare and Medicaid penalties will cause them to close their doors.

In a Stoltenberg Consulting issue brief, Stoltenberg sat down with Char Wray, VP Clinical Operations and Information Systems/Chief Clinical and Information Officer for EMH Healthcare in Elyria, Ohio to get a CIO’S perspective on this issue.  During that conversation, Char examined the issues facing community hospitals. One of the greatest issues is how MU payments are structured. “The way MU payments are structured, a hospital needs to make an investment upfront before it receives any reimbursement.” It is because of this upfront investment that many community hospitals have not been able to embark on their MU journey and start moving toward attestation. Another large obstacle is that community hospitals typically do not have large IT staff in place to handle such a project. One of the often missed obstacles that can bring a community hospital to its knees actually occurs after they successfully implement their new EMR to start their MU attestation- the issue of providing their physician and end users the 24x7x365 support they need to utilize their new EMR so the organization can achieve their required numerics for submitting to CMS.  Due to the small IT staff, these issues becomes a costly scenario preventing their ability to meet MU unless the organization can partner with out-of-the solutions that meets their needs but fit within their budgetary constraints.

Providing insight on where smaller hospitals are finding help, Fred Bazzoli, Senior Director of Communications for the College of Healthcare Information Management Executives (CHIME) explained, “CHIME sees the need to reach out to rural and community hospitals in a really pointed way. These smaller hospitals have to put aside competitive differences and stay in contact with each other to facilitate information transfer.” Bazzoli also feels it is important for smaller hospitals to seek out experts in the industry who have experience implementing the required systems. Stoltenberg shares that view and that passion. Providing that out-of-the box solution is essential to ensuring the future of our community and rural hospitals. This passion will be a large focus of ours at the upcoming HIMSS13 conference in New Orleans, Louisiana.  Ensuring the success of our community hospitals directly impacts our individual health and we must do everything as an industry to guarantee their future.

Thank you for your time, and to our followers who will be attending HIMSS13 next week in New Orleans, stop by booth #4227. Check out the HITStoltenblog throughout next week for live blogging about conference hot topics and speakers.

To see the referenced article, go here.

HIT Policy Leader Places Focus on Client Needs over Vendor Dollars

ImageIn the Feb. 7 Healthcare IT News article, Diana Manos elaborates on comments made by Farzad Mostashari, MD, National Coordinator for Health Information Technology.  His comments came at a meeting of the Health IT Policy Committee.  In these comments, Mostashari eluded to the unfair practices of some EHR vendors.  He also threatened increased governmental regulations to control those practices if they continue.

I do agree there are vendors and consulting firms in our sector that see a dollar as more important than “doing what is best for the client.”  That has plagued HIT for as long as there has been HIT.  Since ARRA and HITECH, this issue has grown.  Any sector that sees the business growth HIT has had over the last couple of years, draws the attention of people that see dollars instead of opportunity to make a difference and impact our healthcare system overall.  This is not new but might be more prolific than in the past.  Mostashari focused on vendors that use unfair “data lock-ins,” contract language that has a chilling effect on clients changing vendors and false claims of interrupted reporting abilities as examples of these unethical but legal practices. In response, he said regulations might be what is required to fix this issue.

My question is why would the regulatory process be required?  As consumers of vendor and consulting firm services, the power rest with the client.  If a vendor or consulting firm is clearly looking only for the almighty dollar and does not have a genuine priority of doing what is best for the client, why would its services be purchased?  As consumers, we all have the ability to set the standards we expect by what we choose to purchase and what we choose not to purchase.  Since there are vendors and consulting firms that clearly have the best intention for their clients, there are other options instead of purchasing services from one that is only driven by the profit.  More regulations are not needed. These vendors and firms can only take advantage of someone when the client signs the contract agreeing to those terms.

In today’s market where so many mergers are occurring, where vendors and consulting firms are becoming behemoths in the HIT market, these practices of putting profits in front of customers will only increase. Using vendors and consulting firms that have resisted this trend to merge so they can continue to focus on each individual client’s needs becomes critical to stopping the growth of unfair practices that put the dollar above the needs of the client. Use your pen to send a message to create the standards you want to see become the norm. Every signature on a contract sends a message to our industry.

Community Hospitals Moving Toward Stage 2 Meaningful Use

Community Hospitals Moving Toward Stage 2 Meaningful Use

Within the Feb. 7 EHR Intelligence CIO Series feature “Moving from Stage 1 to Stage 2 Meaningful Use” author Kyle Murphy interviews EMH Vice President of Clinical Operations and Information Systems/Chief Clinical and Information Officer Charlotte Wray, addressing the goals set for the community hospital system’s movement toward Stage 2 MU. Check out this piece tailored toward rural and community hospitals making note of the first-hand experience behind it.

Find the article here. 

Find out more about EMH here. 

Getting Through a Go-Live

Have you survived a HIT go-live?  Just like “this one time, at band camp,” several of us have “this one time, at a go-live” stories to share.

Entire system go-lives, upgrades, even small optimizations can be considered a go-live. This is the time when you find out if all the testing really helped and if the end users truly absorbed the training.


Though go-lives can be a true test of stamina, here are some tips to best tackle the big event:

1)      Has anyone else gone through a similar go-live?  Schedule calls with other vendor clients to go over lessons learned from their go-live.

2)      Know your schedule long in advance to prepare for the longer workdays.  Your family will be without you.

3)      Get plenty of sleep!  It can be difficult to change your sleep patterns, but you need to be alert.

4)      Don’t eat the junk food in the command center.  If food is being provided, have everyone ask for healthy alternatives to cookies and doughnuts.

5)      Document everything.  Make sure you keep good notes on any build done for the go-live.  You or a co-worker may have to undo something if it causes a problem.

6)      Be invisible when not needed and working on tickets.  The command center can get crowded and out of control at times. You want the end users who stop by to see that everything is in control, so they’ll feel comfortable.  They’ve been given a new system or a change to the system to get accustomed to and take care of patients at the same time.  Knowing their support is in control will help them more than you know.

7)      If a quick fix to an issue isn’t available, try to come up with a workaround until a permanent fix can be completed.  End users on all shifts will need to be kept up to date with workarounds and any fixes.

8)      If you’re very lucky and get caught up, ask if anyone can use your help.  You would appreciate the help, right?

9)      Be sure to thank all of your teammates!  Everyone who has supported you through the go-live would be considered your parachute packers.

10)   Once the go-live is complete and everything is working perfectly, offer your lessons learned to other vendor clients to go full circle.

Please share your best go-live stories.  What could have been done differently?  What are your suggestions for your next go-live.

Disasters or Not, HIE Connectivity Is Critical

This week the Northeast saw one of the most devastating storms in its history it ever has as Hurricane Sandy touched every state in the region in one way or another.  Easily accessible health information is crucial for the care of a patient at any time, but this is especially true when disasters like Hurricane Sandy strike.

With Hurricane Sandy, we saw multiple health emergencies: courageous rescues, patient transfers, life threatening situations, and more.  The most potent example was when regular and backup power failed at NYU Langone Medical Center. As a result, two hundred patients were taken by ambulances to other facilities in the area to be treated.

Rescue workers evacuated NYU Langone Medical Center after power failure. Photo/John Minchillo/AP

Although the people directly in the path were affected enormously, individuals from across the country also felt Sandy’s impact. On a country-wide scale, we saw over 20,028 flight cancellations, according to USA Today. Folks that lived in the Northeast couldn’t get home, and others that were visiting the area couldn’t return to their homes.  This left thousands of travelers grounded and in unfamiliar territory throughout the country.

On Wednesday, Mike Miliard, Managing Editor for Healthcare IT News, published an article from his conversation with David Whitlinger, executive director of New York eHealth Collaborative (NYeC), which oversees the Statewide Health Information Network of New York (SHIN-NY).  Within the article, the two discuss the importance of New York’s HIE network and its critical role for the community and even its trapped visitors during the disaster.   See the article here.

Whitlinger states, “ ‘This health information exchange network really can and should be seen as a public utility, for the public good. And this is another example of how it can be as critical as having roads, as having fire hydrants, as having an electricity backbone.’ ” This statement is an example of how important HIEs are to the people and patients within their communities.  Just as communities in the country have evolved to depend on cars, roads, and electricity in our everyday lives, it is time for our healthcare to evolve from paper records to information exchanges.  Once this evolution occurs, it will be ingrained in our daily lives as much as the cars and electricity we’ve grown to become so fond of.

New York City area is doing a great job with 78% of hospitals connected to the state HIE, according to Brian T. Horowitz on eweek.com.  On a grander scale, the country is not at the same percentage of connectedness (Can we provide this solid number?).  The occurrence of the 20,028 cancelled flights throughout the country is an example of how a National HIE network could improve the continuity of care for patients across the nation.  By connecting all facilities, we could enable physicians to close the knowledge gap of seeing a patient they normally do not see.  Duplicate tests and measures would be eliminated from the care process, and that time can be used better to target the right treatment and improve results on an individual level, as well as cost savings to care providers and patients.

The initiative of a national HIE network is not easy, but organizations like the SHIN-NY, and many others throughout the country are on the right path to helping the nation connect.  The future of exchanging healthcare information keeps getting brighter, and as a patient, it sounds great to me. Come rain or shine, from notifying loved ones of a patient’s status after a disaster to monitoring an expecting mother’s medical progress, HIE is vital in all of our lives.

Stories referenced in this post: Healthcare IT NewsEweek.comUSA Today

A First-Time Attendee Recaps the 20th Annual CHIME CIO Forum


From October 16- 19, the 20th Fall CIO Forum for the College of Healthcare Information Management Executives (CHIME) was held in Palm Springs, CA.  It was my first event with CHIME, and I thoroughly enjoyed every aspect of it.  The events, speakers, education, facilities and people were great.  My hat is off to the CHIME folks who did a wonderful job.  Happy 20 years!  I’ve recapped my week below:

The conference began with a very rewarding experience.  Our group attended a local food bank where we helped box over seven thousand pounds of food for the local community.  Other attendees participated in the annual golf outing and/or a Living Desert tour which showcased the local wildlife.

We were eager to do our part to aid the local community.
Legendary journalist Ted Koppel share stories from his news career.

After the opening reception Tuesday night, Wednesday brought an energetic welcome from Board Chair Drex DeFord, FCHIME, CHCIO.  Following the welcome was a keynote address from the legendary journalist and anchorman Ted Koppel.  He told stories of travelling with the many presidents whom he has followed abroad and domestically.  Koppel also shared some of his thoughts on press in the country today, commenting that journalists are sometimes trapped into giving the news that we want instead of giving the news that we need. Just from hearing his experiences through his stories, I can’t imagine what he has seen and heard firsthand over the years.

Dr. Mostashari called audience members heroes for leading the healthcare IT revolution.

Wednesday continued to be full of energy when National Health IT Coordinator Farzad Mostashari, MD took the stage in late afternoon.  Dr. Mostashari energized the crowd as he shared personal stories and commented about using meaningful use as a tool.  According to Dr. Mostashari, by using meaningful use as a tool, we can help improve three main things: population health, sharing of information through HIEs and increasing patient engagement.  Dr. Mostashari called the audience heroes for leading this great revolution in healthcare IT, and I could not agree more.  All members of CHIME are at the forefront of these important changes in the U.S.

Education was a cornerstone of CHIME with rewarding breakout sessions on Wednesday and Thursday.   experiences and industry knowledge were shared by CHIME members in their respective Track sessions.   I truly believe hearing from real life experiences is the best education, and the sessions did not disappoint.  Although I couldn’t see all the sessions, one session that was very helpful for me was “Meaningful Use Stage 2 – Delayed, but Not to Be Forgotten.”  Speakers were Pam McNutt FCHIME, SVP & CIO of Methodist Health System; Chuck Christian FCHIME CHCIO, CIO, Good Samaritan Hospital; Bill Spooner FCHIME, SVP & CIO, Sharp Healthcare.  Their expertise in Stage 2 objectives/requirements helped me wrapped my head around it more.  It was a beneficial precursor to the afternoon’s Plenary Session with Travis Broome from CMS and Steve Posnack from the ONC.  Broome and Posnack took questions directly from the audience.  Some questions were tough, while others were fun, like How many stages will there be?

Dr. Topol gave a glance into the future of mobile technology.

Thursday’s keynote speaker was Eric Topol, MD.  Dr. Topol, a wireless medicine and genomics innovator who has been a huge proponent of mobile devices to improve patient care, highlighted some revolutionary mobile devices and gave a sneak peek into what is to come with mobile technology and patient care in the future.  He also spoke about genomics, the study of genomes within people and/or organisms, and how it will help save lives by zoning in on specific patients’ information.  Overall, I walked away with a solid sense of how the powerful new devices and research in genomics will help everyone be able revolutionize medicine at a more individual level. Savage, star on the television series Mythbusters, finished CHIME off with the closing keynote on Friday morning.  He spoke about how he came to be where he is today through exploring the unknown.  His skepticism and curiosity have led him down an interesting path.  He urged us to continue our curiosity and skepticism within our field and continue to answer questions that haven’t been answered before.

While CHIME has now been around for an impressive 20 years, this was my first trip to the meeting.  It was an awesome experience, and I thoroughly enjoyed getting to meet the CHIME members in attendance and our fellow CHIME Foundation members.  I’m looking forward to the next meeting.  Thank you, CHIME and Palm Springs.

I don’t get views like this from Pittsburgh.