EMR or EHR Implementation Success Requires Business Acumen

Jonena Relth,
President and Leadership Evangelist,
TBD Consulting, Inc.

Equally important to providing well-designed training is making sure people are ready for the changes they will encounter with a major system implementation such as EHR or EMR. And of course, whoever leading these initiatives should be trained and practicing effective business acumen.

I don’t want to insult anyone reading this, but lately I’ve been amazed to learn that many healthcare leaders are not trained nor do they understand business acumen when it comes to running a medical facility. Here’s a definition:

“Business acumen development is a method used to show how actions and behavior can impact financial decisions and affect financial outcomes at the unit and corporate level. It stresses the links between behavior and financial outcomes and shows how training and development in this area can improve the performance of a manager and bottom-line results of a particular unit or the corporation.”

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When one discusses business acumen, it is usually applied to individuals. What I plan to discuss is the business acumen that hospital administrators should have when considering implementation of IT and mHealth technologies.

It is well known that one of the biggest priorities of hospital administrators today is implementing IT technologies that will have their institutions meet Meaningful Use (MU) standards. The most important step in this process in my view is having the right Chief Information Officer (CIO) in place. Many hospitals did not invest or invest wisely in CIOs. Good ones are now hard to find. There are presently hospitals that are actually outsourcing this position. The job is taking on increasing importance, not only because of the focus on MU, but because of the role of the CIO in implementing even more complex projects including wireless technologies and strengthening IT security (a daily headline grabber). Along with the CIO are other IT employees. Many IT workers wanting to get into healthcare are getting formally trained but are being turned away while being told they do not have enough clinical experience. These people might thrive under the right administrator and support.

Good business acumen is always planning for the future.

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Also join our LinkedIn group EMR/EHR Clinical Transformation. Engage in discussion with nearly 3,000 professionals. This group is for physicians, health informatics and medical professionals, IT and performance improvement professionals. Join this group if you wish to learn from peers, get up-to-date news feeds, and share best practices for implementing EMR/EHR systems to equip clinical staff with the skills necessary to make the transition from paper to paper-light electronic records.

EMR HIT Trends for 2011-2014 – What’s coming to the top of the list?  

Jonena Relth,
President and Leadership Evangelist, TBD Consulting, Inc.

Cari McLean from HIMSS posted a question on LinkedIn asking: “What are your greatest takeaways from HIMSS11?” While the answers were varied, of course, it was fairly easy to pick up on which trends are floating to the top for the next couple of years.

Most people I talk to would most likely agree with the priorities chosen by the respondents which are dwindled down to the short list below. This is an exciting time in our country’s history. We’re in the midst of undertaking the biggest changes to healthcare that our citizens have ever seen. And while it’s taking a coordinated effort by both medical and non-medical professionals to make this a reality, I am certain that we are up to the task!

While all of the tasks need to be accomplished/mastered, I’ve listed them in “my” order of importance from an Organizational Development/Training perspective.

• “Interoperability and the problems stemming from the lack thereof will have to be addressed for overall success.”
  • My take: I’ve been pounding this drum until my colleagues finish my sentences for me. This is crucial folks. What good are systems that don’t communicate with each other? What good are systems that are not accessible? Interoperability is going to be key to long-term success of EMR/EHR. As human beings, we learn best and become proficient quicker when things work together. Having to work in an environment where systems don’t work together is counter-productive and frustrating.

• “Meaningful use – the rush to and the resulting effects of pushing the process is negatively impacting many smaller players which may ultimately change the playing field.”

  • My take: It’s a good thing the dates have been pushed, and I think that we’re going to need additional time to get this right. It’s not just about what needs to be done. Determining best practice processes is going to be vital to MU success. Our heads are already full of all the new things we’re learning to do our jobs. Let’s get best practices down so we don’t have to frustrate people with changing rules and regulations.

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Wireless health technologies and healthcare IT (with electronic health records or EHRs as the most visible component) are both burgeoning sectors of healthcare business. They have similarities and differences which I would like to explore. The market for both of these sectors is huge.

Both mHealth and HIT proponents claim they will make healthcare more efficient and save money. HIT is government mandated in a sense, insomuch as penalties will eventually be doled out for non-adopters who accept Medicare. Wireless technologies are more directed to the purchaser in a somewhat friendlier less intrusive presentation. EHRs are seen as tools for the provider and administrator, and mHealth is seen as a more patient-centric less provider labor-intensive instrument. EHRs are now diffusely used and we are well into the first year’s distribution of financial incentives for Meaningful Use. While MU is a clear priority for hospital administrations, adoption has been slower than anticipated. Barriers include poor implementation, expense, and physician resistance. Many physicians invested in IT systems, and when their practices were bought by hospitals, they had to adopt the hospitals’ systems, resulting in a financial loss as well as having to learn another system.

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Also join our LinkedIn group EMR/EHR Clinical Transformation.  Engage in discussion with nearly 3,000 professionals. This group is for physicians, health informatics and medical professionals, IT and performance improvement professionals. Join this group if you wish to learn from peers, get up-to-date news feeds, and share best practices for implementing EMR/EHR systems to equip clinical staff with the skills necessary to make the transition from paper to paper-light electronic records.

Which is more important: Education, Training or Teaching?

Jonena Relth,
President and Leadership Evangelist, TBD Consulting, Inc.

Question # 1: What do you consider most important to your organization:

1. Users’ ability to efficiently and properly use ERP, EMR or EHR software,OR
2. The quality of the training used to ensure the users can efficiency and properly use ERP, EMR or EHR software.

Naturally, most people will choose #1 as most important. However, why is it that we desire people to be able to do their jobs, but we are often unwilling to provide them the additional “training” necessary for them to do just that? Unfortunately, the answer is most often: leaders simply don’t value training. They see it as a means to an end…nothing more…nothing less.

Question #2: On a scale of 1-5 (5 being high), how often does your organization budget customized training as a priority line item for new software implementations?

I hope you were able to answer “5,” but my experience as a training consultant for 20 years of asking my clients this question is that they usually answer “1″ or “2.”

And please before you start stop reading: Yes, of course we need college and post-grad educated employees who have learned the healthcare knowledge required for their chosen profession. I’m not negating college education in any way. What I’m asking is, “Why do we consider training our medical professionals on other, non-medical topics they need to know as less important when it comes to budgeting?” Yep, this seems to be a finance issue, in my way of thinking.

In healthcare, we highly value education, as we should, but… we often fail to see the similarities in the three “terms” after our employees are on board.

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The patient portal is a small part of electronic health records (EHRs) in Stage 1 of Meaningful Use (MU) and becomes more significant in the subsequent stages. It is, in my opinion, going to be pivotal in ultimately determining the degree of success of the adoption of EHRs. The patient health record (PHR) is the window of the patient to the EHR. It can be as simple as offering the patient a look at the medical history, diagnoses and medications (which itself may be useful in the patient identifying errors), or patient management tools via mobile health platforms which interact with the EHR.

Mobile health technologies will ultimately become an integral part of healthcare delivery. These apps will need to have seamless connectivity with the EHR and it would make sense to do this via the patient portal as the wireless technology will communicate information from or near the patient. The information gleaned from the mHealth apps will only be as good as the interoperability with the PHR and other aspects of the EHR (diagnoses, medication, and potentially other mHealth apps).

The EHR is meant to be a secure set of information fluid and all encompassing with regards to the health record. The key to the word ‘meaningful’ of Meaningful Use, the government’s requirements for EHRs, is paramount to its ultimate success. The ability to synthesize data from various providers, diagnostic testing facilities, government agencies, payers, pharmacies and others, theoretically decreasing duplicate test rates, and improving outcomes because of shared information and safety features such as drug-drug interaction programs. However, the use of mHealth technologies was not specifically included in the plan that the designers of MU had.

Also join our LinkedIn group EMR/EHR Clinical Transformation. Engage in discussion with more than 2,600 professionals. This group is for physicians, health informatics and medical professionals, IT and performance improvement professionals. Join this group if you wish to learn from peers, get up-to-date news feeds, and share best practices for implementing EMR/EHR systems to equip clinical staff with the skills necessary to make the transition from paper to paper-light electronic records.

Participatory Medicine: My First-hand Account

Jonena Relth, President and Leadership Evangelist, TBD Consulting, Inc.

I was being prepped for surgery last week and my surgeon, Dr. Davies, came in to discuss the procedure.  He explained to me that he had reviewed my file several times and decided that he would prefer to perform a less invasive surgery which would result in  less recovery time.  He said the positives outweighed the negatives. I was thrilled that he had taken so much time to thoughtfully consider my specific needs.

He asked my permission and told me his recommendations, but ultimately he said it was my decision. I had been pondering over the same option during the previous week as well.

Our conversation opened up the opportunity for me to ask him if he was familiar with the Society of Participatory Medicine.  I told him about the organization and he quickly made notes of how he could learn more.

I had told him about ePatient Dave and his experience with Stage 4 cancer.  Dave was able to work along side his physicians and ultimately beat the cancer. At that point, my surgeon told me about a relative who had given up on traditional medicine after being told that he was dying and was out of medical options.  He was cured by non-traditional medicine practices.

My surgeon then told me that the phrase he least likes to hear from his patients is, “You decide, you are the doctor.”  He firmly believes that medicine is most effective when patients and doctors work beside each other; the same stance held by the Society of Participatory Medicine.

After much discussion, I decided to have the less invasive surgery.  Going in, I believed my doctor was a competent surgeon, but after my discussion with him, he increased my faith in his abilities ten-fold.  Doctors should be appreciative, not be intimidated by a patient who wants to be involved in their own care.  By the way, surgery went well and I should be back to work shortly.

Related Article:

A Physician’s Experience as a Cancer of the Neck Patient: The Importance of Patient Participation

1. A present and worsening shortage of both primary care physicians, and an even greater shortage of specialists, coupled with healthcare reform which is aimed at increasing access of healthcare will make face-to-face care more difficult.  This, in some areas, has promoted the telehealth industry, whereby a physician will literally see you over the Internet.  Physician shortages and the cost of this technology (most services charge as an office visit and require insurance) limit the widespread potential success of such endeavors.  MHealth initiatives will actually increase contact of the provider and patient via text messaging, email and communication of sensor-derived physiologic data (see below).
2. Obesity is now the biggest threat to the health of Western countries.  It is responsible for the skyrocketing rise of high blood pressure, diabetes, coronary artery disease and even stroke in young people. Most chronic diseases like these are preventable with simple lifestyle changes.  MHealth can effect these changes with educational messages, lifestyle reminders, and the transmission of physiologic sensing data (blood pressure, heart rate, blood oxygen levels, EKG tracing, and others).
3. The cost of healthcare is now literally prohibitive as a percentage of our total national budget. Technological and pharmaceutical development costs due to research, development and regulatory requirements are also at unsustainable levels.  Therefore, both the public and private sectors are embracing mHealth as a solution. The government is making significant funding available for mHealth development.  Large medical device companies are looking to smaller mHealth companies as a vital future of their business plans.
4. The shift of hospital and provider reimbursement from diagnosis-related fee for service management of diseases to to one of outcomes measured goals necessitates better patient participation.  MHealth is a tool that can facilitate better patient care coordination once a patient leaves the hospital.  It will hopefully prevent many office clinic visits and hospitalizations as well. Outcomes based care will necessitate close provider-patient contact upon hospital discharge.  It may decrease the need for home visits by nurses and others due to transmission of information, both clinical and descriptive by the patient.

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Also join our LinkedIn group EMR/EHR Clinical Transformation.  Engage in discussion with more than 2,500 professionals. This group is for physicians, health informatics and medical professionals, IT and performance improvement professionals. Join this group if you wish to learn from peers, get up-to-date news feeds, and share best practices for implementing EMR/EHR systems to equip clinical staff with the skills necessary to make the transition from paper to paper-light electronic records.