The massive expo hall at the HIMSS10 conference may have left health care providers bewildered about choosing an electronic health record system, let alone implementing one. The example of Kaiser Permanente, which began implementing EHR six years ago, offers providers both advice and hope.
The undertaking, not surprisingly, involved numerous challenges, noted Jan Oldenburg, the senior practice leader of Kaiser’s Internet Services Group.
- Kaiser’s eight regions all wished to maintain some independence.
- The IT department was used to custom coding add-ons to its applications.
- Many doctors believed records belonged to them, not to patients.
Furthermore, Kaiser identified some key aspirations in implementing EHR, Oldenburg said.
- Records needed to be made available to patients — and quickly. (No one likes waiting several days for lab results.)
- Records had to both respect the intelligence of patients — by not referring to a condition as “heart trouble,” for example — and provide education in context.
- Patients needed a secure system for email communication with their doctors.
- Clinicians, nurses and even labor leaders needed to be involved with the entire decision making process.
Kaiser began with EHR software from Epic Systems Corp., adding applications along the way for such tasks as e-prescribing and patient behavior analysis. Emphasis was placed on standards — all transactions, even internally, are based on Health Level 7 International standards — and on using features out of the box. The finished product, called KP HealthConnect, emerged in 2004.
Six years later, at HIMSS10, Kaiser announced it has finished implementing EHR across its entire network of 431 clinics and 36 hospitals. In addition, 24 Kaiser hospitals now have reached HIMSS Analytics Stage 7, which represents HIMSS’ highest level of EHR adoption. The provider also said 3 million of its 8.6 million patients, or roughly half of adult patients who use the Internet at least a few times a year, are using Kaiser’s personal health record (PHR) system, known as My Health Manager.
Implementing EHR and PHR certainly comes with risks, the greatest of which can disrupt physician workflows and put patients in harm’s way. But the rewards — easily accessible records, educated patients, engaged physicians and, of course, meaningful use incentives — are well worth the effort.
ATLANTA — One of the more interesting vendor meetings here at HIMSS10 took place with Symantec. The company’s two new offerings, Symantec Health Safe and Image Share, are somewhat interesting: The former is Software as a Service storage hosting for health care images, the latter a Flash-based Web tool enabling physicians to share their X-rays, CT scans and other pictures with each other without having to mail CDs, DVDs or paper copies.
Far more interesting, however, is the deep look it gives into hospital IT culture: Health Safe attempts to solve the problem of the total lack of planning for back-end support when a facility purchases medical imaging equipment. A typical scenario unfolds like this: Chief medical officer or other clinical leader gets administrators to agree to purchase a new 256-slice scanner. It happens to spew four times the data than the machine it replaced. No data storage budget is baked into the purchase, leaving IT staff on the hook for the tab.
Health Safe, targeted to medium (200-bed) and larger hospitals, attempts to arm the IT side with information to help arbitrate this dispute by adding data analytics tools. These are accessible in a hardware appliance Symantec provides its customers to plug in at its facility, interfaces with the PACS systems — a common occurrence when a health system has multiple buildings, multiple imaging systems or a combination of those.
The Health Safe dashboard gives CIOs a snapshot of which machines or modalities (CT scan, MRI, X-ray, etc.) are the gigabyte hogs, and which ones contribute less to the problem — and justification for budget requests when the storage capacity redlines, which is inevitable as each new generation of hi-res medical imaging equipment captures more and more pixels.
“It gives a detailed breakdown of storage across facilities, based on type of modality, and do a day-to-day breakdown,” said Gary Sevounts, Symantec senior director of marketing and product management. “For the first time, you can see how much storage CAT scans are using in Facility A or Facility B. It provides the CIO the possibility of doing chargebacks to each department based on storage utilization.”
Note that word possibility. The problem of IT managers picking up the storage tab is still their problem, and theirs alone. But analytics tools like these, customized for health care image storage, seem — at least at first blush — like interesting little hammers they can use to chip away at their data storage budget problems. Arriving at solutions can be a contentious process in the best of times, and in this down economy, they need all the help they can get.
ATLANTA — The Office of the National Coordinator released its much-anticipated proposed rule outlining the certification program for health information technology during a town hall meeting at the HIMSS10 annual conference.
Released at a modest 184 pages, the certification programs proposed rule provides details of two accreditation programs. There will be a temporary certification process so that vendors can be certified in time to implement technology standards and help providers meet stage 1 meaningful use criteria, as well as a permanent process. The permanent certification process will focus on the future stages of the health IT roll out, and will replace the temporary program.The proposed rule also outlines how the ONC will accredit eligible organizations.
During the temporary program, an organization may apply to both test electronic health records products and then certify that those products meet federally mandated criteria. Under the permanent process, organizations that wish to certify technology will have to apply for two separate accreditations: testing accreditation and certifying accreditation, according to David Blumenthal, the physician who heads the Office of the National Coordinator.
Separating the testing and certifying processes is a standard practice in other industries, and following that same method in health care was a recommendation of the National Institute of Standards and Technology, Blumenthal said after the HIMSS session. “NIST was heavily influential in our decision,” he said.
Previously, the Certification Commission for Health Information Technology was the only recognized certifying body for vendor products. The new accreditation process opens the opportunity for any eligible organization to become a certifying body. CCHIT was established “in a different time” of health IT, and now the ONC is moving in a different direction, Blumenthal said. “We want to make it a world-class process” that follows international practices.
Cruising the press room at a trade show usually provides a snapshot of the newest, greatest stuff, refreshed daily as vendors hype attendees on product announcements. They save them up for big unveilings at industry confabs like HIMSS10 here in Atlanta. Nothing changes, year to year, except reporters now come home with a fistful of thumb drives loaded with media kits, instead of luggage stuffed fat with paper like they did just a few years back.
Leave it to hospital accreditor The Joint Commission to drop color copies of a 14-month-old report to represent itself among this shiny-glossy lineup. It’s a Sentinel Event Alert, a bulletin issued to its accredited hospitals as a heads up about safety issues The Joint Commission issues when it collects enough adverse-event reports on a particular topic to recommend member hospitals review policies and procedures for the sake of patient and employee accident prevention.
While the report, “Safety implementing health information and converging technologies,” isn’t exactly “Dock of the Bay” or even “Love Shack,” it’s an oldie but goodie. It warns hospitals about going slow when introducing new tech into the environment of care, advising to take time to test and understand a given piece of equipment’s potential for negatively affecting other equipment in use and potentially causing patient harm. Such as the hypothetical RFID chip reprogramming a ventilator and shutting it down. The content’s eerily timely, sitting there among vendor press kits pushing the latest and greatest wireless gear bound to crowd the hospital’s spectrum even more than it presently is with computers, phones, patient-care devices, pagers and everything else.
If nothing, it seems even more timely than when issued in December 2008, underscoring the responsibility each hospital has in minding its own wireless backyard and following due diligence on testing before implementation — no matter what bill of goods their vendor sold them at HIMSS or any other trade show they attend.
Hospital CIOs evaluating wireless technology might want to heed the report’s gist, and keep safety managers a part of their evaluation and purchasing process. It offers a detailed, 13-step action list for implementing the converging technologies from the network to the bedside. Highlights include examining how new gear will affect workflow, involving clinicians and staff in evaluating it, analyzing new tech’s supporting network infrastructure, and establishing training programs. Read the full report at JointCommission.org.
Here at HIMSS10, national health care IT leaders discuss their best practices from the dais. One of the many worth sharing today came from David Dawdy, CIO for Phelps County Regional Medical Center in Rolla, Mo., who drafted a corps of 28 “superusers” who help his team test and roll out new equipment and systems.
These group leaders inside the hospital not only offer feedback on what works and what doesn’t, but once they’re sold on a piece of technology, they also become technology champions to their peers.
There’s a lot more to say about Dawdy’s team, which will be covered more in-depth in the future on SearchHealthIT.com, but today, we asked him: Who all is in his superuser group, and what tips does he have for other hospital IT leaders struggling to implement a new piece of technology at their own facilities?
Surprisingly, no physicians are in this particular group (they contribute elsewhere), but instead he’s tapped nurses, respiratory therapists and other front-line providers. In fact, at least one person from every group providing ancillary services is represented among the superusers.
He and fellow speaker at the association’s awards brunch Allana Cummings CIO of Children’s Hospital & Medical Center in Omaha, Neb., told SearchHealthIT.com that these user groups are key to getting systemwide buy-in to new tech. It’s not just the participation that makes it go, but also integrating their wants and needs into the implementation process.
“They’ve got to feel that what they’re sharing with you actually is baked into the decision making,” Cummings said. “If they feel that their time is well-invested, then they are going to want to participate.”
“You have to empower these people because they have to feel they’re part of the team,” Dawdy said. “They have to be making decisions that complement your progress.”
Opening keynote speeches usually provide a big-picture outlook on whatever topic a conference is promoting. From this morning’s session at HIMSS10, one would expect the next four days will be focused on the future of wireless in health information technology.
Not to say Dan Hesse, CEO of Sprint Nextel Corp., did not give a rousing big-picture look at how wireless — specifically Sprint’s 4G network — will affect health care delivery. Indeed, he seemed to be preaching to the choir, if the sea of faces illuminated by the faint lights of BlackBerrys and iPhones as people were busy texting and emailing throughout the presentation is any indication.
And unlike television’s early Sunday morning advertorials, there were no “ShamWow” moments, although there were plenty of references to what’s happening on the “Now Network.”
Still, the speech seemed a departure from past big-picture keynoters: Last year, actor Dennis Quaid provided a personal reflective on medication safety, giving an account of how his infant twins nearly died in the hospital following a drug overdose. The year before, former U.S. Senator Bill Frist broadly discussed the intersection of politics and health IT.
That intersection is on everyone’s minds this year, as well. As the number of sessions, workshops and pre-conference meetings demonstrate, the hot topic at this year’s HIMSS annual conference is what’s going to happen when providers have to implement meaningful use criteria. Attendees might hear more about that during the Wednesday morning keynote, with David Blumenthal, the physician who heads the Office of the National Coordinator.
Not surprisingly, meaningful use is poised to drive spending on health IT in 2010, perhaps even to pre-recession levels, according to the annual leadership survey of the Healthcare Information and Management Systems Society (HIMSS).
The results of the survey, released at the HIMSS 2010 annual conference, suggest that nearly 60% of providers intend to make additional IT investments in order to meet federal criteria for meaningful use and thus qualify for federal financial incentives. Meaningful use was further identified by a plurality of respondents (42%) as the top IT priority of the next two years, with the related issues of implementing an electronic health record (EHR) and/or computerized physician order entry system checking in at 35% and 27%, respectively.
A total of 398 respondents, representing about 270 health care organizations and nearly 700 hospitals, completed the HIMSS leadership survey between Dec. 14, 2009, and Jan. 29, 2010.
Other interesting survey tidbits include the following:
- Nearly three in four survey respondents expect IT operating budgets to return to where they were two years ago.
- Nearly two in three expect to add staff.
- Nearly half have a fully operational EHR system in at least one location, and nearly a quarter have such a system in place throughout their organization.
- More than four in 10 participate in a health information exchange (HIE).
- Thirty percent of respondents said their primary security concern was maintaining compliance with HIPAA security and privacy laws, including new data breach notification regulations.
We expect meaningful use to dominate the discussions, formal and otherwise, at HIMSS10. We also hope to learn how those 60% of providers not in an HIE and those 50% of providers without an EHR system can get started before it is too late.
On site at HIMSS10, where several thousand people are waiting for the opening keynote from Dan Hesse, CEO of Sprint Nextel Corp. The sun has barely risen, but inside the conference ballroom, it’s disco lights and heart-thumping Latin music.
The U.S. Department of Health & Human Services posted a new list of data breaches affecting 500 or more people. What jumps out from the list is the variety of breach sources — including desktop computers, laptops, backup tapes, and paper documents. Facilities currently assessing their security policies and procedures might first look in these places to shore up vulnerabilities.
Some of the greatest hits from this lengthy list:
- 9,309 records lost from a Missouri facility via desktop computer theft.
- 10,000 records lost from a Michigan vendor via theft of backup tapes.
- 359,000 records lost from a Florida facility via laptop theft.
- 596 records lost from a Massachusetts facility via paper documents.
Many breaches occurred via portable electronic devices, HHS also notes. What’s your policy concerning people who bring thumb drives to work? What will your policy be in the future, considering that patients may be toting their own personal health records on thumb drives? All these questions need to be addressed in this new era of HIPAA accountability.
Every single trade show and exhibition claims that right now, its chosen industry is on the brink of some grand new era of something or other. So, it’s nothing new that for next week’s Healthcare and Information Management Systems Society (HIMSS) show, numerous vendors, speakers and HIMSS itself have latched on to the marketing theme of “transforming healthcare.”
Below the veneer of transformational hype, however, this time there appears to be a grain or two of truth.
With billions of federal dollars pouring into the nation’s hospitals, clinics and physician practices to aid them in implementing electronic health records over the next five years, next week’s HIMSS will be the place where facilities’ leaders take home ideas and strategies for implementing EHRs in their own backyards.
Amid the rampant commercialism on display at the Georgia World Congress Center next week will be some very interesting, less commercial demonstrations at the U.S. Office of the National Coordinator for Health Information Technology’s Interoperability Showcase. In one patch of floor space, ONC will have assembled more than 60 demonstration projects that could serve as pilots for thousands more in the coming years.
Some of the more interesting demos — at least on paper:
Supporting midwestern grandparents on vacation: A large urban health information exchange in Cincinnati, a community HIE in southeast Nebraska and a rural HIE in California will together demonstrate how the ONC’s CONNECT toolkit enables the sharing of health data as Nebraska grandparents travel across the country and visit family in Ohio and California.
Improving adverse event reporting: The Food and Drug Administration can collect device reports straight out of EHRs, giving regulators a much more complete picture than the current reporting system can of which patients could be affected by what problem devices.
Building family patient histories: The Surgeon General’s “My Family Health Portrait” pipes data collected from consumers via the Web into EHRs and personal health records.
These early adopters (federal agencies, states, providers and payers) will be showing how they’re sharing health data across public and private networks, and sharing their best practices for standardizing, transmitting and securing it.
Some show attendees will blow right past these without a second thought. The siren song of bigger, brighter lights, louder noise and free stuff will prove too great a distraction.
Take a second look at ONC’s demos, however, because viewing the projects on display in this particular corner of HIMSS might very well be akin to glancing into a crystal ball and seeing your future.