Christina's Considerations

Negotiating "Must-have" Provisions in HIT Contracts

Steven Fox and his associates presented on some important provisions in HIT contracts going forward and his slides and podcast are available on their Health IT Law Blog.  It has been a little while since I addressed the topic on my blog with Resources for Small Physician Practices Selecting an EHR, so I was happy to get an invitation to the presentation.  Unfortunately, due to a tight travel schedule I couldn't make it to the webinar.  But, thanks to social media, I can access the same information when and where it is convenient for me. 

Congress on Healthcare Leadership

Sunday, one week ago, as I flew to Chicago, legislation for heatlh reform was passed.  It was timely since I was attending the Congress on Healthcare Leadership held each year by the American College of Healthcare Executives.  There was a bit of a deflated feeling at first, but a few speakers really helped me put it into perspective.  I share a little of my thoughts on this here as well as some of the other highlights from my Congress experience.

• Richard Pollack of the American Hospital Association (via videoconferencing because he was in Washington) really did a great job providing an overview of the new legislation. He also reminded us that this isn't the first time we as healthcare leaders were handed problematic legislation and had to figure out how to make it work for the patient. Once again, we are called upon as leaders and once again we will work through the barriers and with what we have to do the best we can to put the legislation into practice. It is truly unfortunate that we consume much time, energy and expense working out the problem areas, rather than using these resources to actually care for patients.  We certainly have some bumps in the road ahead of us!

• One of my sessions was on use of non-physician providers (NAs, PAs, etc) and teleconferencing to facilitate a remote presence in the patient care process. We saw a couple of demonstrations of the technology in specific telemedicine scenarios and I thought it was fabulous. It was my first really big telemedicne experience and I'm even more impressed by the potential benefits we can realize with this technology. (Too bad there wasn't any significant change in health reform that will use telehealth to expand access to care.)

• Another session focused on innovation and the globalization of healthcare. We explored how nano technology, social media, human genome, longevity, the Silver Tsunami , transparency, medical tourism and remote tele-treatment and work can/may impact the way care is provided and received. It was the session that takes your thinking out of your box and into the future frontiers.

• Of course, I sat in on the Best Practices for Applying Social Media to Health session. How could I have missed it? It was led by Marty Bonick who is also included in my book. I'm most impressed by the number of people who attended the session and the number of C-suite types - the decision makers.

• While we are on the topic of social media.... I went down to the bookstore and picked up a copy of the new catalog and guess which book is included on the cover? Yep, Social Media in Healthcare: Connect, Communicate and Collaborate. It was pretty cool!

• Throughout the week, there were tutorials for healthcare executives on using LinkedIn. I thought this was a really great idea and was impressed by how many older healthcare executives I saw learning how to use this powerful social networking tool.

• Juan Williams of Fox and NPR gave an excellent and motivating presentation. He reviewed some of the demographic trends of recent generations and their impact on the healthcare industry. I've always enjoyed hearing Juan's perspective, but seeing him in person and having a whole 30 minutes of his thoughts and ideas was the best.

• I also participated in a small group discussion with Lynn Brewer on the topic of corporate ethics and healthcare. We discussed the red flags that increase the likelihood that one will find fraud and/or abuse in an organization. Not surprising, a culture of "tell the boss what he/she wants to hear" rather than the truth seems to be one of the common threads in organizations who have been brought down in recent times. A real leader has to be aware of the good, the bad and the ugly. That is the only way they can lead a turnaround and possibly find a swan under the ugly. We also discussed the current environment related to investigations, especially by the OIG. My advice: assess the culture of your organization and don't be the another emperor with no clothes.

I also discussed my new role with the Northwest Regional Telehealth Resource Center with those I met and others who I've known for years.  Many healthcare leaders acknowledged the potential of telemedicine applications, but pointed to the low, and even lack of, reimbursement and the high cost related to the new expectations on credentialing and priviliging by CMS.  It was the same story I've heard from networks in our 8 state region who see these two barriers standing in the way of more widespread use of telemedicine.  Just as with EHRs and HIE, there are issues related to the accrual of benefits, but those organizations who are both the payor and provider (ie the VA) see the value.   I'm going to work on these issues and welcome your support.

Creating a Pallative Care Program

Creating a Palliative Program:  Insights from Healthcare Leaders is a new paper from the California HealthCare Foundation (CHCF).  I had started to explore creating one at my last hospital, so this paper is of particular interest to me.  Aside from being the right thing to do for patients with terminal conditions, it is also an opportunity for hospitals and others to better manage their resources.

Among 325 California hospitals responding to a 2008 survey, 43% have palliative care programs. The CHCF spoke with administrative and medical leaders from the various types of hospitals across the state to gain insights into how these programs are set up, what the benefits and challenges are, and how clinical staff respond to them. Brief case studies lay out the basics for each program, and a resources section provides links to publications and organizations focused on palliative care.

Among the highlights:

• Typical benefits that accrue to hospitals include cost-savings, improved patient and staff satisfaction, and enhanced reputation.
• Physicians can be more efficient because palliative care staff handle the more time-consuming interactions with patients and families.
• Care can be highly individualized to patients’ and families’ needs by combining curative and comfort measures.

There is a lot we can do to fix healthcare and this is one of those things.  I only wish legislators would let healthcare leaders who are constrained with the regulations and payor policies guide the development of real sustainable solutions.  If only I were king of the healthcare world!

The Great Land Grab of 2010: HIE

I found a new HIT blog and a post on the current HITECH happenings with a frontier twist.  Chilmark Research refers to current HIE activities as the Great Land Grab of 2010 and I have to agree that it does feels that way. 

I've been a little surprised by how fast the government is pushing the $$$ out and can only pray that it is being put to good use.

I know California has a plan(because I helped with it) and is now working on making it operational.  We also have a new State Designated Entity(Cal eConnect), so we should start to see some significant progress on this important leadership front.

Child Abuse: Obesity

Health Affairs puts out some really great work and their current issue is an example.  It focuses on the issue of childhood obesity and the editor even goes so far as to call it out as child abuse.  I have to agree that in many cases, it is a form of child abuse.  Excessive overfeeding of a child is just as bad as allowing them to become intoxicated with alcohol or drugs or develop a smoking habit.  The result is the same - a significant risk to the child's health and life and unnecessary costs to our healthcare system.

I'm going to order a copy of this issue, read it while traveling on a few planes over the next several weeks and post on some of the highlights.  As a society, we need to get control of this preventable public health issue.  We can't afford ($$) to turn our back on this issue.

Personal Prepardness Challenge 2010

The UCLA Health System, Office of Emergency Preparedness developed a great Download Get Ready Stay Ready 2010 Personal Preparedness Challenge  for their Faculty, Staff and Volunteers.  UCLA knows their staff, physicians and volunteers must be prepared at home so they can go in to work and care for the public during an emergency or disaster.

 

I hope you will also review the guide and prepare yourself and family and keep in mind that 3-days is a minimum kit.  Start with a three day kit and when you check it each year continually improve your preparedness by adding items you had not thought of before.

I'm speaking on the subject at a local women's executive group and will share this document with them.  I also want to find a one-page checklist for a handout, so if you want to recommend something please leave a link on this post.

My first month at NRTRC

I've completed my first month as the Executive Director of the Northwest Regional Telehealth Resource Center and thought I'd share some thoughts about the experience.

There is always a learning curve with a new job and this one has reminded me a little of my work with Dr. Brailer and the SBCCDE governing body. I'm an administrator first and have learned the language of health information technology, health information exchange and RHIOs pretty well. But, telehealth technologies is yet another new language. It is better this time, but I do admit that there were a few times when my head was spinning trying to keep up with the conversation.

I have a nice shiny new video conferencing system and will really have to learn to not mind being on video. I'm not one for pictures, so my seeing myself on video is even worse. I've had a couple of rocky moments, but know that I'll do much better once my comfort level with the equipment and speaking into a screen increases.

It is important for there to be a good fit between the person and the position. The job requirements must really match well with the new hire in most of the key areas. In this case, it seems that there is really a good match between my strengths and those that were desired by the board. This is really good because it means that we have a better chance of both succeeding. I can learn about video conferencing and telehealth, but now isn't the time to sharpen my leadership, strategic planning or interpersonal relations skills.

My stakeholders are located in the states of Montana, Wyoming, Utah, Idaho, Oregon, Washington, Alaska and Hawaii and the US affiliated Pacific Islands. I've been to five of the states and have been wanting to get to the others to see what they are like and to meet the people. I now get to combine my love of exploring new places with my passion for improving healthcare. It is a perfect match!

I already have a few trips to these great states scheduled and can't wait to meet the people and organizations that are applying telehealth strategies to solve access to care and patient needs.  There are changes that need to occur related to regulations and payment before widespread adoption of the technologies will occur.  Telehealth is yet another way to save costs and improve access to care, so we will continue to work toward the needed change.

I live in California and my key stakeholders don't.  They still picked me!  Now I'm really living in a flat world.