Christina's Considerations

CAeHC webinair on FBI's Cyber Program

Those who are interested in health information exchange (HIE) privacy and security may want to check out the next CAeHC webinar on Tuesday, November 10 at 1:00 PST.  The speaker is Special Agent James Harris, supervisor of the FBIs Sacramento Cyber Program.

I'll be driving back from an interview and hopefully (if the mountains don't get in the way) can listen.

Looking for a great new boss!

Jury duty (all six weeks of it) is over, final edits are being made on my book and the big push to get California's strategic plan(s) completed for accessing the ARRA HITECH funding is over.  I'm still working with the Public Health Department and will serve on California's Health Information Exchange Committee, but these aren't enough to fill my days.

So, I'm looking for a great new boss (or more) and scheduling interviews again!  

I'd love to find a full time hospital or other healthcare administrator job within commuting distance of Santa Barbara, but also realize this could take a few years.  As a result, I'm also looking for projects or interim assignments that will allow me to utilize my strong leadership, governance and operational expertise.  Some ideas include:

• advisor and coach for performance improvement, compliance and health information exchange projects
• providing interim leadership during recruitment and hiring periods
• initiating operational, financial or strategic turn-around
• disaster/emergency and continuity of operations planning and response
• review and recommendations for revenue cycle, supply, security, and customer (patient) flow processes and systems
• workplace and employee health assessments and planning and implementing health status improvement strategies
• objectively evaluating and monitoring organizational and workforce performance
• governing body orientation, education and performance assessments
• writing, reviewing, revising, and consolidating policies, procedures, protocols, guidelines, job descriptions and plans
• community and public heath assessments and planning and implementing health status improvement strategies
• identifying  and facilitating the removal of obstacles to change
• planning and initiating change strategies (only if leaders are committed to constructively managing and resolving the conflict that will arise)
• facilitating planning and implementation of social media strategies
• safety assessments and recommendations for improvement
• establishing metrics and outcome monitoring and reporting processes
• planning to establish "meaningful use" and access ARRA and HITECH funding

This is just a start and I'll add more as the ideas flow, or let me know if you have a specific need.  But, most importantly, if you are a great boss looking for a star worker, call today to schedule your interview!

Where Healthcare Workers Work

Hospitals and Health Networks Magazine had a great diagram and article summarizing where healthcare workers work in their September 2009 issue.    I'm sharing it here because it also demonstrates the communication needs that we hope to address with health information exchanges. 

Think of the patient who visits their family physician and is referred to a surgeon for an outpatient surgery and is referred to the hospital for further treatment based on some pathology findings.  At discharge the patient is referred back to the surgeon and family physician for follow-up care and to a home health program, or possibly a skilled nursing facility, for support during their ongoing recovery period. 

It will be really great when each of these providers can easily access the patient's records without waiting for the copy service or courier to deliver constantly changing paper records to multiple sites.

Here we go... RHIOs are Connecting!

I've known since 2004 that we would see the day when RHIOs began to find others who shared the same vision and they would pool their resources and collaborate for a sustainable future.  It seems the first to do this are three RHIOs in Indiana and Ohio -- Healthbridge, Indiana Health Information Exchange and HealthLINC.  This pioneering example of interconectivity is just one more (big) step forward as we bring all of a patient's health information to the point of care.

Congratulations to the leadership at Healthbridge, Indiana Health Information Exchange, and HealthLINC!

Trust, Sharing and Managing Health Information

I been wanting to add a couple of documents related to health information exchange (HIE) to my blog since I read the Spring Issue of the Journal of Health Information Management.They are all worth reading in their entirety.

Crying Wolf:  Consumers May be more Willing to Share Medication Information Than Policymakers Think:  While the subtitle of this article says it all, the study revealed that participants almost universally chose to share their medical information with the providers, however, they didn't always understand as a whole the possible consequences of their choices. 

The Next Step in Health Data Exchanges:  Trust and Privacy in Exchange Networks:  The idea that it is no longer efficient for a RHIO to negotiate a separate data exchange agreement with every one of its exchange partners is explored.  The paper explores the use of multi-party trust agreements and their crucial components.

• Common goal to improve clinical patient care

• Stakeholder input

• Mechanism to establish trust

• Protecting exchanged information

• Allocation of liability risk

Best of Breed Strategies:  Hospital Characteristics Associated with Organizational HIT Strategy:  Of the hospitals surveyed, 65% indicated a single-vendor; 29% indicated a best-of-suite; and 10% suggested a best-of-breed strategy. 

• The single-vendor strategy was more common in small, stand-alone, for-profit, non-teaching and/or non-JCAHO accredited facilities.
• The best-of-breed strategy was most common in system affiliated and JCAHO-accredited hospitals.
• The best-of-suite strategy was most common among very large, system affiliated, teaching and JCAHO-accredited hospitals.

California's HIT & HIE Strategic Plans

This summer has been a busy one for me.  When I wasn't writing my book or working on disaster planning, I had the privilege of participating in a couple of workgroups establishing the State of California's plan for health information technology and exchange.  In addition to the main group, I worked on workforce education and training and the governance sub groups.   Both of these have just released RFIs so please take a look.

Governance RFI  and  Workforce RFI

I'm trying to finalize the book and the disaster planning just picked up with pandemic preparedness, but the State's plan is in the final stretch.  If you are in California and want to comment on the draft HIT and HIE plans please visit http://www.hie.ca.gov/HIEPlan/tabid/72/Default.aspx.  I'd love to hear your feedback, so consider leaving a comment, or two.

I'll be sticking around and working on a new committee, so I'll always be open to your thoughts on the subject of HIE and HIT in California.

Smartphone Survey Results

I've been following a survey of smartphone users and the results are in!  Now I'm an administrator, so I'm not too surprised by the fact that Blackberrys lead the way among my peers.  I loved mine and may go back to one when I have a chance to explore my options. I'm also not too surprised by physicians using the iPhone, since I've seen them in action.

Apple's iPhone appears to be the leading contender among all and maybe the dominant smartphone in the market.  However, new technology is introduced everyday.

Now, many of our healthcare respondents thought that no smartphone would become a necessity in the medical world and I think I need to disagree with this belief.  From my research (reading the research of others) I think that smart phones are becoming a necessity in the world of physicians and the use of this tool will continue to grow.  It gives physicians some freedom to have a real life and still be available for their patients.

 

Yes, it is all about the apps and my interest is health information exchange makes me happy to see the graph of current uses.

 

Visit the rest of the results at Software Advice and let me know what you think.  Especially about e-prescribing (my crystal ball says this will grow - hopefully soon). 

 

Wisely Using the Injection of Cash for HIEs

It was a pleasure to be interviewed by the writer of For the Records HIEs Seek a Cash Injection, because it provided me an opportunity to reach a broader audience and hopefully motivate a few hospital administrators and communities to start their planning process now, it they haven't already done so.  Great leaders aren't the ones "wondering what happened"  they are the ones out front "making things happen". 

As I've stated before, lets get it right!

Paperless health care? One hospital's long journey

My local paper had a great story from Associated Press the other day about Childrens Hospital of Pittsburgh and their journey towards a paperless medical record.  They (correctly) see this transition as a process and not buying software and flipping a switch.  They have realized a drop in medication errors of 45% since 2002, but also have a lesson learned about patients trasferred in from other hospitals to their ICU.  Their lesson from the five months after the switch to paperless was that the death rate doubled during the perilous time of the hand-off because of their well organized routine. 

Those who are about to look at their own implementation should address:

• the need for patients being registered en route to avoid delays in medication orders

• increases in time to click through unfamiliar software (perhaps assign your most familiar staff to these cases)

• having wireless computers at the bedside for these new admits.

One of the mom's was intereviewed and reports how the electronic system has made a difference by her not having to haul x-rays around to doctors and a new ease in making specialist appointments.  However, she is also concerned bcause her doctor's practice (affiliated with the hospital) is only partly digital and next year will buy a new system that doesn't talk to the hospital system........!

OK, I know.  It is a process, a journey and there will be some bumps in the road.  But, in the end we will arrive!  I just know we will!

Inventory for Consumer Education and Engagement on HIT

The Consumer Education and Engagement Collaborative (CEE), which is part of the national HISPC effort has released the  HIT consumer education and engagement inventory.  This compliments the work of State of Georgia.  My hope is that consumers are learning about the future of information technology in healthcare and are being engaged by the HIE projects across the country, and world.

DHHS/ONC "Meaningful Use" Defined

The draft text of the  Federal Register notice on "meaningful use"  went public today and will be published on Thursday.   DHHS/ONC  requests comments on the recommended text by Friday, June 26 at 5pm/EST.  The text and definition of "meaningful use" is the result of the Meaningful Use Workgroup presentionto the HIT Policy Committee today.

The Meaningful Use Workgroup presentation to the HIT Policy Committee meeting agenda and materials are available on the ONC website at http://healthit.hhs.gov 

Payer Role in HIEs

Health Data Management had an interesting article in the June 2009 issue on the payer role in HIEs.  I've commented on the subject a few times (Editorial to President Obama, tax on health plans for HIE) and appreciate the steps that are reported in the article, but still want to see more widespread movement by the health plans supporting heath information exchange.   This is an opportunity for improvement that needs to become a priority!

If there are any plans out there who need someone to help develop a strategy, I'd be so pleased to work with you.  Just contact me at cthielst@cox.net.

Readers, what do you think? 

Health Improvement Technology and Efforts

Health Management Technology had a great article on  Health Improvement Technology and I want to share a few of the highlights below.  I also want to call my readers attention to developments related to regional healthcare improvement efforts around the country.  These collaborative organizations are forming as regionally-based, multi-stakeholder organizations that are working to improve the quality and value of health care delivery.   A national coalition, NRHI, of these organizations has formed and their site makes it easy to identify those in your area.   The work of these organizations (towards a value-driven coordinated care delivery system and severity-adjusted episode-based or comprehensive payment system) fits in nicely with HIE efforts and I recommend that you include them as a stakeholder.

Our challenges:

• Our current delivery system, as well as, the information systems that run them, were never designed to expertly manage chronic disease or improve population health.  (They were designed to treat acute illness, injuries and perform procedures.)
• Consumers are effectively disengaged from their own health and not in the habit of proactively improving their health habits and making value-based decisions or managing their own health risks and conditions. (Many still want the healthcare system to take care of them.)
• Neither hospitals nor physicians are rewarded for keeping patients healthy or preventing chronic disease from developing in the first place.  (They are rewarded for treating disease.)

We can't afford this any longer and change is needed, starting with collaborative team processes between payers, providers and consumers.  We need:

• to digitize, re-design and commoditize the collaborative processes driven by people and teams that erase inefficiencies, drive down operational and medical costs and improve personal and population health.

• a focus on collaborative processes and consider data and information merely as valuable inputs to those processes, but not the end goal.

• technology to follow providers and consumers wherever they go and adapt to their analog and digital worlds.

New CA Deputy Secretary for HIE

Jonah Frohlich, MPH is being appointed today as the new CA Deputy Secretary for HIE.   Jonah's experience working to improve healthcare using HIT for chronic disease management and with HIEs, as well as, his perspective from a role at CHCF make him a great choice. 

I look forward to working with Jonah in his new role!

Since first posting this, I've come across a information which should help better understand the role of the new Deputy Secretary.   Position Announcement

Clinical Decision Support Tools

CDS for Medication Management is a "meaningful use" in my book and AHRQ is releasing an online copy of the first chapter of a HIMSS book  titled "Improving Medication Use and Outcomes using Clinical Decision Support: A Step by Step Guide".  I haven't read the book, but can attest to the quality of publications from HIMSS and respect the recommendation by AHRQ. 

Additionally, AHRQ has made materials available from a recent web conference on  ePrescribing and medication management.

If your organization is currently planning for implementing health information technology and accessing the new streams of federal funding, I highly recommend evaluating tools to improve medication use due the the high cost, complexity, risk of errors/reactions and ever changing options.