New Twitter list! Healthcare transparency on the rise, hospitals cutting jobs, fixing the chaotic pricing system of employment-based health insurance, and why healthcare's take on non-compliance is all wrong. Get daily tweets by following us @ExecInsight.
David Chase ONC holds key to dismantling provider & patient lock-in at core of institutional pricing leverage http://t.co/0989mOaNpl
ASC Communications Healthcare price transparency market to grow 55% by 2016. http://t.co/W2z9idiuTZ
Harry Greenspun, MD How mobile phones can improve healthcare -- see the Tanzanian case study: http://t.co/CqnrcM2ECZ via @BloombergView
KentBottles Mayo doc: Stop blaming patients. Healthcare industry's take on non-compliance is all wrong http://t.co/1kMyOTHMFa
Deloitte Health Care How might California healthcare companies thrive in an ever-changing and dynamic environment? http://ow.ly/lWjWF
Ben Miller "How long must chaotic healthcare pricing system of employment-based health insurance in United States persist?" economix.blogs.nytimes.com/2013/06/07/the...
Stephen Wilkins 10 Reasons ACOs Should Invest in the Patient Communication Skills of Their Provider Networks http://t.co/5l7RKvZMN7
Hospital Review Hospitals slash 5,900 jobs in May http://goo.gl/cGcPj
Farzad Mostashari HT @Jonathan_Bush "when I am honest with myself, I know that [gov't] supposed to step in when a market is broken." bit.ly/16Q9HY7
JohnHopkinsMedicine Smart investment: US gov't support for Human Genome Project yields 53k jobs and $293 billion in personal income. http://t.co/r7ItO25PFQ
Editor's note: This blog was written by Don Dally, CTO, and Terry Edwards, CEO, both of PerfectServe.
HIPAA provisions emphasize the risk management process, rather than the technologies used to manage risk – so for hospitals and health systems, the pathway to safeguarding electronic communication of PHI lies in the creation of an overall risk management strategy. Ideally, leaders of the covered entity (CE) will form an information security committee to develop and execute the strategy, which includes representatives from IT, operations, the medical staff and nursing, as well as legal counsel.
Leaders should also consider including an external security firm in the group. Once the committee is formed, the organization should take four essential steps for protecting the security of ePHI.
Step 1: Conduct a formal risk analysis – Whether conducted internally or outsourced to an external consultant, this step is critical, and must include inquiry about the types of technology used for electronic communication, as well as the transmission routes for all ePHI.
To ensure HIPAA compliance, ePHI transmitted across all channels must be "minimally necessary" – which means it includes only the PHI needed for that clinical communication. This layer of complexity, which is common in clinical communication processes, underscores the need for a comprehensive security assessment and strategy appropriate for the organization, coupled with the resources necessary to implement that strategy. The assessment should also evaluate the strength of the administrative, physical and technical safeguards currently in place.
Step 2: Develop an appropriate risk management strategy – Once the analysis is complete, the committee should develop a risk management strategy that’s specific to the needs and vulnerabilities of the organization and is designed to manage the risk of an information breach to a reasonable level. HIPAA does not specifically define "reasonable" – but in general, the risk management strategy should include policies and procedures that ensure the security of message data during transmission, routing and storage. The strategy should also include specific administrative, physical and technical safeguards for ePHI.
Decisions about safeguards will require the committee to consider the limits the organization will impose on electronic communication of PHI. The committee should develop detailed written policies regarding permitted staff behavior when communicating ePHI, including required actions in the case of a suspected breach (e.g., contacting oversight agencies, patients, and media; consequences for employment status). It’s also critical for the group to determine processes for creating an audit trail of messages that includes the sender, receiver, date and time to provide the information necessary for accounting and reporting in case of a breach.
Step 3: Implement policies and procedures and train staff – Implementing new policies and procedures is the biggest challenge for organizational leaders – especially as a substantial proportion of reported security breaches are due in part to insufficient training of staff. As a result, appropriate individuals should be assigned specific implementation tasks for which they are held accountable, while leaders and committee members must carefully monitor the success of implementation. All staff with access to PHI must be educated about the specific policies and procedures, and training should be included during new hire orientation and on a regular basis (e.g., annually) for other employees.
Step 4: Monitor risk on an ongoing basis – To ensure continued compliance with security standards, organizations must conduct ongoing monitoring of their information security risk. Leaders should receive regular trend reports from the information security committee based on their ongoing assessment of ePHI security at the organization. Leaders should ensure the ongoing assessment of security needs as technology and health care delivery change – for example, in response to the greater care coordination required with accountable care.
HIPAA provisions do not include detailed regulations around specific electronic communications like text messaging – making a "HIPAA-compliant texting application" a misnomer. Instead, HIPAA requires that CEs complete a risk assessment and implement policies and procedures to manage the risk of an information breach to a reasonable level. In today’s increasingly complex healthcare environment, analyzing and implementing a broader policy around security across all forms of electronic communications – rather than focusing on any one mode of communication in isolation – and following the steps above will be critical to any health system’s ability to avoid and mitigate the adverse consequences of a breach.
Editor's note: This blog was written by Amanda Guerrero, who originally contributed this piece to Software Advice. Amanda is a writer and blogger specializing in EHR, patient portal technology and Meaningful Use. From her years working as a file clerk at a doctor's office to her time as an implementation manager at an EHR company, Amanda has witnessed the evolution of the healthcare industry's charting system firsthand.
Let's face it: electronic health record (EHR) implementation is a challenge. But it doesn't have to be something your practice dreads. With effective training, your staff can avoid the setbacks many practices encounter. Here are five best practices for training your staff to ensure a smooth EHR implementation.
1. Identify Computer Proficiency Levels and Provide Training.
Determine whether any of your employees need basic computer training in order to be comfortable operating in an electronic environment. You can do this by using assessment online resources - some are free, others are paid, and others even let you create your own test.
If you identify employees in need of training, you'll need to get them up to speed. You could pay for classes at a community college or pay an instructor to visit your office. Alternatively, if budget is an issue, you could take advantage of a free online resource.
2. Select "Super Users" to Help Train Staff.
Identify one or two tech-savvy individuals in your practice who will learn the EHR backwards and forwards to serve as go-to people for EHR questions. These individuals should be highly computer literate, excited about learning new concepts, and willing to help teach others.
Look for someone who's been with your practice at least a year, and who isn't already over-burdened at work - this person will likely be answering a lot of questions for the first few months. Consider offering an incentive (such as extra vacation time or a small bonus) to encourage skilled employees to step forward for this added responsibility.
3. Tailor Training to Each Employee's Role.
Don't make the mistake of thinking every employee needs to learn every function of the EHR. For example, billing employees will need to learn how to submit electronic claims, but not how to view test results or enter a diagnosis.
Avoid confusion among your employees - and save their time - by training them only on areas they'll need to use regularly. This will help get your staff up to speed more quickly.
4. Regularly Gather Feedback After Implementation.
The process isn't over as soon as your EHR is live. Once you begin using the system, you'll likely encounter some snags - some function that isn't clear to you, or a workflow process that isn't efficient. Identifying these issues quickly is important to avoid mistakes.
Conduct regular feedback sessions, and include individuals from across your practice so that every type of user is represented (nurses, physicians, billing, administrative, etc.). When issues are raised, prioritize them by determining how they impact patient care. For example, knowing how to properly enter vitals will be a more immediate priority than redesigning an inefficient workflow process.
Don't try to fix everything at once. Attack issues one at a time, starting with the most urgent.
5. Make Use of Your Vendor's Online Resources.
EHR vendors usually provide learning and training materials online. Take advantage of those resources if questions arise that your "super users" can't answer. You'll also likely find discussion forums, which are often tied to vendors' websites, where you can engage with other EHR users about how they're using the software.
EHR implementation takes time, but employing the best practices provided here will help your practice get operational more quickly while avoiding common headaches. That way you can focus on what matters most: providing quality care to your patients.
New Twitter List! Me-working or team-working, new Internet trends, improving medical communication, decline in number of families having difficulty paying medical bills...and more! Get daily tweets by following us @ExecInsight.
Steve Woodruff Great discussion here: Me-working or Team-working - Where Are You? http://t.co/CfZ8YOKmll
Connecting Nurses Great Challenges: Improving medical communication-sound bites for Twitter http://ow.ly/kpok7
EIN Healthcare News The Price and The Pricelessness of Healthcare http://t.co/zFBeuGSOCW
Vala Afshar All business leaders should carefully read this report: 2013 INTERNET TRENDS http://t.co/6iMUfRRqmL
Gregg Masters RT @dmgorenstein: Chief Med. Officer Sam Nussbaum @WellPoint says 1% if their 36 million customers/patients drive 30% of cost.
HealthLeaders Media Kidney care advocates fight Medicare cuts http://t.co/mdskr86UXw
Medical Device Daily Asia in the Spotlight: Singapore's high GDP translates to excellent healthcare outcomes http://t.co/dOdKJVnEug
SusanMende AF4Q work to engage consumers in health care improvements featured in this month's issue of Health Affairs http://t.co/meg2S3N3BE
Patric Kane Williams Global healthcare IT market estimated to reach $56.7B by 2017
HFNewsTweet Proportion of families having difficulty paying medical bills declines http://t.co/zvcjdU7Kmz
New Twitter list! Tips to ease the ICD-10 switch, implementation guidelines for interoperability and security, meeting Meaningful Use stage 2, healthcare marketing and (surprise) gridlock in Washington. Get daily tweets by following us @ExecInsight.
Brad Justus 13 Tips to Ease the ICD-10 Switch http://bradjust.us/13YpL68
KentBottles Partisan Gridlock Thwarts Effort to Alter Health Law http://nyti.ms/13Umncy
John Sharp One person can make a difference - interview with healthcare marketing professional Dana Lewis http://bizzuka.com/company-blog/one-person-can-make-a-difference---interview-with-healthcare-marketing-professional-dana-lewis
Linda Stotsky Report: radiologists increasingly use tablets, mobile applications. http://bit.ly/16pM6NE
Sue Schade @HarvardBiz: Idea Entrepreneur: The New 21st Century Career. Inspiring piece. http://s.hbr.org/11vZ49p
iHT2 [PDF] Direct: Implementation Guidelines to Assure Security and Interoperability http://dlvr.it/3RY5TZ
Deloitte Health Care Nearly 60% of surveyed physicians don't use mobile tech for clinical purposes http://ow.ly/lsFFK via @MedEconomics
Carter Groome Recommended reading: job searching with social media for dummies http://dlvr.it/3RYGCK
KentBottles Some doctors seeking business experience to deal with changing health care | TribLIVE http://triblive.com/business/headlines/4033495-74/business-doctors-care …
HITECH Answers New Tips for Meeting the Stage 2 Meaningful Use Transition of Care Measure http://is.gd/rCnkSs
Editor’s note: This blog was written by Anthony Cirillo, FACHE, a healthcare consultant and aging expert who helps CEOs connect the dots that start healthcare movements. Contact him at email@example.com and learn more at www.4wardfast.com.
Two JAMA articles last month caused me to pause.
In the first, published online by JAMA Internal Medicine, a survey of almost 22,000 admitted patients at the University of Chicago Medical Center found patient preference to participate in decision making concerning their care was associated with a longer length of stay and higher total hospitalization costs.
Hyo Jung Tak, PhD, and colleagues examined the relationship between patient preferences for participation in medical decision-making and healthcare utilization.
"Preference to participate in medical decision-making increased with educational level and with private health insurance," the authors noted. "…Patients who preferred to participate in decision-making concerning their care had a 0.26-day longer length of stay and $865 higher total hospitalization costs."
"That patient preference for participation is associated with increased resource use contrasts with some perspectives on shared decision making that emphasize reductions of inappropriate use."
Hold that thought.
The second study in the same publication examined a national survey sample of adults who had discussions with their physicians in the preceding two years about common medical tests, medications and procedures. The conclusion: the discussions often did not reflect a high level of shared decision-making.
Floyd J. Fowler, Jr., PhD, from the Informed Medical Decisions Foundation and the University of Massachusetts, Boston, conducted a 2011 survey of a cross-section of U.S. adults 40 years or older and asked them to indicate whether they reported making one of 10 medical decisions and to describe their interactions with their physicians concerning those decisions. The decisions included: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain.
"…We saw great variation in the extent to which patients reported efforts to inform them about and involve them in 10 common decisions," the authors wrote. "If shared decision-making is to be one defining characteristic of primary care as delivered in medical homes, primary care physicians and other healthcare providers will need to balance their discussions of pros and cons to a greater degree and ask patients for their input more consistently."
Wow. How do you balance those two studies?
It seems that while the industry talks a lot about being more person-centered, the second study would conclude that we clearly are not. (Don’t wave HCAHPS scores in my face.) And the first study would seem to indicate the industry might have even more incentive to not be person-centered because it costs too much.
Will the HCAHP reward/penalty be less important than readmission and length of stay costs? Will leaders do the knee-jerk reaction and cave to the finances? How much will things get worse when this influx of patients everyone is anticipating actually happens? It scares me as a potential patient and a healthcare professional.
If we cannot become more person-centered, other industries are waiting in the wings. In one of my recent Hospital Impact blogs, I lamented, "hospitals have missed the boat again. I wrote in March of 2006 about a hospital's place in the wellness movement. I wrote in July of 2007 about the retail clinic revolution….The fact is the wellness industry is now owned by the Whole Foods, the Targets …. and the Walmarts of the world."
Just a month later, The Advisory Board Company backed me up. In a video entitled "Are You Ready to Compete With Walmart?", Lisa Bielamowicz, MD, their chief medical officer, said that Walmart could become your most formidable competitor. They are entering primary care with a vengeance, aiming for a full primary care presence in rural markets in 5 years. And after all, a third of your patients shop there.
The "what if’s" she outlines are fabulous. View the video. She concludes that "health systems need to fundamentally shift their growth strategy because the basis for competition is about to radically change." She says that the industry must promise and deliver better value. (How’s that working so far in light of the JAMA studies?) As she says at the end, if you can’t offer your consumers a high-value experience, someone else will.
New tweet list! Interoperability breakthrough near, treating Oklahoma victims, patient-centered medical homes and the Triple Aim, and graduation advice you wish you'd been given. Get daily tweets by following us @ExecInsight.
FierceHealthIT CCHIT: Interoperability breakthrough near http://t.co/TemVnX9IPm
Gunter F. Wessels SM Hospitals scramble to treat tornado victims - Treating injuries from tornadoes is a well-established job in Oklahoma. http://t.co/M24TGKct4L
Billian's HealthData Hospital Pricing Data: Another Step Down the Rabbit Hole http://t.co/hml1L8t3yD (via @HISTalk)
Kip Piper Pre-Existing Condition Insurance: New CMS rule on federal high-risk pool payments. http://t.co/E9C8KlGYqx
EMR, EHR and HIT Three Tips For EHR Transitions http://t.co/qLyXjcYwSN
Precyse Can you handle ICD-10 training for part-time coders? http://t.co/lzQ4wpjyVI
Harvard Biz Review The Graduation Advice We Wish We'd Been Given http://t.co/00TLAhUGF4
Anita Samarth Never realized the CHEESI acronym - Cerner, HBOC, Eclipsys, Epic, Siemens, IDX! @Forbes interview w/ Judy Faulkner: onforb.es/17uP0Qu
Ben Miller Can the primary care patient-centered medical home help our country achieve the "Triple Aim"? http://moo.pcpcc.net/guide/evidence-quality ...
Mark Palacio Cool video about the opening of @VirtualHealth Voorhees and how they transported patients to the new site http://lnkd.in/DQVYZi
IT labor shortage, clinical documentation, high-tech nurse carts and the pros of being selfish. Get daily tweets by following us @ExecInsight.
Harvard Biz Review Be Selfish. Be Very Selfish. http://t.co/CqJcu6DO6K/t_blank/ohttp:/s.hbr.org/YQVR47
Perficient Health IT New Blog: 3 Great Examples of Telehealth - Robots Optional http://t.co/QorGGidhPf/t_blank/ohttp:/dld.bz/c6UXu
Fast Company These are the most creative people in business right now: http://t.co/18uK3xY5kM/t_blank/ohttp:/trib.al/U52iY9X
Geeta Nayyar, MD MBA Nurse Carts Becoming More Sophisticated in Capabilities and Use http://t.co/UlFgiNRFWR via @HDMmagazine
Reed Smith 7 Ways to Improve Your Social Media Engagement http://t.co/eq06OUxDyc/t_blank/ohttp:/ireed.me/165dmQV
InformationWeek Innovation Isn't Working At 4 Out Of 5 Companies http://t.co/hJiIeG9ArK
PwCHealth Craig Gooch discusses the health IT labor shortage and strategies organizations should consider http://bit.ly/ZNKxUL
Liz Szabo Totally cool: A weekly schedule of health-related Twitter chats. http://t.co/rdB1KyXoFD
Precyse What do EHR audits reveal about clinical documentation? http://ow.ly/l0RkJ
Ken Congdon What does "The Golden Girls" have to do with health IT? I explain in my latest column - http://ow.ly/l16m4
Editor's note: This blog was written by Donna Rudolph, RHIT,CCS director of ICD-10 program strategy
Health Revenue Assurance Association (HRAA).
Today and in the future there is only one word that describes everything humans need to improve –
communication. It is in everything we do and there are various types: We communicate verbally,
use body language to express a thought, make sentences out of ideas and ponderings which are saved
as documentation, and perhaps the most addicting one of all – technology.
ICD-10-CM is a clinical modification of the World Health Organization’s ICD-10 codes that includes the
level of detail needed for morbidity classification and diagnostics specificity in the U.S.1 ICD-10/PCS is
more detailed and specific than codes in ICD-9-CM.
For ICD-10-CM/PCS implementation, communication is the key. It has to be embraced by everyone ICD-
10 touches. It has to become a virus, become infectious. It must be the heart and soul of the hospital or
It starts with training. I-10 is a whole new coding genre. It has to be taught explicitly and its specificity
must be conveyed to everyone who will be using it. This virus will need the best and perhaps several
forms of communication for mostly adult learners.
Once the virus has been ingested in training it must branch out to the next level, which is clinical
documentation improvement. The virus must spread to the CDI Specialists who have to be masters at
communication and focus on persuading physicians to believe and fulfill these obligations known as the
art of documenting a short or complete story.
The final stage of the virus is to morph itself into a permanent condition. Doctors will remember the
medical record is a legal document and dedicate themselves to documenting details of patient visits to
help protect them, and push healthcare research forward. Every hospital and organization will have
physicians who are champions of communication/documentation. They will be praised for spreading a virus that can finally do some good.
1. What Is ICD-10-CM/PCS? American Health Information Management Association. Available at: http://www.ahima.org/icd10/whatisicd10.aspx (last accessed 5/8/73).
Engaging nursing staff, HIE framework breakdown from Farzad Mostashari himself, getting telemedicine to market, why CMO-CFO relationships are important and more! Get daily tweets by following us @ExecInsight.
Press Ganey How engaged are your nurses? Learn how you can improve the engagement of the nurses in your organization. http://t.co/xedsNHaV46
SearchHealthIT.com Pediatric care benefiting from the advantages of telemedicine: http://t.co/r9Lh4OMBoj
Vala Afshar Chief marketing officers must build a strong relationship with the CFO http://t.co/V7QsrxpUCm
Kirby Partners Article: Healthcare CIO Jim Turnbull shares his thoughts on how IT is changing healthcare http://t.co/4eIU8mjIwj
Gunter F. Wessels SM Healthcare continues to see job gains, adding 19,000 more workers in April. http://t.co/PzMWwIdPft
CHIME @ONC_HealthIT releases HIE governance framework; @Farzad_ONC breaks it down. tinyurl.com/buuglul
Xerox Healthcare As healthcare transforms, what do you think will be the role of the patient portal? http://t.co/SsXlensrMN
Billian's HealthDATA Getting Telemedicine to Market in a Meaningful Way http://ow.ly/kPVih
TEDMED Infographic: Doctors Prescribing More Mobile Health Apps http://bit.ly/10bk17r via @mHealthW
NextGen Healthcare ACOs One Year Later http://t.co/kKEkdj7BzP
New tweet list! Patient satisfaction with healthcare (it's up!), AONE and HFMA partnership, moving medical imaging into the cloud and so much more. Get daily tweets by following us @ExecInsight.
AmericanMedicalNews Patient satisfaction with healthcare hits two-decade high http://t.co/2z3JhCLx6x
HFNewsTweet Healthcare M&A deals plummet in Q1 http://t.co/HAl8voQAea
McKesson Health IT Challenges of moving medical imaging into the cloud http://t.co/WAUqyaRhUp
MedCrunch No B for Boring at TEDMED - A Force in the Healthcare Evolution http://t.co/EgBcyDFZYj
AONE AONE partnering with HFMA for exciting new certificate program. Take a look and plan to join us! http://t.co/hj58IdGTol
KPMG Looking around the world we see mounting evidence that the healthcare status quo cannot last http://t.co/IWkghGvTPG
Harvard Biz Review Standard Operating Procedures Can Make You More Flexible http://t.co/sNJ8vc4JsR
Kyle Bradford Jones Health Care's 'Dirty Little Secret': No One May Be Coordinating Care http://t.co/3KzjuIqiSi via @khnews
ONC Momentum for HIT adoption continues to build with more than 388,000 (73%) of EPs registered. The fact sheet: http://t.co/dau9aZULnA
Ben Miller Medication adherence and your phone http://t.co/2P2ioQ1twS
At the third annual PharmEHR Summit April 17, leaders in the electronic health record (EHR) and pharmaceutical industries gathered to discuss the status of EHR adoption and potential collaboration between EHR and pharmaceutical companies.
The summit, hosted by PDR Network and held in Philadelphia's Wannamaker Building, kicked off with opening remarks by Richard Altus, president of PDR Network. Altus gave a roundup of how EHR adoption has evolved over the last three years. Among his points, he noted:
- Sixty-eight percent of physician practices have completed some type of EHR implementation, according to Black Book Research.
- Over 350,000 eligible professionals have registered for Meaningful Use (MU) attestation, according to a December 2012 CMS report.
- The EHR market is expected to grow 21% in 2013, per a survey published in the Feb. 22 Black Book Rankings.
- Development of interoperable EHR solutions has become a priority, as evidenced by the CommonWell Health Alliance - an independent, not-for-profit trade organization open to all HIT vendors and committed to the idea that a patient's data should be available to patients and providers, regardless of where care occurs.
- Remote patient monitoring and communications will become a focus, as healthcare organizations transition to ACO models.
During a discussion on EHR adoption, MU and patient engagement requirements, Douglas Gentile, MD, MBA, CMO, Allscripts, said several factors were contributing to EHR and e-Prescribing adoption rates, but one primary factor was fueling growth: "This is being driven by money, particularly Meaningful Use money."
When physicians implement EHRs, it completely changes their workflow - from documentation to looking up patient information to billing and discharge. "We literally live in the EHR," Gentile said.
One of the biggest problems for the physician becomes filtering the wealth of information offered up by the EHR. In many cases, the physician has become the bottleneck for handling and managing many tasks that used to be overseen by other staff members, Gentile explained. To be successful, EHR solutions must find a way to move these administrative processes back to the appropriate staff.
The growth of patient portals was another area Gentile touched on. The Office of the National Coordinator for Health Information Technology has made patient engagement a priority, with the belief that greater engagement will lead to decreased healthcare costs and better outcomes. Providers have developed a variety of portal environments, using EHRs to deliver information to patients and communicate with them, in an effort toward meeting MU patient education and engagement requirements.
"Patients want and expect to interact with providers online, including Baby Boomers," Gentile said.
The ROI for patient portals is now being realized, as providers are able to push time-consuming paperwork, patient registration procedures and questionnaires to the portals, Gentile said.
Pharmaceutical Partner Opportunities
With the growing need to manage chronic diseases, physicians will have to do more than prescribe drugs; they will need to make sure the patient understands his disease and is taking medications correctly, to affect behavior change. Providing patient education through the patient portal is one way to do this, said Edward Fotsch, MD, executive chairman, PDR Network.
Since pharmaceutical companies are experts in their products, the companies, through partnerships with EHR companies, could offer new communication on a given drug, beyond the usual monograph, as well as educational programs and financial packages/rewards for using their products. Interactivity could avail the companies with feedback from patients on how they are responding to their medications.
The key to such solutions: customization. "Patients want information tailored to them," Fotsch said.
A panel of EHR and pharmaceutical company representatives discussed why the EHR "flavor-of-the -month" mentality is problematic, the need to communicate across multiple platforms and obstacles with delivering granular information to the right place with today's fractionated technologies. Talk also revolved around how pharmaceutical companies can help with drug efficacy questions in the hope of treating patients more effectively and less expensively.
In a session titled "EHRs: The View from Wall Street," Sean Wieland, senior research analyst, Piper Jaffrey, made bear and bull cases for EHRs (he is bullish on EHRs) and painted a future in which a doctor is standing in line at Starbucks and pounding through his EHR. However, he said changes will need to happen to make that vision a reality, as EHR vendors are challenged by outdated technology platforms (e.g., client servers running Citrix), and said cloud technology is where things are heading. The Common Well interoperability effort/Google approach "has to happen," Wieland added.
Michael Golub, MD, FACP, CMO, Digitas Health, a former ER physician, noted in "EHRs: The Clinician's Perspective" that time is the currency of this century. EHRs can help physicians gain time through clinical decision support tools offering evidenced-based medicine recommendations. They "help doctors make fast, smart, accurate decisions at the point of care," he said. By the same token, EHRs add time-consuming tasks to the physician workflow. The take-home lesson: EHR use depends on usability, Dr. Golub said, pointing out that many physicians are moving on to the second generation of EHRs.
Bumping up patient experience scores, emergency management after the Boston Marathon bombings, reducing ER overuse, knowing how much ICD-10 training you're going to need, and more! Get daily tweets by following us @ExecInsight.
iHT2 Hospitals can bump up their patient experience scores with these simple tactics from University of Utah Health Care. http://t.co/Qi2sJcVQOo
Dan Dunlop Emergency Management @The_Hospital: The Boston Marathon Bombings and the Tweets that Followed http://in-training.org/emergency-management-the_hospital-the-boston-marathon-bombings-and-the-tweets-that-followed-1009
MGMA Read our supplement that illustrates how practice administrators can use processes to enhance patient-centered care http://t.co/r1gnBXsSsx
Geeta Nayyar, MD MBA Code-a-thon spurs ideas to close digital divide: Reducing ER overuse (video) http://t.co/U22WFB02Sb
Brad Justus ICD-101: How much ICD-10 training are you going to need? http://t.co/i3vKL3YV1D
NJHospitals RWJF says this is the most downloaded resource on its site: Preserving Medicare for Future Generations http://t.co/88c6AqHPiC via @rwjf
TEDMED TEDMED 2013 Day 3: From Scuba Diving Wheelchair to Death Over Dinner from @medgadget http://t.co/lRegAs1UvS
Paul Roemer My almost new post...Patient satisfaction should be exclusive...to everyone http://t.co/iWvuRqmgL6
ONC The funniest tweets from HIMSS13 - see 12-15 all @Farzad_ONC- related: http://t.co/UCE6M9ywqt
Virginia HIT (VHIT) 3 Greatest Challenges in Fulfilling Meaningful Use Requirements http://ow.ly/kpTCY
Editor's note: This blog was written by Anne Macmillan, Business Development Director for Healthcare, Irisys.
It is commonly known that bacteria thrive on our skin. In fact, the average human hand carries
millions of bacteria, some of which can be harmful to our health. Handwashing has been shown to
be effective in both removing viruses and bacteria and in reducing the spread of infection.1
As a result, men and women alike play a crucial role in helping to contain the spread of infection. But while washing our hands seems like a simple, effective task – do males and females equally practice proper hand hygiene in order to keep us and those around us healthy? Research studies show females may have the edge when it comes to hand cleanliness.
A 2012 survey of over 1,000 Americans revealed that while 60-percent of participants acknowledge the importance of handwashing for overall health, engaging in proper practice is an altogether different story.9 Not only did over half of those surveyed report they do not wash their hands after using public transportation, operating shared exercise equipment or handling money – but gender differences were evident at such critical handwash opportunities. Men proved generally less likely to wash their hands, with 33-percent of men reporting that they fail to wash their hands thoroughly with soap and water after using a public restroom – compared with 20-percent of women.
In the 2012 Bradley ‘Healthy Handwashing Survey,’ 74-percent of respondents reported the observation of people neglecting to wash their hands in public restrooms, especially among men. And while this situation improves somewhat in the workplace, 42-percent of Americans state seeing similar behavior.8
Differences in handwashing frequency have also been studied in the healthcare setting. Among healthcare workers observed in a specific critical care unit, handwashing rates were over 33-percent higher among females when compared to their male counterparts.7
According to Larson et al,6 workplace culture proves influential in encouraging handwashing among healthcare workers.Doctors, for example, tend to follow the leading specialist as to whether they wash their hands after patient contact.11 Generally, nurses wash their hands more frequently than doctors, and among non-healthcare workers, females are likely to undertake handwashing more often than males.11
Research examining hand hygiene practices in response to serious health threats – such as the 2009 H1N1 pandemic – showed an increase in rates of handwashing by the general public during such times, with women being more likely to wash their hands.10
A study researching handwashing tendencies after bathroom visits among school children showed 58-percent of girls washed their hands – as opposed to 48-percent of boys – with girls also using more soap and washing for longer.3
Interestingly, a further study scored females higher on handwashing technique.2
Given the statistics, how we work to improve compliance rates across generations and genders may be in how we frame messaging around the importance of hand hygiene. A study exploring the effectiveness of handwashing-related health promotion messages showed different types of messages work differently on men versus women. Males responded more strongly towards those messages containing a disgust element, whereas females were receptive to knowledge-activated messaging. Both, however, responded well to messages based on social norms.5
In an attempt to measure handwashing compliance of men using a workplace restroom – and the effectiveness of messaging used to encourage it – an audit was conducted in a U.K.-based company over a 22-week period between 2011 and 2012 using non-obtrusive, thermal sensing technology.4
All participants consented to take part in the study, which comprised of three phases:
· Phase 1: Behavior monitoring for one week to establish a baseline level of compliance
· Phase 2: 10-week period of intervention in which a series of seven different messages
designed to encourage handwashing were delivered regularly
· Phase 3: 11-week period during which the messages were removed and compliance
measured to establish the longevity of the effect of the intervention
The results showed initial baseline compliance of 54-percent, rising to an average of 90-percent
during the intervention period – which was subsequently maintained at close to 74-percent in the 11
What does all of this mean for the future of effective, bacteria-reducing handwashing practices? As we move forward in working to enhance hand hygiene compliance, understanding messaging/what to say – as well as how often to reiterate such messages – will be crucial to the development of impactful, memorable, public health handwashing campaigns to reduce the spread of disease. Until then, males should pay greater heed to stepping up to the sink more frequently, and each of us, men and women alike, must do our part to improve public health through proper hand hygiene.
1. Cogen AL, Nizet V, and Gallo RL (2008) Skin microbiota: A source of disease or defence? British Journal of Dermatology, 158, pp. 442–455.
2. Day A, Arnaud SS, Monsma M. Effectiveness of a handwashing program. Clin Nurs Res 1993; 2:24-40
3. Guinan ME, McGuckin-Guinan M, Sevareid A. Who washes hands after using the bathroom? American Journal of Infection Control 1997; 25:424-5.
4. Irisys Healthcare – Data on file.
5. Judah G, Aunger R., Schmidt, W-P, Michie S, Granger S and Curtis V. (2009) Experimental pretesting of hand-washing interventions in a natural setting, American Journal of Public Health, 99(S2), pp. 405 – 411.
6. Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav. Med 2000; 26:14-22.
7. Muto CA, Sistrom MG, Farr BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. American Journal of Infection Control 2000;28: 273-6.
8. Retrieved from: http://www.bradleycorp.com/handwashing
9. Retrieved from: http://www.foxnews.com/health/2012/10/15/employees-report-many-co-workers-not-washing-hands-inoffice-bathrooms/
10. Steelfischer GK, Blendon RJ, Bekheit MM and Lubell K. (2010) The public’s response to the 2009 H1N1 influenze pandemic, New England Journal of Medicine, 362 e65, http://www.nejm.org/doi/full/10.1056/NEJMp1005102
11. van de Mortel TF, Bourke R, McLoughlin J, Nonu M and Reis M. (2001) Gender influences handwashing rates in the critical care unit, American Journal of Infection Control, vol. 29(6) pp. 395-399.
Editor’s note: This blog was written by Anthony Cirillo, FACHE, a healthcare consultant and aging expert who helps CEOs connect the dots that start healthcare movements. Contact him at firstname.lastname@example.org and learn more at www.4wardfast.com.
By now most of you have read about the "Cheating Death" debacle at CaroMont Health in Gastonia, NC, not far from me.
In an effort to startle consumers and have them focus on health and wellness, they shocked and offended the community to the point that the CEO was let go. They seemed to have a perfect tagline before called "In Love with Life" that would complement wellness initiatives.
I think the CEO is a scapegoat here. In my opinion, the director of marketing, the ad agency and the two board members who have relatives at that agency, should have been held accountable. That is for another day.
Here is what I would like you to think about. Marketing and patient experience are tied at the hip. Your marketing sets the expectation for the experience to come. If the expectation matches the reality then that is good for you. If it doesn’t well word of mouth will take care of the rest. Just ask CaroMont.
Exercise some common sense. Put yourself in the patient’s head. If I am coming to a hospital that sets the expectation that I will be "In Love with Life" I feel hopeful that my quality of life will improve. If I come in with the expectation that this place is about "Cheating Death" well the grim reaper might be in my thoughts. That would give me an uneasy feeling about going to this hospital. And after 28 years in this business, I know that people choose hospitals on such seemingly trivial matters.
When I wrote the article The Chief Experience Officer, I never imagined it would become an impetus for starting a movement in healthcare with the Cleveland Clinic using it as partial motivation to establish an office of patient experience. But I wrote it from a marketer’s point of view. Word of mouth is your most important marketing tool. And it comes down to the experience that people have with your services (no kidding!).
Hospital CEOs need to look at how their marketing is going to change in the shifting winds of healthcare. For my money, I would have marketing report to the chief experience officer because at the end of the day, it is about surfacing and telling stories about care. It is not about the latest robot and cyber-knife you have. Trust me. Suspend some of your mass media advertising. Patients will still come.
The other thing that concerns me, especially after attending the World Health Congress, is this focus on wellness by providers. Don’t get me wrong. Wellness is good. But I question the motivation. Now with bundled payments and the emphasis on keeping people out of the hospital, providers have the financial incentive to pay attention to this. But you are late, maybe too late. Speakers at Congress included representatives from Target and Whole Foods. Guess what? They are in the wellness business and have been. Part of CaroMont’s trouble is that this campaign tried to shift the marketing conversation to wellness and backfired. Consider instead having your marketing and business development people partner with the companies leading the wellness movement.
Robert A. Berenson, MD, Institute Fellow, Urban Institute shared that as physicians and hospitals put their heads together in an ACO, they will find efficiencies. They then will be able to see how they can make money in certain scenarios. He is afraid that they will then bundle these services into marketing programs, causing volume growth, much of it unnecessary.
Marketing and therefore its impact on customer experience is in no man’s land right now, talking wellness but still acting to drive volume.
You can’t have it both ways. With the continuum of care blurring, picking care partners that complement your culture and approach to patient experience will be imperative. And telling that story will be as well.
It’s time to retool your marketing. As I told readers in Hospital Impact, it's time to blow up your marketing and start over. Have the courage? When you’re ready, give me a shout.