The Best of Intentions… Not Meeting the Needs of Clinicians

My three-year-old daughter had a recent five-night stay in a large, modern, well equipped urban hospital.  She received excellent care from the entire staff before being discharged. The unfortunate circumstance afforded me a renewed perspective on the quality of care in the US, and a close up view on the failings of IT in enabling clinicians to work in an efficient, compliant and easy manner.

Every room in the ED and pediatric ward had new devices installed with a single-sign-on solution.  Not once over the five days did I see a single nurse or physician use a device. I asked a nurse why, and she explained that it takes too much time away from patients. Ultimately, she said it's quicker to check on the patient, take readings and walk back to the nurses station, and then enter the information into the Electronic Health Record (EHR). Hopefully she does not get interrupted on the way back to the nursing station to and lose track of the details, or worse, enter incorrect information.

My daughter was not administered any medication, but it would have necessitated using the in-room device and the attached scanner. According to the nurse, it would also have resulted in nearly a minute wait for the nurse to gain access to the necessary applications (logins), with a similar delay when she moved to the nurse station or next patient room.

Even with the best of intentions, a large investment in an EHR, hardware, single-sign-on, and virtualization technologies, it still is not a solution that makes the clinicians’ role easier. To the extent that the systems and processes aren’t used as designed, I asked the nurse if she would use the patient room device if the logon time was reduced to 15 seconds.  She responded enthusiastically with, “Absolutely - this would make her life so much easier!”  She loves using an iPad at home for instant access to web sites and movies, and cannot understand how work technology can’t be just as simple. Yes, our consumer experiences with technology are raising expectations of what should be possible in the workplace.

So what to do about it? Designing a solution that meets clinicians’ workflow, compliance and security needs is simple, but not easy. The technology and know-how is available now, so let's raise the bar higher to no longer settle for best intentions.  Let’s meet clinicians where they work and how they work, and make technology invisible so the focus can be where it needs to be… on the patient!

3t Executive Healthcare Forum on Interconnectedness

On October 3^rd, 2012, we had the privilege of hosting another 3t Executive Healthcare Forum.  The topic was “Healthcare Interconnectedness: We are all alone in this together.”  The audience of 100 included distinguished leaders in the healthcare industry, including 23 Chief Executive Officers.  Our experienced panelists from across the country included:

• Dr. Larry Wolk, Chief Executive Officer of CORHIO (www.corhio.org), Colorado’s Non-Profit, state-designated health information exchange (HIE) organization.  Dr. Wolk is a practicing physician, and prior to joining CORHIO, held leadership positions at a variety of health care organizations.
• Carl Clark, M.D., Chief Executive Officer of Mental Health Center of Denver (www.mhcd.org).  Dr. Clark has served as the CEO of the Mental Health Center of Denver since 2000.  Dr. Clark is a nationally-recognized community mental health leader and has challenged the Mental Health Center of Denver to be the Center of Excellence with the best mental health services in the country.
• Wayne Guerra, M.D., MBA, Chief Medical Officer & Co-Founder of iTriage (www.itriagehealth.com).  Dr. Guerra has more than 20 years of excellence in clinical and academic emergency medicine and 15 years experience in emergency practice management, hospital-based emergency department management, third-payer contracting, hospital and physician professional service contracting, quality assurance, and risk management.
• Nancy Wollen, Senior Vice President of Operations at Kaiser Permanente Colorado (www.kp.org).  In her role, Wollen is responsible for developing and implementing regional strategies to position the delivery system for long-term success, in partnership with physician and health plan leadership.

With the combined years of knowledge and experience of the panelists, we posed the question, "How are we all connected in healthcare?”  The question sparked a lively and insightful discourse on a variety of topics including the growing adoption rates of technology among patients, impact of social media on healthcare, incenting clinicians to utilize integrated patient medical records, and how technology is enabling positive changes in clinician workflow and patient care.

Through active participation, and practical perspectives from the panel, audience members were able to gain insight on how to execute their own healthcare strategies.  Dr. Guerra noted, “Seventy-five million people are going to use a mobile application to access healthcare,” demonstrating the growth in the healthcare technology market.

Further discussion centered on how clinicians need to be more involved in the medical social conversation, with Dr. Clark stating, “Sixty-four percent of social media conversations on mental health consisted of requests for help and the vast majority of treatment recommendations were not based in medical science.”  He advocated for clinicians becoming more engaged in social channels in order to provide better patient outcomes.

This led to a dialogue on how healthcare is evolving from a “fee-for-service” based system to a “patient-centric” model.  Healthcare will need to be more wellness focused, with insurance providers migrating towards higher reimbursements for prevention care.  Additionally, patients will demand to be more involved in their own health, and clinicians will need to provide integrated medical records as a result.

I couldn’t agree more.  As a company, 3t Systems has been involved in the transformation of healthcare for over a decade.  We helped create the first integrated medical record system in Colorado, partnering with Northern Colorado Health Alliance on integrating over 13 independent physician practices spanning physical, dental, mental, and substance abuse clinics.  We have always been, and continue to be, dedicated to revolutionizing healthcare through innovative technology.

To join the discussion and be involved in future events, please request to join the 3t Executive Healthcare Forum or follow @3tSystemsIT on Twitter.

Healthcare IT - Are we missing the point completely?

I speak to clients on a weekly basis and hear a recurring theme; IT has become more complex but less useful. While this is not necessarily new news, it’s still confounding that few are talking about it let alone doing something about it. Instead, we see the same themes over and over in the barrage of industry newsletters – compliance, regulation, meaningful use, EHR, measurable outcomes, etc. Granted most of the writers and publications have their own agenda, but I thought I could shed some new light on a relevant topic.

 

The demographics of our physician population and the recent legislative changes suggest a looming shortage of physicians to meet the future needs. Quality of care is seen as the winner with continuing EHR adoption. While we implement increasingly complex systems in hospital systems and physician practices, we actually end up increasing the time spent on interacting with technology and reducing the time available with patients. Industry statistics suggest that for every 12 minutes spent with a patient, 6 minutes are needed to interact with technology. So, we will have less time for patients receiving care directly from physicians. It looks like we are addressing the challenge of collecting data for future analysis and efficiency, but ignoring patient need for high-touch, and high quality care.

 

So what to do about it? Let's try to break down those 6 minutes. Some of that time is accessing and interacting with legitimate documentation and diagnostic information to enable quality care. It's typically what happens to access systems that wastes a lot of time – i.e., securely logging in with multi factor authentication, launching the application, drilling into the application and bringing up the patient record, logging out and moving to the next patient. Try to do that 30 times or more in a given day with systems that are 'slow,' and it's easy to see how most of the 6 minutes may be wasted on waiting for the next mouse click and password prompt.

 

Can all of that be eliminated? Not one hundred percent, for sure. But imagine even if 1 minute was shaved off of the access time. That could mean one extra patient visit per day, or more quality time with patients. Sounds great, right?

So how do we do it? Let’s get back to the basics - figure out what you want your clinical workflow to be, then and only then consider the technology tools that can facilitate the efficiency you desire. In the end, it’s a balance and your job is to find the fulcrum.

The Shifting Role of IT

We are currently living through more disruptive technology changes than ever before; cloud, mobility, security, complexity, and commoditization.  The list is endless.  What does it mean for the C-Level executive who has responsibility for strategic IT decisions?  Change (and moving forward) can no longer be postponed.

Let's start with strategy.  It used to be enough for the IT leader to keep the server lights on, deliver a strategic project every two or three years, and generally just keep the business operational.  This passive approach is no longer an option.  Today's economy requires competitive differentiation and innovation in order to propel a company forward.  While those game changing strategies do not have to originate within IT, it is certainly clear that IT must be at the table when these strategies are developed.  An imperative for the IT leader must be a strong and well-articulated vision with the ability to execute.

Those of us in the IT profession have earned a reputation for providing solutions that keep the lights on and often proposing technology for the sake of technology, - “cool projects” do not necessarily propel the business forward.  It's time to give the routine tactical workload to someone else, and put your mind to solving the bigger questions that will allow your organization to innovate and grow in challenging times by leveraging your knowledge, skills and experience.

3t Systems Executive Healthcare Forum

On August 15th, 2012, we had the privilege of hosting the 3t Executive Healthcare Forum. The topic was -What does the convergence of mobile health and technology mean for the healthcare ecosystem? The audience of 70 consisted of distinguished leaders in the healthcare industry, including 19 Chief Executive Officers.

Our experienced panelists from across the country included:

- Larry Gray, Chief Executive Officer of The Assist Group in Denver, Colorado. Larry has an extensive background in health insurance, health technology and health services. Larry began his career in hospital and medical center administration, and transitioned to managing health plans.

- Dr. Arlen Meyers, Chief Executive Officer of the Society of Physician Entrepreneurs in Washington, D.C. Dr. Meyers is a professor of otolaryngology, dentistry, and engineering at the University of Colorado Denver and is also the CoFounder, President and Chief Medical Officer of www.medvoy.com, a globally integrated, doctor to doctor referral platform

- Nim Patel, Strategic Advisor at Nokero in Denver. Nim Patel has been working with early stage ventures for over 15 years as an investor, board member, mentor and senior executive. Most recently, Nim was Chief Executive Officer of Mobile Accord.

- Bob Durham, Chief Executive Officer of Market Staging Inc. in Newport Beach, a service firm that provides business intelligence services to hospitals across the United States. He consults regularly with executives from a variety of healthcare disciplines to empower mobile data development centered on targeted business development opportunities.

With the combined years of knowledge and experience of the panelists, we posed the question, "What does the convergence of Mobile Health and technology mean for the healthcare ecosystem? The question sparked a lively and insightful discourse on a variety of topics including reform of the employer-provider relationship, consumerism driving change, big data, data analytics, engaging patients via social media, challenges with medical education, and how technology is enabling positive changes in clinician workflow and patient care.

Through active participation, and practical perspectives from the panel, audience members were able to gain insight on how to execute their own healthcare strategies. Speaker Nim Patel reminded the audience that, only 25% of apps that are downloaded are used, leading to the insight that text messaging may be a better form of patient communication. Further discussion centered on how adopting technologies that engage the patient on a social level could lead to better outcomes.

While the discussion covered various trends regarding patient use of technology, the conversation kept coming back to one question, which was - What is the business model that will make Mobile Health successful?

This led to a discussion on how the system could evolve from an employer-provider relationship with group health plans to a patient-provider relationship that centers on individual health plans, similar to how we purchase other types of insurance. Then the patient can be incentivized via social media and technology to take a more active interest in their own health.

Dr. Meyers stated in his concluding remarks, - The only thing that will get us out of this mess is innovation and entrepreneurship.

As a CEO, I wholeheartedly agree. As a company, 3t Systems empowers our healthcare clients to be focused and innovative in their practice, and to outsource technology solutions to produce more efficient communication and better patient care.

To join the discussion and be involved in future events, please request to join the 3t Executive Healthcare Forum.

3t Healthcare Panel Discussion

On June 6, 2012, we had the privilege of hosting 3t Systems Healthcare Panel Discussion on "Executing Healthcare Strategies in an Unpredictable Future." The audience of fifty consisted of distinguished leaders in the healthcare industry and panelists from across the country included:
William Lindsey
Mark Rangell
Howard Diamond
Arlen Myers, MD

, President and CEO at Society of Physician Entrepreneurs. A practicing physician, Dr. Myers is also a professor at the University of Colorado Denver. Last year he was named by Modern Healthcare as one of the 50 Most Influential Physician Executives of 2011., Chairman and CEO of Aventura, a Denver-based software company focused on clinician workflow solutions for hospitals. Diamond has worked to improve healthcare by allowing the access of information when and where clinicians need it to make critical care decisions. , COO of Applied Pathways. Applied Pathways offers a cloud-based visual development platform for clinical innovation, quality management and process improvement in healthcare. , III, President of Lockton Benefits Group. Among his many accomplishments during his distinguished career is regular testimony before congress on healthcare reform. With all the combined years of knowledge and experience sitting on the panel, discussion moderator Jan Rutherford started with one, simple question, "What is right in healthcare today?" The question sparked a lively and insightful discourse on a variety of topics including government reform, consumerism, digital healthcare, data analytics, competing incentives in the payer system, challenges with medical education, caregivers altruism, and how technology is enabling positive changes in clinician workflow and patient care.
 
Through active participation, and practical perspectives from the panel, audience participants were able to gain practical perspectives across the healthcare continuum for executing their own healthcare strategies. The discussion kept coming back to one thing, and it was the answer all four gave to the first question of the day, "What is right in healthcare today?" The answer "The people." What makes healthcare unique is that the caregivers and others involved in the delivery of healthcare do so with the motivation to make a positive difference in the quality of others' lives.

While the entire discussion made plain that virtually every segment of healthcare needs to be interconnected, each panelist expressed a few primary aspirations: People need to take responsibility for their own health; technology needs to enhance, not hinder, clinical workflow; and future strategy needs to reflect the values of the people by which clinical and financial goals align.

And I have to agree. As a company, 3t Systems is optimistic that the solutions we provide our healthcare clients will enable efficient workflows and better patient care. We're committed to being part of what's right with healthcare today and tomorrow!

To join the discussion and be included in future events, please request to join the 3t Executive Healthcare Forum.

For additional perspectives and to enhance your healthcare knowledge, we recommend the following reading list based on Dr. Meyers' recommendations:
Herzlinger, Regina. Who Killed Healthcare? New York: McGraw-Hill, 2007.
Meyers, Arlen. The Life Science Innovation Roadmap. Moscow: Logos Press, 2008.
Topol, Eric. The Creative Destruction of Medicine. New York: Basic Books, 2012.

Work is not a place; it's a mindset

Don’t you just love it when new terms are invented to describe trends that have been evolving for some time? The new term gives it a freshness and a level of originality that it otherwise would not have. Example - Workshifting.

Workshifting is a mindset that defines the growing trend of working from anywhere other than a traditional office. It's related to but is a more descriptive term than telecommuting, virtual workers, home office or any of the other terms that are regularly used to describe working from somewhere other than "the office."

There is also a wider generational aspect to this trend and this term. Generation X and particularly Generation Y demand a level of flexibility in their work lives. So while they expect to be able to come and go from the office more and not have to continuously account for their whereabouts, they are also willing to respond to emails, calls and work after hours as needed. This is driving a results oriented culture in the workplace where ‘getting the job done’ is more important than tracking how many hours you spend in the office.

What are the tangible benefits come from workshifting? Productivity is a winner, if we are able to leverage technology to allow coworkers to more quickly and efficiently respond. Travel time and office space costs can be significantly reduced. Some argue that workshifting reduces stress, increases work life balance, but I believe that the jury may be out on that. Many of us feel the barriers between work and home just got blurred further. Reducing stress requires a level of discipline to not always answer those calls or emails at all hours. Know when to turn off the device, or turn it to silent. There can be a level of technology addiction at play here.

All of this puts more pressure on having technology that facilitates work shifting. Mobility of data, access via any device, anytime and anywhere becomes a key requirement rather than a nice to have. Thankfully, the technology that supports this trend has matured greatly over the past number of years and it’s no longer a complicated and expensive proposition to put in place.

So the next time you need someone to respond to something from home over the weekend just remind them that work is not a place; it’s a mindset!