Reading bits and pieces of information from the internet and different viewpoints, it is quite evident that HIT implementation in a acute care hospital is not the same as implementing EMR for a physician's office.
Interestingly there are around 400 vendors( about 70 certified ones) for EMR. The average de-installation rate is close to 20%
While it is important for an EMR vendor to have a strong customer base and financial resources to keep updating features, it is important that they have the consulting skills and be able to help their clients derive business value from their IT investment. However smaller vendors have attractive pricing policy to compensate for lack of competencies.
EPIC systems for example is a product developed by the vendor internally and not put together through an acquisition plan. This gives them an advantage in terms of application lineage. It allows them to create lite version of the product to cater to a better range of customer needs.
According to Fox Group, 8 critical functions for a physicians office are
- Physician Inbasket
- Medcial Assistance Inbasket
- Patient scheduling
- Patient Check In
- Encounter documentation including workflows. CPT and DRG coding support
- Patient Check Out
- BIlling and Collections
- Patient Portal, reports etc
Moving from paper to computer is an important transition. Meaningful use increases in functionality and sophistication over period of time. Shift in incentives includes incentives payments, possible government financing. In order to have a operationally efficient EMR system and a "meaningful" the following are good steps to follow
- Observe a due diligence
- Assess operation consequences including changes in workflow
- Have a implementation plan and a team to carry it out
- Anticipate and handle disruption during implementation and conversion
- Balance between features. Dont overpurchase or be limited
- Get it right the first time is critical.
Tuesday, February 23, 2010
Saturday, February 20, 2010
A thing or two about change - William Bridges way - Part 1
I was reading Managing Transitions by William Bridges. A great read for anyone into IT consulting.
There is a distinction between change and transition. Change is situational characterized by the movement from one state to the other. It is outcome driven. Transition is psychological, a journey that makes change possible. It is the process by which people internalize and come to terms with the new order introduced by change. Most often than not, an apparently logical and well intended change fails miserably because the tansition is mismanaged.
The first step of transition is to recognize that it is time to bring the curtain down on the old ways; at least some of them. So transition starts with an ending of sorts. It is critical for change managers and project managers to understand the while people have no inhibition to the very outcome generated by the change, they naturally tend to resist the losses and endings that come with it.
Often the change creates a series of Brownian collisions making a far reaching impact. Everyone is losing something and many of the losses are not concrete because change is perceived through the filters of the mind.
Dynamic leadership
Enables the workforce to accept the realities of change
Does not get upset with overreaction
Acknowledge the losses openly and tries to compensate for it(does not have to be monetarily)
The underlying substratum of change is communication. It important that people are not misinformed (usually misinformation spreads at the speed of light). It pays to reiterate what's coming to an end and what is new order in Simple messages. Not all things about the past is necessarily bad and so it deserves some reverance. But it is important to show how the past has ceded the way to the future to unfold like the pupa has to give itself up to become the butterfly.
There is a distinction between change and transition. Change is situational characterized by the movement from one state to the other. It is outcome driven. Transition is psychological, a journey that makes change possible. It is the process by which people internalize and come to terms with the new order introduced by change. Most often than not, an apparently logical and well intended change fails miserably because the tansition is mismanaged.
The first step of transition is to recognize that it is time to bring the curtain down on the old ways; at least some of them. So transition starts with an ending of sorts. It is critical for change managers and project managers to understand the while people have no inhibition to the very outcome generated by the change, they naturally tend to resist the losses and endings that come with it.
Often the change creates a series of Brownian collisions making a far reaching impact. Everyone is losing something and many of the losses are not concrete because change is perceived through the filters of the mind.
Dynamic leadership
Enables the workforce to accept the realities of change
Does not get upset with overreaction
Acknowledge the losses openly and tries to compensate for it(does not have to be monetarily)
The underlying substratum of change is communication. It important that people are not misinformed (usually misinformation spreads at the speed of light). It pays to reiterate what's coming to an end and what is new order in Simple messages. Not all things about the past is necessarily bad and so it deserves some reverance. But it is important to show how the past has ceded the way to the future to unfold like the pupa has to give itself up to become the butterfly.
Wednesday, February 10, 2010
Knowledge Workers
I am sure much has been talked about knowledge workers. Today i had a chance to listen to a video presentation (dated by a few good years) from a professor in Stanford. It appears that quite a bit of it is still real and valid today.I thought it might be worthwhile to put some of those here.
Organization architectures goes beyond the traditional org. structures (from the value chain of Mr. Porter) to include the IT infrastructure and the physical design of the workplace. Interesting example - Office building in Sun Microsystems at Menlow Park is superwide. The rationale is that Sun wants its people to work in teams and they want the teams to be able to walk the stairs together. A subtle effort to speed up communication.
The traditional parent-child (mentor-mentee) relationship has been replaced by peer-to-peer relationship creating flat organizations. The condition of employee retention hinges on the ability of the individual to being value to the table. Increasingly, authoritative heirarchy is being replaced by accountability style of management. Career advancement that was once seen as vertical progress is now more about moving sideways, being current and innovative. Hiring that once based on efficiency has now moved to effectivity. A cultural fit is more important than a skill fit. This becomes vital with more temporary and contract workers. With organizations experimenting new models, the role of people in hub positions has become markedly critical. These are project managers, consultants who act as synaptic nodes between a variety of stakeholders, wearing different hats. They influence without much authority and create more intangible deliverables.
A few themes for our observation.
Let us move away from uniformity and celebrate diveristy by glueing it together with culture and values. Different people work with different management styles. For some constructive confrontation works and for some other consensus and collaboration is the way to go.
The intensity of the knowledge worker has been mentally working round the clock resulting in a a quicker burnout. People need a escape hatch to recharge themselves.
A high employee churn is not necessarily a negative indicator. Leveraging ex- employee alumni is like creating a brand equity in the lateral workforce market.
In a hub style environment, boundary setting is an abosolute must to facilitate quick decision making and conflict resolution. The C-level needs to be well connected with the ground troops to convert resource and competencies into compettitive advantage.
Getting to know the kinetics of this thought process helps me appreciate the organization transition.
Organization architectures goes beyond the traditional org. structures (from the value chain of Mr. Porter) to include the IT infrastructure and the physical design of the workplace. Interesting example - Office building in Sun Microsystems at Menlow Park is superwide. The rationale is that Sun wants its people to work in teams and they want the teams to be able to walk the stairs together. A subtle effort to speed up communication.
The traditional parent-child (mentor-mentee) relationship has been replaced by peer-to-peer relationship creating flat organizations. The condition of employee retention hinges on the ability of the individual to being value to the table. Increasingly, authoritative heirarchy is being replaced by accountability style of management. Career advancement that was once seen as vertical progress is now more about moving sideways, being current and innovative. Hiring that once based on efficiency has now moved to effectivity. A cultural fit is more important than a skill fit. This becomes vital with more temporary and contract workers. With organizations experimenting new models, the role of people in hub positions has become markedly critical. These are project managers, consultants who act as synaptic nodes between a variety of stakeholders, wearing different hats. They influence without much authority and create more intangible deliverables.
A few themes for our observation.
Let us move away from uniformity and celebrate diveristy by glueing it together with culture and values. Different people work with different management styles. For some constructive confrontation works and for some other consensus and collaboration is the way to go.
The intensity of the knowledge worker has been mentally working round the clock resulting in a a quicker burnout. People need a escape hatch to recharge themselves.
A high employee churn is not necessarily a negative indicator. Leveraging ex- employee alumni is like creating a brand equity in the lateral workforce market.
In a hub style environment, boundary setting is an abosolute must to facilitate quick decision making and conflict resolution. The C-level needs to be well connected with the ground troops to convert resource and competencies into compettitive advantage.
Getting to know the kinetics of this thought process helps me appreciate the organization transition.
Monday, February 8, 2010
Revenue Cycle Management in Healthcare organization
Revenue cycle management is one of the most complex operations in the healthcare settings. Below is a diagram to illustrate the same. My thanks to my friend and classmate Clay Demler for giving me a flow chart.
Tuesday, February 2, 2010
Information standards in healthcare Part 2 (final)
Writing anything on information standards without the mention of HL7 will be quite meaningless.
HL7 (Health Level Seven) is a Standards Developing Organization accredited by ANSI. It has complied a collection of message formats and related clinical standards that loosely represents clinical information.
Key observation:
HL7 was initiated to speeden up data interface and exchange between computer application and systems within or connected to one healthcare enterprise; irrespective of architecture, programming language or platform. It is less far reaching that HIPAA which is targetted at transforming business and patient are processes.
HL7 is similar to EDI but developed ground up. HIPAA is derived from X12 standards.
Under HIPAA the addtional information to support a patient claim or encoutner must be in HL7 format. THe likely transaction used in HIPAA are 275, 277, 278, 835.
Refer to Corepoint health for more information.
THe most commonly used message types are
ACK – General acknowledgement
ADT – Admit discharge transfer
BAR – Add/change billing account
DFT – Detailed financial transaction
MDM – Medical document management
MFN – Master files notification
ORM – Order (Pharmacy/treatment)
ORU – Observation result (Unsolicited)
QRY – Query, original mode
RAS – Pharmacy/treatment administration
RDE – Pharmacy/treatment encoded order
RGV – Pharmacy/treatment give
SIU – Scheduling information unsolicited
Some videos on HL7 worth listening to:
HL7 & Healthcare Interfacing Videos | Corepoint Health
Posted using ShareThis
HL7 (Health Level Seven) is a Standards Developing Organization accredited by ANSI. It has complied a collection of message formats and related clinical standards that loosely represents clinical information.
Key observation:
HL7 was initiated to speeden up data interface and exchange between computer application and systems within or connected to one healthcare enterprise; irrespective of architecture, programming language or platform. It is less far reaching that HIPAA which is targetted at transforming business and patient are processes.
HL7 is similar to EDI but developed ground up. HIPAA is derived from X12 standards.
Under HIPAA the addtional information to support a patient claim or encoutner must be in HL7 format. THe likely transaction used in HIPAA are 275, 277, 278, 835.
Refer to Corepoint health for more information.
THe most commonly used message types are
ACK – General acknowledgement
ADT – Admit discharge transfer
BAR – Add/change billing account
DFT – Detailed financial transaction
MDM – Medical document management
MFN – Master files notification
ORM – Order (Pharmacy/treatment)
ORU – Observation result (Unsolicited)
QRY – Query, original mode
RAS – Pharmacy/treatment administration
RDE – Pharmacy/treatment encoded order
RGV – Pharmacy/treatment give
SIU – Scheduling information unsolicited
Some videos on HL7 worth listening to:
HL7 & Healthcare Interfacing Videos | Corepoint Health
Posted using ShareThis
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