My grandfathers taught me something that I’ll never forget. One of them was a successful businessman in the printing trade, however, I always found him taking the time to get to know people, their background and who they are. I can’t let go of the imprint left on me when I’d listen to him intently visit with people during lunch in the small cafe/drugstore out behind the shop. My other grandfather wasn’t financially wealthy, but he too had the gift of getting to know people. One day when I came home,  he and my grandmother were supposed to be there. She was, but he was next door making good friends with the neighbor he didn’t know. It’s like that’s what he lives for, ways to find and listen to people.

About a week ago, I went on a short walk and up ahead was a gal holding a sign on the corner asking for money. Our eyes made contact and I felt that awkward feeling come on. As I looked at her I saw a woman with a story that I had to know. Something in her life brought her to the point of standing on a corner begging for money.

As I spoke with her I was amazed at the trials in her life she had. She was an introvert, yet stood on the corner doing an extrovert activity. I learned she had 3 children she loved. She enjoys being with her family, cleaning and pet sitting. She has dreams of starting her own small business doing the simple things for people in their busy lives. She didn’t want attention, in fact, she would rather be in the background.  Although physically, she didn’t have the things of the world, she had many more things than I did. She had humility. She had the courage to do difficult things. She doesn’t quit. She didn’t need attention to be happy.

The Value

We can become less judgmental, more compassionate, and a bit more tolerable with others when we Take-A-Minute to really learn about one another and the road others have traveled to get where they are today. It’s amazing the real connections with people you make. Human-to-human. Real-to-real. Authentic-to-authentic. Just plain old love for others does wonders for the soul in a selfish world.

Finding this gift in each of us to know people, learning from them, and create new friendship is somehow there inside each of us. My life continually changes by the wonderful stories and journey’s I hear from others. There is courage, grit, and life learnings you hear that gives you that little extra you needed. I’m constantly reminded of how grateful the gift my grandfathers unknowingly passed on. Go find a story in someone…

Now go take on the day…

Take-A-Minute

DEWINGIT

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One day I called up the marketing department seeking some help putting together a communication newsletter that was branded to fit within the organization’s guidelines. In addition, I asked for a common framework that might help me deliver on key points regularly. After the call ended I shook my head in disgust as I realized that I made a huge mistake. I came to the marketing department with a solution in mind. I never explained my problem to them and solicited their expertise in helping me come up with effective solutions. I knew better than this.

About three weeks ago, I sat on a summit planning call and listened to great leaders discuss critical topics that ought to be on this year’s agenda. With so many ideas it was a churning discussion with no real progress, until, a simple question was asked, “What are the problems we need to address?”. You can imagine how the discussion changed.

This type of question is key to really focusing properly and getting to the heart of what is to be addressed. When we focus on solutions without a problem we are leaving ourselves to chance that we get something right. But at what cost? Peoples time, money, and energy?

Finding the problem among symptoms and solutions can be difficult to sort through. Symptoms lead to the problem(s) by asking good “why” questions. Solutions haven’t a place in the discussion when there is no problem.

Here’s an example:

Expressed Problem: Patients aren’t satisfied with their care

Why? Because they don’t like spending so much time in the hospital.

Why? Because they think nothing is happening and they’re wasting time laying in a bed when they could be at home.

Why? Because they just don’t think the care providers are doing much

Why? Because they don’t understand the critical nature of their illness and the critical risk they are in.

Ahhhh, the Problem: The patients aren’t getting the education about their illness and the plan of care required to stabilize them, which leads to dissatisfaction.

Asking “Why” questions can really help sort through the symptoms. Imagine in this situation had a leader ran off with a solution of staff doing more rounding with patients verse the needed patient education about their care plan. All that effort and the leader would have missed the mark. And this can repeat itself multiple times with continued misses.

Search for the problem(s) in your communications with others, sort out the symptoms and solutions by asking good “why” questions. Give this a try and see if it makes a difference for you as it has for me.

Now go take on the day!!!

Read more insightful: Take-A-Minute

How to write a problem statement?

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If I was to hold an apple in my left hand and ask you to close your eyes and describe it, you might say it’s red, has a stem, size of a baseball etc. If I were to hold in my right hand a megabyte and ask you to describe it, it might be very difficult. This is very similar to the ideas and concepts we have in our minds, but we fail to describe it in a way that it becomes real and tangible to people. You leave it up to chance that people know what you mean.

If done well…

There are people with incredible skills in asking the right kinds of questions that help draw out in others this idea and concept they have. A great question I love is “If done well…”. The 3 periods you fill in the blank. It fast forwards people to describe the end state, the outcomes and creates more questions for clarity.

I was on a conference call once and the gal was trying to describe her operational vision and how they were going to transform how they did things. Lots of concepts came spewing out like “a new deployment methodology” and “parallel tracks”. However, I still struggle to understand what of that meant to her. I definitely knew what it meant for me, as I had my own view on this. But I needed to know what she meant and how I could help her achieve this “transformation”. After her articulation, I asked her “Help me understand a bit more, your ideas on a new methodology if it is done well in 8 months what does that look like to you?” It begged for more follow-up questions that really helped her and I to see the tangibility to what ideas she had.

Benefit

There is a huge amount of value or benefit that comes from making things more tangible. First, you have a higher probability that you and others will be rowing in the same direction and achieve your outcomes with a lot less bumps along the way. Secondly, you limit your chances for missing the target or having to go back several steps. Finally, you help others become more successful at what they are trying to achieve.

Now go take on the day…

http://dewingit.net

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It’s not rocket science, it’s that simple. Yet it only seems to only occur when in sales and looking for a job. Follow-up does so much more. When you make a commitment to do something, surprise that person and follow-up on your progress without being reminded, you will be amazed at what happen after a few times.

Follow-Up tells people…

You care.

They are important to you.

Something matters to you.

That progress is valued.

You can be counted on.

You are building trust with them.

Who wouldn’t want this?

Follow-Up can be overwhelming and a good indicator that you may have too much going on. Develop a system for yourself to track those commitments you make in meetings or to others, and exceed their expectations by following-up. You will start differentiating yourself from everyone else, and become a trusted person people can count on.  My system isn’t complex, and I don’t even use technology, but it works for me. When I take notes from a call or meeting I put an asterisk by everything I need to take an action and follow-up on. That’s it.

Now go take on the day!!!

http://dewingit.net

Take-A-Minute

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Healthcare systems have done a great job building their network and creating integrated delivery systems. This hasn’t come without its challenges, we have seen over the past 8-10 years a major shift in healthcare towards seamless technology platforms. Giving up the best of breed system, complex interfacing and functionality, to enable a comprehensive single system. These systems can bring not only integration within their organization, but across their communities of providers creating a hybrid of creative healthcare systems on a single technology. We have seen some of the largest activities around mergers, acquisitions, and partnerships (MAP) or MAP-Mania going on in this country. An unspoken hoarding of technologies are occurring.

The silent giant is there’s a growing number of software technologies that are mounting up in the portfolio, costing organizations sometimes millions of dollars. Some are being used, some are hanging out there just because of legal retention requirements by law. IT costs are mounting and support of these systems are running into high risk situations.

There is a foundational piece of information that is critical to understanding why healthcare systems are hoarders of technology. It deals with knowing what the role of technology plays in an organization. Here is a simple yet powerful model to know:

Understanding the Role of Technology in Healthcare

Let’s examine this a bit. Organizations have capabilities to accomplish their purposes, those are delivered by “how” services are performed or what I call processes. Those processes are automated, streamlined, and capture data by the Applications within an organization. Underneath it all is the infrastructure that the applications run on or accessed.

Think a minute about a merger that takes place. You have two entities coming together that may generally have the same capabilities, however, their processes for delivering services are very different. When you look under the hood, the applications they use to enable their processes are not the same. This is where the culture, duplications and expense pose its largest challenges. It can be a mess. If you’ve been through this before you know what I mean.

Look no Further for Process Improvement

I spoke with an executive team once as they were looking for ways to standardize their care delivery and operations, or what I interpret as their processes in “how” they deliver services. I shared with them, if you want to know where to standardize, look no further than your own application portfolio. A tangible asset that supports processes. I’ve only come across one department in my 20+ years that has an inventory of all their processes. With the absence of this, it is easy to know where your PI departments ought to focus.

In one organization, they had 25+ pharmacy systems. You can’t tell me that one pharmacy is that much different than another operationally. I bet if you documented the processes you’d have 15 different processes. Think about what the cost of this massive duplication and complexity is creating. I could go on, and I’m sure many of my colleagues would have many of the same stories. Hence the title of this article “Health Systems are Hoarders of Technology”

Accumulation through Mergers, Acquisitions and Partnerships

I see the many Mergers, Acquisitions, and Partnership (MAP), along with moving to a single EMR/Billing system, as a great move. However, no one is talking about what is being done about the legacy systems that still sit out there. These systems don’t go away. There are still monthly invoices that keep coming in, capital expenditures to keep them from getting to their end-of-life, and IT staffing that still need to have the skills to know those systems. In many cases, the infrastructure to support it needs to be kept and starts to become a liability and risk as it ages.

Disruption

As you look at the following information, look at things from a different lens and think about what systems are being left behind and have to be maintained. Think about what applications are doing to operational processes as efforts to standardize becomes difficult. Look no further than you application portfolio to unlock some valuable information.

According to KLAS, in 2017, 216 acute care hospitals contracted for a new EMR[1]. EMR vendors are running on this consolidation and standardization craze. Disruptions is occurring in operations and processes like no other time I can remember. Technology costs are rising, not only because of these new systems but legacy systems aren’t going away. Cost on top of cost.

“…customers are investing in Healthcare applications based on new features and capabilities that are expected to replace their existing legacy systems. In many cases, competitive upgrades and replacements that could have a profound impact on future market-share changes will become more widespread.”[2]

In December 2017, Catholic Health Initiatives and Dignity Health, termed the Mega-Merger, announced its coming together at one “Mega” health system[3]. In 2015, Presence Health a recent merged healthcare system in northeast Illinois, set out to consolidate two Epic systems into one [4]. A massive undertaking.

In a recent survey of 190 healthcare executives, conducted by Health Leaders Media, shared that in 2018, those that are both exploring potential deals and completing deals underway (40%) and exploring potential deals (34%) was 74%, six percentage points higher than in this year’s survey[5]. The top drivers were:

Care delivery objectives

Improve position for care delivery efficiencies = 65%

Improve clinical integration = 55%

Financial Objectives

Improve financial stability = 63%

Improve operational cost efficiencies = 61%

With all this activity of mergers, does this mean healthcare costs are lowering because of economies of scale are occurring? My opinion, I think not, but we’ll save that answer for another day. Healthcare Systems are becoming hoarders of technology as this rapid set of changes are occurring. MAP’s, improving care delivery efficiencies, and improving financial stability are drivers in increasing application portfolios. Massive duplication, triplication, and quadruplication is happening.

We need to swing the pendulum the other way and make healthcare cost more affordable. Address our application portfolios and gain the benefits of standardization and efficiency.

[1] Bermudez, Erik, and Paul Warburton. “US Hospital EMR Market Share 2018.” Salesforce CRM – Reviews, Rating, Comments, & Trending Data, 24 May 2018, https://klasresearch.com/report/us-hospital-emr-market-share-2018/1279.

[2] Pang, Albert, et al. “Top 10 Healthcare Software Vendors and Market Forecast 2016-2021.” Apps Run The World – Apps Research & Buyer Insight, 25 Jan. 2018, https://www.appsruntheworld.com/top-10-healthcare-software-vendors-and-market-forecast/.

[3] Kacik, Alex, and Tara Bannow. “CHI-Dignity Will Have to Overcome Some Financial Challenges to Make Their Merger Work.” Modern Healthcare, 9 Dec. 2017, https://www.modernhealthcare.com/article/20171209/NEWS/171209851.

[4] “MERGERS, ACQUISITIONS, AND PARTNERSHIPS: EXAMINING FINANCIAL AND OPERATIONAL IMPACTS.” Healthcare Leaders Media, Healthcare Leaders Media, 2018, https://www.pages02.net/blrhealthcaredivision/Mergers_Acquisitions_Partnerships.

[5] “MERGERS, ACQUISITIONS, AND PARTNERSHIPS: EXAMINING FINANCIAL AND OPERATIONAL IMPACTS.” Healthcare Leaders Media, Healthcare Leaders Media, 2018, https://www.pages02.net/blrhealthcaredivision/Mergers_Acquisitions_Partnerships.

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Digital Health is a new buzz word that really means the convergence of people, processes, technology, and data (PPTD) to improve how patient care is delivered and received, and refinements in operations. It is nothing new, in fact, it has been going on for some time, it has just become more prevalent with care providers as the technology and integration brings out new ways of doing things.

Over the past 10 years, there has been a rapid increase in digital health as fully integrated electronic medical/health records have emerged. This has created an enormous amount of change and disruption on the people side of Digital Health. Changing years of paper charting and verbal or written ordering habits to the use of technology and data is causing a tremendous amount of pain and frustration to the care delivery model. I’m not saying its bad, but it isn’t without its failures.

We have to get it right: It seems so simple

Problem:

A digital transformation isn’t a technology transformation, it’s really the convergence of PPTD that is transformational, and how all four work together in new ways. The approach of instituting new technologies to replace old ways to work, to automate/improve the way care is delivered, and data captured more discretely and comprehensively, is failing at execution. According to Healthcare IT News and Insight Enterprises, we get a sense of the problems which have arisen from this convergence.

5 POINTS OF DIGITAL TRANSFORMATION FAILURE

Insight Enterprises, for its part, said having a roadmap is a key to success, and the new study pinpointed five causes for failure in that category:

1. 15 percent of organizations wanted to make a transformation, but hadn’t even begun discussing it

2. 62 percent failed to document and communicate the IT transformation plan across the organization

3. 39 percent failed to create the culture of change (through documentation and communication) required for success

4. 18 percent communicated their vision but failed to document it, leaving them with no blueprint for implementation

5. 5 percent had neither documented nor communicated their road map

Commissioned by Insight Enterprises, Inc

Bottom Line

A lack of leading, communication and fundamental change management are the major reasons healthcare is struggling or failing. We aren’t good at people changes. Why? Cultural transformation is huge. The “How we behave” to achieve outcomes is being left out.

No plan documented? We spending millions of dollars on these technologies an there is no plan, 62% don’t have one. We are doing this to ourselves.

We better learn

What has been increasingly emerging over the last several years is the notion of Population Health Management and Value-Based Care. With the type of technology now in place, it enables healthcare organizations to make vast strides forward. However, if we haven’t learned from this last craze, we need to put more attention on the people changes and leading sustainable transformation. Getting back to the basics of what makes great leaders great. There needs to be leadership, communication, planning, and human management, or this cycle we are in the midst of will repeat itself.

Jason Ewing

208.880.1636

jewing@dewingit.net

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If you are reading this you might be feeling the same way I do. Recently, my son broke both his ankles going off a motorcycle jump. While registering him to be seen by my local urgent-care, the registrar asked me to pay my copay. I was happy to do so.

I asked him “How much?” he responded, “Your insurance copay is based on a percentage of the total visit.” (Now this wasn’t the response when I too my daughter to different urgent-care a week later for kidney stones).

I said, “Okay, how much will my visit cost today?”

It went silent, then he said: “I don’t know, we’ll just send you a bill.”

This really made me think how “blind” we have gotten to not knowing the cost for health care. I wouldn’t get new tires on my car without knowing how much it will cost, yet we have no problem doing this for our health care.

I could continue my story as I pressed on the imaging costs at the specialist, but my point isn’t to complain, just know that the costs questions I raised continued to be an unknown element with my care providers.

Let me share a perspective from a doctor (since I work in health care). I was in a leadership meeting once talking about transparency of costs to the patient. A surgeon made the comment that when they do surgeries she has no idea how much these packs (a common set of tools for a particular procedure) costs. When she found out that it was over 2000.00, and she only used 1 or 2 tools from the pack, she immediately worked to change that to less expensive pack.

If our doctors knew the price of the supplies, tests, and medication upfront and could agree on standards of care practices, I believe they would be a great help in lowering costs for the patient.

The really complicated thing about the inability to provide a cost of care up front (not an estimate) is the fact that costs are generally negotiated on a fee schedule between the care provider and insurance companies, all different prices for the same thing. The cost for an x-ray depends on what insurance you have, or if you don’t have coverage. Billing has to get involved during the upfront care process to work with the insurance company to figure it out, a huge delay in care especially if it’s a life threatening one. Some fee schedules used for billing could be a flat rate or a percentage in the charge, now this really makes it crazy to manage and figure out. The consumer (Patient/family member) has no idea when they go get care.

Imagine a buy 3 get one free x-ray posted on a billboard along side the local interstate. I can’t.

Insurance companies are trying to educate and drive where people get care at a lower cost. They know how much these services and supplies costs and the least expensive place to go is. It is against the law for them to take choice away from the patient, they are trying to help people make more informed decisions.

Our health is the most important thing to us and our loved ones. We have some of our most joyous and devastating experiences in life within the walls of our a health provider. Our health system is asking people to blindly rack up costs they and their care provider don’t know about. The thing that is most disappointing is that we send people into bankruptcy over it. Providing care and sending people into financial ruin doesn’t add up and what we aren’t about in America. The Dodd Law Firm shares The top 3 reasons Americans file for bankruptcy:

Of all the different reasons Americans ultimately end up finding themselves filing for bankruptcy, the primary one is because of medical expenses.

Health care isn’t free either. There are extensive challenges health providers face like the “frequent flyer’s” that can fake a health problem to get medication, then disappear from an ER bed. Writing off millions of dollars in unpaid services. These are complicated issues and we can do better. 

It’s time to start coming together as care providers, I mean insurance, health systems, doctors, and Medicare/Medicaid to restructure this overly complicated financial piece in health care. Consumers have got to have transparency on their medical costs to better make decisions financially without sending people into financial crisis. We are doing this to ourselves and we need to collectively figure this out and set a course, otherwise, I’m afraid that we will be forced to.

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Governance Landscape

Health Care organizations are making progress on delivering improved transparent care, costs, and outcomes. Most integrated delivery systems have created tight partnerships and innovative efforts, however the progress is slow. Many are working within a new single integrated medical record and billing system. The integrated technology is forcing operation departments to work in a standard and integrated fashion across all points in the integrated delivery system like never before.  Forging new relationships and new ways of making decision together are at the center of the struggles.

Healthcare is lacking a new way of working together with the onset of technology. No longer are the days of being a back-office function, now it’s at the forefront of every aspect of the organizations capabilities. I call for a new invigoration of governance.

What is Governance?

So, what is governance? Governance is a set of formal bodies, populated with the operational owners, that have authority to make the proper decisions on processes, changes, and standardization across the system. What is governed? Technology’s role is to do two things in business, help automate or make efficient processes and collect data. Operations role is to perform the work (processes) for delivering value to the consumer. When you give technology to operations to govern it brings forward the alignment of IT to enable a new partnership and change begins to move much more rapidly. It forges clarity in how teams begin to work together in new more effective ways. IT becomes a delivery mechanism to enable new and changing capabilities for care delivery. They become consultants and advisors to help operations make more informed decisions. Operational leaders learn to communicate and lead more effectively.

Healthcare must advance beyond the integration technology has brought, and work in different ways to achieve greater outcomes. We must take a hold of this new change going on, and drive the outcomes patients want.

For more information on our services, see Governance of IT Services.

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Healthcare delivery systems are really focused on lowering its operating and acquisition costs, this will come through the study of data and standardization of processes. At the recent HFMA conference in Las Vegas Cedars-Sinai Medical Center stated that “the task of studying decisions that doctors make” will help reduce healthcare costs, not only the continuation of reforming operations.

HFMA conference: changing physician choices to lower costs

The one question I’ve heard from several senior executives is “can we trust the data”. Many organizations continue the path of acquisitions of practices, hospitals and health systems. In addition, investing into a single patient record EMR is starting to ramp down. The biggest problem facing these health systems is all the disparate or legacy systems that are no longer being used. The large amounts of data within these legacy systems are critical to not only medical records retention and release of information, but the analytics, trending and predictive efforts to improve patient care are vastly missing and very complex to aggregate and bring into a single patient record.

Responsibilities of managing data are in desperate need of being defined in organizations. There are massive amounts of it, with a lack of common definitions across systems and quality checks for accuracy. Below is a high-level framework for data governance to help illustrate the complexity to get to high levels of confidence in the data. This is a patient expectations of their healthcare providers that they have all the information to help care for them, prevent health issues, and provide the best outcomes possible for their dollar.

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Every Christmas morning we had this unspoken contest of who could wake up with the best morning hair. It gave us all a huge laugh, in fact you had some sort of family pride when you won. Everyone had some sort of tangle mess on top, but my daughter always screamed the loudest when we tried to untangle her mess. Much like our morning hair, in a Health Information Management Department, you will be pleasantly surprised to see how many tangled EMR (Electronic Medical Records) systems and patient records they are sorting through. Icons after icons, in and out of different systems. Your job as an employee of the department will require you to spend an enormous amount of time searching these legacy EMR’s to obtain all the information related to a single patient so that you can fulfill a request from a patient, physician, or attorney. The biggest challenge facing you is there’s no unique identifier that ties all these records together. One might think that there is some coordinated set of standards among healthcare providers.   There is not a well-defined way of handling this. Can you require a Medical Records clerk to determine if a “Tony Smith” in one EMR is the same as “Anthony Smith” in another? Does the birth date for Anthony of August 11, 1981, automatically match with 08/12/1981 in the other EMR? Is it the same patient or not? Did someone mistype the wrong day or is there two different people born this close together?  This puts the burden of inaccurate decision making on the clerk. Determining if the patient receives a diagnosis or misleads physicians can depend on whether these records are merged or not. Bless those Medical Records clerks because I don’t envy that position.

One Problem

There has not been a defined universal standard for identifying a patient among physicians practices or healthcare organizations throughout the country. Usually, through these massive implementations of a single EMR, it is enabling a unique identifier for patients called an EMPI (Enterprise Master Patient Index). When healthcare organizations go through these massive EMR migrations or through acquisitions of clinics/physician practices, it is leaving behind the legacy EMR that contains patients records. It is increasing the complexity of patient information that is not uniquely tied together.

These disparate EMR systems usually just sit out there in a dormant or read-only state to be dealt with at some future time. Not only is it creating complexity in access to patient information, there is a great expense burden carried by keeping these systems up and running. The unique skill set in IT staff, annual maintenance costs to software vendors, and capital costs to keep those systems from reaching their end-of-life. Healthcare organizations have retention policies and state/federal regulations which make it difficult to shut down these systems.

This valuable data in these systems can unlock critical patterns to help the chronically ill, provide a diagnosis to a suffering patient, or improve the quality of care. We are sitting on a gold mine of data that only providers of long ago could only imagine.

The founder of modern nursing and statistician, Florence Nightingale, in 1863 wrote:

“I am fain to sum up with an urgent appeal for adopting…some uniform system of publishing the statistical records of hospitals. There is a growing conviction that in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life….In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison….If wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have means of ascertaining at present.”

Florence Nightingale 1863

4 Major Steps to Take

Step 1 – Application Portfolio

Obtain your application portfolio, which is an inventory of all your systems. This will unlock an enormous amount of information you will need for your business case and legacy systems rationalization efforts. This portfolio should capture not only the name of the application, but you will need things like the contract end date, annual fees, type of data (financial, clinical, etc), current software version, end-of-life version, locations its accessed, servers, database, etc. You will become reliant on a single source of truth and will need to put controls in place to make sure changes are managed accurately.

Step 2 – Design and Plan

This is probably the largest effort and requires good documentation and discussion among key stakeholders. It requires detailed oriented skills that can organize information and documents very well. Some things to consider in this effort:

Scope – You need to know exactly what systems are in scope of rationalizing and the type of data in those systems to accurately put a technical design and plan together. There are 5 buckets I group applications into and its based on the type of data in those applications:

Bucket 1: Clinical, Scheduling systems

Bucket 2: Documents (Scanned Images) Systems

Bucket 3: Financial (Billing) Systems

Bucket 4: Imaging (PACS/CV PACS)

Bucket 5: ERP (HR, Finance, Supply Chain)

Creating several views of your portfolio will assist in your planning and cost efforts. You will know when you will begin to see savings, improve HIM operations, and gain access to a full medical record. You will begin to contain your data to analyze and make improvements to care and operations.

Contract Inventory – Working with legal to gathering up all your contracts is necessary to ensure everything is being handled correctly. It will provide insights into your requirements for termination and breach. Legal input for interpretation of agreements will be necessary, especially when vendors know they are losing your business and their performance drops leaving you in a bind. Avoiding unnecessary costs and additional annual fees because you know when agreements and termination notifications need to go out.

Archive solution design – It is important that the organizations define the requirements for a final resting place or archive of the data. There are critical solution design pieces that need to be considered as it does impact workflow, here is just a couple of example:

1. Will the legacy data need to be accessed through the current EMR or just a look-up in the archive solution?

2. Will AR be worked down prior to migration or will the archive need to be “active” one that continues to capture notes, payments etc?

Total Cost – It is important that you develop out the total cost of the work effort and establish when you will see the benefits of the savings. In a Total Cost model, I like to capture the Capital, One-Time Operating, and On-Going Operational costs. This is critical in building out a business case and your finance folks will have clear visibility into the efforts.

Governance – Are stakeholders that have a vested interest in making decisions that affect their scope of responsibilities.  Without governance over what happens to the data, organizations are leaving decision up to those that don’t have a vested interest, like IT. If ownership of data hasn’t been defined, this effort will help tease this out. Governing data should consider:

Data Consistency – Data is reliable and consistent
Data Relevance – Data is useful
Data Accuracy – Data is Free from errors
Data Definition – Specific meaning of the data element
Data Accessibility – Data is easily obtainable and legal to access

It was too difficult or near impossible to manage data stored in a paper record. Today, it can be as we improve our precision in operations and care delivery. Technology has introduced new types of work for organizations that haven’t been there before, governing data is one of them.

EMPI – A well thought out EMPI (Enterprise Master Patient Index or Identifier) will tie patient records together and bring about the necessary outcomes of an organization. As data is migrated and patient records merged decisions to the accuracy and quality of this effort will need to be determined. It will require registration and HIM departments to work more closely together to reduce duplication of records and ensure ongoing accuracy of patients identification. If this is not done well, patient documentation may be on two or more records, creating a patient safety and legal medical record problem.

After the culmination of this work, a well laid out plan and schedule can be established. Resources can be brought together in work teams and execution can occur.

Step 3 – Car Wash Approach

The actual implementation, I like to call the car wash approach. Each application will go through the repeatable process from migration to decommissioning. The phases below do have outlined roles and activities through each phase of the effort. It takes careful management and decision making throughout each phase is critical as you may be running multiple applications at a time through a given phase. A well-organized project manager is important.

Prep Review      Extract       Translate       Load      QA      Decommissioning     Harvest

Step 4 – On-Going

This process can be done much simpler on-going and should be apart of any acquisition or single EMR implementation. It is repeatable and the framework can be used quickly. It will bring new operational relationship and roles going forward around data.

Just like untangling the Christmas morning hair at my house, it can be difficult, but must be done. Healthcare data and the complex number of EMR’s, is Christmas morning. Untangling the mess will make a huge difference to providers of care and most importantly the patient. Having high levels of confidence in your data will make vast improvements to decision making and avoid errors. In LEAN Six Sigma, your statistical analysis efforts are to gain optimal or perfect practice of a process by reducing waste and errors. Untangling the data mess can be very complex yet worth the effort, however, your confidence in your data and records are now much greater that you can really begin to unleash your data strategies.

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