4th Quarter Go-Lives !!!!!!!

To My Favorite Consultants,

Welcome to the 4th quarter of 2013!

As many you should be extremely busy for the end of this year. Contacts should be signed. Calendars are booked up and negotiations are in the works.

If this may not be true with many of you don't worry for the 1st quarter of 2014 Will be very productive. 2014 it is a very important year for Meaningful Use of 2015.

I wish you all the best on your endeavors.

Stay current with the Meaningful Use changes.



-Your Favorite Consultant
   Shannon K. Donaldson

Are you in need of Health Care It consulting needs ?'

Follow the link to be connected to a Knowledgeable Health care IT Consultant.




http://www.maven.co/join/55oMqqxU





-SKD.

Rolling.... Rolling.... Rolling into September..... How to get noticed for this quarter of the year.

Fall is right around the corner !

Recruiters are starting to get those projects landed fresh on their desk early in the morning.

Oh, you haven't been receiving any calls or emails.... WELL, maybe it is time to update yourself.

Here are a few tips to get noticed for this Fall:

     1. First thing is first, Update your RESUME.
    
          a. Place your current or your latest position. If you start a project within the next two weeks add it onto your resume. Add it as your upcoming project that you are onboard for. Stay Current.

    2. Get Noticed.
    
         a. Upload your Updated Resume onto job boards. And on job boards specific to your area of expertise. Such as, www.HealthcareIt.com, www.Dice.com, www.emrconsultant.com, etc. Along with www.monster.com, www.careerbuilder.com, www.indeed.com, www.simplyhired.comm, etc.
    
        b. Advertise yourself on www.Linkedin.com. Share a status of your current job status, what career path you have chosen, your availability, and/or some of your skills.
          For example, "Available for any Epic Go-Live Projects"...
      
       c. Contact different recruiters. Send out an email to all of your recruiters and any new recruiters.

   3. NETWORK ! NETWORK ! NETWORK ! - Professional Networking. Join www.Linkedin.com .

  4. Have Faith and be kind.

How to Ace that Interview !

Interview at 12pm Sharp !!!!!!!

All that you can think about at this point is OMG !!!!!!!!!!!

Stay Calm.

1. Gather Pertinent information that you may need. i.e. notes about the position that you may want to speak on. Have a list of your skills relevant to the position that you are interviewing for. Along with any background information that you may want to share.

2. Practice a speech that you may want to say to summarize your talents. You are trying to sell yourself to the interviewer. Turn resume into a story.

3. You know your employment timeline fluently. Be able to say I have worked in Health Care for 10 years. I have been an EMR Consultant for 5 years. If there are any gaps be able to share some volunteer work that you may have done within that time. You may have gave back to the community or mentored someone during that time.

4. Gather some background information on the person/company such as values and goals so that you may know what angle to work your interviewer.

5. Relax. You know your stuff OWN it. Make them want to sell themselves to you!

6. Have faith in God.!

Job Outlook Bright for HIT Consultants

August 5, 2013 by HealthTECH Resources Staff

Let’s say the last decade hasn’t been the decade hasn’t exactly had the most stable financial market in American history, and sadly many people found themselves at the wrong end of the unemployment line. Currently there are 11.8 million unemployed persons in the US along with 4.3 million who have remained jobless for 27 weeks or more. While there has been some progress in the aggregate labor market, jobs in Healthcare have continued to surge. Most recently the Department of Labor and Statistics showed that 20,000 jobs were added in June 2013 alone.

As a main catalyst for healthcare technology boom, government mandates like the Health Information Technology for Economic and Clinical Health (HITECH) Affordable Care Act have contributed greatly to the advancement and implementation of healthcare technologies. Through the consolidation and standardization of data within EHR and Meaningful Use phase implementation, HIT Consultants have reason to celebrate.

Research by KLAS enterprises reports that in order to meet expectations and achieve meaningful use mandates, 70% of healthcare providers are actively looking to hire HIT consultants. In the same study entitled “Shifting Demand for Consultants: Who’s Hot, Who’s Not and Why,” KLAS General Manager Mike Smith notes “[HIT] work seems to be in high demand, and a lot of providers are looking to get third parties to come in and help.”

Similarly, in a study by the University of California, San Diego, HIT is listed as one of the top choice careers for college graduates.

San Diego Workforce Partnership President and CEO adds to the discussion of HIT job growth:
“Several factors – a growing industry with vast employment needs, a societal concern with federal backing for broad reform, and a solution incorporating advanced knowledge and skills among workers – combine to form a strong base for workforce development and employment opportunity for the coming decade.”

It’s safe to say that if you’re in the HIT Consulting and Health Informatics field, there are no shortage of opportunities. If you need a little more assurance, take a look at these statistics:
Healthcare Informatics was named one of the top careers in U.S. News & World Report
Health informatics is the #1 emerging industry job opportunity on CareerBuilder.com
Electronic medical records tops ECRI’s Top 7 Health Plan IT Trends to Watch

Steps on how to become a Health Care IT Consultant.

Many wonder what the rave is about being a Consultant in the Heath Care World. Well, honestly it is the money that are driving people. Health care it's self is a Financial opportunity but, when combined with IT (Information Technology) your financials increase. Plus there are those who love their job and field like myself.

Here are few steps...

1. Know Health Care ! - May sound simple, but a few don't understand it. Market yourself by becoming an expert in your field. There are many vocational, online programs, work studies, internships, and volunteer work that are available. Check with your resources, find out what grant programs are available. See what the community colleges are offering. There are a variety of Approved and Accredited Online Health Care IT Programs available.

2. Resume - A Proficient resume in the right lingo will get you attention. It will make you stand out more than the rest. The old way of being taught how to write a resume no longer uploads. Recruiters and HR do not want to see work well with others under your highlights. Think about it who would really admit to not working well with others....

3. Market Yourself - Promote yourself. Sell yourself professionally. Join LinkedIn and connect with recruiters. Join various Health Care IT job boards and post your resume there so that people may contact you. Don't make it private, if private then less contacts you will receive.

4. Present - Stay Current. Stay updated on the latest rules and regulations. Know your area of expertise.

5. Have Faith in God.

Cambridge signs with Epic, which will be Epic’s first UK reference site

5 April 2013 Lis Evenstad

Cambridge University Hospitals NHS Foundation Trust and Papworth Hospital NHS Foundation Trust have signed with Epic for its electronic patient records system as part of their eHospital programme.

The trusts have also revealed they plan to spend £200m on their joint eHospital programme over the next ten years.
US-supplier Epic won the high-profile Cambridge and Papworth EPR procurement in April 2012. Hewlett Packard won the hardware and infrastructure part of the tender.

The contracts were due to be signed in June last year, but Dr Afzal Chaudhry, Cambridge’s clinical lead for IT, told EHI that the process had taken longer than expected.
“The whole process has taken us two years. It’s a complex thing and we’ve spent a lot of time creating a programme suitable for us,” he said.
“It’s taken a lot of time but it’s given us insurance that we are making the right decision for the hospital.”
Cambridge, which will be Epic’s first UK reference site, has come under close scrutiny by Monitor recently.

In November last year, the trust was found in significant breach of its terms of authorisation by the foundation trust regulator due to successive failures to meet several healthcare targets.

This called into question whether the trust was financially able to deliver its eHospital programme, but Chaudhry told EHI that the trust believed signing with Epic would help Cambridge achieve its targets.

“The trust takes the breach of authorisation very seriously: the trust has already achieved several of the targets set out by monitor. The trust board has done a lot of work, so that even in the environment with Monitor we have a programme we can achieve,” said Chaudhry.

“We need to have a programme that’s sustainable and affordable. The programme we have put out underpins that.”

The eHospital programme will involve expenditure of £200 million over the next 10 years.
A statement from Cambridge said eHospital involved clinical information and decision support systems, a wholly integrated EPR and the supporting technology and infrastructure.

The trust’s new chief executive Dr Keith McNeil said the investment was “the most significant decision the hospital has made in recent times”.

Cambridge plans to go-live with Epic in October 2014 and a team of 80-100 staff members - including consultants, junior doctors, nurses, pharmacists and managerial staff - will be seconded to work on the project.

“As part of the implementation plan we have lots of clinicians involved, and they will have a big part in the implementation, defining workflows and embedding that into the system,” said Chaudhry.
“It’s about changing the way our hospital works”.

When Cambridge chose Epic ahead of Allscripts and Cerner, the decision was seen by many as one of the most important NHS IT procurements in recent years. Chaudhry said that despite being the first UK Epic site, he was confident it would work.
“We have decided that Epic would be best for us. We know from previous installations that Epic has done that they have a very established implementation pathway,” he said.
However, he added: “There are elements of the system (needed by the trust) which are more NHS-specific and that needs to be addressed.”

Cambridge said the Epic software would provide staff with automatic guides, prompts and alerts where necessary. Forms would be pre-populated with patient’s information, and test results, medication history, clinical documentation and treatment summaries would be available in one place.
The trust’s eHospital programme also includes new infrastructure and hardware from HP.
“We have an infrastructure now that works, but it doesn’t let us deliver what we want. With HP we can push the boundaries of what we can achieve,” said Chaudhry.

The statement from Cambridge said staff would use tablet, handheld and other mobile devices - including their own - to access, report and communicate critical information.
In the future it also plans to give patients online access to their medical records.
Papworth Hospital, who have partnered with Cambridge in the procurement, will participate in the design process so that they can join the implementation in due course.

Epic Tops List of Meaningful Use Early Responders

Ken Terry |January 18, 2012 02:20 PM

12 EHR Vendors That Stand Out

To date, Epic's electronic health records system takes first place in the race to obtain Meaningful Use incentive dollars. But the score card will likely change radically in the months ahead as a broader cross section of providers attest, stating that they have met the Meaningful Use criteria for incentive payments. In the data released by the Centers for Medicare and Medicaid Services (CMS) and analyzed by Modern Healthcare magazine, the top-ranked EHR vendor among clinicians who received incentives was Epic Systems. Epic was used by 28% of these eligible professionals (EPs), or 6,045 providers. That was more than the next four vendors combined.

 

Mark Anderson, a health IT consultant based in Montgomery, Texas, told InformationWeek Healthcare that Epic has the largest installed base of any EHR company. In addition, he pointed out that its customers tend to be large multispecialty groups, so it's not surprising that so many of the early-attesting EPs use Epic. The next four vendors, in order of the number of attesting EPs who use their EHR products, are:-- eClinicalWorks (ECW): 9%, or 1,847 EPs-- Allscripts: 7%, or 1,449 EPs-- Athenahealth: 5%, or 1,158 EPs-- Community Computer Service: 5%, or 999 EPs While Allscripts claims a bigger customer base than ECW does, Anderson pointed out that the Allscripts Enterprise HER--used by the largest portion of the vendor's clients--required additional modules to be certified for Meaningful Use. In contrast, Allscripts' Professional and MyWay products were ready for Meaningful Use out of the box, he noted.  Athenahealth is a bigger puzzle, since its EHR is only a few years old. Anderson speculated that Athenahealth's process for helping its customers achieve Meaningful Use may have been responsible for its excellent showing.  The vendor utilizes a software-as-a-service (SaaS) model in which all practices use the same version of the software and share a single database, "which makes it easier to monitor and report everything," Anderson said. "Because of their process, it may be easier for them to get their doctors certified."Community Computer Service (CSS), which makes an EHR called Medent, is not as well-known as the other vendors. The company claims that 12,000 providers use its products, but many have only Medent's practice management system. Even if half of them also use the EHR, though, CSS' early showing in Meaningful Use is impressive. Two other facts about the ranking stand out. First, major ambulatory-care vendors such as NextGen, GE, and Greenway are absent from the top tier. And second, a large number of vendors split up the remaining 46% of the EPs.  In total, 217 vendors supplied the EHRs used by the 21,697 providers--including hospitals and EPs--who received incentive payments. Of these companies, 60% had ten or fewer installations.The database includes only EPs who registered for Meaningful Use through Medicare. Although many EPs signed up through Medicaid instead, they didn't have to show Meaningful Use to get payments in the first year. Most of the listed hospitals registered through both Medicare and Medicaid. The leading hospital vendor was Epic, which was used by 26%, or 165, of the 627 hospitals that received payments. Epic was followed, in order, by CPSI (22%), Cerner (11%), Healthland (9%), and MEDITECH (7%).  Again, Epic's win is not a surprise, because many hospitals prefer to have a single EHR that can be used in both inpatient and ambulatory care settings, and Epic has won more favor with physicians than some other EHRs from hospital IT vendors. CPSI's ranking, however, took Anderson aback because this vendor serves mostly small rural hospitals (the same is true of Healthland). Perhaps because these small hospitals have a lot of ED business, Anderson speculated, they could meet the Meaningful Use threshold for computerized physician order entry in their EDs alone.In any case, Anderson observed, the rankings are likely to change in coming months as more providers attest to Meaningful Use. If a large organization like Kaiser Permanente or the Mayo Clinic, he noted, had all of their providers attest, it would add many thousands of doctors to the Meaningful Use rolls. On the other hand, when Kaiser doctors attest, it will give another big boost to Epic.
When are emerging technologies ready for clinical use? In the new issue of InformationWeek Healthcare, find out how three promising innovations--personalized medicine, clinical analytics, and natural language processing--show the trade-offs. Download the issue now. (Free registration required.)

Epic Consultants Hot Job!

Marianne Kolbasuk McGee |March 29, 2012 12:00 PM

10 Top Medical Practice Management Software Systems

 

One of the hottest skill sets healthcare employers are looking for these days --especially those who are rolling out new health IT systems--is in Epic e-medical record products. While there are about 35 different Epic certifications available, and certifications are important in positioning and marketing talent, healthcare employers seem to value experience most highly.These are some recent findings by Foote Partners, a Vero Beach, Fla.-based independent IT benchmark research and advisory firm that regularly compiles and analyzes IT pay, skills, and certification data from thousands of U.S. employers. Next week, Foote Partners will release results of a salary survey that examines pay trends for skills and certifications related to the Epic systems.

 

"Of all the vendors in the EHR/EMR space, the one we kept hearing the most about from our many hospital and health care systems customers and prospects is Epic Systems," said David Foote, co-founder, CEO and chief research officer of Foote Partners. "Epic is by no means the largest vendor, but it seems to have a cachet in the marketplace, a strong product differentiation," he said in an interview with InformationWeek Healthcare. [ For more about Epic's strong position in the EHR/EMR market, see Epic Tops List Of Meaningful Use Early Responders. ] Despite the nearly three dozen professional certifications available for Epic applications and heavy demand for Epic talent, Foote said, "We didn't find that it was very popular for employers to be paying separate premiums for these Epic certifications."  "It’s not like the premiums we’ve been surveying and reporting over the past 18 years for 245 certifications in areas such as security, networking, systems, database, project management, etc.," Foote continued. "There's a gap between Epic talent supply and demand. We thought we’d find pay tied to certifications, but we didn't. It's still too wild West."  According to Foote, the lack of specific pay premiums associated with Epic certifications is similar to what he has seen over the years with another popular software vendor's product certifications, SAP, in the enterprise resource planning arena.  Currently, Epic credentials "are like SAP with certifications. No one pays extra for the certifications," he said. Rather, employers often say they prefer candidates with Epic certifications, but they also look closely at overall skills and experience as well as other certifications, such as project management, relevant to a potential employee's role and responsibilities.  While many healthcare organizations may not have yet figured out formal pay policies to reward talent with specific EMR certifications, the credentials do seem to be important for some hiring employers and clients, said Brock Bauer, managing director of Technisource, a provider of health IT services and staffing, including Epic consultants. "What we're seeing is that a lot of healthcare companies are afraid of hiring non-certified talent," he said. "It's really more of a fear factor than [a] risk factor."  Epic consultants can currently command between $60 and $100 an hour, and sometimes upward of $200 an hour, according to Foote. But much of the higher pay for Epic talent seems more closely related to retaining people once they're involved with implementations.  Erik Hardin, an Epic-certified consultant who works for Technisource, has seen firsthand the kind of demand that's out there for Epic expertise. "I get 10 to 15 calls a week from recruiters," he said. Hardin has eight Epic certifications, has worked on previous Epic implementations, and is currently engaged in a multi-year Epic EMR rollout at a large hospital system in California.  Hardin enjoys his work as a consultant and the rewards it brings. The 27-year old is making "five times" what he earned a few years ago installing Epic at a hospital near his home in Ohio, he said in an interview with InformationWeek Healthcare. Earning nearly $100 an hour, Hardin is also racking up thousands of frequent flyer miles from his weekly commute from Ohio to his West Coast client. That's allowed him to vacation in six countries over the last year, fly his girlfriend to California for weekend visits, and arrange a trip to Hawaii for his parents. The pay and perks compensate Hardin for his heavy travel and frequent 60- to 65-hour work weeks. Eventually, if he tires of the long commutes or if the demand for EMR implementation talent wanes, Hardin says he might consider other health IT-related work within a hospital or other healthcare organization closer to home. "Even when the implementations are done, there will always be a need for support and enhancement roles," he said. But for now, "I love what I do."
The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.)

Healthcare in China

Healthcare in China: At a critical transition phase

Ben Zhou

              

By Ben Zhou, Dell Services Public Sector Managing Director in Greater China

China unveiled a healthcare blueprint for the next decade a few years ago. By 2020, China is expected to have a basic healthcare system that can provide healthcare services to urban and rural citizens.

When China began its economic reform in the 1980s, healthcare switched to a market-oriented system. Hospitals received little government funding and were forced to generate income by marking up drug prices. As a result, personal spending on medical services doubled from 21.2 percent in 1980 to 45.2 percent in 2007.

When the new reforms began in 2009, basic healthcare was defined as a public service for all citizens. The Chinese government invested about 124 billion USD from 2009 to 2011 in these reforms. They established a health insurance system that provides coverage to all citizens, and other reforms continue. In the next five years, China will focus on a national healthcare information platform, public health management, health insurance, basic healthcare and drugs management.

Hospital HIT reforms

The Chinese government began investing in a Hospital Information System (HIS) several years ago. In 2008, data from the Ministry of Health shows that 80 percent of hospitals implemented HIS. In the next five years, they will invest more in a national Electronic Medical Record (EMR) system.
Chinese EMR systems have developed slowly over the past few years because of the absence of a single standard for all EMR system providers. As a result, hospitals are unable to share information or provide qualified health services to patients.

To support EMR systems, hospitals will invest more in data centers, IT outsourcing, and mobility. Cloud services would be an attractive solution for hospitals looking for flexible computing and managing EMR systems effectively. Mobility solutions would enable doctors to receive and update information anywhere and at any time.

Health insurance reforms
To achieve near-universal health insurance coverage by the end of 2011, China created two insurance programs for low-income citizens: the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS). In addition, many Chinese who work for private or state-owned enterprises are eligible for the Urban Employee Basic Medical Insurance (UEBMI).
According to the Chinese Ministry of Health Information Center, by 2009, 0.8 billion citizens had joined NRCMS and all urban residents joined URBMI or UEBMI. However, there is a large gap between NRCMS and URBMI. Both the URBMI and NRCMS programs are funded by the local government and individuals, but the investment level differs. Under the UEBMI program, enterprise employers contribute at least 6 percent of an employee’s annual salary to the program. In 2009, the average local government NRCMS investment per person per year was about USD 25.00, which is much lower than the investment level for UEBMI. Meanwhile, URBMI and NRCMS investments depend on the wealth of each region. East China is wealthier than West China, so this creates an imbalance in health insurance and the imbalance does not compliment the core principle of healthcare reform – public service.

China needs to invest in healthcare infrastructure and make reforms to applicable regulations and policies that will enable them to manage their finances themselves. As a step in this direction, the government has outsourced the administration of some forms of health insurance to commercial players, but much more needs to be done to fill the gap.

Primary care reforms

China’s hospitals are usually grouped into three categories. Class I & II hospitals are smaller and have fewer staff than class III hospitals. The criteria for differentiation are the number of beds, facilities and the clinical staff level. Patients prefer to visit class III hospitals to take advantage of the better facilities and services. As a result, the class III hospitals are overburdened and unable to deliver qualified services to all patients. It is for patients to have to wait for hours for a consultation with a doctor.

CHCs (Community Health Centers) were established to improve urban medical care, and small hospitals were set up for rural areas to improve healthcare standards and coverage. The Chinese government has been testing the CHC model since 2006 when they established about five to eight experimental centers in various cities, and then promoted them across the whole country. Today, most tier 1-3 cities have CHCs, which are managed by big hospitals to balance resources. In rural areas, the government continues to invest in small hospitals and clinics.

Another challenge China faces is a lack of General Practitioners (GPs) to support CHCs and small rural hospitals. Medical education in China focuses on specialized medicine rather than general medicine. Upon graduation, new doctors work in one department, and have no opportunities to train in new areas. As a result, most doctors working at CHCs are not GPs and may be unable to diagnose and treat many common diseases.

Furthermore, China is also testing diagnosis-related groups (DRGs) and clinical pathways to manage health services and improve service quality. Both of these are expected to control medical service costs.

Looking ahead…

The increasing aging population is forcing the Chinese government to increase investment in the healthcare system. China has already made progress since reforms were initiated in 2009, but it still faces many challenges. With investments from central and local governments, nongovernmental organizations, and private organizations, progress will be gradual.

China’s health system is facing a critical transition moment. Some of the government’s reforms, especially those targeted at the imbalance of health insurance and the establishment of a primary care system, should significantly increase access to care. Other reforms, such as improving GP training and relying less on drug markups to fund hospitals, will further improve the quality of healthcare in China.

Ben Zhou leads the Dell Services Public Sector in Greater China. He is a senior executive with a record of integrity and excellence in management, IT services and consulting. As a MD and IT professional, Ben served executive roles and key IT professional roles in multiple organizations.

State Department seeks ambulatory EHR for overseas health sites

December 9, 2010 | By Neil Versel

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The U.S. Department of State is seeking to install a worldwide ambulatory EHR for the 50,000 federal employees and their families assigned to embassies and consulates in 170 countries, Government Health IT reports.
In a formal request for information, the State Department asks commercial EHR vendors to describe the features and functionality of products that could fit the bill. The department wants a system that could work at sites with low bandwidth and high Internet latency, can provide access controls for sensitive data like mental health records, is compatible with Medicare/Medicaid "meaningful use" requirements and supports e-prescribing, even for medications and immunizations not approved by the FDA.
The State Department provides primary care, coordination of local medical care, medical evacuation services and medical clearance assessments for the nation's diplomatic corps and overseas support staff and their families. Overseas health units vary widely in size and scope, with the largest providing medevac services, full-time Foreign Service physicians, local clinical professionals and regional administrative support. Smaller installations may have only a local nurse and provide immunizations and first aid, according to Government Health IT.

Read more: State Department seeks ambulatory EHR for overseas health sites - FierceEMR http://www.fierceemr.com/story/state-department-seeks-ambulatory-ehr-overseas-health-sites/2010-12-09#ixzz2apkpSSvi
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West Coast Go-Live

Immediate Need - West Cost Client needs multiple consultants.

Consultants needed who are experts in the following Epic modules: Willow, OpTime, Anesthesia, Beacon, Radiant, Tapestry, and Stork. They also need leadership level resources for their Enterprise Project Management Office. There are multiple PM/Director level openings at this client site. Send resumes to Patrick at patrick.shaw@thehcigroup.com for consideration Highly lucrative compensation for qualified candidates All travel & expenses paid (no relocation required) W2 or 1099 options available Full benefits including 401K, Health, Dental, Vision, Life, Disability & more Laptops & paid time off available for W2 employees.

Send resumes to Patrick at patrick.shaw@thehcigroup.com for consideration

Highly lucrative compensation for qualified candidates
All travel & expenses paid (no relocation required)
W2 or 1099 options available
Full benefits including 401K, Health, Dental, Vision, Life, Disability & more
Laptops & paid time off available for W2 employees

 

Go-live gone wrong

Are there lessons to be had from a Maine hospital's rollout troubles?

July 31, 2013

inShare3

Though it seems that much of the healthcare industry is finally on board with making the transition from paper to digital records, the transformation comes with a high price. Much anticipated, and sometimes hyped, electronic health record system rollouts cost millions of dollars and often end up causing chaos, frustration, even firings at hospitals across the country.

Case in point: Maine Medical Center in Portland, Maine, a 600-bed hospital that is home to the celebrated Barbara Bush Children’s Hospital, and a part of the MaineHealth network.
Maine Med’s go-live last December of its estimated $160 million Epic EHR system seemed at first to go off without a hitch. But four months later, the hospital network’s CIO, Barry Blumenfeld, MD, (pictured at right) was out of a job, and, in an April 24 letter to employees, Maine Medical Center President and CEO Richard W. Petersen announced a hiring freeze, a travel freeze – and a delay in the further rollout of the EHR throughout the rest of MaineHealth.
“This is being done to concentrate and focus our information systems resources to finding solutions to our revenue capture issues,” Petersen wrote.

The letter, obtained by Healthcare IT News, cited a $13.4 million operating loss the hospital sustained over six months of its fiscal year. Petersen cited as contributing to the loss a decline in patient volumes, the increasing number of patients who can’t afford to pay for their care – and the launch of the electronic health record system.
“The launch of the shared electronic health record has had some unintended financial consequences,” Petersen wrote. “While there have been many advantages in the implementation of SeHR, in some cases, we’ve been unable to accurately charge for the services we provide. This lack of charge capture is hurting our financial picture.”

A Maine Medical Center nurse told Healthcare IT News the charge capture issue was a serious one.
“From what I’ve been told, for six weeks caesarean sections weren’t charged. Big things. Surgeries weren’t charged – big things and little things,” she said.

“Since Epic’s gone live, essentially, the Epic people failed to mention – and certainly, 100 percent failed to teach – that the nurses and the doctors were supposed to be somehow charging people for everything that we do,” she added. “I guess we didn’t know that Epic was supposed to be charging as we went along. Let’s say I document that I put in an IV in – there goes a charge right there. That’s how they get charged for that. The nurse puts in the IV, and then they put in the computer that they’ve done that. There’s supposed to be a charge for that. So I guess, early after go-live, finance people were saying, ‘Something’s wrong; we’re not charging.’ But we didn’t realize that we were the ones who were supposed to be charging, and we actually weren’t taught how to charge. Not only that, but we weren’t taught what was important to charge. We were basically taught how to navigate the right screens.”

Now the clinicians are supposed to be charging, the nurse said, but they have not been taught anything different. “We haven’t been brought back into a classroom and told this is how you’re supposed to be doing it,” she said. “We were never told that we would be responsible for putting those charges through.”

‘We have to pass at this time’
To follow up on the news story about MaineHealth’s troubles, which Healthcare IT News posted on its website May 2, we contacted the communications department at Maine Medical Center May 3 and asked to arrange an interview with then Chief Information Officer Barry Blumenfeld, MD.

The response via email: “Barry has left the organization. We have an interim CIO ... let me see if he’s available.” A series of emails followed back and forth. Maine Medical Center asked for the questions in order to find the right person for the interview. Healthcare IT News supplied them. The emails from Maine Med ended with this one, on May 30:

“Sorry, but we have to pass at this time, as our team is really focusing on follow-up work related to the rollout. Can we check-in later this summer to see if that would be better timing? Thanks, and sorry to take so long with a response.”

On May 22, we emailed Blumenfeld directly to ask for an interview. “I would love to speak with you,” he wrote. “I’ve thought (about) my experiences and believe that I have some things to say that would be of value to your audience. However, I’d like to let MaineHealth know that I will be talking with you before I do it. I’ve sent them a note giving them the heads up and asking if they have any specific concerns – and will let you know just as soon as I hear back.”

A day later, Blumenfeld said in an email he would have to pass on the interview.
Epic, meanwhile, also declined an interview request. A spokesperson told Healthcare IT News that, “Only MaineHealth can share information about their system.
Since each system is configured for their needs, many things are customized.”

Not alone to decline

Maine Medical Center was not alone in taking a pass on an interview about its rollout. At 885-bed Wake Forest Baptist Medical Center in Winston-Salem, N.C., a media contact said, “We are not facilitating media interviews at this time.”

Sheila Sanders, Wake Forest’s CIO, planned to resign at the end of May, according to a May 17 article in the Winston-Salem Journal.

“The health system has struggled with the implementation of Epic, a new electronic medical records system,” the Journal reported. “However, health system officials said Sanders’ resignation was not related to Epic and that Sanders is relocating to Florida to spend more time with family.”
Partners HealthCare in Boston, an eight-hospital system with some elite names – Massachusetts General and Brigham & Women’s, to name two – made its plans for an Epic rollout known last year. But it too declined a June 3 request for an interview with Healthcare IT News, saying: “Given that we are so very early in our effort, we are going to pass on this opportunity. At this point in this very early stage, we would be unable to effectively answer these questions. We are years away from go-live dates. Thanks for thinking of us, and do not hesitate to check in, as we get further along in our process.”

Financial stress

The Winston-Salem Journal reported that Wake Forest had launched another round of “multi-million dollar” cost-cutting measures that would last through at least June 30, the end of its 2012-13 fiscal year, related to “fixing Epic revenue issues.”

Those measures include attempts at volunteer employee furloughs and hour-and-wage reductions, a hiring freeze, a reduction in employer retirement contributions, and elimination of executive incentive bonuses for 2013.

The Journal added that Wake Forest Baptist cited $8 million in “other Epic-related implementation expense” that it listed among “business-cycle disruptions (that) have had a greater-than-anticipated impact on volumes and productivity.” Also listed was $26.6 million in lost margin “due to interim volume disruptions during initial go-live and post go-live optimization.”

Wake Forest Baptist attributes some of its operating loss in its current fiscal year to projected revenue that has been delayed related to problems rolling out Epic, particularly with billing, procedure coding and collections.

Detroit-based Henry Ford Health System, meanwhile, reported total revenues of $4.46 billion in 2012, an increase of $490 million from the $3.97 billion total revenues in 2011. Overall, however, Henry Ford reported $53.1 million net income for 2012, as compared to $62.9 million in 2011 – a decrease of 15 percent.

“The net income decrease is related to two factors,” Henry Ford’s Chief Financial Officer James Connelly noted in an April 25 news release. “The first is an increase in uncompensated care in 2012 for the health system. Second, Henry Ford is making a significant investment in state-of-the-art information technology in our clinical, business and insurance operations, which positions us well for healthcare reform.”

“It’s a large number,” Henry Ford CIO Mary Alice Annecharico acknowledged in a recent interview with Healthcare IT News, about the health system’s more than $350 million EHR initiative. Annecharico went on to say that Henry Ford chose not to float bonds or borrow for the project, but rather to use operating capital to implement the system. “That means we chose not to do other things,” she said. “That means we chose not to build and acquire new organizations that would have a very large capital investment while we’re putting this system in.”

She said it was a decision supported by leadership and endorsed by the board. “We want to be able to serve the community, and this is the grounding platform for us being able to do that,” she said.
As Edmund Billings, MD, sees it, the amount of money and complexity that goes into these types of implementations is not right for mid-sized health systems. Kaiser and Partners might be able to afford these massive EHR rollouts, but smaller health systems struggle.

Billings, who serves as CMIO of Medsphere Systems, which markets OpenVista, an open-source EHR model that has its roots in the VA’s VistA technology, admits to a certain bias toward an open approach.

“I believe that the single source, proprietary, milk-’em-dry model is going to hit a wall,” he told Healthcare IT News. “Particularly when the organizations are not going to be able to go fee-for-service to cover it, or they don’t have the endowment.”
Going live
Kaveh Safavi, MD, (pictured at left) who leads the health industry business for North America for Accenture, a global consulting and outsourcing firm, says Accenture tends to serve very complex, very large systems. Lately, Accenture has worked mostly on Epic and Cerner implementations, but its consultants have also worked on deploying Allscripts and Meditech.
“The general rule of thumb,” he says, “is whatever you spend on your technology, you’re going to spend twice as much on the task of implementation.”
“What is often described as a ‘glitch,’” he said, “could be a glitch at the level of technology implementation, but it’s often at the level of the processes themselves. So translating business rules into technology rules … it’s not really a technology problem, but the technology has to catch it.”

Most organizations change their revenue cycle system either ahead or at the same time they deploy a new EHR, he said. “Because there’s such a close tie between diagnoses and procedures and charges and bills, they’re often linked together. Now, one may precede the other, but many organizations are often making a decision, which requires a substantial change if not a complete replacement of the revenue or billing cycle process ahead of the electronic medical record at the same time, or sometimes close to it.”

As Safavi sees it, “The harder work is more in the process than in the technology configuration. There’s more technology, actually on the process side than on the technology side.”
Devore Culver, (pictured at right) executive director and CEO of HealthInfoNet, Maine’s health information exchange, agrees. He doesn’t know what the problems were at Maine Medical Center, but as former CIO at Eastern Maine Healthcare and in previous roles at Eclipsys and Cerner, he knows a thing or two about implementations.
“Large implementations frequently go weird places,” he said. “Usually a couple things are at the core, one is you don’t fully understand the implications for workflow. When you finally get it turned on, you find out that either you didn’t entertain certain aspects of workflow as part of what the software could or couldn’t do. Or perhaps, as important – and I’ve had this happen to me twice in my life – you don’t fully understand the ramifications of a front-end implementation on back-end systems.”

“When I put in my first patient clinical system in 1996, we had a little bump in accounts receivables for a few months,” he admitted. “It wasn’t outrageous, but it clearly was a factor. You just work through the mappings until you figure out what you missed. That’s the problem with these complex structures. You don’t always know what you’re getting into until you get into it.”

Safavi pointed out that large EHR deployments are much more common today. “It’s a different conversation than it was 10 years ago,” he said. “There used to be a big debate about whether you implement these things incrementally or whether you implement them across an enterprise in a much more rapid fashion – the so-called big bang.”

Meaningful use has driven some of that approach, he said, and processes have been better developed on how to roll out on a much larger scale.
“Where you often see organizations struggle is when they’re a little bit resource-constrained, and they can’t actually invest in the process improvement and the process redesign necessary up front, but they’re still committed to a big bang implementation, but they just haven’t done the prep work,” said Safavi.

Meaningful use puts some pressure on a number of aspects of implementation, he said. Organizations can’t just deploy an EHR; they have to make sure it is configured to exchange information. That introduces another technology, which adds to the complexity. There’s also the patient engagement piece of meaningful use: “Now they’re all under pressure to figure out how to get some level of patient interaction.”

Safavi said there are no “catastrophic” rollout failures today – not since the infamous $34 million Cedars Sinai breakdown of a decade ago, at least.

“It’s much more about (the fact that) this is hard work; it takes a long time; everybody gets through it,” he said. “There’re no real options to avoid it. It’s not the core technologies that are the problem. It’s how we interact with it.”
Jim Turnbull, CIO at Salt Lake City-based University of Utah Healthcare, said he had been able to avoid the pressure of meaningful use.

“My last two employers have done (or are in the midst of) Epic rollouts from revenue cycle through EMR/CPOE, he said. “We’ve been lucky to roll these out in a staged manner over a period of several years, without a lot of MU pressure on the accelerator.”
This has helped to protect the organizations financially, and not expose them to the inherent risks that come with a big bang.

The first rollout – at the Children’s Hospital in Denver – was in the early years of Epic’s entry into the inpatient market space, from roughly 2003 to 2006. The current rollout started in 2009 and will conclude with the replacement of the major inpatient applications this year.

“In hindsight, I guess we are always reminded that these are complex endeavors, and that the process and culture change is much more significant than the technical challenge,” Turnbull said. “Another thing that still seems common in the industry is that EMR projects are considered ‘IT projects.’ As we know, they are anything but!”

Back to Maine Medical Center

Accenture’s Safavi says he’s not familiar with the circumstances at Maine Medical Center. However, it’s not uncommon, he said, for the IT team to suffer fallout from an implementation that does not go off as expected.

“Lots of things can happen, but the most common is surprise,” he said. “It generally exposes an organization around either lack of planning or a cultural issue. You often see the IT organization want to go faster than the clinical organization, and the clinical organization will be unprepared or unwilling.”

Those cases create a difficult problem for leadership and boards, who face answering, “What is more important here? Is it managing the pace and cooperation of our stakeholders, or is it managing the economic cost of the transition?”

“That’s the job of boards and leaders to figure out,” said Safavi. “There’s no one answer. Every answer varies with the organization.”

It made sense to select Epic for inpatient care, MaineHealth’s Blumenfeld, told me in 2010. The Epic EHR was then already rolling out at MaineHealth’s owned and affiliated medical practices.
Rather than a best-of-breed approach that many CIOs espoused in years past, most now see more merit in a single vendor approach. Blumenfeld is among them.

“The end user interface stays consistent across all venues including ambulatory and inpatient, and the information that’s in the repository is integrated in a way that only a single database can do,” he explained.

The goal, said Blumenfeld, is to have a more integrated workflow, a more integrated presentation and more integrated data set.

“This also helps, by the way, when we start to talk about measuring the quality that we deliver and population health efforts – making sure people get their flu shot or making sure everyone gets aspirin after a myocardial infarction,” he said. “Those things are greatly aided by our ability to capture all the data in one big bucket and then analyze it to improve the care we deliver.”

“We found that Epic has a great reputation and ranks high on things like the KLAS rating and generally receives very high marks from the other systems that have adopted them in recent years,” Blumenfeld said.

A couple of years later, when he and his team were preparing for the rollout at Maine Medical Center, he said Epic was enjoying so much popularity because, unlike other EHR companies, Epic had grown, but not through acquisition, thereby avoiding the integration problems that often come with patching disparate systems together.

When Blumenfeld spoke with Healthcare IT News Associate Editor Erin McCann a couple weeks prior to the scheduled Dec. 1, 2012, rollout at Maine Med, he brought up the famous Gartner curve.
“You know where you start out and everyone’s very excited, and you go for a week or two: ‘This is great; this is really cool,’” he said. “Then you start to notice all the problems, and you fall into the valley of despair. That usually happens a month or two into the project.

“Then by three or four months, you’re coming out of the valley of despair, and people are starting to say, ‘Wow, this is OK, you know, I can live with this.’ Then by seven or eight months, it’s, ‘Wow, I don’t know why I ever didn’t live with this.’ That’s when you start getting the real benefits of an electronic health record.”

The Maine Medical Center nurse who spoke with us about charge capture issues is still waiting to see those benefits. Meanwhile, she said, she is concerned about best practices and lack of training.
Most nurses had three four-hour courses, with some specialty nurses getting an extra course. Some of the courses were led by Epic employees, but most were by nurses taken off the floor, trained on the system and then sent back to teach the other nurses.

“It didn’t follow a workflow at all,” she said. “It was really sort of patchwork.” Moreover, she said, when people had questions about the workflow, they really weren’t addressed. “I felt we were not educated well at all. When we actually went live, it was scary. People did not know what they were doing.”

The nurses did not know how to enter orders appropriately. “There were huge gaps of people not knowing how to put orders in and not knowing how to do really important things like blood administration, how to order the blood. We were never taught any of those things.”
Nurses have learned how to do some of those entries by now, she said, but there are so many ways to do the exact same things.

“One person will show you one thing; another person will show you something different,” she said. “There’re eight different ways to do the same thing. Every day, you feel like, ‘I don’t know if I did this admission right; I don’t know if I entered any of my documentation right. There’s a lot of discrepancy in how we were taught to document.”

“The change is a wrenching one,” Blumenfeld told Healthcare IT News in that interview before the rollout this past December. “It’s wrenching for the physicians, it’s wrenching for the nurses and it’s wrenching for the support staff, the financial people, the operations people. Everyone has to do things differently than they did before. So it’s a big, big change for any hospital to go to an EHR.”
Healthcare IT News Managing Editor Mike Miliard and Associate Editor Erin McCann contributed to this story. It was first published in the July 2013 print issue.

GO Live in Oakland

Partner HCIT has been selected as the exclusive vendor for a large upcoming Epic Inpatient CT Program .

We'll have an opportunity to fill approximately 35-40 Trainers on an exclusive basis.

The Epic modules will be as follows: ADT/Prelude, Cadence, ASAP, Radiant, Stork, Clin Doc, Orders, HIM, Optime, Anesthesia, Ambulatory, HB (SBO) Willow and Home Health.

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Larger CO Hospitals On Board With RHIO

Jul 29, 2013 09:57 am | By: Anne Zieger

Colorado’s hospitals have reached an interoperability turning point. With the addition of Exempla Healthcare’s three Colorado hospitals to CORHIO, the Colorado Regional Health Information Organization, all of the state’s hospitals with 100 beds or more are now connected to an HIE network, reports EMR Daily News.

Right now, 29 hospitals are connected to the CORHIO HIE, with 15 preparing to connect, making a total of 44 hospitals now participating in the exchange. The latest to join are Exempla Good Samaritan Hospital in Lafayette, Exempla Lutheran Medical Center in Wheat Ridge and Exempla Saint Joseph Hospital in Denver.

Along with the hospitals, a total of more than 1,800 office-based physicians, 100 long-term and post-acute facilities, 13 behavioral health centers and five national/regional labs are either connected to or in the process of connecting to CORHIO, according to EMR Daily News.

As impressive as CORHIO’s progress is, there’s still more to be done. There are a total of 61 hospitals located in CORHIO’s service area, which means that the exchange still needs to sign up just under a third of hospitals with access to the network. Some of the hospitals which haven’t connected up are in rural areas; to help bring them under CORHIO’s wings, the exchange is partnering with the Colorado Rural Health Center.

The ultimate question here, as it is with any HIE, is whether the business model is sustainable. For the financial year ending September 30, 2012, CORHIO had total revenue of about $9.7 million (between grants, contracts and implementation fees), and total expenses of $9.5 million. That’s not much of a margin, especially in the capital-intensive world of health IT.

Now, there’s no need to make big profits to provide a public service, but it’s helpful to know that your money is coming from a business model that works. I’d say that this is in doubt in CORHIO’s case. I wonder: are other notable HIEs are doing better?

1. Rural healthcare on the mend

By Ashley Gold

 

Rural healthcare is more stable than ever before, thanks to technology and initiatives introduced by the Affordable Care Act. But the challenge now is to maintain and grow those success stories, according to a panel of experts speaking at an Alliance for Health Reform event on July 26 in Washington, D.C.   Keith Mueller (pictured right) of the Rural Policy Research Institute explained that before the ACA, the level of health insurance ineligibility for rural areas was higher. Now, more people can get coverage, but recruiting and retaining professionals for rural practice is a burgeoning challenge--community healthcare centers are affecting workforce expansion. "The questions we need to be asking [are] what do rural residents really need to gain access; what is different about the challenges they confront; how do policy changes affect them?" Mueller said. Regarding accountable care organizations (ACOs), Mueller said, the numbers of enrollment are already "higher than anyone expected." Tom Morris (pictured left) of the Office of Rural Health Policy (HRSA), said his office wants to know how federally-funded programs such as Medicare, Medicaid and ACA initiatives affect access in rural communities. Rural hospitals are unique, and must be treated as such. "Anytime we talk about rural communities, you have to realize it's not a smaller version of urban or suburban--it has its own characteristics," Morris said. The focus is more on primary care and chronic disease management. Any changes made in policy have had a disproportionate impact in rural communities, he said. The HRSA is focused on getting the word out in the coming months. Reaching out to rural communities is different--patients must be able to sign up for health information exchanges by paper. The word must get out about Healthcare.gov, but not necessarily via the Internet. --> READ THE FULL ARTICLE Read more about: alliance for health reform, Accountable Care Organizations (ACOs) back to top

Welcome To My Health Carre IT BLOG !

For those of you who know me and are familar with Email group, I have extended it out to the public.

This blog shall be considered a resource blog. Here you can find information pertaining to Health Care IT ! I will post a variety of articles i.e Meaningful Use, ICD 10, EMR news, etc.

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