HIT Myths Debunked!

A few weeks ago I was thinking about all of the myths that swirl around in healthcare IT circles. Many of these myths are heavily ingrained in HIT beliefs, and some are merely misunderstandings. For example, in IT there is a belief that keeping the server room as cool as possible is best for the hardware, yet a study published by Google showed that hard drive failures do not appear to correlate to temperature at all. I keep my personal server room at 75 or so. No hard drive failures yet!

We decided that a blog series on healthcare myths would be fun. Since I started it, here are the HIT myths that I am tired of debunking.

"A single EHR will solve all of our problems!"

Phooey! This is an age-old argument that has gone on for years. Deeper still, is the general IT argument that best of breed solutions are not as cost effective as single-vendor. IT leaders in healthcare often forget that there are more providers than hospitals and clinics. The documentation and ordering needs of providers like behavioral health, home care, hospice, long-term care, and physical therapy. These other providers will likely always be on separate systems, and we will need to communicate with them electronically. Related to this, let's debunk the number-one myth I hear about interoperability!

“We think Direct is a short-term strategy, and we prefer to wait for statewide HIE.”

Balderdash! When folks talk about where we need to be in HIT they usually tell the story of query-based exchange. We talk about getting injured in a far-away state, going to an ER, and all of our medical information from other facilities is magically downloaded into the EHR there. Life is good!

That is a great scenario, and it will happen someday. However, we can use Direct right now to make a difference in patient care! Even providers who do not have an EHR can benefit from Direct by having secure communication with their referring providers. We should be getting comfortable using Direct and eliminating that stupid fax machine! Further, Direct will likely be around forever, it is not a short-term solution! Did we get rid of our phones when email became popular? 

“Patients in our community are too old to access their electronic patient data!”

Flapdoodle! I used to hear this more often than I do now, probably because we are seeing it isn't necessarily true. We have seen many studies that show this not to be the case too. Older patients have more need for medical care and can be very engaged in the healthcare. Also, many older folks use technology to keep up with their family (Skype, Facebook) and have an iPad or smart phone. Further, when we engage the patient's family and caregiver we can get them to access the patient portal nearly every time.

So, since this is a first-in-a-series kind of blog, help me out! What other myths do you hear? What needs to be debunked out there? What other synonyms for "nonsense" do you know?

One HIT Vendor's Perspective

As many of you know, I live in a rural Northern Minnesota town called Hibbing. You may have heard of it as the boyhood home of Robert Zimmerman, who later went on to fame as Bob Dylan. Hibbing is interesting in many ways, and with this being HIT week, you would be surprised to hear that it is home to a Behavioral Health EHR Vendor! IRCS, Inc is a popular Minnesota vendor for behavioral health and I had the pleasure of working with them a few years ago on a couple of projects. Interestingly, they are the only EHR vendor that I know of that has completely re-written their software from the ground up using new development tools! That was an expensive, but wise move that has enabled them to provide cutting edge software via the cloud. This allows them to provide their software to very small offices as well as large centers.

I have invited Chris Freeman, Chief Operations Officer at IRCS, Inc. to discuss their perspective to support issues. This is a topic I often discuss (see my webinar “Vendor Issues Management”) and I think it is important to consider the perspective of the vendor using a Maslow’s Hierarchy of Need model:

At the core is the requirement to sustain the business and avoid liability that could destroy the business. Next is having a profitable business, and that requires keeping and adding customers. Finally, they want to engage their employees and make a difference in the healthcare community they serve. They can’t do any of that stuff at the top with a failing business! It is important to keep this in mind when you wonder why your support issues have not been resolved as quickly as you think they should be!

Now I would like Chris to discuss the perspective of IRCS, Inc. when it comes to support and product maintenance. Take it away Chris!

IRCS, Inc has been in business since 1982 (33 years), and has been primarily focused on Behavioral Healthcare EHR software for the last 20 years.  Our software, Vireo, which Joe refers to in his introduction, is a brand new software, written from the ground up using new development tools.  Vireo was Stage 2 MU certified on Jan 30, 2014 and we were the 3^rd organization (with the 5^th software application) certified.  We believe that communication between the vendor and the customer is of primary importance.  We commonly answer phone calls directly from our customers (no complicated phone system to get stuck in here), so that is generally how an issue starts its life.   I will now share some tips (that dovetail with Joe's webinar “Vendor Issues Management”) to help your vendor get your issues solved in the least time possible.

Issue life cycle:

1) Issue begins life by either a phone call discussion or email.   A tracking ticket is produced to track the issue.

2) We attempt to reproduce the issue.  If the issue contains enough specific information for us to reproduce the issue, we will typically correct the issue within our development environment immediately.  Following that the issue will be corrected in the next release.  For critical issues, we will issue a hotfix. 

3) If the issue does not contain enough information for us to reproduce, we loop back to the customer in an attempt to obtain that information.   This step is what takes the longest amount of time, usually due to scheduling problems (on both the customer and vendor sides).  If we are unable to reproduce the issue or the root cause cannot be identified the issue is canceled.  If we obtain enough information and are able to reproduce the issue we loop back to step #2.

With any vendor, if you want your support issues corrected in the least amount of time possible, do the best you can documenting how to reproduce the issue.  Typically this takes a subject matter expert on the part of the customer, as a normal user does not have the time and/or big picture knowledge to document the information required.   If you do not have any subject matter experts on staff, you need to develop them, as it is our experience that you cannot completely utilize a software application without them.

Variables to document:

1. Type of device and operating system (i.e. Laptop running Windows 7 Professional vs iPad running iOS 9.0.2) and web browser in use (i.e. Firefox 41 vs Chrome 45 vs Safari 8.0.8).
2. User logged in.
3. Release of software in use and Date and Time issue occurred.
4. Steps to reproduce the issue.

If you follow the steps I have outlined above you will give your vendor enough information to be able to reproduce the issue, and your issue will be solved in the shortest time possible.

Thanks Chris! It is great having someone discuss openly how to best communicate issues to a vendor. 

HIT Week and Review of my 2015 HIT Predictions

Happy HIT week! I have been busy talking HIT to a rural network for the last couple of days, and it is exciting to see how we have progressed in the last few years. As a way to check on our progress, I would like to see how I am doing so far on my 2015 predictions I made earlier in the year. I think I am doing a little better than I did last year!

ICD-10

I was right! It did happen on October 1. So far all seems fine, but let’s see what happens when the bills drop.

Meaningful Use Reporting Period in 2015 will be 90 Days

Right again! The BRAND NEW Meaningful Use final rule came out last night and, as most people thought, the reporting period for 2015 is 90 days. No big surprise…

2015 Will be the Year of the Engaged Patient

Hmmm. This one is subjective, and I think I was wrong (again). We are talking more about engaging patients and we are talking less about why patients won’t engage, which is a start. We are building some momentum, and certainly focus on care coordination and other population health management methods will encourage patient engagement, but the groundswell has not occurred yet.

Stage 3 Will Hammer on Quality Measures and Interoperability

See my blog post tomorrow, where I will discuss the Stage 3 final rule. I will discuss this and other areas more, but I don’t think the clinical quality measure and interoperability requirements will be any greater than they are in Stage 2.

mHealth Killer App

I was hoping that an mHealth app or device would emerge that would drive patient engagement and wellness. I was thinking that perhaps the Apple Watch or the Apple Health Toolkit would take off, but so far I really don’t see this as happening this year. I love my Apple Watch, and it makes me more aware of my daily activity, but it just has not taken off yet.

So I got 2/5 correct. Not good, but for a batting average it is awesome! What do you think will happen the rest of the year?