AskTheExperts

What do you recommend to organizations that want to implement EHRs, but have concerns with data security?

EHRs can have a dramatic impact on improving patient safety, continuity of patient care and improving efficiencies in healthcare operations. However, the adoption rate for EHRs is slow; one of the leading reasons is the fear that patient information, including medical data, is suspect to technical security breaches.

Organizations should be very concerned with the implementation of new EHR systems and potential for security breaches. However, the concern should be for all systems and not just EHRs. During the selection process of an EHR, Healthcare organizations should review the security features of the proposed software, and determine if it meets the processes they have already implemented to comply with the HIPAA Privacy and Security regulations. Healthcare organizations can also discuss the data security functionality with organizations that already implemented the product.  Most EHR vendors are marketing other software products that are fully integrated with the EHR. Chances are if the EHR has minimal security features, then so do the rest of the software products.

Before we're faced with a "slash and burn" reduction, what can we do now to right the ship?

"The mean streets of re-engineering" was a banner headline in the mid-to late 1990's in a variety of health care journals. That was after total quality management didn't quite work for many facilities, and before everyone jumped into satisfaction surveys for patients, employees, and medical staffs. As we begin to walk-the-walk for service excellence, we need to be sure that we’re focused on the right services done in the right setting by the right providers with the right outcome. This is not a Chinese menu that you can simply pick and choose from.  It is a required re-focusing of hospital or group practice administration on operations. Now. Daily flash reports, productivity tools and measurements, gain-sharing financial results reporting down to the staff level, transparency in the c-suite, balanced scorecards, public quality reporting, and the list goes on. At a time when potential employees, particularly hard to find licensed professionals, can chose to work for you or not; physicians can provide services in a traditional hospital setting, or create their own ambulatory setting; and payers can select your facility based upon network needs, cost, quality outcomes, you’re correct to be concerned about this question.

How can hospitals better align themselves with their medical staffs?

Alignment continues to be the key to attract physicians to and retain providers with local hospitals. It is not a static document or 3 ring binder on a dusty bookshelf.It is a non-delegable duty for the c-suite leaders to understand the local marketplace, its impact on the practice of medicine, and to continuing position their organization to offer an array of options to meet doctor’s needs. There is no other option; as your competitor is attempting to do the same thing.

What role does the c-suite play in ensuring the success of so-called centers of excellence?

Centers of excellence, or service line, development presents a wonderful opportunity for c-suite leaders to get closer to their community needs, work with medical staff clinical champions on a volume related project, assess their management’s team and its ability to work across traditional hierarchical lines of authority, and market their successes directly to consumers, managed care payers, and regulatory authorities.Stand-alone community hospitals have traditionally focused on “bellies, babies, and bones” while academic medical centers have been more “high tech” (eg, cardiac or cancer care). With the mergers and acquisitions, or simply network affiliations, the local providers have added their “high touch” aspect to more sophisticated products lines designed to keep patients as close to home as possible.

How do we maximize our IT spend and leverage our legacy system investment?

“Doing more with less” doesn’t just apply to staffing in the departments, or layers of middle management. It gets to the heart of a facility’s constant assessment of allocations of capital dollars across fun-to-do ROI clinical projects, high profile campus expansions or much needed physical renovations, mundane general facility needs, and dreaded IT infrastructure investments. When was the last time that you looked at the latest lab module, ADT upgrade, or billing system conversion and truly assessed its functionality. Make it tomorrow and use a fresh pair of eyes to do it.

How can non-profits adopt the best practices of productivity management from the for-profits?

The key for c-suite leaders is to focus on the desired results and to incent their front-line management team to accomplish these goals. Applying the benchmarks for productivity is the easiest part. For-profits generally look at two things daily: charges and payroll. That’s not charges from the backlog over last several days or the pay period ending payroll completed by an administrative assistant for processing. It is no more than yesterday’s charges and yesterday’s payroll. There is no credit given to what’s not billable (that’s the numerator) and no excuses accepted for not inputting actual payroll spent (that’s the denominator). The outcome of these two efforts is then applied to the standard. Variance from the benchmark is, at first, a discussion of “why”, but it quickly evolves into “what are you doing about it”. It becomes the front-line manager’s focus in specific detail to understand and articulate the volume (backlog of tests, waiting times for outpatient appointments, physician specific requests, patient  scheduling needs, etc) and to staff accordingly (not to budget or plan, but flexed to actual volume need, review all approved OT requests, pre-plan any agency or contract labor premium spend, etc). Daily flash tools should be easy to compile, widely distributed, and readily understood. Waiting for the month-end financials is a lost opportunity to improve an organization’s performance.