Monthly Archives: October 2009

HIT and its Impact on Workforce Development

A Web site titled NetAssets has published the first of a five part series on HIT and its impact on workforce development titled: Part I, HIT Overview

This evening I am in a writing mood and just couldn’t resist commenting on their post. One of the things a blog does is allow me to post my thoughts where friends and colleagues will see them rather than scattering them on fence posts, at the base of trees, and fireplugs around the neighborhood. Comments that would have been scattered at the end of other peoples’ posts just a year ago now go here on my blog.

The three authors of part one, Katz, Saran, and Wool have done a nice job of capturing the current uncertainty surrounding EMRs and the much broader topic of healthcare information technology. Today’s market is badly fractured and still poorly defined. Having said that, I thought it would be fun to take a stand today and look back next week or two years from now and just see how much progress we have made and the direction we have taken.

For what it is worth, my best estimate is that connectivity will be via the Internet with significantly more security at all levels. The primary new employment market will probably be security because is it so critical and the threats will shift as the defenses improve. Block the bad guys here and they will move over there and we have to develop new blocking mechanisms. Then they move again. Security is always more of a process than a project.

Data will be stored using existing technology, both software such as SQL and evolving storage media including virtualized systems and clouds. More people will be needed but the skills will be extension of current skills. At lot of today’s designers, programmers, data base administrators, etc., will use the skills they have to move up. There will probably be a big market back-filling jobs in other industries were incumbents have left to go into healthcare. These will be real jobs, just not in healthcare and they may not qualify for government assistance.

Data acquisition – how the data is captured – will be the place where we see the greatest change. The work-load impact of capturing the information is one of the biggest complaints about most EMRs. There will be new technologies and significant improvement in existing data acquisition technologies. And perhaps equally important, larger markets for these new and improved technologies will bring down costs. Almost all of this will happen in industries outside of healthcare. Healthcare will be buyers, not participants.

There appear to be huge training needs to help almost everyone involved in healthcare learn to use the new tools. Fortunately there a lot of people who are already familiar with computers, office applications, and the Internet. We are not starting from square one. Flip side, most of them know very little about security, the place where I began these comments.

Bill Crounse, MD,  Microsoft’s worldwide health senior director addressed this broader training need in a blog post dated October 7, 2009. “Dr. David Blumenthal (National Coordinator for Health Information Technology) has announced a ‘workforce training initiative’ to educate more health information management professionals with expertise in electronic health records and related technologies.  He says at least 50,000 new jobs are needed in the field.  I would add, based on what I’ve experienced, that we will also need training for perhaps ten or twenty times that number of people; i.e. most of the physicians, nurses and other clinicians who are currently practicing in offices, clinics and hospitals all over America.

“It’s not that these folks have their heads in the sand. Most of them are working so hard day to day in patient care, trying to stay afloat and keep their practices from going under, that they literally don’t have time to come up for air.  So what happens when we expect them to use all of this technology and also give 45 million more people access to their services?  That is going to call for one hell of a training program!


Building an Integrated EMR One Piece at a Time

Today Allscripts made three major announcements:

An agreement with Intuit Inc. to become the first to offer Quicken Health(SM) Bill Pay. The online service integrates with Allscripts’ practice management and revenue cycle management solutions, used by 110,000 physicians, to help patients understand their medical bills and pay them online while helping physicians get paid faster.

An agreement with mPay Gateway allows Allscripts Patient Payment Assurance to provide point-of-care collection of credit card and debit card payments, which all but eliminates the need for patient billing. The solution enables providers to calculate how much the patient owes, based on their own rates and the patient’s insurance, and obtain payment authorization before the patient leaves the office. The patient’s payment card is charged only after the clinic settles the claim with the insurance company. Clinics that are utilizing the solution have realized 50 percent decreases in patient receivables.

A new partnership between Iowa Health System and Allscripts, called ePrescribe Iowa, will offer a free Web-based e-prescribing solution to physicians throughout Iowa. ePrescribe Iowa automates the process of writing prescriptions and transmitting them to pharmacies while alerting physicians to potentially dangerous drug-to-drug interactions, drug allergies, dosage errors and other problems that can occur when writing prescriptions on paper.

This blog post is not intended to be promotion for Allscripts but rather an illustration of how fully functional EMRs may be assembled one piece at a time. Easier for the doctors and a clever marketing strategy that begins with a simple relationship that has  potential for evolutionary growth.

By the way, I picked up this story on that high-tech Web site called Facebook.

Healthcare is dis-integrating its information

Significant parts of American business are integrating information through industry wide interfaces and Enterprise Resource Planning systems (ERP). What is healthcare doing? In too many cases, healthcare is moving in the opposite direction and dis-integrating its information.

Electronic Medical Records (EMR) systems are being designed using proprietary solutions with a facility or group focus that limits the ability to share information outside the facility or beyond a limited group. This is providing better and better data that is aligned to the needs of a limited set of providers with little or no regard for the total healthcare needs of their patients. If a patient needs the services provided by our limited group,we can help. If patients need a service that is not provided by our group, the best we can offer are the services that have been available for years – services from the time before computers.

Clinical systems are being developed using proprietary solutions and are silo focused which makes data and processing incompatible even within organizations.

A Google search for “erp systems for healthcare” lead to a list of links. The top ten included nothing newer than two from 2007, two from 2006, one from 2004, two from 2001, three undated and a vendor job board.

One of the links dated 2007 was Healthcare ERP and SCM (Supply Chain Management)  Information Systems: Strategies and Solutions by HIMSS. The summary of findings included:

Healthcare is far different in its expectations for enterprise-wide systems and solutions due to the nature of the business. The concern that errors in the processes and technology can lead to severe and undesired outcomes has far greater impact than any other industry with ERP and SCM needs. That is why it is alarming that while clinical systems and medical devices continue to evolve, thus contributing to greater and more positive outcomes, the current ERP and SCM solutions are built on 20- to 40-year-old technologies, programming languages, and architectures.

Every technology department has experienced integrating their ERP and SCM information systems with proprietary and cumbersome clinical systems, which are defined in specialties and single purpose roles. In addition, the information remains separated requiring several databases and stores, which are incompatible and not designed to work together. The crisis in healthcare has moved from the operating room to the server room with a need for greater response from the ERP and SCM IS vendors. The healthcare environment and the systems that support it have become too difficult for users to fully utilize all the system capabilities. With constrained budgets and limited resources, the entire system to support the hospital’s business administrative needs becomes a conglomeration of excel, post-it notes, e-mails, and bytes. [emphasis added]

Healthcare reform and cost control will require multiple solutions that include more effective capture, integration and application of patient, clinical and operation data. Integration, not continuing dis-integration.