CMIO Podcast: Recent Episodes
CMIO-Podcast
Making healthcare better isn't easy, but there are devoted clinicians working in informatics and analytics trying to have an impact at the care delivered in the exam room or at the bedside. Dr. Mark Weisman, a practicing physician and Chief Medical Information Officer interviews guest from the health informatics industry to shed light on what is happening in the field of healthcare IT from the clinician perspective. If you have a passion to make the lives of our clinicians better through the use of technology, this show is for you.
Al was a previous guest on the show and he did such a great job in May of 2020 that I brought him back for the sequel. Al is now 1 year into his CMIO role at Nuvance Health and in this episode we discuss what that year has been like, his influence within the C-Suite, and the impact he is having on the care in his community. I know you will like the work he is doing with virtual scribes and the digital front door too.
IT culture is a unique beast, especially in healthcare where there is such a focus on safety. "Go slow and say no" seems to be a common mantra and can create a lot of tension between operations and IT. Adam has a ton of experience with assessing and changing culture as a healthcare IT consultant. He and I discuss changing IT culture, treating IT more like a consultancy, partnering with operations, and having transparency around resources and projects.
Ori is a CMIO with a ton of experience. His recent blog post about training physicians really resonated with me. Train the workflow, not the functionality. Build muscle memory. Allow providers to listen to the material at home and then let them practice. Provide as real a scenario as possible.
This week I cover 2 stories about health insurers pushing us more towards value than volume. Humana launched 2 new bundled payments; one for CABG and another for shoulder replacement. United Health Group CEO discusses how the COVID pandemic is putting more pressure on primary care to switch to at risk contracts rather than fee for service, but also highlights the difficulties. CMIOs should be aware of the technology challenges these models bring to their clinicians. I also cover the INOVA breach of more than 1 million patients related to an attack that occurred to a 3rd party vendor that sells donor engagement software to non-profits. The most interesting article of the week comes out of the latest issue of JAMIA where a team developed an app that lays on top of Epic to provide the user a disease specific view with a very clean interface. This is the future. Watch for more of these SMART of FHIR apps coming out as the APIs open up. Those stories and more on this weeks CMIO News to Know.
Michael has a unique role in healthcare. He helps startups connect with health systems to solve the most pressing problems facing the system. In this episode we discuss how a CMIO is involved with innovators, what to do when a colleague presents an idea they think will be the next big thing, and how to build that critical relationship with a startup if they are partnering with your system.
Hope you enjoyed your Labor Day weekend. It was beautiful here on the east coast and the beaches were plenty busy. This week I cover some of Judy's comment about Epic's Cosmos, nursing optimization, and a bunch of articles around telehealth. One of the bigger moves last week in the telehealth space was Google investing $100 million in telehealth provider Amwell. Finally, I cover the AMA release of the 2021 CPT codes and the HUGE benefit coming our way for documentation relief on Jan 1.
Bill Russell and I discuss the first 90 days of taking over a new team. A quote from Bill: "Our problem in Health IT is we consider it a good day if nothing went down and we got our work done. The reality is every day that nothing went down , and you got was all your work done, you fell one day behind because at the end of the day, the whole world is changing but you're standing still."
This week I cover the Amazon Halo wearable and all the things it can do. Toy or healthcare game changer? For you to decide. I also cover a cool AI story about uncovering illicit online pharmacies, ways to make CDS better, and AI for documentation assistance. Those articles and more on this weeks CMIO News to Know.
This week I cover the letter from AHA to the HHS about keeping telehealth going. We seem to be losing momentum, but we are not out of this pandemic yet and there are certainly benefits beyond COVID-19. I also cover a new tool that normalizes the local COVID-19 lab test names we all use to standard LOINC codes. A friend and fellow CMIO Dr. Dirk Stanley covered the challenges we all face (and created) with finding if the patient has COVID-19 when looking in the EHR in his June 2020 blog post which you can find here. This new tool proposes to help fix this for research use. I also cover a great article by Bill Krause at Change Healthcare that really articulates why the EHR portal is not enough for your digital strategy. I believe the portal is your first step but it definitely has limitations which Bill covers very well in his article here. Those stories and more on this week's CMIO News to Know.
"Why does my computer lock at 8 minutes" and "How come I can't use the VPN to connect to the hospital" are questions I know you get too. So I found a CIO to help me answer them. Dave Lehr is the CIO for Lumenis Healthcare in Maryland and he jumps into the hot seat to take on these questions. Practical advice on IT security and HIPAA protections from Dave that you can put to use right now.
This week I cover the FANTASTIC news that CMS is delaying the penalty phase of the PAMA law that requires providers to consult with clinical decision support before ordering advanced imaging tests. The delay is for another year; perhaps someone will wake up and kill this awful thing before it drains more money from the system. I also cover an interesting article about the strain on primary care caused by COVID and then a different article about how Duke is partnering with One Medical for primary care services. Both issues have Health IT implications. Those articles and more on this weeks CMIO News to Know.
Craig is now a CMO at Nordic, but has significant experience as a CMIO and with informatics. He has his own blog and I picked a few posts to dive in a little deeper on those topics. We cover "Leading the Curated Life", a post about delivering what we know is right and NOT always exactly what the doc asked for. Then we discussed "Healthcare IT Guiding Principles". As CMIOs we can have a significant impact on the workflows so a provider is doing the work that only they can do. The final blog post we hit was "Are Quality Metrics Becoming McGuffins of Healthcare". I love Craig's philosophy that the EMR is a tool for taking care of your patient and not a place to go to enter quality data. Finally, we discuss if he is funnier or better looking than Dr. David Butler. Evidently, they have a competition going on; David may not be aware of it.
This week I cover how UCHealth automated prior auth processes and saved a ton of money; we should all be looking at these technologies to reduce the cost of manual data entry in healthcare. I also cover the difficulties of installing Cerner in the VA, Cerner and Xealth connecting for improved patient experience, and telehealth difficulties for 38% of those over 65. Those stories and more in this week's CMIO News to Know.
Are we getting to the place where AI speech to text is ready to go mainstream? Gabe is a vocal proponent for fighting physician burnout and is always seeking new technologies to make charting more efficient. In this episode, we explore AI speech to text from a company called Saykara and how he uses it in his clinic.
This week I cover a study from JAMIA about the completeness of problem lists; good info for you to compare how your system does versus what they found in the study for completeness and duplicates. The House approved a bill that moves us one step closer to having a unique patient identifier. Inbasket messages cause burnout and none of our EHR tools for efficiency work. Wait - that is not the real takeaway from the story about the JAMIA study on inbasket messages and burnout, but it does raise some interesting points on the topic. I spend a bunch of time talking about the reporting requirements for COVID testing that went into effect Aug 1. Our health department said to hold off because they are not in a position to receive the data. Seems like HHS rushed this one. I also review how some of those measures are very vague and difficult for non-clinicians to answer. Those stories and more on this week's CMIO News to Know.
The Digital Front Door is an area typically covered by the chief marketing officer or perhaps a CTO or CDO, but I think there is plenty for a CMIO to be involved with in this area as well. In this episode, I interview a clear expert in the field. Paddy is well published in the field of digital transformation and shares some of his insights about what a CMIO needs to know about the Digital Front Door.
This week I cover the New Yorker piece on how primary care is struggling; worth reading about to help understand what is going on in private practices. Another article I like from this week is Google's announcement about BigQuery Omni, that lets you evaluate data regardless of your cloud vendor. Seems like a good idea to not get locked down in a single cloud vendor relationship. I also covered the Information Blocking Boot Camp from The Sequoia Project, which is helping us prepare for that Nov 2, 2020 deadline for complying with the ONC rule. Those stories and a lot more on this week's CMIO News to Know. And as usual, I ran out of time so I will cover some other great pieces of news to know again next week.
Everett has an interesting journey as a former CMIO and previous employee at Allscripts. We discuss the importance of showing value to your health system and get very tactical. We provide real life examples of where we focus to generate a positive ROI for the programs we participate in.
This week I cover 6 articles, including what UC health is doing with huge data sets to help us all understand what is working and what is not with COVID treatments, a new bipartisan bill hit the House on Thursday that aims to keep telehealth alive and well into the future (bout time!), RWJBarnabas sent their IT staff home and saw productivity increase (perhaps we do not have to micro manage analysts after all), and an upcoming study that should help with patient matching - eventually. Those stories and more on this weeks CMIO News to Know.
Special 100th episode anniversary for CMIO Podcast. I have Dr. Matt Mesnik on the show to talk about the collaboration we have between Spok and Peninsula Regional. Matt is their CMO and has a phenomenal background in healthcare IT and is an entrepreneur as well. Great story about how he got to where he is today. We discuss clinical communication and how CMIOs get involved with these projects. Everything from paging other doctors, critical response teams, to nurse call integration into your mobile phone system is all possible with today's technology. As the EMR APIs open up we will see more communication coming from our EMRs bringing the clinical data to the clinicians in real time.
This week I cover a story about providers predicting that their telehealth visit volumes will drop to <10% of their visits next year. I disagree and tell you why. I also cover some news about ambient AI for completing your notes, another system going live on Epic without on-site support, and then I go on a bit of a rant against Leapfrog surveys.
We are closing in on our 100th episode! Happy July 4th weekend and I hope your holiday was safe and social distanced. This week I cover that HHS is extending the public health emergency another 90 days; telehealth payment rules are part of this emergency. Walmart plans to expand its health supercenters; currently at 4 but plan for how you will respond before they move to your market. Howard University is partnering with digital Apps to help with diabetes management; crowded space but more research in this area is welcome. Finally, I talk a bit about "digital front doors" and 2 articles that cover the need for seamless patient experiences. I have a guest coming on within the next 2 weeks (Paddy Padmanabhan, CIO) to talk more about why this topic is important for CMIOs.
Michael is from the University of Rochester and recently published an article about the digital landscape in healthcare. U of R is doing some amazing things with outcomes data to deliver meaningful insights to patients and providers. Michael says "I see U of R becoming a digital first healthcare system", and I believe they are closer than most of us. Listen to what they are doing on this episode of CMIO Podcast.
"And what I wanted to instill was curiosity. It was okay not to know. It was okay to be bewildered and to wonder, and to be curious and whatever we were curious about, we would come back and see could we find information about it?" Mark sent me a paper he authored in 1985 about the need for microcomputers to assist with information retrieval (written on an original Mac). As an internal medicine doctor he saw where the industry was heading over 35 years ago. He is probably the most humble, wise, and talented CMIO to never have a CMIO title.
I am back after a 1 week break, although I did record a show with Bill Russell from This Week in Health IT that will air on June 30th. I will send out a post on LinkedIn once it airs. This week I cover burnout that is NOT EHR related. Imagine that?!? Financial stress is hitting the primary care offices hard. Good news from AAFP as they enter phase 2 of the AI assistant and are looking for physician volunteers. I also cover the FDA approval of a new tool that captures respiratory rate without touching the patient (perhaps we will see a number other than 16 in the EHR). Also discuss the integration of a CRM with EHR and ADT data; essential combo for pop health. Finally, I cover a great article in HealthTech Magizine by Michael Hasselberg: https://www.healthtechmagazines.com/fast-following-amazon-to-the-patient-centered-healthcare-system/ . Another one of those Univ of Rochester crew doing some amazing things.
This week I cover stories about patients finding errors in their medical records; a lot of errors and some are scary. I go on a minor rant about that darn PAMA regulation and the burden it places on providers; there is an article that covers the burden but until you go and try it out you will not understand how useless this will be for everyone. I cover an interesting article about using Uber to reduce no-shows for vulnerable patients. And finally, I cover some of the legislation being proposed to keep telehealth in place permanently.
JD is the CIO at Dayton Children's hospital in Ohio and I reached out to him to discuss CMIO/CIO relationships. The reporting relationships for CMIOs varies widely but the most common are the CMIO reporting to the CMO or reporting to the CIO. An interesting dynamic develops when the resources the CMIO needs to be successful live in the CIO shop. The CMIO/CIO relationship becomes critical to getting things done.
This week I cover an article about inequities in digital healthcare, either due to lack of internet access or lack of devices. I also review what the state of Colorado is doing to make sure that telehealth is here to stay; we should all push for such legislation. There is an article about pay cuts to providers at Providence that is a bit scary. And I went on a bit of a rant this episode because there is an insurer in my area that is denying audio only visits for specialists, but they do cover it for primary care. So our sicker patients that need specialty care can't connect to their specialists and we have to make them come into the clinic. Doesn't make medical sense to me, so I suspect the rationale is financial. I'll keep you posted as I advocate for those patients that are either unable to get access in our rural community or who do not have the device to make the connection. Probably futile, but my heart is in the right place.
Welcome to the first week of June and another episode of CMIOPodcast News to Know. This week I talk about non-contact patient monitoring solutions; cool tech if it works. I also cover an article about the potential for improved safety when risk management and clinical data is merged together. Requires resuscitating your director of risk management after you tell them you are consider this. Mayo clinic reveals a bit about their very sophisticated AI tools and what the future might look like. Finally, I wrap with a small rant about the difficulties in telehealth when some of our patients cannot get access to the tools they need to get a visit. We need some pressure on the wireless carriers to have any chance of making this better for our communities.
Will had an early start in computing and healthcare (he clearly was one of those overachiever kids in high school) . His journey took him to the vendor side of healthcare where he worked for companies such as Zynx and now for TigerConnect as their CMIO. We talk about coronavirus, telehealth, and the importance of good communication tools to help in the crisis. His old, large, blue pager from Bellevue Hospital that only flashed one number at a time is not included in the list of good communication tools.
Happy Memorial Day. This week I cover 7 articles CMIOs should know about; bedside smart speakers to improve patient satisfaction and reduce falls, custom app to help with communication around a go-live, super-user development for go-lives, and patient generated health data are some of the topics on this week's CMIO News to Know. Stay Stay.
When I read through the summaries of the 21st Century Cures act, I interpreted the line about not having to release information that could cause harm to a patient to mean that we did not have to auto-release pathology results. I held that belief until I got a message from Justin pointing out the discussion in the Q&A section of the final rule. Sure enough, they clearly state that having a policy for withholding results across the board is considered information blocking; the requirement to withhold information must be individualized. Justin and I discuss the implications of this including the possibility of patients learning they have the genes for Huntington's disease or the diagnosis of cancer from the hospital electronic portal. Yikes.
We also discuss their use of chatbots during the COVID crisis and their journey towards better clinical decision support at the University of Rochester. They have a great informatics team at U of R. I have been fortunate enough to interview a few members of their team and they are doing great things.
This week I continue to work from my home office (also called the kitchen table depending on the time of day) and hope all of you are staying safe as well. I cover thermal scanners for catching people with fever (doesn't work), the rise of telehealth but not for the poor, and the rise of chatbots into healthcare. Those stories and more on this weeks CMIO News to Know.
David is a very experienced CMIO that has taught at the CHIME CMIO boot-camp, served as a strategic advisor to Epic, and now is on the consulting side of the business. He should also have a gig as a stand-up comedian. In this episode we talk about critical skills for CMIOs, the value of mentors, and his journey as a CMIO.
"The patients see the back of their physicians heads. That is not healthcare. That is data collection." - Love that quote from Al. He has a wealth of informatics experience and in this episode we explore a bit about what it was like to be a CMIO before people knew what a CMIO did for a living. We also take about virtual scribes, telehealth, and how to look at new technologies as a CMIO just starting with a new system.
This week I cover a lot on telehealth, because it is finally coming to center stage in healthcare. I discuss Epic's foray into the telehealth delivery side of the visit, new CMS regulations about telehealth, and talk about Seema Verma saying "The genie is out of the bottle", referring to telehealth. I also cover a study from KLAS Research about EMR market share and we see who is increasing and who is decreasing. I also discuss the NEJM article about physician burnout, interrupted. It's about the opportunity to reset healthcare in the face of the crisis.
Elsie has been a CMIO and is now a CMO for a startup and CEO of her own physician coaching program. To become a leader, she needed to transform the way she interacted with others. It's widely claimed that being in informatics is 20% technology and 80% people skills. This episode is all about how to develop that skill set.
This week I interview Naveen, a pediatrician with CHOP (Children's Hospital of Philidelphia) and a fellowship trained informaticist. We talk about clinical decision support, usability, and applying what he learned in fellowship to real world problems. For those of you keep track, I did miss recording last week. Forgive me. We are up to our eyeballs in COVID patients as the surge is now happening on the eastern shore of Maryland. I am sure all of you are working incredibly hard as well and I appreciate you taking the time to listen to CMIO Podcast. Stay Safe.
This week I cover more about the Coronavirus outbreak. The article concerns me the most is about the Mayo Clinic anticipating a $3 billion loss from the lost elective surgery revenue. The impact on hospitals across the country will be significant and IT programs for training and optimization are pretty quick to get cut. This week I also cover a story about Chatbots at Henry Ford, OpenNotes becoming more mainstream, and nurse practitioners being granted more authority to help in the COVID-19 crisis. Those stories and more on this episode of CMIO Podcast.
Twistle is a doctor to patient communication tool that I heard Swedish was using to keep track of PUIs or COVID positive patients leaving their ED. I reached out to the CMO and Dr. Bill DePaso joins us to talk about how patient communication and engagement is important during the crisis and for routine care.
More Coronavirus news this week. ONC basically suspends HIPAA so states and health departments can get the data they need without organizations worrying about HIPAA violations. I also discuss some telehealth items including a survey of 2000 adults where 72% of them didn't understand telehealth; important for us to know what the public thinks about telehealth. I also cover an article about cardiology burnout which once again people are probably over-attributing to the EHR. Finally, let me know what sites you use for following COVID-19 data. I found great graphs on http://91-divoc.com/pages/covid-visualization/
Brett is at the epicenter of the Coronavirus outbreak in Seattle as the regional CMIO. We discuss what the first days were like for a CMIO as the organization moved into disaster mode, hear about the innovation they are applying, discuss their telehealth initiative and more on this critical episode of CMIO Podcast.
Of course I cover Coronavirus, but it's from a CMIOs point of view. Telehealth is the big thing this week as systems try to stand up programs. I wrote an article in HealthTech Magazine (https://www.healthtechmagazines.com/coronavirus-pushes-telehealth-adoption-nationwide/) about getting up and running in under a week; not without speed-bumps, but we are conducting visits. I cover some of the hot topics being discussed in the AMDIS.org listserv, the stimulus bill from the government and how small independent practices are going to be seriously hurt financially, and I discuss two non-COVID articles as well just to give you a break. These two articles come from JAMIA. The first is about the EHR contributing to burnout and has some great metrics in there to consider for your own practices. The second is about the impact of moving external records into an integrated view has a huge impact on utilization of that data. Stay safe.
Sandy is a physician coach who helped over 500 physicians to grow their administrative careers. In this episode I ask her about the skills physicians should work on to advance their careers, how to stand out from the crowd, and how to maneuver with office politics.
The Coronavirus is in the center stage and all the news stories are touching on this unprecedented times. Today I will cover the changes to telehealth, Quality programs, HIPAA, and what others are doing to prepare from a healthcare IT perspective.
Imagine sitting in the exam room, talking to your patient, not touching the keyboard, and when you are done with the visit your note is ready for you to sign. This week I interview 2 CMIOs from Nuance and we discuss Ambient Artificial Intelligence. HIMSS didn't happen so I wasn't able to see this tool in person, but this technology is the future of medicine. This isn't a hypothetical situation. Ambient AI is working for 100,000 patient visits a month. Take a listen to hear how it is going.
Coronavirus is the main topic in every podcast, blog, or other news medium so I can't really avoid it. But I promise not to overwhelm you with it either. Check out what the systems are doing that are at the epicenter of the crisis; Univ of Washington and Providence St Joesph have blogs and other tools you can review to see how your preparations stack up. I also touch on an article about e-consults, a survey about how young doctors look at data, and a Health Catalyst article about growing market share. Those stories and more on this week's CMIO News to Know.
Colin was a CMIO for a looong time before making the jump to the vendor side. He is now at DRFirst and he talks to us about making the transition. We review the skills to have, the war chest you need, and the gut check it takes to make the leap outside of the hospital world. Great insights for those looking to get into the CMIO role or those looking to make their next move.
The absolute most important thing to read this week is....My interview with Jackie Drees in Becker's about physician builders. Other less important articles include HIMSS being cancelled due to Coronavirus, the Final Rule about information blocking should release on Monday. Those stories and more on this weeks CMIO News to Know.
As CMIOs we do not learn a lot about HIEs and there isn't a class you can go take to brush up on this topic. So to learn more, I interviewed the smartest person I know on the topic. Dr. Samit Desai is an emergency physician, and the chief medical officer at Audacious Inquiry, a company that partners with our state HIE (called CRISP). We discuss how HIEs help us with population health, how these entities function, and where we hope to get to with improved interoperability.
This week I cover 2 articles relating to difficult EMR installations, healthcare IT and coronavirus (no great options here), who is going to HIMSS and who withdrew (because of the virus epidemic), Nuance has their new ambient AI tool ready to demo, and I cover a blog post from Health Catalyst about getting the right pieces in place for successful data driven improvements; something we can all use in our roles. I'll be at HIMSS next week. Presenting on Thursday - session 218. Come say hello.
Ryan is the COO of MDstaffers and joins us to discuss the state of the job market for physician informaticists. We talk about the skills that are in demand, the pathways to move up, and the value of working with a recruiter.
News this week: ONC releases its plan to reduce documentation burdens. Training investments paid off for OrthoVirginia (and measuring provider EMR satisfaction is important). Significant article out of Annals of Internal Medicine showing that usage of primary care decreased 24% from 2008 to 2016; important for CMIOs to follow trends in practice patterns. Landmark trial out of the Journal of AHA about SGLT2 inhibitors and its role in primary and secondary intervention of cardiovascular events; will probably impact our clinical decision support tools sooner rather than later. Nebula Genomics offers $299 whole genome sequencing; what are we going to do with all that data?!?!? Those stories and more on this episode of CMIO Podcast.
Rabin has a ton of experience with implementations and building informatics programs and on this episode he shares with us his thoughts on physician engagement. Most health systems have cut away any "fluff" from their programs and leaned down to deal with declining reimbursements. If they want to get further reductions to expenses they need to reduce the variation in care without sacrificing quality. You can't do that with a disengaged medical staff.
Proposing to remove CME from EMR continuing education will be a detriment to physicians. This article from Academic Medicine: (https://journals.lww.com/academicmedicine/Abstract/publishahead/Commercial_Interests_in_Continuing_Medical.97308.aspx) is the controversial one for the week. I would love to hear back from you on this issue, or go to LinkedIn and engage with the post I made on the topic. Other topics include the rise of virtual medical assistants, ransomware attacks, the cost of good IT talent, and navigating a merger as a CIO. As always, I take a look at things through a CMIO lens.
Don has 20+ years of informatics experience and is a wealth of knowledge. Today I ask him to look back and consider some of the high and low points of being a CMIO. We talk about how politics can play a significant role in the success or failure of a CMIO's career. We also talked about being a tactical versus strategic CMIO and how to navigate those worlds.
This week I cover the AMA's article about the increase in physician adoption of technology, One Medical's IPO and the impact on primary care, and I touch on what Cerner is doing as it pivots its business model. One article I mention, "Providers must invest in consumer technologies, or risk irrelevance" discusses online scheduling. I am looking for anyone that who has done this well to come on the show and discuss what strategies work to get provider adoption. Reach out to me either here or on LinkedIn.
"You pay the keyboard price". A great line from Neil about the challenges with all the clicks and scrolls we encounter. Neil is a CMIO and emergency physician looking to transform how care is delivered at WakeMed. We talk about CAUTI reduction, analytics, and how the projects take shape at his organization.
This week I cover some of the hype that is starting for HIMSS including an article about 5G and AT&T, Microsoft has an article too. The interoperability rule is in the news again and it looks like providers won't be the ones financially penalized; ONC is going after the EMR vendors. Those article and more on this week's CMIO News to Know.
Sarah has a really unique background and is the first informaticist I have met that also trades stock options. Her journey has taken her through a lot of systems and a great variety of projects. Hear how she started in a consulting role, gets her next project, and the risks and benefits of this kind of work. She has some great insights into our field. Particularly around change management and interacting with senior administrators.
News stories this week touch on a variety of things Epic is up to. The letter from Judy to health system CEOs made the news and if you weren't aware, Judy doesn't like the proposed interoperability rules. Also in the news is coronavirus and CMIOs should be looking to review their travel screening questions in their EMR. We also touch on some financial stories out of BeckerHospitalReview. Those stories and more on this week's CMIO News to Know.
The extent of my 5G knowledge previously was from the T-mobile commercials that would play during the long booth reviews during a NFL game. But thanks to John, we can now all learn the pros and cons of this new technology and the impact it may have on the future of healthcare. Dr. John Lee is a CMIO and attended a 5G conference put on by CHIME. Sounds like it was a great learning experience.
This week I review the 5 year strategic plan presented by the ONC, and the lobbying fight that is ensuing. The mud slinging is far more entertaining than the strategic plan. We have Silicon Valley on one side and the EHR vendors on the other. Be sure to put your comments on the ONC site if you want to jump in. Cigna and MDLive to start virtual primary care; this is a big deal. Most virtual care is episodic urgent care type activities today, but that will change when the payment model changes. This appears to signal that shift is coming. The article that I found to be the most important of the week is Cerner's data published in Annals of Internal Medicine. They revealed the amount of time a provider is spending in the EMR per visit and provides us with a treasure trove of bench-marking opportunities.
Mark is a practicing urologist and medical staff leader and a student of leadership development. He got hooked on leadership theories while pursing his MBA and now helps develops others seeking to grow into leadership roles. In this episode, we discuss emotional intelligence, conflict management, and taking the time to build your social capital. All critical skills for CMIOs.
This week I cover a few stories about performance in pop health, including the announcement about the NextGen ACOs not creating enough savings for CMS in 2016 and 2017. I also cover Cleveland Clinics announcement of its first Chief Research Information Officer, which I think is a pretty cool title if you are an academic physician. I end with some brief coverage about an editorial that suggests transcription is better than voice recognition; personally, I disagree but I am always open to feedback. One of the articles I cover in this week's news is about the under-utilization of our analytic tools and that really is criminal. If you didn't catch last week's episode with John Wadsworth from Health Catalyst, it is definitely worth it and talks about how to get value out of these analytic tools.
John Wadsworth, from Health Catalyst, has been instrumental in helping organizations improve clinical and operational challenges for decades. He highlights the 5 keys skills informaticists need to drive change with data: 1) Data Query skills 2) Understand Data Movement 3) Understand Data Modeling 4) Ability to Perform Data Analysis and 5) Data Visualization skills. Put those skills on top of a foundation of a solid understanding of how your organization makes money and change management skills and you have all the key ingredients to leading your organization to improve.
Starting the year off with some important topics. Seeing some early adoption of AI and I believe we will see AI become more mainstream. These tools are commercially available and having an impact on care; I cover 3 AI related stories. I also cover the NEJM article about the first blood clot treated in space. Now that's telehealth! Minnesota is cracking down on docs that over-prescribe narcotics; as if docs didn't have enough to worry about. I also cover the NY Times editorial about the need for docs and nurses to band together to fight the evil EHR. Finally, another NEJM article about the lack of benefit from hospital mergers. My 2 cents on this is that integration, especially health IT integration, is really hard and we need a lot more time to see if quality will improve.
Trisha is an amazing informaticist who is now applying her clinical skills outside of the traditional hospital setting. Ever wonder what it is like to survive as an informaticist in a software company? Hear Trisha's insights on what it is like and how to excel. My favorite quote from the episode: " Social capital is a currency you can spend anywhere". Love that line from Trisha.
The final part in the series on EMR Implementation with Dr. Eric Lee. This episode focuses on training, the go-live day, and optimization. Great practical advice for those preparing for a go-live.
This week I cover the ONC data revealing safety issues in our EHRs, the limited data in the literature about how we should train medical students and residents in the use of the EHR, a study about reducing ICU delirium through the use of certain workflows and building these into Epic, and racial disparities in pain management uncovered in EHR data. Enjoy your holidays!
Part 2 of 3 with Dr. Eric Lee. We continue our discussion of EMR implementations including the build phase with all of its inherent challenges. Do you stick as close to the "out of the box" version as possible or customize the tool to bend to your workflows? Do you take all of their clinical decision support tools as is or pick and choose just a few. Those questions and more on this episode of CMIO Podcast.
This week I cover 5 articles. The first is about a Florida medical group that got fined y the OCR for not releasing records to a patient. Watch for this; the government is ramping up legal action against providers that are information blocking. The second article is about real time location tracking apps to help locate you patient transport teams and find the bottlenecks in your system. Very cool tech and it sounds incredibly simple to roll out. The third article is a review of how EHRs are still a pain in the butt, but getting better. The fourth is about remote patient monitoring for lung transplant patients, which I think is a phenomenal use case. Finally, I review an article about population health analytic tools. A challenging space to be in and there are lots of difficulties with executing this analytic project well.
Dr. Eric Lee from AltaMed joins CMIO Podcast this week to discuss the challenges with EMR implementations. We start from the initial selection period and over a few episodes we get through the implementation and into optimization. Practical, hands-on knowledge for CMIOs/physician informaticists.
This week I cover a story on the patient safety risks of the EHR, the difficulty of getting adoption for value based payments, a study on visual aids cutting duplicate orders without the need for invasive alerts, the benefits of e-prescribing, and a tool to help with CDS for PAMA. As always, I view things from the perspective of a CMIO.
What do you do when a physician is throwing a fit over the latest upgrade? How do you handle the passive aggressive doc that runs to the CEO to say how bad everything is with the EMR? Listen to the conversation with Dr. Dale Gold and Dr. Adam Carewe from Kaiser Colorado as they describe their strategies for when our colleagues get out of line.
This week I cover an article about chatbots, GE entering the AI healthcare space (a bit late if you ask me), a health system suing Leapfrog, and a health system taken down by ransomware. There is an article that asks where you should look to find your digital transformation leader and I wonder where a health system could find someone with technology knowledge and clinical acumen to help guide them. Hmmm, if only there were such people already in the health system that could be encouraged to help in this space (there is some sarcasm here for those missing my point). Finally, I end with a few ICD-10 codes that apply to Thanksgiving and hoping you do not have any of them sitting in your emergency department.
Andrew is now the CMO for SureScripts, which all of us know as the pharmacy interface vendor that connects our EMRs to the pharmacies. But they do more than that. Today we discuss how SureScripts helps doctors and patients understand the out of pocket costs of medications at the time of prescribing (Real Time Prescription Benefits), using pharmacy information in population health, simplifying electronic prior authorization of medications, and how to get those recalcitrant docs away from printing their scripts!
This week Google and Ascension have been in the news. I cover what their doctors are saying they are doing and it sounds like they can seriously help healthcare. Also in the news this week is a serious ransomware attack on a post acute EMR system with a big price tag. Humana is growing its Medicare Advantage program and if you want to know why, check out the video from Dr. Eric Bricker from the link on the CMIOPodcast.com blog page. He does a good job in explaining how MA works. These stories and more on this episode of CMIO News to Know.
Rebecca is heavily involved with quality and safety with her medical group in Boston. In this interview we discuss how she does this effectively, the use of external data to help with data accuracy, and her journey towards CMIO. Take a listen.
Interesting article from HISTalk that shows a CMIO earning 770K while the CIO is at 500k (you don't see that every day); the article is actually about the new hospital at Stanford. AMA study Shows the EHR causes Burnout (but is not a definitive study in my opinion). How to Design an EHR Usability Assessment. Post Acute IT spend is dismal and interface with acute facilities is limited; impacts pop health. Penn Medicine covers how they look at integrating technology after an acquisition. This and more on this episode of CMIO News to Know.
Ankur is a co-founder at KenSci, an AI company in the population health space. The company was recently noted in a KLAS survey for a very high level of customer satisfaction so I thought it would be beneficial for us all to hear from him and see what we can learn. His message is consistent with what we have heard from others in the industry; its the operational part that's difficult.
This week I cover 2 articles out of KLAS. The first confirms what we already knew - EHR training improves provider satisfaction and orthopedics is grumpy everywhere. Their other article reviews 6 of the AI companies on the market. I cover a few articles out of JAMIA, including a very interesting case study about EHR slowness caused by a BPA. Those stories and more in this episode of CMIO podcast.
This week I cover 6 articles from the HealthIT space. Two are editorials written by doctors about their dislike of Epic. Optum buys Vivify Health. Geisinger adds functionality to their HIE. CMS delays rule requiring hospitals to put their negotiated rates on line.
"Learning is a Lifestyle" per Mary Ellen Beliveau, CEO of Knowledge to Practice. Sometimes the problem is not the tech, but a knowledge deficit in clinical care. As CMIOs, can we link from within the EHR to clinical content providers will actual use? If we know a provider is weak in managing a certain condition, can we send them an email with a link to a short video on the topic if we detect that condition on the problem list of the patient they are seeing? Just in time education is an interesting concept to consider.
News review for the week: A 312 page report from the National Academy of Medicine on clinician burnout makes into the Washington Post and highlights the need for system approaches over yoga classes. The OCR wacks a hospital system for $2.1 mil for HIPAA violations. ECRI Institute discusses the safety risks in ambulatory care (there are plenty). Text messaging with a secure app that is outside the EMR creates some interesting documentation challenges. Mayo Clinic conducts a study to see if facial recognition software can identify patients who had a MRI of the head which was de-identified for research. 2 articles on telehealth including one about the new OnMed modules coming out of Tampa General.
Are you prepared? Our prescription interface is getting an upgrade and it has an impact on all our providers. A longer sig length, CancelRx, ChangeRx, height and weight requirements on prescriptions and more. Electronic prescribing of controlled substances becomes mandatory in the near future too. Hear from Scott Bonczek, a PharmD informaticist who really knows his stuff on this important topic.
Does the Information Blocking Rule in the 21st Century Cures act basically require systems to release their provider notes via their patient portal (OpenNotes)? I discuss this issue and some other news stories in this weeks CMIO News to Know.
Do you think Amazon purchases a 3rd party machine learning tool to tell them what books you might want to order? No. So why do we expect 3rd party algorithms to solve our core business problems in healthcare? Listen to Leonard D'Avolio as he gives CMIOs practical advice about deploying AI solutions in your healthcare system.
Lots of activity from HHS this week. I review the proposed rule change to the Stark law which has significant impact for CMIOs. Also, HHS released a guide to help providers taper opioids that I think will be useful as a clinical decision support tool. Amazon Web Services has a new tool that can read our scanned images and convert it to discrete data, which I would give my left arm to have in my system. I wrap it up with a discussion about the under use of pneumococcal urinary antigen in the diagnosis of CAP.
Drs. Lee Milligan and Peter Canning from Asante join me for a discussion about the implementation of the upcoming PAMA law. We review what we are doing to prepare our providers, debate the effectiveness of the law, and discuss some of the features of the products we use to help provide the clinical decision support.
Today I review the news about how Providence/St. Joe's tackled master data management for their 20,000 provider network, some tech advances out of Sutter Health, a CMIOs take on cloud computing, a recent article on the state of EMR inbox usability, and an article calling out health plans to reduce the number of quality metrics we need to track.
Hear the science behind measuring EHR satisfaction from Taylor Davis at KLAS. They are truly the experts in understanding how well clinicians are getting along with their IT tools. I love one quote from Taylor as he was recalling a conversation with another CMIO that has a very successful program in place. "We've had to make sacrifices in other areas in order to be able to more robustly build out a team that works with the human beings involved in this equation." Sounds like a strong idea to me.
This week I cover the new FDA guidance for CDS tools, the new CMS rule for reducing burdens in healthcare, Yale's experience with cost accounting, and happy (belated) National Health IT Week!
What does innovation look like in your system? Innovation in healthcare can come from anywhere and our clinical colleagues have a million ideas to bring forward. Most will never see the light of day because there is no process for it. Listen to Justin Gernot from Healthbox, the innovation advisory part of HIMSS, discuss what innovation looks like in top performing health systems.
The only good thing about being a NY Jets fan is that I can turn off the game by half time; leaves me time to record CMIO Podcast. This week I cover recent studies about medication alerts, the latest hospital taken down by ransomware, a physicians impact on patient portals, and more.
Dr. Teich is a different kind of CMIO. He works for Intersystems and still practices emergency medicine. Active in both HIMSS and AMIA, he is a leader in our field and has a very interesting journey to becoming a CMIO. Take a listen.
This week I picked 2 articles about telehealth, 2 on AI, one about hospital coding, and I wrap it up by highlighting the Becker's column by Jackie Drees about CMIOs and the favorite part of what they do. Love to hear the impact CMIOs are having in their systems.
Dr. Topol is world renowned for his expertise in technology and I am thrilled to have him on the show. In his recent article in the New Yorker he mentions that physicians have been turned into data entry clerks. We explore his thoughts on the current and future state of the industry, how AI may help us, and how CMIOs play a role.
Cerner lays off some people in an effort to maintain 22% margins, physicians write more narcotics late in the day or when they run behind, the AMA dips its toe into Physician Burnout. These stories and more in this week's News to Know.
What is the interaction of a CNIO with a CMIO supposed to look like? Back in mid August we heard from Dr. Gregg Nicandri, CMIO at the University of Rochester, and now we hear from their CNIO Rosemary Ventura. Some challenges are similar across all of informatics regardless if we are talking about nurses or providers. Communication to large groups of end users, developing governance structures, and explaining what it is that we actually do to senior leaders is a part of the job for all of us. The skill set required to be successful seems similar as well.
This week I cover ZocDoc for online scheduling (why do we need this?), a fancy new command center in Orlando, price transparency, and proactively finding patient safety events.
An emergency medicine physician, a CMIO, and now a CIO at Asante. Hear the journey Lee took to get there and how different his role has become as he moves through his career. For providers looking to advance in Health IT, Lee's advice is invaluable.
Verona welcomes 8000 guests for Epic UGM 2019, ABIM has a new Board recertification program (maybe), and what it takes to be successful in value based contracts. I cover these articles and more in about 20 minutes. Thanks for listening.
Bill is a highly regarded CIO and visionary in the health IT industry and I was honored he agreed to come on the show and talk about his interactions with CMIOs. I personally listen to his show every week at https://www.thisweekhealth.com/ Great insights in this episode.
I cover the Health IT news for the week that CMIOs should be made aware. In the beginning of the episode I ask a question about how you are handling providers that refuse to upgrade to smartphones but you need them to do so for 2 factor authentication. Email me at CMIOPodcast@gmail.com if you have some thoughts. This episode I cover: Burnout rates for PCPs are up, physicians are in demand for CEO positions, why physicians are not engaged, and voice technology in the exam room is on the horizon.
What is it like to be in the first 6 weeks of your CMIO career? Hear from Dr. Gregg Nicandri, a new CMIO, and an orthopedic surgeon! Probably not a lot of those around. Listen to his journey to become a CMIO, what he has planned, and the relationships he is establishing. After listening to him I am sure you will agree that he has a fantastic career ahead.
A few stories CMIOs should know about including what Cerner is doing in the pop health research space with Duke, What the c-suite knows about AI (not much?), Complying with state Prescription Drug Monitoring Programs, and more. Keep up to date in the health IT space with just 25 minutes of news coverage.
How are your processes for initiating and maintaining clinical decision support? For most of us, the answer is not so good. Dr. Marc Tobias is a national expert in the field and walks us through how to do this right. Through the framework of content, governance, and post-implementation analytics he describes how the best systems in the country are doing this work. If you want to reach out to him for further insights, his website is https://www.phrasehealth.com/
Do you have a strategy to counter a second opinion clinic that is virtually popping up to syphon off your highest margin patients? In this episode I review news stories a CMIO should know. I cover the highlights of the article and then get into why it is important. The theme for this week is "Outside the 4 walls of the hospital". I discuss articles relating to telehealth, remote patient monitoring, and end with a discussion about virtual training.
Hear how Dr. Dirk Stanley, CMIO at UConn Health, uses a CMIO checklist to keep change management organized. When done right, a little organization upfront makes things go much smoother during the tough parts. The checklist includes:
What is the definition and main purpose of this tool?
Who owns this tool?
Who builds this tool?
Who tests this tool? (Director of Regulatory Affairs? MD? RN? Clinical Director? Risk Management representative? CMO? CNO? COO? What committee(s)?)
Who approves this tool? (Med Exec Committee? Forms committee? P&T?)
Who codes this tool? (Who comes up with the coding scheme for this tool?)
What coding schema (naming convention) do you use? (E.g. a number like #2.12 or ABC-123?)
Who publishes this tool? How will your staff be able to find it to use it? In a common place?
Who tracks this tool? (What database tracks the tool, it's code, and its approval date?)
Who educates/implements this tool? (Who is responsible for spreading the word that a new tool has entered your clinical arena?)
Who monitors this tool? (Who looks at the tracking database and checks your quality data to look for problems with the tool or its design process?)
Check out his post at: http://www.dirkstanley.com/2010/08/cmios-checklist.html
This week in the news I cover the UHS settlement with the DOJ, the Senate advancing a drug pricing bill, How Ascension got 100,000 additional visits this year with help from online scheduling, Major hospital groups recommend changes to HCAHPS survey, and an announcement from a company called Nanowear about a remote patient monitoring device. As always, I'll relate these stories to our CMIO world.
Can you get the data you need when you need it? As CMIOs, we understand how the data gets in and are uniquely positioned to understand how to get it back out and make it useful to end users. Having a successful BI and analytics team requires the same skills as the informatics parts of our work. Listen to Dr. Jonathan Kaufmann (CMIO at BayHealth) describe how he did it at his system.
5 articles from the week that I read and found interesting from a CMIO perspective. John Sculley wrote a piece in Fortune about remote patient monitoring and the future of healthcare. The BMJ published an article about patient safety that resonated with me due to the discussions we are having around alert fatigue and preventing patient harm from medication errors. I also cover an article about interoperability (and how awful it currently is. I know you will agree). And more. Check it out and send me feedback to cmiopodcast@gmail.com
Are your problem lists a mess? Well, Todd has solved that for Ochsner Medical Center. We will get very tactical today. Listen to how he did it, the challenges he faced, and what it took to get 80% of providers to use problem oriented charting. I apologize for the fan noise in the background, but it is summer in New Orleans and I guess the mic picked up the background noise. Nevertheless, great content from Todd and incredible results.
3 news stories and my list of 7 rants. 1) We do what is hard for IT if it makes it easier for the clinician. 2) We train our clinicians to a level of proficiency on our IT tools BEFORE they touch a patient. 3) An infinite number of alerts does not make us infinitely safer. 4) Our customers are not always right and we need to deliver a product that exceeds their expectations. 5) For IT to build trust, we must have transparency. 6) Operations determines the "what" and the "when", IT determines the "who" and the "how". 7) When training, we meet our providers where they are and deliver content in the format they need.
I cover 5 things in the news this week that I think CMIOs should follow. 1) The Microsoft and Providence St. Joseph Health partnership to create a cutting edge hospital should produce AMAZING things. Definitely follow this story. 2) Novant is moving their EMR data to the cloud, and many others will follow. 3) ICD-10 released their latest updates; as a CMIO that impacts our groupers. 4) HIMSS TV posted a 5 minute overview on Blockchain for healthcare. Worth a listen. 5) CMS has a RFI out there for Patients over Paperwork. Get your input submitted before August 12th.
Does your system have a comprehensive training program for Health IT? In this episode I cover the creation of the Home For Dinner Program, an initiative designed to improve the onboarding, optimization, and retraining of providers. I cover the history of the program, the challenges it faced, and the resources required to make it a success. I'll put some of the slides I used when developing the program on the website in case you want to see more details. http://www.cmiopodcast.com
Today on CMIO Podcast I interview Dr. Stephen Beeson from Practicing Excellence. Stephen is a practicing physician at Sharp Healthcare and a national leader in patient and provider experience. There is a natural overlap between optimizing a provider and improving patient experience. We cover the role of the CMIO in patient experience, key factors to improving provider engagement, and the benefits of investing in clinicians. You can find more info about Dr. Beeson and the Clinician Experience Project at these sites below: https://practicingexcellence.com/ https://www.linkedin.com/in/stephenbeesonmd/ https://www.linkedin.com/company/practicingexcellence-com/
patientexperience #CMIO #HealthIT
To get a different point of view on healthcare informatics, I interviewed Mairen Baunhofer, a nurse practitioner and associate Chief Medical Information Officer. We cover her journey to entering the informatics field, the challenges faced by nurse practitioners/physician assistants in informatics, and discuss what has been working well for her. It's a great 23 minute interview for clinicians interested in getting into the informatics field and it will also be interesting for the experienced physician CMIO to hear some of the similarities and challenges faced by a non-physician informaticist.