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Thursday, September 4, 2014
Securing data in the network
Friday, August 29, 2014
Perfect Patient vs Physician’s Pain in the A**: How Informed Patients can Lead the Way
by Kami Norland, MA, ATR, Community Program Manager
I have recently been on the hunt for a new primary care provider. My previous provider was fine. Her diagnostic assessments seemed accurate (as my self-assessments were verified from my personal WebMD and CDC searches—I know, I know, I can actually hear cringing and warnings to not self-diagnose from online sources as a hangnail could become fatal according to some websites). Despite my self-diagnosing tendencies, my provider appeared non-judgmental and trustworthy. However, her default mode of intervention was to prescribe a round of antibiotics and hurriedly move on to the next patient. During my time with her, there was no mention of how I could alleviate my ailments through nutrition, exercise or stress management. My visit lasted all of 10 minutes so she never really knew my name and when I left my appointment I spotted her in the back parking lot, lips pierced and lungs deeply inhaling on a thin roll of tobacco.
It was at that moment I realized that I needed to officially begin my search for a provider that was more in alignment with my needs and philosophies toward health. Admittedly, this is no easy task as I have exceptionally high standards for what good care looks like and should be as I travel across the country to small rural hospitals, conversing with the country’s finest physicians and leaders. I have witnessed effective leadership in health care and I know what it takes for a patient to receive high quality care focused on wellness. Top off this knowledge with a personal philosophy that could be rightfully classified as a “health nut” and you have the makings for either the perfect patient or a physician’s biggest pain in the a**.
It was at that moment I realized that I needed to officially begin my search for a provider that was more in alignment with my needs and philosophies toward health. Admittedly, this is no easy task as I have exceptionally high standards for what good care looks like and should be as I travel across the country to small rural hospitals, conversing with the country’s finest physicians and leaders. I have witnessed effective leadership in health care and I know what it takes for a patient to receive high quality care focused on wellness. Top off this knowledge with a personal philosophy that could be rightfully classified as a “health nut” and you have the makings for either the perfect patient or a physician’s biggest pain in the a**.
I primarily conducted my physician search online, hopping from website to website. I held no real loyalty to my provider or the health system, other than wanting to assure that my electronic health records (EHR) could transfer to wherever I ended up. I read a plethora of physician profiles looking for someone who I could grow old with and who understood the value of focusing on wellness and quality of care. I narrowed my search down to two providers, one of which was a resident being overseen by the University Med School in town. Either provider seemed sufficient based on the short paragraph descriptions of their philosophy toward medicine and health, so I let the scheduling receptionist determine who I would see based on availability.
An appointment with the resident was scheduled. During our first visit, I inquired about the resident’s knowledge of the Triple Aim (using my best “Minnesota nice” manners so as to not offend) and set forth my expectations of adhering to a wellness approach. To my surprise and glee, the resident was well informed and asked me questions about nutrition, exercise, stress management and the like. It was evident that she was also prepping me for completing a patient satisfaction survey as she simultaneously entered data into my transferred EHR. Bonus points were even given to my new physician when she later called me to follow up on my physical and emotional well-being from a small procedure.
In the coming era of value-based care, rural health facilities have the opportunity to be seen as transformational leaders in health care rather than just vendors of health services. Implementing this change from the volume- to the value-based model requires an extensive change in how health care is experienced by the patient and the provider. As the provider, it’s about asking the patient the right questions. As the patient, it’s about receiving the kind of care that extends beyond the hospital walls where we can be reassured that our physician not only knows our name but also helps us to stay healthy and out of the hospital.
I don’t think I’m alone in my inquiry and “demands” of seeking a provider who recognizes that the value-based model, one that focuses on wellness and population health, is the right approach to care. I also am not alone in utilizing online sources and being an informed consumer of health care.
I don’t think I’m alone in my inquiry and “demands” of seeking a provider who recognizes that the value-based model, one that focuses on wellness and population health, is the right approach to care. I also am not alone in utilizing online sources and being an informed consumer of health care.
Providers, if you haven’t already experienced the grassroots movement of patients defining their expectations of wellness and value-based care, be prepared to make this transition.
Hospital leaders, prepare your board and staff for this transition by:
- offering education on the Triple Aim
- including wellness as part of your meeting agendas
- referencing practical tips from Improving Population Health: A Guide for Critical Access Hospitals, and help your providers perceive that they have the “perfect patients”
Monday, August 4, 2014
National Cooperative of Health Networks (NCHN) 2014 Annual Education Conference
By Kap Wilkes, MBA, Program Manager
There was a convergence of rural health leaders in St. Louis at the National Cooperative of Health Networks (NCHN) 2014 Annual Education Conference the week of June 16th. I had been getting ready for this conference for several months as I had the good fortune to be part of the conference planning committee. The volunteer group of planners spent a couple of hours a month together and a good number of hours on our own putting together the details; you can imagine how our time and focus increased as the date approached!
Over 125 rural health network leaders from a diverse variety of structures, types of members and network services came together to learn from each other. The highlight for me was to provide some of the content for the conference with my colleague, Joe Wivoda. We presented interactive and dynamic information on building meaningful and impactful collaborations, network sustainability using a systems framework, and using health information technology (HIT) for improved transitions of care.
There were many other learning opportunities at the Conference. More than five Rural Health Information Technology Network Development (RHITND) program grantees presented to their peers on topics like: implementing a rural health network care coordination service, creating a regional collaboration, making member’s health data meaningful for improvement and sustainability, network development strategic business planning, implementing an electronic population management tool as a network service and transforming member’s health care delivery through better use of data. All of these topics are opportunities for rural health networks to build their own infrastructure and capacity and to develop products and services that their members will value.
Another highlight of the conference was the Innovation Circles. We kicked off the conference by forming small groups to brainstorm and select eight topics that would be both relevant and pertinent for round table discussions; Innovation Circles, held later in the day. A cool thing happened; six Innovation Circles took place with robust discussions and meaningful exchange.
These Innovation Circles truly are incubators by bringing together smart, engaged people to share their experience, knowledge and expertise from diverse networks. This is a powerful equation for creativity and solutions. Some of the topics they discussed included: Patient Engagement and Meaningful Use (MU) Patient Portal Development, Challenges of Care Coordination Across Networks and Systems, Challenges with Rural Staffing, Data Analytics: What and Then How to Measure and Challenges Sharing Health Information Across Uncommon Electronic Health Record (EHR) Platforms. My observation was that those who participated in the Innovation Circles and the education opportunities throughout the conference took away fresh insights, deeper knowledge and new connections. The impact of the NCHN Conference will be ripples of innovation and solutions across our country, and the outcome will be more wellness in our communities!
There was a convergence of rural health leaders in St. Louis at the National Cooperative of Health Networks (NCHN) 2014 Annual Education Conference the week of June 16th. I had been getting ready for this conference for several months as I had the good fortune to be part of the conference planning committee. The volunteer group of planners spent a couple of hours a month together and a good number of hours on our own putting together the details; you can imagine how our time and focus increased as the date approached!
Over 125 rural health network leaders from a diverse variety of structures, types of members and network services came together to learn from each other. The highlight for me was to provide some of the content for the conference with my colleague, Joe Wivoda. We presented interactive and dynamic information on building meaningful and impactful collaborations, network sustainability using a systems framework, and using health information technology (HIT) for improved transitions of care.
There were many other learning opportunities at the Conference. More than five Rural Health Information Technology Network Development (RHITND) program grantees presented to their peers on topics like: implementing a rural health network care coordination service, creating a regional collaboration, making member’s health data meaningful for improvement and sustainability, network development strategic business planning, implementing an electronic population management tool as a network service and transforming member’s health care delivery through better use of data. All of these topics are opportunities for rural health networks to build their own infrastructure and capacity and to develop products and services that their members will value.
Another highlight of the conference was the Innovation Circles. We kicked off the conference by forming small groups to brainstorm and select eight topics that would be both relevant and pertinent for round table discussions; Innovation Circles, held later in the day. A cool thing happened; six Innovation Circles took place with robust discussions and meaningful exchange.
These Innovation Circles truly are incubators by bringing together smart, engaged people to share their experience, knowledge and expertise from diverse networks. This is a powerful equation for creativity and solutions. Some of the topics they discussed included: Patient Engagement and Meaningful Use (MU) Patient Portal Development, Challenges of Care Coordination Across Networks and Systems, Challenges with Rural Staffing, Data Analytics: What and Then How to Measure and Challenges Sharing Health Information Across Uncommon Electronic Health Record (EHR) Platforms. My observation was that those who participated in the Innovation Circles and the education opportunities throughout the conference took away fresh insights, deeper knowledge and new connections. The impact of the NCHN Conference will be ripples of innovation and solutions across our country, and the outcome will be more wellness in our communities!
Friday, August 1, 2014
Small Doesn’t Have to be Small
By Rhonda Barcus, Program Specialist
Recently, I had the good fortune of attending the National Rural Health Association (NRHA) 10th Annual Rural Quality and Clinical Conference in Atlanta, Georgia. I stepped off the plane to a cool 61 degrees. Now mind you, this is the middle of July in Atlanta! This was just the first in a number of unexpected pleasures for the day.
My second nice surprise came from the comradery of the folks attending. What a nice way to start the day with my friends from Alabama, including Rural Hospital Performance Improvement (RHPI) Project state partners, Jane and Bethany, and our friends from Jackson Medical Center, Jennifer and Angela. It is always a treat to spend time with such positive and motivated colleagues who continue to care and strive for the best. Thanks for letting me sit at your table even though I’m not official Alabama! It was nice to share the time with Mary Guyot from Stroudwater Associates as well.
For me, the big take-away from the conference came from a presentation by John Worden, PharmD, MS, BCPS, the Pharmacy and Laboratory Services Director at McPherson Hospital in Kansas. He discussed the amazing things that rural is capable of and that “small doesn’t have to be small.” He shared a concept that he uses with the hospital pharmacy—to run his department as an “enterprise.” He works to think Big and lead Big and to really focus on being at the forefront of innovation rather than waiting to be told what needs to be done. Along those lines, he pointed out that “rural is an entrepreneur’s dream” because the opportunities are endless, and it’s important for those working in rural to think in this way.
A second outstanding point from Dr. Worden’s presentation involved the change in practice as a result of change in health care. He shared that pharmacists are no longer just “dispensing pills,” but it is now about putting professionals at the bedside. Pharmacists are now intimately involved in patient education, which affects discharge planning, medication compliance and ultimately readmission rates and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) numbers. This change in health care is really exciting for rural since there is already a history of relationships with patients and the community. He shared his concept of “high touch service” that really encourages and supports that one-on-one relationship with the patient.
The quality conference really was a reminder to me that the BIG things really are the small things…an unexpected cool day, time with good people, a reminder of the many opportunities in rural and the importance of relationships. Oh, and how can I forget…the warm chocolate chip cookies!
Thursday, July 31, 2014
What is Driving Health IT Right Now?
By Joe Wivoda, Chief Information Officer
WARNING: The following is a rant and a plea for a change in direction in health information technology (HIT). I would love to hear what others think. What drives us in HIT? Is it regulation, the vendors, the patients, or quality?
The Centers for Medicare and Medicaid Services (CMS) just closed the comment period for the Notice of Proposed Rulemaking (NPRM) for the Meaningful Use Stage 2 delay. For many of us the biggest question about the NPRM is what does "implementation" mean in the rule? Does it mean that if the vendor is charging a ridiculous amount for the 2014 version, and we found out after the budget process was complete, we have a delay in implementation? We spend so much time thinking about ways to simplify our lives, whether it is taking advantage of a proposed rule, filing for an exception, or implementing the "low hanging fruit" of the meaningful use menu objectives. I asked myself "What is really driving us in health IT?" Or, more importantly, "What should be driving us?"
Prior to the economic collapse and subsequent American Recovery and Reinvestment Act (ARRA) of 2009, HIT was focused primarily on making incremental improvements and slowly implementing clinical systems. The "stimulus" and associated HiTECH Act provided significant impetus to hospitals and clinics (but not elder care, homecare, hospice, behavioral health, the list goes on) to fully implement and adopt electronic systems in health care. Further, money was allocated to support this effort in the form of the regional extension program and workforce development. These steps certainly moved the needle, and as of today we have 93% of hospitals that have received payment for Meaningful Use!
Achieving Meaningful Use does not necessarily mean you are effectively utilizing an electronic health record (EHR), or even that you are using it properly, but the Office of the National Coordinator for Health Information Technology (ONC) and CMS have steadily made improvements to the requirements such that we are being forced to use EHRs to benefit patients. I see so much complaining and hand-wringing over the Stage 2 requirements around patient engagement and transitions of care, even before attempts were made to reach the measures! Is it really that painful and difficult to get 5% of our patients to look at their health information electronically? Shouldn't we agree that electronically sending summaries of care for patients transferred to other facilities is the right thing to do for ALL patients, not just 10%?
I do agree there are barriers to achieving the Stage 2 objectives, but they can be overcome. Vendor performance is probably the most difficult to overcome, and that is the purpose of the NPRM that allows hospitals and clinics to delay Stage 2 or even go back to 2013 Stage 1 measures this year (assuming it goes through). We need to break the cycle of talking about how we need to implement technology, bring up barriers, react to legislation of finances, and finally make incremental changes. Those of us who work in health IT need to stop making decisions based primarily on what the government or the payers say: We need to listen to the patients!
If we focus on patient safety, patient satisfaction and quality measurement, we will not have any problem meeting the requirements for Meaningful Use or payment reform. Stage 3 of Meaningful Use will likely require even more patient engagement and quality measures, so why not focus on those now? We will improve the health of our communities and improve the financial stability of our organizations. I challenge all of my HIT colleagues to ask yourself these questions each day:
"What am I working on that will improve the lives of people in my community?"
"Are my priorities aligned with our patients?"
"What information do we need to make real improvements in quality?"
Sure, we will still need to meet the requirements of Meaningful Use, ICD-10, the Chief Financial Officer, a cantankerous physician and others, but we need to do everything through a lens that focuses on patients and quality.
Now that I am done with my rant, I have to go see if the Stage 3 requirements came out yet...
WARNING: The following is a rant and a plea for a change in direction in health information technology (HIT). I would love to hear what others think. What drives us in HIT? Is it regulation, the vendors, the patients, or quality?
The Centers for Medicare and Medicaid Services (CMS) just closed the comment period for the Notice of Proposed Rulemaking (NPRM) for the Meaningful Use Stage 2 delay. For many of us the biggest question about the NPRM is what does "implementation" mean in the rule? Does it mean that if the vendor is charging a ridiculous amount for the 2014 version, and we found out after the budget process was complete, we have a delay in implementation? We spend so much time thinking about ways to simplify our lives, whether it is taking advantage of a proposed rule, filing for an exception, or implementing the "low hanging fruit" of the meaningful use menu objectives. I asked myself "What is really driving us in health IT?" Or, more importantly, "What should be driving us?"
Prior to the economic collapse and subsequent American Recovery and Reinvestment Act (ARRA) of 2009, HIT was focused primarily on making incremental improvements and slowly implementing clinical systems. The "stimulus" and associated HiTECH Act provided significant impetus to hospitals and clinics (but not elder care, homecare, hospice, behavioral health, the list goes on) to fully implement and adopt electronic systems in health care. Further, money was allocated to support this effort in the form of the regional extension program and workforce development. These steps certainly moved the needle, and as of today we have 93% of hospitals that have received payment for Meaningful Use!
Achieving Meaningful Use does not necessarily mean you are effectively utilizing an electronic health record (EHR), or even that you are using it properly, but the Office of the National Coordinator for Health Information Technology (ONC) and CMS have steadily made improvements to the requirements such that we are being forced to use EHRs to benefit patients. I see so much complaining and hand-wringing over the Stage 2 requirements around patient engagement and transitions of care, even before attempts were made to reach the measures! Is it really that painful and difficult to get 5% of our patients to look at their health information electronically? Shouldn't we agree that electronically sending summaries of care for patients transferred to other facilities is the right thing to do for ALL patients, not just 10%?
I do agree there are barriers to achieving the Stage 2 objectives, but they can be overcome. Vendor performance is probably the most difficult to overcome, and that is the purpose of the NPRM that allows hospitals and clinics to delay Stage 2 or even go back to 2013 Stage 1 measures this year (assuming it goes through). We need to break the cycle of talking about how we need to implement technology, bring up barriers, react to legislation of finances, and finally make incremental changes. Those of us who work in health IT need to stop making decisions based primarily on what the government or the payers say: We need to listen to the patients!
If we focus on patient safety, patient satisfaction and quality measurement, we will not have any problem meeting the requirements for Meaningful Use or payment reform. Stage 3 of Meaningful Use will likely require even more patient engagement and quality measures, so why not focus on those now? We will improve the health of our communities and improve the financial stability of our organizations. I challenge all of my HIT colleagues to ask yourself these questions each day:
"What am I working on that will improve the lives of people in my community?"
"Are my priorities aligned with our patients?"
"What information do we need to make real improvements in quality?"
Sure, we will still need to meet the requirements of Meaningful Use, ICD-10, the Chief Financial Officer, a cantankerous physician and others, but we need to do everything through a lens that focuses on patients and quality.
Now that I am done with my rant, I have to go see if the Stage 3 requirements came out yet...
Monday, July 14, 2014
MN eHealth Summit: An exciting change in HIT direction
By Joe Wivoda, Chief Information Officer
In June, Minnesota held its annual eHealth Summit in Minneapolis, and fortunately I was able to attend. REACH, the federally designated Health Information Technology (HIT) Regional Extension Center (REC) for Minnesota and North Dakota, had a booth that I was able to staff, which is something I really enjoy. It gives me the opportunity to talk to new people, and I jump at the chance!
Most conferences I attend are focused on rural, except perhaps the Health Information Management Systems Society (HiMSS) conference (more about that later: some very exciting rural HIT news coming soon!!!). The eHealth Summit mostly had urban and integrated delivery network attendees, with rural being in the minority. During my presentation I asked how many people were rural and a few hands went up. Interestingly, most of the hands were from folks who work at other stops along the continuum of care besides hospitals and clinics. There were behavioral health, home care, school nursing, dentistry and elder services represented. This is very exciting! These providers have been left out of the Meaningful Use program, and do not receive incentives or get REC assistance, but they see the value in HIT and are very quickly adopting electronic health records. The eHealth Summit was always a good opportunity to see what the Big Systems were up to in HIT, but now the entire spectrum of health care services is at the table.
Some of the most interesting presentations and discussions involved non-hospital and non-clinic providers. For example, I attended a standing-room-only presentation on Behavioral Health IT. The conversation quickly turned into a sharing and learning experience for the room of over 100 attendees. Some of the attendees were from chemical dependency treatment centers, and they shared their concerns for CFR 42 Part 2: Confidentiality of Alcohol and Drug Abuse Patient Records compliance, while some mental health providers discussed the difficulties of finding an electronic health record (EHR) that is designed for behavioral health and that can do billing well.
Sure, there were a number of presentations from hospitals discussing how they are putting in the infrastructure for exchange or how they engaged staff in the EHR implementation. It was more interesting for me to see providers that are not participating in the Meaningful Use program to be rapidly implementing EHRs and learning from their hospital and clinic counterparts. This is a fantastic development for HIT, and more importantly, for patient care.
Now if we can just get everyone to start exchanging information and talking to each other.
In June, Minnesota held its annual eHealth Summit in Minneapolis, and fortunately I was able to attend. REACH, the federally designated Health Information Technology (HIT) Regional Extension Center (REC) for Minnesota and North Dakota, had a booth that I was able to staff, which is something I really enjoy. It gives me the opportunity to talk to new people, and I jump at the chance!
Most conferences I attend are focused on rural, except perhaps the Health Information Management Systems Society (HiMSS) conference (more about that later: some very exciting rural HIT news coming soon!!!). The eHealth Summit mostly had urban and integrated delivery network attendees, with rural being in the minority. During my presentation I asked how many people were rural and a few hands went up. Interestingly, most of the hands were from folks who work at other stops along the continuum of care besides hospitals and clinics. There were behavioral health, home care, school nursing, dentistry and elder services represented. This is very exciting! These providers have been left out of the Meaningful Use program, and do not receive incentives or get REC assistance, but they see the value in HIT and are very quickly adopting electronic health records. The eHealth Summit was always a good opportunity to see what the Big Systems were up to in HIT, but now the entire spectrum of health care services is at the table.
Some of the most interesting presentations and discussions involved non-hospital and non-clinic providers. For example, I attended a standing-room-only presentation on Behavioral Health IT. The conversation quickly turned into a sharing and learning experience for the room of over 100 attendees. Some of the attendees were from chemical dependency treatment centers, and they shared their concerns for CFR 42 Part 2: Confidentiality of Alcohol and Drug Abuse Patient Records compliance, while some mental health providers discussed the difficulties of finding an electronic health record (EHR) that is designed for behavioral health and that can do billing well.
Sure, there were a number of presentations from hospitals discussing how they are putting in the infrastructure for exchange or how they engaged staff in the EHR implementation. It was more interesting for me to see providers that are not participating in the Meaningful Use program to be rapidly implementing EHRs and learning from their hospital and clinic counterparts. This is a fantastic development for HIT, and more importantly, for patient care.
Now if we can just get everyone to start exchanging information and talking to each other.
Thursday, July 10, 2014
The Center’s Workplace Wellness Program: Wellness-a-thon
By Kim Nordin, Program Coordinator
The National Rural Health Resource Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities. That, in a nutshell, is what we work for every day at The Center. It’s a no-brainer that we would also work to sustain and improve the health of ourselves. Workplace wellness programs are linked to greater productivity, less sick leave, and a reduction of long-term health care costs. And… they’re FUN! And fun has been linked to employee retention, overall happiness and morale. The Center started a workplace wellness program about three years ago, but with only about 20 percent of our staff still participating, we were in need of a revamp.
This spring, we rolled out our new workplace wellness program. We call it, “Wellness-a-thon.” The goal was to come up with something that everyone could participate in and something that would encourage us all to work toward wellness. We “walk” across the nation, by individually earning “miles” for various activities from four different categories each week. Our categories are:
- Fitness/Exercise
- Mental Health/Mind-Body
- Safety/Preventative Health
- Nutrition
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Location goals for our 2014/2015 Wellness-a-thon |
Each month, we focus on a different category, and offer bonus “miles” for each person who completes the weekly challenge. These challenges are to get people to try something new, to get co-workers to engage in something together, and to consciously work on things to make us healthier. Examples of weekly challenges are, “No high fructose corn syrup this week,” or “Always use the stairs this week” (our offices are on the 4th floor), or “Workplace humor week - send a co-worker something funny” or “Get your flu shot.” We’re also bringing in quarterly speakers to present wellness topics at our staff meetings.
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Shannon from Whole Foods Co-op in Duluth presented on nutrition and produce tips at a staff meeting |
One way to make our program more fun and interactive was to find reasons to gather as a team. We celebrated National Women’s and Men’s Health Weeks in May and June with a healthy food potluck and daily lunch walks on the lake walk. Just yesterday, 10 of us participated in a 5K walk/run fundraiser for our local YMCA.
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| Casual Friday, taking a walk to celebrate National Men’s Health Week. I look shorter than I actually am here. I brought my dog, Truman, to work that day. Fact: Dog friendly workplaces make employees happier and more productive (and I can say, I’ve honestly never worked anyplace where the staff was as productive and happy as they seem at The Center. It must be due to the fact that we allow dogs and our fun wellness program!) |
It isn’t “all work, no play” around here. We reward each person with a gift card (to a place where something wellness-related can be purchased) once they reach a milestone (130 miles, up to four milestones per year). We are also rewarding ourselves with a wellness activity we can all do together. This month, we are planning to rent bikes to take a group bike ride on our boardwalk together!
I’m proud of our new wellness program. We currently have over 90% of our staff participating in the Wellness-a-thon, and 15 out of 19 of us have reached our first milestone in three months. Over half of us walked or ran in a 5K together, and we’ve collectively “walked” over 3,000 miles in three months (with each staff person able to earn up to 20 miles per week)!
One of my favorite things is when I overhear a couple of coworkers planning to take a walk together over lunch, or when someone sends me an idea for a challenge or a staff meeting. It tells me that people are engaged and invested in their health, which is what our wellness program aims to stimulate. It’s the little things that really add up when you’re talking about health and wellness, and I know The Center’s passion, diligence and enthusiasm will keep our workplace wellness program alive!
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Our Sidewalk Shuffle 5K teams, "Rurally Fast" and "Rurally Slow Centerites," minus Sally Buck, who was running over after a webinar |
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