November 2018

Thoughts From Our President

I had a recent discussion about the impact of mergers and acquisitions on community hospitals and wanted to share some observations and recommendations.

While there are specific reasons in each case, the most common justification for a hospital giving up independence centers around financial pressure, access to capital and the opportunity to be part of integrated clinical networks to expand or maintain services for the community. However, it has been our observation that in most cases, within three years, the outcome is loss of access to some clinical services, with most community hospitals experiencing some regret.

For those in a position to influence the decision process, I strongly recommend your hospital negotiate “information systems independence.” When such a transaction occurs, one of the first actions is to convert your EMR to the host hospital’s EMR. While often done in the name of efficiency, these usually have a high cost that isn’t justifiable in pure economic terms. Rather, it becomes extremely difficult to separate if your hospital wants to return to an independent status. Further, the host hospital now has all the information for marketing services to your community, effectively keeping your hospital hostage to the new relationship.

In most cases, the clinical goals of exchanging patient data can be accomplished via interfaces and the evolution of interoperability standards makes wholesale EMR “rip and replace” a poor financial decision. In many cases, the volume of information going from your hospital to the larger hospital is so small that when you factor in the usually higher IT costs associated with the new system, you might find it would be less expensive to hire an HIM professional to manually enter data directly into their EMR than fund the increased costs. In our observation, the one-time costs (both direct and indirect), the increase in ongoing IT expenses, as well as the disruption, are not justified on a financial basis.

We realize combining general financials, payroll and ERP systems is often necessary and can make economic sense, but the larger costs and efforts associated with converting EMRs is worth careful evaluation. Were it my hospital, I would advocate for maintaining our EMR and carefully evaluating the clinical necessities versus the costs before launching into such a large project, which is very difficult to reverse if your organization so chooses.

If you would like to discuss further, please contact me at jhaffty@navinhaffty.com.

John Haffty, President
Navin, Haffty & Associates

Highlights from MEDITECH’s Physician/CIO Forum

Last month we had the privilege of attending MEDITECH’s Physician/CIO Forum and wanted to share a few highlights. While we can’t do justice to all the presentations in this space, we would encourage you to go to MEDITECH’s website and view those presentation that are of interest to you. Links to presentations can be found here under Education Sessions.

There were two presentations that stood out as relevant to our readers.

First was “Unleashing the EHR Revolution” from Taylor Davis of KLAS featuring their study “Creating the EMR Advantage, The Arch Collaborative EMR Best Practices Study.” Much of his presentation focused on the science of motivation and how highly motivated users embrace change in EMRs. Key highlights:

• 43% of physicians report overall dissatisfaction with their EMR experience. The software vendor or amount spent on information systems does not correlate to satisfaction
• He referenced Daniel Pink’s book “Drive” and its theory of keys to success:
  • Autonomy — The desire to be self-directed. It increases engagement over compliance
  • Mastery — The urge to get better skills
  • Purpose — The desire to do something with meaning and importance
• He aligned these points with the following keys to success for satisfied physicians:
  • Successful organizations invest in initial and ongoing EMR education. Organizations that spend six or more hours in training classes conducted by other clinicians experience higher satisfaction. He also noted their surveys show physicians want more training, not less training, contradicting a common notion
  • Personalization that allows physicians to quickly find data or review a chart are most powerful in improving physician satisfaction
  • Successful organizations have built a culture of IT service and user empowerment. They focus on solving problems and not blaming the software

The Arch Collaborative is KLAS’s initiative to identify and share best practices to improve physician satisfaction and all providers are invited to participate. There are significant benefits to joining, including access to a physician satisfaction survey tool that allows your hospital to benchmark against all others and provides actionable feedback based on the findings from the survey. There is no cost to first time participants who want to measure and compare results with the other 150+ organizations that are already participating. (If you want additional data and/or access to additional tools in their toolset, there may be a cost.)

The other significant presentation was “Burnout, Buzzwords and Breakthroughs” by Hoda Sayed-Friel, MEDITECH’s Executive Vice President. Click here to view her full presentation. She shared details on many exciting enhancements to their EHR, many of which were on display during the Forum. Click on the following links to access the Forum presentations on these topics:

• Virtual Assistant: A Proof of Concept – In collaboration with Nuance, MEDITECH is integrating voice commands into the EHR to help streamline physician efficiency. Examples include retrieving results, chart search, current medications list, and queuing up orders.
• Computer-Assisted Physician Documentation Use Cases – Computer-assisted physician documentation can help create richer documentation, as well as improve coding and care gaps.
• Expanded Standard Content – MEDITECH recently added standard content for specialties such as behavioral health, ENT and orthopedics, with more in process.
• EHR Excellence Toolkits – MEDITECH continues to add to these. Presentations included the Opioid Management toolkit, Heart Pathway toolkit and Diabetes Management toolkit. Further, to help implement these toolkits, MEDITECH plans to offer professional services to roll these out in your hospital.
• Population Health – MEDITECH is looking for early adopters for their Expanse Population Health suite in collaboration with Arcadia.io. The new offering will include risk scores, claims, and utilization-based data assets embedded within patient charts, widgets, and Business & Clinical Analytics.
• Patient Portal/Consumer Based Enhancements – MEDITECH has added patient questionnaires and bill pay to their portal. Online check-in, online appointment scheduling, pre-registration and consent forms are in development.
• Interoperability – CommonWell Health Alliance will be MEDITECH’s platform for interoperability and MEDITECH is the first vendor to leverage FHIR APIs to exchange records. MEDITECH is including this as part of hospital’s current maintenance fees so there will be no additional costs nor any per transaction costs. NHA wants to note that other major EHR vendors are charging both one time and per transaction fees. Hoda also referenced their Greenfield initiative.

Finally, thank you to our clients and friends who attended our welcome reception the evening before the Forum, co-hosted with our friends from CloudWave and Forward Advantage. Click here to see photos from that evening.

Canadian Corner

“Not All Meds Get Along” was the theme for Canadian Patient Safety Week (October 29 – November 2). MEDITECH tied into this theme and used the week to promote some of the capabilities of their software that directly impact and improve patient safety. This theme coincided with our observations that Canadian hospitals have an impressive patient centered focus of care. Unlike the U.S., the Canadian health system is not driven by the needs to collect and transmit lots of information for billing and reimbursement purposes. However, we have been surprised that Bedside Verification (BV) is not widely implemented in Canada. This month we wanted to highlight MEDITECH’s BV software, which has made a significant difference in reducing medication errors and improving patient safety in the U.S.

Using barcode technology and single dose packaging, nurses verify the patient is getting the medication ordered for them. This has resulted in a significant decrease in serious medication administration errors such as giving one patient the medication intended for another, as well as identifying medications ordered but not administered. This process has also highlighted less serious errors, such as medications administered later than ordered. An important tangential benefit has been that real-time information regarding the actual time a medication is administered is now part of the MEDITECH’s EMR, allowing physicians and other clinicians to make more informed decisions on evaluating how medication therapies are working.

Another significant benefit has been the elimination of duplicate steps in the documentation process, saving nurses valuable time. One additional key point is that BV also applies to blood transfusions.

Most importantly, this software is available on every MEDITECH platform: MAGIC, C/S, 6.x and Expanse.

In August, MEDITECH posted a story on preventing medication administration errors with BV.

If you’d like to discuss further, contact your MEDITECH representative or NHA at info@navinhaffty.com.

Here are some tools and resources offered by MEDITECH that you may find helpful in keeping your patients safe and empowering them to openly communicate with providers.

• Hear how MEDITECH’s Point of Care feature gives more resources to nurses and therapists. This is a video on how their integrated, web-based EHR enables you to see the complete picture of care, no matter where your patients receive care. Using smartphones, clinicians can work the way they want to work, keeping their focus on the patient instead of on the technology.
• Prevent medication administration errors with MEDITECH’s integrated BV. With MEDITECH’s BV, clinicians can incorporate barcode-assisted medication administrations into their workflows. MEDITECH’s recommended best practices help you to avoid workarounds and reduce the risk for dosage errors.
• Read how MEDITECH and DrFirst have teamed up to integrate medication history into South Okanagan’s EHR. DrFirst Healthcare Innovations, Inc. recently announced South Okanagan General Hospital (Oliver, British Columbia) has deployed MedHx, their electronic patient medication history service, integrated within the hospital’s MEDITECH EHR.
• Making patient safety personal. Have you seen MEDITECH’s It’s Personal video? This blog posting from Marijo Carnino, MEDITECH Client Services Director, talks about why she is committed to making patient safety a priority.
• MEDITECH is expanding the EHR Excellence Toolkit program to the Canadian market. MEDITECH is researching Canadian clinical practice guidelines and toolkit development is currently underway. For more information on the EHR Excellence Toolkit Program, please contact MEDITECH’S Lisa Bourgeois.

Market Share Update

Healthcare Growth Partners, an investment banking and strategic advisory company, recently published the following information on EHR market share in the U.S. We think it is interesting that many perceive MEDITECH as far behind Epic and Cerner, whose numbers include hospitals running the older Siemens systems they purchased a few years ago. However, the gap between the three top vendors is statistically small. Further, we are pleasantly surprised by how well MEDITECH fares in the ambulatory EHR category.

Retirement Announcement – Brenda Fallon

It is with mixed emotions that I share with you the news that Brenda Fallon, NHA Executive Director, retired in October. Brenda began her career at Cape Cod Hospital, Hyannis, MA where she held multiple nursing positions from staff roles to nursing management. She joined me at a previous consulting company in 1995 and has been consulting to hospitals in the MEDITECH community ever since.

Brenda was the first clinical consultant I worked with and I learned far more from Brenda than she can imagine. Her dedication to her colleagues, her clients and her profession elevated all of us. She was the first nursing informatics leader at NHA where she developed and managed our nursing service line, providing training, direction and professional development for our nursing informatics consultants. Brenda built a strong relationship with many clients who had great respect for her guidance and wisdom. Further, Brenda helped NHA build its reputation within MEDITECH, working closely with key staff at MEDITECH. In the past few years, Brenda led our collaboration with MEDITECH’s development division with our combined efforts on testing Expanse pre-release.

I want to thank Brenda for all she has done to make NHA the organization we have become.

John Haffty

Quick Notes

• Firelands Regional Medical Center of Sandusky, Ohio, which implemented Expanse in 2017 with the assistance of NHA, discusses how MEDITECH’s One Query Theory and unified review process helped their Oncology Center eliminate silos and improve patient safety. To see the video, click here.
• Related to oncology, here is a link to MEDITECH’s white paper on the benefits of integrated cancer management.
• Congratulations to Helen Waters, MEDITECH Executive Vice President, on her recent election to the CHIME Foundation Board. Click here for more details.
• Chris Policano, MEDITECH Regional Sales Director, and John Haffty, President of NHA, address the topic of EHR value and sustainability in this newly released podcast.
• MEDITECH’s Patient and Consumer Health Portal receives Canada Health Infoway certification renewal. Click here for more details.
• Three mental health facilities in Ontario create hub with shared MEDITECH EHR. Click here to read more.
• Congratulations go out to two NHA clients for their recent Go LIVEs on the Expanse platform:
  • Woman’s Hospital of Baton Rouge, Louisiana migrated from 6.0 to Expanse (Web Acute and Web Ambulatory).
  • East Tennessee Children’s Hospital of Knoxville, Tennessee migrated from 6.0 to Expanse.
• NHA is pleased to announce we have been selected by the following organizations for their upcoming projects:
  • Avera Health, Sioux Falls, South Dakota – 6.1 Implementation Support
  • Campbell County Memorial Hospital, Gillette, Wyoming – Optimization Efforts
  • Frisbie Memorial Hospital, Rochester, New Hampshire – Report Writing
  • Lehigh Valley Hospital-Hazleton, Hazleton, Pennsylvania – PI (MU) Reporting for 2018
  • RML Specialty Hospital, Hinsdale, Illinois – Clinical Quality Documentation Optimization

KLAS Update

We would like to share recent commentary collected by KLAS from a CMO at an organization where we are providing services:

“Navin Haffty was our implementation partner, and it was absolutely helpful to have them for the amount of physician training that was necessary. I don’t know whether they brought in expertise that was beyond our native staff’s expertise, but the firm brought in resources that we couldn’t have found otherwise. They knew what they were doing. Working with Navin Haffty was absolutely necessary for us to get through the implementation.” – CMO

Please note selected commentaries may not represent the whole of provider sentiment related to this product or service. For a complete view, visit KLASresearch.com.

Calendar of Events

Upcoming MEDITECH webinar:

MEDITECH Expanse Revenue Cycle: Every Claim Has a Story
November 15, 2:00 PM (EST) | 60 min.
Learn how MEDITECH’s end-to-end integration can help you to minimize lost charges, reduce claim rejections, and improve employee productivity.

NHA is Hiring

If you are interested in consulting, consider joining us. NHA continues to need excellent MEDITECH specialists and for the fifth year in a row, we have been named to the “Best Places to Work in Healthcare” by Modern Healthcare magazine.

We are currently looking for those with MEDITECH Expanse/6.1 implementation experience, with a special interest in clinical leads/project managers, and specialists in the Ambulatory and Revenue Cycle Group (RCG) applications.

Additionally, we are looking for Canadians with MEDITECH implementation experience as clinical leads/project managers for Canadian based Expanse/6.1 projects.

If you are interested, please contact us at recruiting@navinhaffty.com or call us at (855) 309-9334. See what positions are currently available by visiting the NHA Careers page.

Please note we are only able to consider those able to travel up to 80% of the time (also employees from MEDITECH and our clients cannot be considered).

Client Job Board

If you are interested in exploring new positions at other organizations, visit the client job board section of our website. This is a free service of NHA to the MEDITECH community. Currently, there are many postings from MEDITECH organizations. If you or a colleague are interested, check out what’s open.

If you would like to include your organization’s listing on the NHA website, please email Katie Kelly at kkelly@navinhaffty.com. Please note that as this is a courtesy to the MEDITECH community, we will not accept postings from recruiting companies.