One foggy morning last week, I made my way to the Georgia State Capitol for a Technology Association of Georgia (TAG) Health event relating to the intersection of healthcare IT and state legislation. Little did I know that the state’s government is somewhat unaware of the benefits HIT can bring, both to the patient in terms of more coordinated care and improved quality outcomes, and to the state in terms of job creation and revenue.

I also was not aware that, when it comes to moving from paper to electronic health records, some doctors take a bit more convincing than others. And when I say “a bit,” I really mean they may need to be gently dragged kicking and screaming into the digital age. At least that’s the impression I got at the TAG event after speaking with Sherri Mesquita, an EMR/EHR Consultant – Project Manager, at Community Health Systems Inc. She works with ambulatory clinics and hospitals to help them establish strategy around meeting Meaningful Use deadlines, and has developed a keen sense of when doctors may need an extra “bit” of convincing.

What do you think the biggest challenge is for doctors when it comes to accepting that it’s time to change – to make the move from paper to electronic health records?
I believe the biggest challenge is that in order for them to understand how the EHR experience will be beneficial, you have to get them to actually buy into the idea of an EHR. Doctors want to know that the ROI on their investment is going to bring increased revenue to the practice/hospital, provide more efficiency in the practice, and above all provide the best possible quality of care while keeping costs down.

Physicians talk to other physicians about these newer technologies. If they see their cohorts are doing well, and consistently discuss the positive attributes of the EHR software, other physicians are more likely to follow them in adoption – depending on how much money, time and staff resources are currently available.

In addition, some physicians have already implemented an EHR system in the past and, unfortunately, did not get the right information or customer support, or the vendors were not trained in how and which system works best for that specific clinic. Therefore, those doctors have not had a positive experience in the past, and even went back to using paper after spending thousands of dollars on a system that either was not customizable or did not integrate well with the other practice management or billing programs.

In your experience, when does the light bulb go off in a doctor’s mind – when do they realize that it will truly be to the benefit of their practice, their bottom-line and, ultimately, their patients?
There needs to be a lot of hand holding in the beginning stages, and education is key to them seeing what benefits to the practice an EHR can be. Other doctors again are a very important and vital aspect to implementing an EHR. They bring actual experience and important testimony for the process of going electronic.

Last year, I worked on a program with the Rockdale Chamber of Commerce in Georgia to provide a “transfer of knowledge to doctors” by educating them on the important benefits of implementing an EHR, as well as adopting “Lean” and “Continuous Improvement” in their practices. The purpose of the CI/Lean techniques is to achieve unity of purpose to identify and sustain improvements to patient critical needs.

How do you help them reach this point? What examples do you typically give to show them the value of an EHR?
Though the initial costs and implementation challenges are considerable, delaying implementation today may create additional resource drains tomorrow. The availability of an EHR may soon be a minimum standard for new physicians, public and private payers, and patients.

• EHRs are an essential component of reform-related efforts such as the Patient-Centered Medical Home (PCMH).
• Practices that do not meet Meaningful Use criteria will face Medicare penalties in 2015.
• A certified, operating EHR will be essential to participation in both public and private pay-for-performance programs expected in the future.
• According to the Deloitte Center for Health Solutions, 42 percent of consumers are interested in establishing an online connection to their physicians through a personal health record and 55 percent of consumers want the ability to communicate online with physicians.

Can you give any specific examples of EHR implementation success stories? Or perhaps from the other viewpoint – an example of a doctor or practice that absolutely refused to make the transition, and why?
Most recently, I have worked with ambulatory practices in Toledo, Ohio – Catholic Health Partners. The doctors and nurses fought it every step of the way, and even threatened to leave the practices. It was a very hard adjustment in the beginning, and for me as a consultant to come in and change the workflow processes and implement new software rollouts was such a challenge.

I was able to work one on one with the clinical staff and help them to understand they had someone there to guide them through the entire process. They definitely demonstrated gratitude when they could see the end result after two weeks of being live with the software. The practices needed to make sure they scheduled their patients at a 50-percent reduction rate to accommodate the change in software for the first two weeks.

The practices gradually implemented the EHR software of Epic, which resulted in maintaining positive patient-physician relationships and fostering the sharing of medical information. After demonstrating proficiencies, the physicians and other clinical staff were comfortable with the new EHR systems and even say they could then see the potential benefits of the new changes.

One thing that I love about this industry is its willingness to collaborate, and I’m not just talking about collaborative care. I’m talking about healthcare IT’s propensity to brainstorm new ideas as the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20 minutes later you’re going to have a new idea related to care delivery, product development or possible partnership on your hands. It gets even more prolific when editorially minded marketing folks like me are added to the mix.

I’ve been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month in “Finding an EMR Job Champion,” I chatted with Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT certification programs with training and jobs. Some of you may have noticed several comments left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at Cincinnati State – a community college in the HITECH College Consortia; project manager at the Kentucky Regional Extension Center; and creator of the HITECHWorkforce.com, a free resource to help students enter the HIT work environment.

In his comments, he advocates for a mentor-protégé program: “Students still need some more help finding jobs. What I think needs to happen is a “Mentor/Protégé” model. That is, pairing students with industry professionals who can mentor them into the industry. I’ve passively done that…to success. I think that will work.” He later followed up with the news that he hopes to work with HIMSS, which is developing a similar program, to get this model off the ground.

I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to find out just how he plans to jumpstart it:

It seems as if you’ve been kicking this idea around for a while. How did it come about?
Being with the extension center, I’ve mentored a handful of people along the way, and I think there needs to be a more structured process so that students coming out of these [HITECH College Consortia] programs who want to be mentored have a place to go, they know how to get and stay engaged in the process. I think that there is with HIMSS, but I don’t think it’s really been tightly coupled with the workforce development program.

When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really excited to talk with me, and pointed me to HIMSS’ career development page to look around and see what they have out there. I’m thinking of how we can connect [what they’re already doing] into the workforce development program within the overall HITECH project structure, so that we can connect students who come out of these programs with their local HIMSS chapter, which could then pair them up with a mentor that’s in their region. That’s what’s really missing. That’s what’s really necessary to get people plugged into this profession – especially if they’re coming from outside of this profession.

HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don’t think it’s really tightly coupled. I think HIMSS recognizes this, so they’ve been developing their career development program. They’re near completion of a new, entry-level certification called the CSHIMS certification. That is something where you don’t need to have a whole lot of experience in health information technology, but you need to demonstrate some degree of knowledge in subject matter to obtain that certification. That might be a good way to help these students take the next step into the profession, when they’re looking to get a job. That could be part of the whole mentorship program concept.

Isn’t there a double-edged sword to it financially? Wouldn’t students have to become paying members of HIMSS, and then would they have to pay for certification? If they’re looking for jobs, finances might be tighter than usual.
That’s a great point. The question is, what are the costs associated with certification and becoming a member. There is a student membership discount. There’s a cost to certification, obviously, so these are things that are to be considered. That has not escaped me, so that’s going to be part of my brainstorming session. I’m going to meet up with them in Vegas when I go out to HIMSS.

One of the things I want to be able to do is make this attractive for people, particularly students, and if they have to lay out $500 or $1,000, and they’re already unemployed or they’re financially strapped, it becomes not just a double-edged sword, it becomes a disincentive.

I wonder if the vendors couldn’t get involved and offer scholarships.
It’s funny that you mention scholarships because that might be something the local HIMSS chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for students. So this might be something that the boards or the individual chapters could subsidize.

If you’re in the HITECH workforce development program, maybe HIMSS would be willing to waive membership for one year. That might be something they may be interested in doing.

This is part of the whole brainstorming session that I’m going to try to have over the next month or so. I’ll vet this through HIMSS over the next couple of weeks and hopefully we’ll come up with a good strategy by the end of February. And then we’ll start piloting it in the March timeframe.

I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development folks is coming along. It’s nice to know that one industry insider’s idea, and subsequent blog comments, might actually create job opportunity in the industry.

I’m not a big fan of reality shows, especially those that involve contestants singing, telling jokes, dancing, or anything else that could potentially result in public humiliation. I’m in the minority, of course, as this style of television programming shows no sign of abating anytime soon. It’s a worldwide epidemic, in my opinion.

I am a fan of creative marketing – applying concepts traditionally associated with one particular medium (like television) to something entirely different (like healthcare). Needless to say, the Big Break job recruitment program – you could also call them auditions – intrigued me.

In a nutshell, pre-screened candidates take part in a one-day audition process put on by recruitment firm Intellect Resources and participating hospitals. Candidates then compete to become trainers and instruct staff on the use of the sponsoring hospital’s electronic medical record system or related healthcare IT system.

Seems like a slam-dunk concept, in my opinion. Those who are unemployed get a job within their community, and also get a taste of what that popular 15 minutes of fame is like. Did I mention that candidates go through video interviews and public presentations during the daylong process?

I recently chatted with Tiffany Crenshaw, President and CEO of sponsoring organization Intellect Resources, about how the program came about and the impact it has had on its participants’ lives (and go-lives).

How did the Big Break come about?
Tiffany Crenshaw: The Big Break spawned out of a project we were working on at Mt. Sinai Hospital last year. Last fall, they were getting ready for their Epic training and called me in a panic. They were expecting to get 90 to 100 trainers, and were going to use nurses, but realized at the last minute that wasn’t a viable idea. So they called us and said, “We have to do something now – we have no budget and we have no time. And we want to do some sort of done-in-a-day type audition. What can you do?”

So we said this is right up our alley. We created a really cool event – it was at the big Marriott Marquis in Times Square. We had around 500 contestants, and they all went through a timed audition process – stressful for them, but it was still fun.

They had to go through seed interviews and get in front of cameras. They had to get in front of a boardroom of judges and do presentations. At the end of the day, we ended up with 100 trainers that worked at Mt. Sinai to help roll out the hospital’s Epic training and go-live.

So that’s really the model of Big Break. We created it as a solution for Mt. Sinai, and now other folks are getting the word about it. Ochsner Health System is our next one. We’ve got the Big Break event for them in just a couple of weeks (January 21).

Did they reach out to you?
A consultant and dear friend of mine that was actually helping them with their system selection and project planning for their Epic implementation recommended this business model, and brought us in as the vendor to run this product for them. So yes, they did reach out to us, but it was really a consultant that made it happen.

Are you an all-Epic recruiting firm?
At the moment, that’s just about all we’re doing. Through the years, we’ve worked with many other products – with McKesson, Cerner, Siemens. The demand right now is Epic, so by default we’re doing all Epic. That’s just where the demand is, and so that’s where we’re spending our time.

How have you seen this type of program impact sponsoring hospitals and surrounding communities?
We think it’s a business model that works very well for hospitals. It’s a very low-cost way to get good resources. It’s also a good marketing opportunity for them to promote the fact they’re installing an electronic health record to the benefit of their patients, and it’s a great way for them to reinvest in their own community.

At Ochsner, the idea is that this is really for the New Orleans community. They don’t like to hire outside consultants. They really want to empower and revitalize their own community.

Many of the folks that we worked with at Mt. Sinai have gone on to work at other places. Big Break was really their footprint in the door. The end result is that the consultants that come through with really good experiences.  Over 50 percent of them are now working in the industry. Mt. Sinai actually hired four full-time employees. There was a big project up in Rochester, N.Y., that a lot of the people went to after that first project. We redeployed probably 20 of them on several go-lives.

Is there an opportunity for this to work in other cities?
At our very first meeting with Ochsner’s project executive, we talked about the fact that there are several area hospitals in and around New Orleans gearing up for Epic implementations. Our original thought was, let’s do this together, but the go-live timeframes didn’t work.

It would make perfect sense if there were multiple hospitals that could do the event together, do the credentialing together, and then take people from a generic credentialing and deploy them to the individual hospitals to learn the individual builds. I think it’s a model that could be a really good collaboration.

I think one of the neatest things about Big Break is that this industry is so thin on the amount of really good resources that are out there. It’s a great way to breed new talent

You may have noticed several big businesses in the news recently capitulating to customer outrage over new and unnecessary (or completely gratuitous) fees. Bank of America made news in late 2011 when it tried to institute a $5 fee for any customer that wanted to use a debit card. Verizon made a similar move when it tried to put in place a $2 fee for payment made by phone or Web. (Really? You’re going to charge me to pay you?)

I’d even go so far as to lump Netflix’s blunderings in 2011 in with this group. First the price increase, and then the ultimately jettisoned decision to split the business into two product lines – one for DVDs and one for streaming. Though customer outrage wasn’t enough to derail the price increase, I can only assume the backlash had something to do with the decision to ultimately stay with one brand for both services.

As Erika Morphy wrote in a recent Forbes.com article, “It doesn’t take much to enrage consumers these days and while Verizon doesn’t fall in the ignominious category of [a] Wall Street bank, it doesn’t exactly engender fierce customer loyalty or devotion either, the way, for example, Apple does.”

She hit the nail on the head, in my opinion. No matter what your opinion of the Occupy Wall Street movement, I believe it has made the average US consumer more confident in their dealings with Big Business, more apt to cry foul when companies like Bank of America and Verizon try to pull more money out of people’s pockets just because they can. (I know I’m oversimplifying things here, and that these companies have seemingly valid reasons for these fees.) As any healthcare vendor will tell you, being in business is ultimately about the bottom line. So it stands to reason that Big Business will always want to get bigger.

To bring it back around to healthcare, I firmly believe that the customer’s newfound voice of “We’re not going to take it anymore” should be applied to healthcare. Consumers are patients and vice versa. At the end of the day, we all want the best care possible for the least amount of money and inconvenience. Let’s take these lessons learned in the traditionally consumer world and apply them to the patient experience.

Are you looking for a new family practitioner? Choose one that has high quality outcomes, has effectively been using an electronic medical record, is willing to explain the benefits of a homegrown personal health record, and is happy to coordinate care with your specialist two counties away. For that matter, you could make similar demands of your health insurance provider.

I know interoperability isn’t always at the top of our to do lists when it comes time to go to the doctor – often a sudden and unplanned event. If you find yourself being cared for by a doc that’s getting by with paper, become an advocate for change within that practice when the time is right.

It doesn’t hurt to start a dialogue. And as Big Business has shown us, using your voice can actually bring about better outcomes for all.

‘Tis the season to inject a bit of well-informed levity into my weekly blog post. For those of you who might stumble upon this week’s entry, I’m keeping things light.

My household is no stranger to the Occupy movement – whether it’s following the Occupy Wall Streeters in Zuccotti Park, similar protests around the country, or learning how the movement can be applied to healthcare, it’s been a topic of dinner conversation at our house for some time. In fact, my husband made his first trip to New York City a few months ago to take it all in for himself. Santa even brought him, ironically, an Occupy sweatshirt.

Though the movement seems to have died down – or least gone underground – I believe its principles should not be forgotten, especially when it comes to healthcare. I’d go so far as to say that is was one of the most impactful events/trends in 2011. It changed people’s way of thinking about our economy, our citizens, and what we believe we’re entitled to – whether that be multimillion dollar paychecks or socialized healthcare.

The #occupyhealthcare off-shoot is certainly a bit more underground, and not fully understood by some. There are several websites and tweet streams devoted to it, each with their own unique agenda. Whether you pass it off as a bunch of hippies in white coats and stethoscopes or not, I’ll tell you what the phrase means to me – the effort by those with a voice – big or small – to make quality healthcare accessible and affordable to all. I’ve seen first-hand what sort of assistance government healthcare programs can provide, and I’d like to think that everyone should at the very least have access to this sort of semi-funded care. The healthcare IT community certainly has its part to play in this effort, and fortunately we’re already seeing efforts made in this direction. I’d like to think that we’ll see more of this continue in 2012. Time will tell, of course.

So where’s the levity, you ask? Where’s the humor I promised? You know a movement has really “made” it when it becomes the subject of satire, or when active participants know how to have a good laugh at themselves. Take a look at the Occupy Sesame Street movement, or Occupy Lego Land. Who better to bring attention to financial gluttony on Wall Street than Cookie Monster?

If you happen to know of more humorous healthcare videos, please share them in the comments below. Let’s start off 2012 with a healthy dose of laughter. Happy New Year’s y’all.

I’ve blogged before about the importance of decreasing the digital divide in this country in order to truly move healthcare interoperability forward. As I mentioned last month, “Only those patients who have access to these digital healthcare technologies will begin to clamor for them at their next doctors’ visits. Only patients’ whose doctors in turn have reached out to them via email, text or social media regarding the switch to electronic medical records, development of health information exchange and the benefits to care these will hopefully bring will be ready and willing to go with the digital flow.”

When news came across my somewhat cluttered desk of Emdeon’s initiative to provide electronic health record (EHR) technology to physicians in New Jersey’s underserved communities, I first thought, “Yes! That’s what I’m talkin’ about!” Then I put on my journalist/blogger hat and thought, “Will this truly change anything in these particular communities, or is this just good PR?”

A quick bit of background: Emdeon is partnering with the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health, New Jersey Health Information Technology Extension Center (NJ-HITEC), the state’s REC, and the HIMSS Latino Community. Through the initiative, Emdeon will donate Emdeon Clinician licenses to 100 healthcare providers who practice within medically underserved areas and/or healthcare provider shortage areas, as designated by the Health Resources and Services Administration (HRSA), according to a recent Emdeon press release. The company will waive the license fee for these physicians for one year.

The same press release also mentions “EHR adoption is lower among providers serving Hispanic patients who are uninsured or rely on Medicaid, and is lower among providers serving uninsured, non-Hispanic black patients than among providers serving privately insured, non-Hispanic white patients.”

The initiative sounds like a great idea, but the one-year stipulation got me thinking (a bad habit, I know). What will these physicians, who presumably can’t really afford this technology now, do after their year is up? I reached out to Miriam Paramore, Senior Vice President – clinical and government services at Emdeon, to learn more about the ins and outs of the program.

How did the initiative come about?
Miriam Paramore: During the fall of 2010, leaders from the Office of Minority Health (OMH) and Health Information Technology issued a public, written request to health IT vendors, asking them to pay special attention to healthcare providers within underserved communities. This initiative is known as The Alliance to Reduce Health IT Disparities. Emdeon is serving as a private partner with the OMH to offer access to health IT products and services to providers within undeserved communities in New Jersey. We were thrilled to volunteer and to work within these communities.

Has Emdeon ever done anything like this before?
We’re happy to do part of this effort with HHS and it is the first time we’ve partnered with them.  We have great empathy for the challenges of the physicians in underserved communities and we want to help.

What sort of challenges do small physician practices in underserved communities typically encounter?
In addition to challenges like poverty and health disparities amongst their patient population, providers in underserved communities and smaller practice offices face expensive costs associated with on-boarding EHRs. Emdeon created the Emdeon Clinician solution as an affordable EHR “lite” solution for these small practice physicians or those working in underserved communities. They now have an affordable, easy-to-use solution that will help them to qualify for federal HITECH stimulus dollars without unnecessary disruption and expense of a full-blown EHR system.

How will you work with these 100 physician practices to ensure they are able to continue using the donated EHR after the year-long license expires?
Once the 12-month period expires, providers will be able to continue using Emdeon Clinician for only $99 per provider, per month. Emdeon usually has a $500 implementation and training fee [that, for this program,] has been discounted to a one-time fee of $200 for the providers participating in this project. This is a considerable discount and the fee would only have to be paid once. We will begin outreach to these providers in advance of the expiration date so they are aware of the opportunity to remain with Emdeon Clinician for the low fee following the initial 12-month period.

How will Emdeon work with NJ-HITEC and the HIMSS Latino Community throughout this year to ensure that these practices receive continued training and support?
Emdeon has taken the lead with managing this initiative between all partners with monthly meetings to monitor progress. We have a dedicated project manager, who has mapped a process with the internal team to assist with implementing these physicians as soon as possible. Our custom phone number (1-855-840-7120) connects interested providers directly with a dedicated clinical sales executive who can assist them throughout the enrollment process.

The NJ-HITEC and HIMSS Latino partners are assisting in the recruitment of providers who practice within medically underserved areas for this program from their vast networks across New Jersey communities. These partners are working cooperatively with Emdeon to create a strategy that focuses upon identifying and recruiting providers within underserved communities who are willing to adopt EHRs, especially those interested in qualifying for federal incentive dollars.

How many practices do you anticipate being eligible, and how many do you expect will apply?
While we aren’t sure how many will apply, the HHS OMH recognized that the counties of Camden, Essex and Passaic have the largest percentage of underserved communities. Through our collaborative efforts with the OMH, HIMSS Latino and NJ HITEC, we hope to reach many of those physicians within those counties to take advantage of the 12-month program.

How will Emdeon and its partners determine if this program is a success?
Together with our partners, we believe success will be donating all 100 licenses to providers in underserved communities. The reporting element of this project will help OMH understand the progress of EHR adoption in the context of how long implementation takes in its entirety.

So it seems that Emdeon and its partners certainly have their ducks in a row when it comes to aiding and abetting these physicians before, during and even after the program is technically over. I’ll be interested to see if this model will, in fact, be successful, and if it can be supported in other underserved areas across the nation.

For more information on participating in the program, check out: http://www.emdeon.com/newjersey/

Earlier this year I had the good fortune (and the support of my employer) to join the Technology Association of Georgia (TAG), an organization that offers interest groups for every possible IT niche you can think of. I’ve attended a few of their health society events, and at every one I’m confronted with statistics and anecdotes surrounding the dearth of qualified healthcare IT professionals in the city and surrounding areas. Much attention at these events is also given to the fact that these professionals are needed now more than ever to help smaller physician practices and larger healthcare systems demonstrate Meaningful Use and achieve associated electronic medical record (EMR) adoption goals.

I’ve commented before on the disconnect between the increasing number of healthcare IT educational opportunities being created by the government and vendors’ willingness (or unwillingness, as the case may be) to hire fresh grads. EJ Fechenda of HIMSS JobMine posed a question related to this conundrum better than I ever could have: “With federal deadlines looming, healthcare organizations need to get moving and there are a lot of job seekers out there ready for the challenge. Are there organizations or companies willing to extend opportunities to these candidates? Is there a training or job-shadowing program that can be used as a best practice for other organizations to implement? Who are the champions already doing this or willing to lead the charge?”

I may have found a champion in Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey. Wicker is also an adjunct professor at two HITECH-affiliated community colleges, teaching students who already have strong backgrounds in healthcare or IT the basics of process, analysis, redesign, installation and ongoing maintenance to prepare them for second careers in physician office EMR implementations.

He certainly seems to have a passion for the subject. “I’m devoted to the EMR,” he told me during a recent phone interview. “That’s why I started teaching, really, because I want to see that [adoption] happen so badly.”

He tells me his students are guardedly optimistic about their future job opportunities, which he believes will surge this summer alongside an expected increase in physician adoption of EMRs – six months before the deadline to qualify for Meaningful Use incentives.

As we discussed the state of the HIT job market, we both wondered if what type of organization might have a greater role to play in ensuring that graduate from programs like Wicker’s find jobs.

“We had to really battle our way to get one [software] copy from one EMR vendor,” he explains. “I wish they were more amenable to providing educational software/packages like Apple does throughout all their PCs. I know a few different schools have joined with a vendor. One place I know of is showing Vista, another is showing eClinicalWorks, and another partnered with a local hospital that happens to use Sage.

“I have a relatively limited view, but from what I can see, the vendors are not really engaged with the HITECH student development program. I think they’d probably rather do it themselves.”

“Here’s an idea that I came up with,” he adds. “I’ll throw out the RECs (Regional Extension Centers). That’s another entity that’s funded – it’s kind of their job to get the docs to convert. If they could partner with the colleges and the graduates to possibly divert some of their funding to supplementing the graduates’ income while they worked at a physician practice … So the physician, let’s say, for $5 an hour, they could hire a qualified, certified person. These people are pretty good, too. They know what it is to work. They’ve probably worked 10 or 20 years already, either in IT or in healthcare. So they’re mature employees and highly motivated. They would be great to go in and do a 6-month installation. I think it would be great for the physician if, for $5 an hour, you get somebody that would probably cost you $30 an hour somewhere else.

“Let’s say the student can get another $10 an hour supplemented from the REC or somehow through the government. So they get $15 an hour to go in there … they get four or five months of experience doing an installation and then the physician can make a decision … maybe they ultimately hire the person. That’s just a crazy idea that I had that seemed like the pieces are out there that kind of potentially could work. I sent it into the ONC a couple of days ago.”

Could the RECs have a bigger role to play in ensuring that HITECH graduates gain on-the-job experience and employment? I’d love to hear from any readers out there who may work for or with RECs . Is Wicker’s idea doable? Have we found our champion?

I’ve had the good fortune in the past year or two to watch one of my daughters’ favorite babysitters blossom into a full-time nursing student at the University of West Georgia. Not only do my girls benefit from her great bedside manner, including an infinite amount of patience, but I get an occasional inside glimpse into the world of digital medical record keeping in the greater Atlanta area.

Her training at West Georgia has taken her to Children’s Healthcare of Atlanta – Egleston, Wellstar Cobb and Austell, Fayette Piedmont, Tanner Medical Center and Gentiva Healthfield Hospice. She graciously offered to share her rookie’s perspective on the electronic medical records – including SCM/Quest (Allscripts Sunrise Clinical EHR system) and Meditech – she has used at several of the facilities she has trained in.

How long have your healthcare training facilities had EMRs in place?
All except Gentiva Healthfield Hospice – in-home hospice care, for the most part, sticks with paper charting. If they were to make the switch to an EMR, they would have to have access to a central database from their personal computers/iPads/Blackberries, etc. All others have had some sort of electronic database for at least five years.

How intuitive did you find them to be in your first training sessions/rounds?
Once I had been trained in the first system I encountered, the rest seemed very user-friendly. They have been in use long enough now that they are efficient and fairly self-explanatory.

They all allow an employee to cluster patient care and spend enough time with the patient because the time stamp on documentation can be changed to the time that the intervention was completed. For example, I could complete a full assessment on a patient, bathe them and administer their medications without having to document in the computer every few minutes. I could just open their EMR after completing their care and add the correct time stamp on my documentation.

What were the easiest to use, and what were the most difficult?
Meditech was the most difficult to use, perhaps because I had limited access as a student. It was difficult to find complete admission notes and patient histories.

Speaking from a “rookie’s” perspective, what would you tell vendors of these systems to better their products?
Add a patient verification requirement before each documentation session, i.e. each set of vital signs, medications given, etc. (Something simple, like a box with the patient’s name and DOB and an “Ok” button)

Did your supervisors express any enthusiasm or dissatisfaction with any particular systems?
All expressed enthusiasm, but they also were concerned any time a system was to be updated with even minor changes. Fayette Piedmont uses one EMR system for Labor and Delivery, and a completely different system for the rest of the hospital. This means, for the staff, that a new baby’s records have to be re-entered into a new system once they are discharged from labor and delivery and admitted to the NICU or postpartum unit. It also means the pharmacy has difficulty accessing vital information when, for instance, they need to know a baby’s weight to send the appropriate dose of medication to the NICU.

How aware are you of post-implementation training that goes on with EMRs, based on the facilities you’ve trained at? Do your supervisors ever mention it?
Once an employee is hired, they usually must display proficiency with the charting system within a specified training period. When Fayette Piedmont updated SCM/Quest, they did not retrain each employee, but they did send out a packet with a detailed description of the changes. From what I have seen, the older nurses who may have preferred paper charting at one point do not seem to have any problems with the electronic charting.

Have you been made aware of any increase/decrease in positive clinical outcomes as a result of physicians/nurses using these systems? Any examples you feel comfortable sharing?
The major changes to these systems each time they are updated usually involve the addition of safeguards. For example, the newest version of SCM/Quest has the patient’s name, weight, room number and allergies on every page of the charting system, and in multiple locations on the page.

For the employees who pay attention, this has reduced many documentation errors. There is also an embedded link to drug guides in every electronic medication order with explicit instructions and safe dose ranges. For the employee who knows these features are there, they are a tremendous help, and they do serve to protect the patient. It is still possible to document in the wrong patient’s chart, without realizing it, in any system.

Needless to say, it will be interesting to see how her experience with EMRs changes as she continues her studies and then moves into the professional world of nursing, which will likely coincide with healthcare facilities continuing to move through the various stages of Meaningful Use.

Stay tuned for next week’s post, in which I’ll profile an EMR educator, and find out what other students are facing when it comes to EMR training. In the meantime, what sort of healthcare IT-related challenges will our new workforce face in the coming year? Please share your thoughts in the comments below.

I’ve always got my eyes open for news of healthcare facilities marketing their healthcare IT systems to patients. To me, explaining the new high-tech gadgetry at check-in and the new computers/laptops/tablets in each exam room goes a long way towards making patients feel more comfortable before, during and after a visit to the doctor or even hospital.

I came across two recent examples of patient outreach that I think are great ideas, and would certainly get my attention, and perhaps even get me to consider switching providers.

The first is an ad from Martin Memorial Health Systems in Florida, promoting their transition from paper-based records to an electronic medical records system (Epic, if you must know.) News of the implementation in a recent HISTalk post mentions that the ad is part of a campaign announcing the system’s transition starting in December. I couldn’t find any mention of the campaign, or the transition, on the hospital’s website, so I’m not sure where exactly this ad will appear – hospital hallways, local newspapers, etc.

The second comes from Kay Gooding, Project Director of the Region D Health Information Technology Consortium at Pitt Community College. She alerted me to HealthIT.gov’s Campaign Toolkit – a variety of online resources that organizations can use to educate the general public about healthcare IT. The toolkit includes a short video (see below) on Ensuring the Security of Electronic Health Records. I could see this being played in hospital lobbies, doctor’s waiting rooms, or even embedded in some sort of physician-sponsored new patient welcome site, which could also house medical history/personal health records, consent and privacy forms, and the like.

I’d be interested to know from a marketing perspective, whether patient-facing educational campaigns result in an increase in new patients who are attracted to more technically advanced facilities, and if these same patients experience better clinical outcomes and satisfaction as a direct result of new HIT systems. If you hear of anything, let me know.

There’s a lot of talk in the healthcare industry right now about bringing health management tools to the consumer. Whether it’s apps for your iPhone or iPad, games to play on your Wii, or free-standing health-and-wellness kiosks at your local pharmacy, digital applications seem to the delivery method of choice right now. I think those of us in the healthcare IT industry sometimes take for granted that not everybody in the US has a smartphone, computer or even Internet access, which to me always begs the question: How great are these bright and shiny health apps if the populations that need them most don’t have access to them? And aren’t Meaningful Use and Accountable Care incentives/payments targeted towards government-sponsored healthcare recipients? The most likely patient population to NOT have reliable access to the Internet?

It’s this concept of a digital divide in healthcare that I am starting to believe will truly bend the curve when it comes to absolute interoperability – the secure sharing of information between patient, provider, payer, vendor, government, etc., anytime, anywhere. Only those patients who have access to these digital healthcare technologies will begin to clamor for them at their next doctors’ visits. Only patients’ whose doctors in turn have reached out to them via email, text or social media regarding the switch to electronic medical records, development of health information exchange and the benefits to care these will hopefully bring will be ready and willing to go with the digital flow.

I was intrigued by a recent news story on NPR the other morning that detailed a recently unveiled government plan – the Connect to Compete Initiative – to offer cheaper broadband access and computers to low-income families. The story pointed out that “about one-third of Americans – that would be 100 million people, give or take – do not have Internet access in their homes.” (I’d be interested to know how many of that population are on Medicare or Medicaid, or have no insurance at all.) Participating companies will offer broadband service to eligible families for $10 a month, while others will offer computers for as little as $150.

Further investigating into the story dug up a more detailed report from Reuters, which explained that eligible families will be those who have at least one child enrolled in the National School Lunch Program. According to a recent Commerce Department report on U.S. broadband adoption, only 43 percent of households with annual incomes below $25,000 had broadband access at home, while 93 percent of households with incomes exceeding $100,000 had broadband.

I think this is a step in the right direction, and am pleasantly surprised that it’s being enacted by the government – who got this digital healthcare ball rolling downhill fast in the first place.

As more and more low-income/average/middle-class Americans – or whatever we want to call ourselves – begin to speak out about the systemic inequalities we experience in this country’s financial, healthcare and educational systems, it’s nice to think (naively perhaps) that somebody just might be listening. As we see an increase in adoption of digital technologies in the consumer space, so too do I think we’ll see a correlating increase in adoption of healthcare IT by the providers that care for them.