ZachEvans

Believer. Husband. Dad. Coach. Healthcare Thought-Leader. All-Around Good Guy.

Technology

Actively Managed Knowledge

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Project management standards state that a project is not truly over until any lessons learned throughout the project are discussed, documented, and cataloged for use on future projects. When I was in my MBA program I developed an interest in knowledge management that has stayed with me. Whether this interest is driven by my generally-organized nature or my love of reading and teaching, it is a topic that I have passion for and enjoy discussing.

You can find countless articles and papers on the theoretical aspects of knowledge management just as you can find a tremendous amount of guidance on the best way(s) to ensure that knowledge is disseminated throughout an organization. What I fear gets lost is this discussion, however, is the more fundamental topic of what is the best place to store (and share) this knowledge in the first place. On this topic, I believe a structured hierarchy approach is the best way to tackle the problem.

Actively Managed Knowledge

An organization (or individual) that does not take a systematic approach to managing its knowledge will so find itself disorganized and unable to find an disseminate needed information in a timely manner. All of these solutions should have a back-up plan in place and should be used as progressive steps in the process of actively managing knowledge. Additionally, some knowledge may require additional security and/or encryption that is not discussed here.

Perhaps the biggest lesson to learn when it comes to actively managing knowledge is that knowledge must be curated over time. Knowledge that is never reviewed, revised, edited or sunset will, eventually, become useless and potentially harmful to an organization or individual.

Do you think I am missing an option or step or simply have a question or a comment on my thought process? Please leave a comment below or contact me for more information.

 

Contrasting Practices

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I recently completed a short training course produced by a colleague of mine, Dr. Mark Radlauer, who is both an emergency room physician in Colorado as well as an early-stage tech investor. The topic of the training course was improving IT-Provider communication. Dr. Radlauer is a voice I listen to because he understands the clinician’s point of view and workflow and he is a firm believer in leveraging technology to deliver the best patient care and experience possible.

Dr. Radlauer pointed out, correctly, that one of the leading causes of communication challenges between IT professionals and providers is that contrasting practices exist in terms of how each individual approaches their work.

Contrasting Practices

(The one point where I slightly disagree with Dr. Radlauer is in his assertion that IT is organization-driven rather than data-driven but my experience shows that this is sometimes the case. IT–and most all businesses / departments / teams–should be more data-driven than they currently are.)

I believe that seeing a construct such as this helps both IT professionals and clinicians understand the points of view of the other party and, therefore, improve overall communication between the two groups. When communicating across disciplines, it is always helpful to understand how the receiver of your messages (regardless of how they are sent) works and thinks. This understanding will allow you to tailor your message to be as effective as possible.

 

Why Are Electronic Health Records A Challenge to Implement?

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A couple of weeks ago I was privileged to participate in a discussion panel presented by the Nashville Technology Council whose broad topic was healthcare innovation. I sat on the panel with Steve Little from InfoWorks and Bob Chaput from Clearwater Compliance and the panel was moderated by Travis Gregg from Trinisys. One of the questions that was posed by the audience was: “Why are electronic health records such a challenge to implement?”

This is a timely topic for several reasons, not the least of which is the upcoming Meaningful Use: Stage 2 requirements for eligible providers as well as recent, high-profile electronic health record (“EHR”) implementation struggles. When it came my turn to field that particular question I gave three primary reasons why it is difficult to successfully implement an EHR:

  1. Pressure from financial incentives. Many people outside of the healthcare or technology industries may not be familiar with CMS’ EHR incentive programs but the billions of dollars available to eligible providers (both hospitals and individual) that meet specific criteria has dramatically impacted the marketplace. Providers are doing their best to capture as many of the incentive dollars as they can in order to off-set the costs associated with implementing an EHR while the vendors are happy to have a government-funded marketing campaign for their software and services. This financial pressure, while certainly pushing some providers in to the electronic age, is causing some to partner with vendors that may not be the best fit while also encouraging new vendors to enter the market place and established vendors to speed up their development cycles. All of this pressure can add up to poor decision making regarding solutions that may not be ready for wide-scale use.
  2. Immature implementation methodologies. Going hand-in-hand with software that is not ready for prime time, many vendors have looked to further capitalize on government funding by expanding in to implementation services. Likewise, consulting companies around the country are seeing a massive near-term opportunity to build up a healthcare practice helping providers implement their newly-selected EHR solutions. While this may be a standard operating procedure for mature solutions, implementations face great difficulty due to immature (or incomplete) implementation methodologies. Much like yesteryear’s ERP implementations, providers are looking for strong project management leaders driving proven implementation plans but are struggling to find either. This deficiency leads to poorly adopted systems that are not tightly integrated, driving up costs and frustration levels.
  3. Focusing on the wrong fundamental issue. Often led by the CIO, many EHR implementation struggles are seen being driven primarily by technology issues when, in reality, these are the wrong issues to focus on. The issue that causes many EHR implementations to struggle is that the implementing organization failed to adequately understand the scale of the clinical transformation required to be successful. Medical providers on all levels have been documenting the care they render since they first began as a clinician, but they all tend to do it just a bit different than their colleagues. Even with the advent of evidenced-based medical protocols, providers still like to argue about the “evidence” being used and why their patient falls outside the standard. The real challenge is implementing a system that allows for the “practice” of medicine while also enforcing protocols that the larger organization agrees upon. As simple as this may sound, this is in fact a massive undertaking that is often underestimated.

Electronic health records are absolutely worth-while investments for providers of all shapes and sizes and have the capacity to greatly–and positively–impact patient care. Like most great enterprises, however, there are great risks to bear and long roads to travel to unlock all of the potential rewards. EMR implementations do not have to be as great of a challenge to implement as they often times are but they will not go as smoothly as they could without addressing the three points discussed above.

The Grass Isn’t Always Greener

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If you’re in healthcare IT (or just IT in general) and you don’t already ready John Halamka’s blog, you really should. His recent post on The Perfect EHR is well worth the read for any IT leader fighting pressure from their business counterparts to replace an existing core system with something (anything) new.

It should also serve as a cautionary tale for senior executives thinking of approving a change just because a core constituency group keeps asking for it.

A really key point is made in the quote below:

…after listening to many “grass is greener” stories, I believe that what a provider perceives as a better EHR often represents trade offs in functionality. One EHR may have better prescribing functionality while another has better letters, another is more integrated and another has better support. The “best” EHRs, according to providers, varies by what is most important to that individual provider/practice, which may not be consistent with enterprise goals…There will always be dissatisfaction and a claim that something is better. However, I’ve never seen a change in product fix workflow and process issues.

In a soceity (both on a personal and professional level) that relies increasingly on techology, it is always tempting to think that the latest-and-greatest will solve all of my issues and problems. The fallacy with this thinking is that the underlying technology may not be the root cause or the final fix for what is actually wrong.

Technology companies, however, are really very good at holding up the shiny new toy in front of all of us and telling us that if you just have THIS all of your problems will go away. You very recently saw that with the iPhone 4S and at least one reporter is pointing out this exact same issue with the not-yet-released-but-rumored iPad 3.

(Disclosure: I am a very happy owner if an iPhone 4 and an iPad 2 and have no intention of upgrading either device any time soon.)

So, before you advocate for a rip-and-replace of software or even just a basic hardware upgrade ask yourself two questions:

  1. What do I truly stand to gain from the upgrade?
  2. Are there underlying process issues that, if corrected, would remove the perceived need to upgrade?

After all, as Model-Netics teaches us in Acres of Diamonds, the first place to look for a better opportunity (and outcome) is usually in your present situation.

Bring on the Clouds

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For those of you who are more technically-oriented, you’ve been hearing a lot of buzz in the past few years about the cloud, cloud-based computing, or some other Weather Channel sounding name for companies and services that rely on what is, at its core, distributed computing in its purest form (if your eyes have already glazed over I hereby grant you permission to forgo the rest of the post but if you can stick with me a bit longer I think you’ll be happy that did.)

Cloud-based applications and services can (theoretically) be operated with a lower cost basis because you only pay for the computing cycles, hard disk storage, and physical memory that you use. Have you built an application only for you and your parents? Fine: You’ll probably only pay pennies a day. If you have built the next Facebook, well, I hope you’ve figured out your business plan because you’ll need an awful lot of pennies to pay the bill from Amazon Web Services, Rackspace, or any of the other cloud-based hosting companies that are popping up all over the Internet. I, personally, use AWS to store online back-ups of my family’s digital photos for a minimal monthly charge.

Ben Kepes, who writes for GigaOM, recently posted a couple of articles on the statistical benefits of hosting applications in the cloud and one, in particular, that highlights some really exciting findings from cloud-based EMR vendors. By looking at aggregate data across four million patient records they were able to identify trends in commonly prescribed medications. Similar studies focused on the link between socioeconomic status, diabetes and body mass index and patients to target in the case of a potential pandemic.

Could these studies be conducted using data gleaned from traditional server-based EMRs? Absolutely. But as I noted previously, well-functioning health information exchanges (HIEs) and regional health information organizations (RIHOs) are still a ways off and are expensive to build. With readily accessible data already in the cloud, however, these obstacles are nonexistent.

Mr. Kepes is right to point out that we still have to overcome the privacy concerns that individuals have about digitizing their health related information(let alone placing that data in the cloud to be studied—even anonymously), but that by showing a real benefit we may be able to convince the skeptics.

Another industry that is, slowly, making a move to the cloud is education. Google, in a shrewd marketing tactic in my opinion, gives away many of its corporate products such as Gmail and Google Apps to educational institutions (and hopes that their students continue to use their products long after graduation). There are certainly financial benefits of making such a move, as noted in a recent article from ReadWriteWeb, but the long-term benefits go far beyond just dollars and sense.

By moving applications and services to the cloud, educational institutions are leveraging technology to change the culture they operate in to one that more highly values collaboration and transparency. Mashed-up applications are being created and some educators are even using the tools to create open-source textbooks and tools that can be easily shared between institutions. All of this facilitates the sharing of knowledge while bring down costs to pretty much all involved parties. For cash-strapped schools, this may be a panacea they can’t afford to miss.

I certainly feel that, assuming that proper privacy protections are put in place, the potential benefits of cloud-based computing outweigh almost any privacy concern. Don’t you agree?

UPDATE: From the mouths of babes? Check out How 10 Year Olds Explain Cloud Computing.

UPDATE 2: Hindsight IS always 20-20: Facebook CTO Bret Taylor’s Biggest Mistake? Buying Servers.