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Even though our friends in the Mid-Atlantic don’t feel it right now, the arrival of HIMSS reminds us that spring can’t be too far behind. And with spring come more trade shows, user group meetings, and industry group state chapter conferences. Although there are excellent events in the fall also, I always found the spring to be particularly energizing.

So how should we feel heading into this spring? Are things turning around? Are we truly ready to put this recession behind us? Do we have reasons to be upbeat?

Maybe so. While last week could turn out to be an aberration, there were three strategic vendor acquisitions announced. It’s been a long time since we’ve seen that.

This news could be encouraging to many: healthcare investors anticipating a return of a market for investment exits; entrepreneurs eager to get their ideas and businesses funded; and those further along eyeing a potential liquidity event.

Of course, if you work for one of the acquired companies, or if your vendor was acquired, you may feel anxious. But that anxiety is associated more with healthy market activity than the “world is caving in” mentality that we’ve all seen.

Beyond the investor and vendor communities, another gauge is the HIT labor market. To me this is an accurate reflection of the state of the industry. Hiring, competition for talent, hiring freezes, and lifting of these freezes are all indicators of confidence or lack thereof.

Since the end of last year, and especially this year, most candidates I’ve encountered have been encouraged. Unlike six months ago, when fear could be heard in their voices, they now discuss the number of opportunities they are considering. It’s not yet the “candidate’s market” predicted by the country’s demographics, but competition for strong talent is beginning to heat up. And that is a good sign.

It’s a good sign if you’re one of the many who were let go during the downturn, or if you’re an executive or department head deciding whether to make that key hire. It’s also a good sign if you’re awaiting approval to fill that important position that’s been vacant. Maybe now is the time to petition for that approval.

Whether you’re looking forward to HIMSS, AHIP, or another conference, or attending a state chapter or user group meeting, or looking to get back to work, do so with reassurance and optimism. As we used to say when I worked on the back of a garbage truck one summer, “things are definitely picking up.”

Jim Gibson has been in healthcare for 25 years. In 2002 he founded Gibson Consultants after several years in healthcare IT and group health insurance. Gibson Consultants is a national search firm specializing in healthcare IT companies. Like Jim, the other professionals of Gibson Consultants enjoyed successful healthcare careers before turning to executive search. Follow Jim on twitter http://twitter.com/jim__gibson or reach him at (203) 431-1536 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

By Carole Hodsdon, Executive Vice President and Chief Technology Officer, MEDecision

I’ll admit it. In the fall of 1999, I was one of the many IT professionals who waited until the very last minute to ensure that their company’s technology was Y2K compliant. In fact, in October and November of that year I aged significantly. Two months with virtually no sleep will do that to you.

So you think I would have learned my lesson a few years later when it was time to ensure compliance with the then-new HIPAA regulations for electronic transactions. No, once again, despite ample fair warning, my team and I kept putting it off until it was down to the wire. And once again, I aged 10 years in a matter of about six weeks.

I’m fairly certain I’m not the only one. All of you fellow regulations procrastinators out there can now make yourselves known. It’s OK.

But please, whatever you do, join me in vowing not to make the same mistake again when it comes to the looming ICD-10 deadline. Let’s learn from our past mistakes and not think of October 2013 as some far-off, distant time only to wake up one morning in July of 2013 in an utter panic. By now, we should all be well aware of what happens to he (or she) who hesitates.

Our ICD-10 implementation work has already begun here at MEDecision and, thankfully, it appears a growing number of other organizations have started too. While it may be a bit premature to finalize a fully vetted plan, my experience recently has revealed that a lot of companies have at least put the ICD-10 deadline on their proverbial radar and have begun thinking about it. That in and of itself is a pretty good place to start.

As we learned from Y2K and HIPAA, these things are scary and intimidating. And with all of our other day-to-day responsibilities monopolizing our precious time, it’s no wonder we put them off. But health care organizations, particularly insurers, have a real opportunity — now — to spare themselves a lot of grief in a few short years. When the ICD-10 switch goes on in 2013, you can’t just assume you’re going to start receiving ICD-10 claims exclusively. There is inevitably going to be some crossover, and now is the time to start planning for how to deal with that. Larger payers have an even greater challenge since many of them deal with more than one claims system.

So let’s make it a point this time to not wait until the last minute. If ICD coding is the guts of your system(s), start planning now. It’s not necessary to stop the presses and focus on this and this only, but it would behoove us all in the long run to start running some test cases to see what happens. If you get an ICD-10 claim in your system, mock it up, see what it’s going to look like and what it’s going to do. Wouldn’t you rather find out now whether it’s going to send your system into a complete meltdown or process the way you’d like it to? It’s better than waiting until you only have a matter of weeks to get things right. And don’t just make testing a one-off thing — conduct tests regularly so you can work out all of the bugs in a timely and thoughtful way.

If we all start planning now, we can all breath a collective sigh of relief when the fall of 2013 rolls around.

www.medecision.com

Nextgen Healthcare Information Systems

Physicians and healthcare providers across the country have found themselves scrambling to get their arms around the government’s plan to ensure electronic health records (EHR) are implemented within a few short years. It’s easy enough to understand the concept of adoption incentives, which will be activated in 2011, as well as the penalties for noncompliance to be imposed soon after. But other components of the plan are less concrete.

One of the major hurdles healthcare providers have encountered is the criterion that they prove they are “meaningful users” of EHR to be eligible for incentive bonuses. Everyone can agree that “meaningful use” sounds like a good idea – but, until now, no one has known exactly what it entails.

Fortunately, this grey area is close to being finalized. Throughout the summer, the Office of the National Coordinator for Health Information Technology (ONC) has entertained proposals and public comment as it developed a working definition for “meaningful use.” The broad goal they have recommended to the Department of Health and Human Services (HHS) is that meaningful use “enable significant and measurable improvements in population health through a transformed health care delivery system.”

To accomplish this, ONC recommended specific objectives for physicians to meet as they begin using automated systems. Criteria for the 2011 deadline include:

• Allowing patients to access their health records in a timely manner;
• Developing capabilities to exchange health information where possible;
• Implementing at least one clinical decision support rule for a specialty or clinical priority;
• Providing patients with electronic copies of discharge instructions and procedures;
• Submitting insurance claims electronically; and
• Verifying insurance eligibility electronically when possible.

ONC also called for enabling patient access to personal health records by 2013 and will require that all providers participate in a national health data exchange by 2015.

While these standards present no small challenge, the fact that they have been articulated represents enormous progress.  Although these recommendations do not yet carry the force of regulation, all messages from the Center for Medicare and Medicaid Services (CMS), the HHS implementation arm for the program, have indicated that these measures can be relied upon for the final rule.

Many healthcare organizations have hesitated to make purchasing decisions about EHR systems until they understood more clearly what CMS would ask of them.  Now they have the clearest signals so far.

We must keep in mind that, while clearing the “meaningful use” hurdle is a major accomplishment, other challenges remain – like determining the most appropriate approach to EHR certification. We will discuss factors impacting this issue in future posts.

All the guidelines may not be specified yet, but physicians must balance the details of meaningful use and certification plans with the impending deadlines – i.e., achieving meaningful use by January 2011.  In my opinion, finalizing EHR plans should be a major goal for all medical providers in the next few months.

Charlie Jarvis, FACHE, Vice President for Healthcare Industry Services and Government Relations

“Thank goodness I have a job.”

A sentiment often felt when a recession hits. As belts are tightened, budgets slashed, and colleagues laid off, many take solace in knowing they’ve been spared. Issues like job satisfaction, personal fulfillment, equitable work schedules, and – yes – even pay, take a back seat to gratitude for simply remaining employed.

But that was a year ago. It’s starting to feel different now. Now, we’re reading about all the new jobs that will be created by the ARRA. First there was David Blumenthal’s prediction of 50,000 new jobs. Last week the stage one “meaningful use” criteria were released. Their release makes the expected growth seem more real. As if proof, the CEO of an EMR company was in the trade press this week discussing plans to hire hundreds of new employees in 2010. And that’s just one company

It’s widely accepted that economic recoveries are fueled by confidence. While the rest of the world is becoming cautiously optimistic, it’s hard to ignore the growing confidence within healthcare IT. Something special is about to happen.

Yet, as recessions abate and confidence sets in, so does one inevitable dynamic that’s seldom noticed – until it affects productivity. That is employee turnover. It happens at the end of every recession, and it affects hospitals, health plans, physician practices, and most other places of employment.

When a recession hits, people are happy just to keep their jobs. But then as a recovery appears, people begin to feel more confident. They abandon the "hunker down" mentality and raise their standards for job satisfaction. They begin to think about career options.

The polls bear this out. For the past several weeks, job satisfaction is reported to be down significantly. This is across industries and up and down the food chain. No sector or level seems to be immune.

As job satisfaction falls, it can lead to morale issues and turnover…or it can be a wake-up call.

Right now is probably a good time to pay closer attention to your troops and their outlook and expectations. Start the new year with a one-on-one with all direct reports. Thank them sincerely for hanging in there through these tough several months. Many took on more work as a result of reduced staffs and budgets. Jointly evaluate plans and expectations, both yours and theirs. Share your vision. It’s a special time to be in healthcare IT. Let them feel that they’re part of it and that their contributions do matter. Make employee morale one of your top priorities for 2010.

Jim Gibson has been in healthcare for 25 years. In 2002 he founded Gibson Consultants after several years in healthcare IT and group health insurance. Gibson Consultants is a national search firm specializing in healthcare IT companies. Like Jim, the other professionals of Gibson Consultants enjoyed successful healthcare careers before turning to executive search. (203) 431-1536 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it . www.gibson-consultants.com/

“Meaningful use” is the term used in the Health Information Technology for Economic and Clinical Health (HITECH) section of ARRA (aka the

stimulus bill).  It refers to a set of criteria required to receive incentive payments from either Medicare or Medicaid.  The notion is that over the five years of incentive payments, physicians will need to meet a series of benchmarks to demonstrate their meaningful use of an EHR.  The benchmarks will get more challenging in succeeding years.

It is up to the Centers for Medicare and Medicaid Services (CMS) to finalize these benchmarks for meaningful use.  In this task, they will be guided by recommendations from the HIT Policy Committee.  The Committee issued their preliminary recommendations last July (see http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_888532_0_0_18/FINAL%20MU%20RECOMMENDATIONS%20TABLE.pdf ).  CMS will now prepare the final recommendations for public comment and formal issuance, but it does not look like that will occur until the first quarter of 2010.

The recommendations for the 2011 meaningful use criteria will be likely to involve reporting on certain chronic health problems (diabetes, hypertension, and smoking).  Physicians will also be expected to use e-prescribing and computerized physician order entry (CPOE).  CMS will probably require physicians be able to provide patients with an electronic copy of their medical record.

Hospitals are also eligible for incentive payments and the recommendations include benchmarks for how to achieve meaningful use at the institution level.

The incentive payments are scheduled to start in 2011, so there is little time to prepare.  The vendor community is aware of these proposed measures, but given the timing, you should already be discussing how this functionality will be supported by your EHR.  For some systems, the functionality will come with a new release.  Preparing for that will require time and resources, and both are in short supply.

Don’t guess; your vendor’s got a list. 

The stimulus funding, also known as the American Recovery and Reinvestment Act (ARRA) is starting to flow.  Or if not flow, the feds have at least connected the pipes without actually turning on the spigot.  So what does this mean to CIO’s in the health arena?

One funding opportunity (https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=10534 ) will support the creation and operation of health information exchanges.  If you haven’t already connected with the exchange in your state, it is time to do so.  The exchange will likely be run by state government, a private entity, or some combination.  Although there may be multiple regional exchanges in your state, the HIE grant opportunity is targeted to the “state designated entity (SDE).”  This will be the exchange that the state’s Governor names as the statewide exchange.

Your job will be to ensure that your electronic medical record system is able to supply information through the exchange to requestors.  Typically this exchange will be brokered through interfaces maintained by the exchange to your EMR software and with the requesting site.  The kinds of information exchanged will include eligibility and claims transactions, eprescribing transactions, laboratory orders and results, public health reportable conditions, clinical information, and quality measures.  Each state exchange will then connect to the National Health Information Network, allowing interstate transfers of information.

There are a host of policy and privacy issues around this exchange, so you should also be talking to your legal advisors.

Enabling the electronic exchange of health information is a key component in making hospitals and physicians eligible to receive incentive payments from Medicaid and Medicare starting in 2011.  The implicit promise behind funding this infrastructure is lowered healthcare costs through the avoidance of duplicative testing, more complete and timely patient information, and, ultimately, better outcomes.

Most all security guys will tell you that Identity Management (IDM) is a security thing, but if you think about it security is focused on keeping people out of your systems and IDM is a framework for letting people in. I think that IDM fits  better in the privacy area. Privacy is about letting the right people, and only the right people, see your information. In healthcare no one would say that “keeping my data private means that no healthcare professionals should ever be able to see my data’. In a world like that we would be relegated to repeat all tests and procedures over and over again (come to think of it perhaps that IS what we have).

So if security is keeping people out and IDM identifies how to get in to data, then would that not be a privacy thing. If you look at the HIPAA privacy rule it talks about when users can access healthcare data, which is exactly what a well written IDM system does. IDM includes all the processes that control identifying users, and associating them with the services or data they can see or modify. It also has logging for users access (another HIPAA requirement).

So, who cares? IDM is privacy not security. What difference does this make? A LOT. If you look at the focus of IDM today most all of the technologies are primarily concerned with the use case of “the break-in”. (i.e. what happens if the identity is hacked or stolen). If we re-focus the discussion to privacy of information then we can create systems that better track authorization workflows (i.e. what happens if a user can’t get to the information they need). I think we would all agree that as much as I don’t want my information shared everywhere I really don’t want to be poked with a needle because my doctor can’t access the last blood test I had.

It may not change the products, but I think it may change the focus of discussion thereby enabling the creation of environments needed for SHARING of data not SECURING data from others.