Deborah Kohn
Principal, Dak Systems Consulting
Deborah Kohn has more than 30 years of healthcare provider organization management and information technology experience. Since founding Dak in 1985, Kohn has earned a national reputation for her expertise in strategically architecting component technologies of electronic health record and electronic financial record systems for healthcare provider organizations. Kohn is a registered health information administrator (RHIA) with undergraduate degrees from Ohio State University and a graduate degree from UCLA in health services and hospital administration. She is board certified in healthcare management and a fellow of the American College of Healthcare Executives (ACHE). She is certified in healthcare information systems (CPHIMS) and a fellow of the Healthcare Information and Management Systems Society (HIMSS). She is an active member of the American Health Information Management Association (AHIMA) and the Association for Information and Image Management (AIIM).
What is the most difficult PACS strategy challenge for acute-care hospitals?
Acute-care hospitals should manage all diagnostic images into the existing radiology image-management solution to deliver clinical, operational and economical advantages. However, shifting the balance of power in the PACS process — from siloed, department-based decisions to a true, enterprise-wide team approach anchored by IT and telecommunications
— is difficult. Getting locked into one proprietary solution, especially for archiving, often does not translate well across all the image-generating disciplines, leading back to silos of department-based PACS. Integrating department-based information systems — that optimize image management's electronic order entry, patient scheduling, reporting and charge capture, such as radiology information systems (RIS) or cardio-vascular information systems (CVIS) — requires expertise that is [often] not readily available.
The key is vendor-neutral, centralized archives, which allow for shared financing and centralized hosting opportunities. Each image-generating discipline takes ownership of the specific application hardware, software or modality provided by their specific vendor. Each discipline shares ownership of the enterprise-wide PACS by paying only for those infrastructure technologies and services that are required. For the archive, this means that the images from all the disciplines are archived from multiple locations, stored in separate locations in the same archive and retrieved by the disciplines' applications (e.g., RIS, CVIS). Through the use of the digital imaging and communications in medicine (DICOM) query/result function and a Web application, the images are viewed virtually anytime, anywhere. The processing required for a specific application's work-flow application for a particular study, such as digital mammogram or a cath-lab study, is accessed by a thin or thick client or even a smartphone.
Richard P. Mansour, M.D.
CMIO and VP, product innovation, Eclipsys
Board certified in internal medicine, oncology and hematology, Dr. Rick Mansour is CMIO and VP of product innovation at Eclipsys. He is currently an associate professor of clinical medicine at the Feist-Weiller Cancer Center. Dr. Mansour is founding partner of Vital Software and participated in the development of its oncology products prior to selling the company. He has worked on developing browser-based medical software prototypes for the pocket PC, prescription writing software and browser-based software for clinical research. His Web-based structured documentation software that incorporates SNOMED CT, automated ICD-9 coding, E&M coding and Medicare compliance rules checking was integrated into the Sunrise Clinical Manager design for physician documentation.
He has two patent applications pending, one related to structured documentation and a second related to the automated abstraction of electronic medical records for construction of data cubes for advanced analytics.
What is the most difficult challenge of ICD-10 implementation?
Machines adapt without complaint. Humans, well, that is an entirely different story. The clinical and business community using ICD-9 has developed a “keen eye” or pattern recognition based on this coding system. It will take some time for these highly trained and efficient people to develop the new pattern recognition for the ICD-10 coding system. Computer systems can do it with the turn of a switch and without complaint. We need to design our software to ease the transition and flatten the learning curve for this more complex coding structure.
Paul Bleicher, M.D.
CMO, Humedica
Paul Bleicher is chief medical officer of Humedica. Prior to Humedica, he was the founder and chairman of Phase Forward, where he grew the organization from concept to a publicly traded company providing integrated clinical-trial data-management software and safety solutions for the biopharmaceutical industry. Previously, he had led clinical trials at a biotechnology company and clinical research organization. Dr. Bleicher received his M.D., Ph.D. from the University of Rochester and his BS from Rensselaer Polytechnic Institute. He trained in internal medicine and dermatology, did a post-doctoral fellowship at Harvard and began his career as a physician/investigator and assistant professor at Massachusetts General Hospital and Harvard Medical School.
What is the most difficult challenge of CPOE implementation?
Often, project teams for CPOE implementation focus on the technology and process, but they miss the critical importance of the end user. Clinical teams have to be able to give meaningful feedback on the usability of the system during the selection process, and the process must be built with flexibility to accommodate post-implementation modifications. Furthermore, there must be careful attention given to optimal work flow, whereby user training and incentives are well aligned with organizational goals.
Successful implementation typically is accomplished when incentives are more “carrots” than “sticks.” The clinical team should be given actionable insight into the cost and quality of their care of patients through quick, easy-to-use analytics and reporting. When users perceive value, they will become regular users of the tool and be willing to overlook the minor annoyances that come with any new software and process improvement.
John Santmann, M.D.
President and CEO, Wellsoft
Dr. John Santmann founded Wellsoft in 1988 to provide real-world software solutions in emergency medicine. He completed his undergraduate degree with honors at Johns Hopkins University in 1977 and graduated from Washington University Medical School in 1982. His emergency medicine residency was completed in 1987 at Norfolk General Hospital, and he has practiced emergency medicine in various hospitals in San Francisco, St. Louis, and throughout New Jersey. Dr. Santmann's desire to merge his interest in computers with emergency medicine to improve patient care has inspired him to devote his energies full time to Wellsoft Corporation.
What is the most difficult challenge related to systems interoperability?
The main challenge to achieving better interoperability has been a lack of clear direction and, for some vendors, conflicting motivations. For years, many vendors have not seen interoperability as a development priority, partly due to marketing strategies that promote a single-vendor solution. Today, many vendors have their own version of HL7 v2 messages that do not conform to the HL7 standard. I see this changing.
Up until now, it was not always clear which standards to use for a given purpose. The meaningful-use requirements help solve this problem. In the future, I am confident we will see a major focus on interoperability by all leading vendors and true compliance to the standards.
With the advent of meaningful use, this integration and interoperability will become much easier for both vendors and hospitals, resulting in decreased cost and increased quality of patient care.
W. Ed Hammond
Director, Duke Center for Health Informatics
W. Ed Hammond is director, Duke Center for Health Informatics. He is professor, Department of Community and Family Medicine; professor, Department of Biomedical Engineering; and adjunct professor in the Fuqua School of Business at Duke University. He has served as president of the American Medical Informatics Association (AMIA), president of the American College of Medical Informatics, and as chair of the Computer-based Patient Record Institute. He has served three terms as chair, Health Level 7, chair of ISO TC 215 WG2, and chair of the Joint Initiative Council (ISO, CEN, HL7, CDISC, IHTSDO, and GS1). He was chair of the Data Standards Working Group of the Connecting for Health Public-Private Consortium. He was a member of the IOM Committee on Patient Safety Data Standards. He was awarded the Paul Ellwood Lifetime Achievement Award in 2003 and the ACMI Morris F. Collen Award of Excellence in November 2003.
What is the most difficult challenge of EMR implementation?
The EHR needs to become so valuable to the provider that it no longer becomes a question of “should we?” First, we need a common set of data elements in which each term is unambiguously defined and understood. Data is aggregated across all sites of care, providing the confidence of quality data and complete data. The EHR contains only what is needed in the patient's care, now and in the future, but only that. Social, economic and environmental data are used to achieve accessible, timely and equitable healthcare. Knowledge is seamlessly integrated into content.
The EHR is part of work flow, engaging the provider only when human input is necessary. The EHR becomes the focus of patient care, research, public health and reimbursement. Global clinical data warehouses are the source of clinical trials with timely analyses of data, creating real-time, evidenced-based medicine with real-time use.
Lori Wright
Vice president and general manager, Symantec Health
Lori A. Wright is the vice president and general manager of Symantec Health, a division of Symantec founded to develop technologies for the healthcare industry. As vice president and general manager, she is responsible for product development, sales, marketing and government policy functions. Prior to leading the Symantec Health Group, she served as chief of staff to the CEO. She joined Symantec through the VERITAS Software acquisition in 2005 and held roles at VERITAS in mergers and acquisitions, strategic operations, finance and marketing.
What is the most difficult challenge of implementing EHR security?
The biggest threat to EHR security is people. While you hear stories of unauthorized clinical personnel looking at the medical records of celebrities, cases like this are usually in the minority. It is more likely employees act with no ill intent. Some breaches may result from an employee's careless behavior, such as leaving a company laptop in the trunk of their car where it can get stolen, or unknowingly giving out sensitive data, such as when a doctor sends patient data to another doctor who is working on a similar case but doesn't take out patient identifying information. Security is only as good as the weakest link.
Through proper education these situations are easily mitigated. Security training programs can teach healthcare providers, and all other organizations handling personal health data, that they should know where a patient's data is at all times, since it is the organization's responsibility to protect the patient's health information. There are also solutions that can improve EHR security without negatively impacting employee productivity or patient care. Usually, when an organization implements new technology, security of the solution is not top of mind. However, when integrating EHRs into an organization, it's essential to make security one of the top considerations in
the implementation.
