Guest Blogger Dr. Marvin BorenMarv Boren 1.jpg is a passionate knowledge management professional and forward thinker.​

Challenges

Picking up where I left off, I will discuss some of the challenges or barriers to HIT adoption.

It would be easy to compile a long list of challenges to the adoption of HIT. Nonetheless, I'll limit my discussion to a brief review of two general areas that I believe are of greatest importance: stakeholder attitude and technology challenges.

Stakeholder Attitude:

If the goals set forth by the HITECH Act are to be realized, healthcare providers must make the transformation from paper to digital records - no small feat. Thus far, the transformation has been met with considerable resistance. As reimbursement for services continues to decline along with increasing overhead expenses, efficiency and productivity must be maximized. Many stakeholders feel that the workflow changes needed in order to achieve Meaningful Use are burdensome and counter-productive. In addition, some question the value of the information gained from the Meaningful Use objectives. The consensus is that at the very least, the use of EHR is more time consuming than traditional charting methods. Statistics show that adoption of EHR and achievement of MU has grown substantially since the Program's inception in 2009 to date. Nonetheless, measurable achievement of the aforementioned goals arguably, has yet to be realized. Accordingly, there is no shortage of skepticism among stakeholders whether there is a direct correlation between achieving Meaningful Use and enhancing health care quality and efficiency. Additionally this attitude contributes to the perception that adopting CEHRT lacks value.

 In order to overcome these barriers, it is essential that organizations establish a culture of trust. I would expect that those organizations most successful transitioning to CEHRT had already established a culture of trust and encountered the least resistance to change. While I am not aware of any such studies substantiating my expectation, it may be an interesting study worth pursuing.

Technology:

"The HITECH Act seeks to improve patient care and make it patient-centric through the creation of a secure, interoperable nationwide health information network. A key premise is that information should follow the patient, and artificial obstacles -- technical, bureaucratic, or business related -- should not be a barrier to the seamless exchange of information. Therefore, secure information exchange needs to occur across institutional and business boundaries so that the appropriate information is available to improve coordination, efficiency, and quality of care." ("How does information exchange")

Although there has been a proliferation of local, regional and state Health Information Exchanges (HIE the noun) to facilitate information sharing, for the most part, data remains siloed in disparate EHR systems.

Most industry leaders would agree that in spite of a greater prevalence of structured data, primary obstacles include a lack of standardization and a lack of a nationwide interoperability infrastructure to facilitate Health Information Exchange (HIE the verb). Adding fuel to the fire so to speak, are accusations that information blocking has contributed to the challenge of establishing nationwide interoperability. The seriousness of these accusations prompted a request by Congress for the ONC to produce a report on the extent of health information blocking and a comprehensive strategy to address it.  It was also requested that "the report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee."

According to the REPORT TO CONGRESS, APRIL 2015 - Report on Health  (ONC, 2015) (pp.15-16) as a result of current economic and business incentives, some stakeholders have knowingly and unreasonably interfered with the exchange of electronic health information by limiting its availability or use.  The Report goes on to say that "ONC's understanding of information blocking is informed in part by a substantial body of complaints and other anecdotal evidence. However, this evidence has significant limitations that prevent ONC from confirming individual cases of information blocking. Identifying and confirming specific instances of information blocking is a difficult and highly fact-specific task. Empirical data on information blocking is also limited at present. There is little quantitative data available with which to reliably identify and measure the extent of information blocking." Finally the report suggests that "successful strategies to prevent information blocking will likely require congressional intervention". ​​

Dr Marvin Boren is the Meaningful Use Program Coordinator at Akron Children's Hospital (Akron, OH) which has successfully attested for Stage 2 Meaningful Use. He formerly practiced podiatry in Canton, OH and has over five years of experience consulting in Electronic Health Records. He is currently working on a Master of Science degree in Health Informatics at Kent State University. He can be reached at marvboren at google.com


References

1. The Office of the National Coordinator for Health Information Technology (ONC) Department of Health and Human Services (April 10, 2015). Report to Congress on Health Information Blocking. Retrieved from https://www.healthit.gov/sites/default/files/reports/info_blocking_040915.pdf

2. EHR incentives & certification, How to attain Meaningful Use.  Retrieved from https://www.healthit.gov/providers-professionals/how-attain-meaningful-use

3. How does information exchange support the goals of the HITECH Act? Retrieved from http://www.healthit.gov/policy-researchers-implementers/faqs/how-does-information-exchange-support-goals-hitech-act

4. The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services (September 21, 2015). Federal Health IT Strategic Plan 2015-2020. Retrieved from: https://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf​​​

csalanova.JPGGuest Blogger CaseyAnn Salanova currently heads the Interlibrary Loan department and serves as the Core Team Leader at Schmidt Library at York College of Pennsylvania.

Surprise, surprise, knowledge management impacts employees! What a novel idea, right?

Not really when you think about it because where does knowledge lie? Within people. And employees—at least for now—are people. And the knowledge we have (as employees and through our collective experiences) can contribute to a rich learning environment, adaptability, and overall satisfaction within the workplace.If an organization or company has a successful knowledge management structure, it can facilitate learning through externalization, internalization, and socialization. Consider this: I was sitting in my office the other day chatting with my officemate. We work at a library and were talking about a specific functionality within the system we work with. We ended up exchanging different stories about how training was handled previously at the library and how it is handled now.  Really, we were both externalizing our tacit knowledge on the subject and in turn, internalizing the knowledge we heard from each other—all through an informal social exchange.

What if you received a memo from your administration informing you that your department would now be merged with another department? The heads of both departments will be replaced with a CIO and you are to be housed in one building. How would you react? It would be unsurprising if your response was not well​. 

And that is why trust is such an important component in knowledge management and employee adaptability (Association of Project Management, 2014). An organization’s KM processes can facilitate the sharing of knowledge between employees because they themselves “likely possess the information and knowledge needed to adapt” (Becerra-Fernandez & Sabherwal, 2015). Having the ability to participate in conversations and contribute ideas and opinions help create an environment in which employees are more open to be aware of and accept change (Becerra-Fernandez & Sabherwal, 2015). But, if the organizational culture is not conducive to constructive exchanges and the structure of the company creates independent silos, change is hard. Integration is difficult. And communication suffers. It jeopardizes the chance for change to be successful. But, if change is approached first as a conversation with the opportunity to contribute ideas garner feedback, then outlined, initiated, implemented, and accessed, it can be successful—and if not, you can learn from the process.

Through the simple implementation and support that allow for opportunities for employees to learn and share knowledge, combined with the creation of an environment of trust and collaboration, directly affects employee job satisfaction—for the better (Becerra-Fernandez & Sabherwal, 2015).  Add in the fact, that now, as millennials are taking over entering the workforce, their (our) satisfaction comes from meaningful relationships, learning opportunities, and believing in a cause and a meaningful impact on the world (Lewis, 2015). In the end, by adopting knowledge management solutions, organizations will be helping themselves and their employees. Job satisfaction goes a long way and contributes to the willingness to share knowledge, expertise, and remain in the organization longer (Becerra-Fernandez & Sabherwal, 2015). And really, in the end, wouldn’t you as an employer, want your employees to be happy?

Guest Blogger CaseyAnn Salanova is a graduate student at Kent State University studying Knowledge Management and Library and Information Science. She currently heads the Interlibrary Loan department and serves as the Core Team Leader at Schmidt Library at York College of Pennsylvania.


Works Referenced

Association of Project Management. (2014, April 10). We really need to talk about knowledge management [Video File]. Retrieved from https://www.youtube.com/watch?v=HwMzpJa6Y-w&feature=youtu.be

Becerra-Fernandez, I., & Sabherwal, R. (2015). Knowledge Management Systems and Processes. New York, NY. RoutledgeTaylor& Francis Group. 

Lewis, Katherine R. (2015). Everything You Need to Know About Your Millennium Co-Workers.Fortune. Retrieved from http://fortune.com/2015/06/23/know-your-millennial-co-workers/

Silo Image. (n.d.) Retrieved from http://www.thehumanenterprise.com.au/Images/marketing-offers/Public-Engage-WebPage-Image.png

CaseyAnn Salanova is a graduate student at Kent State University studying Knowledge Management and Library and Information Science. She currently heads the Interlibrary Loan department and serves as the Core Team Leader at Schmidt Library at York College of Pennsylvania.


Libraries, unfortunately, are all too often viewed as antiquated as your grandmother’s chintz curtains.

The public perception of the total value of a library is often veiled by their large budgets and seemingly little return. The reality is though, libraries have dealt with cuts for years now with budgets decreasing even as prices on databases, materials, and technology increase. Even within the library world, a common topic of conversation and conference theme is its own relevancy. Many graduate Library Science programs, like Kent State, ask applicants to write an essay on the relevancy of libraries. Such a requirement is already setting up a professional perception of its own irrelevancy.

Toronto Public Library.JPG(Martin Prosperity Institute, Page 1, 2013)

But, libraries are in fact useful and economically advantageous. The Free Library of Philadelphia pinpointed four major economic areas that libraries contribute to: literacy, workforce development, business development, and increased home and neighborhood values (Fels Research & Consulting, Diamond, Gillen, Litman, & Thornburgh, 2010). The Toronto Public Library estimates it has created over $1 billion in total economic impact (Martin Prosperity Institute, 2013). The bottom line is they provide a low cost education and cultural platform for society (Z. Zhou, personal communication, November 10, 2015).

What is true though, libraries are at a crossroads and in need of a revolution—“one that remakes the institution’s technology, goals and training (Lozada, 2015).” Knowledge management can be a part of it, if not a catalyst. It is an approach to the management and effective use of intellectual capital.  ​

The key to knowledge management is approaching it with the creativity of design and the pragmatics of a business. There is not a one size fits all approach nor is there only one approach that leads to successful knowledge management (Becerra-Fernandez & Sabherwal, 2015). Really, it is holistic. But, not in the granola eating, tree hugging, meditating mentality (even though that is perfectly fine, too). Rather, knowledge management is an interconnected process that requires internal and external analysis, participation organization wide, a willingness to adapt, and a commitment to sustainability. So, why do it in a library?

Libraries are at a moment in time that is ripe for opportunity. They provide an ideal stomping ground for knowledge management through a collection of people from varied backgrounds which differs from the typical KM business case. Their commodity is that of knowledge and it is ever increasing in breadth, format, and structure. They already have a strong technical infrastructure, workflows system, and a long tradition of documentation and onsite training. And just as IKEA’s founder, Ingvar Kamprad changed his business practices to the Ikea we know and love today (Liedtka, 2011), libraries have been adapting for years from papyrus to calfskins, printed books, microforms, and electronic resources. It is just now, some consider Google as “America’s reference librarian and Starbucks its ISP (Internet Service Provider)” (Lozada, 2015). Technology is changing at a rapid pace and libraries need to adapt quicker.

Knowledge management can help change the internal and external perception of a library as well as provide the necessary knowledge to compete and thrive. Through the process of developing a strong KM Solution, hard questions will be asked including the contingency factors that affect the overall process (Becerra-Fernandez & Sabherwal, 2015). But, ultimately a better understanding of the context, innovation and knowledge sharing, succession management, employee orientation, learning, and development, and the identification, documentation and dissemination of processes, practices, and expertise of the organization will arise which will lead to the development of a successful knowledge management plan (NCHRP, 2014).  But, what many libraries are lacking in is the motivator.

It does not matter where within the library an individual stands—anyone can become the motivator. Knowledge management can begin as an organically grown movement, but key individuals need to get on board—within a library it is typically the director and upper level administrators. Without the support of the organization’s leader, it is unlikely KM will succeed (Becerra-Fernandez & Sabherwal, 2015). A common occurrence though within the knowledge management sector is for a CLO (Chief Learning Officer), CIO (Chief Information Officer), or CKO (Chief Knowledge Officer) to be hired on a temporary basis and then it is assumed knowledge management will be integrated into company/organization practice (Becerra-Fernandez & Sabherwal 2015).

Let us not assume, but sustain. Knowledge management processes can be customized and adapted to current and future needs. They can be designed to meet budgetary needs with many knowledge management solutions functioning at virtually no or low cost.   So, be the motivator and embrace knowledge management in the library. It can help propel the library into the future while still sustaining the knowledge cultivated from tradition.


Works Referenced
Becerra-Fernandez, I., and Sabherwal, R. (2015). Knowledge Management Systems and Processes. New York, NY. RoutledgeTaylor & Francis Group.
Fels Research & Consulting, Diamond, D., Gillen, K.C., Litman, M., Thornburgh, D. (2010). The Economic Value of The Free Library In Philadelphia. Retrieved from http://www.freelibrary.org/about/Fels_Report.pdf
Liedtka, J. (2011). Why Design? In Designing for Growth: A Design Thinking Tool Kit for Managers (3-20). New York: Columbia University Press.
Lozada, C. (2015). Do we still need Libraries? Washington Post. Retrieved from https://www.washingtonpost.com/opinions/do-we-still-need-libraries/2015/04/23/c2105778-e92e-11e4-aae1-d642717d8afa_story.html
Martin Prosperity Institute. (2013). So Much More: The Economic Impact of the Toronto Public Library on the City of Toronto. Retrieved from http://martinprosperity.org/media/TPL%20Economic%20Impact_Dec2013_LR_FINAL.pdf
NCHRP. (2014) Scan 12-04 Advances in Transportation Agency Knowledge Management. Retrieved from http://www.domesticscan.org/wp-content/uploads/NCHRP20-68A_12-04.pdf

Guest Blogger Dr. Marvin BorenMarv Boren 1.jpg is a passionate knowledge management professional and forward thinker.​

​​​​

I'll finish my discussion on the information sharing and knowledge management initiative resulting from the HITECH Act with some highlights from the Federal Health IT Strategic Plan 2015-2020 - HealthIT.gov (ONC, Office of the Secretary, 2015) released in October 2015 by the ONC. In her opening letter, Dr. Karen DeSalvo, the National Coordinator for Health IT, presented commentary on the Plan's past, present, and future. As I wrap up my discussion, I believe her remarks provide an excellent perspective and are worth sharing. The following are highlights of her letter. 

"Over the past five years, our nation has experienced a remarkable transformation in the collection, sharing, and use of electronic health information. Updating the Federal Health IT Strategic Plan 2015- 2020 (Plan) has given us a chance to reflect on our health IT journey."

"Implementation of the prior Plan created a strong foundation for achieving this Plan's goals and objectives. Over 400,000 eligible hospitals and professionals participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. This incredible achievement was not easy. Hospitals and health care providers have invested capital, time, and hard work to digitize their patient medical records. This has created a strong demand for the seamless sharing of information across technology systems, information platforms, location, provider, or other boundaries."

"With this updated Plan, the federal government signals that, while we will continue to work towards more widespread adoption of health IT, efforts will begin to include new sources of information and ways to disseminate knowledge quickly, securely, and efficiently."

Dr. DeSalvo goes on to point out the increased expectations of our information systems and the difficulty of predicting innovation and technological advancements. In closing, she states: "Efforts of state, local and tribal governments and private stakeholders are vital to ensure that health information is accessible when and where it is needed to improve and protect people's health and well-being."

The Plan itself elaborates on the goals and objectives. Among the goals are the following:

Goal 1: Expand Adoption of Health IT - Digitizing health information collection allows for easier, appropriate sharing of that high-quality, accurate, and relevant information to connect care and empower individuals to manage their health and well-being.

Goal 2: Advance Secure and Interoperable Health Information - Interoperable health information and health IT solutions will lead to more efficient and effective health systems, better clinical decision support, scientific advancement, and a continuously learning health system.

Goal 5: Advance Research, Scientific Knowledge, and Innovation - Researchers can use data to identify target populations, make informed sample size estimations, recruit potential trial participants, collect more baseline data, and, within the framework of integrated health care systems or payer programs, streamline follow-up.

There you have it. Hopefully, the knowledge I've shared with you has provided greater insight and appreciation for health care's tremendous transformation in information sharing and in the discovery, capture, sharing, and application of knowledge.  Perhaps the next time your doctor appears engrossed in his computer, you might be a bit more understanding. With a little luck, over time doctors will get better at balancing between face to face time and focusing on the computer.

I'll close with one final thought - Sir Francis Bacon is credited with the famous quote "Knowledge is power ". To that I would add that "if knowledge is power, knowledge management is exponential power!"

Marv Boren 1.jpgDr Marvin Boren is the Meaningful Use Program Coordinator at Akron Children's Hospital (Akron, OH) which has successfully attested for Stage 2 Meaningful Use. He formerly practiced podiatry in Canton, OH and has over five years of experience consulting in Electronic Health Records. He is currently working on a Master of Science degree in Health Informatics at Kent State University. He can be reached at marvboren at google.com

References

1. The Office of the National Coordinator for Health Information Technology (ONC) Department of Health and Human Services (April 10, 2015). Report to Congress on Health Information Blocking. Retrieved from https://www.healthit.gov/sites/default/files/reports/info_blocking_040915.pdf
2. EHR incentives & certification, How to attain Meaningful Use.  Retrieved from https://www.healthit.gov/providers-professionals/how-attain-meaningful-use

3. How does information exchange support the goals of the HITECH Act? Retrieved from http://www.healthit.gov/policy-researchers-implementers/faqs/how-does-information-exchange-support-goals-hitech-act

4. The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services (September 21, 2015). Federal Health IT Strategic Plan 2015-2020. Retrieved from: https://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf