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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​​​

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

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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

Guest Blogger Jacquelynn Seymour 

Jackie is a Sr. Project Portfolio Manager/Clinical Systems within the Information Technology Division Project Management Office at a large healthcare organization in Northeast Ohio. She is anticipating graduation in May 2016 with a Master's Degree in Information Architecture and Knowledge Management – Health Informatics. She is zealous about the possibilities of the application of this field in health care.

We are a big organization, and one trying to fundamentally change how we deliver health care.  Certainly it is a true statement that massive change is not an easy task and we have heard many times that the larger the ship, the harder it is to change course.  Is our vision of KM as the way doomed? Despair not – others have boldly gone where no one has gone before.  We can learn their secrets and blaze our own KM trail.

When it comes to size, IBM comes to mind in the top tier of large organizations (in 170 countries and 370,000 employees seems to qualify as large don't you think)? They are legendary for their mainframe systems and technology solutions, yet times changed and they diversified and expanded their services into five global lines of business: global business services (GBS), technology services, systems and technology, software, and global financing.   The GBS division is a consulting team of over 150,000 employees geographically located across the globe. The team offers clients consulting and systems integration and application management services.  Wow, think about the complexities of discovering, capturing, sharing, and applying knowledge in this context!  Lots of people, many locations, consultants that need to be experts in their area or locate and connect with other experts in the moment, and share knowledge with the other 150,000 experts when they are working for their client or guess what?  The client could become dissatisfied, lose confidence, or worse, fire them.  By the way, this is an important point for our organization and our KM journey – thinking like a consultant reminds us that delivering value to the client (our patients, our peers, our communities, outside agencies) is a top priority. IBM made a conscious decision to embrace a KM strategy to give them competitive advantage and be recognized as the best of the best.  Simply put, they saw learning as an outcome (Morris, 2015).

They had some distinct knowledge-sharing challenges.  Much like health care, the sheer volume of information and knowledge was overwhelming, exponentially increasing, and not likely to all be captured in codified format.  Much of the most valuable knowledge lives in people's brains and experiences.  They are facing retirements and the risk of that tacit knowledge not being codified or transferred and this is a new generation that is not interested in learning old programming techniques.  Locating and connecting to an expert with which to seek or share knowledge was problematic.  It was like finding a needle in a haystack, especially when the term "expert" is contextual and may not even be on a resume or in searchable format.  And, it is not easy to create relationships and network across such a large group in diverse locations.  There had to be a way to help the teams find and interact with each other and gain trust in each other as experts and colleagues, to find the "go-to" people.

It didn't happen overnight.  The transformation began with their vision of creating a knowledge organization and sharing information including technology, processes, content management, and Communities of Practice (CoP) that evolved over three phases and that was tied to the business value.  They are simplifying the process of knowledge sharing and contribution in hopes it will be perceived as an enhancement to every-day activities versus an interruption and time-consuming activity.  Getting a little excited here thinking about how we can use this, it could definitely be a "WIIFM" proposition for our teams!  You know, the What's IIFor Me.

The outcomes look promising based on their indicators and measures of success trends.  Considering themselves in constant beta-mode they continue to evolve and change the culture to transform the way they do business.  One of the most interesting facts is that participation in portal usage and as an expert is voluntary and employees control what information they want to be accessible.  Privacy concerns are honored for content and individual data   This will play well in our world – especially with our physicians.

Some considerations from their lessons learned here:

  1. Make sure we are on solid legal ground early on (so very important for health care and HIPAA regulations). Our legal team can help.
  2. Make sure the experts for the blog strategy are more than interested parties; they are the experts in their field.  This is especially important for patients who will follow the blogs.
  3. There is a tradeoff between privacy and analytics.  Not everything should be mined and accessible.

So one big ship is changing course using KM, what about others?  Is this a one-off example and can size be an advantage?

According to Bonchek & Fussell (2012), there is a "tradeoff between size and speed", yet there are advantages of being large.   It is seen in biology – As an example whales are large, efficient and live longer than birds that are faster and may be more resilient.  The tradeoff is size vs. speed and adaptability.  Contrast this with cities that as they grow become faster and better, boasting higher incomes and more innovation.  If turning the ship is related to size, how do cities get better and faster as they grow?  The article suggests it is due to the creativity and versatility of networks seen in social systems like cities and communities, or virtual communities such as Twitter or other social communities.

Large organizations operate more like whales (economies of scale yet slow and not agile).  Yet, if a large organization runs more like a social network they stand to gain speed and agility, just as IBM did.  Back to the size advantage – bigger organizations have larger networks with more information, so we can extrapolate that organizations that act like a city or community can move faster BECAUSE they are bigger.  Skeptical?  The U.S. Military is a large organization, very whale-like wouldn't you agree?  The 9/11 event highlighted the need for nimbleness and speed, relationships that are network-based vs. hierarchical models.  They used their size and extended network of organizational relationships as an advantage.  The four strategies outlined in Bonchek &Fussell are worth a look.

So we leave you with these examples we can use and apply to our very large organization and this thought - it is not a "do it once and you are done" type of program.  Transformation is not an end point; it is a journey.  IBM thinks so according to their future plans for digital transformation and the reinvention of the modern corporation!

Guest Blogger Jacquelynn Seymour 

Jackie is a Sr. Project Portfolio Manager/Clinical Systems within the Information Technology Division Project Management Office at a large healthcare organization in Northeast Ohio. She is anticipating graduation in May 2016 with a Master's Degree in Information Architecture and Knowledge Management – Health Informatics. She is zealous about the possibilities of the application of this field in health care.

Sources:

Bonchek, M. & Fussell, C. (2012, November 5). Can bigger be faster? Harvard Business Review.  Retrieved from https://hbr.org/2012/11/can-bigger-be-faster

Joshi, Y. (2015).  Digital transformation – will IBM attain its aspirational leadership position? Sherpas in blue shirts.  Retrieved from http://www.everestgrp.com/2015-06-digital-transformation-will-ibm-attain-its-aspirational-leadership-position-sherpas-in-blue-shirts-18007.html

Morris, E. (2015). IAKM Week 8 Foundational principles of KM [Lecture].  Retrieved from https://learn.kent.edu/webapps/bb-collaborate-BBLEARN/recording/play?course_id=_121458_1&content_id=_4584684_1&recordingId=8984243

O'Dell, C. & Hubert, C. (2011). The new edge in knowledge: How knowledge management is changing the way we do business. Hoboken, NJ, USA: John Wiley & Sons.  Retrieved from https://kent.ares.atlas-sys.com/ares/

Satell, G. (2015).  How IBM plans to help reinvent the modern corporation.  Retrieved from   http://www.digitaltonto.com/2015/how-ibm-plans-to-help-reinvent-the-modern-corporation/

Image by Seymour, J. (January, 2016).  Organization culture transformation. [Image]. Words adapted from Becerra-Fernandez, I., & Sabherwal, R. (2015). Chapter 3 Knowledge management foundations: Infrastructure, mechanisms, and technologies, Power Point] in Knowledge Management Systems and Processes. New York, NY: Routledge