If I were to ask you to name one of the most critical competencies for success in healthcare and healthcare IT, how would you answer? Technical aptitude? Deep clinical expertise? No doubt those are important, but the one I had in mind was actually lifelong learning. This skill is now recognized by educators, accreditation organizations, certification boards, and employers as one of the most important competencies that successful people can possess.

I’ve written previously about the dizzying pace of change we all face. Products change, software changes, processes and policies change, and so too do the needs of our businesses and the customers we serve. To keep up with all this change successfully, we must be able to adapt to it. And learning is a key component in developing that ability. Consider the importance of this attribute in recruitment. For healthcare leaders facing a multitude of changes on every front, it may be vital to choose lifelong learners when building teams that navigate major changes successfully.

Lifelong learning doesn’t require being permanently enrolled in classes or continually racking up qualifications. It’s more an attitude and set of behaviors that help us succeed. If you are choosing among several strong candidates to hire, how do you recognize a lifelong learner? Watch for these characteristics:

1. Lifelong learners realize that learning is a process that never ends. It is a way of continually improving, both professionally and personally.
2. Lifelong learners keep an open mind. When we think we know all there is to know about a topic or situation, it’s easy to miss or disregard new information because it conflicts with something previously learned. An open mind means we can benefit from any learning opportunity.
3. Lifelong learners are always curious. The question “why” is a basic and obvious sign of the desire to learn more. Instead of relying on others, they take charge of their learning, including goal-setting, acquisition of knowledge, self-assessment, and self-reflection.
4. Lifelong learners learn everywhere. They recognize that the classroom is not the only source of knowledge, and they manage a personal network of knowledge sources, including colleagues, books, Internet and social media, experimentation and even their own and others’ failures.
5. Lifelong learners help others learn. And they know that when they teach others they are not only helping the student, but also increasing their own mastery of the subject.

Do you recognize yourself and your team members in some of these? As you consider each of the characteristics, ask yourself how you and your team measure up, and commit to doing better. Set an example for others by following a blog or two on a topic of interest or strike up a conversation with someone whose knowledge or skills you admire, regardless of their position in the organization. It’s never too late to build a team of lifelong learners who face and conquer change with the success that all great organizations seek.

In nursing school I was trained in how to thoroughly assess a patient's pain in order to provide the best treatment. This involved questions such as, Where is your pain? When did it start? And maybe most importantly, Does your pain radiate or travel anywhere else in the body? While a patient may believe his or her problem is located at the precise point of the pain, the pain may be a symptom of a problem somewhere else.

As an informatics nurse specialist, I continue to use those skills to treat a much different kind of patient. Customers from all clinical backgrounds report kinks and catches within the system. Often the most valuable question is, Does this problem travel or radiate? While customers may be adamant that they know the source of a problem, it does not necessarily mean the problem didn’t originate elsewhere, or that it doesn't affect one or more other areas of the electronic health record (EHR).

While I want to find the quickest solution to a customer problem, I must also address its source and prevent other issues elsewhere in the chart. Although the customer may be seeking a fast fix, ( no one likes to deal with pain for any length of time) as an informatics nurse, I must make sure I'm not causing further problems by implementing a resolution without first weighing the pros and cons of each solution.

Treating the source of a problem is done in much the same manner it would be in a hospital--- through consulting a team of experts. Through collaboration and brainstorming, a team of web developers, user-experience designers and fellow product managers can help determine the best solution in the shortest amount of time, while minimizing the impact on the rest of the system. That approach provides "pain" relief and increases "patient" satisfaction. The ultimate goal is to get the user "logged in, logged out, and on their way" to better EHR health!

Many of us remember the days of integrated delivery systems, global capitation and huge physician organizations. If you were not working in healthcare in the early 90s, I am sure you hear people talk about the failures associated with those models, including accusations of poor quality and challenges with patient access. The failure of hospital-owned physician practices, large physician practice management models and independent practice associations (IPAs) were all well-publicized. Part of the debate, and frankly the criticism, around the current health and payment reform is the concern that what we are doing now feels an awful lot like “back to the future.”

So, what makes payment reform different this time? You may question, and rightly so, what is so different about an accountable-care organization (ACO) versus an IPA that took capitation risk and failed? One of the major differences that everyone is counting on this time is information technology. That is a simple statement but a complex issue. It is not just the data that was late or missing in the 90s, it was the lack of a care-coordination model for managing a patient throughout the delivery system. Information technology allows information, not just data, to be shared and utilized.

Why do I make that distinction? We had data before, but it wasn’t timely or easily shared. Physicians in the IPA might have had the data, and it may have been timely, but it couldn’t be shared with the hospital or home health agency or anyone else for that matter, and certainly not the patient. This time physicians and hospitals will be able eventually to share quite a bit of information. Integration tools allow physician EMRs to “talk to” hospital EHRs. Non-affiliated physicians in a market can share information through local IT networks sponsored by hospitals, health plans or health-information exchanges (HIEs). New business intelligence tools will be able to extract the data and turn it into actionable information for both hospitals and physicians. Understanding if diabetic patients have received all their quality measures in the hospital or practice(s) can help both physicians and administrators manage to the standard of care. For the patient, Stage 2 meaningful use requires a patient portal, where the same information can be shared and acted upon by the patient. In turn, that data can be effectively utilized when communicating with payors about the collective efforts of the healthcare team.

Research has shown better utilization of services will result in lower costs and better quality care. Payors and the federal government will begin to pay based on the performance they see from the healthcare team, leading to payment reform. Those that have the information exchange and the tools to track and manage performance will be victors.

CMS has announced it will consider a delay in the implementation of ICD10 beyond the original date of October 1, 2013. How long will they extend it and what does it mean? Does CMS need more time, or are there political reasons to delay, maybe to make nice with the AMA? At this point, it appears there are more questions than answers about this major industry transition.

So, be truthful, were you going to be ready? Will you keep your timeline now or relax? Recent online surveys have revealed that a large majority of respondents are in favor of keeping the original deadline. Are these responses from people that were going to be ready anyway?

If you are guessing about the length of the delay, here are some possibilities:

1. Delay one year: This makes the most sense to me. CMS often aligns changes with their fiscal year.
2. Delay six months: This is a possibility, but this option might not be long enough to satisfy those who oppose the current timetable.
3. Delay the enforcement like HIPAA 5010 (3 months): Would this mean you have to justify your delay to CMS?
4. Stagger deadlines: Sure, why not add to the chaos?

A delay might be a reasonable action to take. Many may feel that other, parallel priorities already are interfering with preparation – like 5010 conversion, meaningful use, electronic health records, and denial management issues.

While everyone waits for answers and a decision from CMS, here are some things to do:

• Documentation (by physicians and others) will be very important when coding requires more specific information. Make this a focus of new processes and coordination among staff members who prepare and use it. A 3M senior consultant provided this list at the AHIMA ICD10 Summit of their top 10 documentation issues (with ICD10):
  
  1. Diabetes mellitus
  2. Injuries
  3. Drug underdosing
  4. Cerebral infarctions
  5. AMI
  6. Neoplasms
  7. Musculoskeletal conditions
  8. Pregnancy
  9. Respiratory/vents
  10. ICD-10-PCS—“the whole book”
• Training - Make a plan for training coders and other staff members. Now you will have longer to improve the ability of current staff instead of hiring/contracting or just being “short-handed.”

Have you really ever thought about what goes on when a nurse administers a medication? Let’s think of something even simpler. What workflow occurs when you want toast for breakfast?

If you said, “put the bread in the toaster,” you’d be mostly right. However, you do much more than that. You might have to take out your toaster, find your bread (unless you forgot that you ran out), and you’ll probably think about what you want on your toast for a topping.

What does this have to do with administering medications, or any other process, for that matter? Let’s take our earlier example of administering a medication.

Medication administration starts with an order. So the workflow needs to be started at the order level. From there, think about any processes that may occur in parallel, or those that may fall before or after one another.

After defining your workflow, you can really start to see potential points of failure where improvements can be made. You might come to realize that the original problem that you were trying to solve isn’t the problem at all.

Visualizations are an important part of explaining and presenting workflows. Creating a visualization of your workflow can help someone who is not involved in your process understand the issue that you are trying to solve. These visualizations are not always simple, and in fact are often very complex.

Think about getting down to basics with your visualization. Don’t be afraid to break out the pencils, pens, crayons, markers, and paper. Maybe you would do better to go small-scale; why not try sticky notes up on a wall?

Give yourself time to think about the process and lay it out in front of you. When you feel like you have what you need, you can then transfer this knowledge to an electronic medium and refine it further from there. This tool can be valuable for all, from creating a new screen during software development to creating or updating policies.

All things have a workflow, whether simple or complex. If you can understand the workflow, you will add a new tool to your arsenal to help make improvements, from medication administration to making toast.

Click on graphic below for larger view.

This is the third in a series of posts regarding how HMS is integrating customers into our product development process. This post focuses on how we are accomplishing this.

Our first step is to identify the projects for which we want additional input. Typically, we focus on larger initiatives that are complex and require an extensive understanding of workflow, such as Physician Documentation.

The second step is to identify participant characteristics. Working with our account management team, we use a variety of criteria to identify candidate organizations, including:

• Bed size
• Geographic location
• Diversity of HMS applications in use
• Length of HMS system use
• Experience with non-HMS systems Number of facilities in the organization (1 versus 10 versus 100…)

This allows us to obtain a cross section of facility types that improve the odds of HMS building and delivering a system that meets the needs of our diverse customer base. Once we select candidates, they are asked to participate in project overviews and demonstrations. From there, they are asked to join online demonstrations to review and provide input at various stages of the development process.

These ongoing relationships allow us to gain insight and feedback over the life of the development project. This also forms an initial pool of potential beta candidates.

As HMS evolves this emerging process, we continue learning how to improve it and make it as effective as possible. Customers who agree to participate are helping us and their peers in other hospitals as we move our product suite to the next level.

The scene: busy neighborhood pub on a Friday night. Glasses clinking, waiters hustling, weary diners welcoming the weekend. Convivial group around the table, old friends and new.

And a hot topic of conversation: electronic health records.

Wait . . . really?

It’s true. One diner has shared the happy news that long after she stopped hoping, she is expecting a baby. Being new to town, she and her husband immediately initiated a search for the right provider for pre-natal care, delivery, and pediatrics.

The really revealing part about the current sea change in healthcare was what came next. The first selection criteria she mentioned were not reputation, or specialty expertise, or a reference from her best friend—it was not how this provider delivers her care, but how they deliver her information.

Everyone at the table listed intently to her description: “Did you know that if you are a patient at (hospital name), wherever you go—to the doctor’s office, for scans or tests, anywhere—they already have all your information? So they don’t ask you to carry your x-rays or lab results around? Even the stuff from my former doctors in my home state—they had all of it, and any of them could see it instantly.”

And the story continued: “The part I like best is that they have a really great website where you can sign in and see EVERYTHING. I got an email that my test results were in, and I logged in to read them. I went to the same site to review all my charges against my insurance bill—it was all very easy to find, right in front of me. It’s great. I love it.”

Another diner whose elderly mother is in need of frequent care responded with this equally telling observation: “Wow. I might move Mom’s care there. I can’t even imagine how much easier my life would be. It would be huge. Are all their doctors connected to the hospital like that?”

Clearly, this hospital successfully delivered two important, interrelated benefits. The hospital chose a good EHR that helped caregivers do their jobs and made the patient aware of that benefit everywhere she turned. The second was equally important: the hospital made her part easy by delivering a patient portal that was easy-to-use, appealing, seamless.

In the highly competitive healthcare market where this dinner took place, those strengths gained the hospital and its affiliated physicians a loyal new customer. In a smaller community, such a strategy could make the difference between local providers keeping a patient in their hometown for care or losing them to out-migration.

A strong EHR strategy has become a highly marketable competitive advantage, but hospitals and physicians will have to tell their EHR story boldly to get the most out of it. Those who ignore that opportunity in this window of time will never be the highlight of dinner-table conversation and gain the patients who come along with those priceless testimonials.

As a professional in the world of training and development, I find that people are constantly coming to me with training needs. “We need a class,” they tell me. Clearly, I love classes; however, I always try to remind people that a class is only one component of the learning process. What happens before and after the class should be every bit as important as what happens in it.

I believe that learning transfer—the process of taking the information learned in a class and applying it to the job—is an absolutely critical component of training. It’s also one of the biggest challenges for instructors: We can try to fill our learners’ heads with knowledge, but how much of that will reach the workplace, where they need to use it? After all, we don’t train people so that they know more, we train them so that they can do more, or better, or differently. The goal of training is to improve performance.

So how can we help make the transfer from the classroom to the workplace happen? One way to facilitate transfer is to make sure our learners are ready to learn. Adult learners need to be motivated. They need to believe that the new skills they will be learning are relevant and will be of benefit to them, and they need to feel confident they’ll be able to use those new skills on the job. Taking some time to make sure learners are motivated, enthusiastic, and understand how the training will help them is a great investment and one that research shows can increase learning transfer by up to 70 percent.

Make sure that the training classes you deliver or attend answer the question: “What’s in it for me?” Structuring training—whether live, online, or at a distance—to reinforce meaningful benefits, both explicitly and implicitly, will help make sure learners stay open to the class content and are ready to use it back on the job, where it matters most.

With the current trends in healthcare IT and the move toward meaningful use, most facilities are currently evaluating their clinical processes and how new clinical features and functions will impact their organizations.

When identifying the key resources who will be responsible for the successful adoption of the clinical function throughout the enterprise, it is vital to understand the change-management process and its impact on the enterprise.

Even before you purchase new IT applications, you should, as stakeholders—M.D.s, nursing, HIM and ancillary (IT is more of an enabler and facilitator in this process)—meet to discuss the areas that will be impacted by the purchase (process, systems and organization structure), the motivation behind the potential change and how the new processes will be governed with the new applications moving forward. Changes of this magnitude will impact all areas of the enterprise. This work will not be easy as many day-to-day operations and processes will be altered, but it’s for the good of the organization.

With any change there are two key components that must be understood before change can actually happen: CHANGE MANAGEMENT and PROJECT MANAGEMENT.

Project Management is the application of knowledge, tools and techniques to meet specific requirements.

Change Management is the process, tools and techniques to manage the human portion of the change to achieve the desired business objectives.

Any change to the processes, systems or organizational structure will have a technical and a human element that will need to be managed, and we need to think of these as separate and distinct. Project management requires you to formulate a set of plans and steps to achieve the desired outcome, and change management requires you to create an enterprise-wide approach to the change to help the people who are most impacted by the change be successful. This hand-in-hand approach will speed the goal of adoption and ultimately project success.