Kathleen Sebelius, who was confirmed by the Senate in a 65-31 vote as secretary of Health and Human Services yesterday, was sworn in at the White House earlier today by President Barack Obama on the 100th day of his administration.
"Obviously, we have a lot to do to make sure that healthcare is affordable for the American people [and] to deal with critical issues like food safety. But we wanted to swear her in right away because we've got a significant public health challenge that requires her immediate attention," Obama said, referring to the current global concerns over swine flu.
"I expect her to hit the ground running, and I have every confidence that given her experience as a governor who's managed crises before, who's worked on public health issues since she's been in public life, she is the right person at the right time for the job," Obama said. Sebelius resigned her position as Kansas governor last night.
The confirmation finally fills President Barack Obama's last cabinet post. It comes at a time when other healthcare issues, including healthcare reform, are dominating the headlines--seemingly foreshadowing the busy agenda Sebelius will encounter as she begins her new position.
What's next for Sebelius
As new HHS secretary, Sebelius will lead an agency of 65,000 employees and a $750 billion budget that overseas HIPAA-related activity.
The leader of HHS is charged with defining countless regulations of the American Recovery and Reinvestment Act of 2009, signed two months ago, namely ones surrounding the effort to move hospitals to complete electronic health record adoption by 2014; these are included in the Health Information Technology for Economic and Clinical Health Act (HITECH Act).
HHS already is on top of HITECH deadlines, and the delay in Sebelius' nomination does not push off the HITECH deadlines, says Rebecca Herold, CISSP, CIPP, CISM, CISA, FLMI, of Rebecca Herold & Associates, LLC, in Des Moines, IA.
HHS beat the 60-day window imposed by Congress to define "unsecured protected health information" on April 17, when it issued its draft guidance.
David C. Kibbe, MD, MBA, senior advisor to the American Academy of Family Physicians, says HHS has been working with a small staff.
"Someone told me in jest there are seven people working in HHS right now, and they're peddling as fast as they can," said Kibbe, who also chairs the ASTM International E31 Technical Committee on Healthcare Informatics and is a principal for The Kibbe Group LLC, in Raleigh-Durham, NC.
Kibbe says there is a "certain fogginess" over HHS the last few months, but Kibbe adds healthcare leaders should focus on what happens in-house from here.
A good place to start is with Rahm Emanuel, Obama's chief of staff, and Peter Orszag, the president's budget director, says Joseph Paduda, principal, Health Strategy Associates, LLC, in Madison, CT.
Those two are the "centers of power" in healthcare reform, Paduda tells Healthleaders Media. Emanuel does not want to take on the doctors and big pharma right now, but Orszag believes that you can't fix the economy without fixing healthcare.
"And therefore the two are inextricably intertwined," Paduda says. "Sebelius, while a great choice and a strong candidate, is likely not going to play as significant a role in reform as these two heavyweights."
"Who is the head of HHS is not going to change what's already been written," Herold says. "Enforcing regulations is the goal."
Sebelius will also need to fill several key positions including the head of the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Centers for Disease Control, and the U.S. Surgeon General.
Dom Nicastro, a managing editor with HCPro, Inc. contributed to this report.
CIGNA has made its Cost of Care Estimator available to 550,000 doctors, hospitals, and clinics around the nation as a tool to inform patients about their share of the cost of care before they get services, the company said. The itemized, real-time estimates, which are based on a member's specific health plan, explain how the insurance will be applied and what the patient would owe. The information can help avoid financial surprises and may head off potential over-billing by care providers, CIGNA said.
Many Connecticut ERs, like those across the country, are packed even under normal circumstances. So the prospect of a growing swine flu outbreak has doctors and hospital officials examining preparedness plans, anticipating an increase in concern among residents, and considering how they would cope with an influx of patients.
And they're contemplating challenges, such as the potential for emergency rooms to become even more taxed, or keeping medical workers healthy if the state begins to see a high volume of cases of a flu that so far has no vaccine.
One of the first documents that details the Senate's plans to overhaul the healthcare system started trickling out, beginning with a 52-page report that members of the Senate Finance Committee plan to debate. Many of the proposals use Medicare as a testing ground for ideas that could eventually be expanded to the broader market. One of the top points is to provide payment incentives to hospitals that reduce preventable readmissions of patients, and provide a single bundled Medicare payment for certain types of care, instead of paying hospitals for individual tests and services.
President Obama's Cabinet was finally filled after the Senate, on the eve of President Obama's 100th day in office, voted 65 to 31 to confirm Kathleen Sebelius to head the Department of Health and Human Services. Hours later, the former Kansas governor was sworn in in an Oval Office ceremony. Democrats had sought a quick vote on Sebelius as Congress moves ahead with healthcare reform this summer, but Republicans slowed her advancement.
When the uninitiated think of electronic health record implementations, they focus on build and rollout. Most likely, the implementation is considered an "IT project," and the communication machine starts rolling just before staff members are affected. However, the initiated know that EHR implementations—successful ones, that is—are process, workflow, and operational in nature. They are considered operational improvement projects with a healthy dose of change management, and communication begins when the decision to move to an EHR is made.
With the American Recovery and Reinvestment Act's HITECH incentives, healthcare organizations are being urged to roll out EHRs and use them in a "meaningful" way. The following are three areas that often get the short shrift during an EHR implementation, but they are as critical to success as the functionality itself.
Communication. One of the first steps in an EHR implementation is to carefully create a communication plan that focuses on all classes of end users. The message should address the benefits of the new system's functionality, as well as, the changes that will occur post-implementation to people's everyday workflow. From implementation experience at academic medical centers, ambulatory facilities, and community hospitals, my colleagues and I have identified the need to better prepare end users for the effects on their daily processes.
The learning and change process begins with these early communications. In addition to the "training" concept inherent in it, early adoption questions can surface that may alter the build and the training program. In addition to end users, leadership and the project team require early and frequent knowledge. You can use e-demos and training materials based on actual scenarios to help assimilate everyone involved to the new environment.
"IT" project vs. "operational improvement" project. It is a common mistake to label these types of implementations as IT projects. Regardless of whether it's an EHR, PACs, laboratory, or other system, the purpose of the implementation is to improve operations. Even though the IT department provides technical direction and support, the owners are the users. Early communication and adoption of this concept results in a more engaged user base, and the implementation feels more like a cross-functional team effort. This heightened participation leads to input that makes the system configuration and optimization more relevant to users. It should also eventually improve patient satisfaction, as end users across the organization represent various aspects of the patient experience.
EHR training approach. All too often, the topic of training is an afterthought. Yet if people aren't adequately trained, an EHR implementation can fail. By failure, I mean that delays mount along with frustration, and inversely, patient satisfaction plummets. Although it's understood that training is required, early focus is on acquisition, build, configuration, technology, and implementation. Therefore, the training team is usually not identified until later in the process and thus not involved in the build and configuration processes. Early involvement with the project team allows trainers to:
Have adequate time to create a good curriculum based on the build and configuration requirements.
Develop an understanding of operations and workflows that should be integrated into training scenarios.
Develop relationships with application and user teams to enhance communication and response time regarding issues, questions, and resolutions.
The following are some suggestions for how to approach the training aspects of an EHR implementation.
Create a training plan that clearly communicates the vision, mission, and approach. The plan should identify the organization's approach to staffing, curriculum, and process based on an assessment of the technology, environments, and audiences involved. This document will be used to obtain support during early communication sessions and with the organization's leadership.
Obtain leadership support for your training strategy. The training mission, vision, and delivery strategy should be reviewed and approved by administrative and physician leadership. It is important to communicate the critical training requirements to physicians, clinical care providers and general staff. For example, training may be optional for some and mandatory for others. Or, access to the new system will be granted only to those passing a competency assessment. My clients have found that a best practice is to tie system access to passing a competency assessment. Executive buy-in is absolutely critical for this to be successful, however. It should also be communicated by executive leadership versus the project team.
Staff up. Identify potential trainers early in the process. Look for people with good communication skills at all levels, experience in training environments—preferably with a system implementation, and other characteristics like patience. Don't wait. Identify trainers on staff or hire outside trainers during the initial phases of the project to begin involving them in all activities, including design, build, validation, and any re-engineering processes sessions. Training in and of itself is a significant endeavor.
Determine training methodology. There are many questions to be answered, such as: Will there be a dedicated training team? Will a train-the-trainer approach be used? How will the role of super user be defined? Will training be instructor-led or computer-based? How much can a user learn about the process and the software application in a short formal classroom session? Based on my experience, the approach most often used is a blend of instructor-led and computer-based training. Here are some suggestions:
Don't rely entirely on computer-based training. Given the number of staff who may not be very computer literate, it will not be the most effective way for them to learn.
Combine computer-based training, instructor-led training, hands-on exercises, and practice time. This blended approach should meet most of the diverse end-user characteristics.
For end users who need additional training, computer-based training is a good option.
Create curricula based on the design, build, and validation processes that focus on the specific goals or requirements of the role and the associated workflow that individuals need to know.
Cover computer basics. Early in the implementation process, evaluate end users' computer knowledge. The quickest way to frustrate staff is to give them tools that they cannot use or understand. Provide basic skills to those who need them to shorten class time during training. Our experience with clients has shown this strategy should lead to better adoption rates, a clearer understanding of application flow and workflow, and increased use of the system.
Communicate changes. In the training communication plan, include a process for distributing updated training materials to staff. This includes specific updates for managers and super users.
Set up post-training environment. You will most likely have users with a variety of unique training needs. Therefore, it's important that the communication plan clearly identifies the post-training requirements for all users. For example, a "playground" or test environment is a great way to enable users to practice without worrying about making mistakes.
Transfer knowledge. Training is a collaborative process. Trainers will need to work closely with physicians, nurses, technologists, financial staff, and other members of the healthcare organization to successfully develop and deliver training. The objective of training is to transfer knowledge to end users so that they can enhance the quality of patient care. The EHR is one tool to do this. The other tools that are just as important are processes and workflows that complement the technology. Although the initial training sessions will focus on application functions, the actual "learning" and optimization of the applications will come after the training, through use. That is why post-implementation support is so important. Whether it's the training "playground" or additional classes, users will have more questions once they start using the system and living in the new workflows. Processes may need to be fine-tuned; therefore, trainers and technical staff should be readily available post go-live.
These three areas: communication, classifying implementation projects, and end-user training can create a foundation for the technology to succeed. Some mistake them as "fluff," but that is a costly mistake.
Rob Drewniak is a consultant with Hayes Management Consulting in Newton Center, MA, and the former senior vice president of clinical resources at Glendale Memorial Hospital. He can be contacted atrdrewniak@hayesmanagement.comor visit www.hayesmanagement.comfor more information.
Chief information officers are not always a member of the CEO's inner circle. In fact, only a quarter (25.23%) of CEOs listed a CIO as members of their senior executive team, according to the 2009 HealthLeaders Media Industry Survey. But the passage of the American Recovery and Reinvestment Act of 2009 may have just elevated their position. The federal government's $36 billion incentive package to install electronic health records means that more CIOs will report directly to the CEO and help set the strategy of the organization.
The role of the CIO has been evolving during the past several years beyond a position that focuses solely on technology and is viewed as the "keeper of information resources." In the April issue of HealthLeaders magazine ("Not Just Techies Anymore"), we examine how that role has evolved during the past several years. Now more than ever, CIOs are helping drive the operational strategy for the organization, says Asif Ahmad, vice president for diagnostic services and CIO for Duke University Health System and Duke University Medical Center. "If you look at the for-profit sector, most of the time the person who is running operations is also responsible for making sure the technology works," he says. "Healthcare needs to follow in those footsteps."
Thirty-nine percent of CIOs already view themselves as a "key leader who contributes to overall organizational strategy," and another 39% saw themselves as an important operations leader, according the HealthLeaders Media survey.
Some of the chief information officer's new job responsibilities include:
Learning clinical operations in order to deploy clinical solutions.
Thinking strategically four or five years down the road.
Serving as a link between technology and the physician/nursing staff.
Focusing on how technology works in the context of the business of healthcare.
CIOs will have to step out of their comfort zone and focus on the business aspects of healthcare if they want to secure their seat at the table. In the coming months, they will have to make a business case for the technology components their organization needs to qualify as a "meaningful user" of EHR technology and secure the reimbursement offered in the stimulus package, which could amount to millions of dollars for health systems and $44,000 for individual doctors. Trust me, no CEO or CFO wants to leave that money unclaimed if they can avoid it. So if you aren't already fluent in the language of the CFO, you better get practicing.
Traditionally, focusing on the financial ROI of a clinical technology system hasn't always been a necessity for CIOs. Nearly 27% of CIOs said financial ROI was not factored into the decision to purchase clinical technology, and about 61% said potential financial return is measured but doesn't influence the final decision, according to the HealthLeaders Media survey.
Of course healthcare organizations want to buy the best clinical technology for their patients. That goal hasn't changed, but healthcare facilities can no longer afford to ignore the ROI of large technology purchases, either. According to a survey by the American Hospital Association, 43% of hospitals say they expect losses in the first quarter, up from 26% for the first quarter of 2008. That is probably one of the reasons why 66% of CIOs expect to be asked to make further cuts in IT spending before the end of 2009, according to a recent survey of healthcare CIOs.
When constructing the business case for health information technology, it is essential that CIOs know the total cost of ownership, said Andrew Wiesenthal, MD, associate executive director for clinical information support with The Permanente Federation, during the recent HIMSS annual conference on Chicago. That means the licensing fees, hardware, and the development costs. It is also important to know the cost of training and what impact changing the workflow will have on physicians and nurses. There is a learning curve to these systems and productivity will likely decline—at least initially.
In order to sell the technology that can ultimately help improve patient care and reduce costs, "CIOs and IT staff have to learn how to speak the language of finance," says Wiesenthal.
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Eclipsys Corporation has announced that Kenosha, WI-based United Hospital System has selected a wide range of the company's clinical, ambulatory and performance management solutions to support patient care. As part of the net-new client agreement, UHS will implement a suite of Eclipsys' clinical applications.
This white paper is designed to provide capabilities, functionalities, and case examples for how health IT can be implemented to support the patient centered medical home.
The Medicare Telehealth Enhancement Act, House Resolution 2068, would expand Medicare reimbursement to telemedicine facilities in urban and suburban areas. The bill would also provide $30 million in grant funding for healthcare organizations.
