The Driving Force

EMR Transition Pitfalls: Regulatory Compliance in an Electronic World

In the world of mountain climbing, it is well-known that those that race to the top as quickly as possible without taking the necessary steps are doomed to fail. Thinning oxygen levels coupled with harsh conditions at high altitude compel successful climbers to take the right gear and acclimate at base camp. Similary, it can be overwhelming to try to throw yourself headfirst into the world of EMRs without taking stock and adjusting to the new system. Preperation minimizes the risks involved in the ascent toward the ultimate goal, as it has for generations of mountain climbers.

In 2009, Congress enacted the Health Information Technology for Economic and Clinical Health Act (HITECH) as part of the American Recovery and Reinvestment Act (ARRA) to expand upon HIPAA regulations pertaining to electronic transmission of health information. Given the significant increase in EMR/EHR adoption, it is important to proactively manage the transition from manual to electronic logging when distributing protected health information (medical records with patient identification). In fact, both HIPAA and the HITECH Act mandate that all providers implement a consistent and compliant logging of all health information releases.

Currently, HIPAA reqires the accounting to include the items below for each disclosure (164.528(b)(2)

• The date of the disclosure;
• The name of the entity or person who received the protected health information and, if known, the address of such entity or person;
• A brief description of the protected health information disclosed; and
• A brief statement of the purpose of the disclosure that reasonably informs the individual of the basis for the disclosure.
• A copy of the request for health information or a brief statement of the purpose of the disclosure

A few summary areas of how the HITECH Act changed the HIPAA regulations:

• They closed HIPAA's exemption of privacy rules for electronically transmitted medical records
• There are new breach of information notification requirements in the transmission of EMRs
• Breaches affecting a number of individuals must be made public and reported to the Department of Health and Human Services
• Of special note: Healthcare providers must now manage all aspects of tracking electronic disclosure, including information pertaining to carrying out treatment, payment and health care operations, and provide them to individuals requesting an accounting of disclosures for a period of three years prior to the date on which the accouting is requested

I will be covering these issues in more detail in discussions to come. For a complete list of modifications to HIPAA under the HITECH Act, click here.

A few suggested steps for your journey up the EMR compliance mountain:

• Implement an automated release of information system, logging both electronic and paper records disclosed
• Incorporate all faxing of health information into a centralized release of information process
• Maintain electronic images of the request for health information as part of your automated logging system

 

Burning the Ships

One of the greatest of the 16th century explorers was Hernando Cortez.  While no model for humanity, what he lacked in moral character, he made up for in anecdotes for leaders.  In the spring of 1519, Cortez took an armada of 11 ships carrying 508 men from Cuba to the Eastern shore of Mexico just beyond the Yucatan peninsula.

The expedition was to create a Spanish settlement by conquering the inhabitants and taking their riches.  What they found was a hostile, treacherous land, and indigenous Aztecs who practiced human sacrifice and cannibalism.  After 5 months of being on the foreign, unforgiving land, Cortez's men decided to return to the safety of home and leave Captain Cortez to fend for himself.  To ensure his men stayed in Mexico and were properly motivated, Cortez did not have a motivation meeting, one-on-ones with the opinion leaders, or even threaten the men (as far as we know).  He took away the one thing that tethered the men to their Spanish homeland--he burned the ships.

The thing to realize is that Cortez' goal was not to execute a successful voyage to foreign lands nor to touch down and go back to Spain an Explorer Hero.  His charge was to subdue if possible or conquer if necessary the land's inhabitants, and start a Spanish settlement.  He did so by conquering the Aztec nation of 5 million with less than 1000 soldiers.  Most experts agree if Cortez had not set the ships ablaze, someone else would have discovered and conquered Mexico.

I find myself consulting with a handful of companies whose owners and leaders want to ensure they are not keeping their old ships (outdated strategy, market, and operational models), and that both they and their staff know what their "real mission" is while making the bold moves necessary for success.

To successfully navigate our economic realities, competitive onslaughts, and shifting customer demand; business leaders should consider a few questions from Cortez' motivation manual:

• Are we concerned with the methods we are using more than accomplishing our ultimate goal?

• Has being in the survival mode made your top staff or you hazy on the vision your organization is pursuing (one generally follows the other)?

• Has the last few years taught us to be so risk-averse that we keep the old "ships" that have worked in the past (i.e. old strategies, value propositions, views of who is our customer / competition, etc.) rather than evaluating those ships allowing new strategies, solutions and value propositions to be considered?

• Have the payroll reductions, bonus freezes, job uncertainty, and extra workloads caused your team to take a "I just work for my paycheck now" attitude? --Be honest.

• Are you as a leader prepared to make the bold moves needed to be successful in the new market realities, or are you busy with the old "ships" while others are conquering the marketplace?  A good read for this is  The Innovator's Dilemma   by Professor Clayton Christensen of Harvard Business School 

One last thought.  Historians tell us that although Cortez accomplished his expedition’s goals, he did not accomplish his own mission: to rule Mexico.  Being aggressive was not his problem, knowing when to use aggressive leadership was (like conquering the Aztecs who initially welcomed the Spanish visitors).  So, one last question:

• Are you accomplishing goals in a way that will detract from your full mission?  Most of us know what our default leadership/communication style is, but rarely use other styles based on the demands of the situation.  In my next post, I will bring a few lessons learned in this area and a few tools that helped.

 

Cheering from the Sidelines

I wanted to say a heartfelt thank you to all the staff, customers, and investors who have traveled the CH Mack journey with me over the last three and a half years.  Together, through the toughest economic time since the great depression, we have jointly tripled the size of the company while releasing next generation Healthcare software.  For the investors who believed in (and put your money behind) the vision of having a growing company with a market leading solution; for customers who have given us their partnership, feedback, and of course opportunity to serve them; for the company's management, staff and contractors who have been asked to do much more with less, to believe when times were tough, and to not quite till our customers objectives (both internal and external) were accomplished---THANK YOU!   You have been and always will be my heroes. I agree with the co-founder and CH Mack's sales rainmaker when he said that the company is in the best strategic position of its 18 year history.  Each one of you allows the company to have deep experience, global talent, and a broad skill set that are sustainable advantages and that position the company well for the future.  

Of the many things I will cherish from our time together, the greatest is having fought hard battles to attain our success and having become better people because of it.  This has been brought home to me as I have received messages from staff who have fought beside me in the trenches over last several years; One kindly stating "you are a good man and you will be missed."  

While I will be on the sidelines now, know that I will be cheering on each of you and CH Mack as it moves forward.

Take Care,

Chris

 

 

The Opportunity Cost of Not Investing

 

A while back I  was interviewed by the Department of Development on the receptive climate of Ohio to businesses.  I believe the Department of Development has added much to our state and entrepreneurial spirit in this region.  However, there is an area that we did not cover in the interview that I would like to emphasize: 

While the Ohio business climate (and most of the US for that matter) is fertile for business investments, too few businesses are really investing. Before my counterparts running businesses decide to unfriend, unlink and generally disavow me, let me explain.  Over the last 5 years our economy in this region, nation and in much of the world has gone through significant change

s while going into and out of the recession.  These changes have pushed many business leaders to reevaluate the value proposition for our business investments (a good thing).  Unfortunately, many otherwise smart business people have what psychologists call apprehensive expectation (a bad thing).   The actual definition of this defies logic, but the idea is that we learn unhealthy, defensive behaviors--behaviors like hoarding the largest cash reserve vs. GDP in our nation’s history.  Take even the Federal Reserve who thought they had learned the correct fiscal policy lessons after the 1920–21 recession.  Believing it understood deflation and liquidation dynamics, the Fed tightened the money supply and helped the Depression to spiral out of control.

No, I am not accusing American businesses of pushing us into a depression, only to consider the costs of learning the wrong lessons.  At a minimum this may mean losing opportunities for their businesses and stakeholders, but may also lead to a generation of misguided business leaders who believe that underinvesting is the best way to protect their businesses.  Let us all consider this a threat to our businesses and communities in this area, region, and nation. We must prepare for rainy days, WHILE we invest for the future.

 

How business problems solved, customer-care value must be top priority

Standards in areas of customer service and customer property-safety set great businesses apart from the pack. We all do business in a consumer-centric society, and there can be no better business trait than clients feeling your organization takes personal care to their needs and desires.

I’d like to share two polarizing experiences I’ve had where customer service and property safety played a key role in my future dealings with two separate organizations.

I have used airport valet parking at a regional airport for the last several years. In fact, I have seen the service as extremely valuable when having to quickly transition from one event to the next.

A number of weeks ago, while picking up my car, I was shocked to see the car had been damaged while under the company’s valet service’s care. The front bumper, air dam and driver’s side quarter panel had been severally dented in some places and cracked in others — repairs and replacements necessary.

I had numerous conversations with a manager of the local service, who had been cordial; however, initially unresponsive to sending in an insurance claim.  After a few weeks of discussions/e-mails, he sent me a claim form, which noted the “attendant who received the vehicle had marked that section of your car for existing damage.” Interesting risk-management procedures.

This could not be the case.  I am the only driver of my car and it had no damage when I gave it over to the valet.  I understand it is crucial to have procedures for risk-management. –

Of course in business, it’s usually not the problem — but how you resolve it.

Going through a pain-staking process to even be heard and then being given back auto-generated responses, even from the company’s CEO that made me chose between spending my time fighting with a face-less, non-caring corporation versus moving on at my own expense.

Leaders in business must understand that their customers need to be heard and care must be given to the property entrusted with them. It is not enough to make the customers initially feel valued if your core value proposition conflicts with your being a steward of your customers.

On the flipside, an organization’s unwavering support to see my company meet its targeted objective resonates highly with me. It was our fault. Plainly, we had an important industry show that fellow executives and I were attending. The well-intentioned marketing assistant had shipped the entire contents of our tradeshow booth, including flat-screen monitors with an expected delivery date of a day after the actual show began.

We scrambled, attempting to get the equipment there sooner, but with no guarantee. After arriving in Washington, D.C we realized we were going to have to find our equipment within the FedEx national equipment info structure.

After a few minutes with their customer service representatives, we were given the local shipment hub’s contact information, which fortunately was only 90 minutes from the airport. As it turned out, two of our three packages had made it to the hub, with the third being MIA.

Fortunately for our trip, my business and this blog, the night shift supervisor at the Virginia FedEx hub not only helped us track down the third package, but also spent the better part of two hours ensuring that we could pick up our precious cargo with the newly rented maximum-sized SUV.

We ended up loading the last of the packages at midnight, well after this woman’s shift was supposed to be over.

The moral of these stories: Our business value propositions must match our level of customer care. Anything else calls into question both our business model and our competitive edge’s sustainability.