Optimization can come in 31 flavors!


Summer is my favorite time of the year, mostly because I love ice cream! Of course, it also happens to be bathing suit time, and it seems like an opportunity to streamline my waist as well. It may sound oxymoronic to say I love ice cream and that I am thinking about my waistline, however with constant improvement and transformation, I can find a great balance for the optimal state, or at least keep trying. I take this exact same approach in my day-to-day work with clients. How do we streamline, increase efficiency, save money, and get the Electronic Health Record into its most optimal state?

Optimization is the key, and like ice cream, it can come in 31 flavors and all different shapes and sizes. Many healthcare IT departments have project-driven roadmaps and have recently been focused on regulatory-driven or vendor-driven projects, such as Meaningful Use, ICD-10, Quality Reporting, Interface Migrations (e.g. ConnectR to CIE/Rhapsody), Upgrades, and Hot Fixes. Often, these project-driven departments overlook or have difficulty finding time to perform the optimization work that I typically find my clients needing. “We need to do an optimization but just have to find the time.” An effective approach to this common dilemma is to consider dissecting what could be a large project into more achievable mini projects. This produces quick wins and successes with immediate results, versus tackling the grand project which will take a longer time to yield improvements. Optimization is about more than just user experience/satisfaction; it also directly impacts finances associated with opportunities such as reducing inefficient staffing costs and exploiting untapped revenue gains.

Using the Galen methodology, we break down an optimization project into something that can be easily achieved with incremental goals. Our methodology includes the following phases: Discovery, Approach, Adaptive Execution, Activation, and Operations. Let’s walk through how an organization can take any one of the many flavors of an optimization project and reap the rewards.

  1. Discovery: the first step is to understand the need. Is the need reducing clicks, decreasing time of task completion or note signing, or is it participating in a new regulatory reporting (PQRS, PCHM) program to gain revenue? Is it possible to develop an optimization program that covers all of this in some aspect?
  2. Approach: next, develop the plan. Decide on the metrics, qualify the goals, and clearly state deliverables that denote success. A simple example of a type of optimization is benchmarking current state on the time it takes providers to verify a result or sign a note. Both of these drive patient safety and quality. How long it takes to sign a note can have a revenue impact if claims are held until notes are signed to avoid audit ramifications. Due to ICD-10 compliance, future audits rates are expected to increase, and this is a great “flavor” of optimization to consider.
  3. Adaptive execution: documenting the plan is key. This important step of clearly stating tasks and deliverables helps to limit the risk for project failure. List out the resources utilized and actual tasks to be executed in order to meet the desired goals/metrics.
  4. Activation: follow the plan. This seems like it would be the easiest but, in my opinion, is often the hardest phase of any project. Periodic benchmarking of goals/metrics and mitigating risks that come up along the way can be a challenge, just like the summertime carnival game “Whack-a-Mole.”
  5. Operations: plan for support. Every project, regardless of the size, should have a period of support/maintenance. Some projects lack this phase, and once the metrics/baselines are achieved and the project is completed, things just go back to the way they were. Change is hard! Just as with controlling my ice cream intake and streamlining the ole waistline, continued support and maintenance is required.

Now that we have a methodology in place, what could an optimization project look like in your organization?

Below are some suggestions/examples to consider:

  • Enterprise optimization: usually this refers to the configuration/build of a given area within the application. It could be that you decided on a fast implementation to gather adoption at the onset, but you now want to go back and fine-tune. Perhaps resources have changed since the initial rollout, and the current team wants to look under the hood at a deeper level. The following areas are typically reviewed in an optimization for recommendations on how to improve their configurations:
  • Note optimization: oftentimes, this is its own category, whether trying to move from v10 to v11 to ACN, or merely looking to improve the amount of time it takes to sign notes by tweaking existing notes or retraining.
  • Meaningful Use, PQRS, ACO (other regulatory initiatives): reviewing if by simply altering a minor workflow or configuration, you could reduce clicks or improve attestation statistics. More importantly, this could reveal an opportunity to participate in an incentive program that you were previously missing out on or unaware of.
  • Specialty focused: is there a certain specialty within your organization that could benefit from some type of optimization?

In working with clients over the years, we have developed a variety of optimization projects with a proven track record of results-driven metrics, such as reducing the number of notes left unsigned by a certain time of day for a provider group, or decreasing the time it takes to complete a task, such as verifying results or renewing medications. One optimization project we performed demonstrated an overall reduction in task completion time by 18%. A decrease in the time it takes to complete a task can lead to improved patient care as well as the ability to see more patients. These types of optimization projects not only add value by improving patient safety and quality of care, which is key in the healthcare reform arena, but also mean less time in the office and more time enjoying summer and getting out for that ice cream or round of golf!

For more information regarding Galen Optimization services, join us on 8/21 for a public webcast or contact me at Christy.Erickson@GalenHealthcare.com.

Top 10 Recent Quotes on Healthcare Interoperability

Much print has been dedicated to interoperability over the past several months. At issue is whether the government (ONC) should attempt to solve healthcare interoperability or continue the course and let the market solve it (or perhaps some in between). We will be discussing this issue with our partners at our annual GPAC event next week in Boston. To prime the discussion – and as part of our interoperability blog series – we present the top 10 recent quotes on the issue:

  1. Interoperability may not have gotten enough attention in the early days of Meaningful Use’s electronic health records (EHR) gold rush, but it’s now taking center stage as healthcare providers, government agencies, vendors, and committees consider how to support the exchange of data easily and securely. It’s very easy to point fingers at folks. People underestimate how challenging this work is,” Sawyer told InformationWeek. “I think the vendors are being cautious before spending lots of research and development money before a standard is more clearly defined.

    -Alison Diana, Information Week, “Healthcare Interoperability: Who’s The Tortoise?”

  1. If Big Data is the new oil in healthcare, clinical business intelligence is the refinery.

    -Brendan Fitzgerald, HIMSS Analytics, “Infographic: The future of clinical & business intelligence in healthcare”

  1. Congress doesn’t think that the marketplace has created the interoperability it thought it was mandating in the HITECH Act. The right question is: How do we ensure that patients, clinicians and caregivers all have read and write access to a patient’s longitudinal health record in real time? More generically, how do we ensure that the right information gets to the right person at the right time?

    -Flow Health Blog, “Beyond Interoperability”

  1. “information blocking” – I believe this concept is like the Loch Ness Monster, often described but rarely seen.   As written, the information blocking language will result in some vendors lobbying in new political forums (Federal Trade Commission and Inspector General) to investigate every instance where they are getting beaten in the market by other vendors.  The criteria are not objective and will be unenforceable except in the most egregious cases, which none of us have ever experienced. We are in a time of great turmoil in healthcare IT policy making.   We have the CMS and ONC Notices of Proposed Rulemaking for Meaningful Use Stage 3, both of which need to be radically pared down.   We have the Burgess Bill which attempts to fix interoperability with the blunt instrument of legislation.  Most importantly we have the 21st Century Cures Act, which few want to publicly criticize.   I’m happy to serve as the lightening rod for this discussion, pointing out the assumptions that are unlikely to be helpful and most likely to be hurtful

    -John Halamka, Life as a Healthcare CIO Blog, “21st Century Cures Act”

  1. The good people in Congress recently asked ONC: When it comes to the nationwide roll-out of a connected health IT system, are we getting our 28 billion dollars’ worth?

    -HealthBlawg “Locked Down or Blocked Up? ONC Report on Health Information Blocking”

  1. The bill abolishes theHealth IT Standards Committee and proposes to have the work of developing interoperability standards contracted out though usual procurement channels, and reviewed and approved by NIST and the Secretary ofHHS in addition to ONC. It also requires attestations by EHR vendors as to their products’ compliance with the interoperability standard, and it calls for the creation of a federal website that will have full transparent pricing for every certified EHR (and its components and interfaces) 

    -David Harlow, JD MPH, Principal, The Harlow Group LLC, “Whither Interoperability”

  1. The U.S. healthcare stakeholders include patients and individual physicians. Unfortunately, these two stakeholder groups are seldom represented in technical standards organizations and, more importantly, have almost no purchasing power when it comes to electronic health records or health information technology. This contributes to the slow rate of progress and has created significant frustration among both patients and physicians. The beauty of patient-driven interoperability is that ancillary infrastructure is helpful but not mandatory. As with auto-pay transactions with your bank, directory services are not required and certificate authorities are already in place. Certification tests would still be needed but the the Internet provides ample examples of open tests and self-asserted certification that would bypass most of the delays associated with legacy methods.

    -Adrian Gropper, MD, The Health Care Blog, “Patient-Driven Interoperability”

  1. I believe that the sufficient conditions for interoperability include the following:
    *A business process must exist for which standardization is needed. As Arien Malec put it recently, ‘SDOs don’t create standards de novo. They standardize working practices.’
    *A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation.
    *A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose. The business purpose may include satisfying regulatory requirements, or meeting market pressures, or both.
    *A ‘network architecture’ must be defined that provides for the identity, trust, and security frameworks necessary for data sharing in the complex world of healthcare.
    *A ‘business architecture’ must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur.
    *A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed.
    *And almost no healthcare standard can be deployed in isolation, so all of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard.

    -John Halamka, Life as a Healthcare CIO Blog, “Standards Alone are not the Answer for Interoperability”

  1. Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay

    Anne Zieger, EMR & EHR, “HHS’ $30B Interoperability Mistake”

  1. This is one of the most public and noteworthy conversations that has taken place on the issue of patient identification. It’s time that Congress recognize the inability to accurately identify patients is fundamentally a patient safety issue.

    Leslie Krigstein, CHIME Interim Vice President of Public Policy,  EMR & EHR News Blog,  “Patient ID Highlighted as Barrier to Interoperability during Senate HELP Hearing”


Galeneers Volunteer: Chicago FarmWorks

Chi FarmWorks1

I recently had the pleasure of organizing a volunteer opportunity for members of Galen Healthcare Solution’s Chicago office.  Galen believes in supporting its local communities, and even created a program that encourages its employees to volunteer their time.  I wanted to get as many people involved to help a worthy cause, and it turned out to be a great team building activity and a chance to bond with colleagues outside of the office work environment.

Leyva Working

There were so many charities in the area seeking support that I thought I was going to have a difficult time selecting just one, that is until I came across Heartland Alliance, the leading anti-poverty organization in the Midwest.  The group was founded over 125 years ago and continues to grow with a wide variety of programs including housing, healthcare, economic security, and legal services.

We worked with Heartland Alliance to identify an area of need where Galen could lend our help, and selected Chicago FarmWorks, an urban farm located in Chicago’s East Garfield Park neighborhood on a vacant 2.6 acre lot.  The farm, which opened three years ago, produces food for the Greater Chicago Food Depository and provides transitional jobs for many individuals with various employment barriers.  The operation was barebones but very impressive, especially considering there was no electricity, plumbing, or shelter.

I thought it was great to venture to an area of the city that I typically don’t make it to. More importantly, it was nice to serve those communities in a manner that satisfies a pressing need.  I would gladly do it again. – Jon Deitch

While onsite our team worked in the gardens installing trellises, pulling weeds, and transporting supplies.  In our limited time, we were able to accomplish a lot and learned a great deal about the cause.  The FarmWorks employees were very dedicated, passionate, and knowledgeable about the work being done.

It was a great morning, volunteering with Heartland. It was fun spending time with coworkers and making a difference at the same time. As we weeded the vegetable patch, our event manager kept us entertained with stories of the organization’s cultural relevance in Chicagoland. – Samy Simha

Lewy Working

We learned that all of the food grown there is given to people in need, with none of it going to waste.  One way they accomplish this is by growing crops that they know will be consumed.  By producing foods that are used across a wide variety of cuisines, such as tomatoes, corn, and beans, they make sure nothing gets thrown away.  Another waste-reducing strategy they employ is allowing their consumers to select produce off of a shelf.  This helps ensures that people take home only what they want and will eat (vs going home with random bags of mixed vegetables).

Overall, the experience was very rewarding, and we were happy to be involved with Heartland Alliance and Chicago FarmWorks.  As members of the Galen family, we’re proud to work for a company that encourages us to get involved in our communities, and are already looking forward to the next amazing opportunity!

Volunteering your time always feels good, but today’s time spent with Chicago FarmWorks felt extra special because I knew the work we were doing was helping to feed the people in that very neighborhood.  After spending a couple hours with the workers at Chicago FarmWorks, I have a new appreciation for their dedication and what they do every day to help those in the community and I was happy to have shared in that. – Matt Leyva




Galen is proud to unveil its MEDITECH Technical and Professional service lines, which extend across the acute care modules and the ambulatory suite!  MEDITECH sets itself apart from other EHR solutions with interoperability between the acute and ambulatory care settings, which is inclusive of the emergency department, home health, and other ancillary departments.  In early 2000, MEDITECH partnered with LSS to deliver an ambulatory solution to round out their offerings, and in 2013, completed a 2-year long acquisition and merger with LSS.

If your organization is considering MEDITECH as a new EHR, has recently moved to the MPM product, or is just curious as to how it looks and feels, join us for a high-level overview of MPM.  You’ll get an opportunity to view the MPM 6.0 version as we navigate the ambulatory system with best practice workflows.  We’ll demonstrate the Physician Desktop, Note Templates, Ordering, and Sign Queue functionalities involved in documenting patient encounters, and will also include coding of visits and processing of tasks.

To attend this free MEDITECH MPM 101 webcast on Friday, July 24, make sure to register here http://www.galenhealthcare.com/event/meditech-mpm-101.

Mirth Connect Security White Paper

Galen Healthcare Solutions Mirth Security White Paper

Mirth is a cross-platform interface engine that enables bi-directional sending of messages over numerous industry standard protocols.  Whether trying to comply with HIPAA, SOX, FIPS or any other federal regulation regarding the robustness and integrity of data, security is a paramount concern when it comes to an interface engine that too often has been underemphasized. When talking about securing an interface engine, most organizations are aware of and take steps to ensure the data entering and exiting the application is secured in some form, usually a VPN as many legacy systems are only capable of traffic over TCP\IP or directly to file.

Mirth Connect Channel Security Encrypt Message Content

This sort of security is proficient for external threats but not internal and shows how in-comprehensive security can leave open potential vulnerabilities. As an example of hardening an interface engine and covering many different points of failure for the integrity and security of its messages, I will be highlighting security options for the Mirth Connect interface engine (v3.1.1) in order to promote Healthcare IT best security practices in this whitepaper titled Best Practices and Vulnerabilities of Mirth Connect”.

Download the full white paper here. Please contact us to learn more about our interoperability and security solutions & services.

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