David L Miller, CHCIO, CDH-E, CPHIMS, FHIMSS, MHSA

Now that our HIT industry has spent nearly 40 years figuring out how to effectively pass data between sites, settings, and institutions of care (and while that journey isn't completely over, we're well on our way), we can finally turn and look farther down the road and consider what's next. In my view, advancing process consistency, agility, and change is that horizon. The BPM community is focused on that challenge, and having recently transitioned into HL7 as HL7 BPM, is squarely trying to take this on. With today's press release, HL7 is truly open-for-business in this space. Thanks to the OMG for nurturing this work along and for HL7 for having made our next home for this effort. So much to do! https://lnkd.in/dAF96g3n

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Implementing an electronic health record (EHR) or migrating to a new one is a complex process. It requires you to keep track of timelines and stay on budget – all while keeping clinicians happy and not interrupting patient care. In its latest report, Gartner® notes that when implementing a new EHR “healthcare provider CIOs can avoid setbacks and position for success by undertaking an organizational readiness assessment and mitigating risks during the strategy and planning phase.” Access the complimentary Gartner® report, Gauge Readiness and Mitigate Risk to Succeed in EHR Implementations, to learn more. Read the report: https://bit.ly/3KCgZVY #EHR #EHRmigration #EMR #EMRmigration #healthcare #interoperability #digitalhealthenablement

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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This is a great article from Modern Healthcare. At Sanford Health, I am so glad cybersecurity is an organizational wide accountability and isn’t taken for granted. Here are a few key takeaways from the article. Cybersecurity needs to be a top priority and a shared goal across all areas of your health system operations. You can’t buy your way into a risk free environment. Healthcare is an industry designed around connectivity and interoperability. Third and fourth party risk needs to be given proper attention. Having a Rapid Response Plan, not only for your security operations center, but also for your enterprise leadership team, is invaluable when the tough stuff happens.

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This is an interesting article because EHR companies, like Epic and Oracle's Cerner, have made siloing data a major part of their business model. Overall, I like EPIC’s ability to review records from other EPIC shops. It also has a nod to interoperability with its “Care Everywhere“ feature. However, this is often a disorganized and outdated collection of information. Using it requires a ninja level of both tech expertise and medical knowledge possessed mainly by younger physicians and chief residents. I am a fan (and advisor) of companies like Zus Health focused on user-friendly, comprehensive, and up-to-date interoperable health care data tools.

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What equity frameworks does your organization use? Have you seen the Agency for Healthcare Research and Quality's "Practical Guide for Implementing the Digital Healthcare Equity Framework"? AHRQ takes an intentional approach to considering equity throughout the digital healthcare lifecycle aims to promote improvement in: • Clinical outcomes such as mortality, morbidity, and health/quality of life • Process outcomes such as care continuity, care coordination, and care quality • Healthcare experiences such as patient satisfaction/engagement and provider satisfaction/engagement #HealthcareEquity #ClinicalOutcomes #PatientExperience https://lnkd.in/eTA9d9Gn

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This topic and these two experienced experts should be on your #Healthcareprofessional development bucket list! Sign up today! DM me and I’ll connect with more details!

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Why do Healthcare Systems Need Policies and Tools for CMS and OIG Updates in CDI Programs? To ensure the success and sustainability of Clinical Documentation Improvement (CDI) programs, healthcare administrators, CDI professionals, and compliance officers must play a pivotal role in implementing robust policies and utilizing effective tools. This is how they can stay updated with CMS (Centers for Medicare & Medicaid Services) and OIG (Office of Inspector General) regulations. 📊 Ensures Consistency: Clear policies and reliable tools guarantee that all staff members follow the latest guidelines, promoting uniformity in documentation practices. 🛡️ Enhances Compliance: Policies combined with advanced tools help prevent compliance issues by ensuring that regulatory changes are systematically tracked and implemented. 🏥 Enhances Patient Care: Proper policies and tools ensure accurate and up-to-date documentation, directly improving patient care quality and leading to better health outcomes. 💼 Safeguards Revenue: Well-defined policies and efficient tools reduce the potential risk of claim denials and penalties, protecting the organization's revenue stream. 📚 Supports Training: Policies provide a framework for continuous education, while tools ensure CDI professionals can access the latest information and resources. 🔄 Facilitates Adaptability: Having policies and utilizing tools allows for swift adaptation to regulatory changes, maintaining operational efficiency and compliance. By integrating comprehensive policies and leveraging the right tools for CMS and OIG updates, healthcare systems can ensure their CDI programs' ongoing success and effectiveness. 🌟 #CDI #HealthcareCompliance #PolicyMatters #CMS #OIG #PatientCare #HealthcareManagement #TechInHealthcare

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Choosing the best clinical communication solution is foundational in efficient and effective healthcare delivery. But how do you decide? Our “Cheat Sheet” outlines the eight must-ask questions to guide your evaluation process when looking for a CC&C solution.​ 🔎Asking the right questions will help you select a solution that meets your organization’s needs and improves patient care delivery.​ Don't miss out on these insights. Download the eBook now and elevate your clinical communication.​ 🕮 Download the eBook​: https://buff.ly/4e9dYd9​ #ClinicalCommunication #Healthtech

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Years ago, CMS forced health systems and ambulatory providers to ONC-Certified EHR technology through Meaningful Use (but also paid for it). Post-Acute and Behavioral Health Providers were not included in this. Today, through payment models being released into the industries (such as GUIDE), CMS is forcing the adoption of Certified EHR technology by requiring it for these models. This is so that organizations can share information and collaborate on patient care in payment models that reward them for doing so. This trend continues for home health with Transforming Episode Accountability Model (TEAM), which provides a new model of care for home health organizations to participate in for 5 of the most expensive surgical procedures that require post-acute care (launches in 2026). From a technology standpoint, an EHR's Certification is only the first step. There are clinical scales, tools, and content to be licensed plus built. Changes to billing functionality. Reporting on measures to create workflows and analytics around the capture on numerators and denominators. Make sure any vendor partners you work with has actually prepared for these things, on top of certification, in the models of care you're pursuing. GUIDE has a profound impact for hospice/palliative care providers by allowing them to be properly reimbursed for taking care of some of nation's most elderly and vulnerable populations. Proud that Netsmart has taken multiple providers on this list LIVE in the last two weeks on the model, operationalizing GUIDE through all of the above in a way that takes care of one of our most vulnerable populations.

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Join our next webinar in the introduction to Information standards series. This tme focused on OpenEHR, what it isand what it is used for. Previous information standards webinars, including FHIR and SNOMED CT are available on the BCS health and care webpage. BCS - Primary Health Care Specialist Group (PHCSG) The Federation for Informatics Professionals Richard Kavanagh Sobath Premaratne Elisavet Andrikopoulou

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🚨 Top 10 #PatientSafety Concerns for 2024. 📌 Have significant changes been made over the last decade? An important question is to reflect on what has been done, what we are doing, and what remains to be done.

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Did you know that the Centers for Medicare & Medicaid Services Innovation Center (CMMI) has announced 8 models in the last year? That may be surprising for some, given CMMI leaders announced a shift from its "many flowers bloom" strategy to focus on a narrower set of models after the first decade. (Michael Chernew has a great op-ed on the rationale for this "garden to portfolio" shift [1].) While it may seem like a lot of new models, this latest batch of new APMs aligns with the priority areas CMMI outlined in its 2021 strategy refresh [2] (e.g., state-based and Medicaid-focused APMs, accountable care and accountable care-compatible models, and specialty-specific models) and reflects a more curated portfolio approach to model development. As far as potential upcoming models, I wonder when we will see the next iterations of CMMI’s value-based kidney care models (KCC is set to end Dec 2026) and whatever model(s) will succeed ACO REACH (also ends Dec 2026). Any other ideas or signals on potential future CMMI models? P.S. My Health Management Associates colleagues Melissa Mannon, MPP, Vicki Loner, and I are writing a brief on the new ACO PC Flex model. Let me know if you're interested to read and I'll share. [1] https://lnkd.in/gVpyg8_b [2] https://lnkd.in/g9xpZhxT

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IT'S ABOUT TIME! How many healthcare professionals recognize the almost unlimited opportunities in the leveraging of SDOH data and information, but don't know where to start? Your solution is here and available! In her new book "The Shift: SDOH Program Design & Operations," Dr. Shannan Swafford provides a comprehensive and insightful guide that is essential for any healthcare organization looking to effectively address the social determinants of health (SDOH). As someone who believes in "a little less talk and a lot more action", Dr. Swafford cuts to the chase in both style and content. This book stands out for its clear and actionable approach to help organizations navigate the intricacies of SDOH program design. Her deep expertise and proven strategies provide readers with the guidance needed to operationalize SDOH initiatives. One of the key strengths of "The Shift" is its focus on the critical importance of SDOH in healthcare and its impact on patient health. Dr. Swafford's expertise and insights into health policies and reimbursement structures are particularly valuable. She outlines how to support SDOH initiatives within existing healthcare frameworks while focusing on improving health equity and patient outcomes. She also emphasizes the need for data analytics while reminding us that behind every piece of data is a person. Overall, "The Shift: SDOH Program Design & Operations" is a must-read for anyone involved in healthcare who is dedicated to making a meaningful difference in addressing the social factors that influence health outcomes. The Shift: SDOH Program Design & Operations https://a.co/d/6oRzMoB #Healthcare #SDOH #HealthEquity #HealthcareInnovation #DrShannanSwafford #NewRelease #HealthcareLeadership #AHIMA #HILeadersareneededhere

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Value analysis is transforming partnerships between health systems and suppliers in health care. In a recent article from The Journal Of Healthcare Contracting, insights from the IDN Insights West panel featuring Cheryl Smith Anderson, DNP, MBA, RN, BSN, system director of Value Analysis at Steward Health Care, and Jimmy Chung, MD, MBA, FACS, FABQAURP, CPE, CMRP, chief medical officer at Advantus Health Partners, sheds light on the pivotal role of value analysis. Cheryl and Dr. Chung discuss their approaches to value analysis and the key components of successful partnerships. From prioritizing patient care outcomes to fostering transparent communication, their insights show the importance of collaboration in driving value for both healthcare organizations and their patients. Read more about how strategic partnerships in value analysis are reshaping the healthcare supply chain landscape: https://lnkd.in/gB7NgJF3

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To lead effectively amid the 2025 Medicare Advantage and Part D Final Rule changes, leverage data-driven compliance measures, employing predictive analytics to anticipate and prevent regulatory breaches. Champion ethical marketing practices, employing sentiment analysis to ensure transparency and authenticity in communications. Forge partnerships with community organizations to enhance access to behavioral health services, utilizing geospatial analysis and machine learning to optimize resource allocation. By pioneering these strategies, healthcare analytics leaders can navigate regulatory complexities while ensuring equitable care delivery. #DataDrivenCompliance #EthicalMarketingr #EquitableCare #PredictiveAnalytics. https://lnkd.in/eq3vf6qs

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Federal agency employees utilized human-centered design by #GuidehouseExperts to access relevant resources and improve critical project management processes. Guidehouse Technology Solutions | #ITStrategy #TechModernization #PMP #ProjectManagement #Businesstransformation #HumanCenteredDesign

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Last week with The Intelligence Group at Lincoln Healthcare Leadership Group, I facilitated a workgroup that included several C-Suite leaders from across the country. Our topic was comprehensive Back-Office operations. Given the digital advancements, the need for efficiency, and the increasing desire for expansion via M&A, it was undoubtedly a loaded topic. The group was both insightful and eager to learn from each other. The key takeaway was the necessity of measuring advancements in terms of outcomes. This realization has led me to emphasize Critical Thinking within our teams. If we are to rely on the creative thinking of our employees, we must also teach the essential skill of Critical Thinking, especially in this digital age. Below is an excellent article on developing this crucial skill. Forward Faster https://lnkd.in/eTmjTU_V

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