Find solutions to Top Challenges in healthcare IT that CIOs are facing — EHR optimization, population health, and Meaningful Use.

1. Three Challenges
That Keep
Hospital CIOs
Up at Night
(And ways to
make your job easier)
An Iatric Systems eBook

2. 2
Table of Contents
Introduction 03
CIO Challenge #1: EHR Optimization 04
CIO Challenge #2: Population Health 08
CIO Challenge #3: Meaningful Use 18
About The Iatric Systems Professional Services Team 25

3. 3
Hospital CIOs and IT leaders have a lot on their plate. Growing workloads,
shrinking budgets, and continued rapid change most likely have you concerned
about your ability to keep pace. Every day you and your staff are asked to take
on more and more tasks. Many involve technology that’s new and unfamiliar.
All are important and needed urgently.
In a 2014 survey of hospital CIOs
asked: “Which of the following areas does your health system perceive as most
critical?” CIOs responded:
Population Health & Analytics Initiatives
Meaningful Use Stage 2 (and now Stage 3)
This eBook examines these challenges and provides key steps to help them go
more smoothly. When you go home at night, you’ll know that your most critical
Introduction

4. 4
provide clinicians with the information they need at
the time of care. To a very large extent, this is the
role of interfaces — the connections between different
systems that allow data to be transferred and shared
CIO Challenge #1:
EHR Optimization
Interoperability Is
Possible Now
This need for interoperability has
been embraced by ONC, which in
early 2015 released its draft
Nationwide Interoperability
Roadmap to a future healthcare
IT ecosystem. This IT ecosystem
will be glued together by an
interoperability standard, which is
in the early stages of development,
and which will be rolled out during
the next 10 years. Milestones are
There are steps that you can take
now to begin the process of making
your systems interoperable.

5. 5
How to Make Your Systems Interoperable:
Many hospitals would like to move forward with integration,
or build interfaces more effectively, but are uncertain how to proceed.
While every project varies, there are seven key steps to bringing
interoperable systems to life:
where information is not being transferred between systems.
about all the information that needs to be transferred. Document
3. System Integration: Map the data between the systems being
connected.
4. Testing: Build the interfaces and test them to make sure they work
as designed.
5. Go live: Evaluate any testing issues and review for any
stoppers. This evaluation should be conducted by a cross functional
monitor
severity of those issues.
7. Keep up with evolving requirements: Document internal and
external requests and evaluate if additional interfaces are required.
Then, start the process again.

6. Integration Challenges
View this Infographic: Integration Challenges for more detail
Does your staff have
time to build and
manage interfaces
without falling
behind on other
critical IT projects?
What is your internal
level of interface
expertise? Is it
feasible to teach
staff how to build
interfaces?
Do you have time
to coordinate all
required activities?
team members
monitor interfaces
24/7/365?
Can your staff
troubleshoot when
there are problems
sending information
from one system to
another?
Can your IT team
scale up and down
as needed?
Are you able to
quickly manage the
potential risks if
your interfaces crash?

7. 7
Tying up resources to handle building and managing
staff who typically have many other responsibilities.
Here are some of the ways that an interoperability
service provider can relieve the burden:
Ability to leverage existing relationships with health
IT system vendors
Experience with similar integration projects, industry
standards, coding, networking, and regulations
Ability to provide 24 x 7 monitoring and support
Quality, consistent, complete documentation
A trusted resource for recommending solutions and
educating staff
Getting Help:
Interoperability Experts
If the answer to any of the previous
questions was “no,” then you may decide
that your strategy should involve out
sourcing some of your interoperability
work. Tapping the expertise of outside
interoperability experts provides a num
because you’ll have access to
Your staff is more productive and
can focus on other critical projects
Faster implementations, so you
can meet your critical deadlines
project failure
You’re protected when employees
leave or retire
Ability to rest easy, even on
holidays, with dependable

8. 8
Population health refers to improving the outcomes of members
of an entire patient population, particularly underserved groups
and those affected by environmental and economic factors that
could adversely impact health. Its goals also include improving
individual quality and patient experience, and reducing the per
capita cost of care.
This section examines three areas of population health
management where hospitals can focus their efforts, with the
ultimate goal of improving population health.
Patient identity and EMPI
Connecting to a Health Information Exchange (HIE)
Population health analytics
CIO Challenge #2:
Population Health

9. Patient Identity and EMPI
records, and poor data quality cost hospitals
millions in unnecessary tests, medical errors,
fraud, billing errors and delays, and extra
administrative work. When the data exchange
requirements of connected care initiatives
and Health Information Exchanges (HIE),
are added to the mix, the challenge —
and importance — of accurate patient
Fortunately, there is a solution. An Enterprise
Master Patient Index (EMPI) solution provides
the healthcare enterprise. By ensuring that
each patient is represented only once
across all software systems, an EMPI
provides a single, comprehensive view
of the patient. With an EMPI solution, you
can aggregate results from multiple systems
to create one patient entity in order to make
population health management decisions.
Improved
registration and
scheduling
Greater
the exchange of
patient information
between systems
Better
patient
care
More
billing
The results are:
01
03
02
04

10. 10
How an
EMPI
Provides
ROI
Provides
compliant
audit logs
— shares information
across information
systems
Consolidates
duplicate
patient records
Performs global
patient searches
Eliminates
duplicate
patient
registrations
Accurately
the correct
patient

11. 11
Tuning the algorithms:
EMPI algorithms look at
decide based on a rule or
weighed score whether
records are a valid
match. Incorrectly tuned
algorithms can be a recipe
for disaster, causing false
positives where records
are matched to the wrong
patient or cause legitimate
matches to be missed.
You want to get it right
Hospitals often
requirements to implement
and manage an EMPI.
It takes a lot of training,
time, and expertise to
manage and remediate
or adjudicate records,
especially when the EMPI
isn’t tuned properly.
Uncertainty over
data governance:
Someone needs to identify
key stakeholders and
policies and processes
that are consistent across
the enterprise, and make
sure people follow them.
Interpreting the data:
The EMPI will reveal
information previously
under the radar, such as
a social security number
shared by two different
people. The EMPI can help
determine the rightful
owner, and determine if
this is a case of potential
fraud or just a data entry
blunder.
EMPI Challenges
The goal of an EMPI is to create a complete, accurate data set across a healthcare

12. 12
IT staff is too busy with other pressing projects
to correctly manage an EMPI system and its data,
resulting in a higher rate of duplicate patient
is engaging experienced experts to implement and
manage your EMPI for you.
Depending on your needs, an EMPI expert can
complement your existing staff or take on all
Getting Help:
EMPI Consulting
Capabilities include:
Assessing your EMPI needs: Evaluate
your hospital’s current EMPI solution,
determine your current duplication
rate, and recommend steps to meet
your EMPI goals
a maintenance plan for ongoing patient
data management
Implementing the EMPI solution:
Build and test interfaces to enable
algorithms, clean up duplicate identities,
and document data governance
policies and processes
EMPI training: Includes detecting and
remediating duplicate records, tuning
your algorithms, and interpreting the
data
Ongoing maintenance of patient
with EMPI solutions and the health
systems being connected
about EMPI Services

13. 13
Connecting to an HIE (or Building Your Own)
Another aspect of improving population health is connection to a Health Information
Exchange (HIE) which gives all providers in a geographic region access to the complete
patient record. HIEs will be the way that provider practices and health systems will
better patient outcomes.
What Is the Right Exchange for Your Hospital?
Today, there are many models and business approaches to support electronic
health information exchange. These include:
exchange networks
Services provided by national exchange networks
Building your own private HIE to connect a group of hospitals
With so many exchange options, hospitals are often unsure which one is the
right choice. Hospitals initially got started with HIEs to meet Meaningful Use
requirements, but then found that their exchange didn’t meet their needs.
So, many hospitals are migrating to a different HIE.

14. 14
OPTIONS
TEAM
HIE Challenges
01 What is your HIE strategy? How
do you want to access and use the
data in an HIE? Do you have a good
patient matching system in place?
03 What is the timeframe? What
are the action steps, and how much
time is needed for each?
02 What are the options? What are
the advantages and disadvantages
of each? (
)
04 Who will handle the implemen
tation? Do you have the right team
in place?
Getting Help
effective to work with an outside partner
familiar with the HIE landscape, who can
evaluate the options, recommend an
approach, and bring it to life.
Here are some of the ways that HIE
professional services can make your life
easier:
Assessing your needs — Evaluate your
existing systems, establish your goals, and
recommend the right course of action
and set the timeline and action steps needed
to make connectivity a reality
Implementing the solution — Assist you at
any step, including research, planning, and
implementation
Best Practices in Joining an HIE: How
to Make Your Connection Work for You
As hospitals are considering creating or joining an HIE,
these are the key challenges that they should plan to
address for a successful implementation.

15. 15
Population Health Analytics
Hospitals are becoming increasingly aware that the future of care quality
to obtain actionable insights, analytics solutions prevent errors, improve
These types of solutions enable improvements in many areas, from
operational performance, and workforce
management. However, the most
important healthcare trend
accelerating the adoption
of analytics is population
health, according to a
recent survey of CHIME
executives.

16. A platform for analytics
Hospitals that have a platform for analytics
and the infrastructure to support it can now
leverage a new generation of opportunities for
managing and improving population health: improve patient experience
Measure overall population values and the ability to
drill down to segments, provider groups, individual
providers and individual patients
national norms
your population
Help you design effective outreach programs and
challenges and opportunities
performance of programs or vendors

17. 17
Addressing the Challenges
Many healthcare CIOs are actively searching for
products and services to build the foundation for
analytics. However, for hospitals just getting started,
with the right expertise can be a challenge. In the
CHIME survey previously noted, when asked to rank
the biggest obstacles to the adoption of analytics,
healthcare CIOs cited a lack of analytics expertise
and resources to adopt the technology. The next
biggest obstacle was dealing with the many other
IT priorities they face.
Another major concern was interoperability — the
need to make data available from disparate systems
to examine it as part of the analysis. A recent survey
by CDW Healthcare found that two of the top
challenges with implementing an analytics solution are
combining data from different sources and achieving
interoperability between technologies.
Some hospitals solve their interoperability challenges by
implementing new interfaces. Others choose to solve
the challenges of lack of resources, and competing IT
priorities, by turning to outside resources for help.
Getting Help
To make your life easier when
getting started with analytics,
consider outsourcing some or
all of the work to a Professional
Services
to do it all yourself, an experi
enced service provider can:
Make sure you have the right
technology in place
Build the connectivity that
captures the right data in
real time
of healthcare analytics to
bring the right solution to life
at your facility

18. 18
Meaningful Use is a top CIO concern because of the
incentive payments and potential penalties that are
requirements and changes.
In this section, we’ll examine three Stage 2 Core
Objectives that seem to come up time and again, and
according to the plans for Stage 3, will continue to haunt
IT teams in the future. We’ll also review how to prepare
for the moment of truth — what you need to know to
successfully attest, and how to defend against an audit.
CIO Challenge #3:
Meaningful Use

19. Core Objective 6.2
Provide Patients the Ability
to View Online, Download,
and Transmit Information
about a Hospital Admission
CMS recently announced a potential
change for Measure 2, from a
requirement of more than 5% of
portal to only one patient in total
required to access the portal. This
change is still pending.
However, Stage 3 will go in the
opposite direction, and potentially
require more than 25% of
patients to access the portal.
As a result, now is a critical time for
hospitals to continue to focus on
patient engagement. Fortunately,
there are steps you can take to
increase portal usage:
Signing up patients while they’re still in the
hospital is the most effective way to increase
your numbers. Make sure your staff is aware
of the portal so they can inform patients and
encourage them to sign up.
There are many ways to get the word out —
posters, social media, signs, buttons, press
releases, etc. Patients have to know that
the portal exists, and what’s in it for them.
provide a small gift for everyone who signs
up. Hold staff contests for whoever signs
up the most patients.
Onsite sign-up
Marketing
Get creative

20. 20
TIP:
Be aware this
measure may be
retired if the
proposed NPRM
is approved.
Core Objective 12
Provide a Summary of Care
This is an objective that many people intensely dislike —
both IT staff and the physicians that it is supposed to
all the information contained in the summary of care
document, but the hospital is still obligated to provide it.
The following are a few tips to make your experience
with this objective relatively painless:
Measure 1 — Provide a summary
of care record for more than 50%
of transitions and referrals
Measure 2 — Provide a summary
of care record for more than 10%
of such transitions and referrals
electronically
Measure 3 — Conduct one or
more successful electronic
exchanges of a summary of care
document counted in Measure 2
with a recipient who has different
or more successful exchanges
TIP:
Records can be either
paper or electronic, and
both types can be added
together. Be aware this
measure may be retired
if the proposed NPRM
is approved.
TIP:
You just have
to prove that the
receiving party
received it, not that
they opened it!

21. 21
Core Objective 16
Automatically Track Medications
with an Electronic Medication
With this objective, we’ve seen a lot of misunderstanding about
what CMS is looking for. While the requirements now state that
wasn’t always the case.
Actual measure: If a medication is ordered using an eMAR,
just remember that every dose of that medication must be
entered in the eMAR, otherwise that order cannot not be
included in the numerator.
It’s also important to ensure that the tool and process used for
nurse in giving the medication.
Many hospitals have problems with the placement of the barcode
on the medication label, where the label fails to scan because it is
not positioned correctly. In an emergency, the nurse then has to
omit the scanning and enter the information manually, which
and more accurate.
Note that there is an exclusion
that can apply to many critical
access hospitals. If your
your reporting period is fewer
than ten patients, you can qualify
for this objective without having

22. 22
Incorporate all changes that CMS has
made along the way. Preserve a record of
the CMS requirements at the time you attested
since they may have changed subsequently.
step 01
Attestation Challenges
Have a staff member, who is in charge of
Meaningful Use, document clearly, and
save documentation in a central location.
Because you can be audited for up to six years
after you attest, sometimes the person who signed
the attestation will no longer be at the hospital.
step 02
Plan to monitor your progress. During the
attestation period, it’s very important to have a
dedicated resource who can spend a few hours a week
to monitor your progress. In addition to ensuring that
you’re meeting the thresholds, you also need to make
sure that the numbers are correct and understand why
certain patient records fail a particular measure.
step 03
Hospitals often see Meaningful
Use attestation as the end of
the process, but it isn’t. Today,
20 percent of hospitals are being
selected for a Meaningful Use
audit after attestation. Not
passing an audit results in
having to pay back 100%
of any incentive money
already received and your
hospital may be subject to
repeated audits for future
attestation periods.
When preparing to attest,
hospitals also should prepare
to get audited. Fortunately
there are steps you can take
during the attestation period
so you can keep the money
you’re entitled to:

23. 23
Getting Help
If you aren’t able to assign a staff member to conduct
all of the steps outlined here (including documentation,
tracking, and monitoring) you might want to consider
using the services of an experienced outside consultant.
monitor your progress toward Meaningful Use, especially
when you consider the potential consequences.
A competent resource can:
Monitor your percentages
Ensure none of your thresholds are at risk
Take a lot of stress off a hospital and its IT staff
Remediate all security gaps, and keep
documentation to prove it. You can do so by
conducting a Security risk analysis, which meets
Stage 2, Objective 7 criteria. Many hospitals
failed their audits in 2014 because they didn’t
conduct a Security risk analysis. As a result,
these hospitals were required to pay back
their incentive dollars.
step 04
Be vigilant in watching for your audit notice.
If your hospital is selected for an audit, an email
is sent to the individual that signed the attestation,
giving three weeks to respond. It’s important to
keep this in mind, in case the employee who
submitted the attestation leaves the hospital or
changes roles. You’ll need to continue to monitor
that employee’s email.
step 05
Meaningful Use challenges.

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Importance of a Mock Audit
There are so many aspects of Meaningful Use
and you can’t be expected to know everything.
Even with huge teams working on Meaningful
Use, crucial details often slip through the cracks.
Thus going through a mock audit in order to
prepare for the rigors of an actual audit is
very important, especially because CMS has
stated that many more hospitals will be audited
starting in 2015 than in the past.
Hospitals that have gone through mock audits
are often surprised at the holes they uncover.
A mock audit can identify and assess potential
records before it’s too late. It’s a valuable
insurance policy and stress reliever, so when
you with a mock audit, look for a team that can
run every part of your system and data through
is ready to be audited. Check their track record
— how have hospitals that used their services
fared during an audit?

25. 25
To learn more about Meaningful Use Audits,
read the eBook:
Preparation for a Meaningful Use Audit
A mock audit should
include the following:
assessment
Interviews
with your
Meaningful Use
stakeholders
to capture
a complete
Meaningful Use
picture
A scorecard
report against
Meaningful Use
requirements
with documented
compliance
Assessment Interviews
Data Tracking Scorecard
on how to
correctly store
and document
Meaningful Use
data for successful
tracking

26. Watch this 2-minute
video to learn more.
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