Data Governance and Ownership: HIT and the Imperative of Strong Electronic Health Vendor Relationships
This article was written by Rene S. Cabral-Daniels, CEO of Community Care Network of Virginia, Inc., for the December 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center
Recent healthcare literature is replete with articles regarding the importance of paying greater attention to healthcare data. Many suggest a healthcare organization’s ability to harness data value is the fulcrum to the organization’s success or failure. While these articles encourage greater use of healthcare data, they often fail to inform health entities of the importance of assuring proper data ownership as well as stewardship, integrity and dissemination.
Data requirements: what they are and what they aren’t
Healthcare leaders may mistakenly believe that compliance with the Health Insurance Portability and Accountability Act (HIPAA) health data protection sections insulate them from any potential legal claims. HIPAA is an important, albeit complex, federal law that addresses both health data protection as well as confidential handling of protected health information (PHI). The determination of data ownership as well as necessary PHI protection is further complicated by the use of electronic health records (EHR). Health records no longer reside on a shelf in a doctor’s office but can now be shared by few keystrokes on a computer. EHR usage changes the parameters of astute data governance responsibility from one concerned with data ownership to one focused on data stewardship.
Recent legislation promoting quality-based payments such as the Medicare Access & CHIP Reauthorization Act (MACRA) and the 824-page final rule describing implementation assure the use of electronic health records will continue to grow. The parameters of this growth are carefully prescribed in section 1848(o)(2)(A)(iii) of MACRA and the definition of “meaningful EHR user” under 42 CFR 495.4, which require eligible professionals to report on Clinical Quality Measures selected by the Centers for Medicare and Medicaid Services using only certified EHR technology, as part of being a meaningful EHR user under the Medicare EHR Incentive Program.
EHR use by providers is already rather substantial. According to the Office of the National Coordinator for Health Information Technology, in 2015, 96 percent of all non-federal acute care hospitals possessed certified health IT. While small rural and small urban hospitals had the lowest rates at 94 percent, 96 percent of critical access hospitals had certified health IT. Clearly, EHR vendors and their products are an integral part of data usage and PHI confidentiality, the keystones of data governance efforts.
Data governance: key component of care delivery models
Many healthcare organizations struggle with data governance. A 2014 American Health Information Management Association (AHIMA) survey of over 1,000 healthcare professionals revealed only 11% characterize their data governance programs as being mature while over 50% of the respondents did not have governance practices in place.[i]
The Health Information Management and Systems Society (HIMSS) has an excellent resource on overcoming data governance obstacles. The article is entitled, “A Roadmap to Effective Data Governance: How to Navigate Five Common Obstacles” and defines data governance as “the exercise of decision-making and authority for data-related matters.” [ii] The article analogizes the importance of having an effective data governance program seamlessly embedded within the overall management and operational practices to patient safety as an integrated component of a comprehensive care delivery model in any healthcare system. One obstacle identified is not addressing data governance from an enterprise perspective, which can perpetuate data integrity challenges.
Data integrity: accuracy, quality, and completeness
Assuring data integrity is certainly an essential component of data governance. Data integrity is defined by the Department of Health and Human Services’ Office of Civil Rights as “the property that data or information have not been altered or destroyed in an unauthorized manner.” Note that the alteration is not limited to intentional alteration; unintentional or mistaken alteration can compromise data integrity.
Data integrity is particularly challenging for both providers and EHR vendors when it concerns patient identity. Accurate patient identity is an imperative. Health information exchange cannot be accomplished in a manner that assures integrity without first assuring patient identity integrity. AHIMA defines patient identity integrity as “the accuracy, quality, and completeness of demographic data attached to or associated with an individual patient. This includes the accuracy and quality of the data as it relates to the individual, as well as the correctness of the linking or matching of all existing records for that individual within and across information systems.” While data integrity must be the cornerstone of any institutional health provider’s data governance principles, individual healthcare providers must communicate often with their EHR vendors to be certain that the correct patient’s health information is the information being exchanged.
Data dissemination: the call to collaborate with vendors
The final area regarding data governance concerns data dissemination. This area has the greatest potential for achieving excellence for providers by nurturing a strong partnership with EHR vendors. Data dissemination is occurring at unprecedented rates, and its future upward trajectory is projected to be even greater. MACRA includes a provision that expands the availability of Medicare claims data which took effect on July 1, 2016. This section expands how qualified entities will be allowed to use and disclose Medicare data under the qualified entity program.
Another MACRA provision that advances data dissemination is one that aligns with earlier efforts promoting interoperability. The tenets of the Certified EHR Technology criteria, which promote application programming interfaces that allow for interoperable data sharing necessary for big data analytics and population health management, will likely be coupled with MACRA’s Advancing Care Information (ACI). ACI will count for 25 percent of the Merit-Based Incentive Payment System (MIPS) attestation score in the first year of participation. MIPS advances population health management and care coordination by utilizing health IT that relies on open application programming interfaces (APIs) and an app-based approach to technology. Because APIs can be customized, providers will need to join forces with EHR vendors if they are to realize the financial benefits afforded by MIPS.
In summary, true data governance will not be possible without a strong partnership with EHR vendors. The partnership must go far beyond payment for services and assuring a business associate agreement (BAA) is executed. The BAA must be customized so that both parties have a meeting of the minds regarding data governance and other important factors that are memorialized in writing. Strong data governance must involve meaningful EHR vendor participation if it is to be sustainable.
Community Care Network of Virginia, Inc. (CCNV), a community health center-owned and governed provider network, was legally incorporated as a statewide network organization in 1996 consistent with the Affiliation Policies of the Bureau of Primary Health Care. CCNV has a long, successful history of providing integrated, network-based services and programs to Virginia’s health centers, including the acquisition and implementation of a centralized practice management system, help desk, and support infrastructure commencing in 1999.
 Cohasset Associates, "2014 Information Governance in Healthcare Survey." American Health Information Management Association, May 2014; at http://www.ahima.org/~/media/AHIMA/Files/HIM-Trends/IG_Benchmarking.ashx
 See 'definitions of Data Governance.' The Data Governance Institute; at
Tis the season to be grateful. Here are just a few of the reasons we have to be grateful for this year.
I am grateful, appreciative and impressed with the Minnesota hospitals that are participating in the Integrative Behavioral Health (IBH) project! As a former clinician, I know the difficulty addressing behavioral health issues, especially when resources are limited. I also know the impact they have on the individual’s quality of life as well as the lives of their families and communities. Thank you for all you do!
I would like to send a thank you to all the networks across our country who are working at improving the access to health care for rural America. The diversity of projects and locations makes it a fascinating group to work with. Their outcomes are amazing. We will have a healthier population in Rural America because of them.
I am grateful for our rural health partners that work with The Center to support the power of rural (FORHP, NRHA, NOSRH, RHIHub, Rural Health Value, Flex Monitoring Team, NCHN, NORC).
I’m incredibly inspired by and grateful for The Heart of New Ulm Project, born out of New Ulm, MN. The 10-year initiative is producing financial and health outcomes that are preventing disease versus treating it after it occurs. The project was just awarded the Most Meaningful Life-impacting Improvement award at the Health Analytics Summit. This rural community is a perfect example of how collaboration and partnerships really can change an entire population’s health!
I’m grateful for all of the organizations and groups like the National Center for Farmworker Health, Research for Indigenous Community Health Center, Arizona Rural Women’s Health Network, and countless others that work to improve the health of vulnerable populations, including rural communities. It’s inspiring to see their outcomes and accomplishments.
I’m grateful and amazed by the passion and persistence of those we work with here at The Center. No matter what our mission and vision statements say, we’re all shooting at the same target; enabling our rural providers to provide the very best quality of care to their communities and keeping rural areas healthy and vital.
Thank you to the thousands of rural health providers (hospitals, clinics, community health centers, health professionals, including EMS volunteers and community health workers) who are dedicated to providing care and improving health outcomes in rural America.
I’m grateful my grandparents have a critical access hospital in the next town from where they live, instead of the next closest hospital another 30 miles away.
I’m grateful for the honor of working to support rural health care. It is an honor to work in an industry that makes a difference in the lives of 2.5 million people not only at just one point in time - they day they are seeking care - but for their future and the future of their loved ones.
I am grateful to the Minnesota Accountable Community for Health (ACH) Teams. These 15 teams have worked so diligently over the past three years to provide Minnesotans with better value in health care through integrated, accountable care using innovative payment and care delivery models. The work they’ve done is not only ground-breaking but truly inspiring. True leaders and pioneers in rural health.
This article was written by Sally Buck, Chief Executive Officer at the National Rural Health Resource Center
Today is National Rural Health Day, an event coordinated by the National Organization of State Offices of Rural Health (NOSORH) to Celebrate the Power of Rural. The National Rural Health Resource Center (The Center) is proud to support this important day by highlighting the community-based solutions and committed providers that overcome the unique health care challenges that rural citizens face. These challenges include a shortage of primary care and mental health physicians and dentists as well as higher rates of poverty and uninsured.
Rural providers are committed to the goals of the United States Health and Human Services, Centers for Medicare and Medicaid Services (CMS) initiative of Better Care, Smarter Spending and Healthier People. At The Center we have seen this demonstrated by working with hundreds of rural health networks, small rural hospitals and State Offices of Rural Health (SORH) as a grantee technical assistance provider. Despite critical access hospitals (CAH), community health centers and rural health clinics being left out of many new innovation payment and care models initially due to their low volume or cost based reimbursement structure, there are many organizations leading the way towards value-based payment and care with an emphasis on quality and outcomes. These include:
Key partners for The Center are SORHs and state Flex Programs in our work to support rural communities and providers with services, information and resources to increase collaboration, improve quality reporting and improvement, recruit health professionals and support access to care by stabilizing hospital operations and finances through technical assistance, education and funding. This national network of rural health organizations and leaders are key to the power of rural.
We see that our vision of “collaborating and innovating to improve the health of rural communities” is happening throughout the country through the dedication, innovation and partnerships and strongly demonstrates the power of rural.
 CMS (2015). Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume [fact sheet].
 Mueller, Keith and Fred Ullrich (2016). Spread of Accountable Care Organizations in Rural America, Brief No. 2016-5, RUPRI Center for Rural Health Policy Analysis.
 Mueller, Keith and Fred Ullrich (2016). Spread of Accountable Care Organizations in Rural America, Brief No. 2016-5, RUPRI Center for Rural Health Policy Analysis.
 Rural Health System Change Embedded in State Innovation Models (2016) Keith Mueller, RUPRI Center for Health Policy Analysis, Rural Health Value, [PDF - 494 KB]
Strengthening Your Problem-Solving Muscles: How an understanding of Lean can support network objectives
This article was written by Becky Gourde, program coordinator at the National Rural Health Resource Center/Rural Health Innovations, for the November 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Rural health networks are often formed in response to collective challenges or needs arising out of the communities they serve. As part of health care’s current transition from a focus on volume to a focus on value, networks help drive and facilitate performance improvement efforts that contribute to CMS’s approach of Better Care, Smarter Spending, and Healthier People throughout the delivery of health care. Because Lean efforts usually require little, if any, direct financial investment, the related processes and tools can be a useful option for small organizations working to improve the health outcomes of their rural communities.
What is Lean?
In short, Lean is first and foremost a way of thinking that helps solve problems. Many of the ideas that we now categorize as “Lean” were developed out of the automaking industry. Shortly after World War II, Toyota began developing the Toyota Production System, or TPS, which was influenced by several thought leaders in industrial engineering. Although most people associate Lean with the practice of reducing waste and improving process efficiency, at the heart of the Toyota philosophy are a group of management principles characterized by (1) continuous improvement and (2) respect for people.
Their success with the system inspired other automakers and eventually other industries to adopt similar techniques. (Lean is often associated with a similar methodology called Six Sigma, which was developed in the US in the 1980s and 1990s.) Specialized systems of Lean (Lean Healthcare, Lean Sigma Healthcare, etc.) focus on applications particular to the processes involved with caring for patients.
Applying Lean to rural health networks
For networks with a small number of staff (if any), modest infrastructure, and little influence on the direct provision of patient care, how can network leaders derive benefit from learning about the principles and practices of Lean? Interestingly enough, the Lean way of thinking dovetails with the objectives of rural health networks and provides new approaches for building network capacity. The actions listed below offer ideas for how networks can use Lean practices to their best advantage.
1. Tackle complex problems
One of the notions of Lean is that problems are best solved when groups of people representing diverse roles or perspectives come together to identify issues and implement actions to address those issues. This format of problem solving is a common benefit arising out of rural health networks: networks often serve as ideal settings for candid and strategic discussions regarding the challenges being faced in the community. The network participants around the table have the power to collectively enact solutions that take into account multiple factors and perspectives.
The key to addressing problems using Lean is to work on the underlying root causes under your control, rather than wasting time developing plans to alleviate 20 or 30 symptoms of those root causes. There are several Lean tools that facilitate the process of root cause analysis in ways that offer simple frameworks for dialogue and planning.
2. Lead a culture of continuous improvement
Networks function most effectively when they help articulate members’ shared vision for the future of their communities. A shared vision expresses an ambitious and hopeful destination that all members are committed to using as a beacon for developing strategies and activities. The vision and goals are revisited periodically to assess progress and appropriateness, with new goals or elements revised as progress is made and circumstances change.
This iterative process of striving toward better and better outcomes is at the very core of Lean principles. Network leaders are often in the position of facilitating and carrying forward that drive. Understanding Lean’s models for nurturing a mindset of continuous improvement can help guide network leaders through culture reinforcement and change management efforts among members.
In fact, culture is often regarded by Lean experts as the highest priority for organizations wishing to become more effective and efficient: without an open commitment to progress and the empowerment of all participants to take part, performance improvement efforts are doomed to failure.
According to Toyota, this transformation can be accomplished through the “respect for people” principle. Network leaders may recognize the tenets of “respect for people” as their own best practices for network collaboration:
3. Offer education
As central sources for knowledge sharing, networks often allow member organizations to pool resources to pay for training or education that they otherwise couldn’t afford on their own. Because Lean has shown such positive outcomes throughout health care, coordinating and hosting educational opportunities on performance improvement can be a valuable service provided by a network to participating members and partners. The existing network configuration also provides a natural support system for members to get ongoing input from network leaders and from one another as they implement projects to improve outcomes in their own organizations.
If performance improvement support is something a network is interested in pursuing as a value-added service, it may even be a worthy investment for a network director to become certified in Lean or Lean Six Sigma so that they can serve as trainers and project leads for members, preventing members from having to seek out external consultants on a case-by-case basis.
4. Gather and share outcomes
Part of tracking the outputs and outcomes of a network’s work includes selecting measures and gathering data. The “simple” task of determining which metrics are most appropriate can be an intensive and tiresome process in and of itself, before the data collection even begins. Lean training incorporates an entire emphasis aimed at supporting users in what makes a good metric and which factors to consider.
Many of the recommendations around Lean metrics offer valuable guidance for networks involved in evaluation planning:
It’s also helpful for a network to serve as a repository of member data on selected measures that are relevant to the network’s goals. This process of collecting and sharing member information can encourage benchmarking and sharing of best practices among member organizations working in similar areas.
The information-collector role also allows networks to collect the designs of and results from the various improvement efforts being undertaken by member organizations, providing members with a quick way to see what’s been working well (or not so well) in their regions.
You don’t have to become an expert to begin benefitting from an awareness of Lean principles and tools. In fact, performance improvement efforts are often most effective when you start small. If you’ve never been introduced to Lean or a similar methodology before, you may want to look into free or low-cost leaning opportunities (like books or online resources) to see if it would be a valuable investment in your professional development. Or if there’s someone within your network’s member organizations with a background in Lean, you could consider inviting them to a network meeting to review a few ideas that are relevant to a particular network initiative. Selecting one or two new performance management tools to practice with can also help you decide whether to seek out additional training or expertise.
Jamie Martin, Lean Six Sigma Black Belt, SigmaMed Solutions
John Roberts, Lean Healthcare Black Belt, Midwest Health Association Management
Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction by Mark Graban, 2009, Productivity Press
The Six Sigma Book for Healthcare: Improving Outcomes by Reducing Errors by Robert Barry, Amy C. Murcko, and Clifford E. Brubaker, 2002, Health Administration Press
The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer by Jeffrey K. Liker, 2004, McGraw-Hill
This article was written by Joe Wivoda, CIO of the National Rural Health Resource Center/Rural Health Innovations.
The news is filled with stories of health care organizations that have had their data held hostage by hackers. Sometimes they choose to pay the ransom, sometimes they don’t. Regardless, the damage has been done because it is still a breach of Protected Health Information (PHI) and often needs to be reported to the Office of Civil Rights (OCR) as well as local media. Of the 168,000,000 reported breaches in the OCR database, 126,000,000 list hacking or IT as a factor. Clearly we have to take malicious software, known as “malware”, seriously.
What are the threats?
Malware comes in many forms, from computer viruses, worms, Trojan horses, spyware, adware, scareware and who knows what else! Ransomware, where a user is usually tricked into allowing a malicious program or web page encrypt and hold their data files hostage are getting a lot of attention and causing a lot of stress on IT leaders. Many of these attacks are difficult to stop with traditional AntiVirus software. Some use “social engineering” to convince a user to click on the malware and enable it.
“Warning! Your PC is infected. Click here to clean your PC NOW!”
This is not a virus warning, this is likely a malware attack, perhaps even ransomware!
How do you protect yourself?
Of course every computer on your network needs antivirus, but it is much more than that. In an environment with many computers, which includes all rural hospitals and many other rural providers, it can be difficult to manage all of the updates without central management of the antivirus software. Further, antivirus software will only stop so many threats. Some will get through even with a well-managed antivirus package running, it just depends on how well the users are trained and aware that they are targets!
That message that says “your computer is infected, click here to repair it” might as well say “feel free to click this and we will charge you money to get your data back” because that is one of the likely results. All organizations, including rural health care facilities, need to protect themselves in several ways:
The best intentions and efforts to protect your facility do not mean you won’t get caught by one of these nasty programs! Ransomware in particular seems to be showing up everywhere, and you have to be ready to respond when it does happen (see that mention of “incident response team”? That’s important!)
What if you are a victim of ransomware?
Many rural hospitals and clinics have been hit by ransomware in the last year. CMS and the Office of Civil Rights (OCR) have determined that if Protected Health Information (PHI) has been encrypted then it has been “acquired”. That is a key term! “Acquired” means that it is considered a data breach under HIPAA and needs to be reported.
Do you pay the ransom or not? Either way you will need to report the data breach and offer identity theft protection services to the patients affected, so it becomes a question of cost-benefit analysis. If the ransom is low enough, it may be less expensive than doing a full restore of the data (you do have good, well-tested backups, right?). Even if you pay there is no guarantee that the data-kidnapper will release the data. Now that you have agreed to pay, why wouldn’t you pay a little more? For these reasons most experts feel you should not pay. Estimate what the costs in time, money, patient safety, and other factors are before making the decision to pay the ransom or restore the data.
Rural IT leaders and others need to be aware of the risks that malware presents and understand how to mitigate those risks. The HIPAA regulations provide good practices, like risk assessment and incident response teams, that will protect your network but they need to be put in place. It is very hard in a rural setting to get everything done, particularly when most CAHs and RHCs have limited staff. It is necessary in most cases to use outside experts, at least to some extent. Talk about these threats with your end users and leaders, because they are the front lines in safeguarding your precious PHI!
Fact Sheet: Ransomware and HIPAA
Health IT Playbook
By Jo Anne Preston, MS, Workforce and Organizational Development Senior Manager, Rural Wisconsin Health Cooperative (RWHC). This article (“Introverted Leaders”) was originally published in RWHC’s Leadership Insights.
MYTH: Extraverts make better leaders.
TRUTH: Both strong and weak leaders can be found in any personality style. An even bigger, and often misunderstood truth: personality traits are not the same as skill.
What does it mean to be introverted?
You might be introverted if you:
✓ Tend to prefer thinking things through before speaking vs. thinking out loud
✓ Find that situations with lots of stimuli tend to drain your energy
✓ Generally are more energized working alone or with a very small group than in an open team setting
No one is “pure” when it comes to personality style, and we are all a complex array of traits. Though it’s not static like our blood type, when it comes to navigating the energy dynamic of our internal and external world, most people lean in one direction more than another.
Stereotypes of extraverted leaders as charismatic and “verbal stand-outs” can sometimes make it tough for introverts to get noticed for leadership opportunities. It’s a little bit like extraverted kids in the classroom who raise their hand with their whole body, drawing all the attention, leaving the more deliberate and internally focused introverted students unnoticed.
When it comes to being a leader, being authentically you is a strength, notes Susan Cain, author of Quiet: The Power of Introverts in a World that Can't Stop Talking. Being “authentically you” starts with spending some time reflecting on who you are, and personality exploration is a fun and useful way to be “positively self-centered.”
Tips for improving your leadership capacity
If you are an introvert:
1. Don’t assume you won’t be a great public speaker! Strongly introverted Susan Cain's TED Talk with 14 million views is just one example of evidence to the contrary. Effective speaking takes practice, and anyone who wants to excel must do the drills. As an extraverted speaker, most of my best ideas I have learned from Cella Janisch Hartline, RWHC Nursing Leadership Senior Manager, who is an extreme introvert AND gifted speaker and educator. She is powerfully engaging, impacting learners like a force of nature, proof that introversion is not the same as talent. It is also not the same as being shy. Introversion is about how you re-energize. After teaching all day she seeks time alone, and understanding personality differences helps me to not take that personally-a huge benefit in our working relationship!
2. Be conscious of your facial expressions. A very common experience among introverts it is that people often ask them, “Are you mad at me?" The introverted thinking face can look a lot like irritation or anger. Be aware that you may feel very approachable, but it doesn’t work if others don’t experience you as such. Isn’t some of this on the other person’s part to assume good intent? Yes. And. We are still accountable for the message we are sending out.
3. Be mindful of the toll that “people-ing” takes on you. A “best use” for personality tools is understanding your own wiring so that you can meet your needs. We all need to know what kind of fuel our engine takes to recharge, and then it’s up to us to go after it. Manage your energy by:
✗ Allowing—and valuing as productive—the thinking time you need before beginning something new
✗ Asking for agendas and written material to review prior to meetings
✗ Seeking out some opportunities to work alone
✗ Asking others for time to think about or process their questions before responding
4. Reveal your thinking. Help others understand your personality and what makes you tick. People want to know what you think, and in a vacuum of information, rumors will fill in the gaps. One daily habit to develop is to ask yourself, “Who might benefit from knowing what is on my mind?”
Understanding your strengths
Skeptical of personality instruments? They can still help if you are open to asking, “What can I learn from personality awareness to make me a better leader?” With an open mind, these tools (and there are many) can help individuals and teams appreciate, rather than fight against, diverse approaches to work and life.
Rural Wisconsin Health Cooperative (RWHC) has been providing affordable and effective services to healthcare organizations since 1979. RWHC is owned and operated by forty rural acute, general medical-surgical hospitals. The Cooperative's emphasis on developing a collaborative network among both freestanding and system-affiliated rural hospitals distinguishes it from alternative approaches. RWHC offers a variety of programs and services to its members as well as to other clients across the nation.
This article was written by Joe Wivoda, CIO of the National Rural Health Resource Center/Rural Health Innovations, for the September 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
The Rural Health Information Technology (HIT) Workforce Program wrapped up this August, and we want to take a moment to recognize the amazing work they have accomplished. The Rural HIT Workforce Program was a three-year grant program funded by the Health Resources and Services Administration’s (HRSA’s) Federal Office of Rural Health Policy to support rural health networks in activities relating to the recruitment, education, training, and retention of HIT specialists. The 15 grantees engaged in exciting projects that have made significant impact across the country.
HIT in perspective
This is a difficult time period for the profession of health information technology (HIT). HIT is a new field; we are just beginning to understand HIT roles, and organizations often do not grasp the full value of HIT professionals. In addition, HIT certifications and licensure are in a state of flux.
The 15 grantee networks in the Rural HIT Workforce Program worked within these muddy conditions to define HIT roles and education for the benefit of rural providers. Impressively enough, they are on track to have collectively trained more than 500 individuals. The networks work with hospitals, clinics, FQHCs, emergency services, school districts, public health agencies, and others across over 400 counties throughout rural America. It is truly humbling how many lives have been impacted, directly and indirectly, by their efforts.
Successes among Rural HIT Workforce networks
Here are just a few of the successes the Rural HIT Workforce grantees have shared:
“We successfully employed students in HIT positions at 5 organizations and equipped staff with more HIT knowledge at a 6th organization”
“Helping the smallest Critical Access Hospitals in our state to have some background in Health IT and understand/complete their quality reporting requirements more easily.”
“Through the training we provided, we have over 60 students obtaining certification credentials. All of our 31 network members have obtained MU Level 3.”
“Developed a network of employer partners with active participation in curriculum development, professional practice experiences, work-based learning opportunities and hiring strategies.”
Identifying and surmounting barriers
Of course, there were plenty of challenges along the way as networks worked to achieve these successes. Here are some challenges our grantees experienced and what they did to overcome them:
“Many of the students who enrolled in our program had significant life challenges - illness, family deaths, relocation, unemployment, foreclosure and opportunities - births, marriages, pregnancies. We had to learn early on that life happens and flexibility is necessary. We were able to give students some flexibility with timelines for completing apprenticeships and meeting expectations in order to help them accomplish their goals in the program.”
“Recruiting veterans was a challenge. We increased tuition incentives for veterans which increased our veteran recruiting percentage.”
“Student communication and follow-up quickly became a challenge in our fully online curriculum. However, staff prioritized their schedule around constant outreach, both online, over the phone, and scheduling face-to-face meetings, to establish a comfort level with students and encourage them in low points. The program mandated a face-to-face orientation, which found much success in its implementation and impact throughout the final six months.”
As the new curriculum for HIT education is released by the Office of the National Coordinator for Health Information Technology (ONC) next year, this group will be at the forefront in rolling it out and finding the best ways to use it in their local communities. As the Rural HIT Workforce grantees have shown, the ONC HIT curriculum is a good framework that can be made most effective by modifying it with local needs in mind. Vendor-specific modifications, state reimbursement specifics, or provider-specific workflow training are just a few of the examples of how the grantee networks have been serving their members.
Lastly, the Network TA team at Rural Health Innovations (RHI) would like to say “Thank you” and “See you later” to the Rural HIT Workforce grantees. We wish you continued success and want to remind you to stay in touch with us and with all of your fellow grantees in the years to come. Your work will continue to make a difference in rural communities across our country.
This article was written by Tara Dilley, Executive Director of Southeast Texas Health System, for the August 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Southeast Texas Health System (SETHS) members recognized early on that in order to have a greater impact on the services offered to their communities, cooperation and collaboration were key. The members share a common goal of operating a cost-effective and quality-integrated healthcare delivery system that provides a continuum of healthcare services and products. The member/owners are primarily rural and in the Texas Gulf Coast Region between Houston, Austin, San Antonio and Corpus Christi. SETHS’ business model, much like a rural utility cooperative, is the foundation of which SETHS products and services are delivered. The cooperative model is democratically controlled by members of the project and benefits its members in proportion to their participation. Historically, this model has created trust and consensus with the participants, which ensures sustainability.
Competing and cooperating as a network
Competition is primal, instilled in us as a necessity, while cooperation is more internal, allowing association for mutual benefit. In most situations, the two have a tendency to coexist. For example, people tend to enjoy activities where they can simultaneously cooperate with their teammates while competing against another team. This statement applies to rural health networks as well, yet it depends on how the sentence is interpreted. Depending on the network, the “other team” one is competing against could be another network member, third-party vendor(s), local competitors not in the network, etc. For Southeast Texas Health System (SETHS), the network board simultaneously cooperates with their fellow SETHS members and collectively, as a network, competes for better reimbursement rates from third-party payors, discounts for volume, grants, CMS’ recognition of the uniqueness of rural ACOs (as compared to urban ACOs), etc.
The need to cooperate as rural providers
The tyranny of small numbers has prevented many SETHS facilities and providers from individually negotiating managed-care contracts, developing and sustaining patient programs and implementing most of CMS’ cost-savings programs in the Accountable Care Act. Quite frankly, rural providers do not have the volume of patients and supporting data in one market to demonstrate value with empirical evidence, or have a business case that would support the necessary technology to do so. By collectively working together, SETHS has a greater opportunity to be successful with the products and services that it offers.
Below are a few examples of how SETHS network members cooperate for the success of the product, service or project.
SETHS members recognize that the opportunity to compete and cooperate at the same time exists daily, yet they have chosen to collaborate and cooperate with each other in order to collectively compete for better outcomes in their communities. To ensure the future of rural health networks and providers, cooperation will need to remain in the forefront.
Southeast Texas Health System (SETHS), founded in 1994, is a Texas nonprofit corporation equally owned by 8 independent hospitals. SETHS’ network members work toward goals that cannot be achieved alone. Due to geographic location, SETHS members are very fortunate to not be in direct competition with each other. SETHS’ purpose is to collaborate to create economies of scale and scope in the delivery of healthcare in the region. The network’s mission is to integrate locally and regionally for purposes of responding to growth in a way that preserves local control and maintains the independence of the members. Southeast Texas Health System has been an active member of NCHN (National Cooperative of Health Networks) since 2012.
This article was written by Chris Hopkins, MBA, VP of Strategy and Business Development for Montana Health Network, for the July 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Montana Health Network has received several grants throughout its existence, and with each new grant the required task of communicating results seems to grow in frequency, depth and complexity. In short, the reporting burden seems to grow with each opportunity. Providing information can add to the work load, but there are important reasons behind communicating results.
First, know your audience
When providing results, the target audience must be kept in mind. Are these results going to a project officer, community members, board members, other stakeholders or the press? Each entity may have different data requirements or wish to see different things. The communication of results should not be one-size-fits-all.
Other than grant requirements, which may have a pre-prescribed data set, the main reason to provide and share results is to show value to the intended audience. Results can come in many forms, including graphs, charts, financial statements, statistical reports and personal impact stories. How and what gets presented depends greatly upon the audience’s needs. When a network is providing value and can demonstrate its results, then sustainability is close around the corner.
Many of Montana Health Network’s successes came in the form of demonstrated cost savings. The initial strong, demonstrated cost-saving results of our service lines, communicated to the board members through financial charts, have led to increased trust and the opportunity to explore new products and to continue to grow the network. These are specific results communicated to a specific audience and have the desired result of continued support.
Another purpose in sharing results is to educate. Recently Montana Senator Jon Tester, together with CMS and other federal partners, held a rural health summit in western Montana. Members of Montana Health Network were in attendance and able to present information about rural health topics such as workforce, healthcare needs and hospitals.
This was not the time for charts and graphs. The presentations shared results through stories of the need for rural healthcare and the difference it has made in people’s lives. Horror stories were shared regarding labor shortages, but success stories were also shared about saving lives and grateful families and patients. The purpose was to paint a picture of what life was like in a rural/frontier healthcare environment. Both successes and failures were shared, through stories, in an effort to educate and paint an accurate picture. In this case, this method of presenting results was effective in meeting the goal of educating and soliciting change.
Posting and sharing results internally is a great way to motivate staff and to solidify the organizational message. Together with staff, the organization can celebrate successes and rally around struggles, as long as everyone understands what the organization is trying to accomplish (mission) and the results that indicate progress towards that goal. It is rare to walk into a rural healthcare facility and not see current trends and results posted in a public area or at least an area open to the view of the staff. Progress toward results can share the organization’s story to potential new recruits and explain why the organization matters and where it is making a difference.
Don’t leave out the bad results
Sharing results is crucial, especially with board members, grant administrators or stakeholders, at a time when you wish to solicit guidance or direction. Without really showing a true picture of a project’s current status, it is hard to get the direction needed to reverse a negative trend. Everyone would like to successfully implement a project or meet grant objectives. Unfortunately, that cannot always be accomplished.
There are two key factors in sharing bad results. First, did the effort not succeed due to a bad idea, or bad execution? Without consistently reporting results and measuring impact, there really is no way to tell an accurate story. Additional support and wisdom from stakeholders, board members and grant officers can often mean the difference between success and failure, but not if they don’t know the current results.
Secondly, the importance of frequency and timing is crucial. If the organization is consistently sharing results, either positive or negative, there should not be any surprises. For board members, surprises, especially negative, can be very frustrating. Establish early on in the organizational process what kind of data is needed by each of the stakeholders and how frequently they should receive it.
While it is never comfortable to communicate bad results, the frequency and honesty with which they are shared will dictate whether a supportive team environment, looking for solutions, will be created, or whether the interactions will be less pleasant. Many grants are designed to be exploratory, and therefore less-than-successful results only add to the learning process.
Communicating results, both good and bad, can be a useful tool to solicit support, tell your story, show value and motivate staff. The keys to communicating results are to be aware of your audience and determine the frequency and best method to display the results you share. The proper sharing of results will help strengthen support for your network and create an air of transparency and trust within the organization.
Montana Health Network’s (MHN) mission is to support and influence the evolution of healthcare organizations, and enhance the well-being of individual communities through:
This article was written by Leslie Flick, executive director of Health Future, LLC, for the June 2016 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
When serving an industry where change is a constant state of routine, keeping the workforce of an organization productive, efficient, flexible, and able to adjust to required changes in workflow or focus at all levels is imperative. This requires a clearly stated mission, transparency, collaboration in the setting of goals, and development of key performance indicators that define “success.”
It also requires discussing concerns about possible barriers to meeting those goals from varied perspectives and creating a plan to increase progress toward identified targets. Who knows a network’s obstacles better than those who are responsible for setting the foundation for reaching our goals: our frontline staff. It is in their daily interactions with members, consumers, strategic partners, and other stakeholders that success is rooted.
Alignment of workforce with network goals
There are several ways to ensure that staff members are connected with their role in reaching organizational goals.
Employ the right associates to join your team. While a bit obvious, the first step is to offer the right individuals an opportunity to be a part of your team. Tasks, in and of themselves, are relatively easy to teach. Attitude, dedication, energy, compassion, humility and “presence” are attributes that are important to keeping the workforce moving together toward common goals. During the interview process, consider asking nontraditional questions like:
Assign new-hire mentors/buddies. Place your new hire with one of your stars! Ask the mentor their opinion of the new hire and specific areas that might need some special attention to help them succeed. It won’t take long to determine if the new addition is a good fit who will assist in your movement forward.
Hold morning huddles. Spend five to ten minutes with work units each morning to ask for report-out of progress from the day before, what the day ahead looks like, any barriers encountered or anticipated today that need to be addressed, and/or any suggestions for improvements to consider.
Track key performance indicators and post them for review, showing progress or decline. Engage in management walk-throughs that note progress on a consistent basis.
Develop cross-functional teams to share information on work in other areas of discipline across the organization. It helps us learn how stakeholders in other areas are impacted by the work of each work group. We have found that development of project teams with assigned first and second chairs who have complementary skills and setting clear lines of accountability have helped all workforce members feel empowered and valuable to the overall success of the organization.
Accountable, empowered and valued teams
Encouraging accountability and empowerment throughout the workforce instill pride in the work being done, which also helps improve outcomes. Staff members build confidence as they learn new skills and as new knowledge (education with purpose) is shared across the organization. When staff plays an active role in removing barriers to others’ success, the network can foster a sense of camaraderie among its workforce.
Staff must feel valued as an essential piece of the larger puzzle for them to be satisfied in their roles. Communicating the network’s appreciation for key staff allows each individual to experience being counted as an important contributor to success. It also builds respect for the work that is being done on all levels of the organization. Employees take more ownership of their roles and maintain a direct line-of-sight with the mission when the network demonstrates the value of their contributions.
Overall, creating an agile workforce is really about developing an inclusive management style, building trust through transparency, and verbalizing appreciation for the work. Keeping people engaged and eager to improve facilitates change for the greater good, ensures focus on the mission, and creates ownership in the outcomes.
Health Future, LLC, headquartered in Southern Oregon, was founded in 1979 to develop and manage a variety of programs and services for its members and associates to address health care concerns. Today, Health Future, LLC is a unique healthcare consortium owned by Oregon hospitals and healthcare systems that operate as an integrated network for quality improvement, margin enhancement, and cost reduction. Health Future, LLC has been an active member of NCHN (National Cooperative of Health Networks) since 2005.
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center.