1 Hot Technology Topics You Need to Understand!5 Hot Technology Topics You Need to Understand! Richard De Jong, Chief Technology Officer, Symbria Aaron Hagopian, Director of Information Technology, Symbria

2 Topics Topic 1: Strategic Technology PlanningTopic 2: Technology and Care Transitions Topic 3: E-Prescribing/Pharmacy Integration Topic 4: HIPAA Privacy Pitfalls Topic 5: The Good and Bad of the Technology Cloud Say topics, discuss format  - Q&A after each topic, introduce Rich Rich De Jong is the Chief Technology Officer at Symbria and leads the Symbria Analytics division. With more than 15 years of technology and analytic experience, Rich promotes the practical and effective application of technology using enterprise analytics systems as a tool to streamline operations, understand and enhance business processes, and improve customer experience and loyalty.

3 Topic 1: Strategic Technology Planning

4 Purpose Topic 1: Strategic Technology PlanningCreate Expectations Simplify Decisions Direct Priorities Encourage Alignment Increase Awareness We have all heard the motto, if you fail to plan, you plan to fail, and I believe that most of us understand why planning ahead is so important, why we operate our business using budgets and goals, why we create blueprints before starting a new construction project, and why we use a GPS to find our way to somewhere new we haven’t been before. But strategic planning is much more than just planning, strategic planning Creates Expectations, by making sure that everyone is on the same page and understands what the goals are.  Strategy allows us to simplify decisions as technology solutions are being implemented. To Direct priorities, so that taking care of day to day responsibilities don’t cloud the overall goals; to encourage alignment between departments and IT and alignment with the mission of your organization; and to increase awareness to all stakeholders of what solutions will be implemented, and when.

5 How to create an effective plan Topic 1: Strategic Technology PlanningMeasure Observe Understand Document Assess Needs/Dreams S.M.A.R.T. Goals Investment Communicate Define Mission Value Prioritize Align Implement Focus Execute Adjust as needed Revise Success Failure Review TO create an effective strategy, it is important to have 6 steps.

6 Assess Topic 1: Strategic Technology PlanningMeasure Observe Understand Document Assess Assess Topic 1: Strategic Technology Planning Measure – Survey Set a foundation for understanding current state of technology Observe – Meet with the right people Understand – Know the areas to focus on Document – Outline all observations

7 Define Topic 1: Strategic Technology PlanningNeeds/Dreams S.M.A.R.T. Goals Investment Communicate Define Define Topic 1: Strategic Technology Planning Specific – Who, what, where, when, which, and why? Measurable – How much? How many? How is “done” measured? Attainable – Is this with reach? Can we invest in this? Relevant – What is the value? Timeframe – When will this be completed?

8 Align Topic 1: Strategic Technology PlanningMission Value Prioritize Communicate Align Align Topic 1: Strategic Technology Planning No Alignment Some Alignment Strategic Alignment Within each organization, we have many different departments, who all have many different plans, we have many different people all with different goals, and we have a mission for the future. Since we have so much happening day to day, it is important to align everyone. Without strategy, everyone will still work on their plans, often bumping into each other in the process. With good leadership, most plans move in a similar direction and we can see Some alignment. But with good leadership, and strategic planning, all departments, all goals, and all plans move forward together for one mission.

9 Execute Topic 1: Strategic Technology PlanningImplement Focus Communicate Execute Execute Topic 1: Strategic Technology Planning Implement the solutions outlined in the strategic plan Focus on the priorities Regularly review the goals and understand the progress Continue to communicate progress through out the implementation phase

10 Revise Topic 1: Strategic Technology PlanningAdjust as needed Prioritize Communicate Revise Revise Topic 1: Strategic Technology Planning “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” – William Arthur Ward, writer

11 Review Topic 1: Strategic Technology PlanningMeasure Success Failure Communicate Review Review Topic 1: Strategic Technology Planning Measure – Survey Understand the current state of technology and compare to the previous results Review the success Understand the failures What did we learn? Communicate the outcomes

12 Success! Topic 1: Strategic Technology PlanningMeasure Observe Understand Document Assess Needs/Dreams S.M.A.R.T. Goals Investment Communicate Define Mission Value Prioritize Align Implement Focus Execute Adjust as needed Revise Success Failure Review TO create an effective strategy, it is important to have 6 steps.

13 Questions? Discussion?

14 Topic 2: Technology and Care TransitionsAaron Hagopian is the Director of Information Technology at Symbria and is responsible for its software development and technology solutions. Aaron has been involved in long-term care for more than 20 years and has specialized in information technology for more than 15 years.

15 Topic 2: Technology and Care TransitionsSource:

16 Current tools and resources Topic 2: Technology and Care TransitionsA few standalone products are currently available to help manage these processes Health Layer 7, or HL7, offers integration along the continuum of care Continuity of Care Document (CCD) and Continuity of Care Record (CCR) – not widely adopted, but available Mostly done with the sharing of PDF type files Usually doesn’t integrate directly with the EMR Talk about use of exchanges, direct messaging, hospital EMR portals (EPIC)

17 What does the future hold??The future of technology driven care transitions. Topic 2: Technology and Care Transitions What does the future hold?? Source:

18 The future of technology driven care transitionsThe future of technology driven care transitions. Topic 2: Technology and Care Transitions “In the future, all individuals, their families and health care providers should be able to send, receive, find and use electronic health information in a manner that is appropriate, secure, timely and reliable.” – Office of the National Coordinator for Health Information Technology Source:

19 The future of technology driven care transitionsThe future of technology driven care transitions. Topic 2: Technology and Care Transitions Source:

20 Nationwide interoperability roadmapSource:

21 No more games of telephone with your medical records.The future of technology driven care transitions. Topic 2: Technology and Care Transitions No more games of telephone with your medical records. Source:

22 Questions? Discussion?

23 Topic 3: E-Prescribing/Pharmacy Integration

24 Facts & fiction Topic 3: E-Prescribing/Pharmacy IntegrationE-prescribing is a prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care

25 Facts Topic 3: E-Prescribing/Pharmacy IntegrationCMS considers e-prescribing as “an important element in improving the quality of patient care.” Long-term care exemption lifted 10/1/2014: Back to manual faxes if using any automation that was not e-prescribing Many EHR vendors support e-prescribing right now, some even can send controlled substances Adoption/implementation has been slow Physicians can e-prescribe both from your (supported) EHR and their own EMR systems

26 Fiction Topic 3: E-Prescribing/Pharmacy IntegrationE-prescribing will immediately save me time and money Requires good planning Things may be slightly worse before they get better All orders will always be in sync Phone orders or orders via direct e-prescription from the physician may not get pushed back into the EHR (depending on the vendors involved) May need to be entered manually Sometimes pharmacy needs differ from community’s Data field conflicts

27 How it works: No community e-prescribing Topic 3: E-Prescribing/Pharmacy Integration

28 How it works: Community e-prescribing Topic 3: E-Prescribing/Pharmacy IntegrationMention the physician orders from their own EMR don’t make it back in the community EHR

29 Plan Implement MaintenanceSteps to a successful rollout Topic 3: E-Prescribing/Pharmacy Integration Plan Implement Maintenance

30 Plan Topic 3: E-Prescribing/Pharmacy Integration: Steps to a successful rolloutWhy? Demonstrate the reasons Improving patient care, accurate and timely orders Cost effective Be ready for resistance to change and have answers ready to combat those fears Who? Appoint a cross functional team with a project leader/owner Include pharmacy, EHR vendor, nursing, physicians, IT, etc. Make these assignments known to all

31 Plan Topic 3: E-Prescribing/Pharmacy Integration : Steps to a successful rolloutWhat? Define goals, procedures and a test plan What does a successful e-prescribing solution mean to you? What fields are included in transactions? Who is the source for all fields in the transactions? For example, allergies Account for normal and exceptions in your documented procedures Write test plans Involve key stakeholders in all of the above

32 Implement Topic 3: E-Prescribing/Pharmacy Integration: Steps to a successful rolloutHave regular meetings with key stakeholders Continuous communication is most important to this project Monitor progress and react quickly to issues before they sour the experience Be ready to change the timeline if the project gets off track Unexpected problems will occur

33 Maintenance Topic 3: E-Prescribing/Pharmacy Integration: Steps to a successful rolloutYou will end up with some workarounds Schedule a regular meeting (at least annually) to look at processes and further improvements or new features in your EHR Software updates coordination Changing vendors

34 Questions? Discussion?

35 Topic 4: HIPAA Privacy Pitfalls

36 Are you compliant? Topic 4: HIPAA Privacy PitfallsHow do you know if you are compliant? Who is your security officer? When was your last assessment completed? When did you last change your password? What is your policy on HIPAA violations? What is your policy on HIPAA Breaches? Do all of your vendors have a BAA? How often do you audit them?

37 Minimize your risk! Topic 4: HIPAA Privacy PitfallsChances are that your organization will experience a breach Statistics for 2015: 245,919,393 breached records were reported. 1,673 breach incidents were reported. 81% of healthcare organizations have been compromised by cyber-attacks in past 2 years Every Day 1,939,383 Every Hour 80,766 Every Minute 1,346 Every Second 22 Source: 2015 Breach Level Index | 2015 KPMG Healthcare Cybersecurity Survey

38 Minimize your risk! Topic 4: HIPAA Privacy PitfallsMinimize your exposure HIPAA was not just designed to provide as much protection as reasonable and appropriate, but to minimize exposure to vast amounts of personal health information if a healthcare organization was to experience a breach Embrace encryption Only 4% of reported breaches in 2015 were “secure breaches” rendering the stolen data useless

39 Minimize your risk! Topic 4: HIPAA Privacy PitfallsManage your vendor relationships Make sure to have a Business Associate Agreement with each one Audit and review these agreements on a pre-defined schedule Training, training, training Employees are the most common cause of ePHI breaches 95% of all security incidents involve human error 95% of advanced and targeted attacks involved spear-phishing scams with s containing malicious attachments that can cause malware to be downloaded onto the user’s computing device

40 Understanding HIPAA Topic 4: HIPAA Privacy PitfallsHIPAA regulations can be confusing The “HIPAA Administrative Simplification” released on March 26, 2013, by the U.S. Department of Health and Human Services Office for Civil Rights is 115 pages! 72% of healthcare organizations say they are only somewhat confident (32%) or not confident (40%) in the security and privacy of patient data shared on HIEs 2014: The Year of the Mega Breach - Ponemon Institute© Research Report

41 Understanding HIPAA Topic 4: HIPAA Privacy Pitfalls“Standards” vs. “Implementation Specifications” 18 standards explain what a covered entity must do Administration safeguards has 9 standards Physical safeguards has 4 standards Technical safeguards has 5 standards 12 standards have implementation specifications 6 standards have no implementation specifications 36 implementation specifications explain how to do it 14 specifications are “required” 22 specifications are “addressable”

42 Understanding HIPAA Topic 4: HIPAA Privacy Pitfalls“Required” = You must comply with these standards “Addressable” ≠ Optional Your organization must use reasonable and appropriate measures to meet the standard These must be assessed and implemented as specified if reasonable and appropriate to your organization. If not reasonable and appropriate, the reason it is not must be documented and an equivalent alternative measure must be implemented if the alternative is “reasonable and appropriate.”

43 How do you become HIPAA compliant? Topic 4: HIPAA Privacy PitfallsAssess Audit Plan Budget Timeline Policies Implement Processes Training Evaluate Review Audit Processes Audit Policies How do you become HIPAA compliant? Topic 4: HIPAA Privacy Pitfalls

44 Questions? Discussion?

45 Topic 5: The Good and Bad of the Technology Cloud

46 Topic 5: The Good and Bad of the Technology CloudWhat is the cloud? A resource that is provided over the internet

47 The Good Topic 5: The Good and Bad of the Technology CloudEase of administration: If it's not your core competency, then you need not become an expert in it Disaster recovery is generally less of a concern Distribute service in different locations: If one goes down everything does not go down Barriers to entry are low (usually little or no capital expense to start) Work from anywhere Some offer non-profit pricing breaks/donations

48 The Bad Topic 5: The Good and Bad of the Technology CloudRequires reliable internet speeds If your internet goes down, your cloud service is down If you do not want publicly accessible, requires complicated Virtual Private Networks (VPNs) Downtime (although they are probably down less than you are)

49 The Bad cont’d Topic 5: The Good and Bad of the Technology CloudWithout a BAA you are not covered: If your providers “can” access your data, they are business associates Some exceptions for providers of data transmission services (“mere conduits”) with random or infrequent access . So easy to use and share information, sometimes people forget the HIPAA basics Oregon Health & Science University preemptively notified 3,044 patients because physicians were using cloud-based spreadsheets for sharing information about patients

50 Some services to consider Topic 5: The Good and Bad of the Technology Cloud Remote backup/long-term storage File sync Phone system Website development and hosting HR/payroll Accounting Sales & marketing

51 Questions? Discussion?