Leading Change in Health Informatics
Given this scenario, which of the following would you say to your former roommate?
"Mmmm...those concepts apply to both for-profit and non-profit companies."
You work for the office of telemedicine at a local health system. You've recently hired a new member of the team who is fresh out of college. The 1st task assigned to the employee involves creating a detailed flowchart of the process used by the office of telemedicine for accepting new project proposals. The new hire is excited to roll up his sleeves and get to work. Within just 20 minutes he returns with a flowchart and shares it with you. You take a look at the detailed flowchart and in just looking at 2 of the nodes you gasp.
-Diamonds are decision nodes and should lead to yes/no or other options for various decision paths. The first diamond seems to actually represent a step---and should therefore not be a diamond but a rectangle. -There are capitalization inconsistencies ("Legal, compliance and Payor"). -There are spacing/formatting issues (isconsidered) (TelemedicineAdvisory) -The second diamond needs to have connectors leading to the different decisions. In its current form, it only leads to one path (hence, it is not a decision). -If TDW is spelled out elsewhere and then abbreviated, that's fine. Or if there's a legend/key indicating what TDW stands for--that's fine too. But, assuming neither of those are the case--then using an abbreviation before specifying what it stands for is problematic. (All of the Above)
Dr. Greene opens up his email and sees a message from 1 of the analysts on the Ambulatory CDS committee. The message reads: "There is an outbreak of Lassa fever in Nigeria that is the push behind this urgent need. We have been contacted by the Infection Control representatives about the need to develop a mechanism for developing an alert that fires based on Travel History response. We'll need to get feedback on the alert appearance options, as well as the acknowledgement reasons offered to clinicians." Which of the steps from the knowledge management life cycle is represented in the email Dr. Greene is reviewing?
1,2,3,4,
Which of the steps from the knowledge management life cycle is represented in Dr. Knight's description of her team studying the usage report for the alert?
6
Several Emergency Room physicians are irate because they are being bombarded with unnecessary alerts. While admitting a patient named Frederick Mychart, one of the ER physicians had the following alert fire and was in disbelief because Frederick was a 75-year old male with multiple medical problems who had suffered a stroke and had been confined to a nursing home for the past 4 years. He was in the ER because of altered mental status from a urinary tract infection and certainly hadn't traveled outside of the country. This is the alert that had been released into production 24 hours ago, and was firing on 80% of patients coming into the Emergency Room, including Frederick:
6, 7
Question 2 In the example below from a process flowchart, the three different symbols you see are:
A start, connector, and step
Gantt Chart
A time and activity bar chart that is used for planning, managing, and controlling major programs that have a distinct beginning and end.
Asynchronous transmission
A type of serial data transmission in which data is sent when it is ready to be sent without being synchronized.
You're nearing the 1-year anniversary in your role as the lead business intelligence platform developer for Magical Insights (a healthcare analytics company). It's been a stressful six months because two of the main clients started complaining that only having access the dashboards via a web browser was insufficient. They put extreme pressure on your company's executive leadership to make the dashboards available via mobile app. You and your team have been working overtime to make this a reality. You offer colleagues from human resources a free pizza lunch in exchange for them looking at the dashboards and answering questions like this: The best way to describe the pizza lunch session would be to say it's part of which of the following?
A usability evaluation
You were hired six months ago as a project manager for a government contractor. The main project you've been assigned to involved modernizing state child welfare information systems. The legacy systems are not nimble enough to handle evolving needs. You work closely with the policy experts and technical staff at your company. This could be deemed a successful project if:
All of the above
A local group of community physicians has historically made all referrals for non-medical issues using a paper-based system. So, even though the physicians have been using an electronic medical record for many years, only referrals to medical providers were made using the electronic platform. So if a patient had chronic knee pain that was worsening, the order for a referral to Orthopedic Surgery could be made in the EMR. If a patient with long standing hypertension and Coronary Artery Disease was developing worsening symptoms of shortness of breath despite optimal medical management, the referral to a Cardiac Surgeon could be done in the EMR order-set for surgical referrals. On the other hand, any problem related to social determinants of health like housing, food insecurity, transportation or financial barriers involved the clinician filling out a paper form that was then sent to a social worker who would address the issue on a future date. If the patient was struggling with issues related to alcohol or smoking, those referrals for services were also done on paper. Over the past year, a new initiative has been underway to get providers to use the EMR for all of these types of referrals as well. They have piloted the online referral system for non-medical issues and 1 example of the type of clinical decision support (CDS) embedded in the EMR is a Best Practice Advisory (BPA) related to smoking cessation:
Based on Kotter's 8 step process, the Friday lunch parties would be a good idea because they help celebrate short-term wins.
You're very excited about your new role as the administrative coordinator for Slopkins Medical Center. Flopkins is made up of 2 outpatient clinics, 1 hospital and a co-located Emergency Room. It's a daunting task, but on January 1st, you will be going live with telemedicine. The roll-out plan is summarized in the image below:
Big Bang
You are the project manager for a very important clinical decision support (CDS) project where a dashboard is being built for providers to monitor the effectiveness of the CDS embedded in their EHR. Unfortunately, there were some issues with licensing the software that was to be used for data visualization. Therefore, the project is falling behind schedule. You should do each of the following, except:
Continue to accept additional tasks so that it shows your supervisors how committed you are to the company.
Based on the discussion, it was clear that the Corrie app is a consumer facing application. Once patients have a heart attack and are admitted to the hospital, certain criteria in the EMR can lead to Best Practice Advisory (BPA) being fired. This alerts a researcher on the Corrie team that a potential candidate has been admitted. One of the partnerships the Corrie team formed is with Apple, which has enabled them to leverage Apple CareKit. Which of the following is a true statement?
Corrie leverages CareKit, which is an example of an open-source software framework.
8 Step Process for Leading Change
Create a sense of urgency Build a guiding coalition Form a strategic vision and initiatives Enlist a volunteer army Enable action by removing barriers Generate short-term wins Sustain acceleration Institute change
You heard Kelly Gleason talk about the role of patient portals in clinical trial recruitment. She explained that in order to advocate for change, the research team would explain to stakeholders how long recruitment was taking by traditional methods. They also used data to show how expensive the historical approaches were. Another argument they made was that resources and time were wasted when patients in the past would receive study invitations, but then would be deemed ineligible based on criteria that couldn't be factored in. Which of the steps from Kotter's 8-step process for change is best supported by what she describes?
Creating a sense of Urgency
Slopkins" Health System is having a difficult time recruiting Radiologists because of the cost of living in the area as well as some negative press they've received recently for their lack of systemwide operational efficiency. During a recent executive retreat, the decision is made to explore Teleradiology services. There are several vendors in this space and it might behoove Slopkins Health System to contract for these services that would enable academic radiologists from around the globe to provide image interpretation to Slopkins providers. The problem is, the executive team isn't very familiar with this domain. Some of the vendors only cover the off-hour needs of hospitals, some of them only handle a certain subset of imaging types. What would be a good next step for Dr. Red (the current CMIO of Slopkins)?
Dr. Red should have her team put out a Request for Information (RFI).
A friend you've met in graduate school tells you about his previous work with a non-profit organization in California. He recalls one project where his boss directed him to work on a Letter Of Intent (LOI) regarding a bid the organization would be making to provide Health Information Management services to a local public health department. Your friend shows you some of the information he had to review in preparing the LOI.
False
Although you have technical expertise, you're not a clinical or health policy subject matter expert. As such, you make sure to organize meetings with key stakeholders at the health plan who have this kind of domain expertise. Their input is very helpful in refining the Statement of Work (SOW). True or False: As you work on the scope, you should be intentionally vague with the wording so that the population health analytics project team will have flexibility in the type of work that they ultimately get done.
False
As you reflect on the following data from the HealthIT.gov website, you think about how the vast majority of office-based physicians had adopted EHRs by 2015 itself. As such, change management is really much less of an essential skill these days for leaders in health IT in the public or private sector. Is this statement True or False?
False
Corrie is a smartphone application that can help patients and caregivers in managing care following a heart attack. As the lead software developer, you're very excited to see the results of some usability testing that's been conducted. As part of the usability evaluation you know it's important to: Ask users how intuitive the interface is. Ask users to assess the interface by navigating through the system in a manner that would support the way they do their work. Ask users if the system allows them to easily accomplish the tasks they must perform. Ask users what they like most and like least about the product when they finish "testing" the system. You sit down at a meeting to hear about the results so you can determine if any changes are needed to the iOS interface. The team members who conducted the usability testing shows the image below that is from the Notes section of the EMR.
False
One of the reasons Slopkins Health System is having a difficult time recruiting Radiologists is because of the antiquated PACS (picture archiving and communicating system) they've been using. There's agreement that they need a significant update in their medical imaging software and radiology information system (RIS) platform. Your team is tasked with selecting a new vendor. As part of this, you have some of the Radiologists and Radiology techs participate in usability testing. True or False: When asking the users about the intuitiveness of the interface or how easily it allows them to complete their tasks, you should have the actual vendor present in order to clarify any misinterpretations of how the digital imaging software and communication system is intended to be used.
False
Question 2 True or False: Scenario Planning is a great tool to use in strategic planning, especially when looking ahead at the forecast for next quarter.
False
True or False: A project has to result in the generation of a new product.
False
True or False: When it comes to leading change in health information systems, creating a guiding coalition is very important. In the example of leveraging patient portals for clinical trial recruitment, the guiding coalition is best comprised of physicians, who are the main users of electronic medical records. Ensuring that physicians from a from a variety of disciplines are a part of the guiding coalition is a sufficient way to ensure that change efforts will be successful.
False
You're at a monthly staff meeting where the Director of Clinical Informatics is presenting information about the latest overhaul underway for the hospital. During his lengthy presentation, he shares the image below with the staff. What would you call this type of diagram?
Gantt Chart
Imagine you work for a large healthcare system and are the lead software developer for the patient portal. Your boss informs you that the team will be going bowling after work on Friday. Your boss explains that a lot of hard work has gone into re-configuring the system to send notifications to patient who might be eligible for clinical trials. Early numbers indicate that there have been decent rates of recruitment. And in comparison to messaging patients via a letter in the mail, rates of patient portal recruitment have been higher. The team can't yet take credit for having higher rates than in-clinic recruitment. But the costs are certainly lower than in-clinic recruitment, and it's still in the early stages of being introduced as a novel approach in the health system. Which of the steps from Kotter's 8-step process for change is best supported by the boss putting together a bowling session for the staff?
Generate Short Term Wins
Question 8 What do we call the phenomena when poor decisions are made by a group of individuals because they are feeling a pressure to agree with each other and reach consensus?
Group think
You work for the Camden Coalition in New Jersey and are very excited to be one of the hubs chosen by the Center for Medicare and Medicaid Innovation (CMMI) to be part of the Accountable Health Communities (AHC) Model. As part of the development and testing, you've been asked to incorporate a standard screening tool into each of the outpatient clinics where patients in the network are seen. The screening tool developed by CMMI for use in the AHC model includes questions about housing instability, food insecurity, utility needs, interpersonal violence, and transportation. You make a presentation to some of the clinics that will have the screening tool embedded into their workflow. You start off with your 1st slide in a 5 slide powerpoint deck. You explain to the audience that this is information directly from the federal government website and they can go to CMS' innovation website to read more. Many of the social workers and case managers in the room are nodding their heads in agreement.
Individual Reaction
In the process flowchart above, "Fax/phone clinic for renewal" is represented by which symbol?
Input/output
In reviewing a report on rates of influenza vaccination you note that one Centreville outpatient clinic had lower rates of vaccination this past flu season when compared to comparable clinics. You look at Centreville's historical rates and this year is clearly an anomaly. This is especially surprising because a new best practice practice advisory (BPA)--a form of clinical decision support)--had been introduced this year with a flu vaccine orderset embedded in it. The BPA fired for all MDs, DOs, or Physician Assistants (PAs) seeing a patient eligible for the annual influenza vaccine. You speak to providers at the clinic and they explain that in the past the Nurse Practitioner (NP) in their clinic offered the flu vaccine to all patients who qualified and helped them fill out relevant paperwork. She then administered it herself. The new BPA didn't fire for her because it was restricted to show up for the provider types of MDs, DOs, or PAs. Which of the following would be a correct reaction to hearing about the scenario above?
It's a shame. A detailed workflow analysis with some simple workflow redesign could have potentially prevented the low rates of influenza vaccination.
Your boss informs you that the hospital is facing multiple challenges with its homegrown electronic health record. The legacy system just doesn't meet the needs of the providers, patients and populations. Transitioning to a commercial EHR is a big undertaking and your boss asks if there is any guidance from other industries on how to successfully transform. You describe Kotter's 8-step model for organizational change and reference each of these steps that are a part of it, EXCEPT which of the following?
Keeping Tight Control of All Key Projects
After graduating from the School of Public Health with an MPH, your best friend starts working for a government contractor. She is tasked with helping them apply for funding that is focused on providing support to Local Health Departments (LHDs) in order to promote their adoption of electronic health records. As part of the application for funding, your best friend sees that one of the questions is about basic information regarding how many LHDs currently use EHRs. She recalls some courses during her graduate degree when she learned about combining data from the National Association of County & City Health Officials Profile survey and the Area Health Resource File to find the necessary counts. She runs the data again, and starts typing in the application that, "Although there has been a rise in LHD adoption of EHRs, a majority still rely on paper records based on the data presented in Appendix D. If awarded this funding, our company would ensure that the 3 Local Health Departments we are responsible for would be able to identify the right EHR vendor and product for their particular needs. We would guide them through the vendor selection phase, and would also be involved in implementation of the new system." As part of the application, your best friend's last sentence is an example of which of the following?
Megachange
Dr. Blue asks you if an organizational readiness assessment is primarily focused on helping Slopkins Health System figure out if it's financially ready with the right funding sources to successfully tackle organizational change. You reply:
NO
There are several sections to an organizational readiness assessment. In the healthcare arena, it's best to have the survey completed by which of the following?
None of the Above
Which of the following are not included on a Gantt Chart?
None of the above
You go on to read the description on the website: "This is not a request for a proposal, this is a notice that the National Institutes of Health, Clinical Center, Office of Purchasing and Contract intends to award a Sole Source Contract to Carefusion Solutions, LLC. 3750 Torrey View Court, San Diego, CA 92130 for Rental and Maintenance of CareFusion Pyxis SupplyStation System.The Government intends to award a sole source contract pursuant to the authority of FAR 6.302-1". Based on what you've seen, which of the following could correctly describe this particular opportunity?
None of the above
You're the office manager for a dental clinic in Des Moines, Iowa. The lead dentist is a 70% owner of the practice and after years of resistance, has come around to the idea of adopting an Electronic Dental Record (EDR). He's not very familiar with the various vendors out there and is still concerned about the costs. He starts researching some of the major players online and get frustrated about how these types of business decisions aren't things that were taught during his clinical training. He turns to you as the office manager and asks, "Why do all the vendors keep referring to the total cost of ownership (TCO) for an EDR?" You explain to him that the TCO is important because the upfront cost of initially acquiring the EDR is:
Only a portion of the total expenditures the dental clinic will need to make in order to acquire and maintain the EDR.
4 Types of Change
Operational, Strategic, Cultural, Political
You're the case manager working at a non-profit that provides healthcare to the homeless. It's been a challenge ensuring that the other providers have access to your detailed notes and recommendations for the patients. Especially for this population, it's imperative that social determinants of health be taken into account. And you're the only individual in the clinic that takes the time to dig deep into the non-medical issues contributing to the homeless individuals' health. In recognition of the value you bring, the non-profit recently used a large grant to purchase a new IT system that enables providers to easily access your notes prior to seeing the patients. Use of this new document management system will start in 2 weeks. The staff at the homeless healthcare clinic has created a detailed process map and identified specific areas where changes would need to be made in the sequence of administrative and clinical tasks to ensure effective use of the new system. Training is being provided to staff on the expected changes with hopes of minimizing unintended consequences. Based on the description above, the non-profit you are employed by has done which of the following? 1 point
Performed workflow re-engineering
Blockchain is being heralded by some as a breakthrough technology for secure sharing of healthcare data. Your significant other works for a large health system that sees enormous value in blockchain's potential. They are looking to participate in a blockchain network. Prior to initiating this transformation, you want your spouse to know that the health system would most benefit from: 1 point
Performing a blockchain readiness assessment
Please read the scenario below, and answer the question that follows. You've been hired as a marketing manager for a government contractor that is focused on software development for public health agencies. You see the following posting online from a government procurement website: The Centers for Disease Control (CDC) has not been able to identify an existing network of organizations ready to test health IT in real-world settings. There has been a previous attempt at setting up such a network by the Centers for Medicare and Medicaid Services (CMS) with respect to testing eCQMs, but the effort was not able to be realized. As such, setting up such a network would help provide a ready path for clinical testing for a variety of health IT. In particular, there is a need to expand on the sandbox idea to test true interoperability across EHR platforms as well as different clinical organizations in situ. To help inform approaches CDC can apply with respect to setting up a National Test Collaborative (NTC) that can support robust clinical testing needs, please respond to the following questions in order: Please confirm the examples in the background section and identify additional examples of clinical testing needs that could be met with a NTC. How could CDC design and execute a national testbed infrastructure that can support all the clinical testing needs identified? Please consider the importance of an agile development approach in the design and execution of a NTC. Should a phased approach be considered to accommodate all the clinical testing needs? For example, should the initial scope of the testing begin with CDS, eCQMs, and a limited number of additional health IT and then expand to more types of health IT? Should a NTC support testing needs beyond those related to clinical care? If so, what kinds of additional testing needs should it support?
RFI
Question 2 During a bi-monthly call with the client (state officials who awarded your company the original contract), you hear the lead project officer from the client side say, "We've done some testing on the front-end portal you developed. From a technical standpoint, you've done an excellent job. The user interface takes into account human factors principles and is very easy on the eyes. We know the original plan was for Case Managers & Social Workers to be using the tool. But we actually think this portal would best be utilized not by front line staff, but by their supervisors. We know this means that some changes will need to be made to the layout of the portal we'd originally agreed upon. And we might need to revisit some of the essential data elements that are being populated." The phenomenon being described here is:
Scope Creep
You work for a cybersecurity firm that specializes in healthcare. With some of the recent ransomware attacks on hospitals in the DC metro area, there is heightened interest in your companies work. The Human Resources department is hiring new staff as quickly as they can. You're finding it difficult to manage your day to day tasks along with training one of the new hires. You're quickly trying to get her up to speed on the current project. You share with the new hire the current Statement of Work for the project to get her up to speed. It will actually be helpful to have this new staff member as you begin the project planning process. Which of the following is NOT a part of the PMI's project planning process?
Starting the work on the most challenging process first
You're excited about this new designation as a project manager and feel confident that if things go well you might be up for a raise. There's a lot to do and you begin by examining the project goals and reviewing the expectations of the various health plan stakeholders. When completing this initiation phase, what document will have been created that describes the analytics product that will be produced by the end of this population health project?
Statement of Work
Question 2 What is the name of the global initiative focused on technology & informatics education reform and interprofessional community development?
TIGER
You are the clinical informatics and privacy officer for a large outpatient clinic. Your clinic will be adopting sign-in kiosks for patient registration, where patients can enter their information, scan their insurance cards and make co-payments using their credit card. This will decrease patient wait times, as patients will not have to wait at the front desk for the intake person to manually register them in the system before they can be seen by healthcare personnel. The collection rate for co-pays are also likely to increase, as patients can now pay using their credit cards at the time of visit, rather than send a check in the mail. While you are excited, you are not sure if other personnel in the clinic feel the same about these changes. You plan to use the Organizational Readiness Assessment toolkit (developed by StratisHealth) from the HealthIT.gov website to evaluate the readiness for this change in your clinic. Which of the following conditions, if present, would indicate a better readiness for change in your clinic?
This technology is being viewed as a tool to enable health care quality and achieve strategic business goals.
Second-order change
This type of change usually occurs as the result of a strategic change or a major crisis such as a threat against system survival. Second-order change involves a redefinition or reconceptualization of the business of the organization and the way it is to be conducted. In the medical area, changing from a paper medical record to an electronic medical record represents a second-order change, just as automated teller machines redefined the way that many banking functions are conducted worldwide.
Question 2 You work for an organization that has recognized the need to transform its current disease management program into one that is more consistent with a population health management approach. At present, the disease management offerings are condition-specific with a big focus on improving access to medical care for patients. However, since non-medical determinants drive about 80% of health outcomes, it will be important for the system to be integrated with community based organizations (CBOs) and the local health department in order to address the broader spectrum of issues that can impact patients' health. A project team is assembled to tackle this transformation. They will perform background research to determine if the population health offering should be centralized (so a separate department that owns care management across the board) vs. decentralized (care managers are employees within medical groups/ service line for better communication with clinicians). One of the considerations will be whether they should 1) enhance the existing EMR to support the evolving care management needs or 2) build a home grown application that supports different population health needs or 3) get a new vendor who is specialized in the care management area. For this undertaking, the project team will be following steps in the standard project lifecycle defined by the Project Management Institute (PMI). Which of the following is not a process group or specific step in a standard project lifecycle?
Vendor Selection
Which of the following best describes the daily process of the reporting team?
Which of the following best describes the daily process of the reporting team?
Question 5 You work for a company that mines pharmaceutical claims data to calculate rates of adherence, potential areas of therapeutic duplication, and even cheaper equivalent alternatives for brand name drugs. Health plans purchase your software with hopes of improving rates of medication adherence in their populations, reducing adverse drug events, and reducing costs. You recently traveled to Philadelphia to pitch your product to a health plan there. A week after the on-site they send an email saying their actuaries performed a total cost of ownership analysis comparing your software solution over 2 years to another vendor they're looking into. They share the results below: 2-Year Total Cost of Ownership for Rx Analytics Software Your Company: $2.2 Million Competitor Company: $1.9 Million ******* What do you need to be prepared to discuss?
Why your company has a 15.8% higher TCO than the competitor.
You've recently been promoted to a Director level position with an organization that generates most of its revenue from government contracts. You have your MPH as well as an MBA and although you're only 29 years old, have moved up quickly in the ranks. Although the organization has its main offices in Baltimore, they are expanding to a new building about 20 miles south of the city. Part of the agreement with your promotion was that you'd be leading the charge in ensuring the expansion goes smoothly. This really isn't where your interests lie--after all, you went into this field to work on deveoping new quality measures and episode payment models that could be used in the Merit-based Incentive Payment System (MIPS). Before you can get your team to work on sophisticated modeling and claims data integration, you need to ensure the office space is set up properly. Unfortunately, your organization doesn't have experience with expanding and so there's no clear blueprint on how they'll purchase computers, printers, and other basic hardware for the new office. You think back to your previous work at CMS (The Centers for Medicare & Medicaid Services) and how when you worked for the government, there was a pretty standard approach to these types of non-technical hardware purchases. What is the name of this standard approach?
a quick bid
First-order change
a variation in the way processes and procedures have been done in a given system, leaving the system itself relatively unchanged. Some examples are creating new reports, creating new ways to collect the same data, and refining existing processes and procedures.
One of the hospitals in a town near Slopkins Health System recently suffered from a ransomware attack. Now, the executives at Slopkins are very concerned about this happening. In your role as Director of IT Security you're told to spend the next month having your direct reports evaluate metrics from other health systems that have more advanced cybersecurity processes in place. The CIO needs you to report back to her on what your team has found and then wants to design a process to apply the best practices at Slopkins. You set up an all-hands-on-deck meeting with your staff to discuss how to proceed with (________), which is what your group has been tasked with. Which of the following terms best fits in the blank in the sentence above?
benchmarking
CPOE
computerized physician order entry
Scenario planning is a strategic planning tool best suited for (select all that apply):
highly challenging environments uncertain situations
Question 1 Dr. Davison checks her email and sees a message about the following: According to the seminal article, "Managing Change" by Lorenzi & Riley (2000, JAMIA) this would be an example of:
microchange
If your health system is conducting a SWOT analysis, it would:
need to take into account Strengths of the internal organization
SWOT is a strategic planning tool best suited for (select all that apply):
stable situations, moderately challenging situations
3 steps of Lewin's Change Model
unfreezing, changing, refreezing
