I’ll be doing some promotions which you will hear about later, but for now here’s the description on Amazon:
Retaining Expert Knowledge: What to keep in an age of information overload covers two major topics central to capturing and transferring expertise in organizations:

• Methodology and best practices for interviewing subject matter experts (SMEs) to capture their knowledge
• Identifying the SMEs to interview

The more critical problem is identifying the SMEs and the knowledge that needs to be captured.

One reason identifying the right experts is now so important is that in the next 10 years, the largest recorded exit of talented and knowledgeable workers from organizations will occur as baby boomers retire. In their wake, they leave their former employers understaffed and, even scarier, under-informed. Identifying the right SMEs is also critical because of the rapid acquisition of new knowledge. Some estimates say knowledge now doubles every two years, so it is crucial each organization identifies its journey and catalogues it individually and collectively.

This book provides managers with answers to the following questions:

• Are we talking to the right subject matter experts?
• What knowledge should we capture?
• What knowledge needs to be captured immediately as opposed to eventually?
• If we have limited resources, which experts are most important to speak with first?

Every organization has a history, a culture, and knowledge that may have lost its current relevance but not its importance. It is that broader vision of capturing knowledge, which this book addresses. It guides readers on how to preserve corporate knowledge and provides tools to assess organizational circumstances and judge the value of the resources to capture.

Retaining Expert Knowledge is a training resource, but it is also a business resource. As knowledge proliferates and organizational culture rapidly changes, now is the time to step back and determine what has been important to your organization’s success, where the organization is today, and what it will take to stay in the game tomorrow.

Your company houses knowledge, skills, attitudes, intellectual property, trade secrets, company culture, and individuals who will never be replicated exactly as they are today. Because they have demonstrated value in the past and are demonstrating value today, these treasures are worth preserving. This book shows how to preserve these valuable assets today for tomorrow’s successes.
You can buy this wherever you normally purchase your books.

Here’s a link directly to Amazon. 

by Peggy Salvatore and Terry McGinn

This article is cross-posted at www.workingwithsmes.com

Sometimes expert knowledge isn’t really knowledge at all. In fact, if your data sounds too good to be true, it just might be.  Sadly, for reasons of human sloth, greed or carelessness, sometimes the experts who supply your data are giving you bad information – and they know it.

In Finding Your SMEs, we discuss times when you may be dealing with conflicting expertise or when you may be asked to ignore some information and favor other information in your documentation to please a stakeholder. In those cases, you aren’t dealing in bad data. Rather, you are dealing with differences of opinion.

That’s an honest debate of the relevant facts.

Falsifying data to purposefully mislead someone is different than simple disagreement among experts.

When you are dealing with falsified data, there are no facts. There is no honest debate. There is only an intent to deceive. In regulated industries that depend on quality data to remain in legal compliance, falsified data can have many bad outcomes including products that are substandard, dangerous or deadly. Your best defense is to know your regulations and how to work with them because, remember, you can be guilty simply by omissions.

Remember Volkswagen? What About Your Drugs?

In 2015, the U.S. Environmental Protection Agency discovered that many VW cars were outfitted with software programmed to falsify data during emissions testing showing the cars met carbon dioxide emission standards. The brand suffered substantial damage and the company was exposed to up to $18 billion in fines when it was discovered the cars actually emitted up to 40 times the allowable amount. This attempt to defraud the public resulted in massive car recalls and a loss of company credibility along with profits.

Money lost. Reputation lost. Environment damaged.

In biopharmaceuticals, clinical trial data is the stuff upon which the Food and Drug Administration makes decisions about the safety and efficacy of pharmaceutical products. Does data get falsified there, too? Unfortunately, yes!

A 2001 study showed that falsification of scientific data used in FDA evaluations of experimental drugs was not uncommon, and it ranged from falsifying the identities of clinical trial subjects and their physical exam results to creating duplicate records to achieve the desired number of trial subjects.

It still happens today.

Just a few weeks ago, a Kyoto University research group headed by Nobel laureate Shinya Yamanaka was found guilty of fabricating all six main data figures in a study published in Stem Cell Reports. The study claimed it had modelled the blood-brain barrier in vitro using pluripotent stem (iPS) cells. Yamanaka, who won the 2012 Nobel Prize in physiology or medicine for discovering iPS cells, reportedly was going to donate his salary to the university as a mea culpa but the damage to his reputation will live beyond his paycheck.

Bad data can hurt – or even kill- patients and it exposes the biopharma research companies who rely on quality data to potentially billions of dollars in fines and, at the end of the day, the delay or loss of up to a billion dollars in research and development for a product that can’t be supported by strong, reliable data sets.

Is Your Data Subject to Tampering?

One of the ways to ensure that your data is valid is to have strong processes in place for data collection and auditing. Long before an FDA or compliance inspector finds a problem with your product or process, you can lock down your documentation with well-written and faithfully executed standard operating procedures.

By taking some strong action today, you can implement steps to avoid harm to your brand reputation, delayed or denied product approval, heavy fines, jail time and, of course, harm to patients.

If you would like to discuss your process for developing and implementing standard operating procedures, write to us at workingwithsmes@gmail.com and schedule a no-obligation appointment for a review of your organization’s data integrity vulnerabilities.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection.

By Peggy Salvatore and Terry McGinn

Each company in a regulated industry is required to follow written procedures.  The written procedure describes how steps or tasks are to be followed to achieve the desired outcome or result.  Having these steps identified permits the distant or precise way to achieve the end of your process or practice. 

Knowing the critical nature of having written procedures, your standard operating procedures and best practices need to follow a few procedures of their own so you can replicate what you do across your organization.  In other words, your standard operating procedures need to be transparent and streamlined.

One of the many purposes of the SOP or best practice process is to ensure that the process flow can meet expectations. Done well, your standard process or procedure should result in a quality product or achieve the desired result every time.

Knowledgeable and trained  personnel must have the SOP available to follow because no matter how many years’ experience they may have, even experts get stuck for a variety of factors. In fact, some experts know their jobs so well that they think they can skip or modify steps, take shortcuts, or do it from memory. This is a red flag!

The SOP should be written in a logical process flow that will allow someone looking for the cause of a failure later can pinpoint where a difficulty arose. Reviewing the SOP with someone internally or externally who is checking or auditing your procedure should allow them to identify what and where things  went wrong.

When you have a point of failure, an examination of the SOP should indicate gaps or problems that can include one or more of a host of issues including materials, equipment, environment and much more. Often, a failure can point to the source of your complications by reading the SOP against practice.

A well-written procedure or best practice document will:

1. Be written to describe the flow clearly to anyone trained on it
2. Include every essential step without including extraneous steps or materials that can and should be accessed elsewhere
3. Always be followed by everyone from the new hire to the veteran employee using the current SOP

Expect you will have changes to your SOPs on occasion. Expect you will need to review your documents periodically according to your SOP. And expect that when you have a clean, clear, streamlined SOP process that your errors should be few and easily identifiable.

To summarize, standard operating procedures and best practices need to follow procedures of their own so you can replicate what you do across your organization.  In other words, they need to be transparent. If they are the opposite of transparent – opaque – they are hard to follow and may result  in errors.

If you would like to talk to us about your SOP process, give us a call for a no-obligation preliminary review of your procedures.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection. To have a conversation about writing your standard operating procedures, write to us at workingwithsmes@gmail.com to set up an appointment.  

Photo by Drew Hays on Unsplash

By Terry McGinn and Peggy Salvatore

We’ve been getting quite a bit of interest and feedback regarding our series on standard operating procedures, so we’ll continue writing about this topic this week.

After all, inherent in the word “expert” is the idea that something is done correctly. Correct procedures and best practices need to be captured and passed on. Sometimes, though, it seems the only people who care if the SOPs are followed are the experts who wrote them.

Truth is, everyone needs to care. Accountability right down to the last man or woman is absolutely the key essential ingredient in ensuring regulatory compliance.

Train for Accountability

Employees who are tasked with executing the many small, incremental steps are responsible only for their piece of the process. Sometimes in the laser-focus on one task, people may lose sight of the bigger picture. That bigger picture – a safe product going out the door – needs to be reinforced occasionally. Training usually steps in here for both reinforcement and correction. When that fails, the regulatory authorities will notice. Companies get slapped with government warnings and fines at a higher rate than the average person may realize. But if you are in a regulated industry, you know how often you are out of compliance.

Think about dialing the failure point back to its origin. The failure point is when the SOP is not correctly written, understood and applied.

Only then does the employee fail to perform to specifications.

Only then will training have to step in for often very expensive correction.

Only that will happen when an audit reveals you are out of compliance with your SOPs, and the Corrective and Preventative Actions (CAPAs) applied at that point of failure. That doesn’t need to happen.

In a perfect world, it should look like this:

If your current plant is not operating flawlessly as above, identify your points of failure:

1. How many people are asked to retrain personnel after a deviation or equipment issue?
2. How many SOPs do you have? Are they overwhelming or conflicting?
3. Are they easy to understand and do they follow a logical, stepwise process?
4. After a deviation, is the SOP reviewed?
5. Are people observing the CAPAs?

And, the big question…

Do your employees feel responsible and accountable for performing their jobs according to the SOPs in place?

Employees feel empowered when they are able to follow well-written SOPs, and when they are acknowledged for contributing to a well-run organization. Points of failure cannot be business as usual. Organizations that accept points of failure as the status quo have a company culture that unintentionally encourages non-compliance.

Maybe that is worth repeating:

Organizations that accept points of failure as the status quo have a company culture that unintentionally encourages non-compliance.

And the road to audit hell is paved with regulatory non-compliance.

The Solution

Dial back your points of process failure to the source.

Ask yourself:

• Are my SOPs well written?
• Do my employees feel a sense of responsibility for performing to specifications?

If your answer to either of those questions is, “No” or “I don’t know”, give us a call.

We would be happy to speak with you.

Unlike some problems in the universe, the problem of poorly-written and executed SOPs can be solved. Let’s do it.

Terry McGinn has worked in regulated industry for many years and has experience in written procedures that will help pass scrutiny of a regulatory authority inspection. To have a conversation, write to us at workingwithsmes@gmail.com to set up an appointment.  

Photo by Drew Hays on Unsplash

In the spirit of innovation, the entries this week are organized according to the order in which they arrived in my inbox. This relieves me, as the host, of the awesome responsibility of finding a compelling theme. First in, Dr. Bradley Flansbaum.

The Early Bird

 Dr. Bradley Flansbaum offers a birds-eye view of the physician relationship with the pharmaceutical industry at The Hospital Leader: the Official blog of the Society of Hospital Medicine. Dr. Flansbaum details his interactions with the pharmaceutical industry – from a young hospitalist receiving speaker’s honoraria to a pharma-sponsored researcher. If you want to know about the relationship between the pharmaceutical industry and the medical profession, this is a good primer. Dr. Flansbaum has chosen to opt out of all relationships with pharma, and he is eloquent in explaining his professional position. At the risk of taking the suspense out of his story, in part, here is his conclusion:

“Remember why we call industry, industry. It’s a business. They sell, and we buy. That’s my message so do with it what you will.”

Healthcare Economist Asks “Is P4P doomed to fail?”

 The way pay-for-performance and quality incentive programs are currently structured, the conclusion one draws from Jason Shafrin’s question is, “Yes, P4P is doomed to fail.”  Jason bases his discussion on a referenced article in Health Economics that calls out a “fundamental design flaw in P4P design” which is, simply, a provider chasing too many quality metrics that result in rewarding competing measures. For providers and health care organizations looking to be reimbursed based on this model, the ensuing confusion can be hazardous to your patients’ health and the health of your bonus payment. Read the detail at Healthcare Economist.

Tracking ACA Enrollments: Figuring Out How Many Grandfathered/Grandmothered Plan Are Still Around

In this week’s entry, Charles Gaba of ACASignups.net gives us a breakdown of a tally of Grandfathered and Grandmothered plans in the individual market. He did, in his own words, a “back of the envelope” calculation and, with input from Louise Norris of healthinsurance.org, came up with an estimate of those old plans still hanging around. Charles says, “My Conclusion? There should be roughly 1 million people still enrolled in Grandfathered policies and perhaps 1.5 million in Transitional/Grandmothered plans today.” If you want to know the difference between Grandfathered and Grandmothered health care plans and the detail, click here.

Dare Roy Poses Suggest: Healthcare Leaders Should Come From Healthcare

Roy discusses a New England Journal of Medicine article describing “Immersion Day” during which members of the board of a non-profit hospital system who had no healthcare background were given a one-day exposure to life in the hospital. Roy Poses poses (sorry, I couldn’t help myself) an interesting hypothesis: “True health care reform would put more health care professionals back in control of health care, or failing that, would at least promote leadership by people with some knowledge of health care who would support health care values and would be willing to be accountable for doing so.” Read the detail about the NEJM article here.

 ObamaCare Wear: Gasoline Pants

Hank Stern’s InsureBlog is on top of the dish on ObamaCare. Blogger Mike Feehan writes this week that we have more bad news about the ACA. ObamaCare Co-ops are going the way of the dodo bird, according to Mike. In fact, I can’t improve on Mike’s description of the status quo, so here it is, in his own words: “As Nipsy Russell might have observed, the Obama administration’s health policy is running thru Hell in gasoline pants.” Read More Bad News About ObamaCare Co-Ops – Part CCIX – at InsureBlog.

 Health Plans Need to Consider the UX

Just as Apple figured out that computer users needed an intuitive interface to finally integrate computing into their daily lives, Joe Paduda of Health Strategy Associates says that the health plans that figure out how to give their members a good user experience will be winners. “Members do NOT want to wade thru fine print stuffed with SAT-test words and jargon that’s murky at best. Blaming the consumer for misunderstanding a benefit plan is just nuts; write the plan so it’s understandable for everyone” Read more at JoePaduda.com.

California Is the Harbinger of Things to Come

California often leads the way in trends that work their way across the country. Anthony Wright at Health Access Blog writes out of the state capitol in Sacramento from Health Access California where he and co-blogger Bethany Snyder tell us “Covered California produced a report about potential 1332 waivers, and gave a greenlight to one proposal to allow undocumented Californians to buy into the exchange with their own money.” Yes, insurance is governed at the state level, but keep your eye on California’s move to allow undocumented people to buy into the healthcare system and the implications it could have for the future of health insurance. Read Opening Up Covered California here.

The CMS Innovation Center and Next Generation ACOs

Writing for Health Affairs, Chris Dawe, Nico Lewine and Mike Miesen discuss the recent CMS Innovation Center announcement saying ACOs can share in 100 percent of the savings they create for the payer’s largest book of business, theNext Generation ACO. In Today’s Most Attractive National ACO Model is Offered By…CMS, the authors write, “Would-be Next Gen ACO participants must grapple with two primary hurdles: risk exposure and a closing decision window.” Read more about the tension created by being exposed for full risk for spending in excess of targets and opportunities to enjoy capturing savings at the Health Affairs blog.

Another Medicare Pilot: Medicare Comprehensive Primary Care

If you’ve read this far, you know that Dr. Jaan Sidorov is not the only HWR contributor this week who wonders if government should get out of the way and let healthcare do its job of caring for patients. In this entry at Disease Management Care Blog , Dr. Sidorov explains that Medicare has just launched a multi-year primary care initiative aimed at improving care, but that might not be as good as it sounds. Dr. Sidorov tells us that it is based on a two-year-old pilot that hasn’t shown improvement in costs or quality. He asks, “Should CMS get out of the care management game and let others handle the work of caring for populations with chronic conditions?”

Lack of Transparency or Just Plain Greed?

David Williams at Health Business Blog writes about healthcare’s version of the military’s $10,000 toilet seat: in this case, a $427 hospital charge is reimbursed at $22. He wonders what could be wrong. Is the hospital overbilling to begin with? Is the health insurance company underpaying? Or both? In Urgent Care Billing: Eyebrows Raised , David discusses the implications of this type of billing/reimbursement discrepancy.

And Finally, A Little Education from Worker’s Comp Insider

Julie Ferguson takes time to educate about occupational medicine and its unique place in healthcare. At Workers’ Comp Insider, Julie writes about how occupational medicine differs from other specialties, and she offers an informative video, “Introduction to Occupational and Environmental Medicine (OEM)”. Check out this training at Workers’ Comp Insider here.

Blabbin’ with the Wonkers at Health Wonk Review On Air with David Harlow

If our biweekly dose of health policy leaves you wanting even more detail about things like QALYs and risk corridors, please join us live, online, every other Tuesday for Health Wonk Review On Air with David Harlow. David is joined by other HWR contributors to discuss details of the most recent edition and whatever else is on their minds health policy-wise.

Blab is interactive, so it is a good place to ask questions and join the discussion. If you miss the session, you will be able to view the recording later. David posts the link at HealthBlawg.com.

 The next edition of Health Wonk Review On Air Blab is Tuesday, April 26 from 1 to 1:30 p.m. Eastern.  

This is one of a series of blogs posted out of the ePharma Summit 2016 where pharmaceutical marketing folks talked tech for three days.

The future is here. We just need to recognize it and start using it for the good of patients. The technology available today allows the healthcare industry to stop talking at patients, or talking past patients, and engage them in meaningful conversations.

It is at the intersection of patients, the providers who care for them and the payers who have to manage the finances to pay for it all where technology will integrate these powerful forces. There was a fundamental frustration you could feel from the futurists at ePharma Summit 2016 that they are dragging a reluctant healthcare sector along to make this future that is now, actually fulfill its promise now.

Vendors had exciting innovations. More on a few of those in the next blog. The issue that calls out for immediate attention, though, is the nexus of and reason for all the efforts and stakeholders at the table – the patients we need to engage. Those patients are us.

Co-founder and CEO of StartUp Health Steven Krein said, “We are all part of this in a way no other industry is. If we aren’t personally, somebody in our family is a patient.”

As an industry, how quickly those of us in pharma can get caught up in the sales numbers, the marketing strategy and the fun techie gadgets and forget that the patient is the whole point of why we are in this industry. When you scratch a healthcare professional – no matter whether a doctor, nurse, marketing executive or pharma sales rep – they will tell you they are in it because they care about a disease, a patient, a cure.

As founder of The Stupid Cancer Show, Matthew Zacchary, said in his powerful presentation to the industry, “The humanity you stand for can’t get lost in this. You guys and your kids get cancer too. We’re all patients, we’re all humans.”

Yes, we’re all human and we’re all patients. And technology can help us make those personal connections that drive our industry and our reason for being.

The story about Ebola has been dominating the news, and I didn’t feel any particular need to weigh in on it since there is plenty of information out there. Then a few little bits of information hit my inbox and I feel compelled to discuss the seriousness of it because the electronic patient record system has been implicated.

According to a story in HealthLeaders Media on the morning of October 3 by Cheryl Clark (who writes accurately and prolifically for HealthLeaders), Patient Duncan’s travel itinerary was tucked into a note in the nurse’s record which was not connected to the physician’s workflow. The way the unnamed electronic patient record software is set up, different caregivers can enter notes that are not cross-posted to other caregivers.

You can read the full article at: http://www.healthleadersmedia.com/page-3/TEC-309001/Hospital-EHR-Flaw-Obscured-Ebola-Patients-Travel-Note

If we stop and digest this for even half a New York minute, the flaw in this design is obvious and egregious.

That night, this tidbit hit my email alert by Joseph Goedert (also an accurate and prolific reporter) 10:25 p.m. October 3 in HealthData Management, “Friday evening, the hospital issued another statement:

“We  would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic patient record (EHR), including within the physician’s workflow.

“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event. [end of statement]

“Emails to two Texas Health Resources spokespersons late Friday asking what changed so that the hospital now believes there was no fault in the workflow of the EHR, or if the attending physician simply missed the travel history, were not quickly answered.”

Huh?

You might imagine for a minute the panic at the up-until-then unnamed software vendor. Since then, I have seen the name, and I choose not to mention it here. But there are only a few biggies in hospital systems today, and it is one of them.

The truth is important. It really is.

Where You’ve Been Matters

At first, I was moved to put keyboard to screen when I read this story because I had an experience before the proliferation of electronic patient records that further supports the fact that our travel is a critical piece of information when we present with symptoms. About 20 years ago, I began to have serious gastrointestinal problems. I couldn’t keep anything inside me – solid or liquid. When it was clear that no matter how much I put into my body, I was losing it all immediately and starting to slip away, my primary doc sent me to a gastrointestinal doc. The gastro guy asked me a few questions and within 10 minutes knew exactly what I had and where I got it: after hearing the symptoms, he asked specific questions about my vacation the previous summer. He knew the lake, he knew the bug. He prescribed a heavy duty antibiotic and within 10 days I was recovered. He probably saved my life.

Doctors are human, too. They don’t all know everything; they can’t. That’s why we have specialists. And that is why all the information in an electronic patient record needs to be accessible to every provider who touches the patient. You never  know what little gems in there may really be the golden key in the hands of the right physician.

A thorough history shared with providers all along the caregiving continuum is not a luxury. It is essential to providing efficient and effective care, as quickly as possible, at all points along the healthcare spectrum. And travel histories, especially when a patient presents with a mysterious illness, is critical information. Travel histories are critical information today, especially with the proliferation of bizarre viruses and flu epidemics popping up all over the country and the globe. Where you’ve been matters.

That is the beauty of the potential of electronic patient records. The case of Patient Duncan in Dallas highlights the importance of designing the record systems so we can extract the value they could provide when done right.

Points to ponder:

1. Electronic patient records need to be comprehensive and include travel histories, especially when the patient presents with a mysterious disease.

2. All providers need access to all patient information across all sites of care.

3. As to the disparate reports, it is worth repeating that the truth matters or the record is pointless.

The Health Information Portability and Accountability Act (HIPAA) has fascinated me since it was first passed in 1996. You know HIPAA. It’s the reason you sign a lot of papers when you go to the doctor that allows them to share your private health information with other providers.

To give you a little background, I was fortunate enough to be involved in some early HIPAA analysis for the pharmaceutical industry and, as a result, the whole issue of privacy of patient records has remained on my radar screen. As HIPAA was hammered out, one of the major concerns of our client was that pharmaceutical companies would not have access to individual patient records so they could use it for drug marketing efforts.

So today, when the news hit (see http://mobile.bloomberg.com/news/2014-06-26/hosptials-soon-see-donuts -to-cigarette-charges-for-health.html) that hospitals, doctors and insurance companies may track your private purchases at, say, Dunkin Donuts and pass that information on to your healthcare providers sort of made me wince. No, actually, I think I wanted to scream, “Are you kidding?”

It is nearly impossible to describe the kind of thought and the hours of debate that went into the nitty gritty details of HIPAA to come up with a workable law that protected patient privacy. I wrote a response to the federal regulations for a major pharmaceutical company so I read that law, line-by-line. Don’t ask me now about the details, but in an overarching way I remember that the point was to protect the privacy of individual data in the interest of having access to aggregated, de-identified data to study populations.

For the purposes of research and to derive clinical protocols, this makes a whole bunch of sense. We don’t need to know who you are, individually, but it makes sense for healthcare researchers to have access to everyone’s healthcare data so we know what costs money and what works. Under this scheme, your individual right to consume Boston crème donuts is protected…theoretically. Your private healthcare information collected at the point of care is used to care for you, period.

Now, one of the reasons I reacted strongly to this story today is that – just yesterday – I was exposed to an unintended consequence of HIPAA that has negatively impacted healthcare workers. I spent the day training healthcare providers in a long-term-care facility about how to respond to patient aggression. In the nursing home population of mostly infirm elderly often with dementia, aggression is a fairly common and serious problem. At least 8 workers in this particular facility had incurred injuries this year from bites, scratches, kicks, and so on from agitated patients.

One of the issues is that, due to HIPAA regulations which require the privacy of patient information, patients who are prone to aggression can no longer be identified publicly. That means that the staff can no longer place a little symbol on their door (even something as innocuous as the picture of a small, furry animal or some other clue) to identify that the patient inside may be prone to violence. So, caregivers who are new or occasional cannot immediately identify which patients require special handling or backup.

Which leads me back to the Boston crème  donuts.

HIPAA laws were intended to protect the privacy of patient data especially as electronic patient records were anticipated. It was believed, in the late ’90s, that one of the biggest hurdles to the uptake and full use of electronic patient data was concern for the privacy of patients’ medical information. Once a patient’s private health information was out there in the ether, might someone use it against them? Would it make is harder to get insured? Would their insurance rates rise? Could their health status be used to discriminate against them by their employer? What about a legal case, like a divorce?

It seems that the latest news that our personally identifiable private consumer purchases can be put in the hands of our healthcare providers violates the spirit, if not the letter, of the intent of the HIPAA privacy laws. Should private consumer purchases be subject to HIPAA if they occur outside the protected health records environment but are then entered into the health record? What if those same purchases are inferred – correctly or not – to impact our health? Hmmmm…

At the same time, as evidenced by the injured caregivers at the nursing home yesterday, important information that caregivers need at the point of care is being withheld due to patient privacy concerns.

I wonder if the law of unintended consequences has devolved to its illogical conclusion. What about patient safety? Caregiver safety? Having access to the information  that you need at the point of care?

With the caveat that I am not a lawyer and not current on the latest gyrations in the HIPAA law, I would invite comment from people who are closer to this issue to offer insight. Maybe I’m mixing apples and oranges, but it seems the core issue here (pun intended) is the privacy of our personal information, who legitimately needs access to it and under what circumstances.

Until then, my spidey sense tells me that some things aren’t working out quite the way the framers of the HIPAA law had intended.

For readers who are training people, you know that KSAs are Knowledge, Skills and Atttitude. You can teach KSAs.

Here are some examples of teaching KSAs in Health IT:

• Knowledge training includes compliance training. Health IT learners need to know the laws that govern the use of electronic health information such as HIPAA regulations regarding the use of personal health information. Some trainers I’ve worked with call this “head knowledge”.
• Skills training includes the actual, hands-on software training. Learners experience how to sign on to an application, which fields must be filled in, and how to access, save and send information. Providers learn how to use a laptop or tablet in patient interactions so the device does not interfere with the relationship.
• Attitude training includes what are known as “soft skills” in the parlance of human resources. Soft skills include things like leadership, empathy, management of self/others/projects. In health IT, attitude training includes change management techniques such as finding champions of an IT implementation and sending them out on the floor to make sure people are on board with the implementation. Soft skills health IT training includes managing the people, timelines and workflow, making sure there is a smooth transition.

You can lead an HCP to health IT, but can you make them think? Think what? This is where attitude training enters:

• Think about the value of gathering the correct patient information for high-quality care
• Think about the overall efficiency of gathering information to be disseminated to other caregivers who might be outside your immediate care team – say the dentist and the ophthalmologist
• Think about the value of patient data to researchers in the fields of cardiology, oncology and neurology (just as examples) based on the accurate information you have entered about the patient in front of you
• Think about the correct clinical protocol returned to you when you enter patient information into the system

Question: Are you employees trained in essential soft skills related to health IT? Would it help?

The Borg in Start Trek said, “Resistance is futile.” In health IT, resistance is probably futile in the long run. But in the short and medium run, resistance has probably slowed progress.

I would appreciate your feedback on whether you are doing soft skills training for your health IT implementation.

Please leave a comment or email me at peggysalvatore@healthsystemed.com. I am very interested to hear your thoughts on this issue.

See www.kevinmd.com to sign up.

Table Etiquette Rule #7

Table etiquette rule #7 is “Put napkin on lap to unfold. When leaving the table temporarily, place the napkin on the chair. At the end of the meal, place napkin to the left of the plate.”

I know this. I had learned virtually every one of the 30 rules, and most of them ingrained to he point that if I violate one, my conscience nudges me. Well, that is until lately.

I have been placing my napkin on my chair when I temporarily leave the table almost all my life; it’s one of those instinctual things. Not everyone does it; many people who demonstrate good table manners put their napkin on the table when they excuse themselves momentarily. Over time, somewhere deep down inside, I started to wonder if I “remembered it wrong.” After all, maybe the rule had changed.

The table etiquette article affirmed my instincts and, since I tend to see things through the eyes of a trainer, reminded me about a few things regarding training as well.

1. Reinforcement. Even if we learn something well, we can get sloppy over time, cut corners, or begin to question ourselves when people around us don’t apply the learned behavior. Occasionally, we may need a refresher or a job aid placed at our work station to reinforce the learning.

2. Learn it well the first time, apply it often. The original learned behavior “stuck” because it was repeated many times with correction for failure. The ingrained behavior is automatic and deviation causes a little subconscious nudge.

3. Teach everyone the same rules and processes for consistency. We don’t like to be different than our peers. If someone does it differently, long enough, we may start to emulate them to fit in. Make sure all, or at least the majority, of your employees know the correct way to do something and it will spread to others who may not have learned it as well, or at all.

The Stickiness of Training

The Learning, Education and Training group on LinkedIn has a hot trending topic this week on “In 10 Words or Less…Why do you think learners forget what they’ve learned so quickly?” This topic has garnered over 1,000 comments, akin to going viral. Just about everyone agrees stickiness is all about having the learning be relevant to your job, using it soon and frequently.

We all know this. But after we write and implement training, how often do we go back to reinforce what we’ve delivered? Sure, maybe we don’t have the time or resources. Or the managers back on the job don’t know the new learned behavior or don’t reinforce it. Or something.

If we’re going to stop wasting training dollars, we need to put in the time and effort to follow-up to make sure what we’ve taught is reinforced in the workplace and relevant to the job at hand. Then our employees will always place their napkins on the chair when they temporarily dismiss themselves from the table, just the way they learned it the first time.