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Read this if you are considering an EHR system implementation.

Recently, we were working with a client project team on an electronic health record (EHR) system implementation across multiple locations. We were reviewing the results of integrated and unit testing and it was apparent that more testing was needed—but not enough timeline remained before the go-live. The decision was made to delay the go-live. It was the right decision to make as now the team had the time to have a more fully tested and ready system. However, the CIO was concerned that a delay in the go-live would reduce the urgency and effort the project team had been putting in.

We told the client that they needed to go the same speed, and just needed more road. “Same speed, more road” became our battle cry for the remainder of the project, and after a two-month delay, we had a successful go-live.

Organizations are often hesitant to think about changing the schedule or delaying a go-live. It is an understandable hesitation as many things are tied to the schedule including conference room reservations, vendor travel, reduced patient schedules, and even vacation blackouts. However, using the project schedule should be at the forefront of an organization’s project management toolkit. 

The Iron Triangle of project management has three primary variables: scope, schedule, and resources. And in the center of them is the quality of the project. 

In the current healthcare environment, hospitals, nursing homes, and health systems may find it challenging to consider scope or resources as primary tools. 

• Scope
  Whether you are a hospital replacing multiple EHRs with one, or a nursing home replacing paper charts with an integrated EHR, the foundational scope needed is large and expansive and with few items that you can pare back. The required scope limits your ability to use a reduction in scope to improve project outcomes.
• Resources
  Between the significant staffing shortages across healthcare and the financial headwinds health systems are facing, resources are scarce. In the face of these challenges, using resources as a primary tool to keep a project on track presents its own challenge.
• Schedule
  A schedule is the most available tool to use to keep an EHR project on track. While this is a tool not without limits, challenges, or problems, planning for it from the onset of an EHR project is key to successful implementation. 

EHR system implementation schedule flexibility tactics

To have schedule flexibility as a readily available tool for your EHR project, here are tactics to set you up for maximum success:

• Realistic timeline
  EHR vendors often provide you with timelines that may be realistic to achieve under ideal conditions but may fall short when reality sets in. Reviewing and planning an EHR implementation timeline with your preferred vendor in advance of contract signing is beneficial. You should look to incorporate known constraints, known risks, and sufficient contingency time to keep the project on track when issues arise. For example, if a vendor provides you with a six-month implementation time frame that starts in October and concludes in April, it may not account for the disruption the fall and winter holidays could have in shrinking the actual number of project weeks within that six-month window. 
  
  If you anticipate a survey window during a particular point in the project and have no contingency time to redo a project even if the surveyor shows up, that could cause problems. Also, when reviewing the timeline, look at the time between each testing event and the scheduled go-live. If there is not sufficient time between each of these important project milestones, you will not leave yourself enough time for defect resolution or an additional testing event without having to change your go-live date. By setting a realistic timeline with sufficient slack time between major events, you increase your likelihood to address issues and maintain your planned go-live date.  
• Effective contracts
  Negotiate contract provisions with your preferred EHR vendor to give you schedule options that are not overly punitive to your health system. Contract provisions that allow you to delay if the vendor has challenges that warrant the delay without financial penalty are essential. You will need clear acceptance criteria that must be achieved in order to go live and set expectations for how schedule changes would be addressed if you need to delay for your own resources. Without planning the options in advance of the project, schedule changes and delays can become overly contentious with the vendor and costly to your health system.
• Set priorities
  Work with your senior leadership, medical staff, and board to understand how the schedule may be used as a tool for project success. Describe how, why, and when a project delay may be used. Get everyone on the same page with the go-live criteria that will be used, conditions that would warrant a delay, and how the timeline will be used to bring about a successful go-live. 
• Know why
  No EHR go-live is perfect or risk-free. It is all about acceptable levels of risk in order to proceed to go-live. Be clear and differentiate between being nervous and needing to delay. Use your go-live criteria, your risk and issues logs, and the input from senior leadership and staff to establish if you are just nervous or are actually at a risk level that warrants a delay. 
• Be better
  Delaying and doing nothing differently can make you run later and more expensive, but no more successful than had you gone live on the original date. At a minimum, embracing the “same speed, more road” battle cry is warranted with a delay. There is no slowing down, taking a break, or stepping back. If anything, depending on your situation, it may warrant “faster speed, more road” to be successful. This can come in the form of daily project huddles, repeated pulse surveys, dedicated events focused on resolving project issues, additional testing events, and any recurring meetings between your leadership and the EHR vendor’s leadership team. When you delay, have a clear plan of attack for improving the project.
• Try not to kick the can
  If you are facing a project delay, it can be very tempting to want to delay it as little as possible. This is understandable as everyone has been working hard and wants to reach the go-live date. Be cautious and confirm your delay is sufficient to address the risks, issues, and tasks needed to improve the project. Medical staff and colleagues will be tolerant of a delay to achieve a successful EHR go-live but will grow wary if you must delay repeatedly. When you make a delay call, build a plan and schedule with sufficient time, including contingency time, built in. It is better to be ready and confident early than have to face the challenge of a repeated delay.

EHR implementations are hard, stressful, and intense endeavors. They overturn nearly every process in your health system. By the time you approach go-live, people are ready to get there and hesitant to make changes. However, you may not be ready to go live successfully. The scope of the project may not be able to be reduced and additional resources may not be available. Using schedule flexibility to your advantage may be your best option for a successful go-live. Know why, how, and when to use this tool—and communicate clearly and broadly to your organization—and success can follow. 

Read this if you are looking to find balance with digital usage at your organization.

The current digital well-being environment

Over the last few decades, there has been a major shift in the use of smartphones, laptops, tablets, and other devices. Technology has become an integral part of people’s private and professional lives and the constant innovations and improvements in technology have made information much more accessible than ever before. Some people are finding themselves to be too reliant on technology, however, and the transition to a technology-driven environment and constant exposure to screens have led to a serious dilemma for employees and employers: finding a healthy work-life balance. 

Studies have consistently shown the detrimental effects of excessive technology use, which include:

• Physical health concerns, such as vision problems, neck strain, and even heart complications due to extended periods of sedentary behavior.
• Mental health concerns, such as increased stress, anxiety, depression, and a general sense of dissatisfaction with life.
• Social isolation and feelings of loneliness, as digital interactions may not fully substitute for meaningful face-to-face connections.
• Disrupted sleep patterns, as the use of technology before bedtime makes it harder to obtain quality sleep and can lead to sleep disorders.
• Reduced engagement and performance in the workplace, potentially impacting productivity and job satisfaction.

What is digital well-being? 

The negative impacts of excessive technology use can prevent employees from maximizing their potential. This has paved the way for digital well-being, which is an emerging concept designed to help manage some of the inherent risks of increased technology use and help employees find an ideal work-life balance. 

Digital well-being is about creating and maintaining a healthy relationship with technology. It is a subjective and individual experience of understanding the optimal balance between the benefits and drawbacks obtained from technology. A common example of how technology can have a negative impact on employees is the overuse of social media during the workday. This can quickly lead to employee disengagement and decrease work performance. Although many workers rely on technology to perform their jobs, digital well-being is about using technology in such a way that helps employees. Objectives for increasing digital well-being include:

• Developing a clear understanding of the advantages and potential risks associated with technology usage.
• Striking a balance between professional commitments and personal life responsibilities. 
• Cultivating and maintaining meaningful connections with coworkers, family members, and friends. 
• Efficiently managing workload and minimizing digital distractions.
• Actively participating in social and community events and activities.

Why is digital well-being important?

With the shift to a technology-driven environment, the ability to concentrate without distraction is becoming increasingly valuable among employers. An individual’s technological dependencies and habits may decrease their ability to focus for prolonged periods of time, especially if they are constantly interrupted by incoming communications and notifications. Technology should help individuals achieve their private and professional goals, rather than distract them or get in the way.

Digital well-being enables employees to be more engaged and productive, as well as maintain healthier lives outside of the workplace. Adopting leading digital well-being practices can help employees focus on their work and cause less exhaustion and distraction. For example, an employee who checks their smartphone four to five times a day will likely be more productive than someone who regularly checks their device every few minutes. This can result in improved individual performance over time and a greater contribution to team and company performance.

Finding balance in the workplace

As remote work gains popularity and flexible work arrangements become the norm, technology can be both helpful and intrusive. Collaboration tools, such as Zoom and Microsoft Teams, can help keep employees digitally connected but can also be distracting for team members being bombarded with communications and requests. Additionally, employees may be tempted (or expected) to answer communications and continue to work after the workday is over. This makes it hard for employees to separate their work life from their private life. But employers can help their workforce find this balance. 

The National Day of Unplugging, celebrated on the first Friday of March, has been followed by many organizations for several years and encourages people to disconnect from technology for 24 hours and engage in activities that promote well-being. 

Best practices for digital well-being

Ultimately, employees are responsible for their digital well-being. Simple changes made consistently over time can make a big impact. Some best practices for individuals to follow include:

• Be mindful of the information and media you consume online. By engaging with reliable sources, fact-checking information, and balancing digital experiences with offline activities, you can increase your digital well-being.
• Focus on positive aspects and achievements of others online. When you avoid negative social comparisons online, you develop healthier relationships and interactions online.
• Understand and manage your digital identity and footprint. Our online habits and activity can shape how others perceive us and can impact our personal and professional lives. This is especially true for social media. By being mindful of the impact our words and actions can have, we can contribute to a more supportive digital community.
• Express yourself and be creative. It is important to engage in creative activities online that promote mental well-being, boost self-esteem, and enable you to explore your passions and talents.
• Address digital clutter. The accumulation of unnecessary and disorganized digital files, emails, and applications can have a negative impact on productivity and stress levels.
• Optimize workspaces. Whether you are in the office or at home, an optimal workspace can improve productivity and reduce distractions. 
• Distinguish between intentional and passive use of technology. Intentional use involves purposeful engagement, while passive use can lead to mindless scrolling and excessive screen time, which can negatively impact your overall well-being.
• Set boundaries and take breaks. Engaging in offline activities, practicing mindfulness, and setting boundaries with technology allows individuals to recharge, reduce stress, and maintain a healthy balance between digital engagement and self-care.
• Develop a healthy pre-sleep routine. Getting sufficient and quality sleep is essential for overall well-being. Excessive use of digital devices, particularly before bedtime, can disrupt sleep patterns and negatively impact physical health.
• Consider a digital detox. Sometimes we just need a break from digital devices and social media platforms. A digital detox is a period when you disconnect from digital devices and technology, typically for a temporary duration, to reduce screen time and digital distractions and promote overall well-being.

To encourage and help workers find a healthy work-life balance, employers should:

• Foster a positive digital culture. Encourage collaboration, enhance employee engagement, and prioritize well-being. This type of culture can promote effective communication, reduce misunderstandings, and enhance productivity.
• Train employees on how to use digital tools and platforms. Being familiar with technology allows your team to adapt to new tools and stay updated in a fast-paced digital environment.
• Help employees stay focused and limit distractions. You should not only focus on training your team on how to use technology, but also provide guidance on how to concentrate on tasks, be more efficient, minimize interruptions, and achieve goals. 
• Educate employees on privacy and security. This can help your employees feel more confident and empowered in their use of technology and can help reduce the risk of cyberattacks, such as data breaches and ransomware attacks.
• Provide ergonomic support and help optimize workspaces. Whether your team members are in the office or at home, it is important to help create workspaces that support proper posture, comfort, and overall well-being. 
• Collaborate and communicate strategically. Collaboration and communication are critical for teams, particularly for hybrid and remote workforces. At the same time, excessive emails and chats can be distracting and lead to disengagement. Too many meetings, particularly virtual meetings, can also lead to physical and mental fatigue. When possible, find ways to meet face-to-face.
• Support employees on their digital journey. You should provide resources to help your team develop healthy digital habits, manage stress levels, avoid burnout, reduce feelings of isolation, and find a healthy work-life balance.
• Develop a sense of connection and community. This can help create a supportive and inclusive environment that allows team members to share common interests, receive support, engage in collaborative activities, and foster a sense of belonging.
• Check in with employees on a regular basis to verify that their digital needs are being met. Managers should ask targeted questions such as: Are you finding it difficult to disconnect from work after hours? Are there tools you feel that are hindering your productivity or well-being? Do you feel a sense of fulfillment, satisfaction, and purpose in your work?
• Encourage breaks and physical activity throughout the workday. By decreasing the amount of screen time and allowing the brain to rest and recharge throughout the workday, team members can reduce eye strain, fatigue, and other physical discomforts, improve productivity, reduce stress levels, elevate mood, and enhance creativity. Your organization may consider implementing activity challenges to promote physical activity and encourage healthy behaviors.  
• Encourage employees to disconnect. Managers should set clear expectations for when employees need to be available and advise them only to contact one another after hours with urgent matters. Additionally, when possible, employees should have the ability to turn off notifications on personal devices after workday hours.

Conclusion

It is important for organizations to recognize the impact of technology on employee health and happiness. In today's current environment, technology is an essential part of daily operations, and its overuse can quickly lead to burnout, stress, and decreased productivity. 

Being proactive about employee digital well-being leads to a more supportive work environment that benefits both employees and the organization. This can lead to higher productivity, increased job satisfaction, and reduced turnover rates. Additionally, it sends a clear message to current and potential employees that the organization cares about their well-being, which can help to attract and retain top talent. 

Digital well-being resources

If you would like more information about digital well-being or have questions about your specific situation, please contact our Well-being Consulting team. We’re here to help.

Read this if you are a State Medicaid Agency (SMA).

On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) published a proposed new rule titled “Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality,” intended to address the most critical elements of access and person-centered care. The COVID-19 Public Health Emergency (PHE) tested states’ abilities to connect individuals to quality care, stabilize the workforce, and monitor Medicaid managed care programs. Leveraging the proposed changes in this rule, CMS aims to provide guidance to states to help advance CMS efforts to improve access to care, quality, and health outcomes, and better address health equity consistent with the CMS Framework for Health Equity 2022 – 2032.

This summary is intended to offer a glimpse of the proposed provisions for which CMS is seeking feedback. Below are some highlights of the significant changes:

Enrollee experience

To enhance state monitoring of network access, CMS is proposing that states take on a qualitative and quantitative approach to monitoring service access. Specifically, CMS proposes to revise regulations to explicitly include “enrollee experience” and require states to use the results from the annual enrollee experience survey and secret shopper surveys that offer a person-centered view to understanding network deficiencies.

Transparency

In an effort to promote transparency and empower enrollee choice, CMS proposed several requirements that would make states' websites easier to use. The proposed rules require states to post up-to-date information on their websites, including making available a one-stop location for enrollees to compare health plans.

State Directed Payments (SDPs)

Given the growing number of SDP preprints submitted for approval, proposed changes in this area are focused on strengthening vague contractual, procedural, and monitoring requirements to help ensure access to care and implement proper fiscal and program integrity guardrails.

Medical Loss Ratio (MLR) standards

CMS aims to establish consistency in MLR methodology across multiple markets (private, Medicare, Medicaid, and CHIP) to improve administrative efficiency for the states regulating insurance and Medicaid/CHIP and for the collection and measurement of data to calculate an MLR and provide reports. The proposed changes include revisions to requirements for clinical or quality improvement standards for provider incentive arrangements, prohibited administrative costs in quality improvement activity reporting, and additional requirements for expense allocation methodology reporting

In Lieu of Services (ILOS) and settings

ILOS offers states the flexibility in managed care to substitute a service or setting for a service or setting covered under the state plan, when medically appropriate and cost effective, to enrollees. This proposed rule looks at ILOS as a mechanism for addressing Social Determinants of Health (SDoHs) and health-related social needs, proposes that states evaluate the impact ILOS has on health equity, and evaluates whether ILOS is an appropriate and efficient use of Medicaid and CHIP resources. There are several requirements based on helping to ensure fiscal protections are in place for investments in ILOS.

Medicaid managed care quality rating system

CMS is proposing changes to how states monitor quality of services delivered and aimed at promoting member choice. The goals of quality improvements are intended to make quality reporting more transparent and meaningful for driving quality improvement, reduce burden on certain quality reporting requirements, and establish a rating system for Medicaid and CHIP health plans.

CMS is seeking feedback on these proposed rules. Public comments are due by July 3, 2023, and can be submitted at the following link: Regulations.gov.

If you would like more information or have questions about the proposed rule and guidance on assessing, developing, or implementing changes to your managed care program, please contact our Medicaid consulting team. We are here to help.

Key employees, as their name suggests, are integral to the success of the companies they lead, as they are responsible for the direction of their company and many of the fundamental decisions that must be made. Given the weight of the decisions that are made by people in these roles, it is important to attract and retain the highest-quality leaders in your organization. Employment contracts are an effective tool companies can use to attract, support, and retain their key employees, as they formally outline terms that both parties agree on, and protect both parties’ interests. Some elements of an employment contract include:  

• Outlining job responsibilities and schedule
  Setting clear expectations and goals for all employees, including leadership, can help to keep the company focused on its overall mission. These expectations can include individual performance goals, as well as strategic goals relating to the vision of the company. The contract can also set the expectation of what type of time commitment is required, if there will be a lot of traveling, and who the key employee should be regularly communicating with about business decisions and results. 
• Duration of employment
  Outlining the duration and conditions of employment is another expectation that can be set early on. This can include considerations such as how many years the employee will serve in the position, if there is an opportunity to renew and extend the relationship, and other important timeline details. Giving this clarity to leaders can help them appropriately frame their timelines when they are deciding their vision for the company and what they can reasonably accomplish during their tenure. 
• Compensation and benefits
  The responsibilities owned by key employees are often directly linked to the increase in compensation and benefits they receive. Employment contracts allow employers to state clearly how key employees will be compensated and demonstrate to prospective employees how they will be compensated for the position they are accepting. This also provides an opportunity to discuss bonuses or performance-linked compensation, including nonqualified deferred compensation, which ties in with the above-outlined responsibilities and goals, as well as who will be determining those goals. Like compensation, strong benefits can entice talented prospects to not only join your company, but to remain. It is important to maintain a competitive edge if you want to attract key leaders and retain them going forward. Establishing these incentives and benefits is a promise to your key employees that you value their hard work and want to recognize and reward their commitment. 
• Non-compete and confidentiality agreements
  There are many other clauses, conditions, and perks that can be included in these contracts. One to consider is a non-compete agreement, which bars an employee from competing with the company for a specified duration of time during and/or after employment. The contents of the agreement can differ depending on the company, but can include various stipulations such as prohibiting employees, for a period of time, from leaving the company to work for a competitor or starting their own business selling competing products or services. A confidentiality agreement can give employers protection by asking their employees not to share any confidential or proprietary information the employee has access to during employment. 

An appropriate employment contract can protect both the key employee and the company by defining important terms of employment and setting expectations from the start. It offers legal protection and can be referenced when evaluating performance or deciding who is responsible for certain decisions and actions. Without an employment contract, both the employee and the company are left open to misunderstandings. For additional perspective on employee considerations, please reach out to a BerryDunn professional.

Read this if you are at a state agency looking to implement or improve your 988 Suicide & Crisis Lifeline. 

The 988 Suicide & Crisis Lifeline offers numerous opportunities to improve crisis response. The National Suicide Hotline Designation Act enables states to pass legislation to support planning and implementation of the 988 Suicide & Crisis Lifeline. As of September 2022, 23 states¹ have passed legislation to facilitate the implementation of the 988 Suicide & Crisis Lifeline. Colorado, Nevada, Washington, and Virginia enacted legislation with 988 telecommunication fees to support 988 operations and to provide financial sustainability for the system. The fees range from $0.18 to $0.40 in these states, who plan to use the revenue for crisis outreach and stabilization services, 988 call routing, and establishing mobile crisis teams². Several states such as Connecticut, Indiana, Maryland, and Virginia have introduced a 988 fund to protect 988 fees, appropriations, and other funding sources. These legislations can be a model for many other states who are still in the planning phase of 988 Suicide & Crisis Lifeline implementations. 

Many states are utilizing federal funding sources to implement the 988 Suicide & Crisis Lifeline. Texas received an $8 million dollar Substance Abuse and Mental Health Services Administration (SAMHSA) 988 State and Territory Cooperative Agreements grant. Texas is utilizing the grant to improve state response to 988 contacts by supporting workforce capacity building and unification of 988 responses statewide³. Washington received $2 million to improve state and territory response to 988 contacts and California received $14 million to support 988 implementations⁴. Maryland received a $2 million federal grant, which will be used to increase staffing within the state’s call centers, improve workforce, integrate 988 and 911, and enhance behavioral health preventive services⁵. 

Click here to view various funding sources along with the eligibility and usage of the available funds that states can leverage for the implementation of 988 Suicide & Crisis Lifeline. 

If you have any questions about implementing a 988 Suicide & Crisis Lifeline, or have questions about your specific situation, please contact act BerryDunn’s behavioral health consulting team. We’re here to help.

¹https://www.nashp.org/state-legislation-to-fund-and-implement-988-for-the-national-suicide-prevention-lifeline/  
²https://www.nasmhpd.org/sites/default/files/988_Convening_Playbook_States_Territories_and_Tribes.pdf
³https://www.hhs.texas.gov/sites/default/files/documents/9-8-8-implementation-study-rider-58.pdf 
⁴https://www.samhsa.gov/grants/grants-dashboard?f%5B0%5D=by_award_fy%3A2022&f%5B1%5D=by_nofo_number%3ASM-22-015#awards-tab 
⁵https://conduitstreet.mdcounties.org/2022/05/05/maryland-receives-2-million-to-implement-9-8-8-suicide-prevention-lifeline/