How to survive without grants

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Tight Squeeze
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OK. You’ve landed here, maybe out of desperation for your organization. Maybe you are reaching the end of the proverbial rope and you believe that your funds are about to run out. If you are a non-profit healthcare organization, you likely survive only by means of generous donations/fund raising/foundations, and by finding grant sources. But, where to look?

But, how about approaching the problem from a different angle? If you’ve reached this page, you no doubt have already found some sort of funding, albeit sparse. But, what if you found more efficient ways of using those funds that you already have?


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If you still need some brainstorming, starter ideas on where to find funds, check out the notes section at the bottom of this post. If you want some suggestions on how to be more efficient with the money that you already have, keep reading.

Eliminate Paper, and Double-Data Entry

If you are collecting data as a grantee for reporting purposes, eliminate paper from the process. An economist from The World Bank found that switching to cell phone based surveys from their paper equivalents resulted in 71% average cost savings, and a 3.6% reduction in the time it takes to survey while still improving on the data collection quality from the prior year.

With an increasing number of smartphones out in the market, reasonable return on investment for enabling smartphone data collection is feasible, if you plan accordingly. And, If you only need some to collect some simple survey data that are not tied to other data within your organization, you might even be able to accomplish it for free over a weekend using a service like

Streamline Workflow

While you are reducing paper, also reduce workflow bottlenecks. Identify key personnel and processes and determine if any of them are possible single points of failure. Think like McDonalds. Do you only have one person who understands the intake forms or systems required from the majority of your grantors? Make sure they have a competent backup. Do you know how long it takes for those intake processes to complete from start to finish? Maybe there are ways to do some pieces of that intake in parallel, like having the consumer complete some of the forms online or even at a kiosk at the intake station while your staff are recording other pertinent information related to the intake (like housing or income verification).

Automate Where Practical

That old axiom “a stitch in time saves nine” may seem quaint, or even incomprehensible to a modern culture, but putting in a little early effort can actually save you a lot of effort in the long run. Take a look back to your paper forms and your workflows. Are you duplicating collection or even reporting efforts with that information on those forms — are you having to retype that information from paper back into one or more electronic systems? If so, spending a little time and money implementing “re-heat/re-serve” of existing electronic data might save you a lot of staff man hours. Don’t retype anything, even if you think some translation has to take place between the source material (paper/electronic) and its final destination.

Say, for example, that you collect all of the Current Procedural Terminology (CPT) codes from your physicians, nurses, and physicians assistants, but your grantor only wants some aggregate rollup count of daily visits per consumer. Don’t spend the time retyping or calculating those CPT values — find a cost effective way to automate that aggregation.

Measure, Measure, Measure

Finally, remember another adage, “what doesn’t get measured, doesn’t get done”. You need to identify those key metrics for your organization just like a Harvard MBA might, even if you don’t really see a correlation between that analysis and the type of service you provide. The best  way to root out inefficiencies within your organization is to implement measurements around those high cost/expense areas of your organization in terms of time, payroll and full time employee resources.

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Need some outside help? Sometimes you can’t see the forest for the trees, and we can help you improve your outlook. Give us a call.


  1. Federal Healthcare grants
  3. Good home health Federal grants overview post
  4. Check with your State Dept. of Health (e.g., Texas DSHS).
  5. National Institutes of Health
  6. Check with your county and city purchasing departments, especially local departments of health. (e.g., Houston’s Harris County Health Dept and Houston Dept of Health and Human Services)

Decision Support Systems: Silver Bullet or Lead?

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silver bullet - 4160817135_a925e3f61f
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You might have seen the Jeopardy! episodes in 2011 where Watson, an IBM computer system, beat the biggest all-time human money winner, and also beat another record holder for the longest championship streak. Watson’s creators have aspirations of it eventually becoming your physician’s assistant, but are these type of computer assisted tools really ready for prime time?

Fans of Ray Kurzweil, the noted technology futurist and entrepreneur, would chalk this up as just one more inevitable notch on the progression towards real and practical artificial intelligence. Kurzweil has noted the exponential growth of computing power, which began, he says, with 1890 U.S. census, and has continued practically unabated since — leading up to the current wonder, Watson.

The folks at IBM’s DeepQA project have set even higher hopes for Watson than just uncanny gameshow trivia — they want to revolutionize the way healthcare providers make critical decisions by having Watson serve as a high-end clinical decision support (CDS) system.

There’s no doubt of the need for some sort of intelligent assistance when it comes to healthcare decisions. Dr. Herbert Chase, a Columbia University medical school professor, has said that for at least 30 years, doctors have been unable to keep up with the information overload . “Every day, doctors have questions they can’t find the answers to. Even if you sit down at a search engine, it’s so labor intensive and it takes so long to find answers.”

Futurists forecast that a mobile-accessible, cloud version of Watson is in the works, which would be a game changer. Think Siri + + MEDLINE.

Instead of waiting for Watson, many providers have turned to home-grown, or commercially available CDS solutions. But are these tools really viable for novice and experienced healthcare providers?

The medical research studies attempting to answer this question have returned with a mixed bag of results. We’ve dug through more than 40 studies conducted within the past ten years and have found that the answer is both yes and no — or a definite maybe.

All waffling aside, the majority of studies reporting positive impacts of current CDS seem to be for those systems that are very narrow and targeted in their application. Concerned about adverse drug events within a hospital or clinic setting? A couple of studies1 indicate a positive impact of utilizing these tools. Want automated real-time pneumonia and heart failure decision support? One study2 shows promise.

But, widen your net of what you want from decision support and the current crop of solutions don’t seem to be making much of an impact. One research project3 hypothesized that CDS functionality would result in higher-quality outpatient care compared with electronic health record (EHR) use without CDS. The results? Not even close. Neither EHRs nor CDS was associated with ambulatory care quality.

Many of the studies cautioned that CDS’s are not silver bullets, and urge decision makers to employ multiple factors before embarking on this path. Get buy-in from key, experienced staff. Try to envision unanticipated effects that the CDS introduction might cause — for example, one study referenced the ability for nurses to routinely override the CDS recommendations, which could lead to an increase rather than a decrease in variation or errors4.

Whatever your approach, wise counsel is always advisable. Need some help? Give us a call.

Research Study References:

  1. [Drug Saf] Drug Safety: An International Journal Of Medical Toxicology And Drug Experience 2011 Mar 1; Vol. 34 (3), pp. 233-42.;              [Am J Health Syst Pharm] American Journal Of Health-System Pharmacy: AJHP: Official Journal Of The American Society Of Health-System Pharmacists 2012 Feb 1; Vol. 69 (3), pp. 221-7.
  2. [Am J Health Syst Pharm] American Journal Of Health-System Pharmacy: AJHP: Official Journal Of The American Society Of Health-System Pharmacists 2009 Feb 15; Vol. 66 (4), pp. 389-97.
  3. [Arch Intern Med]. 2011;171(10):897-903. doi:10.1001/archinternmed.2010.527.
  4. [J Clin Nurs] Journal Of Clinical Nursing 2009 Apr; Vol. 18 (8), pp. 1159-67.


Spreadsheet Hell

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Jack O'Lantern hell
photo by Logan Ingalls

When it comes to relying on spreadsheets for day-to-day business, that old idiom, “better the devil you know, than the devil you don’t”, seems to be the orthodox mantra. Numerous studies indicate that more than 70% of organizations repeat the mantra of using spreadsheets as their daily financial information bread and butter — despite the fact that spreadsheets can quickly be outgrown and can become onerous task masters.

In one 2004 survey by CFO Research Services, respondents across the board (>60%) reported that they spend too much time on forecasting, budgeting, and planning — time spent inside their beloved, yet despised, spreadsheets. 43% reported that they don’t have enough time to analyze the data that they have collected.

Earlier this year, Oracle and Accenture commissioned a research study on the challenges of corporate financial reporting with input from more than 1,100 large organizations across the US, Europe, Middle East and Africa. More than 60% reported inadequate visibility into financial data. More than 80% say it is difficult to control the quality of financial data and other supporting information. Yet, spreadsheets and email are still used by more than 68% of these respondents to track and manage reporting.


What are some of the culprits for this disconnect between current methods of sharing data and with controlling quality?

The CFO study found that the biggest problem was over dependence on key personnel (nearly 50 % of respondents). These people are overburdened. And from a corporate memory perspective, the organization might have too many mission critical processes trapped in too few personnel minds — risking business disruption if those key personnel no longer can perform their duties.

More than 35% of the CFO study respondents reported that version control was their biggest problem. Too many different versions of similar Excel spreadsheet data are floating around in that corporate mindspace of file shares and email. User collaboration and data consolidation are related to this same version control issue — another 35% of respondents reported these as problematic.

Complexity is another bugaboo. Just because you are capable of doing something does not mean that it is a good idea. We have clients who have come to us with Excel workbooks containing hundreds of worksheets, drowning their users in unmanageable and unresponsive data. Just because Excel can hold hundreds of worksheets does not mean that you should base your reporting infrastructure on that ability. Why, there’s even a Tetris game created within Excel, to add to the absurd lengths some people will go to stay wed to spreadsheets.

Spreadsheet Data Model
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Are you drowning in spreadsheets and need a lifeline? Give us a call.

Avoiding the Wall of Shame: Protect PHI

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Photo by archer10 (Dennis)

In one of our previous posts, we said that step one in avoiding the “wall of shame” is to identify any Protected Health Information, or PHI, that your organization may have.

Step two is to protect those PHI elements, rendering them unusable, unreadable, or indecipherable to unauthorized individuals.

Isolation of PHI can be multifaceted. First ask yourself, “Do we really need to collect this? Why?” You might be surprised to learn that the real answer is “No”. One method of isolation may be not collecting the data at all.

For those instances where the PHI must be collected, you need to utilize encryption — likely multiple modes of encryption depending upon whether the data is at rest (within a database and/or on computer media), or is in motion (moving between computers). The National Institute of Standards and Technology (NIST) has guidelines that can be used as a starting discussion point for data that is at rest, and for data that is in motion.

You can also come up with a consistent method of sharing de-identified equivalents by removal of information which links medical information to a particular individual. Using a patient chart ID, for example, might sufficiently identify a record without needing to use the patient’s name and address.

You might find that for the majority of occasions where the PHI is really not needed for the task at hand, then de-identified substitutes can be used. While coming up with these equivalents, ask yourself again if the de-identified element alone is enough for all of the tasks without having to collect the actual PHI behind it.

For example, we have clients who regularly need to share lab data (CD4, HIV Viral Load, etc.) among healthcare providers. Some of this same data must also be shared with government entities charged with tracking disease progression, statistics, and outbreaks. The community-based organizations (CBO) may need a way to verify individuals to whom they provide care, while the government entities may only need to know some basic demographic data about the individual (while still isolating each individual).

For the CBOs, we might use a de-identified client code comprised of a few letters of their first and last name in combination with the individual’s date of birth and gender. The CBOs could then use an agreed upon method of comparing that client code against physical identification that the individual provides at the time they receive services — maybe requiring the individual show a government issued ID.

For the government entities who need the lab information, we might just associate some auto-incremented serial number with those same individuals when the lab and demographic information are passed along.

The key to PHI isolation and protection here is to identify those elements that must be collected, identify with whom to share those elements, and identify what form that sharing takes place.

Need help clarifying, isolating and protecting your PHI data? Give us a call.

Avoiding the Wall of Shame: Identify PHI

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In one of our previous posts, we referenced the “wall of shame” maintained by the U.S. Dept of Health and Human Services, which lists organizations who reported lost, stolen, or improperly disclosed patient records.

What can you do to protect your organization from inadvertently screwing up like this, and making it onto this lineup?

First, know what is worth protecting. In reference to “wall of shame” avoidance, you need to know what constitutes Protected Health Information, or PHI.

What is PHI

PHI, as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), means any information recorded in any form/medium (or shared orally) that meets both of the following criteria:

  • Is created or received by a health care provider, health plan, employer, or health care  clearinghouse; and
  • Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
    • That identifies the individual; or
    • With respect to which there is a reasonable  basis to believe the information can be used to  identify the individual.

So, depending upon what service your organization provides, and even possibly where you are located, what you need to protect will vary.

Location, Location, Location

Why would location matter? Take, for example, one of our clients who provide healthcare services to individuals with HIV or AIDS in a dense urban setting where tens of thousands of people live within a single ZIP Code. Inadvertent disclosure of just a five digit ZIP Code from this dense urban area would not alone constitute a HIPAA breach.

Take a similar provider providing HIV/AIDS services in a sparsely populated, rural region, and all bets are off. ZIP code alone might be enough to identify that person.

Not sure what to protect? Contact us.

Wall of Shame

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Wall of Shame
(Photo by Sarah G...)

Since 2009, almost 21 million patients have had their medical records stolen, unlawfully disclosed, or just lost, according to the Office for Civil Rights (OCR) of the U.S. Dept of Health and Human Services (HHS). The result is a “wall of shame” (and possible fines) for these healthcare organizations — a wall your organization should avoid getting posted on at all costs.

The wall is a by-product of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 — part of the umbrella of the American Recovery and Reinvestment Act (ARRA). HITECH fulfills a promise made by President Obama with the goal of modernizing portions of the American healthcare system.

During a speech at George Mason University, President Obama said:

“To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that, within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests…But it just won’t save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system.”

There are a number of carrot and stick incentives inside HITECH to encourage rapid adoption of Electronic Health Records (EHR) by hospitals. Due to these incentives, the Congressional Budget Office (CBO) has increased its projected EHR adoption rate from 65% to an estimated 90% among physicians by the year 2019. This increased projection estimate is a direct result of HITECH.

EHR is a fantastic idea, but as with most things digital, ease of use/access within EHRs means that electronic health record information can also be easily copied, stolen or disclosed in an unauthorized manner. So provisions are needed to protect the privacy and security of patient information.

HITECH addresses some of this by giving HHS some enforcement teeth. Via section 13402 of the Act, HHS is required to issue regulations (and possible fines) for breach notification by entities subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and their business associates. Via section 13402(e)(4) of HITECH, the HHS Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals. So, 21 million breaches may be a conservative estimate.

How can you avoid getting your organization on the “wall of shame”? Stay tuned here for a future follow-up with suggestions, or contact us for more information.