EHRs the New Target of Malpractice Litigators

EHRs the New Target of Malpractice Litigators

Medical malpractice litigators have found a new target: Electronic Health Records (EHRs).

Amidst the concerns of data security and protecting EHRs from breaches, certain legal teams are finding ways to exploit the imperfect nature of electronic records for legal gain.

Targeting Electronic Records

Many EHRs are designed with a digital experience in mind. Information is stored in templates that populate correctly on a screen but don’t keep the same clean format when printed. This can create confusion for those viewing the printed records—data may populate in several locations at once, giving the appearance of mismanaged records and internal disorganization.EHRs the New Target of Malpractice Litigators

Litigators, whose job it is to discredit medical organizations during malpractice suits, prey on this confusion and use it as an example of poor healthcare practices. The argument is that if the record itself is confusing, it stands to reason that overall care will be marginal. Legal teams can take this even further by questioning the authenticity of the data itself.

This leads to situations where healthcare providers are embroiled in malpractice disputes about quality of care, but have to defend how their medical records work. This litigation is controversial—rather than discussing the actual issues the defendants in the complaint, litigators are shifting the focus to technical failings to help win their cases. Every healthcare organization must know of this trend and do what it can to prevent EHR templates from damaging credibility.

Avoiding Confusion

Litigators exploiting the shortcomings of EHRs rely on one primary element for their cases—confusion. If healthcare organizations can improve their communication and documentation protocols, they will be less vulnerable to the drawbacks of EHR paper documentation.

Understanding the context of care is essential when determining how to address malpractice concerns. Organizations must be able to defend their actions in the face of scrutiny, even when printed EHRs provide irregular readouts. Questions concerning how care is viewed, which provider did what, and when they did it all contribute to understanding health outcomes. Each of these questions must be thoroughly documented for each patient to prevent legal teams from using data confusion as ammunition for malpractice suits.

In addition, communication between C-suite staff, caregivers, and EHR providers must be seamless and transparent. Litigators targeting EHRs rely on the inherent disorganization that comes from transferring digital information into print. When processes and patient care are documented thoroughly, they become easy to understand at a glance. This helps reduce the likelihood that litigators can leverage the weaknesses of printed digital templates to discredit healthcare providers.

Desh Urs iBridge LLC

Written by Desh Urs

Desh Urs brings more than 20 years of entrepreneurial, start-up and Global 500 corporate experience in sales, marketing, and general management to the customers of iBridge. He has led sales organizations as SVP at Qsent, Inc. and VP at Acxiom Corporation, and has focused on the usage of data in data distribution, direct marketing, fraud prevention, and law enforcement.

As a Vice President of Global Sales, Services, and Marketing at Silicon Graphics, Inc., Urs managed engineering and non-engineering functions, developing solutions in sciences, telecommunications, manufacturing, media, business, and defense intelligence, for companies with revenues of several billion dollars. During his tenure as Vice President at Think Tools AG and Brio Technology, Inc., he ran business development and alliances providing solutions in Business Intelligence and Decisions Cycle Management to Global 100 corporations worldwide. In the late 1980s, Urs founded Indus Systems, Inc., which he profitably sold to a systems integration company.

Urs serves on several Advisory Boards, as well as many company Boards, in the United States and India.

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Americans Still Unprepared to Share Health Information Online, Pew Reports

Americans Still Unprepared to Share Health Information Online, Pew Reports

Although healthcare technology and EHR management tools are improving in security, a new survey by Pew found that Americans are still unprepared to share their health information online.

Americans Still Unprepared to Share Health Information Online, Pew Reports

Pew’s research showed that American tolerance for healthcare data breaches is low—just over half of Americans surveyed felt that doctors should use health information websites to manage patient records, citing privacy concerns as the biggest drawback. Another 20 percent of respondents said their comfort with online sharing would depend on the scenario, and 26 percent felt that accessing online health information was unacceptable.

Respondents cited various reasons for their aversion to online record sharing, but each reason speaks to a larger trend in the healthcare world—patients strongly safeguard their own information, and must trust the clinicians with whom they share information.

Privacy is Case-by-Case

Throughout Pew’s survey, many respondents agreed on one point: their comfort with sharing data depended on the unique circumstances of each medical situation. Before sharing their information online, respondents wanted to know:

  • Do I trust this clinic?
  • How will they store the data?
  • How will the data be used?
  • Is my data secure?

Respondents also claimed that the record type stored made a difference in their comfort level. Patients were comfortable with sharing surface level information, such as appointment scheduling or providing basic personal details. However, they complained about having their health information and medical outcomes exposed, which they felt could negatively affect their ability to secure credit, purchase insurance, or find jobs.

“My health records are confidential,” one respondent claimed. “I don’t want them in the hands of someone unscrupulous or marketing companies possibly trying to recommend a drug or something based on a condition I may have.”

Building Trust

Despite the reluctance to share information online, respondents agreed that their personal relationship with that clinic factored into their decision to share data. If they trusted the organization, they were more open to online health records.

Clinicians must remember this as they move towards electronic health records. Although the surge in data breaches over the past few years has painted digital healthcare management in a bad light, clinics still have options to protect themselves. Choosing the right data security options for enterprise health platforms will help prevent data loss, build trust with patients, and ensure that digital records are just as secure as paper files.

Desh Urs iBridge LLC

Written by Desh Urs

Desh Urs brings more than 20 years of entrepreneurial, start-up and Global 500 corporate experience in sales, marketing, and general management to the customers of iBridge. He has led sales organizations as SVP at Qsent, Inc. and VP at Acxiom Corporation, and has focused on the usage of data in data distribution, direct marketing, fraud prevention, and law enforcement.

As a Vice President of Global Sales, Services, and Marketing at Silicon Graphics, Inc., Urs managed engineering and non-engineering functions, developing solutions in sciences, telecommunications, manufacturing, media, business, and defense intelligence, for companies with revenues of several billion dollars. During his tenure as Vice President at Think Tools AG and Brio Technology, Inc., he ran business development and alliances providing solutions in Business Intelligence and Decisions Cycle Management to Global 100 corporations worldwide. In the late 1980s, Urs founded Indus Systems, Inc., which he profitably sold to a systems integration company.

Urs serves on several Advisory Boards, as well as many company Boards, in the United States and India.

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CMS Easing the ICD-10 Transition

CMS Easing the ICD-10 Transition

The Centers for Medicare & Medicaid Services (CMS) aren’t taking the ICD-10 transition lying down.

Providers are voicing new concerns regarding claims acceptance. While EHR interoperability and billing procedures were once the primary transition concerns, providers are now questioning how their revenue will be affected by rejected ICD-10 claims. The mounting tension has caused a public backlash against the ICD-10 transition, culminating in a series of public letters to Congress requesting a delay for the deadline.

CMS responded to these concerns by implementing a new ICD-10 service initiative that pledged to help prepare physicians and healthcare providers for the switch.

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CMS Support

The services offered by CMS are fourfold:

  • Instituting a Communication Center: With the massive number of changes that accompany ICD-10, CMS announced that they would set up a collaboration center to address any transition issues that may arise.
  • Allowing a Grace Period: Physician claims processed within 12 months of the ICD-10 transition won’t be denied by CMS, provided that the submission is from the right code family. This buffer will give providers time to adjust to new code usage with less worry of rejected claims.
  • Quality Reporting Flexibility: CMS will protect physicians from quality reporting penalties based on code specificity, as long as the diagnosis used was from the correct code family.
  • Advance Payment: If Part B Medicare Contractors cannot process physician claims in a timely manner, a conditional payment may be made to the provider until the claim has been processed in full.

Bridging the Gap

These services promise new opportunities for coding flexibility and physician freedom during the rocky transition period. Grace periods on submitted codes give healthcare providers time to adjust to their new coding systems without rejected claims or severe penalties. Many of the concerns expressed by providers involved the ways ICD-10 would interrupt their cash flow and day-to-day operations; CMS has tried to publicly address these pain points and facilitate a smoother transition for all involved.

The efforts of CMS to ease the ICD-10 transition come as a welcome change to the obstinate attitudes expressed by other physicians. In an industry where communication, transparency, and collaboration are necessary for success, any initiative that facilitates an easier transition can only be a positive.

Dean Van Dyke iBridge LLC

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsourcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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New Contracts to Increase Military IT Interoperability

New Contracts to Increase Military IT Interoperability

A new military IT contract with Cerner, Leidos and Accenture will be implemented to increase the interoperability of EHRs nation-wide with thousands of civilian healthcare facilities. This contract promises to diversify healthcare outreach for the nearly 10 million active duty and retiree military members that receive care by privatized providers.

Cooperation Is Necessary

EHR vendors have traditionally been slow at making their systems interoperable with other organizations, creating challenges for an industry that relies on communication and transparency for patient data and information sharing. This new contract was designed to overcome these shortcomings and enhance the business practices of hundreds of facilities that currently avoid cooperation.

Image courtesy of Jeroen van Oostrom at FreeDigitalPhotos.net

Image courtesy of Jeroen van Oostrom at FreeDigitalPhotos.net

This connectivity will not be simple to implement; hundreds of EHRs platforms will be integrated, including those provided by rival bidders. Over 1,200 military healthcare sites will experience changes, including international facilities in Iraq and Afghanistan.

Dr. Johnathan Woodson, Assistant Secretary of Defense for Health Affairs, spoke to the necessity of cooperation with these private-sector companies, which provide 60 to 70 percent of healthcare for soldiers and their families.

“Part of our requirement is to position ourselves to be interoperable with the private sector, but the fact of the matter is, the private sector has to make itself interoperable as well. What we’re doing today will help advance that public preparedness.”

Looking to the Future

This commitment to interoperability of the public and private sectors comes at a critical time, as the compliance deadline for the ICD-10 transition is less than two months away. Healthcare organizations in the middle of this transition must focus their efforts on communication and cooperation with other facilities to ensure that the quality of patient care does not suffer.

This is particularly true for the military and private-sector companies that must adjust their policies to reflect the needs of civilian and public-sector partnerships.

Federal Health IT Coordinator Dr. Karen DeSalvo commended the contract, calling it “…An important step toward achieving a nationwide, interoperable health IT infrastructure.” She pledged her office’s support of the Defense Department: “To help ensure its interoperability efforts align with nationally recognized data standards and industry best practices.”

While new standards of cooperation are a step in the right direction, military healthcare facilities will need to undergo rigorous testing to confirm the viability of their updates. Interoperability is necessary progress for the health field, but requires constant improvement to maintain its efficacy.

Dean Van Dyke iBridge LLC

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsourcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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The Streamlining of Meaningful Use Measures

The Streamlining of Meaningful Use Measures

Changes do not always come easy in electronic healthcare reporting, but new regulations for the reporting of Stage 2 meaningful use measures may indicate that the voices of healthcare providers nation-wide are being heard.

Electronic Reporting Standards

On Aug. 29, The Department of Health and Human Services published its final mandate regarding the reporting period for online medical records, remaining firm on a 365-day window for allocation of records. Despite the supposed ease of use and flexibility this method promised, physicians, hospitals and healthcare facilities across the country were vocal in their protestations against this regulation that placed an undue amount of burden on an industry already bogged down with details.

The CEO of The College of Healthcare Information Management Executives (CHIME) Russell Branzell noted that if more flexibility could not be brought to the meaningful use program in 2015, the future of the program itself was in jeopardy.

Young Female Doctor Holding A Tablet

Image Courtesy of Stockimages at FreeDigitalPhotos.net

A Welcome Change

Somebody out there was listening, as The Centers for Medicare and Medicaid Services (CMS) recently announced that the reporting window for meaningful use measures in 2015 would be reduced to a 90 day period, ostensibly to reduce the complexity of online reporting and ease the burden on healthcare facilities.

This announcement was met with great applause from a multitude of leaders in the medical IT industry, including CIOs from CHIME, The Mayo Clinic and other prestigious medical colleges across the country. The news not only promised a smaller reporting window to allow greater flexibility for physicians to participate in the meaningful use program, but was also an indicator of an encouraging trend within the industry.

“… I think it reflects that the voices of CIOs and others in the industry are being heard […] It reinforces that we need to never give up. We need to have a voice,” said Sue Schade, CIO of University of Michigan Hospitals and Health Centers.

Government regulations have been notoriously slow to adapt in the past, so the news that CMS would amend its reporting standards based on the feedback provided by healthcare professionals is a significant change. Knowing that CMS and other government medical organizations are considering their opinions, physicians and other professionals are given confidence to continue participating in the program and to have faith that their issues can be addressed should a new problem arise.

The Future of Electronic Health Records

While still in its infancy, electronic healthcare reporting is a process that must be developed by communication between both the sponsors and the users. While there will be many more bugs that must be worked out of the system, the willingness to adapt and make concessions on both sides is an encouraging step in the right direction. With the new reporting standards in place, managing electronic health records will become simpler and more convenient for all involved.

Dean Van Dyke

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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Gaining Consumer Trust in EHR Security

Gaining Consumer Trust in EHR Security

Doctors, hospitals, patients, insurers, and everyone in between agree that electronic health records (EHRs) are a great idea. But not everyone trusts their security. A recent survey of healthcare consumers found that a majority are concerned about the security and privacy of their EHRs, and some even withhold information from their providers for fear of having it compromised.

The value of EHRs (and the return on the investment in EHR systems) increases as more patients participate. What can healthcare providers do to gain the trust of their customers and increase their willingness to participate? Here are some ideas:Watch, computer keyboard, computer mouse
Have outside experts conduct a security audit. Provider IT teams, where they exist, are often stretched thin and lack the expertise to conduct a comprehensive security audit. Having an outside consultant audit your security stance can be invaluable in two ways: they will find vulnerabilities of which you would never be aware, and their independence makes your security claims more credible. Customers are more likely to trust you if you have an expert’s stamp of approval to show them.

Teach and enforce good security practices. Data security is not just the responsibility of the IT department. Everyone who has access to provider data systems has a role to play in keeping EHRs secure. When staff are trained on the importance of EHR security and on how to incorporate security best practices in their everyday work, patients will notice. Staff should not be trained only once—it’s an ongoing process that must be reinforced regularly.

Consider an investment in additional security technology. Another way to gain the trust of your customers is to show you have put automatic technical safeguards in place to keep insiders from compromising data. These tools can monitor a network and its computers, recognize sensitive data and prevent employees from inadvertently or deliberately distributing it to the outside world.

Don’t rely on compliance alone. Hacking tools and techniques evolve much faster than compliance standards can keep up. Complying with last year’s security standard could mean you are vulnerable to an attack today. If you can show customers you have gone above and beyond what a security standard requires, you will gain their trust much more easily than if you show you only meet the bare minimum.

The recent upswing in medical record data breaches shows that customer skepticism over providers’ data security is not unfounded. To ensure the success of EHRs, providers must prove to customers that the security of patient information is a top priority.

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Are You Ready for an EHR Audit?

Are You Ready for an EHR Audit?

With the many advantages of electronic health records (EHRs), there are disadvantages, including the potential for misuse and fraud. To guard against this potential, the U.S. Office of the Inspector General (OIG) is stepping up its audit efforts for healthcare providers’ EHRs. Proactive providers should follow some commonsense practices to be ready if an EHR audit occurs.

OIG has requested a budget of $400 million for fiscal year 2015—a large increase over the previous year—and almost 300 more staff to carry the increased workload of auditing EHRs. In addition, they intend to use forensic data analysis methods to identify questionable activities in providers’ EHR systems. , they are seeking evidence that federal EHR incentive payments were improperly claimed.

Female Doctor Using Tablet

Image Courtesy of Stock Images at FreeDigitalPhotos.net

Preparation for an EHR audit should not differ from preparing for any other audit, whether from the Food and Drug Administration, an ISO certification provider or a financial auditor. By way of review, here are things providers should think about to ensure readiness for an EHR audit.

Audit Readiness Checklist

Audit preparedness is a matter of documenting what you do, and doing what you document. This starts with your standard operating procedures (SOPs).

  • What is the state of your EHR-related SOPs? Are they up to date?
  • Have EHRs been reviewed within the required time frame (consider period for time frame)and approved by management?
  • Have all required personnel been trained on SOPs?
  • Where are the training records?

An EHR system is an IT system, and fraud prevention starts with proper IT security.

  • What are your policies for controlling access to the EHR system?
  • Where are the records that show these policies are being followed?
  • Do all personnel have levels of access for their job functions?
  • Are the user accounts of former employees disabled in a timely manner?
  • Are your computers, servers and firewalls properly configured, and do they have the latest security updates?
  • Where are the records for these updates?

Another part of a successful audit lies in making sure your personnel are ready.

  • Do you have an audit response team?
  • Do they know their roles and responsibilities?
  • Do you have a room where the auditors can work?
  • Have all personnel been trained on how to interact with the auditors?

Finally, OIG will look for patterns in the EHR data that might indicate fraudulent activity or misrepresentation. A healthcare provider that has claimed EHR incentive payments had better have the records to back up these claims.

The time to assess your audit readiness is now—not when the auditors come knocking on your door. With an honest assessment, you can try to ensure you are ready for an EHR audit.

Dean Van Dyke

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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Meaningful Use: More Trouble than It’s Worth?

Meaningful Use: More Trouble than It’s Worth?

As the deadlines loom for meeting electronic health records (EHRs) “meaningful use” requirements, it is becoming clearer that the effort to meet those requirements is disproportionately burdening those entities least able to cope: individual physician practices. Some are questioning whether the potential benefit is worth the trouble.

The promise and the potential of EHRs is indisputable: A standard means of collecting, storing, protecting, and sharing medical records can increase the quality of care and patient outcomes through better coordination between doctors, hospitals, and clinics; more accurate diagnoses; and fewer errors in administering treatment and medication. As a bonus, EHRs can reduce overhead costs and therefore reduce the costs of medical care.

Female Doctor Using Laptop

Image Courtesy of Phaitoon at FreeDigitalPhotos.net

However, implementing such a system on a nationwide scale is proving to be far more complex and onerous than anticipated. Larger facilities, which typically have full-time IT departments and larger budgets, are having a difficult enough time certifying that they are meeting the meaningful use requirements of the HITECH act. It’s proving to be even more daunting for individual physician practices, which usually lack the staff and expertise to implement compliant systems, even on a small scale.

Implementing an EHR system for an individual practice can run into the tens of thousands of dollars—a staggering amount for an entity whose IT budget for a year may be only a fraction of that. Some practices are questioning whether the return on that investment will make the effort worthwhile, or if it would be easier and less expensive to merely pay the penalty amount for non-compliance.

The baby is in danger of being thrown out with the bathwater here. If physicians are considering not implementing an EHR system because it’s the easier path, then the whole program and the schedule of meaningful use mandates may need to be re-examined.

This cannot be solved with steeper penalties. The Centers for Medicare and Medicaid Services (CMS), which is administering the meaningful use program, needs to work with physician groups to find a reasonable solution that gets all physicians on board and compliant. Physicians need all the help they can get at an affordable price, not extra penalties.

Physicians are often the first point of contact with patients, and their participation in an EHR world is critical if the system is to succeed. If the meaningful use initiative can be viewed less as a mandate-and-penalty model and more of a partnership between physicians and regulators, EHRs are more likely to see the success that everyone—patients, physicians, hospitals, insurers, and regulators—wants to see.

Dean Van Dyke

Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.

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Electronic Health Records: Boon or Boondoggle?

Electronic Health Records: Boon or Boondoggle?

In 2009, the U.S. Congress passed the Healthcare Information Technology for Economic and Clinical Health (HITECH) Act, which requires doctors’ offices and hospitals to implement electronic health record (EHR) systems. Facilities face penalties if they do not implement EHR systems meeting certain standards by 2015. The idea of EHR systems is to improve the quality of care by enabling patient health record interchange among doctors, nurses, and other healthcare professionals, to coordinate care, reduce duplicate tests and conflicting medications and reduce errors. Hospital IT departments have been working hard to implement EHR systems, and, as is often the case with large-scale IT projects, the results so far are mixed. Although nurses and doctors using some EHR systems are satisfied, in many other cases they feel that the systems are ineffective and difficult to use.

What sets the successful EHR implementations apart from the rest? The answer is no different for EHR systems than it is for other IT projects, large and small: Get the requirements right, and involve the end users.

Source: freedigitalphotos.net

Source: freedigitalphotos.net

Get the Requirements Right

A successful EHR project starts with a complete, correct set of user-level requirements. Although the HITECH Act provides a high-level framework to work within, many of the details of how users are to interact with the system are left to the system designers and developers. Getting these details right means considering all of the end users of the system (such as doctors, nurses, and facility administrators), the processes that must be supported, and the working environments in which the users will use the system. For example, a general practitioner working at a desk will use the system in a very different manner from a nurse working in a hospital emergency room. This is a formidable task, especially in large facilities with many departments (and possibly multiple locations), each of which has its own special needs.

Get the End Users Involved

So how do the designers identify, document, and validate all of these detailed user requirements? The end users must be involved in every phase of the implementation. They have to be observed in their working environments, they have to be interviewed, they have to review and confirm the documented requirements and they have to help test the system.

Apart from ensuring a complete set of requirements and getting the bugs out of the system before it is rolled out, keeping the end users involved gives them a sense of ownership and empowerment. The alternative—deciding for them and cramming it down their throats—is a recipe for low morale, high turnover, and difficulty in attracting talented personnel, plus poor-quality care for the patients.

Without good requirements and end user involvement (plus good project management), you can implement an EHR system that meets the letter of the HITECH law, but is a complete disaster for practitioners and patients alike.

Dean
Written by Dean Van Dyke, Vice President, Business Process Optimization

Dean Van Dyke is the Vice President of Business Process Optimization for iBridge. He brings more than 18 years of customer relations, business process outsurcing, lean six sigma, program/project management, records management, manufacturing, and vendor management experience to iBridge. Mr. Van Dyke was the former head of Microsoft’s corporate records and information management team, and served honorably for over fourteen years in the U.S. Navy and Army National Guard. He received his Bachelor of Science in Business Administration from the University of South Dakota and his Master’s in Business Administration from Colorado Technical University.