Volume 4 - Issue 3 - May 2009
Editor's Note 
By: Donna Carroll
Editor - The MEDITECH Community Bulletin
VP, Business Development & Recruitment - Systems Personnel
Welcome to the May issue of The MEDITECH Community Bulletin. I'd like to draw your attention to a couple of items in this month's newsletter:
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This month's feature article focuses on the currently popular topic of "meaningful use" as it relates to electronic health record (EHR) technology.
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Are you a healthcare facility in Massachusetts or Connecticut and could use some extra help with your health IT needs? Would you like the knowledge of an RN who can assist with application design, end-user training, and/or go-live support? I've been contacted by a seasoned nurse who is also a graduate student completing dual MSN degrees, one in Clinical Systems Management, and the other in Clinical Education. She needs to complete an intership or practicum as part of her degree program and is available for part-time or full-time hours. If you're interested in getting some FREE help from an experienced RN, please contact me to learn more.
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John Sharpe of Comstock Software is once again sharing his wealth of NPR knowledge in our Tricks of the Trade column. In addition, John is making a special offer available. Has your organization implemented Meditech Client Server 5.5 or greater? Implemented most Meditech Modules? Interested in FREE Meditech NPR Training? Comstock Software will be hosting 1-hour remote NPR Workshops via WebEx for the Meditech community. Your hospital will provide Comstock Software with access to NPR in your TEST environment. In return for being the host site, your organization will receive free NPR training for its employees at no cost. To learn more, contact John at jsharpe@comstock-software.com.
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All information and content for the June issue of The MEDITECH Community Bulletin must be received no later than Thursday, May 28th. Thank you.
Happy Memorial Day!
Donna
Industry Spotlight: Industry Weighs in on Definition of Meaningful Use
By: Carrie Vaughan, Technology Editor for HealthLeaders Media
Healthcare providers are antsy to start working toward becoming "meaningful users" of electronic health record technology so that they can claim some of the American Recovery and Reinvestment Act's financial incentives when they become available in fiscal year 2011 and 2012. While providers wait for the government's definition of "meaningful use" of EHR technology, which ultimately is the only definition that matters, they did receive some guidance this past week as just about every association and industry group released their own definition of what meaningful use should include. Here's a breakdown of those recommendations.
CHIME: The College of Healthcare Information Management Executives says that meaningful use should focus on the use of quality metrics and outcomes regardless of the technology in place, a phased approach should be used to encourage adoption, the industry should explore alternative ways to connectivity in the short term that can lead to participation in a health information exchange, and the industry should consider alternative ways to exchange health data other than the continuity of care document—at least initially—because some organizations may not have the capability to immediately deploy the CCD.
AHIMA: The American Health Information Management Association says the most crucial element of meaningful use is the widespread adoption of certified EHRs and that the expectations are applied uniformly across all industry segments and not vary by payer, patient, or provider. AHIMA recommends the focus should be on the end goals to improve quality, cost and health system performance not the technology itself; the initial criteria should be based on what is achievable with the current technology with the measures becoming more strict in the next several years; the certifying body should be the Certification Commission for Healthcare Information Technology; it should be measured and reported in a way that minimizes manipulation; and it should be relevant to consumers.
AMIA: The American Medical Informatics Association recommends that meaningful use should focus on process and care improvements over time, include EHR functionality and capability, and establish approaches to measure meaningful use. The AMIA notes that EHRs have the potential to support and enhance clinical care and decision-making, but simply implementing an EHR does not mean that the organization will effectively use the system or achieve the desirable patient outcomes and changes to clinical processes.
ANI: The Alliance for Nursing Informatics says meaningful use should include patient-centered documentation—initially focusing on patient summary data—that can enhance cross continuum communication and improve safety, quality, and processes of care delivery; collect standardized clinical performance measures as a byproduct of care delivery and clinician documentation; use processes and infrastructure defined by HITSP—initially focusing on a subset of existing NQF-endorsed measures—to submit quality measures; use existing initiatives such as HITSP and IHE to guide standards use within all systems that record, transmit, collect, and share information for care delivery; and expand the definition of "meaningful user" to include registered nurses and advanced practice registered nurses.
HIMSS: The Health Information Management Systems Society recommends that CCHIT be the certifying body of EHRs; using an incremental approach to adopt metrics that can be reasonably captured and reported beginning in fiscal years 2011 and 2012, and then made increasingly stringent using intervals of not less than two years; bridging the existing gaps in interoperability of health information by creating new standards and implementation guides in coordination with HITSP and IHE; and reconciling the gap between "certified EHR technologies," "best of breed," and "open source" technologies.
The types of features and functions HIMSS recommends in phase one for hospitals are:
- Major ancillary department information systems (lab, pharmacy, and radiology) and a clinical data repository that are interfaced with the patient accounting system.
- Discrete clinical observations electronically entered and available to clinicians throughout the organization. Physician documentation is desirable, but optional.
- A combination of compliance metrics and National Quality Forum-endorsed quality measures that align with national quality and performance goals. The hospital's EHR must be able to capture and report relevant statistics without manual intervention. For example, baseline reporting of percentage of medical orders entered electronically into the EHR by physicians; re-admissions within 24 hours of discharge; duplicate diagnostic test orders; and present-on-admission tests compliance.
- The electronic exchange of health information via scanned documents, text documents, or XML transactions.
Phase one recommendations for physicians include:
- An EHR infrastructure that has clinical data display and computerized practitioner order entry, with independent licensed practitioners entering the order.
- Electronic prescribing technology to transmit prescriptions to pharmacies.
- A sub-set of existing National Quality Forum-endorsed measures that align with national quality and performance goals. For example, baseline reporting of medical orders entered electronically by physicians; Agency for Health Research & Quality quality outcomes; National Priorities Partnership goals, convened by National Quality Forum; adverse drug events; and percentage of prescriptions electronically sent to the pharmacy.
The Markle Foundation recommends seven principles for meaningful use and qualification of certified EHRs in the report, Achieving the Health IT Objectives of the American Recovery and Reinvestment Act.
- The overarching goals of health IT investments should improve healthcare quality, reduce growth in costs, stimulate innovation, and protect privacy. "If the goals and metrics are not clear before technology is commissioned and the incentives are offered, the government will risk wasting valuable resources and losing support from both healthcare providers and the public for further health IT investments," the report says.
- The definition should focus on the needs of patients and consumers, not on the mere presence or functions of technology. The end goals cannot be achieved through the installation of software or hardware alone, so it is essential that the information is being used to deliver care and support processes that improve patient health status and outcomes.
- The definition should be demonstrable in the first years of implementation without creating undue burden on clinicians and practices. For example, improving medication management and coordination of care is an early opportunity to achieve meaningful use. It should initially rely on standard information types such as recent medications and laboratory results that are electronic and already widely adopted.
- The definition should gradually expand to encompass more ambitious health improvement aims over time.
- The definition of "qualified or certified EHR technology" should support the goals of meaningful use, security, and privacy. For a technology to be certified, it should embed the capability for clinical practices and hospitals to attain meaningful use without undue additional reporting burdens.
- Metrics for achieving meaningful use should enable a broad range of providers to participate. The definition should reward the actual use of information and not the mere purchase of specific hardware or software products.
- Consumers, patients, and their families should benefit from health IT through improved access to personal health information without sacrificing their privacy.
There are a few key areas that the industry agrees on. Namely, that the focus of "meaningful use" should be on the desired outcome, which is improving quality of care, reducing costs, and making care delivery more efficient, not the technology itself. In addition, the definition should encourage the widespread adoption of EHRs by using an incremental approach that requires more stringent criteria as time progresses.
Now providers must wait and see if the government takes the industry's recommendation and defines meaningful use in a way that a large number of hospitals and physicians can achieve with the technology that is currently available.
Carrie Vaughan is a senior editor with HealthLeaders magazine. She can be reached at cvaughan@healthleadersmedia.com.
Tricks of the Trade: Reformatting NPR Report Output Using Find & Replace
By: John Sharpe, President, Comstock Software, Inc.
The billing extract you’ve just sent to a payer has been rejected. There are quotes in the data, and they must be removed in order for your file to be processed.
You update the NPR extract and resend. This time everything goes through.
Most applications & programming languages today have a subroutine or function that allows you to replace a character with another character. For example Microsoft SQL Server has the REPLACE function.
Using a routine like STRING.FIND.REPLACE (below) can mean that you won’t have to change the format of the file. Fortunately, changing the content of your extract can be easier than changing the format of the entire file.
Here’s the before & after snapshots of the change.
BEFORE:
AFTER:
But wait, there’s more! For your future reference, here’s the URL for the code in copy & paste format.
---->FREE OFFER!
Has your organization implemented Meditech Client Server 5.5 or greater? Implemented most Meditech Modules? Interested in FREE Meditech NPR Training? Comstock Software will be hosting 1-hour remote NPR Workshops via WebEx for the Meditech community. Your hospital will provide Comstock Software with access to NPR in your TEST environment. In return for being the host site, your organization will receive free NPR training for its employees at no cost. To learn more, contact John at jsharpe@comstock-software.com.
John Sharpe is President / NPR Consultant at Comstock Software, Inc. Learn more about NPR Report Writing at the MEDITECH NPR Report Writing Blog.
Recent News: Boulder Community Hospital Selects the Summit Integration Suite and agrees to a multi-year Integration Outsourcing Contract
Braintree, MA, April 3, 2009 -- Summit Healthcare, a leader in healthcare system integration and task automation, today announced it has entered into an agreement with Boulder Community Hospital to migrate from their existing interface technology to the Summit Integration Suite. Boulder Community Hospital is a non-profit, community owned facility with 265 licensed beds across multiple facilities currently running the MEDITECH Healthcare Information System.
In addition to implementing the Summit Integration Engine technology, Boulder Community Hospital will be installing a failover server system known as the Summit Hotbox to ensure system uptime. To round out the partnership, Boulder Community Hospital has agreed to a multi-year Integration Outsourcing contract to migrate all existing interfaces and subsequently manage integration efforts.
"Boulder Community Hospital selected Summit Healthcare because of their proven track record for streamlining complex interface environments. The Summit Healthcare solution will replace two engines at BCH and not only will this save the hospital money, but it will allow us to implement interfaces faster and with fewer resources,” remarked Linda Minghella, Chief Information Officer at Boulder Community Hospital.
Read article...
Recent News: Memorial Hospital and Health Care Center Selects Corepoint Integration Engine to Replace Their Existing Integration Engine Platform
Plano, TX, March 5, 2009 -- Memorial Hospital and Health Care Center, a regional health care facility serving southern Indiana, selected Corepoint Integration Engine™ to replace their existing integration engine platform. Memorial Hospital was live and running within eight days of installing Corepoint Integration Engine. ADT migration and several interfaces were connected within the first day.
“Initially, the hospital was attracted to the ease of deploying and maintaining interfaces with Corepoint Integration Engine. During the evaluation period, MEDITECH customer references confirmed the reliability of Corepoint Integration Engine and the comprehensive support delivered by the Corepoint Health support center. Following the selection of Corepoint Integration Engine, the entire implementation process was absolutely smooth. Implementing Corepoint Integration Engine and migrating interfaces to it was seamless.”
The difference in the implementation experience with our first interface engine and Corepoint Integration Engine was significant. With the previous interface engine, the initial implementation took 30 days and ongoing issues resulted in escalating costs and time. With Corepoint Integration Engine, the implementation happened within one week, and there were no lingering issues,” said Richard Meinhart, Systems Engineer.
Read article...
Recent News: Inteck, Inc. has been Selected to Conduct Two Presentations at International MUSE 2009
Denver, CO, April 15, 2009 -- Inteck, Inc., an information technology (IT) consulting firm for the healthcare industry, announces that they will be conducting two presentations at the International MUSE 2009 located in Vancouver, BC Canada. As a past participant at this conference, Inteck understands that this event is beneficial to MEDITECH users and will present topics of concern for MEDITECH healthcare providers. Inteck will educate healthcare facilities on historical patient clinical and financial data conversions, external database design, security and maintenance, storing, and designing legacy databases as well as the optimization of nurse documentation.
Inteck is excited to be invited to conduct these two educational sessions at this year’s conference. The sessions are entitled Maintaining Historical Data: Movement of Historical Data to Stand Alone Data Base and MEDITECH Nursing Documentation Modules: Optimization of Existing Intervention and Assessment Screens. Both sessions are certain to provide insight, and help providers to better understand how to utilize their system to the highest capability while saving money.
Inteck will also be an exhibitor and will offer participants additional opportunities to learn more about their seminars and to discuss other issues and questions with Inteck’s experts in their booth. Appointments for individual consultations are currently being scheduled. Inteck has assisted numerous facilities with their MEDITECH IT needs for over 25 years. Inteck’s services complement MEDITECH's products and help ensure that a healthcare organization will implement the MEDITECH system effectively, upgrade it so they can take advantage of new capabilities offered by MEDITECH, and use the system to obtain the greatest benefits possible. Inteck's MEDITECH Consultants have years of experience to ensure the organization's system works the way they work.
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Recent News: PatientKeeper Announces Continued Growth in 2008
New Customer Acquisition and Existing Customer Expansion Demonstrate Demand for Company’s Solutions.
Boston, MA, March 24, 2009 -- PatientKeeper®, Inc., the leading developer of integrated physician information systems, experienced dramatic growth in 2008 across all areas of its business. The combination of installations at new customers and product expansion with existing customers doubled PatientKeeper’s registered user base to over 30,000.
PatientKeeper cites increased demand for both information connectivity and anywhere-anytime physician workflow tools as fueling the growth. In particular, PatientKeeper saw the number of charge transactions processed by its revenue cycle applications increase from five million to over seven million in 2008. To keep pace with this growth, PatientKeeper added key senior management positions and increased total staff by forty percent.
In 2008, PatientKeeper added clients across the entire continuum of healthcare delivery including:
- Regional Health Systems: BroMenn Healthcare System (IL), Parkview Health System (IN) and Northern Arizona Health System (AZ)
- Academic Medical Centers: H. Lee Moffitt Cancer Center (FL)
- Community Hospitals: San Juan Regional Medical Center (NM)
- Large Group Practices: UBMD Physicians’ Group (Buffalo, NY) and General Medicine, PC (MI and other central states)
- Small Group Practices: Capital Allergy (CA) and Hartvigsen Family Medicine (SC)
- Health Information Exchange (HIE): Healthy Ocala RHIO (FL), a self-sustaining community HIE
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Recent News: Patient Edu LLC in the Spotlight Again as President Obama's Stimulus Plan is Passed
East Longmeadow, MA, March 4, 2009 -- With the passage of President Barack Obama’s economic stimulus plans, there is $18 billion on the table that could dramatically transform the health care information technology industry, with funds going toward such IT measures as electronic medical records (EMR) and electronic prescribing.
PatientEDU, a Massachusetts-based healthcare IT firm recognized industry-wide for their patient-education content and software products that integrate with most EMR products on the market, once again finds itself at the center of the solution matrix.
“PatientEDU is designed perfectly to take advantage of these proposed economic and healthcare stimulus plans,” said Steven Graziano, president of PatientEDU. “Our product can lead to better outcomes for patients, as well as providing more complete patient records for administrative purposes.”
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Worth a Read: Articles of Interest to the Healthcare IT Field
A House Divided
By: David Raths
HealthCare Informatics, March, 2009
Bridging the chasm between clinical and financial data involves merging clinical data with the financial piece to get true performance management.
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Blade Runner
By: Daphne Lawrence
HealthCare Informatics, March, 2009
Although blade servers are one of the fastest growing segments of the server market, there are some pitfalls. This article reviews some of the major benefits of using blade servers and virtualization as well as the difficulties associated with a lack of standardization within this technology.
Read article...
Using Barcode Medication Administration to Improve Quality and Safety
Authors:
Julie M. Hook, M.S.
Jonathan Pearlstein, B.A.
Anita Samarth, B.S.
Caitlin Cusack, M.D., M.P.H.
AHRQ Health IT Portfolio, December, 2008
A review of the challenges faced by grantees of AHRQ (Agency for Healthcare Research and Quality) in developing, implementing, or evaluating barcoding interventions.
Read article...
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