Volume 3 - Issue 4 - May/June 2008

Customer Spotlight: Berkshire Health Systems Finds Downtime Solution in Physician Portal

By: Donna Carroll, Editor, The MEDITECH Community Bulletin

Lately, I’ve noticed an increasing number of resumes which mention the product PatientKeeper on them, and I became more curious about the vendor and its product offerings. So, I started to ask around and found one customer--nearly in my own backyard--which was not only using the product, but singing its praises. That organization is Berkshire Health Systems (BHS), based in Pittsfield, Massachusetts. I called a consultant I knew working at BHS to ask a few questions and she was kind enough to set up a conference call for me with the organization’s Chief Information Officer (CIO) and Chief Medical Information Officer (CMIO).

First, a little background about Berkshire Health Systems (BHS). BHS is a private, not-for-profit organization serving the Berkshire County region through a network of affiliates which include a 302-bed acute care community hospital, a 27-bed critical access hospital, a large VNA/home health program, a long-term care affiliate, and approximately 15 community physician practices.

Berkshire Medical Center (BMC), BHS’s flagship hospital, is one of only 10 hospitals in Massachusetts to have an electronic system in place that can significantly improve patient care and safety. This comprehensive electronic medical record (EMR) with computerized provider order entry (CPOE) represent major investments by BHS in its ongoing efforts to ensure the best care possible for their patients.

Over the past five years, BHS has invested approximately $15 million on creating and implementing the EMR system. This included the introduction of MEDITECH, PACS, online nursing documentation, and automated medication dispensing. About $1.5 million was invested in CPOE, which is expected to be in full use by January 2009 at both BMC and Fairview Hospital.

BHS expects to have a fully electronic medical record by the end of 2009. In the process, the system will increase availability and accessibility of information; reduce medication errors; gain operational efficiency; and capture and provide needed information for pay-for-performance and other external reporting requirements.

Implementation of this technology places BHS well ahead of the curve nationally, based on the HIMSS Analytics’ EMR Adoption Model. But, is there a potential downside to such a technologically advanced healthcare environment? To learn more, I spoke with Dr. Michael Blackman, Chief Medical Information Officer, and Joe Diver, Chief Information Officer, at Berkshire Health Systems.

Dr. Blackman said, “As the EMR becomes the primary source of patient information, it is critical that we provide access to that data 24/7/365.” So, what happens when a system goes down unexpectedly, or a scheduled downtime lasts for longer than was planned? Dr. Blackman continued, “PatientKeeper provides the medical staff continuous access to the record, from any location, even during downtime events.”

I wondered how BHS came to select PatientKeeper as a downtime solution. Well, they actually stumbled upon it quite accidentally, a couple of years ago. When their MEDITECH system was temporarily down, one of their medical staff discovered that he could still access patient data through the PatientKeeper application on his PDA. Once they realized this was possible, BHS decided to take it to the next level and use it as a formal downtime solution. BHS brought this idea to the vendor and PatientKeeper performed some further development of the product to prepare it for BHS’s downtime solution.

BHS was preparing to perform some extensive testing of the solution during their upgrade from MEDITECH CS 5.52 to 5.54, but they actually had to roll it out more quickly during an emergency situation. Joe Diver said, “A recent February upgrade landed Berkshire Health Systems into an extended downtime situation and with the rollout of the PatientKeeper Business Continuity solution, physicians were able to access the critical information required directly from any web browser or handheld device. Our physician users were very happy to have the solution ready.”

Berkshire Health Systems was already a customer of PatientKeeper, using it’s physician’s portal product to provide physicians access to patient data stored in the EMR. Diver says, “PatientKeeper’s solutions support and further enable the physician on the move. The physician’s job is difficult enough without all of the internal and external requirements and the added complexity of a hospital EMR. With the majority of the patient’s record in an electronic format, we have the ability to allow immediate access but without a computer in every nook & cranny of the hospital access is difficult. With the PatientKeeper Mobile Clinical Results running on a PDA or Smartphone, physicians can have immediate access to critical information.”

PatientKeeper applications can be run via the web portal or handheld devices. Click on the two links to see screen shots of both applications.

Although PatientKeeper offers a full suite of applications that support physicians throughout their entire day, customers can start with just a single application and add new capabilities as needed; all of their applications are tightly integrated with each other. And because their platform integrates with existing healthcare systems, there's no need to replace legacy systems.

PatientKeeper doubles as a downtime solution to help ensure that physicians and other users throughout a healthcare organization have access to all available clinical information during scheduled and unscheduled system downtime. Because PatientKeeper is logically and physically independent of the systems feeding it data, it does not share their software and hardware vulnerabilities. As a result, data can be easily retrieved during downtime, and is current up to the time the clinical information system went down.

Paul Brient, President and CEO of PatientKeeper, explains, “If you are a nurse or physician in a hospital trying to take care of patients while a core HIS system is down, having uninterrupted access to patient information can literally be lifesaving. Not only does HIS downtime slow down workflow for people used to working in an automated environment, it also introduces risk and creates many potential opportunities for making errors. With PatientKeeper Business Continuity, our customers have the redundancy they need to ensure physicians and patients stay connected.”

PatientKeeper applications will work with most of the major HIS vendors available in the market today. Peter Henderson, PatientKeeper’s VP of Marketing, told us that to date, “PatientKeeper has contracted with more than 10% of the acute care hospitals in the United States.” Of course my special interest is on the MEDITECH market, so I asked about PatientKeeper’s penetration in that segment of the market. Henderson continued, “We have also contracted with more than 12% of the MEDITECH customer base.”

So, for all of you MEDITECH sites out there, we asked Berkshire Health Systems what is the best piece of advice they have to offer other facilities who might be seeking a downtime solution. Their answer: “Just do it! It’s imperative to have a method in place for continuous access to critical patient information. There are a lot of downtime solutions available in the market, but the PatientKeeper Business Continuity solution works very nicely with MEDITECH as it supports and facilitates the same workflow your physicians are accustomed to.”

To learn more about PatientKeeper, please visit their web site at www.patientkeeper.com.

Personal Note: Special thanks to Brenda McConnell, “Consultant Extraordinaire” from CRH Consulting, Inc., for her assistance in coordinating the meeting with Berkshire Health Systems.

Industry Spotlight: One Voice, One Vision: Transforming Health and Care

Source: http://www.healthitweek.org/

National Health IT Week 2008, held the week of June 9-13, 2008, is the leading forum for developing common ground to advance adoption of health information technologies transforming health and care in the US.

Organizations with diverse perspectives on health and care will gather in Washington, DC, to work together under one banner with the goal of improving healthcare efficiency, quality, cost-effectiveness and patient safety through health IT. View the list of partners.

National Health IT Week 2008 coincides with several partner events, including HIMSS Advocacy Day—an event that connects participants with congressional leaders and their staffs for an open discussion on health and care issues.

By supporting National Health IT Week, you send our nation’s policymakers a powerful message on the importance of fostering widespread health IT adoption in order to improve patient safety and healthcare quality. We value and invite your participation—please contact us for more information on how you can get involved in National Health IT Week 2008.

Working together, we will transform health and care for all.

Tricks of the Trade: First Class Denizens of the Universe (Part 2 of 3)

Contributed by: John Sharpe, President, Comstock Software, Inc.

As a MEDITECH Client Server Analyst who is aspiring to greater responsibilities, no doubt you’ll find yourself writing NPR reports. This article is the second in a series of three (see the April 2008 issue for Part 1) where we examine strategies to keep you in the limelight for all the right reasons.

In Part 1 of this series, we wrote a report to keep an eye on our use of MEDITECH Server Resources. In Part 2, we look at another way to keep server resource usage to a minimum.

Recently, I was challenged to improve the performance of a report in the NUR.PC.WORK DPM. This was challenging because the NUR module didn’t have the index I needed. It was also challenging because the report was already using an index.

The NUR database had 10 facilities. To return the records for only 1 facility required processing each patient in the database and then evaluating whether the patient’s facility was the right one. Since the report was already set up to use the NUR.PC.WORK.doc.x index file, I wanted to leverage the existing index where possible.

Index: 		NUR.PC.WORK.doc.x
Subscripts: 	[patient,int.base,int.urn,act.date,act.time]
Physical: 	?(N1)NPCWDT[aa,nib,niu,nod,not]


Sample Records:
?(N1)NPCWDT[“AA1234”,10001,1,20080101,0900]
?(N1)NPCWDT[“MD1234”,10001,1,20080101,0900]
?(N1)NPCWDT[“MD5456”,10001,1,20080101,0900]
?(N1)NPCWDT[“PO1234”,10001,1,20080101,0900]

To limit processing to those patients for a single facility, we can use the MIS.FACILITY.acct.number.prefix to mark the starting place in the NUR.PC.WORK.doc.x index where we should start processing. To only process the “MD” records we use the account number prefix to set the starting point in a macro. First let us set a SELECT for ADM.PAT.facility on Page 2, which will be used in the macro.

The macro will be called from the Footnotes as AL D detail.

The first time the detail macro executes, the patient is reset using the value obtained from the MIS.FACILITY.acct.number.prefix.

IF{/PROCESSING.POINT.SET=1 @WHEN.ACCT.PFX.DOESNT.MATCH.GO.TO.END.OF.INDEX;
   @SET.PROCESSING.POINT}


SET.PROCESSING.POINT
; Use the ADM.PAT.facility SELECT from NPR Page 2.
ADM.PAT.c.facility^MIS.FACILITY.mnemonic,
; Return the MIS.FACILITY.acct.number.prefix as /ACCT.PFX.
@MIS.FACILITY.acct.number.prefix$2^/ACCT.PFX,
1^/PROCESSING.POINT.SET,
/ACCT.PFX^patient

In our example, the detail macro has reset the processing point as patient = “MD” on the first time through.

?(N1)NPCWDT[“AA1234”,10001,1,20080101,0900]
“MD” 
?(N1)NPCWDT[“MD1234”,10001,1,20080101,0900]
?(N1)NPCWDT[“MD5456”,10001,1,20080101,0900]
?(N1)NPCWDT[“PO1234”,10001,1,20080101,0900]

This improves report performance by skipping thousands of records for the other facilities that come before the patients for our facility. What can we do to stop processing records that come after our facility in the NUR.PC.WORK.doc.x index? Once all the patient accounts that start with “MD” have been processed, we can stop the processing by skipping all the way to the last record in the index.

WHEN.ACCT.PFX.DOESNT.MATCH.GO.TO.END.OF.INDEX
IF{@patient$2=/ACCT.PFX;
   @Last(patient,doc.x)^patient}

In our example, setting the last record @Last(patient,doc.x) brings us to this record:

?(N1)NPCWDT[“PO1234”,10001,1,20080101,0900].

This approach can be used in other modules like ADM or MRI when an index is either absent or doesn’t meet your needs. It’s a great way to keep the consumption of server resources to a minimum.

John Sharpe is President / NPR Consultant at Comstock Software, Inc. John hosts the ‘Meditech NPR Report Writing’ blog at http://comstock-software.com/blogs/npr/ where you can learn and read more about NPR Report Writing.

Featured Employer: Sponsored by MeditechCareers.com

Every month, we feature one employer who has advertised their job posting on our affiliate web site: MeditechCareers.com. In addition to the basic job posting, we provide some information about the employer, their location and environment, and highlight them as a "Featured Employer" in this newsletter. MeditechCareers.com provides MEDITECH professionals a place to explore career opportunities. Having a separate web site for this purpose will allow us to maintain the original focus of The MEDITECH Community Bulletin for our loyal readers who are seeking news and information.

To advertise your MEDITECH-related opportunity on MeditechCareers.com and become a "Featured Employer", contact Donna Carroll at 413-569-1111.

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Hebrew SeniorLife
Boston, Massachusetts

About the Organization:
Hebrew SeniorLife (HSL) is a 100+ year-old organization committed to maximizing the quality of life of seniors through an integrated network of housing, health care, research, and teaching programs, serving more than 3,500 seniors annually in the Greater Boston area.

Hebrew SeniorLife is a system of care for seniors that includes:

• Hebrew Rehabilitation Center, a 640-bed long-term care facility, a short-term, post-acute care unit and a medical acute care unit in Boston

• three apartment complexes: Jack Satter House in Revere, Simon C. Fireman Community in Randolph and Center Communities of Brookline

• the Institute for Aging Research in Boston

• Orchard Cove , a continuing care retirement community in Canton

• NewBridge on the Charles, a multigenerational community to be built on the Dr. Miriam and Sheldon G. Adelson Campus in Dedham

Hebrew SeniorLife also offers services to the community, including adult day health programs at Hebrew Rehabilitation Center and in Brighton; rehabilitation services; outpatient services; and home health care.

About the Location:
We are next to the Arnold Arboretum in Boston's historic Roslindale neighborhood. In our state of-the-art facility you'll find a friendly attitude, excellent ongoing learning and professional growth opportunities, and benefits designed to help you build and enjoy a full life.

All of Hebrew SeniorLife's facilities are located in and around the greater Boston area, just minutes from the shores of the Atlantic, the bleachers of Fenway Park, the shops of Quincy Market, and the birthplace of the American Revolution. The region offers four beautiful, distinct seasons, an unparalleled cultural, artistic and academic tradition, and a diverse array of exceptional communities that our staff are proud to call home.

About the Department:
The dynamic IT team at Hebrew SeniorLife manages the robust and sophisticated technology infrastructure of one of New England’s most acclaimed senior care systems. With the continued expansion of bold technology initiatives designed to support the state-of-the-art 640-bed Hebrew Rehabilitation Center, the Orchard Cove community in Canton, MA, the world-renowned Institute for Aging Research, and an extensive network of leading edge services...Hebrew SeniorLife offers IT careers defined by more challenge, opportunity and reward than you ever realized. Our IT professionals play a valuable, high-profile role in driving corporate strategies and objectives through automation and technology. We're committed to maintaining strong, positive relationships with each of our internal customers, and to creating effective solutions through the efficient bonding of People, Process and Technology.

IT at Hebrew SeniorLife is a corporate shared service. Our collaborative involvement in all lines of service and operational areas will provide you with a remarkable opportunity to see firsthand how sophisticated application of advanced technologies directly benefits our patients - and allows them to experience a higher level of care in a safer, more efficient environment.

The result is a sense of deep satisfaction and purpose that defines every career we build and every project we take on. For example:

• Rollout of a completely integrated electronic medical record and online clinical information system as part of a multi-facility hospital information system

• Wireless, mobile technologies supporting online clinical services in all areas of the hospital

• Web-based, self-hosted enterprise applications supporting our three senior supportive housing sites in the greater Boston area

• Integrated Retirement Community systems that incorporate business systems as well as primary care practice systems, assisted living systems, skilled nursing clinical systems and an electronic health record for all retirement community members

• Voice over IP (VoIP) telecommunications

• Wide area Networking supporting 10 HSL Locations in the greater Boston area

• Over 700 PCs and nearly 100 servers on our enterprise network

• Data Warehouse Reporting Systems, OLAP Reporting and Digital Dashboards

Hebrew SeniorLife is a mission-driven organization dedicated to utilizing technology and innovation to reach our goals. We offer a friendly, collaborative work environment,excellent growth opportunities, and a generous benefits package designed to make the balance of work and life a reality.

Current Position(s) Available:

MEDITECH Clinical Systems Analyst
Permanent, Full-Time

Description:
The Clinical Systems Analyst will be responsible for implementation and support of clinical MEDITECH applications, as well as managing several projects in a multi-disciplinary environment with competing priorities and budgetary concerns. The ideal candidate will have working knowledge of clinical processes in a health care setting and experience training end users on MEDITECH clinical systems such as PCS, ITS, POM and EMR.

Qualifications:

• Bachelor’s degree in a clinical field, information technology or other similar background preferred

• Bachelor’s degree in a clinical field, information technology or other similar background preferred

• In-depth knowledge of MEDITECH applications strongly preferred

• 3-5 years experience supporting clinical information systems required

• Working knowledge of clinical processes in a health care setting

• Experience training end users on MEDITECH clinical systems such as PCS, ITS, POM and EMR

• Strong PC skills required with knowledge of Microsoft office suite required

• Must have excellent communication, interpersonal, organizational and problem-solving skills

How to Apply:
To apply for this Job, please e-mail your resume to jobs@hrca.harvard.edu.

Or mail to:

HRC
Human Resources
1200 Centre Street
Boston, MA 02131

Or fax to: 617-363-8917.

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Systems Personnel ... Your Partner in Healthcare Search
Work from Home Opportunity!

About the Organization:
Founded in 1989, Systems Personnel is a professional search firm specializing in the nationwide search and placement of Healthcare IT, Management, and Sales & Marketing professionals. We pride ourselves on our personal approach to your search. We become your partner in the search process and will guide and advise you each step of the way. This consultative approach promotes an atmosphere of teamwork which practically guarantees success.

Current Position(s) Available:

MEDITECH NPR Report Writer
Permanent, Full-Time

Have you always wanted to work from home, but never found the right opportunity? Well, here's your chance to do what you enjoy from the luxury of your home, and potentially increase your earnings!

Description:
We are currently seeking a very skilled NPR Report Writer to work full-time (40 hours per week) developing NPRreports for a multitude of modules on MEDITECH's Client Server and/or MAGIC platforms. You will work from the comfort of your home and enjoy great flexibility in your schedule, but you must be very responsive to customer needs and be able to meet deadlines.

Qualifications:

• Minimum of 5 years of experience with MEDITECH

• Strong Intermediate to Advanced level NPR report writing skills (macros, fragments, arrays)

• Experience writing NPRs for a multitude of modules (clinical, financial, administrative)

• Experience on Client Server platform (ideal candidate will have both CS and MAGIC experience)

• Ability to work independently and be self-directed

How to Apply:
To apply for this Job, please copy the questions below and email your ANSWERS and RESUME to Donna Carroll and reference NPR Report Writer.

1. What NPR training courses have you completed?

2. What is your level of proficiency (Intermediate, Advanced)?

3. How many years of experience do you have writing NPR's?
- Client/Server:
- MAGIC:

4. Have you written:
- Fragments?
- Macros?
- Arrays?

5. Have you re-created standard reports, such as MAR?
- Please explain:

6. For what modules have you written NPR's?
- Client/Server:
- MAGIC:

7. How many hours per week can you commit to this work?

8. How soon could you begin work?

9. In what time zone do you live?

10. Have you ever performed this work on a contract basis before?
- If yes, for whom and when?

11. Contact information so we can talk with you further about this:
- Day Phone?
- Eve Phone?
- Email address?

Recent News: MEDITECH Announces New Interoperability and EHR Initiatives Portal

Source: http://www.meditech.com

There is a new source for information on MEDITECH's data sharing efforts, with the debut of the Interoperability and EHR Initiatives portal on meditech.com. The goal of this product resource page is to provide the health care community with the latest information on MEDITECH's interoperability initiatives, our Health Information Exchange (HIE) models, updates on national-level EHR initiatives, and more.

As you navigate through the portal, you will find an abundance of information on a variety of topics, including product news, customer success stories, and organizations MEDITECH is actively involved with. You'll also find flyers, videos, and presentations which provide detailed overviews of MEDITECH's interoperability products and initiatives in the resource library.

In addition, this portal is your one-stop-shop for information on industry trends, as well as national Electronic Health Record (EHR) standards and requirements. As the country continues to move toward interoperable EHRs, MEDITECH remains committed to following these developments and to helping our customers achieve their data exchange goals.

More info: http://www.meditech.com/aboutmeditech/pages/newsinteroperabilityportal.htm

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Recent News: Characterizing the Health Information Technology Workforce: Analysis from the HIMSS Analytics™ Database

April 17, 2008 -- By William Hersh, MD, and Adam Wright, PhD

The latest HIMSS analysis reveals an increase of 40,000 IT professionals to the workforce is needed to adequately use advanced technology to control costs, decrease medical errors and improve patient care.

More info: http://billhersh.info/hit-workforce-hersh.pdf

Worth a Read: Articles of Interest to the Healthcare IT Field

Future State
One-on-One with Newt Gingrich
HealthCare Informatics, April, 2008

A strong proponent of IT as a solution to our healthcare woes, Newt Gingrich shares his vision for changing the way healthcare is handled in our country.
Read article

Turning Crisis Into Opportunity
By: Daphne Lawrence
HealthCare Informatics, April, 2008

Using a separation from the parent organization as an opportunity to rebuild a top notch financial system, Christ Hospital in Cincinnati found that a fresh implementation of their current parent vendor brought many advantages.
Read article

The Art of the Project
By: Mark Hagland
HealthCare Informatics, April, 2008

Project Management has become vital to CIO’s and IT executives when planning projects within the context of the organizations strategic priorities. This articles looks at two Healthcare systems that not only created a formal project management offices, but also trained all of it’s IT professionals in project management methodologies.
Read article

Trouble at the Bedside
By: Kate Huvane
HealthCare Informatics, April, 2008

What do we do with nurses who are frustrated by unreliable and unwieldy point of care data entry systems? This article looks at how the collaborative process between nursing and IT can promote the duality of ownership and effectively utilize technology to advance workflow efficiencies.
Read article