White Papers

Implementation Testing Is Over. Now What?

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You have just released an EMR upgrade that fixes several issues that have been a problem for your organization for quite some time. In the beginning, all seems well and good, but then the Help Desk starts to get flooded with issues that you were not even aware were part of the upgrade. Then you start getting calls from angry Directors and Vice Presidents asking “did you even test the system before you added the new fixes?” You are thinking “where did we go wrong?”

In order to conduct good testing, you need to make sure you plan well in advance. During this planning phase, you need to analyze the upgrade notes and any new scripts that the vendor may provide. When analyzing the new upgrade, identify the existing workflows/processes and other external systems that will be impacted and the timeline for the testing phase. You will also want to start developing test cases and scripts ensuring that you are testing the entire workflow along with any external systems.

 

Coordinating Care Across the Healthcare Continuum

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Consumer-driven demands on healthcare coupled with the economic and political realities are resulting in a new definition of how best to provide healthcare in the United States. We also need to understand that there are multiple consumers to consider and that new delivery models are needed that can address the respective expectations and needs of these groups.

The complexity of the problems facing healthcare systems in meeting these evolving demands is a daunting challenge even for the most sophisticated and well-run organizations. Accountable Care Organizations (ACOs) or similar organizational risk-sharing relationships are rapidly emerging as a preferred approach for garnering the support of patients, providers and payers for optimizing care. For ACOs to be completely effective, the depth of preparation and fully understanding the complexities surrounding the diversity of care that ACOs need to address must be understood and incorporated into the organization’s fabric for it to succeed.

 

Biomedical Device Integration. Getting Vitals Where and When Its Needed Most

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In the world of medical technology, increasing connectivity across care settings to get vital real-time patient health information into electronic medical records (EMRs) is of growing importance with the accelerated adoption of EMRs occurring across the country. As The Centers for Medicare and Medicaid Services (CMS) sees their Meaningful Use of Electronic Health Records (EHRs) program helping increase the procurement and implementation of EHRs across eligible hospitals and eligible providers (48% and 19% respectively that have received incentive payments through May 2012),i the opportunity for biomedical device integration (BMDI) is becoming ever more important. In this white paper, we provide some insights to key issues in BMDI implementation, a case study on Sentara Healthcare and how they have managed their BMDI program, and benefits from BMDI implementations.

 

Getting the Most Out of Your Epic EMR Training Program

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Even the best-planned, financed, and resourced electronic medical record (EMR) implementation projects have unexpected issues; however, one thing should be expected and planned for in every EMR implementation – system training. It is critical that all personnel – from administrative staff, to physicians, to clinicians – be trained efficiently, effectively, and in a timely manner on the new system. Lack of proper and effective training can sabotage even the best EMR implementation projects.

At Divurgent, we understand how important a well-designed and implemented training program is to an EMR’s success. We have developed a comprehensive Training Program Methodology that is based on years of experience, takes into consideration the unique requirements of each client, and has proven effective regardless of organizational size or implementation complexity.

 

Clinical No-Show Rates. Is Technology a Contributor?

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Following the 2001 Institute of Medicine’s landmark report “Crossing the Quality Chasm: A New Health System for the 21st Century”1, a great deal of attention has been given to the transformation of care. With the implementation and utilization of technology involved in most transformational efforts, many processes can be streamlined and made more efficient. However, implementation of technology can also have a disruptive affect as well as unintended consequences.

This study will examine the current body of literature surrounding patient “no-shows” to a medical appointment and will look at how one system’s transformation of care, involving implementation of electronic scheduling and electronic health record, disrupted many aspects of transitional care, ultimately leading to a higher no-show rate.

 

Consumer-Centric Healthcare. Consumer-focused Initiatives Offer Opportunities and Challenges for Providers.

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Consumer-centric healthcare initiatives have never been more important. Healthcare executives must keep the consumer’s perspective in mind—including baby boomers and generations X and Y—when evaluating the direction for new programs, partnering initiatives and planning for their organizations.

In our book, Consumer-Centric Healthcare: Opportunities and Challenges for Providers (Health Administration Press, 2010), we focus on initiatives that..

 

Implementing an EMR – A Client / Vendor Perspective

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Implementing an Electronic Medical Record (EMR) is a huge undertaking. Any project manager can tell you that there are too many moving parts for one person to get all of the work done alone. Proper planning and preparation improves project quality, positions the implementation for success, and ultimately reduces support costs. Choosing the right partner early in the process, and working together to identify, implement and improvise will help ensure an on-time, on-budget, successful Activation.

Below are two viewpoints, one from the client and from the vendor, which contributed to a successful EMR implementation.

 

DIVURGENT’s ACORM Framework, The Right IT Infrastructure for ACOs

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After reading the final rule for Medicare Accountable Care Organizations (ACOs), one might conclude that the IT infrastructure needed to support an ACO is too daunting to build. CMS alludes to dozens of technological documents and processes in the rule, including electronic health records (EHRs), personal health records (PHRs), telehealth, health information exchanges (HIEs), data warehousing, analytics, and member registries. The resulting ACO IT platform would involve a very complex and expensive implementation. In fact, Medicare’s estimate of $1.75 million for ACO infrastructure is a low estimate for most healthcare organizations. Healthcare organizations are likely to spend many times that amount to properly implement all the IT elements envisioned for Medicare ACOs. Furthermore, since implementing this type of ACO platform would require technology not readily available in the present marketplace, a considerable amount of custom development would also be needed.

 

Mobile Applications in Healthcare

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One in five mobile phone owners today owns a smartphone,1 a trend that is on the rise as consumers increasingly use these devices as handheld computers. Not surprisingly the number of consumer smartphone applications (apps) that were downloaded went from 300 million in 2009 to five billion in 2010.2 With mobile devices outnumbering personal computers,3 we are approaching the point where they will be the most common way to access data.

 

The Role of Patient-Centered Tools in ACOs

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When the U.S. Department of Health and Human Services released new rules to help health care providers better coordinate care for Medicare patients through ACOs, involving patients was an important issue. Since the goal of an ACO is to deliver seamless, high quality care for patients – a model that will eventually be adapted more widely – it’s difficult to conceive of an ACO without involving patients. In fact, the name Accountable Care Organization implies accountability and therefore participation on the part of the patient. Looking ahead, it’s likely that Patient Health Records (PHRs) will be included in Stage 2 of Meaningful Use. “PHRs, like CPOE and bar coded medications, are considered to be part of the right answer for our healthcare system,” said David Shiple, Senior Consultant at DIVURGENT a national healthcare management consulting firm. PHRs fit in perfectly with the spectrum of care offered by ACOs; just as providers are connected in an ACO, these systems offer an avenue for patients to connect as well. They are destined to become the tools that will be utilized to help make patients accountable for their care.

 

Virtual Integration: The Role of the Electronic Medical Record

Click here to to download a PDF version of HIMSS’ Summer 2011 JHIM. Article on page 56 

In today’s healthcare environment, physician-hospital integration is an important strategy for delivering efficient, affordable healthcare and improving health outcomes. Virtual integration utilizing electronic health records (EHR) has the potential to create solid alignment between hospitals and physicians that strengthens their relationship and allows for improved patient care. Relaxation of the Stark regulations, which allows hospitals to donate up to 85 percent of EHR-related software and services, paves the way for utilizing EHR technology and implementation to integrate with community physicians.

 

Meaningful Use Requirement for HIPAA Security Risk Assessment

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The Health Information Technology for Economic and Clinical Health Act (HITECH), set forth by Title XIII of the American Reinvestment and Recovery Act of 2009 (ARRA), not only defined requirements for meaningful use of electronic health records but also set forth numerous modifications and enhancements to the Health Information Portability and Accountability (HIPAA) information security and privacy standards.

 

Lessons Learned: Avoiding Some of the Common Pitfalls of EHR Activation

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Healthcare organizations across the U.S. are moving towards the adoption and “meaningful use” of electronic health records (EHR) to improve care, reduce costs, and improve organizational efficiency. This is due in large part to the HITECH incentives; however, upcoming changes in the standards for electronic health care transactions, such as the ICD-10 coding requirements on all HIPAA transactions, are also increasingly proving significant drivers for adoption.

 

Evolution of Care Delivery – Accountable Care Organizations and Preparing for Implementation

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Physician practices, hospitals, and payer organizations have worked together to advance a new healthcare service model to improve quality, efficiency and cost of care. This article describes some of the currently known requirements for establishing this new model called the accountable care organization (ACO) under the forthcoming Centers for Medicare and Medicaid Services (CMS) ACO program. Potential benefits from implementation are discussed along with challenges that include: management of the ACO, technology infrastructure (electronic health records (EHR) and health information exchange (HIE)), equitable distribution of savings, maintaining patient volumes, and financing of care.

 

Social Media in Healthcare: An Addicting Phenomenon

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Who knew five years ago that tweeting could save lives and Facebook posts would boost business? Who expected a social networking site like LinkedIn to be a treasure box to recruiters? The idea that eVisits, electronic consultation between physicians and patients, will be able to replace doctor visits and become a mandatory benefit for physicians has emerged due to the rapid growth of technology.

 

Using Strategies from the Nuclear Power Industry to Improve Patient Safety

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Ever since the Institute of Medicine released its pivotal report “To Err is Human: Building a Safer Health System” in 1999, much attention has been focused on improving patient safety. Tens of thousands of patients die each year as a result of medical errors, two-thirds of which are preventable.

 

CPOE Project Management

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The current healthcare reform bill is pressuring healthcare systems to satisfy the HITech Act, a portion of the American Recovery and Reinvestment Act (ARRA), and meet the requirements of meaningful use. CPOE, computerized physician order entry (or as CMIOs like to call it, computerized physicians order management), must be completed by 2017.

 

Flying Lessons: Crew Resource Management in Healthcare

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In 1977, two Boeing 747s collided on a runway in the Canary Islands, killing 582 people. It was the largest accident in aviation history and it led to an industry-wide examination on the cause of aviation accidents. It turned out that up to 80 percent of aviation accidents were caused by human error. This revelation prompted NASA to convene an aviation safety workshop in 1979, which led to the development of Crew Resource Management (CRM), an error-reducing method that has revolutionized air travel safety. In following aviation’s lead, CRM was first applied to healthcare in the operating room of University Hospital in Basel, Switzerland, in 1994. In 2001, the IOM recommended that this type of training be used to increase patient safety and it also advocated by the National Academies, the Agency for Healthcare Research and Quality and the Institute for Healthcare Improvement. Today, CRM training programs are being used in a variety of healthcare settings, including operating rooms, anesthesia departments, emergency departments, intensive care units, and labor and delivery departments.

 

Designing your EMR Training Program

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Even the best-planned, financed, and resourced electronic medical record (EMR) implementation projects have unexpected issues; however, one thing should be expected and planned for in every EMR implementation – system training. It is critical that all personnel – from administrative staff, to physicians, to clinicians – be trained efficiently, effectively, and in a timely manner on the new system. Lack of proper and effective training can sabotage even the best of EMR implementation projects.

 

Critical Success Factors For Successful ECM System Selection

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With healthcare reform at the top of our current administrator’s agenda and widespread electronic medical record (EMR) adoption at the forefront of the American Recovery and Reinvestment Act (ARRA) of 2009, the move toward digital accessibility of information is the reality for today’s healthcare organization (HCO). Comprehensive patient information must be available in a secure, central location to those who need it, when they need it, and where the need it.

 

How One Healthcare Organization Successfully Achieved Physician Adoption

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Today, widespread adoption of the EMR is at the forefront of President Obama’s healthcare reform strategies as evidenced by the American Recovery and Reinvestment Act (ARRA) of 2009, signed into law in February 2009. This economic stimulus package provides incentive payments for physicians and hospitals that adopt EMR systems. As expected these incentives come with a timeline and are not without conditions, with penalties levied on health providers who have not yet installed EMR systems beginning in 2015. So, if the consensus is that the EMR can, and will, fundamentally change healthcare, why is it only a small number of U.S. physicians have adopted these systems (and for those that do, 1 in 5 of these efforts will fail or stall)?This paper presents a case study of how one health care provider (HCP), Sentara Healthcare (Sentara), effectively implemented an EMR and credits much of its success to one thing, engaging physicians in the adoption process.

 

System Selection: Aligning Vision and Technology

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President Obama’s recent allotment of roughly $20 billion for health information technology (HIT) has healthcare information technology (IT) professionals and provider organizations across the U.S. reconsidering long-deferred IT projects. Whether embarking on the monumental task of an electronic health record implementation, or simply replacing an out-of-date billing system, it is imperative to select the vendor and system whose strengths are most in line with organizational vision and functional needs.

This paper discusses a system selection methodology for aligning the provider organization’s strategic vision, goals and objectives with the proposed technology solution being purchased from the vendor.

 

Organizational Structures for Clinical Transformation

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The healthcare industry is in the process of transforming itself using technology. These transformation efforts focus on moving from manual processes, often based on historical practices, to technology-enabled or even automated processes. The overall effort involved in such a transformation creates a tremendous amount of disruption to all aspects of the organization, creating the absolute need for a commitment to managing change.

This paper explores, through case studies, the clinical and cultural considerations in implementing and managing workflow changes at three large healthcare systems.

 

Business Intelligence: An Essential Tool for Every Healthcare Organization

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Market pressures continue to make it harder for healthcare organizations to maintain a positive bottom line. Decreasing reimbursements, increased costs, and the desire to increase quality at any expense are having a major impact on the bottom line. Organizations are investing millions in computer systems, diagnostic technology, and preventive care programs in an attempt to meet organizational goals. Are they working?

 

Developing a Project Management Office: Ten Lessons Learned from the Trenches

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The number and complexity of projects occurring simultaneously within even a moderately sized integrated delivery network can be staggering. In order to deliver these projects on time, within scope, and on budget, the establishment of a PMO is essential.

This paper identifies the ten critical success factors (lessons learned) identified during our team’s years of combined experience managing projects and establishing health care PMOs.

 

New Frontiers in Home Telemonitoring
Journal of Healthcare Information Management / Volume 22 / Number 3 / Summer 2008

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Home-monitoring technology is a somewhat rare example of highly effective healthcare information technology that patients “get.” Clinical and IT professionals throughout the United States and Europe demonstrate that patients quickly understand and grow to value telemonitoring as a tool to take charge of their own health. Healthcare providers involved with home telemonitoring programs report significant direct and indirect benefits for all stakeholders, as well as a number of lessons learned when working with patients, clinical and medical staff, healthcare administrators and board members and third-party payors. Despite decades of successes, health telemonitoring technologies are still relatively untapped. However, new technologies are reaching the marketplace. Demographic and regulatory shifts are pushing stakeholders toward a new frontier in telemonitoring. Based on their own experiences and an extensive literature review, the authors conclude: the new frontier of home telemedicine is here. Where are you?

 

Improvements in the Emergency Dept.: Understanding and Managing Computer Simulations

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Changes to any emergency department- large or small, rural or urban, busy or, well, busy-cause numerous and sometimes unforeseen consequences to healthcare delivery. Whether change is deliberate or is visited upon a provider from outside forces, it will impact patients, staff and the community. Computer simulations offer a safe and cost-effective way to experiment with changes to processes, staffing and even the footprint of a department or entire hospital. In this way, simulations guide administrators in making the best decisions for their facilities.

 

IT Training for End Users

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Many healthcare systems are weighing multi-million dollar technology investments. In an industry with slim margins and demands for better access to affordable high quality care, executives must know the expected costs and benefits of all facets of its information technology investments, as noted in an earlier DIVURGENT white paper.

Training of staff and clinicians in the use of new healthcare information technology (IT) is a significant and important component of a thorough analysis of costs.

 

Understanding the Total Cost of Ownership (TCO) Analysis for IS in the Healthcare Setting

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In an industry with slimming margins and increasing demands for quantifiable results in every business and clinical area, it is increasingly important for healthcare organizations-and the internal “owners” of budget line items-to identify in a compelling way:

the total cost of ownership of specific investments and
the benefits expected over the life of the application.

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