Volume 4 - Issue 1 - February 2009

Editor's Note

By: Donna Carroll
Editor - The MEDITECH Community Bulletin
VP, Business Development & Recruitment - Systems Personnel

Welcome to 2009! Okay, I know I'm a bit late here, but since we didn't publish a newsletter in January, this is the first issue of The MEDITECH Community Bulletin this year.

What many of you may have already noticed is that we have a new web site. We've re-designed our site to provide a number of improvements and new features, including:

• Improved Layout & Navigation: We've re-designed the layout of the newsletter to make it easier to read. Navigation has been simplified by the use of menus on the site. Across the top is the main navigation bar where you'll find the major sections of the site: About, Current Issue, Archives, Careers, Resources, Subscribe, and Contact. Along the left side of the site are individual menus which list the different categories of the newsletter.

• Site Searching (powered by Google): In the top-right corner of the site, you'll find a Google search box. Using their search engine, you can now quickly find whatever you're looking for on our site. NOTE: At the time of this writing, Google is still producing search results from the old web site. This issue should resolve itself in a couple of weeks when Google re-crawls our new web site and indexes all of the pages. Although the hyperlinks on the results page do not currently work, the content can still be accessed on our new site. Simply read the URL listed for each search result and go to that newsletter issue in the 'Archives' section.

• Emailing of Articles: This is a new feature which allows you to email an article or the entire newsletter to a friend, colleague, or yourself. Each newsletter issue and individual articles contain an 'Email' button at the top of their own page. Click on the button to send a hyperlink of the item to anyone via email.

• Improved Archives: Past issues of the newsletter in its entirety can be found in the 'Archives' tab on the main navigation bar. In addition, individual articles of past issues can be found in their own archive section under the 'Columns' menu.

• Re-design of MeditechCareers.com: Previously, we had a separate web site for MeditechCareers.com. We have now integrated MeditechCareers.com into this new web site, and it can be found via the 'Careers' tab in the main navigation bar. MeditechCareers.com is already recognized as a niche publication with a very targeted audience of MEDITECH professionals. Integrating it within our newsletter site provides our customers even greater visibility for their 'Featured Employer' posting. We've also re-designed the layout of the MeditechCareers.com section to provide a better presentation, easier navigation, and search-engine-optimized pages.

• Links & Resources: This is a new feature to our newsletter. The 'Resources' tab on the main navigation bar will give you a list of useful 'Links & Resources'. Categories include Consulting Services, Developer Resources, Industry Associations, Industry Publications, Software Vendors, and User Groups & Forums. If you'd like to suggest a link to be included, please tell us by using the 'Contact' page in the main navigation bar at the top of the site.

• Subscribe & Contact Pages: The main navigation bar contains tabs for 'Subscribe' and 'Contact' pages, making it easier for you to contact us. These pages allow you to subscribe, unsubscribe, change your email address, offer suggestions, ask questions, or provide us your feedback. We'd enjoy hearing from you!

• Just for Fun! Page: This is a revised feature of our newsletter. The 'Just for Fun!' page has replaced our previous 'game of the month' and can be found under the 'Columns' menu. This page is purely for fun...because everyone needs a coffee break now and then.

Most of these changes have been made in direct response to your suggestions and feedback...please keep them coming. Now in Volume 4 of its publication, we hope The MEDITECH Community Bulletin continues to be a valuable resource for you, and we thank you for your support.

Wishing you all a healthy and prosperous 2009,
Donna

Industry Spotlight: RAC is Coming: How to Survive

By: Kay Jackson, Financial Marketing Manager, Iatric Systems, Inc.

RAC IS COMING

What is RAC? The acronym stands for Recovery Audit Contractors, a group of companies selected by CMS (Centers for Medicare and Medicaid Services) to help identify and collect improper Medicare overpayments, as well as identify and reimburse underpayments.

Overpayments have well exceeded underpayments thus far, and CMS has begun recouping large sums of money from hospitals. California, Florida and New York were selected as pilot states for a RAC demonstration period, which is now complete. On January 9, 2009, results from the RAC demonstration period were released. Total overpayments collected were $992.7 million. The RAC process has proven to be a profitable one for CMS, costing only about 20% of every dollar recouped.

As noted on CMS’ website, Section 302 of the “Tax Relief and Health Care Act of 2006” makes the RAC program permanent, and it will be expanded to all 50 states by 2010. So, make no mistake about it. RAC is here to stay. When will your hospital face its first RAC audit? Dates have changed and vary by state. Contact me for an up to date National RAC Rollout timeline. No matter what the date will be, now is the time to prepare.

HOW TO SURVIVE

While RAC is a somewhat dreaded reality, it can also have a positive impact on your hospital. When properly implemented, your RAC policies and procedures can provide attention to areas within your facility that need process change, from patient care to billing and coding.

RAC audits are separated into regions A-D, and regions are divided by state and by RAC audit companies. There are 4 RAC regions and 4 audit companies. Regions A and B will be audited by Diversified Collection Services, Inc. (DCS), and CGI Technologies and Solutions, Inc. Regions C and D will be audited by Connolly Consulting and Health Data Insights (HDI), who were involved with RAC audits during the demonstration period. RAC audit companies are paid based on a percentage of the amount of dollars they recoup.

Here are a few other general RAC facts. RAC audit companies cannot subject claims submitted before October 1, 2007, to RAC review. Furthermore, there is a blackout time if your hospital has recently moved to Medicare Administrative Contractors (MAC). Hospitals should appeal any and all denials that are deemed incorrect after review by your hospital’s RAC Review Team.

One question commonly asked is, “Should our hospital allocate reserve funds to cover the possibility of recoupment due to RAC?” Some experts suggest you make an estimate based upon 2% of your Medicare payments for each year and retain this total over and above normal reserves. Others suggest review of your current CBR (coding, billing and reimbursement) compliance activities. Please refer to “Compliance for Coding, Billing & Reimbursement – A Systematic Approach to Developing a Comprehensive Program”, a book by Duane C. Abbey, for guidance on this subject.

Below are more detailed RAC facts, together with additional recommendations on how you can survive:

• Complex audit requests from RAC require submission of medical records. Include all documentation that supports your coding and billing, and include a cover letter for each request. Form a RAC Review Team to review all documentation that you submit and do not miss the 45 day deadline. If you miss the deadline, the RAC audit company will start the recoupment process. Your RAC Review Team could also review all denials and make the decision about whether or not to move forward with an appeal whenever necessary.

• No more than 10% of your average monthly Medicare claims (with a maximum of 200 records) can be requested within a 45 day period. Track records requested for complex review, as well as accounts selected for “auto” review (where a determination will be made by the RAC company without submission of the supporting records).

• If an account was previously reviewed by your Medicare payer, it cannot be audited by RAC. So, I suggest placing a flag on accounts to alert your RAC team of this fact.

• The RAC audit company is required to reimburse the hospital 12 cents per page for printed copies of submitted records and should pay within 45 days. You should not need to bill the RAC company for these fees. I would suggest tracking the expected reimbursement for the records until you have confidence in the RAC process for payment. Records can be submitted on a CD vs. hardcopy.

• Setting up your RAC Review Team doesn’t have to be difficult. Team members should be strong and knowledgeable. I have authored a document on how to set up the team, including who should be on the team and what each job duty should be. You can request this document free of charge by writing to me at kay.jackson@iatric.com. The number one key is to have a multidisciplinary team in place for RAC review.

• Your RAC liaison is a key member of your team. Inform your RAC audit organization of the name and address of your primary RAC liaison, so all request letters and documents are sent to one person. The duties of your RAC liaison may become full-time as the program progresses, so choose wisely for this key position. Some sites have elected an HIM staff member, some a Case Management member and others someone from PFS. This liaison must have the backing and support of senior management and report to said management on a monthly basis.

• AHA (American Hospital Association) will be a key player for the RAC rollout. Your state’s AHA and RAC audit company will work together to educate providers using methods such as town hall meetings. Another advantage that AHA will bring to the table for your site is a survey question program they will launch to secure data from all hospitals (whether AHA members or not). AHA will compile all data and work for the good of all hospitals regarding RAC issues. Your organization will want to participate in these activities.

• The appeal process is a 5 level process, and each level has its own time frame and requirements. Interest can accrue if you are not successful in your appeal. The most recent statistics reveal that 22.5% of RAC determinations were appealed, and of those appealed, 34.0% were successful. You can optimize your chances for success. Read Transmittal 144, which provides details on the Appeals Activity Form (CMS-2592). Track timelines for each process and keep proof, such as the envelopes the complex records request came in, a copy of all documents sent for audit as well as the certified receipt of the records sent showing that the records were received and received on time. Familiarize your team will all RAC deadlines and requirements, track deadlines and if necessary, ask for an extension on cases that requires more review time.

• The process for appeals for RAC determination is largely the same as the standard CMS appeals process for MAC (Medicare Administrative Contractors) claims. One significant exception is that all RAC first-level inpatient appeals will be handled through the fiscal intermediary that processed the claim; for MAC claims, all first-level inpatient appeals are handled through the Quality Improvement Organization. There is a very detailed RAC Appeal Process Timeline that I can send to you upon request.

This article has just a few of the facts that your team needs to be aware of to prepare for RAC audits. Be sure to check out CMS RAC FAQs on their webpage. It is a great source of info, and it gives you the ability to ask your own questions, too. The National Medicare RAC Summit is scheduled to be held in March, and you can attend the two day session from your office via the internet to save on travel costs.

When it comes to RAC:

• Be well educated
• Establish a RAC Review Team and thorough RAC procedures
• Optimize coding, billing and reimbursement
• Appeal whenever a RAC audit is incorrect

Remember, only you and your team can protect the revenue of your hospital!

Additionally, Iatric Systems offers IatriTRAC, a solution to track RAC at hospitals that operate the MEDITECH HCIS. To see a demonstration of IatriTRAC, please contact info@iatric.com, or attend one of our upcoming public webcast demonstrations on:
- Wednesday, March 4th, from 2:00-3:00pm Eastern
- Tuesday, March 10th, from 2:00-3:00pm Eastern

Kay Jackson is a Financial Marketing Manager at Iatric Systems, Inc. For 15 years, she was in management at third party payer companies developing methods for delaying and denying medical claims submitted by hospitals. When she “saw the light” she moved into the hospital environment, where she had 10 years of management in Scheduling, Access, Patient Accounts and Case Management. For 8 years, Kay consulted on strategic hospital planning, redesign of Access and Patient Accounts processes, and developed software for the admitting and business offices. Kay has been a requested speaker at over 100 conventions, and her speaking engagements include many RAC educational sessions. Kay is also an AHA RAC vendor participant. For more information, visit them online at http://www.iatric.com/.

Customer Spotlight: Gaylord Hospital Executives Gain Insight with MEDITECH Healthcare Dashboards

With the growing adoption of EMR & CPOE, MEDITECH community hospitals face reporting challenges when shifting from a single ERP system to multiple data systems.

Administrators at Gaylord Hospital (Gaylord) know that its overarching goal of providing safe, effective, efficient patient care requires careful attention to data management, quality measures, and national healthcare standards. As national reporting demands increased and the number of the hospital's data sources grew, Gaylord sought a business intelligence solution to streamline and enhance both internal and external reporting and analysis. Using tools from Business Objects, database and reporting experts at Golden Consulting (Golden) helped Gaylord implement an efficient, flexible, and user-friendly reporting and dashboard system. The hospital's goal is to develop executive dashboards to monitor their quality performance and ultimately improve quality patient care.

The Hospital

Located in Wallingford, Connecticut, Gaylord Hospital is a long-term acute care hospital (LTAC) specializing in the care and treatment of medically complex patients, rehabilitation and sleep medicine. Gaylord is staffed and equipped to handle the specific needs of acutely ill or chronically disabled patients whose average length of stay is at least 25 days. The hospital is also able to treat those who need rehabilitation for illnesses or injuries related to the brain and nervous system, bones and joints, lungs, and other conditions. Licensed as a 109-bed chronic disease hospital, Gaylord admits more than 1,000 inpatients each year and offers over 50 outpatient services.

The Challenges

Gaylord was on the verge of deploying two distinct EMR applications to meet the clinical documentation needs of both its inpatient and outpatient services. Consequently, Gaylord faced the challenge of integrating two distinct billing systems. The finance staff sought a solution that would integrate these disparate data sources in order to provide a unified picture of Gaylord's patient population data that would transcend the artificial segmentation created by the two EMR systems. Financial managers needed to analyze, track and report on patient utilization, revenue, quality, and costs across the entire continuum of care, and to communicate that information effectively to hospital executives, payors and providers.

Like many small- and mid-sized community hospitals, Gaylord had used MEDITECH as its primary hospital information system (HIS). MEDITECH had dedicated modules to meet much of the hospital's needs — clinical, billing, GL, Accounting, human resources — in one centralized data system. Crystal Reports was the primary tool used to produce reports from the MEDITECH repository.

The deployment of electronic medical records (EMR) meant that Gaylord's data was now generated from multiple data sources. Business Analyst Randy Whelan recalls that executives were trying to make decisions based on data from three or four different data sources, each using a different report writing tool. "The reports were all trying to look at the same information, but they would generate different numbers" Whelan explains. "We needed a tool to nail down the correct information."

This proliferation of data sources came at a time when increasing national reporting requirements were making accurate, comprehensive reporting more critical than ever before. The Centers for Medicare & Medicaid Services (CMS) compels hospital administrators to report CORE quality measures, and the National Association of Long Term Hospitals (NALTH) now requires quarterly CORE measure and financial data submissions in an effort to benchmark hospitals against one another. "Under a Value Based Purchasing model, CMS is transitioning their "pay for reporting" initiative to a "pay for performance" plan. In the future, hospitals will receive a financial incentive for meeting or exceeding quality benchmarks," explains Pat Salem, Golden's Vice President for Healthcare Planning and Business Intelligence.

Gaylord administrators anticipate that their hospital's Medicare and Medicaid reimbursements will soon be tied directly to its CORE measure performance. Furthermore, much of the NALTH quality data was housed in stand-alone Access databases and Excel files throughout the organization, which made it a nightmare to collect, analyze and report.

Behind the scenes, Whelan was manually compiling, customizing, and distributing over 300 Crystal Reports within the hospital each month. This effort left him little time to manage the EMR implementation or develop a better data management system in order to comply with the new NALTH reporting requirements.

Golden's Smart Solution

Gaylord needed a comprehensive business intelligence tool from a vendor who understood the unique needs of healthcare organizations. As a Business Objects Platinum Partner, Golden offered a dedicated team of dashboard designers, database experts, and report developers with both managerial and technical hospital-industry expertise.

To integrate Gaylord's disparate data sources, Golden deployed BusinessObjects Edge Professional, a comprehensive business intelligence platform designed for mid-sized organizations. By creating a metadata layer, Edge Series connects source data from multiple systems like MEDITECH and eClinicalWorks. Eventually, this solution will allow Gaylord to create interactive dashboards that will take the integrated data to the next level, i.e., near real-time visual representations of key quality, financial and operational performance indicators, like the CORE measures, charges, and percent occupancy.

"During the initial proof-of-concept meeting — even before the actual implementation began — Golden's consultants presented an initial dashboard which raised a 'red flag' regarding an important aspect of our data collection," Whelan recalls. "Our executives were impressed, and as we saw more and more of the solution, they were even more enthused."

The Results

Interactive tools like Gaylord's new census and patient occupancy dashboard put critical operational metrics at executives' fingertips. They are now alerted when the patient census reaches a critical threshold, which provides an opportunity to take action before reduced patient flow creates major bottlenecks. Data which formerly updated only at midnight now updates automatically every five minutes, and management no longer spends time manually manipulating spreadsheets and PowerPoint slides just to get a visual representation of data.

Golden's deployment also streamlined Gaylord's Crystal Report distribution. "I used to spend half a day each Monday just distributing reports," Whelan recalls. Now the production reporting features of BusinessObjects Infoview — scheduling, publishing, security — mean that weekly, monthly and quarterly reports now run automatically, and the information is more accurate than before.

In the near future, Gaylord is preparing to launch a NALTH quality dashboard to integrate all of the hospital's quality indicators to allow for core measure reporting directly into the NALTH submission file. "These dashboards will empower users with time-sensitive information required to make critical decisions that will impact patient care and the bottom line," notes Salem. "BI tools that were once used only by large academic medical centers are now packaged for the mid-market community hospital, clinic or physician practice."

Later phases of the implementation will compile EMR from all three areas of the hospital — inpatient, outpatient, and sleep medicine — for a more complete understanding of the patient utilization and outcome data. Since different areas use different data systems, physicians are unable to get a comprehensive picture of a patient who had transitioned through multiple service areas. "Our source data is all over the place," explains Whelan, "but the metadata layer will allow the different systems to 'talk' to each other."

With help from Golden and Business Objects, Gaylord will continue to remain at the forefront of quality patient care. Whelan has already received requests for business intelligence functionality from other hospital departments, and he anticipates eventually rolling out solutions to the marketing and human resources departments. "Compared to the rest of the IT world, hospitals are typically not up to speed," remarks Whelan. "This Business Objects implementation is a proactive step that will keep Gaylord ahead of the curve."

To learn more about Gaylord Hospital, visit them online at www.gaylord.org.

To learn more about Golden Consulting Group, visit them online at www.goldencg.com.

Guest Spot: Doing More with Less
Seven things you can do with a small investment to save big

By: Margaret Mayer, Director, Boston Software Systems

Hospitals around the world are feeling the results of the economic downturn and the consequences are massive budget cuts and hiring freezes. Squeezed between tough economic times, a complex revenue cycle and demands for improved patient care, hospitals are under growing pressure to do more with less. With minimal time and money, you can start to relieve the pressure for your staff, systems and bottom line.

Like tossing your spare change into a piggy bank, the small things you do to reduce resources and time-to-revenue can add up to significant savings. We'll look at how using scripting technology to automate seven manual tasks plays a role in helping hospitals streamline processes and work smarter.

1. Report Generation

Daily, weekly, monthly, quarterly even annually – how many regular reports do the departments in your facility generate to manage business operations, patient census, or financial status? At South County Hospital in Rhode Island, CIO Gary Croteau has transferred the work of generating more than 50 daily reports, which are built via MEDITECH NPR and Microsoft Access, from the department managers by automating the process. Using scripting technology, all standard reports are automatically created and posted to an Intranet site as .pdfs. Now managers have access to the current and past reports at their convenience. No IT resource is required to run or manage daily report generation, allowing valuable staff to focus on areas of greater need.

2. Processing Purchase Orders

Ten hours each day. That’s how much time Computer Systems Specialist Michael Maggio at Woman’s Hospital in Baton Rouge, LA is saving by automating the purchase order process. The script searches MEDITECH once or twice a day for purchase orders that have been entered by various departments, and then checks inventories for items that have fallen below minimum reorder points. The script automatically creates a new PO or adds those items to an existing one. It then ensures that the PO meets minimum order and other requirements, and sends it to vendors electronically or via fax. Buyers receive email notification of any issues and can then add items to the order or hold it until that minimum is met. In addition to saving resources, Woman’s Hospital has eliminated unnecessary minimum order fees - penalties that had been costing more than $300 a month.

3. Cash Adjustment Posting

When Halifax Health Medical Center brought on the LSS Physician Billing & Receivables module, the goal was to bring the physician billing into its patient billing and financial services area and automate the cash posting adjustments for the physician billing. Transaction-based billing adds to the difficulty of cash posting in this environment, along with the possibility that contracts for hospitals and insurance companies may change every year. Correct patient co-pay on the account is critical to patient satisfaction when statements are distributed. On the management side, timely yet appropriate, adjustments are crucial to the facility in terms of revenue cycle management and A/R days.

If you had to allocate money to manually creating efficiencies, you probably wouldn't do it. It just takes too much time, too much money and too much manpower, to accomplish it. Fortunately, developing scripts doesn't take much time, and it creates operational efficiencies throughout the entire hospital. One significant benefit is a more productive and happy workforce, which translates to a higher quality of care in all facets of the organization.
- Bill Overbey, CIO/CFO at Hayes Medical Center

Halifax Health is running LSS with approximately 25 physician practices or departments. By automating the posting process, Halifax has saved the hospital approximately one eight-hour day per week from a posting representative. Without this automated process and the increased business, those hours could have risen significantly. The staff now has more time to post actual cash and analyze underpayments, which is more productive.

4. Employee Updates

One of the most common data entry tasks that occurs is updating employee files for annual raises. With anywhere from 1,000 to 5,000 employees in any one region, Christus Health, headquartered in Dallas, TX, needed four to five people, and more than a week of data entry, to accomplish this update. Using a script, the task is done accurately and in much less time. Often a single computer working 24 hours can automatically input the raises for an entire region’s employees (about 5,000 records), ensuring that they are rewarded in a timely manner. In addition, Christus automatically pulls personnel data from MEDITECH into the timekeeping application on a daily and weekly basis.

Other hospitals have used scripting to track and apply individual employee deductions. The script connects to a third-party Web site to transfer the file and then uploads it to MEDITECH for payroll – saving roughly eight hours per week.

5. Data Conversions and System Migrations

Greenwich Hospital in CT applied scripting technology to automatically convert registration information to centralized scheduling. More than 10,000 appointments already in MEDITECH needed to be converted into the proper time slots in a new scheduling module. The script automatically and accurately pulled appointments from a spreadsheet and uploaded them to the new scheduling application. This kind of conversion would normally take 700 man-hours or about $10,000. If it had been done on an overtime basis, it would cost the hospital $16,000. Greenwich developed the script in four hours and had it running by the end of the week.

6. Lab Registration

Robert Todd, Director of CareGroup IS at Mount Auburn Hospital and his staff realized that if they could pre-register specimen taken in the doctor’s office and headed to the hospital lab then the lab personnel could order the lab work needed without having to perform the registration based solely on the information delivered with the specimen. In addition, accurate pre-registration would save time and money by smoothing the billing process.

They developed a script which runs unattended and in real time to pre-register patients and/or specimen for lab work. The script automatically registers the patient into the hospital’s Meditech Magic system and produces an audit file detailing the number of records processed and any exceptions that were encountered. In addition, it formats and sorts an Excel™ spreadsheet that details all of the actual data sent from the physician’s office. Both files are produced daily, are date stamped, and the actual data is backed up.

"We've not only improved the quality of information that accompanies a patient or specimen to the hospital," commented Todd, "we have been able to realize faster turn-around in billing with fewer corrections and our lab personnel are ordering lab work instead of registering patients."

7. Streamline Billing

Wrong charges on the wrong accounts frustrate patients and slow revenue. Using scripting technology, Hayes Medical Center in Hayes, KS has eliminated the time-consuming task of reviewing each account, which may involve moving charges from one account to another when errors are found. In addition to saving staff time and improving accuracy, clinical staff doesn’t have to verify account numbers to accurately document services.

"Scripting has saved us time and money," said Bill Overbey, CIO/CFO at Hayes Medical Center. "If you had to allocate money to manually creating efficiencies, you probably wouldn't do it. It just takes too much time, too much money and too much manpower, to accomplish it. Fortunately, developing scripts doesn't take much time, and it creates operational efficiencies throughout the entire hospital. One significant benefit is a more productive and happy workforce, which translates to a higher quality of care in all facets of the organization."

The bottom line? Look around you. Anywhere you see someone typing data into an application there’s a potential for using scripting to automate that task. Automating these projects not only allows you to redirect staff to more productive work, it also ensures the accuracy of your data, which can save a bundle in billing.

Margaret Mayer has been focused on workflow automation and systems integration for the healthcare industry for more than 10 years. At Boston Software Systems, Margaret directs all marketing activities, including strategy and marketing communications. Prior to Boston Software Systems, she served as the VP of Corporate Marketing at New Era of Networks. Margaret earned a B.A. in English from San Diego State University, and post-graduate studies in advertising and marketing. She can be reached at margaret.mayer@bossoft.com . To learn more about Boston Software Systems, visit them online at www.bossoft.com.

Vendor Spotlight: GE Healthcare Provides Clinicians a ‘Gateway’ to Patient Vital Signs

A member of HCA’s TriStar Health System family of hospitals across Tennessee and Southern Kentucky, Skyline Medical Center is a two-campus facility offering a comprehensive range of high quality medical services. Skyline Medical Center’s main campus is located on a 59-acre site on the highest point in Davidson County, overlooking downtown Nashville, Tennessee. The 196-bed state-of-the-art facility features all private patient rooms and offers the most advanced medical and surgical technologies available along with personalized patient and family-based care.

In The TriStar family of hospitals, a commitment to healthcare technology and innovative new procedures is nothing new. They have been dedicated to finding better surgical procedures and to improving hospital systems for decades. In fact, today the hospitals that make up the TriStar family are recognized leaders in technology.

At the heart of TriStar hospitals’ healthcare technology is MEDITECH’s hospital information system, known throughout all HCA-owned facilities as Clinical Patient Care System (CPCS). CPCS is the electronic medical record system (EMR) that allows for sharing of patient clinical information with physicians and other providers involved in their care. CPCS eliminates the need to transport medical records from one facility to another or from one physician office to another. Physicians can access records in the hospital, in their office or in their home. With all patient clinical information in CPCS, the benefit to patients is that physicians and clinicians have access to patients’ entire medical picture, making it easier to diagnose and treat quickly.

Like most facilities, however, Skyline Medical Center faced a challenge when it came to documenting patient vital signs in CPCS (MEDITECH). Rynda Christensen, RN, Senior Systems Analyst, explains how retrieving information from patient monitors was done in the traditional way, "In order to get data from the monitor, the nurses would have to print a piece of paper, then sit down and manually enter it into our documentation system. It was very time-consuming." She continued, "And if you have a doctor sitting in his office and he wants to see what’s going on it’s only as accurate as the last person’s data entry."

To help address this challenge, the hospital integrated GE Healthcare’s Aware Gateway in two of its Intensive Care Units (ICUs). GE Healthcare's Aware Gateway is a bi-directional interface between GE patient monitors and the hospital information system (MEDITECH). This link enables nurses to review and confirm patient monitoring information that is then automated and sent to the rest of the hospital environment. Physicians are able to view the information almost instantly, from anywhere they can access the patient record, and use the data to make clinical decisions. Nurses are also able to spend more time at the patient’s bedside as opposed to spending hours documenting patient information.

Ms. Christensen, a long-time HCA employee, was working at Skyline Medical Center for seven years when the hospital sought a solution to streamline this process and improve workflow efficiency. She was a member of the Aware Gateway implementation team, comprised of ICU nurses, IT&S staff, and vendor representatives. Hospital Administration first expressed an interest in implementing the solution and Skyline became the pilot site for HCA to implement Aware Gateway in two of its ICUs. Since then, a few other HCA facilities have implemented Aware Gateway, with several others currently in the process of rolling out the product.

Ms. Christensen noted that communication was crucial to the success of the project. There needed to be constant communication with the users about the intent of the project—how it would improve their daily work routine. Nurses were consulted for their input regarding workflow issues and screen design.

Celecia Cutts, RN, Clinical Coordinator for critical care and neuroscience at Skyline, also referenced increased communication between nurses and physicians as a resulting benefit of the implementation. She explained that physicians can now receive the information on their handheld device or computer, helping to speed clinical decision making and leading to improved communication with nurses.

Nurses also found the system to be user-friendly and more efficient. While a few were initially resistant to the change, staff quickly adapted to the technology once they saw how easy it was to use.

About GE Healthcare’s Aware Gateway:

The Aware Gateway interface offers easy, bi-directional transfer of data between a Hospital Information System (HIS) or Clinical Information System (CIS) and patient monitors using the HL7 protocol standard.

• The Aware Gateway interface automatically sends trended vital sign data to almost any charting system, saving time, increasing nurse productivity, and providing a more complete picture of the patient’s condition.
• In addition, admission, discharge and transfer (ADT) data captured by a HIS/CIS is sent to the monitoring system, eliminating time and errors associated with manual data entry. The system transfers a growing list of over 285 vital parameters to the hospital’s HIS from bedside monitors and third party peripheral devices and reduces errors and lost time associated with manual entry of patient information at the bedside during admission.
• Aware Gateway collects data from up to 250 GE Healthcare monitoring devices connected to the Unity Network®, and seamlessly interfaces to HIS/CIS from leading vendors including GE Centricity®, Meditech®, Cerner®, Epic®, Visicu® and others.

To learn more about Aware Gateway and GE Healthcare’s monitoring solutions, visit them online at www.gehealthcare.com/us.

To learn more about Skyline Medical Center, TriStar Health System, or HCA, visit them online at www.skylinemedicalcenter.com, www.tristarhealth.com, or www.hcahealthcare.com.

Tricks of the Trade: Using Meditech Client Server NPR to Keep Everyone on the Same Page

By: John Sharpe, President, Comstock Software, Inc.

People agree on common definitions; except when they don’t. Example, healthcare professionals might define a PEDS patient as: a) a person under the age of 18, OR b) a person under the age of 14, OR c) another range. Without clearly defined terms, even the simplest and most common of things can get confusing.

Hospitals using the Meditech Client Server System use NPR Reports as a primary source of information. As NPR report writers, we can help by clarifying these terms at report run time.

The ‘General Population Report’ is a case in point. In this report, the terms ADULT & PEDS are clearly defined and available at the time the report is used. Let’s review the techniques used to customize the screen and present available choices.

Step 1: Define Custom Fields

We can use a custom field 'xx.population.segment' to present the ADULT / PEDS choice. Then use the 'xx.age.selection' field to do the work of selecting and filtering out records.

Both fields will be defined under the report Picture as custom fields.

xx.population.segment custom field definition:

xx.age.selection custom field definition:

Step 2: Define Choices

To present the ADULT & PEDS choices, use option 9. Entering a ‘Y’ to access the field attributes.

The CH attribute is used to build the list of items presented in a ‘Lookup’ box at report run time.

Step 3: Type Definitions

Using option 8, type in the definitions for ADULT & PEDS so that they are visible at report run time.

At run time, the report looks like this.

Now, when someone at the hospital is talking about the PEDS population report, everyone will be on the same page.

NOTE: If future report maintenance requires changing report SELECT fields, recheck this information as Meditech CS NPR clears out customizations when the SELECT screen is changed.

John Sharpe is President / NPR Consultant at Comstock Software, Inc. Learn more about NPR Report Writing at the MEDITECH NPR Report Writing Blog.

Featured Employer: Sponsored by MeditechCareers.com

The online career hub for MEDITECH professionals

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.

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

Centura Health
Penrose-St. Francis Health Services
Colorado Springs, Colorado

About the Organization:

Centura Health is Colorado’s largest family of hospitals and health care services and one of the state’s largest private employers, operating 12 hospitals, seven senior residences and home care and hospice services. As a faith-based organization, what distinguishes us more than size is our daily dedication to sensitively serving the sick, injured and elderly.

We seek to create a covenant of caring that improves the health of the people in our communities. As a not-for-profit organization, Centura has no shareholders to whom returns are distributed; all profits are reinvested in our mission and communities. By treating and touching the whole person—body, mind and spirit—our 12,000 associates transform each Centura facility into a healing sanctuary. We offer our patients a place of safety and skill that recognizes unique needs and nurtures each individual with excellence, integrity and compassion.

Join Centura Health, and follow your passions. At Centura Health, you can fulfill your passion for healthcare and your passion for life. The people of Centura Health help provide the highest quality care using the most sophisticated technology available in a faith-based, not for profit setting. Plus, with over three hundred days of sunshine a year, there’s no place in the world like Colorado. So come join the Centura Health family and help heal minds, bodies and souls. Because helping people is your calling.

About the Location:

Centura Health's headquarters are in Englewood, Colorado, located within the Denver Metropolitan area. Penrose-St. Francis Health Services, a part of Centura Health, is located in Colorado Springs, Colorado, about an hour’s drive south of Denver.

Colorado is an outstanding place to live and work, with world class skiing, cosmopolitan large cities, quaint mountain villages, and unmatched hiking and camping opportunities. Colorado enjoys four distinct seasons—and averages 300 days of sunshine per year—plus offers exquisite dining, wonderful spas and cultural entertainment.

About the Department:

At Penrose-St. Francis Health Services, in Colorado Springs, Colorado, we are continuing our transition to MEDITECH that began just over a year ago, and have a training and support opportunity available. At our headquarters location, the Centura Health IT Applications Department provides support across all 12 hospitals, seven senior residences, and home care and hospice services. Current or near future projects include developing IT strategy and solutions for Pharmacy, ED, and Centura’s physicians and allied health providers; and implementing the Meditech Risk/Quality Module.

Position Profile:

Penrose-St. Francis Health Services, in Colorado Springs, Colorado, needs to fill a key position in the continuing transition to an electronic medical record (EMR). The candidate will work with the lead physician services coordinator to establish physician training and computer support opportunities with the Penrose-St. Francis system. Our clinical information system was implemented just over a year ago and this position is part of the team that trains new physicians and manages the impact of upgrade and new service roll-outs for physicians.

Qualifications:

The successful candidate will have a Bachelor's degree in Business or Healthcare related field and a minimum of 3 years’ experience in Marketing and IT. This position serves as liaison between Penrose-St. Francis physicians, senior management and departments where physician engagement is critical. You will serve as the computer trainer to the physicians. Must maintain a working knowledge of regulatory and legal issues regarding physician/hospital relationships. Communication, organization and training skills are imperative in this position. Flexibility with regard to daily schedule is required. Clinical background is helpful.

How to Apply:

To learn more about this opportunity, please contact Suzanne Kowalchuk at SuzanneKowalchuk@centura.org, or visit www.centuracareers.org, requisition # 31439 to apply.

Please note that Centura Health does not use outside recruitment firms/agencies. EOE/AA

Recent News: Business Intelligence Mega Merger Announced

Boston, MA / Hartford, CT, January 29, 2009 -- Today, Business Intelligence Technologies, Inc. and Golden Consulting Group, LLC have announced an agreement to merge all business interests of the rapidly expanding companies. The two companies will be operating as one company on March 1, 2009.

"Based on the expanding needs of our customers and partners, we feel it is extremely important to provide significant organizational capabilities across the complete spectrum of business intelligence needs," said Brian Jordan, CEO of Business Intelligence Technologies, Inc., Massachusetts' top business intelligence (BI) provider. "By merging two leading BI businesses and technology consultancies we can now provide all facets of the BI spectrum: business need assessment, industry-leading software, installation project management and support, data warehouse development, education services and business evolution for clients of all shapes and sizes." Jordan will continue as CEO of the newly merged company.

Both Business Intelligence Technologies (BIT) and Golden Consulting Group (Golden) are Platinum Partners of SAP Business Objects. Golden is also an Authorized Education Partner that provides extensive training services across the United States and at its training center in Bloomfield, CT. In addition, BI Technologies is also a Microsoft Business Intelligence Partner with significant installations throughout the Northeast. As such, both companies have demonstrated success implementing BI solutions for clients of all sizes and industries as they seek to better manage, report and analyze their business data and make smarter business decisions.

Read article...

Recent News: Margaret Mary Community Hospital Implements Chart Links Rehabilitation Software for Therapists

Chart Links, LLC announces the implementation of its rehabilitation workflow management software by the Outpatient Rehabilitation Center of Margaret Mary Community Hospital, a not-for-profit critical access hospital located in Batesville, IN. The implementation includes functionality to manage therapy documentation, scheduling, referrals, insurance authorizations, charges, and more.

New Haven, Connecticut and Batesville, Indiana (PRWEB) January 26, 2009 -- Chart Links, a provider of rehabilitation work flow management software, announces the implementation of its therapy documentation and scheduling system by a team of 19 physical, occupational and speech therapists at the Outpatient Rehabilitation Center of Margaret Mary Community Hospital (MMCH), a not-for-profit critical access hospital providing inpatient and outpatient services in Batesville, IN.

The implementation includes functionality for electronic therapy documentation, cross-discipline therapy scheduling, referral and insurance authorization management, charges and more. It also includes inbound admission/discharge/transfer (ADT) and outbound billing and results interfaces to the Meditech hospital information system.

Read article...

Recent News: ICD-10 – No Time To Relax

January 19, 2009 -- Final rules were published on January 16 for ICD-10 codes and the related electronic transactions. The relaxed compliance dates offer no reason to relax.

The health care industry will switch to ICD-10 on October 1, 2013. Encounters and discharges occurring before October 1, 2013 will use ICD-9, and those occurring on or after that date will use ICD-10. The final rule suggests that compliance activities (gap analysis, design, development, internal testing) should begin in January 2011.

ICD-10 will be used where ICD-9 is used today. More specifically, ICD-10-CM (Clinical Modification) will be used for diagnosis coding and ICD-10-PCS (Procedure Coding System) will be used for inpatient hospital procedure coding. CPT and HCPCS codes will continue to be used in an ambulatory setting.

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Recent News: Overlake Hospital Medical Center Chooses Summit Healthcare’s Integration Suite Engine as the Standard for their Interface Needs

BRAINTREE, MA – November 24, 2008 -- Summit Healthcare, a leader in healthcare system integration, today announced a partnership with Overlake Hospital Medical Center to migrate 140 existing interfaces from their MS Accelerator Engine to the Summit Integration Suite. In addition to the implementation of the Summit Integration Suite, Overlake Hospital will also be installing a failover server system known as the Summit Hotbox as well as consideration of outsourcing their interface needs to the professional services division at Summit Healthcare.

Overlake Hospital Medical Center, a 337 bed facility with a Level III Trauma Center is located in Bellevue, Washington. This non-profit regional medical center provides care to the entire Eastern Puget Sound Region and employs over 2,200 facility including 800 active and courtesy physicians.

"After reviewing their options, Overlake Hospital quickly identified the long-term strategic value of partnering with Summit Healthcare. They were pleased with our superior products and services which will be scalable to meet all of their future integration needs," remarked Steve McDonald, VP Sales, Summit Healthcare.

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

Show Me the (Grant) Money
By: Mark Hagland
HealthCare Informatics, January, 2009

Historically the majority of healthcare IT projects have been self or privately funded, however the growing need for health information access is driving an increase in grant funding. Experts say the best approach is to go with an already planned initiative and find the funding to match the project, not the other way around.

Read article...

Connecting the Dots
By: Kate Huvane Gamble
HealthCare Informatics, January, 2009

Implementing patient flow and bed management systems that integrate with patient care systems can eliminate bottlenecks and provide current information on what is needed to keep the flow at its optimum.

Read article...

Relationship ROI
By: Mark Hagland
HealthCare Informatics, December, 2008

With the right internal culture that includes an entrepreneurial spirit and intelligent risk-taking, co-developing new solutions with vendors can be a good choice.

Read article...