Volume 4 - Issue 2 - March 2009

Editor's Note

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

Welcome to the March issue of The MEDITECH Community Bulletin. I'd like to draw your attention to a couple of items in this month's newsletter:

• Rich Elmore of Avance Health has contributed our Guest Spot column this month. It's a very timely article focused on the potential impact on the healthcare industry by the recent passage of the stimulus plan. Rich publishes an online newsletter/blog, Healthcare Technology News, which serves healthcare organizations and healthcare technology businesses with a focus on value, policy and economics. If you've never visited the site before, I encourage you to take a look and subscribe to this valuable resource.

• John Sharpe of Comstock Software is once again sharing his wealth of NPR knowledge in our Tricks of the Trade column. Specifically, John is making available his List Builder utility to everyone through his MEDITECH NPR Report Writing website. Thank you, John, for your contributions to the MEDITECH software community.

Happy March!
Donna

Guest Spot: Getting By or Getting Better?

By: Rich Elmore, Healthcare Technology News, Avance Health

There are 20 billion reasons to be hopeful about the passage of the stimulus plan’s HITECH provisions. Certainly the plan will drive greater physician and hospital adoption of EHR's and will ultimately help improve coordination of care across health care settings. The CBO believes that there is a roughly 3:1 financial return on this investment. That’s all good news.

But will the stimulus plan provide the lift that hospitals and systems need to realize the full potential of EHR’s, improving outcomes and reducing costs? Or will hospitals do just enough to justify reimbursement and to avoid future fee penalties?

The investment and implementation choices that are made today will be with us for a very long time. And there is reason to be concerned with the outcome.

I recently spoke with the president of a publicly traded large healthcare tech company that does business with most hospitals in the US. I asked for his take on the stimulus program and its effect on his business. His response was that the stimulus plan was certainly needed, but was insufficient to restore hospital capital spending on technology. His view is that the US Treasury's plan for the capital markets is much more critical to financial recovery in healthcare.

The best way to test this hypothesis is with the credit rating agencies that evaluate risk and financial health of healthcare organizations. Fitch Ratings recently released their special report on 2009 Nonprofit Hospitals and Healthcare Systems Outlook which found that hospitals "will be severely tested and under intense pressure over the next 12- 18 months."

The outlook is "negative" (a very strong word for a credit ratings agency) based on "constrained access to capital, a deteriorating payor mix, elevated interest rates, severe investment losses, ... increasing uncompensated care and higher capital costs." They forecast that government reimbursement will remain constrained by the economic crisis, employers will continue to shift healthcare costs to employees and small employers will face greater challenges providing healthcare for their employees. "These factors, coupled with increasing unemployment and declining utilization will likely depress operating profitability well into 2010... Economic stimulus initiatives and healthcare reform efforts could be beneficial over the longer term but are not expected to provide significant immediate relief."

Financial market conditions including swap risk, the collapse of variable-rate demand bonds, the lack of fixed-rate debt, pension fund obligations and higher capital interest costs are all contributing to reduced liquidity for hospitals.

For many hospitals, the level of days cash on hand, a key financial operating metric, has fallen 20-30% from 2007 to 2008. In addition, hospitals are facing operating pressure related to increases in uncompensated care and declining utilization, which is expected to reduce profitability for 18-36 months. Fitch expects that hospitals will respond by "curtailing or deferring capital spending, reducing staffing, cutting costs to bolster profitability... (and) anticipates these actions to continue throughout 2009..."

Hospitals can expect "volumes to continue declining as consumers delay or postpone non-urgent procedures and as unemployment levels continue to rise." While reimbursement levels should be adequate, hospitals should anticipate "continued increases in bad debts and charity care..." A recent AMA study on the impact of the economic crisis on hospitals reinforces many of these findings.

Fitch contends that hospitals are going to need to focus more on driving revenue and productivity gains. (For examples of these initiatives, see High Margin Revenue Cycle Strategies.)

Reflective of a more strategic view of healthcare technology, "the degree to which providers have invested in health information technology can also influence Fitch’s assessment of long term viability."

Fitch concludes that "while much work remains to be done in defining, funding and implementing meaningful change in the healthcare industry, a common theme of various federal and state reform proposals centers on creating payment incentives that encourage value – the delivery of effective, appropriate care in an efficient manner."

With this backdrop, it’s easy to imagine a few scenarios where hospitals treat healthcare technology as a strategic enabler, and many other scenarios where hospitals work to just get by, doing enough to reap the financial reward but no more.

In one of its few moments of inspiration, Congress gave HHS the authority to define "meaningful use" of healthcare technology. The "meaningful use" metric determines whether providers are paid for their EHR investments.

Historian Paul Johnson said that "the word 'meaningful' when used today is nearly always meaningless." Given the many pressures on hospitals to just get by, this one key definition, and the way it is operationalized, may define the trajectory, results, patient outcomes and costs that we live with for years to come.

Rich Elmore is editor for Healthcare Technology News, serving healthcare organizations and healthcare technology businesses with a focus on value, policy and economics. Rich is President of Avance Health, providing consulting services to providers and healthcare IT companies, specializing in revenue cycle management (RCM), electronic health records (EHR), health information exchange (HIE) and healthcare technology. At IDX Systems, he was the Hospital P&L leader and Vice President for Development serving physicians, hospitals and payers. His extensive experience with RCM, EHR and HIE led to a charter role on the Interoperability Workgroup for the Certification Commission for Healthcare Technology (CCHIT). He has presented at numerous conferences, including HIMSS and MIT’s Future of Health Technology. For more information, go to news.avancehealth.com.

Customer Spotlight: The Avera Health Story...Integrating the Enterprise

Introduction

Avera McKennan Hospital & University Health Center is a member of Avera Health Systems which stretches across 5 States, 231 Care Locations and employs over 12,000 Physicians and staff. The Avera McKennan Facility, as a stand-alone, is a 506 bed tertiary care hospital located in South Dakota offering award winning care and has recently been named one of the 100 most wired hospitals.

Avera McKennan has been a Meditech client running the Magic platform since 1989 and has always used a mixture of tools to solve their integration challenges. They exchanged HL7 data through an interface engine, addressed workflow automation using scripting and addressed print automation and downtime reporting through a manual paper processes.

Read on to find out how this prominent hospital system implemented the Summit Integration Toolset to streamline interoperability and integrate the enterprise.

Evaluating the Past and Looking into the Future

As mentioned above, the mixture of tools being used to meet integration needs was a challenge for Avera’s IT department and it was determined that there was a need for a more streamlined approach. Additionally, a strategic decision was made by the organization to migrate to one central EHR on the MEDITECH CS platform. In order to accomplish this, the following needed to occur:

• Conduct an integration assessment
• Build a new data center to support a centralized EHR model
• Implement integration tools through partnership with one integration provider

Integration Assessment

It was decided that the mixed integration tool approach did not make efficient use of hospital resources. After conducting an integration assessment it was determined that the current interface engine in operation was lacking in functionality and the organization would look toward evaluation and purchase of a new integration engine. Additionally, Avera McKennan wanted to contract with one integration technology partner who could also streamline and assist with the workflow, print automation and downtime reporting needs. There were numerous factors that contributed to the decision to move forward with the implementation of a new interface engine.

Meeting the EHR initiative

To meet the EHR initiative and prepare for the migration to Meditech CS, Avera McKennan implemented a centralizeddata center with over 175 servers. The Avera Enterprise created a phased approach to migrate all facilities from Meditech Magic to CS. Avera McKennan was the first facility to migrate with the next 31 facilities to go live through 2010. With the data center in place it was now confirmed that the enterprise would partner with one integration company to solve all integration initiatives at the organization.

A Partnership is Formed

Avera evaluated numerous integration partners but only one, Summit Healthcare, was able to meet all of Avera’s integration needs. Summit Healthcare provided an integration toolset that included HL7 interface technology leveraging Microsoft Biztalk, workflow automation scripting technology, print automation and a downtime reporting tool.

Summit Healthcare is proud to serve Avera Health’s current and future integration needs surrounding healthcare integration. At the close of a very successful implementation of the Summit Integration Suite and other flagship integration products such as the Summit Scripting Toolkit, CS Print Manager and the Summit Downtime Reporting System; Avera IT staff commented on how nice it was to be able to sleep at night again without having to deal with integration issues that were commonplace with their old integration products.
- Terry LaPointe, Senior Project Manager at Summit Healthcare

The first phase of implementation included the Summit Interface Suite which provided a robust interface engine leveraging Microsoft Biztalk. In just 30 days, over 70 interfaces were converted using the new engine to meet the Meditech CS conversion timeline which pleased the administration and freed up much needed IT resource hours. The IT staff quickly recognized how scalable the Summit Interface Suite was when they saw that that, after only a short time, there were over 94 interfaces live and over 1 million messages processed per week. The “sleepless” nights were over; Avera McKennan had a stable Interface Engine in place.

The next phase of the implementation was to include implementing the Summit Scripting Toolkit across the enterprise. While there was already an existing scripting toolkit vendor in place, Avera had committed to one integration partner and after further evaluation determined that the Summit Scripting Toolkit was more robust in functionality and could easily accomplish and meet the demands of the departmental needs for workflow automation. The highlighted script solutions included 835 remits, dictionary conversion and elimination of redundant manual tasks across ALL departments.

The final phase of implementation included print automation and downtime reporting. The Meditech CS platform did not include print automation while the Meditech Magic platform had featured this functionality. Due to this lack of functionality, there was an immediate need for print automation across all departments. Summit Healthcare provided the Summit CS Print Manager product for print automation which was implemented across all departments and ultimately accounted for 180 scheduled jobs running daily. The print automation component integrated with the Summit Healthcare Downtime Reporting product and provided Avera a safe, reliable solution in the event of Meditech or Network downtime. The Summit Downtime Reporting application encrypts the scheduled reports and distributes them across the enterprise to local PC’s. The reports are then decrypted using a defined password and are available for immediate printing and viewing capabilities. Again, there were less “sleepless” nights ahead for the Avera organization.

Looking Ahead

With the Integration toolset in place and the partnership formed, Avera has seen improved patient care and rapid access to critical data for clinicians and other departments. Through a reliable interface engine, workflow automation scripting technology and a print automation/downtime reporting solution, the hospital is running smoothly on all cylinders. Department and IT training has been standardized and the support and transfer of knowledge is now easily accomplished. The ability to work with one integration vendor has proved to be extremely rewarding and has enabled a strong relationship to form.

We at Avera Health are extremely pleased with the Summit Healthcare HL7 Adapter/BizTalk 2006 Integration Engine. The Summit implementation folks were great to work with and helped us GO LIVE with over 70 interfaces in a multi-hospital environment in just 30 days. Today we have 94 interfaces running like clockwork and we are processing well over a million messages a week through the Summit Engine. We have plans to add on more interfaces as we continue to migrate our regional facilities to Meditech Client Server.
- Jason Bolssen, Integration Engineer at Avera McKennan

To learn more about Avera Health, visit them online at www.averahealth.org.

To learn more about Summit Healthcare Services, visit them online at www.summit-healthcare.com.

Tricks of the Trade: Using NPR to Save Time on Repetitive Tasks (Meditech Magic)

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

Sally is a Meditech BAR Analyst and already it has been one of those days. She opens her email and finds a message from Sharon at the Business Office.

---------------------------------------------------------------------------------------------------
Sally,

Please look in BAR for the account balances on these accounts.



I know you are busy...but if possible, please get me this information before the 3:00 p.m. meeting.

Thank you,
Sharon
---------------------------------------------------------------------------------------------------

Good thing Sally has been brushing up on her Meditech NPR skills. Looking this information up by hand would have been a nightmare.

Reviewing the BAR.PAT.zcus.account.info report below, we’ll look at one way Sally might have retrieved the necessary information. We’ll also look at a free NPR Report Writing Utility named List Builder that you can use to speed up NPR Report Development for these one off audit type reports.

Here’s a quick overview of the NPR setup.

NPR Report Writer - Page 1 - Setup:

NPR Report Writer - Page 2 - Setup:

Instead of using a SELECT Prompt of ‘Accounts:’ and entering the accounts 1 by 1 at report run time, we’ll populate the /ACCOUNTS list using an AL START macro.

NPR Report Writer - Footnotes - Setup:

NPR Report Writer - Start Macro - Setup:

Here instead of typing by hand, Sally might have copied the list of accounts from the email into the List Builder.

Next … paste the list of /ACCOUNTS into the AL START macro.

NPR Report Writer - Start Macro - Setup:

By using the List Builder for MEDITECH NPR Macros in conjunction with an AL START macro to populate the /ACCOUNTS array; the list could easily scale from 20 or so accounts to 500 or more with hardly any additional effort on the part of the NPR Report Writer. If, on the other hand, even 50 accounts had to be entered by hand into the NPR Select at Report Run time, the process would be less than satisfying.

NPR Report Writer - Page 3 - Setup:

This report is built in a DOWNLOAD format, which means you can print to the printer named DOWNLOAD. Printing to DOWNLOAD allows you to save the file with a .CSV file extension. Microsoft Excel is a great application for opening and analyzing files in the .CSV file format.

If you have ideas on free report writing utilities such as the List Builder, email John at jsharpe@comstock-software.com.

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

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. 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.

Samaritan Medical Center
Watertown, New York

About the Organization:

Samaritan Medical Center (formerly House of the Good Samaritan) has dedicated itself to meeting the diverse healthcare needs of all Northern New York residents. The facility has grown from a five-bed hospital serving the City of Watertown to the leading provider of healthcare services in Jefferson, Lewis, St. Lawrence, and northern Oswego counties.

Today, Samaritan Medical Center a not-for profit, 287-bed full-service community hospital, and Samaritan Keep Home, a 272-bed long term care nursing home, are the two anchor facilities of Samaritan Health System. Patients and Residents entering the Samaritan Health System can expect state-of-the-art facilities and services as well as a strong commitment to high quality healthcare from its 1700+ employees and 180+ physicans. The hospital provides a full array of medical, surgical and emergency care, including medical/surgical beds; critical care services, pediatrics, maternity and emergency department. The hospital also provides inpatient mental health services.

Samaritan Medical Center offers a variety of specialized services typically associated only with larger urban healthcare centers. Specialty services available locally include comprehensive cancer treatment, physical medicine and rehabilitation, high risk maternity and level II neonatal intensive care, cardiac rehabilitation, trauma care, cardiac and pulmonary care, diagnostic cardiac catheterization and ambulatory surgery.

About the Location:

The town has a population of 30,000+ and is situated in Northern New York just west of Lake Ontario. Our service area is approximately 200,000. Some of the greatest benefits of working at SMC come from the unique relationship the hospital shares with nearby Fort Drum. SMC is part of a United States Department of Defense pilot project. There is not a hospital on post, so military personnel rely on community healthcare providers and SMC for many healthcare services. With approximately 17,500 soldiers and 4,000 civilians on payroll, Fort Drum is the region’s largest employer. Civilian and military doctors work side by side, as many military physicians are credentialed as part of the SMC Medical Staff. Our civilian physicians and nursing staff are therefore able to work on and learn about entirely new sets of diagnoses and treatment modalities through their relationship with military medicine.

Outdoor recreational opportunities abound providing miles of wilderness trails along with rivers for whitewater rafting and some of nation’s best trout fishing. People have the luxury of vacationing where they live and work. The region offers:

• Comfortable relaxed lifestyle with a low cost of living
• Safe attractive neighborhoods, quiet rural areas, affordable housing, light traffic, first-rate school systems and a gorgeous landscape.
• Public and Private institutions offering undergraduate and graduate degrees
• Easy accessibility to major metropolitan areas, specifically:
  • Albany 210 miles
  • Syracuse 70 miles
  • New York City - 330 miles
  • Kingston, Ontario - 60 miles
  • Montreal, Quebec - 200 miles
  • Niagara Falls - 235 miles
  • Toronto, Ontario - 315 miles
  • Washington, DC - 450 miles
  • Rochester, NY - 155 Miles

About the Department:

It’s an exciting time to join the Samaritan Health System. As we start a 61 million dollar expansion project our leadership team is committed to leveraging the healthcare industries best technology so we can remain the area’s leading provider of healthcare services. Our platform includes MEDITECH Client Server HIS and Fuji for our PACS system, MedHost for ED automation; and we’re continuing forward with our EMR and CPOE implementation.

Position Profile:

Reporting to the CIO, the Applications Manager supervises a staff of 5 responsible for overseeing the organization's repository of software applications. Project planning expertise is necessary for success. Responsibilities include management and coordinating the processes required for the provision of user applications and systems necessary for business operations. Ability to apply proven communication and problem-solving skills to guide and assist the user group on issues related to the design, development, and deployment of mission-critical information and software systems is required.

Qualifications:

Bachelor's Degree in Computer Science or Information Systems, or a commensurate level of education and work experience. Five years of experience in hands-on healthcare software implementation and support. Must have professional appearance and manner and be able to exercise creativity, good judgment and initiative. Candidates should possess a high degree of each of Samaritan’s core values: Honesty, Empathy, Accountability, Respect, and Trust.

How to Apply:

To learn more about Samaritan Medical Center, visit us online at www.samaritanhealth.com. EOE. Interested and qualified applicants may apply online, or send your resume to:

Samaritan Medical Center
ATTN: Human Resources
830 Washington Street
Watertown, NY 13601
TEL: 800-892-4785

Recent News: Corepoint Health Launches as the Next Generation of NeoTool

NeoTool Updates Brand to Reflect Long Term Growth Plans and Continued Focus on Delivering Exceptional Customer Service and Products that Simplify the Challenges of Healthcare Integration and Data

Plano, TX, February 17, 2009 -- Today, Corepoint Health is the new brand name for NeoTool. The company’s proven, innovative software solutions, commitment to customers, and singular focus on information technology in the healthcare market have made consistent growth possible for many years. Corepoint Health is simply the next generation of NeoTool and the brand under which the company will accelerate the expansion of its product and service offerings.

"Through the Corepoint Health name, we will build on the deep heritage that we have in delivering practical, productive solutions for healthcare integration,” stated Phil Guy, CEO of Corepoint Health. “Our customers will continue to see rapid innovation in our products as we listen to their challenges and deliver solutions in response to their needs."

Guy added, "What will remain unchanged is our intense commitment to delivering exceptional customer service and results-oriented solutions that improve healthcare operations and workflows."

Read article...

Recent News: Leading Hospitals Turn to PatientKeeper to Improve Safety and Efficiency of Physician Hand-Off Process

VCU Medical Center, CHRISTUS Health, and Mercy Medical Center Implementing PatientKeeper Sign-Out

Boston, MA, February 26, 2009 -- PatientKeeper, Inc., the leading developer of physician information systems, announced today the implementation of PatientKeeper Sign-OutTM at its customer sites. Leading healthcare facilities, including: Virginia Commonwealth University Health System (VCU); Mercy Medical Center of Cedar Rapids, IA; and Dallas-based CHRISTUS Health, which serves communities in more than 60 cities in Texas, Arkansas, Louisiana, Missouri, Georgia, New Mexico, Utah and Mexico, are among the organizations implementing PatientKeeper Sign-Out.

PatientKeeper Sign-Out improves communication between physicians at the transition of care to streamline patient handoff and sign-out and to simplify discharge planning, and provides a standard process as specified by requirement 2E of the Joint Commission 2008 National Patient Safety Goals. Hospital organizations are increasingly turning to PatientKeeper for a formal mechanism to manage the handoff process so covering physicians know, at a glance, tasks that need to be done and how to prioritize patient needs.

"The safety of our patients is paramount to everything we do as an organization," said Alistair Erskine, VCU chief medical information officer. "Our implementation of Sign-Out is helping us to coordinate smooth communication about patient status between shifts, adding simplicity to our care management processes that will positively impact patient care."

Read article...

Recent News: Southeast Missouri Hospital Implements Chart Links Rehabilitation Software for Therapists

Chart Links, LLC announces the implementation of its rehabilitation software by HealthPoint Rehab which consists of two outpatient rehabilitation centers for Southeast Missouri Hospital, a 269-bed regional medical complex serving southeast Missouri and southern Illinois. The implementation includes functionality for electronically managing therapy documentation, scheduling, referrals, insurance authorizations, charges, and more.

New Haven, CT and Cape Girardeau, MO, February 27, 2009 -- Chart Links, a provider of rehabilitation workflow management software, announces the implementation of its therapy documentation and scheduling system by a team of 26 physical, occupational and speech therapists and assistants at HealthPoint Rehab, consisting of two outpatient rehabilitation facilities, for Southeast Missouri Hospital. Southeast Missouri Hospital is a 269-bed regional medical complex serving nearly 600,000 people in 21 counties in southeast Missouri and southern Illinois.

The implementation includes functionality for electronic therapy documentation, cross-discipline therapy scheduling, referral and insurance authorization management, charges and more. It also includes an ADT and billing interface to the Meditech hospital information system.

"Transitioning to electronic medical records was the right decision," says Frankie Erlacker, PT, MHS, Executive Director of HealthPoint Rehab. "Southeast chose Chart Links both because it could be customized to meet the unique needs of the department and because of the support Chart Links offered during the building and implementation process. With Chart Links, we will document according to national standards in a way that makes sense to both clinicians and our referral sources. The management staff will be able to more effectively monitor trends and strategize proactively."

Read article...

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

A Competitive Edge
By: Mark Hagland
HealthCare Informatics, March, 2009

CIO’s are under increasing pressure to make every dollar count. This article shows clear ROI’s for facilities with a greater willingness to invest in technology.

Read article...

Tech Trends 2009
HealthCare Informatics, February, 2009

A look at the top tech trends for 2009, with links to articles about each trend.

Read article...

Ask Nicely
By: David Raths
HealthCare Informatics, January, 2009

Although the number of grant sources can be overwhelming, a few simple techniques can help facilities through to a successful outcome.

Read article...