Volume 4 - Issue 9 - December 2009

Editor's Note

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

Welcome to the latest issue of The MEDITECH Community Bulletin. Below are just a few of the items found in this month's newsletter:

• Our Guest Spot column features Kathleen Catalano, RN, JD, FHIMSS, discussing how MEDITECH is making the grade when it comes to National Patient Safety Goals.

• In our Vendor Spotlight column, Thom Blackwell of Boston Software Systems considers the question: Interface vs. Integrate - Is it an Either-Or?.

• John Sharpe of Comstock Software is once again sharing his wealth of NPR knowledge in our Tricks of the Trade column.

• Please note that there will be no January issue of our newsletter. All information and content for the February 2010 issue of The MEDITECH Community Bulletin must be received no later than Thursday, January 28th. Thank you.

I wish you all a wonderful holiday season full of God's blessings!
Donna

Guest Spot: The Joint Commission’s 2010 National Patient Safety Goals…how MEDITECH is making the grade

By: Kathleen Catalano, RN, JD, FHIMSS

Executive Summary

For 2010, the Joint Commission has significantly shortened the list of National Patient Safety Goals (NPSGs) (Source: http://www.jointcommission.org/NR/rdonlyres/868C9E07-037F-433D-8858-0D5FAA4322F2/0/RevisedChapter_HAP_NPSG_20090924.pdf). As a matter of fact, the number of NPSGs has gone from 20 in 2009 to 11 in 2010. Seven NPSGs have been integrated into the Joint Commission standard, one was deleted and the jury is still out as to the fate of the NPSG dealing with medication reconciliation. This article will focus on the NPSGs that will be surveyed in 2010, and how MEDITECH’s Health Care Information System (HCIS) measures up against those goals.

Throughout this article, reference will be made to the NPSGs applicability to the Hospital, Ambulatory Health Care, and/or Office-Based Surgery Accreditation Program.

Brief Recap of the Evolution of the National Patient Safety Goals

The Joint Commission’s NPSGs were first surveyed in January 2003. Since that time these NPSGs have undergone eight iterations. Some NPSGs have remained throughout the eight years while others have been removed due to the fact that compliance with the NPSG was at a high level. In addition, the numbering of the NPSGs has remained static except for the change accorded through the Standards Improvement Initiative (SII) first begun in October 2006 and coming to a conclusion in January 2010. Once given a number (i.e., NPSG 1), the number will only be used for that specific goal. All new goals will be given a different number. This is to afford easy tracking of NPSG compliance.

The Joint Commission’s Sentinel Event Advisory Committee formulates the NPSGS annually and then forwards them to the Joint Commission’s Board of Commissioners for their “stamp of approval”. After which the NPSGs are published with a lead time of a few months so that organizations can prepare for the actual “go live” the following January.

Goal 1

The first goal, NPSG.01.01.01, has remained the same for eight years and is applicable to all three accreditation programs (Hospital, Ambulatory Health Care and Office-Based Surgery). Its purpose is to eliminate the errors caused when a procedure or treatment is performed on the wrong patient.

Goal 1 is to “improve the accuracy of patient identification. ” There are two Elements of Performance (EPs) for this goal; both of which are “direct impact requirements”. A standard or EP is a “direct impact requirement” if non-compliance is likely to create an immediate risk to patient safety or quality of care.

Goal 1 requires that at least two patient identifiers be used when administering medications; when providing treatments or procedures; when collecting blood, or blood components; and when collecting blood samples and other specimens. Note that the patient’s room number or physical location is never to be used as an identifier due to the fact that the patient’s location often changes throughout their stay at a facility. Additionally, all containers used for blood and other specimens are to be labeled in the presence of the patient.

An augmentation to Goal 1 is NPSG.01.03.01 which became a goal in 2009 and requires the organization to “eliminate transfusion errors related to patient misidentification”. This Goal has three EPs, all of which are direct impact requirements” and applicable to the Hospital, Ambulatory Health Care and Office-Based accreditation programs.

Goal 2

Goal 2 used to include NPSG 02.01.01, that for verbal or telephone orders or for telephone reporting of critical test results, there was a read-back verification process in place between the person receiving the information and the person giving the order; NPSG 02.02.01, necessitating that each organization have a standardized list of abbreviations, acronyms, symbols, and dose designations that were not to be used in the organization; and NPSG.02.05.01 regarding hand-off communications. All of these Goals have been moved to the Joint Commission standards and are no longer included as NPSGs.

Now Goal 2 consists only of NPSG.02.03.01 which is applicable to the Hospital accreditation program only and requires the organization to “improve the effectiveness of communication among caregivers.”

Goal 3

NPSG.03.03.01 referring to the handling of look-alike/sound-alike medications has been moved to the standards and will be surveyed there. That leaves NPSG.03.04.01, pertinent to all three accreditation programs, and NPSG.03.05.01, applicable to the Hospital and Ambulatory Health Care accreditation programs only, for discussion here.

Goal 3 is to “improve the safety of using medications.” NPSG.03.04.01 is very important to the perioperative areas as it pertains to the labeling of all medications, medication containers, and other solutions, both on and off the sterile field. Of course, the rationale is to decrease the chance of error when a medication or other solution is placed in an unlabeled container.

NPSG.03.05.01 is specific to “reducing the likelihood of patient harm associated with the use of anticoagulant therapy.” This Goal has eight EPs that address how the medication is prepared and distributed, the use of approved protocols, baseline and ongoing coagulation tests, programming of pumps for consistent and accurate dosing, and education of the patient and families regarding compliance, drug-food interactions and the potential for adverse drug reactions and interactions. Most of these requirements will be fulfilled by actions taken by the pharmacy and the nursing units which is why elaboration is not considered necessary.

Goal 7

Goal 7 is to “reduce the risk of health care-associated infections” and encompasses NPSG.07.01.01, NPSG.07.03.01, NPSG.07.04.01, and NPSG.07.05.01. Each will be discussed separately.

NPSG.07.01.01 is applicable to all three accreditation programs and requires the organization to comply with the Centers for Disease Control and Prevention (CDC) or World Health Organizations (WHO) hand hygiene guidelines.

Note that as of September 9, 2009, NPSG.07.02.01 has been deleted and will no longer be surveyed under any accreditation program. This Goal relates to managing as sentinel events all identified cases of unanticipated death or major permanent loss of function related to a health care-associated infection.

NPSG.07.03.01 refers to the implementation of evidence-based health care-associated infections due to multidrug-resistant organisms in acute care hospitals. Thus, this Goal is only required for the Hospital accreditation program and has nine EPs that require risk assessments, surveillance, measurement and monitoring of prevention processes and outcomes, and education of all staff and licensed independent practitioners (LIPs) regarding health care-associated infections, multidrug-resistant organisms, and prevention strategies at hire and annually thereafter.

Then there is NPSG.07.04.01 that is also only applicable to the Hospital accreditation program. This Goal has to do with implementing evidence-based practices to prevent central line-associated bloodstream infections.

NPSG.07.05.01 is the Goal most pertinent to perioperative services under this subset. This Goal requires the organization to “implement evidence-based practices for preventing surgical site infections”. This Goal is applicable to all three accreditation programs and has eight EPs.

Goal 8

As of this writing, The Joint Commission has not yet published changes for NPSG.08.01.01 through NPSG.08.04.01. This affects all three accreditation programs. There was a great deal of question regarding implementation carrying out of the Goal and as of January 1, 2009, Goal 8 has been continuously evaluated during onsite surveys, however the findings have not been included into the organization’s accreditation decision and no Requirements for Improvement (RFIs) have been generated as a result of the surveyors findings. The Joint Commission expects to have a revised version of Goal 8 early in 2010 and after field review is conducted should have a surveyable Goal by mid-2010 and possibly sooner .

Goal 15

The overarching premise of Goal 15 is that “the hospital identifies safety risks inherent in its patient population” and is applicable to the Hospital accreditation program only. NPSG.15.01.01 focuses on the identification of patients at risk for suicide. Generally, perioperative areas do not deal with suicidal patients. That said it is still prudent to know and understand the organization’s policy for this Goal.

Goals 9, 11, 13 and 16

NPSG.09.02.01 regarding the implementation of a fall prevention program that includes an evaluation of the effectiveness of the program has been moved to the standards. This affects the Hospital accreditation program and was never applicable to the Ambulatory Health Care or Office-Based Surgery accreditation programs.

Likewise, Goal 13 that encouraged the patient’s active involvement in their own care as a patient safety strategy and Goal 16 requiring improved recognition and response to changes in a patient’s condition, have been moved to the standards.

However, Goal 11 that was specific for the Ambulatory Health Care and Office-Based Surgery accreditation programs has been deleted from these programs all together. Goal 11 was to “reduce the risk of surgical fires. ” This is still a very important aspect of patient safety that should be exercised even though it is no longer a Goal of in the standards.

Universal Protocol

The Universal Protocol (UP) is undergoing a fairly dramatic change in 2010. The Joint Commission determined, through field study and comments from many facilities, that there was a need to focus on the “Goals” of the UP rather than specifics. The Joint Commission has removed several of the detailed processes found in the 2009 UP because they were seen as confusing and were causing a lack of compliance with the UP. Now, a focus on safety can be maintained and the UP requirements are more achievable across various types of situations. Of course, the main goals of the UP are to perform surgery on the correct patient, at the correct site, and with the correct procedure. Note that the entire UP is applicable to all three accreditation programs without exception.

UP.01.01.01 – Conduct a Preprocedure Verification Process

According to the Joint Commission, the rationale for this UP is that, “Hospitals should make sure that any procedure is what the patient needs and is performed on the right person. The frequency and scope of the verification process will depend on the type and complexity of the procedure. ”

UP.01.02.01 – Mark the Procedure Site

In the commentary regarding the “marking of the procedure site”, the Joint Commission notes that while marking of the procedure site is a hotly debated topic, the LIP who will be performing the procedure should mark the procedure site.

UP.01.03.01 – a Time-Out is Performed before the Procedure

Of course the purpose of the time-out is to be certain that the correct patient is about to undergo the correct procedure, and that the correct site will be used. A designated member of the perioperative team must be responsible for initiating and conducting the time-out and ALL members of the perioperative team must participate through the use of active communication.

In Summary

The NPSGs and UP are not new to healthcare and yet they continue to be surveyed in an effort to ensure that the patient’s care is delivered in a safe and effective manner, and that the patient’s outcomes are measurably improved. The following table demonstrates how MEDITECH’s HCIS is providing the tools necessary to meet the NPSGs. (Source: http://www.meditech.com/IndustryNews/pages/jcaho.htm)

Compliance with the NPSGs and the UP is non-negotiable. Results of care are being reported more frequently by the media and patients and their families and friends are more than willing to expound, to anyone that will listen, about their harrowing healthcare experiences. It is recommended that every MEDITECH customer be aware of these NPSGs and the UP, document how their HCIS is meeting these goals, and be fully prepared to demonstrate it during any Joint Commission survey.

Kathleen Catalano is an RN with over 30 years of healthcare experience. Ms. Catalano has a Juris Doctor degree and a Bachelor of Science degree in law, a Science Degree and Nursing Degree, and is a Fellow of HIMSS. She is a keynote speaker, subject matter expert and educator on Joint Commission Standards and National Patient Safety Goals, Regulatory Compliance, HIPAA, ARRA and the HITECH Act, Hospital Quality Measures, CMS Compliance, Sentinel Events, Risk Management, Performance Improvement and Patient Safety. To learn more about Kathleen Catalano, visit her LinkedIn profile at: http://www.linkedin.com/pub/kathleen-catalano-rn-jd-fhimss/3/612/633.

Vendor Spotlight: Interface vs. Integrate - Is it an Either-Or?

By: Thom C. Blackwell, Product Manager, Boston Software Systems

In today’s hospital setting, the chief information officer (CIO) must manage technology to serve different departments. And while each department has highly specialized needs, in order to maximize efficiency and improve patient care, departments must not operate within information silos. They must be able to share patient information. The end goal is to provide technology tools that allow healthcare providers to do their jobs, document their efforts in an efficient way and assure the hospital gets paid for the services it provides.

CIOs tend toward one of two basic strategies: choose departmental software based on individual merits (referred to as “best-of-breed”), and link these systems together with interfaces or follow one primary vendor with intent that their departmental systems will naturally work together.

Single Vendor Option

So which is better, best-of-breed or single vendor? Boston Software Systems works with hospitals in each camp. We have an interesting perspective, since our software can automate the tasks, which all-in-one hospital information systems (HIS) cannot do. We find hospitals opting for the single vendor solution seem to be locked into specific workflows and sets of information; they don’t have much control if the workflow needs to be changed.

Even if a hospital purchases an integrated system from a single vendor, it’s likely going to include or require interfacing. To gain customization, a hospital may request a product change from the vendor. However, these special requests can be expensive or require specialized technical and communication skills. Most of these vendors have grown through acquisition, purchasing what used to be best-of-breed applications and adding them into their own system.

Even for the pure single source vendors, we find that there are holes in functionality, as they can’t be a solution for everyone. The strong market for niche bolt-on applications proves this point. A hole in functionality typically requires manual effort to complete a workflow. Sometimes this effort crosses multiple modules of the system, other times it’s between a human content builder and the application. That’s when desktop level interfacing often comes into play.

This example of interfacing within a single vendor solution is saving IS staff and users as much as a thousand hours each year. When South County Hospital in Wakefield, R.I., purchased its MEDITECH system, Gary Croteau, Assistant Vice President/CIO, and his IS team realized that one major component missing from the HIS was the ability to put reports into production. At the time, Croteau and his team were managing report production manually, which was time consuming for the IS resource side. In addition, the demands of teaching and assisting staff to run reports were not efficient. In order to run daily reports, the IS staff uses scripting technology to automate their production and push them out to the Intranet. It does not require additional resources from the IS staff to run reports because the process is automated.

Best-of-Breed

The issues hospitals face with a single vendor solution don’t seem as prevalent from best-of-breed adopters. However, an ill-fitting application will have these problems.

Interfacing best-of-breed applications has gotten easier. In pre-HL7 days, simply moving data was a challenge, as the network architectures and applications weren’t as sophisticated as they are now.

In reality, many hospitals need to purchase or develop a point-to-point interface to send or accept a message feed from a vendor or third-party consulting firm. To customize their workflow, a hospital may request a product change from the vendor. However, these special requests may require specialized technical and communication skills and be an expensive proposition.

Standards such as HL7 have helped tremendously with the ability to share information, as have the development of standards- and non-standards-oriented interfacing software such as Boston WorkStation and interface tools. There will always be specific interfacing situations where a standard simply doesn’t exist, is too inflexible or is not supported by a vendor for a given workflow. We help hospitals and vendors solve these challenges every day.

Interfacing does not always mean behind the scenes data movement using messages, files or scripting. Interfacing can also occur at the user’s desktop. These types of interfaces maximize productivity and increase accuracy by linking helper applications with the main systems, especially in registration and the business office. This desktop level interfacing can enable additional functionality that may not be a native feature of the application. Examples include: insurance and address verification, document scanning/archiving or even custom-built productivity enhancements.

Seemingly simple interfaces linking applications on a user’s desktop can yield huge productivity gains. Take a walk to the business office and see how often users are alt-tabbing between applications on their desktop to work accounts. Many times, they are typing the same information multiple times or using copy / paste to move data. Desktop level interfacing can automate a lot of this, which equates to significant productivity gains.

Saint Clare’s Health System in Denville, N.J., interfaces and automates different applications almost daily, even outside its clinical practices. The organization has recently rolled out an invoice-scanning system that uses scripting technology to connect the invoice scanning system to the materials management system, from which approved invoices are forwarded to another system for payment. Automating this workflow streamlines the handoff process between the scanning system and the materials management system. The Human Resources department is using scripting to integrate spreadsheets received from individual departments into the human resources software system to be automatically updated with approved salary adjustment information.

The reality is there is no either-or choice between single vendor and best-of-breed. Every healthcare organization must study its own processes and count on needing interfacing skills – both standards and non-standards based, back-end and desktop. In order to maximize workflow and increase productivity, hospitals will need to interface applications to bridge the gaps in functionality no matter what system is used. It is a cliché but, working in the complex healthcare environment, the devil truly is in the details.

Thom Blackwell's career has focused on automating workflow and integrating applications in the healthcare industry. His experience includes the early scripting technology, MicroScript, New Era of Networks and Sybase, where he worked directly with customers to best architect their automation and integration needs. As product manager for Boston Software Systems, Mr. Blackwell offers a special understanding of the workflow in healthcare organizations, and how to bring technology to bear in reducing the time and costs associated with information management. Mr. Blackwell is a popular speaker at major conferences where he simplifies technology jargon and shows attendees how to automate the tasks they are faced with every day. To learn more about Boston Software Systems, visit them online at: http://www.bostonworkstation.com.

Tricks of the Trade: MEDITECH NPR (Client Server) – MEDITECH Data Definitions, Only Easier

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

If you’ve been writing reports for awhile, you’ve found that MEDITECH Data Definitions are essential to your success in writing reports. Report writers, everywhere, use them on a daily basis.

Sleuthing through each application, module and segment looking for a field, CPT code for example; takes more time than you’d like. You could be looking through ABS, BAR, OE and more - before finding what you were looking for.

Maybe you know the field you need is located in ABS somewhere; you’ll still be looking through each module and segment to find the field you need.

OR … you could download the MEDITECH Data Definitions and query them in a Microsoft Access Database as pictured below.

If you don’t use Microsoft Access, other viewing and searching options might include:

- Microsoft SQL Server or MySQL Database
- Microsoft Word or Microsoft Excel 2007
- Notepad, or your favorite Text Editor - mine is TextPad.

Now by this time, you’re wondering how you can get access to the MEDITECH Data Definitions for your personal use. If you work at a MEDITECH hospital and have access to the MEDITECH NPR Report Writer, you need the NPR report for the MEDITECH Data Definitions, to get it: click here. Once you’ve loaded this NPR report into your TEST MEDITECH system, you can print the report to DOWNLOAD.

In the near future, you'll receive more information on a FREE Workshop where you can learn more about querying the MEDITECH Data Definitions to write better reports. To learn more, sign up for the MEDITECH Reports Blog via Email.

In the meantime, won't you join some of the smartest people in the MEDITECH industry in asking and answering questions at the MEDITECH Knowledge Exchange?

Thoughts? Email them to 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.

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

Systems Personnel
"Your Partner in Healthcare Search & Consulting"

About the Organization:

Systems Personnel is a professional search & consulting firm specializing in the Health IT, Management, and Sales fields. With 20 years of success in the search industry, our commitment to excellence is demonstrated bythe numerousawards we've earned in the world's largest recruiting network. We are also members of the Healthcare Information and Management Systems Society (HIMSS), and the Capital Area Roundtable on Informatics in Nursing (CARING).

Systems Personnel performs a variety of services on a nationwide basis. All fees are paid by client companies, and there is never a fee to candidates.

• Permanent Placement
• Consulting Services:
  • Business & IT Consulting
  • Staff Augmentation
  • Interim Management
• Temp-to-Perm Hiring

Opportunities Available:

We are currently conducting numerous searches for MEDITECH and Health IT professionals. To learn more about Systems Personnel and search our database of thousands of jobs, visit us online at www.carrollsearch.com. Interested and qualified applicants may email your resume or call Donna Carroll at:

Systems Personnel
Donna@CarrollSearch.com
TEL: 413-569-1111

Recent News: Cayuga Medical Center Selects Summit Healthcare for Interface Management and Physician Office Integration as they migrate to Meditech 6.0

BRAINTREE, MA (December 3, 2009) -- Summit Healthcare, a leader in healthcare system integration and task automation, today announced it has entered into an agreement with Cayuga Medical Center to be their one integration partner as they migrate to the Meditech 6.0 platform. This migration effort will include implementing Summit Express Connect, a robust interface engine to meet the current and future integration needs. Cayuga Medical Center is a 204 bed, full service not for profit facility located in Ithaca, New York.

Cayuga Medical Center recognized the cost savings that come with partnering with one integration and automation vendor. The immediate short-term goal for Cayuga Medical Center is to enable their staff to concentrate on the Meditech 6.0 project management while ensuring their readiness and implementation efforts are not compromised. To accomplish this short-term goal, Cayuga has also entered into a 1 year Outsourcing agreement with Summit Healthcare to handle all interface migration and management efforts. In addition to the integration efforts underway, Cayuga Medical Center will be implementing the Summit Scripting Toolkit and Summit InSync products to streamline data migration and dictionary maintenance efforts. They have chosen to price protect the Summit Downtime Reporting System as a potential future initiative to tackle the challenge that comes with Meditech or Network downtime.

Read article...

Recent News: Northeast at 96 Percent CPOE

BEVERLY, MA (December 3, 2009) -- There are several secrets to the Northeast Health System’s 96 percent uptake of computer physician order entry (CPOE), but they all boil down to collaboration.

“We really pulled together,” said Robert Laramie, CIO of the Beverly, Mass.-based health system, which serves communities along the state’s north shore. “It was amazing.”

The health system, which uses a Meditech electronic health record, includes 58-bed Addison Gilbert Hospital in Gloucester, BayRidge Hospital, a 62-bed psychiatric hospital in Lynn, and 227-bed Beverly Hospital in Beverly. There are also two outpatient facilities – Beverly Hospital at Danvers, a day medical and surgery center, and Beverly Hospital Cable Center in Ipswich.

Read article...

Recent News: The Leapfrog Group Announces Its 2009 Top Hospitals: Proof That The Nation’s Best Care Can Be Delivered Efficiently

Leapfrog Adds a New Efficiency Standard to Its Quality Criteria for Top Hospitals and Introduces a Category for Top Rural Hospitals

WASHINGTON, DC (December 3, 2009) -- While Congress debates whether health care reform would control health care costs, today employer purchasers point to 45 hospitals that lead through example—delivering the best quality care in the nation while attaining the highest levels of efficiency. Thirty-four urban, eight children’s and three rural hospitals have been named 2009 Leapfrog Top Hospitals, based on results from The Leapfrog Hospital Survey. The survey (found at www.leapfroggroup.org) is the only national, public comparison of hospitals on key issues including mortality rates for certain common procedures, infection rates, safety practices, and measures of efficiency.

Qualifying criteria for Leapfrog’s Top Hospital Award list remain virtually the same as 2008, with one added dimension: once hospitals demonstrate top quality, they must also rise to the top of the list on efficiency.

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Recent News: Picis Chooses Summit Healthcare’s Summit Scripting Toolkit to Embrace the Challenge of MEDITECH 5.6/6.0 Integration

BRAINTREE, MA (November 9, 2009) -- Summit Healthcare, a leader in healthcare system integration and task automation, today announced it has renewed a long-term vendor agreement with Picis to address its MEDITECH integration needs. Picis is a global provider of innovative information solutions that help increase patient satisfaction, improve clinicians’ access to patient information and optimize organizational efficiency in the acute care areas of the hospital such as the ED, OR, PACU and ICU.

The new MEDITECH 5.6/6.0 technology presented new challenges for MEDITECH hospitals and vendors alike. Picis, a long-term vendor partner with Summit Healthcare, approached Summit Healthcare when determining its new integration business model to support customers on this technology. Picis needed its solutions to integrate seamlessly with the MEDITECH 5.6/6.0 platforms, as well as any subsequent versions. Summit Healthcare worked closely with Picis to demonstrate the robust functionality of the Summit Scripting Toolkit 7, which was a rebuilt, ground up effort of the latest scripting and integration technology available on the market today. SST 7 has been proven to handle the intricacies of the new MEDITECH platforms such as a unique non-positional approach to data capture that provides script reliability.

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