News & Information for the MEDITECH Community
Volume 2 - Issue 6 - August 2007

The MEDITECH Community Bulletin is a periodic newsletter covering a broad range of topics that are relevant to the MEDITECH community.  In addition, this newsletter provides a forum for guest contributors including consultants and, of course, MEDITECH customers. The MEDITECH Community Bulletin is published and distributed free of charge to you by Systems Personnel, a professional search firm specializing in the Healthcare IT and Management market.  Visit us online at www.CarrollSearch.com.

If this is the first time you're reading the The MEDITECH Community Bulletin, consider it a warm smile and a handshake as we introduce our newsletter to your company.  If you're a long-time recipient, we hope that you'll find this issue of the The MEDITECH Community Bulletin just as useful as always.

Thanks for your continued ideas, contributions, and feedback!

Regards,
Donna Carroll

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Vendor Spotlight  |  Career Corner  |  Industry Spotlight

Recent News  |  Worth a Read  |  Contact Info

Vendor Spotlight:  Workflow Efficiency Abounds for MEDITECH Clients using Boston WorkStation

Contributed by:  Margaret Mayer, Director of Marketing, Boston Software Systems

Technology for the healthcare industry is one of the fastest-growing areas of software development, and healthcare organizations of every size are under constant pressure to invest wisely in technology solutions that are flexible and will extend the capability of their applications.  Hospitals across the country that rely on MEDITECH use a tool called Boston WorkStation™ to automate data gathering and remotely manage and monitor personnel as they interact with MEDITECH.

Boston WorkStation is a workflow automation and integration technology that allows healthcare organizations to respond to changing business, financial and compliance requirements by automating common tasks throughout the organization including revenue cycle projects, interactions with Web sites, integrating new applications, systems and devices, and electronically monitoring and managing user activity.

“Boston WorkStation is used in over 500 MEDITECH facilities around the world,” said Steve Cohen, executive vice president, Boston Software Systems.  “Scripting is compatible with every MEDITECH system - Magic, Client Server, NUI, as well as all MEDITECH modules and applications.  We’ve designed specific products for our MEDITECH users, such as the UNISON dictionary synchronization tool, which can accelerate the development of a dictionary synchronization from 30 hours to 20 minutes, and schedule it to occur regularly without human intervention.  MEDITECH hospitals can use Boston WorkStation to streamline business processes and automate workflow easily throughout the hospital.”

Greenwich Hospital Handles Data Conversion in Days

It didn’t take long for Brian Thiel, Manager of Managed Care at Greenwich Hospital, a 174-bed community hospital serving lower Fairfield County, Connecticut and Westchester County, New York, to realize the power of scripting technology.  Brian manages many time-intensive and monotonous projects involving data entry or data transfer.  Yet, they are critical for the efficient flow of managed care contracts and fee schedules.  He had always wondered why there wasn’t a way to automate these tasks and eliminate the need to spend so many man-hours on these projects.  Two years ago, while at a MEDITECH User Group Conference (MUSE), Brian met the people from Boston Software Systems.  When he learned about their workflow automation tool, Boston WorkStation, he found what he was looking for.

In his position, Brian had been analyzing managed care contracts and fee schedule tables, and loading these fee schedules into MEDITECH.  The challenge is that there are several hundred CPT (current procedural codes) that are associated with the prices in these contracts.  It used to take Brian three days to load each new fee schedule for each managed care contract for every year that it was updated.

“Multiply that by at least 10 contracts, and you’re talking about a months worth of time spent on manual data entry and nothing else,” Brian said.  “This was one of the reasons why we were going over budget in the business office.”

Brian then used Boston WorkStation to automate the upload.  It took him only a day to write the script and the benefit has been dramatic.  Automating just this task is saving the hospital tens of thousands of dollars per year.  And this is only one of the places where Brian is using scripting.  He uses the tool to convert all of the appointments that are in one of the dictionaries to the new central scheduling module in MEDITECH.  More than 10,000 appointments had already been registered and booked in advance in the previous system.  Brian needed a way to convert all of those appointments into the proper time slots in the new system.

Brian also created a Boston WorkStation script to first take an extract out of the dictionary and convert it into an Excel spreadsheet.  The script continues by automatically and accurately pulling the appointments from the spreadsheet and uploading them to the MEDITECH scheduling module.  This kind of dictionary conversion project would normally take 700 man-hours or about $10,000.  If it had been done on an overtime basis, it would have cost them $16,000.  Brian wrote the script in four hours and had it running and finished by the end of the week.  “It’s essentially like having an extra employee or two,” he says.  “Any time you have a lot of data you need to transfer, that’s where a script is really useful and saves a lot of time,” he says.

Coffee Health Group Automates Processes, Generates Revenue

Ben Bowling, interface/intranet specialist for Coffee Health Group, a not-for-profit health care system located in Northwest Alabama, has also realized the power of scripting.  Coffee Health Group includes Eliza Coffee Memorial Hospital in Florence, AL, and Shoals Hospital in Muscle Shoals, AL, and an outpatient facility.  It has more than 200 physicians on staff representing more than 42 specialty areas.

Ben and his IT team are using scripting throughout Coffee Health Group’s three main facilities to automate processes, generate billing files and patient care reports, and manage many departmental reporting processes.  The business office realized that the hospital was losing potential revenue in the emergency department based on a problem with the coding of nursing assessments.  Since the health group had no designated employee entering the coding for the emergency department, the codes for the thousands of nursing assessments that occur at the hospital each day were often done improperly.  This cost the hospital staff valuable time and the hospital money in lost revenue, because without correct coding, the claims could not be processed.

Using Boston WorkStation, the IT team created a script that generates a spreadsheet of the billing codes for the nursing assessments in the emergency department.  Every assessment is entered into a batch that is automatically posted each night, and the spreadsheet is time-stamped for validation.

In order to be billed correctly, patient charges must be posted on the same day, and automating this process ensures that a complete, accurate batch posts each night, guaranteeing the billing cycle and maintaining a steady and accurate revenue flow.  In fact, the hospital estimates that it has generated about $30,000 of new revenue each month - this is money that was being lost through poor claims processing before scripting was used.

Ben stated that “it would have been humanly impossible to achieve these results without Boston WorkStation.  The automation we now achieve with Boston WorkStation touches every department of the hospital.”

As evidenced by these examples, automating specific tasks yields fast returns on investment.  Intelligent automation tools allow hospitals to develop processes that manage and support end users.  As a result, organizations can address not only their technological and tactical needs, but also strategic business requirements.

Margaret Mayer directs Boston Software Systems' marketing activities, including market strategy, field and technical marketing, marketing communications and public relations.  Prior to Boston Software Systems, she was with New Era of Networks, where she was responsible for all marketing communications initiatives as vice president of Corporate Marketing.  Prior to New Era of Networks, Ms. Mayer was VP of Marketing for MicroScript Corporation, where she directed the marketing efforts of this healthcare integration products company.  She has a BA degree in English from San Diego State University and completed post-graduate studies in advertising and marketing.

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Career Corner:  Featured Employer Job Postings and New Web Site

By:  Donna Carroll, Editor

You asked for it ... you got it!

Since we began publishing The MEDITECH Community Bulletin over a year ago, we've received numerous requests by MEDITECH customers wishing to advertise their job postings in our newsletter.  Thus far, we have declined those requests because the purpose of this newsletter was never to serve as a 'job board'.  We'd really like to maintain our focus on news and information relevant to the MEDITECH user community.  However, these numerous requests have caused us to reconsider what might be of value to our readers, and it seems that many of you find value in having a niche publication in which to advertise MEDITECH-related job openings.  So, we're going to try something new.

Beginning next month, every issue of The MEDITECH Community Bulletin will feature one employer and allow them to advertise their job posting in our newsletter FREE of CHARGE.  In addition to the basic job posting, we will provide some general information about the employer and their environment.  If you're interested in getting your job advertised for FREE, simply email us the job description, along with your full contact information, and we'll contact you for additional details.

The featured employer will also have their job advertised in our new web site: MeditechCareers.com.  This new web site was created in order to give MEDITECH professionals a place to explore career options and opportunities.  Visitors to the site will be able to view MEDITECH-related job postings and submit their resume for consideration.  Having a separate web site for this purpose will allow us to maintain the original focus of The MEDITECH Community Bulletin on our loyal readers who are seeking news and information rather than job postings.  We certainly hope this new web site will provide some value to the MEDITECH user community.

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Industry Spotlight:  CPOE on Steady Rise

By:  Patty Enrado
Reprinted from:  Healthcare IT News, July 1, 2007

The CPOE Digest 2007: A Report on Computerized Physician Order Entry by KLAS Enterprises, which was published in February, reported that interest in CPOE remains “strong” and CPOE deployment by healthcare providers is “steadily increasing.”

“Momentum is measurable, meaningful and successful,” said Adam Gale in his report.  “CPOE becomes a question of when, not if, as steady deployment of CPOE results in 6.8 of U.S. hospitals doing some CPOE using commercial software products.”  While re-entry of pharmacy orders continues to decline as vendors add more functionality to their software, the capability for alerts remains “elusive” and patient barcode scanning is still in its infancy, according to the report.  CPOE vendors are listed alphabetically and are not ranked.

Cerner Corp. - Cerner Millennium
Features:
Cerner Millennium provides quick access to the most relevant information for timely decisions, supporting common tasks and anticipating clinicians’ next steps.  The solution offers a simple, intuitive visual interface designed by clinicians for clinicians working in both acute care and ambulatory settings.  Cerner Millennium delivers the benefits of a clinical database, with functionality allowing users to view clinical data, complete orders and optimize clinician documentation in one powerful solution.
Do physicians have the ability to enter all medication orders?
Cerner CPOE includes a physician-centric ordering application that works in conjunction with Cerner Millennium’s robust data repository, viewer, clinical documentation tools and clinical decision support.  Physicians view results and existing orders, place orders and modify, renew and cosign orders.  Dynamic modification enables the physician to modify an order, retaining the history of the order without requiring additional steps.  Time-saving features include pre-built order sets and sentences, a favorite orders folder and linked reference text.
Do pharmacists reenter orders done by physicians?
Cerner Millennium organizes data around the person rather than the encounter.  This eliminates duplication and increases patient safety by placing data only once in a central repository.  This access makes pharmacies more efficient, saving pharmacists time and money and allowing them to become more closely linked with the care team.  Cerner Millennium links pharmacists, nurses and doctors from the time caregivers order medication through its administration, ensuring efficiency, continuity and safety.

Eclipsys Corp. - Eclipsys Knowledge-Based CPOE
Features:
Eclipsys Knowledge-Based CPOE, the industry’s most widely adopted computerized physician order entry system, provides real-time clinical decision support, including expert alerts relative to changes in a patient’s condition.  The user-friendly interface promotes adoption while actionable knowledge gives physicians confidence that the system will help them enhance care delivery and achieve improved patient-care outcomes.  The Eclipsys system can easily be customized to meet the care delivery requirements of any healthcare organization, including specialty care providers.
Do physicians have the ability to enter all medication orders?
Yes.  Physicians can place tapering orders, loading-dose orders and multiple-frequency orders as one order, not multiple separate orders for each component.  They’ll also find comprehensive support for sophisticated chemotherapy orders, complex orders and linked order sets.  Full orders-to-flowsheets functionality makes it easier for the care team to work together efficiently.
Do pharmacists re-enter orders done by physicians?
No.  Eclipsys offers an advanced, end-to-end solution that tightly integrates the workflows of physician order entry, pharmacist verification and dispensing, and nurse medication administration.  Clinicians share the same patient record, rules engine and eMAR, so physician, pharmacist and nurse are kept informed at all times.  Combined with streamlined support for complex orders and faster time to treatment, this global insight is particularly effective in treating high-acuity patients.

Epic Systems Corp. - EpicCare Enterprise Clinical System
Features:
EpicCare supports inpatient and ambulatory CPOE.  Capabilities include automatic order recommendations based on diagnoses and other patient data, order sets with links to references, decision support that helps avoid errors and promotes best practices through “actionable” alerts, point-of-ordering displays of relevant results (e.g., creatinine for ciprofloxacin), starter order sets and specialty order Preference Lists, automated cosign workflows, e-prescribing and connectivity with prescription information networks, and full integration with Epic’s inpatient pharmacy, eMAR and ancillary applications.
Do physicians have the ability to enter all medication orders?
Yes.  EpicCare is designed for electronic entry of all physician orders.  It supports weight and BSA-based dosing, default doses and other details to simplify order creation, and forms that guide entry of TPN and IV orders.  A single patient medications list simplifies medication reconciliation, and reordering of prior-to-admission prescriptions as inpatient medications and inpatient medications as discharge prescriptions.  For inpatient medication orders, Epic’s system selects corresponding drug products based on the dose and available medications.
Do pharmacists reenter orders done by physicians?
No.  Clients who license Epic’s inpatient order entry functionality also license the integrated EpicRx Pharmacy System.  EpicCare and EpicRx create a closed-loop medication process, where the order created by the physician is the same order the pharmacist reviews and verifies.  Order changes made by pharmacists are immediately available for review by physicians and appear on the eMAR.

GE Healthcare - Centricity Enterprise-CPOE
Features:
Centricity Enterprise-CPOE includes basic field edits, structured orders, pre-defined order sets and order pad for quick access to orders commonly used by individual providers in specific scenarios.  There is order checking, flagging for possible drug interactions, allergic reactions, therapeutic duplications and excessive or under dosing by linking the patient record with First Databank, a third-party online pharmaceutical reference database.  Centricity Enterprise has complex orders, automatic dosing calculation, and order relevant patient data capture, in addition to rules-based prompting alerts.
Do physicians have the ability to enter all medication orders?
Yes.
Do pharmacists reenter orders done by physicians?
No.

McKesson - Horizon Expert Orders
Features:
The Horizon Expert Orders software solution was created by clinicians for clinicians to specifically address the common barriers to physician adoption of CPOE, focusing on the clinical decision-making process instead of order entry.  McKesson’s Horizon Expert Orders solution features proven clinical content driven through a simple clinical interface and intuitive workflow that supports the way physicians practice medicine.
Do physicians have the ability to enter all medication orders?
Yes.  With Horizon Expert Orders, physicians have the ability to enter all medication orders – simple to complex (sliding scale insulin) and IV additive to TPN.  With this physician order entry tool, the prescriber uses clinical decision support provided at the point where it’s needed – embedded within the physician’s workflow.
Do pharmacists reenter orders done by physicians?
No, re-entry of the order by the pharmacist is not required.  Once entered in, the order is available in the pharmacy task list, which helps the pharmacist and other pharmacy staff electronically prioritize and complete tasks for review and verification.  Also, if the order has been modified to allow appropriate dispensing or for clinical reasons, the verified order with any changes is communicated back to the physician via Horizon Expert Orders.  The physician always has access to the most current medication profile and full history of the medication order.

MEDITECH - MEDITECH Physician Care Manager (PCM)
Features:
The Physician Care Manager’s CPOE component includes order sets based on physician preferences, drug information from hospital formulary services, dose and conflict checking, a dose calculator, evidence-based order sets, duplicate order checks, patient’s allergies, adverse reactions, medication checks, relevant clinical information such as vitals and test results, historical patient information, support for organization’s standards of care and safety initiatives, and a direct link to Medication Administration Record to update the patient’s record.
Do physicians have the ability to enter all medication orders?
Physicians have the ability to enter and manage all orders from the hospital, home or while traveling.  Capabilities from throughout the MEDITECH HCIS are integrated to ensure a coordinated and safe ordering process.  Pharmacists, nurses, laboratory and radiology technicians, and the rest of the care team are all tied into the physician-initiated process.  What’s more, physicians can sign any verbal orders and view results from wherever they may be.
Do pharmacists reenter orders done by physicians?
Physician Care Manager (PCM) is not a word processor that sends an order to a printer in the pharmacy where it would need to be re-entered into a separate database.  All PCM orders seamlessly flow to the appropriate clinician’s worklist.  For instance, medication orders will appear on the pharmacist’s worklist to be processed and filled.  Our unparalleled integration allows staff to process all medications from a single, centralized process screen from throughout your enterprise.

Misys Healthcare Systems - Misys CPR
Features:
Misys CPR delivers enterprise clinical management through a computerized patient record solution.  Providing access to comprehensive patient information and decision support at all points of care, Misys CPR helps drive higher quality of care, cost control and successful outcomes.  Misys CPR provides an integrated CPR with a suite of modules including: CPR, CPOE, integrated pharmacy, radiology and laboratory, clinical data repository, automated nursing documentation, automated medication administration, document imaging and a physician Web portal.
Do physicians have the ability to enter all medication orders?
Misys CPR is designed for physicians to enter all medication orders.  The process begins with the system allowing the physician the ability to access their patients.  Once the patient is accessed, the physician can immediately begin to enter orders.  For facilitated order entry, the system provides the physician with the ability to build common orders, orders based upon drug therapy (such as antibiotics, antihypertensive, etc.) and standing orders.
Do pharmacists re-enter orders done by physicians?
Pharmacists do not have to re-enter orders because Misys CPR provides the ability for the physician to enter the order, and once entered, the order is electronically sent to the appropriate pharmacy queues for processing by pharmacists and dispensing by the pharmacy.

QuadraMed - Computerized Physician Order Entry
Features:
QuadraMed CPOE provides physicians with the ability to review clinical information and enter orders with built in intelligence to support clinical decisions with presentation of information tailored to specific patient diagnosis and conditions.  The high level of personalization allows physicians to customize the application to suit their preferences and workflow.  Integrated features include: order sets to support clinical protocols; personalized order sets to streamline the order process; and e-signature support for verbal orders and transcribed documents.
Do physicians have the ability to enter all medication orders?
Yes.  Physicians can enter orders for all types of tests, medications, care needs and procedures.  They are able to use order sets that are defined by the facility or they can create their own.
Do pharmacists re-enter orders done by physicians?
No; however, the system does support the usual hospital required protocol for the pharmacist to review and verify orders that physicians have entered into the system.

Siemens Medical Solutions - Soarian Clinicals
Features:
Soarian Clinicals combines departmental solutions with core clinical information system components to provide integrated clinical workflow to meet the needs of the acute care hospital environment across the complete continuum of care.  This solution includes task and census management, interdisciplinary clinical documentation, CPOE, and operational and analytical reporting, as well as precise workflow functionality that extends to meet the specific needs of defined patient populations and specific clinical departments.
Do physicians have the ability to enter all medication orders?
Soarian Clinicals provides extensive flexibility to support the ability to enter all medication orders.  Types of orders that can be entered into the system include but are not limited to: simple medications; complex medications; compounded medications (ex. creams, ointments, solutions, suspensions, etc.); non-formulary medications; sliding scales; IVs including pre-mixed, compounded, alternating, titration and complex IVs; PCA; and TPN.  Tapering doses and alternating doses can be entered with a single order, streamlining the ordering process.
Do pharmacists re-enter orders done by physicians?
Soarian Clinicals communicates information on admission, discharges and transfers as well as details about allergies and physician orders to Siemens Pharmacy via a bi-directional interface.  The Soarian Clinicals workflow engine can use rules to generate alerts displayed on the pharmacy monitor.  Further supporting pharmacist workflow, the Pharmacy Orders Monitor provides a view of routine and stat-unvalidated orders that are entered through the physician order entry system or scanned through Siemens Document Management system.

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Recent News:  MEDITECH Offers New Training Website and Portals

MEDITECH is offering a new Client Server 5.6 training center website.  The site offers downloads of tutorials that give a general overview of the new look and feel of Client Server 5.6 as well as application specific details.  The new C/S 5.6 Application Training Center is located in the top left-hand corner of the header section on the Updates Homepage (Support Tools> Updates> Client Server 5.6).

There are also two new portals on the customer services homepage.  The first new portal, Advanced Clinical Resources, offers a “one-stop” resource for implementing the MEDITECH Advanced Clinical Product suites, which include Patient Care and Patient Safety (also known as MAGIC NUR or C/S PCS), Physician Care Manager (PCM), and Emergency Department Management (EDM).  Using their years of experience in implementing these applications, MEDITECH is using this site specifically for clinical workflow and implementation resources.  The second new portal, HIM Resources, provides both MEDITECH and Industry standard information, tools and resources specific to HIM.

More info:  http://www.meditech.com/customerservicehome.htm

Recent News:  LSS Data Systems Celebrates 25 Years of Successful Business

July 29, 2007 -- LSS Data Systems marked its 25th year as a business with a celebration for families, friends and business partners on the grounds of its Minnetonka facility.  The celebration featured rides and treats for the children, a catered lunch and formal presentations marking the important milestone.  The mayors of Minnetonka and Eden Prairie (the cities that are home to LSS’s two buildings) were present, along with honored guests from the company’s primary business partners (MEDITECH and MEDITECH South Africa), several physician advisors, and number of long-time friends and business associates.

LSS CEO and Chief Technology Officer Ken Carlson provided a retrospective look at LSS, taking the audience back 25 years before the company’s founding, to 1957, before the integrated circuit was developed when only a dozen or so electronic computers existed.  Jumping forward to 1982, the year both LSS and MEDITECH South Africa were founded, there were already over one million personal computers and the FCC had just authorized cell phone technology in the U.S.  Bringing us up to the present, he observed that there are roughly a billion personal computers in the world (one for every seven people) and 120 million cell phones; we’ve decoded the human genome; and we can manipulate matter at the atomic level.

MEDITECH President and Chief Operating Officer Howard Messing observed that any company that makes it to its 25th anniversary has achieved something impressive, but it’s even more remarkable for a husband-and-wife team to found and run a company so successfully.  He also commented upon the strength of the partnership LSS and MEDITECH have, and the benefits both companies derive from it.  “It’s not only LSS that has benefited from our partnership,” Mr. Messing observed.  “MEDITECH has, too, from LSS’s involvement with physicians in the clinic and practice environment.”  Mr. Messing presented a gift from MEDITECH — a beautiful Lakeside metal bench with a grass and leaf cut pattern, evocative of the company’s founding near Lake Superior.

More info:  http://www.lssdata.com/viewer/viewer.php?viewer=news&story=312

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

A Stark Future?
By:  David Raths
HealthCare Informatics, July, 2007

A May 2007 IRS memorandum has removed fears of donating IT to physician offices.  With this door opening, will hospitals rush to open up relationships between physicians and IT?

Read article

Does E-Prescibing Lower Prices?
By:  Michael Coleman, M.B.A. and Craig Morrow, M.D.
HealthCare Informatics, July, 2007

By increasing the number of generic prescriptions and reducing the number of time consuming phone calls between provider and pharmacy, Southwest Medical Associates (SMA) in Las Vegas has saved millions of dollars.  This article reviews the EMR and E-Prescribing implementation process that led to this successful outcome.

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A Time of Change
By:  Lyle Berkowitz, M.D.
HealthCare Informatics, July, 2007

Dr. Berkowitz speaks to how technology and consumers are driving changes in patient care in two arenas: web-based care and non-traditional office settings.  He also discusses some possible future changes involving physician extenders, telemedicine, and robotic-enhanced encounters.

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Predicting Health
By:  Jeff Kaplan
HealthCare Informatics, July, 2007

A review of the six basic steps of predictive analysis to look at clinical and financial data to proactively identify opportunities for improved clinical and financial outcomes, better patient satisfaction, less medical errors and greater revenue capture.

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