By InterOpNurse guest contributor: Austin Merritt from Software Advice

By now you’ve heard about the American Recovery and Reinvestment act of 2009 - the stimulus bill recently passed by Congress. If you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to promote use of Electronic Medical Records (EMRs). 

This new EMR subsidy has absolutely stimulated demand for EMRs. However, while we don’t like to be pessimists, we’re concerned the subsidies won’t change healthcare providers’ late adopter mindsets about information technology. Providers may jump at “free software” and try to avoid penalties (starting in 2015), but will they:

•    Truly believe in the value of an EHR over traditional paper charts?
•    Take a leadership role in advocating adoption of the new EHR in their practice?
•    Change their old workflows to match the best practices in leading EHRs?
•    Take part in intensive training to learn the new system?
•    Ride out the difficult stages of new software adoption and change management?

Traditionally, the substantial costs of EHR systems keep the luddites from buying technology in the face of these challenges. But with “free” EHR software, we expect more than a few providers to throw caution to the wind, buy an EHR and overlook the critical implementation and change management practices that are critical to success.

In the article, “Get Ready for EHR Failures, But Don’t Blame the Software” we present 5 critical steps for a smooth, successful EMR implementation. If you follow these major guidelines - and a lot more small steps in between - you’ll have a much greater chance of EMR success.

By-Line:

This article was written by Austin Merritt from Software Advice, a website that reviews and compares electronic medical records.

Great Nursing Informatics News!

President Obama has named Mary Wakefield, R.N., PhD, as administrator of the Health Resources and Services Administration. An agency of the Department of Health and Human Services, HRSA delivers health care to the uninsured and underinsured through the National Health Service Corps.

 Read more…

Obama: Health Reform Starts Now

A major effort to reform America’s health care system starts next week, President Obama told the nation during his State of the Union Address on Feb. 24. And that’s on top of health initiatives, including major information technology provisions in the American Recovery and Reinvestment Act, enacted during the past month.

Read more…

I was interested in learning more about the Presidential candidates and their position on various topics in healthcare. Especially after reading the endorsement of Senator Barack Obama by the American Nurses Association, it prompted me to do my own research. Here are the results of my findings presented to you in a side by side comparison.

Click here to see a more in depth comparison

Source:  www.health08.org

I want to try a new column here.  This will be an evolution of a previous column, “InterOpNurse Thoughts” that started but never really took off.  I am calling my new column “Ask the HIT Nurse.”  This is for a lack of a better slogan for this column, but just like any of my column it may evolve again.  Here is the premise of this column; while I was in the shower tonight (sorry for the TMI = too much information), I came to a realization (no, I was not staying at a Holiday Inn Express).  When I first entered this industry I call Healthcare Information Technology (HIT) I had a steep learning curve to overcome.  I had a lot of questions, but was either too intimidated to ask any questions, or really did not know who to ask.  Fortunately for me, I was able to surround myself with the right people, who were open to answering my questions.  I realized tonight, if I felt that way, I am sure other new nurses getting into this field may be feeling the same way.  So, what I want to do is open up my blog to questions.  My intent is not to seem to know it all and imply being correct about my answer, but provide you my take.  Provide the readers insight to what I would do.  It may not be the popular answer; in fact it might be the wrong answer.  But my hope is to gather enough readers (knowledge base) that collectively via this medium we can come up with multiple answers, or shall we call it recommendations.  So, shall we give this a try?  Here is what I am thinking.  If you have a question you can utilize my “contact” page or email me at info@interopnurse.com (I will find a better medium to obtain questions in the near future) and I will post your question and I will provide you my answer.  I will open the post to comments (for now, only registered commentators will be allowed to avoid the spam bots), it can be anonymous (again, I will find a better process in the near future to facilitate this) and jointly we can learn from each other.  

Now I am open to any topic.  You can be a nurse from a different specialty looking to for advise on how to get in this highly completive industry.  You may be a nurse who by default have been asked by your administration to help launch and implement an Electronic Medical Record (EMR) project.  You might be in sales and want advice on how to market a product.  You may be the CIO of an organization wanting to find other ways to get better end-user adoption.  I want to be open to any topic…

Now let me give you a little bit of my background.  I am a Registered Nurse, and my nursing background has provided me a myriad of experiences.  From my humble beginnings as a Critical Care Nurse, I have done Public Health Nursing (more specifically Parish Nursing), Travel Nursing, Critical Care Transport Nursing and now Nursing informatics.  I have been working in the HIT industry for 5 years now starting in the vendor side and now on the provider side.  My implementation experience is in the inpatient arena.  I am open to discussions related to other disciplines (i.e. ambulatory, financial, ancillary, etc…) because I feel the process is the same.  I am not PMP certified, nor do I hold prestigious letters after my name from HIMSS.  I am not even Board Certified in Nursing Informatics.  All my experiences have been OJT (on the job training).  Depending on your opinion, I personally feel I am gaining the experiences based on real life situations, just like I felt I learned more during my nursing new grad program, than I did in nursing school.  Nursing School definitely gave me the fundamentals, but the critical thinking skills were developed while on the job. 

So, just as I have learned from great people on the job, together we can broaden this experiences through this great medium – The Internet. 

Looking forward to your questions…

By InterOpNurse guest contributor:   Heather Johnson

The internet has extended its tentacles all over the nursing industry.  While information technology is one of the best ways nurses’ jobs are made easier, the internet has made it possible for hiring managers to find the best available nurses for their staff.  There are thousands of websites that claim to be the best out there for finding nurses, if you’re going to be in the recruiting business for your facility you need to be honest and up front.  Aside from that most crucial piece of recruiting advice, here are six more things you need to know about recruiting on the internet:

1. Explicitly define your benefits package.  Nowadays, your benefits that you offer your workers are often deal breakers or deal makers.  Explain your salary structure, retirement savings plan, health insurance plan, time off procedures, etc.  This will be one of, if not the, first things that prospective nurses will look at.
2. Let nurses know who you serve.  Identifying your demographic base will give nurses an honest description of where they may be working.  This goes hand-in-hand with our cardinal rule of being up front with your prospective employment base.
3. What kind of environment can nurses expect?  Explain the resources you have available for your nurses.  Let them know what kind of experience your staff has.  Who makes the decisions for nursing care?  Is personal and professional growth a priority?  These are all things you should be advertising and questions you should be answering.
4. Introduce key personnel.  On your main page, introduce the people that your new nurses will be reporting to on the administration and nursing levels.  This will foster a more personal attitude for the prospective nurses.  Don’t be afraid to put faces to the people that your nurses will be working with and if this is a problem then that’s something that could be a major issue down the road.
5. Be current with the times.  Most reputable organizations welcome online resume submissions.  It’s not enough just to accept resumes in this fashion but you need to take ownership and provide initial feedback within a day.  This practice will make you come off as an organization that is responsive to the technological demands of the incoming crop of nurses.
6. Make your mission known.  We recommend that you put your mission statement somewhere prominent on your main page.  Let visitors to your site know your methods and what you expect from all levels of personnel.

By-line:

This article is contributed by Heather Johnson, who regularly writes on top nursing school. She invites your questions and writing job opportunities at her personal email address: heatherjohnson2323 at gmail dot com.

This is such a good article with wealth of information, I found it necessary to embed here…

———–

The New York Times: June 19, 2008

Most Doctors Aren’t Using Electronic Health Records

By STEVE LOHR

A government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself. The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

The national survey found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.  Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost. “Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”

Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.
“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay,” said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.
To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations. The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion. Individual doctors will be offered up to $58,000 over the five-year span of the project, which is intended to test the impact of incentives on the spread of electronic health records.

Further programs across the country are planned.  The report published in the journal also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors.
Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.  The findings of the study, which was paid for by the Department of Health and Human Services and a grant from the Robert Wood Johnson Foundation, broadly echo previous research on the adoption of electronic health records. Large medical groups have long been the early adopters, and small practices have struggled.
But the new study is based on a large sampling — more than 2,600 doctors across the country — and a detailed survey, making it more definitive than past research, experts say. The results, they say, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history.  For example, 82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care.  “Those numbers are huge and very encouraging,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration.

Dr. Brailer also pointed to the 54 percent of doctors without electronic health records who said that not finding an electronic health record that met their needs was a “major barrier” to adoption. In short, they are not satisfied with the existing products, which tend to be designed for hospitals — big customers — instead of small practices.  “What we see is a deficit in innovation, and that is something innovators and the capital markets can address,” said Dr. Brailer, who leads a firm that invests in medical ventures, Health Evolution Partners.  One wave of innovation is coming from big technology companies, like Microsoft and Google, which recently have begun services that offer consumer-controlled personal health records over the Web, which are stored in the companies’ data centers. These consumer-controlled health records are intended to link up and exchange information with electronic patient records in doctors’ offices and hospitals. Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.”  He could not afford conventional software, and chose a Web-based service from Athenahealth, a company supplying online financial and electronic health record services to doctors’ offices.  Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record.

Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.  “Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

Copyright 2008 The New York Times Company

32% of RNs Say They Shouldn’t Be Driving After Work  

Thought everyone might be interested in this article from the Congressional Budget Office on the Evidence on the costs and benefits of health information technology. It might help with those trying to determine metrics for the implementation of an EHR.

Telehealth Promise…Better Health Care and Cost Savings for the 21st Century - report from AT&T Center for Telehealth research and Policy, U of Texas…

Telecare made easy…A very strong case can be made that the UK is way ahead of the US in Telecare.

Advances in electronic medical records have led to the need for standardization of nursing language and “finding a place for nursing’s voice to be heard,” says a Florida Atlantic University professor of nursing. She is working on an e-records model that will allow nurses to enter not only medical data but also their notes on relationships with patients

A great website concept for connecting cancer survivors.

Has anyone seen the new device from Amazon called the “Kindle.”  If they actually start having nursing and medical textbooks be available, this might actually have a place in the health care sector.

Here are some EMR/EHR company spoof sites.  This is too funny.  If you do not read teh fine prints, you can be fooled to thinking it is a legitimate company.  Great website design at least.  Here you go:

• Extormity = “At the confluence of extortion and conformity lies Extormity, the electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize and prohibitively expensive healthcare IT solutions.”
• Seedie = “SEEDIE, the Society for Exorbitantly Expensive and Difficult to Implement EHR’s”

Nurses aren’t trained to be managers. They’re trained to be clinicians. So how can your hospital ensure that it is providing the additional training and leadership development needed to create the next generation of chief nursing officers…

Doctors using Virtual Approach.  Rush University Medical Center’s new study reports that elederly patients suffering from chronic illnesses receiving virtual care from a team of medical experts linked together via phone, fax, and email make fewer emergency room visits. Also download a presentation on the Virtual Integrated Practice approach.

CMS’ proposed rule to allow physicians to be reimbursed for telehealth follow-up inpatient consultations could encourage insurers to provide similar reimbursements, Modern Healthcare reports (Vesely, Modern Healthcare, 7/2).

Details of Proposed Rule

The proposed CMS rule for 2009 Medicare payments, released this week, would allow physicians to bill for electronic consultations following inpatient visits. It also would add new codes specifically for telemedicine consultations for health care providers who are consulted by a patient’s physician but are not available for in-person consultations (iHealthBeat, 6/30).

The telehealth consultations would include monitoring a patient’s progress, recommending care-management changes or providing a new plan of care. The e-visits would be performed in real time with interactive communications systems in all states except for Alaska and Hawaii, where store and forward technology is being used in federal telemedicine demonstration projects, according to CMS.

The three new billing codes would reflect the complexity of each different e-visit and the amount of time spent by the physician.

Private Insurers

Jonah Frolich, senior program officer for the California HealthCare Foundation, said that while e-visits are still new, some insurers already have begun reimbursing health care providers for the service. Five California insurers are paying $40 per e-visit, and some national plans have launched telemedicine reimbursement pilot projects, Frolich said.

He added that insurers tend to adopt billing practices used by CMS (Modern Healthcare, 7/2).

Considering telecare for someone with dementia.  In this social worker’s blog he/she describes going to assess a client for the first time. It’s heartening to see that some form of telecare is automatically considered as part of that process

A blogger Alfred Fortin came up with 101 things to do with a mobile phone in healthcare. 

AHRQ is currently seeking for clinicians to provide them input via a web based focus group, to understand how to get a broader perspective on adoption of Healthcare IT tools.

Video tool would aid sign language interpretation.

Where are we on the ADN versus BSN debate.  I personally believe that from a professional standpoint and development of Nursing, the BSN should be a minimum requirement.  I understand that we are at a shortage, and require a medium to fast track nurses into the work force.  But, there is no relief in sight for the shortage, so now more than ever, a professional standard should be imposed…

CIGNA Healthcare to offer expert online second medical opinion services through E-Cleveland Clinic.  Isn’t Cleveland clinic the pilot area for the new Google PHR.  I wonder if there is a future plan to merge the two services together?

Cultivating an informatics culture within nursing education.  I agree 100% that education about uinformatics needs to start in the academic setting.  But, personally, noramlly it is the new grads that get it…that know the impoiratnce of integrating informatics in practice.  The question is, how do you cultivate already practicing nurses?

A nursing professor - Patrick Hickey will climb Everest to help bring attention to the nations nursing shortage issue. 

I will be trying this new column, I am calling “In the News.”  My plan is to of course include Healthcare IT (HIT) related stories, but to also have a column to collate news I find interesting.  Hopefully I can enage you, my readers to comment on them and utilize these columns to dialogue about news and events.  For now, until I find a clever way to enable comments without attracting all the spam, I will require you to register.  Any suggestions on how I can manage this better is welcome and appreciated.  Shall we give this a try….

Microsoft came out with a medical imaging product at this years HIMSS conference in Orlando called Amalga (formerly known as Azyxxi).  It looks like they are now trying to staff for this product.

Thanks to Facebook, a top ten list has been compile as to why someone should date a nurse.  My top two favorite from the list is #5 “you will never need to buy condoms, paracetamol, toothbrushes or any hospital supplies” and #6 “they know how to handle bodily fluids!”

I do no mean to sound like a pessimist, but according to this article, RN’s are warming up to Inforamtion Technology…please wake me up, I am apparently dreaming. 

Apparently research work done at UCLA has shown a correlation between children behavioral problems and mobile phone use.

HP joins the Tiny Notebook race, as it competes with ASUS Eee, Classmate, Netbook and Sony Vaio.

Apple will be holding its Worldwide develpoers conference on June 9-13 in San Francisco.  Rumor has it that Steve jobs will be announcing the release of iPhone 2.0 which will now have Microsoft’s activesync support.  I wonder what the impact this will have for IT departments who utilizes Mocrosoft exchange and the surge of people whol will now want the iPhone?

Todd Davis, CEO of LifeLock who made a bold move to promote his company by publishing his real social security number to challenge identity theft.  Apparently after two years of daring people to steal his identity…it finally happened.

Doctors in Cincinnati are experimenting with text messaging to get tweens and teens to take their medications for chronic illnesses, such as diabetes, kidney disease and asthma. “It’s a time of so much change in these kids’ lives,” says Dr. Marva Moxey-Mims, of the National Institutes of Health. “It’s very difficult when you’ve got a life-threatening illness to say, ‘Let them make their mistakes.

Read more…

A federal legislator has a filed a bill designed to encourage active-duty military nurses and those retiring from military service to become nurse educators. The legislation, modeled after a Defense Department program helping military personnel move into education, offers varied fellowships and scholarships to nurses interested in faculty positions. Retired nurses would get financial incentives for serving as full-time faculty at an accredited school of nursing. The bill hopes to address the drastic shortage of nurse educators that prevails today. According to the American Association of Colleges of Nursing, U.S. nursing schools turned away almost 43,000 qualified applicants in 2006.
http://www.modernhealthcare.com/

This is quite an impressive account of user-friendly telemetry implementation, both productive and economically feasible!

BILLINGS, MT – The Centers for Medicare and Medicaid Services has just closed the books on the second performance year of its Medicare Physician Group Practice demonstration, and the Billings Clinic released a case study on its participation of that pilot.

Read more…

From Jane Sarasohn-Kahn…

Social media on the Internet are empowering, engaging, and educating health care consumers and providers. While consumers use social media — including social networks, personal blogging, wikis, video-sharing, and other formats — for emotional support, they also heavily rely on them to manage health conditions.

Read more…

You may want to visit her blog at http://www.healthpopuli.com/