To RSVP go to  www.cityofhope.org/career-events

LOCATION: City of Hope Medical Center, 1500 East Duarte Road, Duarte, California 91010

R.S.V.P.: Please register to obtain additional information. Online registration is required by Tuesday, March 20, 2012.

You are invited to City of Hope for our Career Invitational! As a Healthcare Information Technology Professional, you know the future — perhaps better than anyone!

You know how the right technology in the hands of the right people can improve communications, increase efficiency and, most importantly, lead to even better patient care. At City of Hope, we’re growing into the world of electronic record keeping, however, the thing you have to know is that we plan on setting a new standard. We’ve been watching, testing, observing, and learning. We know what we want and now we need EMR analysts who know nursing, know technology, and know how to build in the human element that transforms a technology system into a living, breathing asset to everyone.

At City of Hope, a National Cancer Institute-Designated Comprehensive Cancer, you’ll work with some of the most gifted physicians and researchers in the world. Working here is about quality of life for you, your family, and the incredible patients and families we see every day.

Come meet our team and hear about the exciting future City of Hope is building. Be a part of creating the best clinical informatics system in one of the best cancer centers on the planet. City of Hope provides a unique environment of diversity, discovery and unlimited potential. This could be an important move for you.

Direct hire and contract positions available • Adoption Specialists • Clinical Analysts • Clinical Data Analysts • Clinical Informatics Architects • Product Support Analyst • Report/MLM Analysts • Solution Architects • Trainers

We are offering up to a $25,000 sign-on bonus DOE to Healthcare Information Technology Professionals with analyst, clinical adoption liaison or physician liaison backgrounds and one year of Allscripts experience.

HISsies 2012 Winners

Note: anyone could nominate candidates for all categories. The most-often nominated were placed on the ballot, with voting limited to the HIStalk e-mail subscriber list with one vote per reader. Agree or disagree, voting reflects the opinions of around 1,000 HIStalk reader-voters. 

Smartest Vendor Action Taken 
Google shuts down Google Health

Stupidest Vendor Action Taken 
GE and Microsoft move their healthcare products to a new joint venture

Best Healthcare IT Vendor or Consulting Firm 
Epic

Worst Healthcare IT Vendor or Consulting Firm 
GE

Best Leader of a Healthcare IT Vendor or Consulting Firm 
Judy Faulkner, Epic

Best Provider User of Healthcare IT 
Kaiser Permanente

Most Promising Technology Development 
Mobile health

Most Overrated Technology 
Social media

Most Overused Buzzword 
Cloud

When ______ Talks, People Listen 
Farzad Mostashari, ONC

Most Effective Healthcare IT Provider Executive 
Ed Marx, Texas Health Resources

Most Effective Medical / Clinical Informatics Professional 
Paul Tang, Palo Alto Medical Foundation

Industry Figure With Whom You’d Most Like to Have a Few Beers 
Jonathan Bush, athenahealth

Industry Figure In Whose Face You’d Most Like to Throw a Pie 
John Hammergren, McKesson

HIStalk Healthcare IT Lifetime Achievement Award 
Judy Faulkner, Epic

HIStalk Healthcare IT Industry Figure of the Year 
Judy Faulkner, Epic

Email 101

1.      The More the Fewer… As a rule of thumb, the more people to whom an email is sent, the less likely any single person will respond, much less perform any action requested.  Those addressed in the “To” field are expected to read and respond. Those addressed in the “cc” field are not expected to respond. Only those who need to be aware of the message of the email should be copied and the number should be limited to the greatest extent possible. The “bcc” field should be used even more sparingly, as those recipients will not visible to others.

2.      Get to the Point! Always include a subject and make sure it is specific and clear. Do not make the reader wade through a long message to get to the point. State the most important point first.

3.      Don’t Write a Book! Like the number of addressees, the longer the message, the less likely recipients will respond quickly. The message will be set aside until there is more time, and, unfortunately, forgotten. Long messages should be written in memo form and attached to an email. However, if you must send a long email, warn the recipient in the subject line by stating, “LONG EMAIL ALERT". Presumably, the message will explain why an email was used instead of a memo. This is especially important in the days of smart phones where reading long emails is cumbersome.  

4.      Stick to the Point! Don’t discuss multiple subjects in a single message. This makes it possible for the sender and the recipient to scan subject lines later to find the message.  It also contributes to briefer e-mail messages and a greater likelihood of a response.

5.      Provide “If-Then” Options.  Provide options to avoid the back and forth of single option messages.  For example, “If you have completed the assignment, then please confirm that via e-mail.  If not, then please estimate when you expect to finish.”  Or, “I can meet at 10:00 a.m., 11:00 a.m. or 2:00 p.m.  Will one of those times work?  If not, would you please reply with three times that would work for you?”

6.      Never Assume.  If you are not sure of the intent of the message, ask! This will avoid misunderstandings.

7.      This is Not a Guessing Game! When responding to an email, answer all questions, and when possible, pre-empt further questions. If you don’t know the answer to a question, say so and either state where the answer might be found or indicate when you will respond with the answer. This saves everyone time – AND frustration. If you are able to anticipate follow up questions, do so. The recipient will be grateful and impressed with your efficient and thoughtful customer service.

8.      Silence is Not Golden! E-mail doesn’t demand an instantaneous answer; however, it does generally require a timely response. If you are in sales, customer service, tech support, or similar fields, a rapid response – within hours – is expected. For most others, responding within a day, maybe two days, is sufficient. 

9.      Don’t Take That Tone With Me! Unlike face-to-face meetings or even phone calls, those who read your e-mail messages don’t have the benefit of your pitch, tone, inflection, body language or other non-verbal cues. You need to be very careful about your tone.  Sarcasm is especially dangerous.  If something gets “lost in translation,” you risk offending the other party.  The more matter-of-fact you can be, the better.

10.  Sleep On It… Never fire off an e-mail in anger.  They rarely serve their purpose or further long-term interests and often result in ruined relationships. If it makes you feel better, go ahead and write the message, BUT DON”T SEND IT! If you go back and read it a day or two later, you’ll understand the wisdom of restraint.

11.  Facebook This Isn’t! When you are one of many recipients on an email, unless asked, don’t “reply to all”. Not everyone needs to know if you are booked on Friday at 10:00! This just adds to everyone’s already unwieldy Inbox.  Your default response should be only to the sender.  

12.  Don’t Be a Tattletale! It’s one thing to copy someone’s boss as a courtesy, such as when making an assignment to someone who is not a direct report to keep their supervisor in the loop.  But it is not a good idea to do this as a form of coercion. It is not subtle and you aren’t fooling anyone. You may be tempted to do this when you don’t get a response to an earlier email. You will be better served to pick up the phone and call the person.  If they are not responding to your e-mails, try a different communications strategy.

13.  Full Disclosure Is Required. Use a signature with your contact information.  This is a courtesy for those receiving your messages.  It also cuts down on e-mail messages, since people don’t have to send a second or third e-mail asking for your phone number or mailing address.

14.  English 101. Lapses in grammar or punctuation can be forgiven, but misspelled words are just too easy to correct.  That’s why we have spell-checkers.  Make sure yours is turned on.

15.  Measure Twice, Cut Once!  It’s a good idea to re-read your messages and make sure that you are communicating clearly and observing good e-mail etiquette BEFORE you hit send!

16.  Decisions Decisions! Don't assume that email is always the best method.  Decide whether it is better to write or call. You don't have to reply to an email with an email. If it is more effective, call the person and talk through the issues raised in the email. And if you find that you are emailing back and forth with someone trying to come to closure on a topic, pick up the phone and resolve it in real time. A good rule of thumb is that if there are three emails (email, response, response to the response), pick up the phone or use your feet to go across the hall.

17.  Early Dementia?  Be sure your email box is set up to include the original email in your response. (Also, don’t click “New Mail” instead of “Reply” when responding.)  Don't leave out the message thread. If your recipient sends and receives many emails, he / she can’t remember each individual email. A “threadless” email will not provide enough information about the context of the message and will frustrate the recipient.

     I have learned earlier on in my nursing career that, in order to lead my patient toward wellness, I have to apply the nursing process as a method of problem solving which enables a nurse to organize and deliver nursing care.  It is an element of critical thinking that allows nurses to make decisions and intervene based on reason.  The nursing process is used to diagnose and treat human responses to health and illness by utilizing five steps:  assessment, diagnosis, planning, implementation, and evaluation (ADPIE).  ADPIE provides a blueprint for critical thinking which allows the nurse to individualize care and respond to a client’s need in a timely and reasonable manner therefore improving or maintaining the client’s level of health. The purpose of the nursing process is to identify the client’s health care needs (assessment), determine priorities (diagnosis), establish goals and expected outcomes of care, establish and communicate a client-centered plan of care (planning), provide nursing interventions designed to meet client needs (implementation), and appraise the effectiveness of nursing care in achieving expected client outcomes and goals (evaluation).  As laid out, these principles can easily be applied in parallel to project management.

     Project Management according to Lewis (2007, Chapter 1) is, “a temporary endeavor undertaken to produce a unique product, service, or result.” Similarly, project management follows the same basic tenets as the nursing process of ADPIE.  Every project manager needs to define the project (assessment), develop solution options (diagnosis), plan the project (planning), execute the plan (implementation) and finally monitor, control progress and close out the project accordingly (evaluation).  Just as a nurse ensures that the patients transitions from health to wellness, Lewis (2007, Chapter 2) quips, “the primary responsibility of the project manger is to ensure that all work is completed on time, within budget and scope, and the correct performance level.”  A project manager will develop a work breakdown structure, (WBS) to pictorial represent to team members and stakeholders all the components that are necessary to deliver the project.  The nurse in return has a similar tool the equivalent of a WBS called the Care Plan, which is the documentation of a plan identified by a nurse as all the necessities required to assist a patient (a nurses project), move from illness to wellness. Just as every project team member utilizes the WBS to gain a big picture perspective, all nurses involved in patients treatment regimen will look to the care plan.

     With healthcare reform currently at the center of our nation’s political debate, what has been overshadowed is The Health Information Technology for Economic and Clinical Health Act (HITECH) enacted into law by President Obama in February of 2009 with the basic premise of providing healthcare organizations with stimulus dollars and emphasizing on quality and efficiency and utilizing information technology to affect changes the healthcare industry desperately needs.  In a struggling economy it was only natural for the organization I work for then, a not for profit, faith based community hospital, to strategically align itself to realize the full profit potential the stimulus funding can provide.  In our usual annual fashion my Chief Nursing Officer (CNO) provided me with a report on projects approved by the organization’s Executive Team.  In reviewing these approved projects, it became apparent to me that the strategic plan for the year will be without complications.  Utilizing the process of ADPIE I quickly realized that my organization was asking me to do the equivalent of building a roof without the basic structure a home needs to support it.   In order for our organization to sustain the yearly requirements for stimulus funding, certain prerequisite projects were needed to scale our system to the desired end point.  Furthermore, I knew building the system without the prerequisite architecture would fragment data and therefore ultimately affect how the clinicians provide patient care and, subsequently affect patient outcomes.  As a health care provider I became quickly cognizant of the demands that have been overlooked, but I also knew I could not merely respond by saying it cannot be done.  I then embarked on a process of analysis, using ADPIE as my basic framework, to foresee how I could continue with the approved projects and at the same time reinstate the previously dismissed projects and build a business case that still aligned itself with the organization’s strategic plan for the year.  Apparently, I was organically utilizing project management principles in the process as well.  With a business plan the equivalent of a work breakdown structure (WBS) and risk analysis in place, I then engaged my CNO in a crucial conversation in which I asked her to re consider reinstating the previously dismissed projects.  Following a principle provided by Verzuh (2008, Chapter 11), “the best way to communicate difficulties to customers and managers is simply to present them the facts.”  I went on to articulate crucial components of a plan, in essence the critical path, which included reallocation of funding and resources to support the end goal.  The plan had a slight caveat, the need for additional funding with an amount that I felt was reasonable and minimal in quantity considering the funding and returns on investment that would be realized.   Clear and transparent communication being the key, my CNO was in agreement that certain items may have been overlooked by the Executive Team, and felt I had equipped her with enough information to confidently go back to the leadership team and request additional funding.   Approval was ultimately obtained and I came to the realization that in the process I had learned to advocate for the needs of the healthcare consumer as well as our healthcare providers.

     Project Management however goes beyond the day to day managing of task and deliverables.  If projects were that easy, then we would not see a failure rate of 83%, which basically suggest that a project is bound for failure the minute it is started (Lewis, 2007).  There is a crucial component to project management which I like to call the people management. These include the managing of the project team and the crucial conversations that must take place between the project team and the project stakeholders.  As a project manager, assumptions can be a dangerous thing, even detrimental.  As a people manager, a project manager has the difficult job of ensuring all parties are moving towards the ultimate goal, which is the successful implementation and completion of a project.  It is not just completing the project that determines success.  It is doing so in such a way that meets your stakeholder’s original intent, along with being on time and on budget.  Clearly there are three major moving parts; people, timeline and budget that ultimately will define if a project is indeed a success.  Lewis (2007, Chapter 10) explained the difficult task of a project manager the best when he stated, “a manager should try to satisfy the needs of the organization, while simultaneously helping individuals satisfy their own needs through participation in the project.” 

     In my years working in Healthcare Information Technology I have leveraged the use of the nursing process not realizing I have also been utilizing project management concepts.  Both of these principles have been an objective tool that has been so ingrained in me that I have used it often.  In the almost seven years that I have been in a managerial role, managing the electronic medical record implementation for hospitals, what has enabled me to thrive and manage such a complex implementation with multiple moving parts and sometimes conflicting priorities, is my very own knowledge and utilization of the project management process which has allowed me to achieve, and has been instrumental in, realizing my managerial potential.  Clearly whether it is patient care, or project oversight, structure and proper methodology is needed in order to be successful.  The process of ADPIE is such a universal concept that it can be an instrumental tool versatile enough that it can be used in business practices as well as in life decision making processes.  By using this blue print one can prioritize and approach critical situations with ease and confidence.

References

Lewis J P 2007 Fundamentals of project managementLewis, J. P. (2007). Fundamentals of project management (3rd ed.). New York, NY: AMACOM.

Verzuh, E. (2008). The fast forward mba in project managment (3rd ed.). Hoboken, NJ: John Wiley & Sons, Inc. 

RECRUITMENT STATEMENT

Date:  June 8, 2011

Fellow Informatics Professional:

Your assistance is needed in planned dissertation research on Pioneers of Nursing Informatics.  I am a doctoral student in Nursing at the University of Connecticut, and I am seeking to prioritize a list of Pioneers in Nursing Informatics for more in-depth qualitative research.  If you choose to participate in this Delphi survey, you will be asked to identify the top 5 Pioneers from an established list, or of your independent choosing, who meet the following definition and criteria:

Pioneer:  An innovator, trailblazer, or groundbreaker in some aspect of nursing informatics, who was “first” in opening up a new area/aspect of nursing informatics, shaped the thinking/direction or nursing informatics, and demonstrated sustained leadership in nursing informatics.

Prioritization should be based on the degree to which you, the participant, believe the Pioneer embodies the achievements and qualities listed in the definition as well as the weight the participant gives to the amount the Pioneer or their work has influenced their own career in nursing informatics.

If you choose to participate, you may follow the following link to a brief, anonymous survey.  Consent is assumed upon completion of the survey. 

http://www.surveymonkey.com/s/YJJFZ9Z

Thank you for your assistance.

Ann Zievers Branchini, MSN, RN

  ­­  

The Care Extender Program provides opportunities for volunteers to experience health care from a clinical perspective through patient contact and volunteer involvement. CareExtenders are trained to assist Medical Center staff, who, in turn, are able to share their personal experiences with their volunteers.

Time spent in the program proves invaluable because it provides each Care Extender with "in-the-trenches" experience in a real hospital setting. Care Extenders are respected as professional members of a patient care team. As a result, they gain an insiders’ understanding of the operations of the hospital- an experience which helps them determine their specific course for future studies.

Below are the steps to becoming a Care Extender:

-To qualify, you must be 18 years or older, currently attend college or already have a degree.

-Attend a mandatory orientation/application session (by reservation only) and submit the complete application at the end of that session

-If selected, attend an interview session.

-Upon acceptance into the program (requires one year commitment), you must attend a mandatory training session.  You will also need to get CPR certified by the American Heart Association, complete a 2-step TB test, and have proof of MMR vaccination and Varicella vaccination (or proof of history of chicken pox).

Spring 2011 ORIENTATIONS ARE ON THE FOLLWING DATES:

Tuesday, March 29^th: 7-9pm

Wednesday, March 30^th: 7-9pm

Saturday, April 2^nd: 10am-12pm

To sign up for one of the sessions, please click and follow directions on this link:

http://sites.google.com/site/careextendersprogram/Home/staff/faq/how-to-apply

You should bring a pen to the orientation so that you may complete the application, and you may use your resume for as a reference – resumes will not be collected. Dress is casual.  Orientations will be held in Ronald Reagan Hospital.

Please email questions to:

Cheryl Yashar: cyashar@ucla.edu

Blame it on Hollywood: thanks to an endless stream of TV series and movies set in hospitals, most of us probably have the wrong idea about what nurses do and just how important they are to the medical field. They’re usually depicted as smart but somehow inferior to doctors, as if they didn’t have their own medical knowledge or years of experience to guide them through the days. But this, like a lot of other popular portrayals of nurses, is almost moronically lazy and misinformed. Nurses are integral members of a health care team. If you’ve ever come across any of the myths below, or even if you’ve perpetrated them, know that the truth is a lot more interesting than the fictions.

1. All nurses are women: Not true. Admittedly, women outnumber men in the nursing field by a large margin — in the United States and Canada, only about 5-6% of nurses are men — but still, it’s wrong to say that there aren’t any men in the field. As a result of the gender imbalance, the profession is often perceived as an exclusively female one, which in America makes it a feminized one and therefore a less powerful or worthwhile one. Accordingly, portrayals of male nurses perpetuate the stereotype; a few years ago, on Scrubs, Rick Schroder played a nurse with the surname Flowers. Come on.
2. Being a nurse isn’t as challenging as being a doctor: Are you serious? Being a nurse requires education, critical thinking skills, and serious amounts of medical training. Nurses perform research, participate in surgeries, administer medicine and treatments, and act as the glue that keeps the hospital running. The hours can be long, but the work can be extremely rewarding on personal and professional levels. What part of that doesn’t sound challenging?
3. Nurses function as gofers for doctors: Again, a common misconception but a horribly wrong-headed one. Nurses often work in a capacity that sees them assisting doctors, but they’re anything but errand-runners. Nurses diagnose and treat patients, provide health care strategies for the infirm, and work to ensure people know how to take care of themselves. Nurses save lives, period. They apply medical knowledge in a host of areas to a steady stream of patients, and they do it every day. Helping out a doctor, even when it means retrieving something, doesn’t turn them into dull physical laborers in scrubs.
4. Nursing is a dead-end job: The Bureau of Labor Statistics pegs nursing as a hot field, with prospects for RNs listed as "excellent." Why? Well, baby boomers are getting old, and we’re also living longer in general, which means there’s going to be a glut of Americans putting a strain on the health care system. If you’ve got the training, you can likely find work, especially if you’re willing to relocate. What’s more, nurses with the right kind of training can further their careers in specialized fields (midwifery, elderly care), which opens doors to even more jobs and opportunities. In short, a smart nurse will succeed.
5. Nurses are all the same: Even patients in hospitals are rarely aware of what nurses do. They see people in scrubs walk in and out, but that’s about it. It’s easy to start thinking that all nurses have the same duties, training, goals, and career paths. But think for a second about the fact that you see nurses in all parts of the hospital, no matter what department or specialty you’re visiting. That’s not an accident. Nurses working for ear, nose, and throat doctors have otolaryngological training; pediatric nurses have knowledge of and training with children; etc., etc. Being a nurse means committing to any one of dozens of specialties, and more if you change tracks.
6. Nurses are people who couldn’t hack it in med school: One of the ugliest myths out there. It’s not unique in assigning weakness to a particular medical job that’s misunderstood; dentists deal with the same stuff. (Thanks, Jerry.) But nursing isn’t a fallback. It’s not an also-ran for people who wanted to be doctors. It’s not a consolation prize. It’s a conscious career choice made by people who want to work in health care, and it’s one that requires some real education. Many nurses hold bachelor’s degrees in their field, and some nurses even go on to attain higher medical degrees but remain devoted to nursing or working a nurse-like relationship. Nurses provide top-flight medical care for patients. They know what they’re doing.
7. Nursing is grunt work: It’s true that nurses are often called upon to perform physically demanding tasks in the course of providing medical care to patients of all ages and shapes, but it’s incorrect to assume that all nursing boils down to a willingness to lift people, boxes, and bedpans. What’s more, nurses work in a variety of fields, whether in hospitals or other areas, and such tasks are only usually a fraction of what they deal with in a given day. This myth is related to the one that says nurses are merely hired hands or assistants meant to run errands, but it’s insidious enough to count as its own separate untruth because of how badly it misrepresents the scope of what nurses do.
8. Nurses don’t get paid well: The federal government reports that median income for RNs in 2008 was $62,450, with earnings ranging from $43,000 to $92,000. That’s nothing to sneeze at, considering that some studies show that anyone earning more than $70k a year has already hit peak happiness in terms of salary. What’s more, many hospitals provide tuition reimbursement for classes designed to advance your degree, which helps save cash. Plus there’s access to entire fleets of medical professionals who know you personally. The medical benefits of being a nurse are definitely not to be overlooked. Between the perks and the salary, it’s a smart job choice.

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Masters in Healthcare  is your source for finding the best online Master’s in Health Care Degrees

HIT Consulting, LLC is offering to personally precept, train and challenge interns in their specialty areas. This is an unfunded opportunity which will serve as a valuable experience as you gain experience and skills in an exciting health informatics profession.

HIT Consulting provides Healthcare Information Technology solutions and services to Military, Federal and Commercial healthcare clients.  We leverage our team’s collective experience and passion to identify solutions, services or products which can help our customers meet their business, healthcare, operational or quality objectives.  Most all of our associates are clinicians, and a great many are veterans, so we are eager to bring solutions to patients, Wounded Warriors, veterans and beneficiaries alike. Leveraging technology and mindful of the changing healthcare delivery paradigm, we work with our clients to help design or revise processes which are patient-centric, efficient and effective. 

It is definitely a benefit to consider an internship in nursing informatics, health information management, or health information technology prior to graduation. Internships allow for on-the-job training and the ability to interact with other individuals in your target career path or profession. In addition, many students who complete internships can usually land a job at their place of internship.

Qualifications:

The ability and willingness to shadow a preceptor, work independently with modest supervision, and take on projects. You will be a part of the team and will also assist the CEO in defining health IT services and solutions. Interns must have a B.S. in Health Information Management, B.S. in Health Information Technology, Master of Health in Administration/Informatics, Master of Science in Nursing-Informatics, B.S. in Computer Information Systems – Healthcare Informatics, B.S. in Health Studies – Health Informatics, M.S. in Health Informatics.

Location:

Were located in northern Virginia and there will be opportunities to work from varied locations which will largely be dictated by current projects and need.

If you are interested, please contact, Mrs. Michelle Lardner, Master in Nursing Informatics, at michelle@hitconsulting.us

As physicians are often unsure about what they need from an EMR service, more and more practices and hospitals are finding consultation services necessary.  Online Electronic Medical Record (EMR) comparison and consulting service company EHR Scope, LLC has reported a rise in the demand for its EMR vendor matching services through EMRConsultant.com – as well as doctors’ reliance on EMR consulting. 

“Busy doctors” contribute to the rising popularity of EMR consulting services.  Physicians spend their entire workdays seeing patients and simply do not have the time to perform the proper research.  This, coupled with doctors having fewer employees due to the recent reimbursement cutbacks, has left many doctors with the same questions about which EMR is the correct one for their specialty and their office.  As the right EMR system will improve organization, decrease staff workload, and streamline office functions, the lack of time greatly increases the importance of making the right decision through the purchase and proper implementation of an EMR system.

Choosing an EMR is even further complicated by new government-backed initiatives that provide funding to physicians who successfully adopt Electronic Health Record (EHR) systems. New standards of certification – established by the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) in 2009 have changed the government’s level of involvement in EMR regulation. Additionally, it has changed the plans for the American healthcare system over the next few years and has made it difficult to stay fully informed.  Qualification for government funding under the ARRA program requires a full awareness of its standards -including “meaningful use” and hiring an EMR consultancy helps the practice or hospital make an informed decision.

Certification by third-party, government-appointed certification bodies has been introduced to help give physicians confidence when purchasing an EMR system. An updated list from the Office of the National Coordinator (ONC) has been published recently and it includes the following approved certification bodies: Certification Commission for Health IT (CCHIT), the Drummond Group and InfoGard.  The recent addition of two new certification bodies (InfoGard and Drummond Group) has created an even more challenging environment for physicians searching for EMR systems that are eligible for government funding.  Active certification by one of these three certification bodies is just one of the requirements for “meaningful use” funding.

New legislation and busy medical professionals can certainly make the task of selecting the right EMR service seem daunting, but seeking a service like EMRConsultant.com makes the switch to electronic medical records more manageable.

About The Author
Eric Fishman, MD is the founder of EMRConsultant.com, a division of EHRScope LLC, provides medical professionals with a free, online consulting service to match their practice or hospital with the best EHR service for their needs.  Started in 2004, the company is today one of the largest and most sophisticated EMR consulting services available.  For more information, visit them online at www.emrconsultant.com.

Houston Neal, EHR Market Analyst for Software Advise states, "We received a total of 87 responses in our poll asking "Will Regional Extension Centers Deliver on their Mission?" 62 respondents answered no and another 25 answered yes. While not a huge turn out, we did receive a lot of great comments. I listed all 52 comments in a Google Doc that you can access from my blog post."

Thank you to all InterOpNurse readers who assisted with the survey!!!

Eight months have passed since the Office of the National Coordinator for Health IT (ONC) began funding Regional Extension Centers (RECs). Since then, sixty RECs have been created, $662 million has been awarded and electronic health record (EHR) software negotiations are under way. Will RECs be able to deliver on their mission?

———–

     Embarking on a journey of implementing a Computerized Provider Order Entry (CPOE) has been of recent a strategic goal for many health care organizations looking to take advantage of stimulus funding made available by the American Recovery and Reinvestment Act (ARRA).    The impetus to adopt such a technology stems from a November 1999 Institute of Medicine Report (IOM) that found 98,000 Americans die every year from preventable medical errors in hospitals (http://www.iom.edu).  Consequently the health care industry has focused on a new technology CPOE as the messiah that can provide organizations the tool needed to prevent all of these unwarranted errors and subsequently improving patient safety.  Unfortunately, “use of CPOE is not widespread.  Presumably, implementation lags because CPOE, by reputation, is hard to implement, expensive and difficult to coax clinicians (Physicians) to use (Ash, Stavri & Kuperman, 2003).”  Recent legislature however provided health care organization with the proverbial iceberg that was desperately needed or that sense of urgency to propel a CPOE change effort from a nice to have to a must have.  President Obama’s American Recovery and Reinvestment Act (ARRA), includes a provision “to improve American health care delivery and patient care through an unprecedented investment in health information technology (HIT)…the Act focuses primarily on promoting the wide deployment and use of electronic health care records (EHR) among health care administrators and providers across the country (http://recovery.gov).”  This act has laid out an aggressive incentive program to assist organizations move towards HIT, but also penalties for those slow to adopt.  This review will chronicle how the book, Our Iceberg Is Melting has masterfully outlined the steps necessary for a successful change transformation effort.  Specifically, how crucial it is to have a sense of urgency and identifying the appropriate team to be the ambassadors of change.   In the process a parallel analysis will be exemplified by looking at the dynamics experienced in the Penguin colony and similarly to organizations who implement CPOE.

     Our Iceberg Is Melting is a clever fable that helps provide readers key insight into the psyche of a penguin colony as they shift a long standing lifestyle to a nomadic one (Kotter and Rathgeber, 2005, p.  140).  The utilization of a fable is a clever approach to bring light to a topic that is typically the canonical “elephant” in the room that no one dares to discuss.  It provides simple stories to assist change agents realize that merely saying business as usual can no longer exist, but change is now necessary to compete in a continuously evolving world.  This fable truly reminds us that the word change and its inherent meaning may seem simple, but doing and making it happen and stick is where the difficulty truly lies. 

   There are numerous publications that site the obstacles organizations face when implementing CPOE.  The challenge however is not so much in the technology, but in the ability of organizations to weather through the resistance that comes with such a huge organizational overhaul.  Case in point was Yale New Haven’s three hospital system that utilized a separate CPOE software package (Birk, 2010).  In Birk’s (2010) study it was evident that Yale New Haven as an organization was able to show that CPOE will work with three different systems, and there are pros and cons to each of the products.  But it is not the products that are going to make the difference; it is the leadership support of the implementation (Birk, 2010).  As depicted in Our Iceberg Is Melting, leaders like Louis were necessary in any organization serious about making a change.  It is leaders who possess Louis’ leadership trait that can help manage the NoNo’s in every organization who claim to support the change effort, but only to later find out the support was only when it was convenient and did not affect their respective areas.  Leaders such as Louis is necessary because they have the foresight to understand and strategically hand select the right group matrix to lead the change.  Every organization will need an Alice with an unwavering personality that will help the organization stay the course and keep the transformation efforts going.  An out of the box thinker like Fred is a necessity because they have the ability to look beyond the status quo.  Of course every change effort requires factual, evidenced based best practice citations that only a Professor in the group can provide.  But as Kotter and Rothgeber (2005) suggest, change efforts is often an emotional transformation rather than a logical one and therefore you need a Buddy who has the ability to appeal to the emotions of the masses (pg.  142).  A guiding coalition such as the one identified by Louis is truly necessary in any transformation efforts that will buy in to the vision and ultimately understands why change is necessary.

     Lacking that sense of urgency is truly the reason why many organizations fail in their transformation efforts (Kotter and Rothgeber, 2005).  A CPOE implementation is no different in that not having enough urgency will not propel an organization to be convinced that change is necessary.  A firsthand account of this dynamic was evident at a non-profit health care organization that decided to implement CPOE, but did not evoke a strong enough sense of urgency.  Despite a Chief Information Officers (CIO) plea to the organization to understand the ARRA requirements are looming, not enough in the hospital leadership was converted to the idea that a CPOE implementation was a high priority.  This was evident at project launching and the Chief Executive Officer (CEO) in the process was practically non-existent.  The CIO created a CPOE Leadership Committee where in leaders can strategically collaborate on the implementation effort, but the CEO was never in attendance.  In defense of the CEO, he did provide the project the lip service it needed, publishing his full support in monthly publications to all staff.  Communication of this support even went to the extent of publishing its importance in a quarterly newsletter that was typically addressed to the organizations Board of Directors and Medical Executive Committee.  However, the project lacked the outward display of support it needed from the CEO.  CPOE projects require the needed tangible support that one would typically see evident in actual face to face meetings, rather, the support was displayed in the safe confines of printed memos and newsletters where it was harmless and practically did not provide a venue to challenge any of his statements.  The CEO in this case did not have the conviction of a Louis who can withstand the grumblings of the colony.  The CEO did not provide the CPOE project what Ash et al. (2003) call the commitment that is unwavering and visible.  In order for CPOE implementation to be successful, the organization must have adequate finances, technical infrastructure, project management expertise and staff readiness for CPOE, this has to be coupled with real and visible commitment of the CEO (Ash et al.  2003).  The lack of CEO support was clearly evident when decision time came to strategically identify if CPOE was going to be mandated or voluntary.  The other clinicians (i.e. Nurses, Pharmacist and Respiratory Therapist) who would be affected by this change made it clear to the CPOE Leadership Committee that mandating CPOE would be the less risky route, because the source of orders would be less ambiguous which could lead to medication errors.  The CPOE Leadership committee with a strong recommendation from the CEO, afraid at the potential turmoil a mandatory physician CPOE requirement would illicit decided against it and made the use voluntary instead.  This was truly an example of a lack of shared vision regarding the purpose of CPOE and why, “the current state is suboptimal and change is needed (Ash et al.  2003).  Because the CEO did not have the same conviction of a Louis, the organization did not have the type of leader that was needed that would say, “Yes, this is hard work. Yes, the physicians will resist, but it is the right thing to do.”

     Although very clear that a sense of urgency along with a strong guiding coalition is necessary to push any transformation efforts, the fable however due to its simplicity fails to underline the tremendous challenge that comes with injecting an organization with the right amount of urgency.  Clearly, the non-profit organization due to the lack of leadership did not have the foresight to see a CPOE project as a quality initiative for the entire hospital (Birk, 2010).  Despite having a clear and present “iceberg” which in this case even involves the Federal government providing the necessary pressure, logic is defied by emotions.  Unfortunately in the case of the non-profit organization, it may take a failed project coupled with financial penalties to be the strong force that will convince leadership to provide the CPOE project its much needed recognition and support to be successful. 

References

American Recovery and Reinvestment Act.  (2010).  Health IT grant funded by recovery [Data file].  Retrieved from

http://www.recovery.gov/News/featured/Pages/HealthcareIT.aspx

Ash, J.S., Stavri, P.Z., & Kuperman, G.J. (2003).  A consensus statement on consideration for a successful cpoe implementation. Journal of the American Medical Informatics Association. 10(3), 229-234.

Birk, S. (2010, May/June). CPOE physcican adoption.  Healthcare Executives, 24-30.

Institute of Medicine.  (1999). To err is human [Data file]. Retrieved from http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf 

Kotter, J., & Rathgeber, H. (2005), Our iceberg is melting: Changing and succeeding under any conditions. New York, NY: St. Martin’s Press. 

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• Representing:       ~140 Hospital Organizations

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