Think about commenting on this proposed regulation and its impacts on you, your practice, and your information system solutions.

The Centers for Medicare and Medicaid Services (CMS) has proposed revisions to the hospital Conditions of Participation, the criteria hospitals must meet to be reimbursed for services by Medicare/Medicaid. The changes are needed to remove unnecessary and burdensome regulations that create barriers in care delivery. The changes, if adopted, include:

• Broadening the concept of “medical staff” to include other practitioners, including APRNs, PAs, and pharmacists, practicing within their scope of practice and in accordance with state law.
• Changes in nursing care planning to allow for a stand-alone plan or an integrated plan with other disciplines.
• Allowing medication orders by practitioners other than physicians where the law and hospital policy allows.
• Allowing a program for patient or “support person” to administer some medications.
• Calling for standing orders and protocols to be based on nationally recognized and evidence-based guidelines.

There is a 60-day comment period. The CMS would like your comments. The proposed regulation can be found in full via a link on this page near the bottom: http://www.cms.gov/CFCsAndCoPs/06_Hospitals. Or go directly to the PDF here.

To submit a comment, visit www.regulations.gov, enter the ID number CMS-3244-P, and click on “Submit a Comment.” 

Nursing I.T. Award Deadline Approaches

HDM Breaking News, October 13, 2011

Nominations are now being accepted for Health Data Management’s seventh annual Nursing Information Technology Innovation Award. The deadline for submitting an essay is Monday, Oct. 31, 2011.

The award recognizes innovation and excellence in using information technology in the field of nursing to directly improve the quality of care and patient safety while maximizing nursing resources, improve the work experience of nurses, or to help further the professional practice of nursing. The co-sponsor of the award is ANIA-CARING, the nation’s largest educational and networking group for nurses interested in health care information technology (ANIA-CARING.org).

The award will be presented to a team of nursing professionals at a health care organization (hospital, physician group practice or any other care-giving site). At least one of the primary coordinators of the I.T. project must be a nurse. The project must be ongoing.

To qualify for this award, a health care organization must submit an essay with detailed information on the nursing information technology project and the specific, measurable results of that project. The contribution of nurses to the innovative project must be clearly identified.
Judges may interview finalists by phone before determining the award recipient. The Feb. 2012 issue of the magazine will include a story on the winning organization and runners-up.

This year’s judges will be:
* The founder of the Nursing I.T. Innovation Award, Susan K. Newbold, PhD, RN-BC, is a healthcare informatics consultant based in Franklin, Tenn.  She is a founder of ANIA-CARING, a fellow in the American Academy of Nursing and a fellow in the Healthcare Information Management and Systems Society. Identified as a pioneer in nursing informatics, Newbold created a nursing informatics review course in 1995, co-edited five books and has written numerous articles on informatics topics.
* Contest co-founder Dana Womack, MS, R.N. is a nursing informatics specialist at Inova Health System in Northern Virginia. After five years in acute care nursing, Dana earned a master’s degree in nursing informatics from the University of Utah. In over 12 years as a consultant, she has helped launch several new health I.T. initiatives and has worked in analytics, product development, system implementation and policy development. She has particular interest in the intersection of data visualization, operational informatics, and healthcare quality.
* Cindy Esser, BSN, MBA, MHA, is the director of emerging technologies at Butler Memorial Hospital in Pennsylvania.  Responsible for the strategy and identification of new innovative technologies, Esser was the founder and champion of the award winning technology for the 2009 Nursing Information Technology Innovation Award.  Prior to working in healthcare technology at both McKesson and Marconi, she formerly served as director of strategic services for Highmark Blue Cross Blue Shield and a manager of healthcare consulting at Deloitte. Her clinical, educational and work experiences has allowed her to be instrumental in organizational strategy, the adoption and initiation of new technologies, workflow efficiencies and implementation.
* Verna Tereceita (Terry) Laidlow, DNP, MS, RN-BC is a healthcare initiative specialist at Sinai Hospital of Baltimore and an assistant professor at the University of Maryland, School of Nursing in Baltimore. She holds degrees in trauma critical care, nursing education and nursing informatics. She is currently a member of ANIA-CARING. Laidlow was instrumental in implementing an organization-wide, integrated, electronic protocol that won the bronze award in the 2011 Nursing Information Technology Innovation contest. Having worked for several years as a clinical implementation and management consultant, she is a champion of integrative technology in clinical practice.
* Gary Baldwin, the editorial director of Health Data Management, has been covering health care since the early 1990s. Prior to rejoining Health Data Management, he served as technology editor for HealthLeaders Media for nearly five years. At HealthLeaders, Baldwin won five national editorial recognition awards from the American Society of Business Publication Editors and the American Society of Healthcare Publication Editors. He earned a masters degree in journalism from Roosevelt University, Chicago.

To enter, submit a document attached to an e-mail to gary.baldwin@sourcemedia.com. At the top of the document, list the following:
* Name of organization and address.
* Description of size of organization (total physicians, total inpatient licensed beds, and so forth).
* Name of key nurse(s) involved in the project, and their roles.
* Name of person who prepared the nomination and contact information (phone and e-mail).
* Name of senior executive with organization who could be available to answer questions, and contact information.

Entrants should prepare an essay of up to 1,250 words answering the following questions:
1. What is the nursing I.T. project that is worthy of recognition? Precisely identify the technology involved.
2. What is innovative/groundbreaking about the project?
3. What are the measurable results/outcomes of the project? Be as specific and detailed as possible. Examples of results can include: achieving tangible improvements in the quality of care; reducing the time nurses spend on non-care activities by automating tasks; improving workload management through telehealth technologies and other systems; enabling performance improvement through data analytics and reporting.
4. How does the project support quality improvement? Focus areas may include the Institute of Medicine’s Domains of Quality: effectiveness, efficiency, equity, patient-centeredness, safety, and timeliness. Projects may support other federal and regulatory reporting programs, such as meaningful use or Joint Commission requirements.

In addition, the essay should describe the contribution of nurse(s) to the project and whether the nurse(s) was the project leader, product manager, trainer, implementer or executive sponsor.
Questions about the award should be e-mailed to gary.baldwin@sourcemedia.com.

http://www.healthdatamanagement.com/news/nursing_IT_Award_nurse_recognition-43394-1.html?ET=healthdatamanagement:e2058:21489a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_101811

Excerpt from the Advisory Board briefing about this article, for those that don’t have access:

Paging Dr. Nurse?

Health professionals debate roles, honorifics associated with advanced degrees

As more health professionals earn the "doctor" designation, some physicians are concerned that using the honorific in a health care setting will confuse patients, the Times reports.

As a result, various physician groups are supporting legislative efforts to restrict the use of the word "doctor." For example, a proposal in the New York State Senate would prohibit nurses from touting themselves as doctors regardless of their degree.

Meanwhile, laws in Arizona, Delaware, and other states already bar nurses, pharmacists, or other health care providers from using the title "doctor" without immediately identifying their profession.

A deeper debate?

According to the Times, "the battle of the title ‘doctor’ is in many ways a proxy" for a "deeper battle" over the role of various professionals in the health care system.

As a major primary care physician shortage looms, many states are turning to nurses and other health professionals to fill the gaps. Currently, 23 states allow nurses to provide care without physician supervision, and some nursing groups are lobbying to increase that number, the Times reports.

http://www.nytimes.com/2011/10/02/health/policy/02docs.html?_r=1&ref=health

Sign up is now open to participate in this great project at 

http://wiki.siframework.org/Query+Health

CDC Public Health Informatics Training Program

http://www.cdc.gov/PHIFP/

     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

  ­­  

I recently moved to a new position and as part of the transition I am also coming out of one well known EHR system to learn another.  As part of any newbie, I have been on the path of meeting new people that I will have to work with.  Part of the initial draw to this new position was the opportunity for growth.  I came from a medium sized community hospital, to now being a part of a well known prestigious academic center.  I came to a realization however that despite organizational type, the dilemma an implementer faces does not change…just the magnitude.  With that said, I have begun to list what I call, “The Implementer’s Dilemma.”

·         You only have one chance to implement correctly.  The second chance will be a climb of magnitude proportions.

·         Physician’s have a lot of input to provide, but do not have a lot of time to see it through its fruition

·         Clinician’s are willing to provide you their input to enhance and optimize your system.  But, when the rubber meets the road and their peers “jury of their peers” do not like what has been implemented, these willing input providers will be the first to turn their backs on you.  Even fabrication of communication can be found in some instances, for example:

o   “That is what I told them.”

o   “I told them that would not work.”

o   “I must have been absent when they made that decision.”

o   “I would never have approved such a thing.”

·         It is easy for executives to call an implementation “mandatory.”  But, unless the “mandatory” imposition has some teeth, it truly is just voluntary.

·         Most clinicians feel that “computerization” has taken them away from the bedside.  Therefore EHR/EMR are seen as a big intrusion in their practice.

I wanted to keep this going, so comments section open for additions.  I will collate and see what we come up with J