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.

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

Leapfrog leaders discuss CPOE performance-testing results

By Mark Hagland 

On June 30, leaders of the Washington, D.C.-based Leapfrog Group, the large healthcare purchaser organization focused on patient safety and value, held a telephone press conference to highlight the results of their new study on computerized physician order entry (CPOE). The report, titled “Leapfrog Group Report on CPOE Evaluation Tool Results, June 2008 to January 2010,” discusses the process whereby leaders at 214 U.S. hospitals performance-tested their CPOE systems to detect common medication and other errors, using Leapfrog’s web-based simulation tool.

Aggregating the results from that testing process, Leapfrog leaders announced that, collectively, 52 percent of the adult medication orders tested, and 42.1 percent of the pediatric medication orders tested, did not trigger appropriate warnings or alerts within the CPOE systems. What’s more, of the potentially fatal adult orders involved, 32.8 percent of adult and 33.9 percent of pediatric order sets did not spur appropriate warnings to clinicians. Among the numerous issues evaluated included single and cumulative dose limits, contraindicated route of administration and age- or weight-based dose limits, and therapeutic duplication.

The obvious lesson, said Leah Binder, Leapfrog’s CEO, is that, in addition to moving forward to participate in the stimulus funding expected to be released to hospitals and physicians under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health Act (ARRA-HITECH), every hospital implementing a CPOE system needs to test and retest its system’s performancein order to ensure that it is actually averting medication and other orders. “CPOE systems are not plug-and-play,” Binder emphasized during the telephone press conference. “And that’s true of any technology implementation in any industry. There’s a complexity to the adoption process that has to be honored, and then systems have to be tested and monitored regularly over time. But CIOs are somewhat at a disadvantage now because there’s so little information available to them to do this complex implementation process,” she added. “Every CIO shouldn’t have to reinvent the wheel each time,” she said. “They shouldn’t have to rely only on their vendors for information.” In other words, Binder  urged, it was time for the leaders of the large majority of hospitals that have not yet fully implemented CPOE to turn to the pioneers for conceptual and practical help in moving forward. (Only 12 percent of U.S. hospitals have fully implemented CPOE, according to the Leapfrog’s standards and validation process.)

“The good news,” said Dr. Barbara Rudolph, Leapfrog’s senior science director, “is that 102 hospitals have taken the test twice—we require at least a six-month interval between tests. And those hospitals clearly worked on their systems between tests, because 94 percent improved their systems’ performance during that interval. And that tells us that this test is useful. And we are glad that this tool can help them do so. But ultimately, the findings are disturbing.”

Binder, Rudolph, and their colleagues noted that Leapfrog is actively working with the Chicago-based Healthcare Information and Management Systems Society (HIMSS) to, as Binder said, “develop a Wiki that will offer hospitals the opportunity to share information about the adoption of CPOE; they’re close to being live with this Wiki. Hospitals will be able to continually update their colleagues,” once the Wiki goes live sometime this summer.

In addition to supporting federal funding for CPOE implementation in hospitals, and to working with HIMSS to provide knowledge-based tools for CPOE implementation, performance testing, and optimization, David Knowlton, president and CEO of the New Jersey Health Care Quality Institute, and chair of the Leapfrog board of directors, said that “Leapfrog will continue to push for hospitals to adopt CPOE. CPOE systems can reduce adverse drug events by up to 88 percent, preventing 3 million adverse drug events a year in the U.S., and saving billions of dollars. It will not be sufficient to rely on the memory and skills of individual clinicians” going forward, he emphasized.

For more information on this initiative and to see a PDF-format copy of the report, go to www.leapfroggroup.org.

Official posting projected to be in the Federal Register 7/28/10 will start the clock for rules to be in effect 60 days later

Meaningful Use is now defined as 2 sets of objectives and measures (see images below)

–        Core Set with mandatory 15 objectives and measures and,

–         Menu Set select 5 of 10 objectives and measures

•          All EPs and hospitals must choose at least one of the population and public health measures to demonstrate as part of the menu set

•          “This is the only limitation placed on which five objectives can be deferred from the menu set”

All Hospitals – must report 15 Quality Measures

–        2 Emergency Department Throughput 

–        7 Ischemic stroke 

–        6 Deep Vein Thrombosis 

–        Same requirement regardless if Medicare, Medicaid, CAH

–        Alternate measures for Children’s Hospitals

–        Eligible Professionals – 6 Quality Measures

–        3  mandatory “Core” Quality Measures

•          Hypertension, Tobacco Use/Cessation, Adult Weight Screening

•          Alternate Core: Weight Assessment/Counseling Children, Influenza Immunization > 50 years

–        Select 3 more from list of 41 Quality Measures

This website was created to track incentive payments http://www.cms.gov/EHRIncentivePrograms/

For 2011 only

–        Hospitals and eligible providers can start demonstrating meaningful use in Jan 2011

–        First incentive payments distributed around May 2011

–        CMS anticipates will take up to 45 days to process the incentive after the attestation of meaningful use.

All eligible hospitals and Medicare eligible professionals must have:

–        National Provider Identifier (NPI)

–        Be enrolled in the CMS Provider Enrollment, Chain and Ownership System (PECOS) to participate in the EHR incentive program

–        Most providers also need to have an active user account in the National Plan and Provider Enumeration System (NPPES).

–        CMS will use these systems’ records to register for the program and verify Medicare enrollment prior to making Medicare EHR incentive program payments.

THESE BELOW GRAPHICS SHOW THE CURRENT FINAL MEASURE COMPARED TO THE PREVIOUS MEASURE ON THE RIGHT

Nursing and computers have not always been a perfect mix. Typically, nurses try to get away from new computer systems as much as possible. However, it is an inevitable workflow evolution in today’s hospitals. Read more…

MEDICAL BILLING AND CODING

If you are interested in becoming a medical billing and coding specialist, another field you might want to consider would be Nursing Informatics.  There are many similarities between nursing informatics and medical billing and coding.  For instance, nursing informatics is in the medical industry, but does not carry the burden of customer service.  Also, nursing informatics is a technical job that is carried out in an office or some work out of their homes.  It is not necessary for them to be present in the hospital or doctors office to perform their jobs.  The demand for nursing informatics is growing rapidly, like medical billing and coding, due to the new expectations placed on the medical field by the Federal Government.  Since the aim is to have all patient information accessible on line, there has been rapid growth in these two industries.  It would be impossible for medical records to be electronically accessible without either medical billing or coding, or nursing informatics. Read more…

ANIA-Caring Merge into a single organization

Falls Church, VA. – The American Nursing Informatics Association (ANIA) and CARING, both nationally recognized non-profit Nursing Informatics organizations, announced their January 1, 2010 merger into a new entity, ANIA-CARING. The combined organization, with 3000+ membership in 50 states and 34 countries, is of the largest associations of its kind in the country.  

For more information, view their website at:  http://www.ania-caring.org

 AT HOME WITH THE UPWARDLY MOBILE

Treating patients at home requires mobile access to data. A few trusts are learning how to make this work

• Tracey Caldwell

 Smart Healthcare, Wednesday 17 February 2010 09.00 GMT

That’s all write: a digipen user completing a maternity visit form. Pen strokes are recorded electronically and sent through a mobile device to a record system. Photo: Anoto Read more…

LOOKING FORWARD: HEALTH CARE AND THE FUTURE OF NURSING CAREERS

What does the future look like for nursing careers? It is predicted that in the next ten to twenty years, things might be quite different from how they currently stand. As new technologies, treatments and drugs, shifts in health care policies, insurance policies, limited healthcare professionals especially nurses, indications are that the health care profession may have to reinvent itself. For instance, with advancements in technology, many functions could be automated. For instance, patient records and documentation, smart beds that can monitor patients vital signs, use of bar codes, and automated medicine carts could conceivably be used to save time and reduce errors in medication dispensing. Also voice-activated technologies would cut down the need to write down many things. Tasks such as serving meals could be taken taken over by trained aides to free up nurses to provide a human touch to their patients. Read more…

VIRGINIA GETS MILLIONS FOR ELECRONIC HEALTH DATA

Virginia will receive $24 million in federal money during the next four years to improve the exchange of electronic health information. Read more…

It appears that the Meaningful Use rules (PDF) will take effect in 30 days following a public comment period. A 556 paged document is also provided for the Incentive rule (PDF).

• Meaningful Use Rule
• Incentive Rule

Do not have time to read through all the documents, I found a great summation of the important details courtesy of Mr. HISTalk:

CPOE 
Practices: Use CPOE for orders involving medications, laboratory, radiology, and referrals. 
Hospitals: medications, laboratory, radiology, blood bank, PT, OT, RT, rehab, dialysis, consults, and discharge and transfer. 
Orders do not have to be sent electronically to the fulfilling department (lab, pharmacy, etc.) 
Practices must enter 80% of their total orders directly by the clinician into the CPOE system. Hospitals must have 10% of all orders entered by CPOE.

Clinical Checking of Orders 
Real-time screening (drug-drug interactions and drug-allergy contraindications), formulary check, user ability to maintain screening rules, track user responses to alerts.

Problem List 
Longitudinal current and active diagnoses coded in ICD-9-CM or SNOMED CT. 
80% of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry (hospitals and practices).

E-Prescribing 
Practices only. 
Must send 75% of non-controlled substance prescriptions electronically.

Active Medication List 
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices). 

Medication Allergy List 
Longitudinal with allergy history. 
80% of unique patients must have at least one coded entry, with “none” being an allowed entry (hospitals and practices).

Demographics 
Practices: preferred language, insurance type, gender, race, ethnicity, and data of birth. 
Hospitals: all of the above plus date and cause of death if applicable. 
80% of patients must have demographics recorded as structured data

Vital Signs 
Height, weight, BP, BMI, growth charts for patients 2-20 years old, temperature, pulse. 
80% of patients aged 2 and over must have blood pressure and BMI entered. 
Children 2-20 must have a growth chart.

Smoking Status 
Record if current smoker, former smoker, or never smoked. 
Must be recorded for 80% of patients.

Structured lab results 
Display results, translate LOINC codes, allow maintenance based on new results. 
Must record as structured EHR data 50% of all results that are delivered in positive/negative or numeric format.

Patient Lists 
Allow user to select, sort, retrieve, and output patient lists based on demographics, medications, and conditions.

Report Quality Measures to CMS and States 
Calculate, display, and submit quality measure results

Patient Reminders 
Practices only: issue based on patient preferences, demographics, conditions, and medication list.

Five Clinical Decision Support Rules 
Beyond drug screening, based on demographics: diagnoses, lab results, or medication list. Real-time alerts and suggestions based on evidence. Track response to alerts.

Eligibility 
Allow user to record and display based on eligibility response from insurer. 
Must cover 80% of unique patients.

Submit Claims 
Must submit 80% of all claims filed electronically.

Electronic Copy of Health Information to Patients 
Allow user to create an electronic copy of test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospitals must also provide a discharge summary but not procedures. 
Must provide an electronic copy of health information to requesting patients within 48 hours.

Electronic Copy of Discharge Instructions 
Hospitals only. 
Must provide electronically to 80% of discharged patients who request them.

Timely Patient Access to Health Information 
Practices only: diagnostic results, problem list, medication list, medication allergy list, immunizations, and procedures. Within 96 hours of availability. 
Must provide to 10% of unique patients.

Clinical Summary of Each Office Visit 
Practices only: diagnostic results, medication list, procedures, problem list, immunizations. 
Must provide for 80% of office visits.

Information Exchange 
Enable electronic sending and receiving of diagnostic test results, problem list, medication list, medication allergy list, immunizations, and procedures. Hospital requirements also include a discharge summary. 
Must conduct at least one test of exchanging information.

Medication Reconciliation 
Compare and merge two or more medication lists into a single list that can be displayed in real time. 
Must be performed in 80% of encounters and care transitions.

Submit Data to Immunization Registries 
Must conduct at least one test of submitting information.

Submit Lab Results to Public Health Agencies 
Hospitals only. 
Must conduct at least one test of submitting information.

Submit Syndrome Surveillance Data to Public Health Agencies 
Must conduct at least one test of submitting information. 

Protect Electronic Patient Information 
Unique identifier, emergency access for authorized users, session timeout, encryption where preferred, encryption when exchanging information, maintain audit logs, provide integrity check for recipient of electronically transmitted information, verify user identities and access privileges, record PHI disclosures. 
Must conduct a security risk analysis and implement security updates.

Transport Standards 
SOAP and REST 
HL7 CDA R2 Level 2 CCD or ASTM CCR 
ICD-9-CM or SNOMED CT for problem lists 
ICD-9-CM or CPT-4 for procedures, moving to ICD-10-PCS or CPT-4 for Stage 2 
RXNorm for medication lists 
UNII for Stage 2 allergy lists (no standard now) 
CDA template for Stage 2 vital signs (no standard now) 
UCUM for Stage 2 units of measure (no standard now) 
LOINC for lab results 
NCPDP Formulary & Benefits Standard 1.0 for drug formulary checks 
NCPDP SCRIPT 8.1 or 10.6 for prescription information 
ASC X12N and NCPDP for transactions 
CMS PQRI 2008 Registry XML for quality measures 
HL7 2.5.1 for submitting lab results to public health agencies, with UCUM and SNOMED CT encouraged 
HL7 2.3.1 or 2.5.1 for submitted surveillance information to public health agencies and for immunization information 
Encryption only if organization sets it as a standard

Median Estimated One-Time Costs for CCHIT-Certified EHRS to Be Certified as Complete EHRs 
CCHIT Ambulatory 2008: $1 million 
CCHIT 2007/2008 Inpatient: $1.38 million

Median Estimated One-Time Costs for Pre-2008 or Uncertified EHRS to Be Certified as Complete EHRs 
Practice EHR: $2.4 million 
Hospital EHR: $3.3 million

Estimated Median Industry Costs for EHR Preparation 
2010: $61.35 million 
2011: $54.53 million 
2012: $20.45 million

Comments are open, would love to hear feedback…

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

I have posted about Google’s Healthcare Advisory board and the lack of Nursing representation. This was not very well accepted by a good number of nursing commmunities. CARING being one of them, a big push to educate google became a mission. As a member of Caring, the president decided to provide us members an update, which I want to share in this blog.

———————–

A Message from CARING President Jerry Chaimberlain:

Fellow CARING members -

This is just a brief note to let
everyone know that a representative from Google responded last week to
our ANI letter regarding their recent Health Advisory Council. As you
may remember, Google announced in June of 2007 that they had formed a
Health Advisory Council in order to help “…better understand the
problems consumers and providers face every day and [to] offer feedback
on product ideas and development.” This announcement was quickly
recognized as significant not only because of the impact Google has to
the health care consumer but also because of what many felt was lacking
in their council membership….nursing representation. The blog press
release from Google can be found here.

As
the professional community began to react, our Alliance for Nursing
Informatics elected to generate a formal response on behalf of the 23
distinct nursing informatics groups and our 4,000+ nursing &
healthcare informatics professionals. Over the course of several days,
leaders from each of the ANI organizations collected and routed
feedback into our Alliance infrastructure and a response was
constructed and sent to Google. A copy of that letter can be found here.

I
am happy to report that Missy Krasner, product manager at Google, has
responded to our letter and acknowledged our concerns. In her letter
back to ANI, Ms. Krasner explains that although their council did not
include representatives from every stakeholder group in healthcare,
“efforts were made to choose an advisory panel whose experience
reflects diverse expertise.” She further explained that at the present
time their council is currently full, however she will bring our
comments forward to Dr. Dean Ornish and the rest of their council for
review prior to the next meeting. Included in her communication to
the council, will be a recommended candidate from our nursing
informatics community.

Thanks to all who responded objectively and passionately to
this issue. It was a great to see our Alliance in-action with a
unified response, and we couldn’t have done that without your input.

—- Jerry

Jerry Chamberlain, MS, RNBC
President & Board Member, CARING
www.caringonline.org

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