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.

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

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