Here's an excerpt from the introduction:

With few exceptions, [government policy] debaters assume that healthcare costs are fixed, that America's proud history of medical care and innovation comes with a staggering bill.

http://goo.gl/b/uhyl ]]> http://interopnurse.com/2010/08/on-the-mend/feed/ 0 http://interopnurse.com/2010/08/cpoe-physician-incentives-survey-results/ http://interopnurse.com/2010/08/cpoe-physician-incentives-survey-results/#comments Wed, 11 Aug 2010 18:51:27 +0000 InterOpNurse http://interopnurse.com/?p=653 Survey: 

• Email Distributed to: To  > 500 via ANIA-Caring List Serve; to 55 via Email
• Responses:   23 from List Serve;  15 from Email
• Sample Size: 38 Respondants
• Representing:       ~140 Hospital Organizations

You may access the full summary of responses here…

This survey was a joint effort between  and  

A published summary of the survey to follow…

As for the traditional route of marketing via television ad campaigns, Toyota has truly struck gold by segmenting its marketing and targeting the pro-environmentalist groups states Gutsa, N.H. (2009).  Part of the success of the Prius, Maynard (2008) suggest, “the Prius has been featured in dozens of movies and TV shows as the car driven by the main actor, such as CSI Miami, Weeds, Evan Almighty, and Superbad,” therefore not only giving it the Hollywood endorsement but also the star appeal that it needs to penetrate an already challenged automotive industry.

To obtain a better understanding of what marketers of the Toyota Prius have done to heighten awareness with their line of popular Hybrid car, I performed an exhaustive search online to understand what the Prius marketing strategy is.  I started my search utilizing Google, utilizing the following search criteria: Toyota marketing, Toyota green, Toyota press release and Toyota celebrities.  This definitely led me to numerous articles written regarding the Hybrid, but none of my search has actually provided true marketing collateral for the Prius.  The closest I have encountered is actually the website for Toyota which has a special web page dedicated to the Prius. It has a tagline that states, “Harmony between man, nature and machine,” along with links to numerous Prius related content.  Part of the experience one would have by visiting the Prius web site is access to other marketing venues that a lot of companies are beginning to utilize now such as Facebook and Twitter. It is obvious to me that Toyota is trying to appeal to the population that is hip to this new era of social networking.  Upon visiting the Prius Facebook site (http://www.facebook.com/prius), it is very clear that the site is meant to conjure up excitement over the Prius.  The Facebook page allows existing owners to share their experiences with their beloved Prius.  One can even clearly see that Prius is clearly trying to appeal to the eco conscious as evidenced by a section of its page publishing the, “random acts of prius.” Prius calls the campaign as, “the little things you can do everyday to make the world brighter (http://www.facebook.com/prius?v=app_139815434211).”  Now, I must admit, it appears that one of the unintended consequences of the Facebook page is for the unhappy customers to now visit the Facebook page and express their dissatisfaction with the product.  The Facebook page seems to lack moderation from Prius and therefore one can argue what the value is of having this open forum.  If I was thinking of purchasing a Prius the commentaries would actually make me think twice before purchasing. A trip down Twitter (http://twitter.com/toyota) land however I find a more benign site mostly praises over the Prius and the company, photo postings of new Prius owners and links for visitors wanting detailed Prius recall information.   

If you are eco conscious, tired of paying high prices of gas and want to decrease your carbon footprint, then you are the segmented target audience of the Toyota Prius.  It is obvious that Toyota is not launching a heavy marketing campaign for its Prius because they have been able to establish the value that it provides in the marketplace.  Not to mention the free publicity it gets by having a product heavily endorsed by Hollywood superstars such as Will Ferrell (Berman, 2006) who states, "I absolutely love our Prius. In addition to being obviously economical and environmentally friendly, they drive great and are just plain sexy. There’s no reason all Americans shouldn’t be driving hybrid cars." 

With the automobile industry in such a volatile state, clearly being innovative and providing more eco friendly options has been identified as the best strategy to thrive in such a struggling economy where in automobile owners now more than ever are holding on to their automobiles longer than previous years.  Although riddled with bad press, Toyota is clearly trying to pull itself out of this public relations nightmare.  Toyota has started a commercial campaign showing people re-purchasing Toyota products therefore pushing the issue that their products are safe to drive.  Luckily in terms of the Prius in a side by side comparison with other hybrid models, it still ranks number one in most miles per gallon (http://www.allabouthybridcars.com/comparison-chart.htm).  This has allowed the Prius in my opinion to prosper despite the negative publicity it has experienced lately.  As a matter of fact for 2009 the Prius has won a prestigious loyalty award (http://usa.polk.com/Company/Loyalty/).  According to Polk the loyalty award is based on Toyota’s ability to retain previous customers.  Although Polk does not publish how loyalty was established one can speculate that the marketing push Toyota embarked on with its commercials showing actual testimonials form return customers purchasing a Toyota product has assisted them to turn the tides.  The on-line presence of Toyota as well, allowing existing customers to connect with each other and share their great experiences with the product via Facebook or Twitter can do nothing but increase buyer confidence on the Prius.  Who would resist the notion of purchasing a product that not only will allow you to save in a world of increasing gas prices, but also do your part in preserving the environment?  It sounds like a win-win proposal to me or rather, “a random acts of prius.”

Bibliography

Allabouthybridcars.  (n.d.).  Website.  Retrieved July 16, 2010, from  http://www.allabouthybridcars.com/comparison-chart.htm

Berman, Bradley. (2006). Celebrity Hybrid Cars. Retrieved July 12 2010, from http://www.hybridcars.com/hybrid-drivers/celebrities.html

Maynard, Micheline. "Toyota May Make Prius a Brand and Widen the Model Lineup ". New York Times10/9/2008: B1-B8

Nyasha Harmony, Gutsa. (2009). Marketing Mix in Action: Toyota Prius. Retrieved July 13 2010, from http://www.associatedcontent.com/article/1804334/marketing_mix_in_actiontoyota_prius.html

Polk.  (n.d.).  Website.  Retrieved July 16, 2010, from http://usa.polk.com/Company/Loyalty/

Toyota.  (n.d.).  In Twitter [Twitter page].  Retrieved July 16^, 2010, from http://twitter.com/toyota

Toyota Prius.  (n.d.).  In Facebook [Fan page].  Retrieved July 15, 2010, from http://www.facebook.com/prius

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

I am a recent subscriber to Audible and I must say I love the service.  Its is great way to get caught up on all the books you have always wanted to read, but could not find the time.  I find myself listening to books to actually enhance the experience.  

Please help me welcome Audible to the InterOpNurse family of sponsors:

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 Please check out my Audible Page for my recommendations…

To solidify my decision in purchasing an iPad, as an eBook reader and a portfolio alternative, I did an exhaustive search reading multiple online sources such as blogs and product reviews’.  I started my review of sites by utilizing Google and simply typing in, “iPad review.”   This provided me commentaries and detailed reviews from sites such as Engadget, Gizmodo, CNET, PCMag, Huffington Post and the likes.  I also expanded my search, being a Microsoft Windows user that I am to obtain various viewpoints, specifically those expressed by windows based users and this was achieved by also doing a Google search for, “windows users review of the iPad.”  To ensure that I truly get multiple perspectives on this topic, I did a Google search of Apple fans and read their review of the iPad.  It comes as no surprise however that the proclaimed Apple fanatics practically revered the iPad for the most part as the Holy Grail of Apple.  Nonetheless, the online research did not do justice to this device, not until I was able to actually visit a local Apple store and physically test out the device.  It was at that magical moment as I interacted at the very responsive yet intuitive user interface and the stunning design Apple is known for that I realized the iPad had just raised the bar in terms of consumer expectations with mobile devices.  

In order to classify this purchase as a fruitful one the factors necessary to solidify my decision would be based on battery life, how distracted my colleagues would be as I bring this device to meetings and lastly how I would adopt to the paradigm shift of moving from paper based textbooks to an electronic one.  Specifically, how would I handle the workflow process that one generally takes with paper based textbooks which includes bookmarking, annotations and highlighting of important text?

To those who know me it could be said that I have been one of Apples toughest critic.  Apple is known to be a closed proprietary product, only allowing third party application that has been granted approval.  To some it is merely Apple acting as curators to make sure only great quality products are released to its user base.  To others like me, I say let us the users decide what is best for our purchased product.  Let the public be the curators and not be objects of Apples discretion because there is this notion that they know better what is best for us users.  So in closing the determining factor on whether this decision to purchase an iPad can be considered a successful justification is based on how it can adopt to my daily workflow not only as a professional going through the daily grinds of one meeting after another but also now as a graduate student with the need to ensure textbooks are mobile and can accommodate the typical interactions I have with paper based textbooks.   In my estimation, one month would be a good time frame to ensure productive use has been properly instituted on the iPad to deem it an excellent selection and perhaps even profess that it is a device that has changed my world for the better.

A qualified super user is experienced within their healthcare specialty, knowledgeable about their unit and is recognized as an expert resource that will prove invaluable in helping others to understanding the work processes of the unit (Hunt, et al).  In an optimum situation, the super user should have a deep interest in the project.  Unfortunately at our organization, due to labor shortages of nurses, the default super user becomes, whoever is drafted by the department manager.  The unintended consequence is now the SIT is working with an unwilling participant that is not interested with doing the task at hand and provides minimal effort at best.  In some situations, you may get a very willing participant, but they are typically the younger clinicians, who may not have enough tenure to overcome resistance from a more seasoned staff.    Compound the problem with an organizational goal to deploy a super user ratio based on project scope size and proven published methodologies (McNeive, 2009).  The other intent with the super user deployment was for these identified staff to maintain their post after activation, with each department managers assessing the needs of users to maintain super users support model.  Again, due to labor shortages department management were forced to pull the plug on the proposed super user model prematurely due to pressures to meet patient care demands.  Therefore, there was a leveling off in the engagement of our super users to a point they have dwindled off from the department’s workflow.  There was now a perception issue that super users are no longer needed and that they were super users only when it was convenient for the identified super users.  The SIT team now faces the challenge of having a user base with varying degree of experience with the application.  Boudreau (2003) studied a state institution’s successful implementation of an enterprise system and found some employees who became functional, experienced users while other employees were struggling with using the new system – with some just able to perform their job responsibilities and lacking an understanding of the systems capabilities. Consequently our current help desk model, which is staffed by analyst type, that is essentially equipped to handle day to day software issue such as password resets and security issues and not the very specific workflow processes that patient care entails.  The help desk model did not prepare for this unintended consequence due to the original strategy to rely on departmental super users to field these types of issues.  Because the super users are practically non existent, in review of the help desk tracking system, there has been a significant increase in training request.  On average the organization receives approximately 250 help desk request a month for our application.  Findings further indicate that 60% of these were training related that should a good super user model been established one can conclude would make this issue nonexistent.

To solve this inequality with the super user engagement, and the increasing help desk request for additional training on software features and functionality, what I would propose as a solution is what I call a “shared staffing model.” The key difference in this model would be the fact that the staff reports to the Software Implementation Team.  The shared staff is carefully hand selected to ensure proper fit, as opposed to hand selected by department managers who may not know what the right qualities a super user should possess.  By nature of the shared staff reporting to the SIT, there is now a much better control and a more directed approach at the distribution of the resource.  With the shared staffing model, the SIT can concentrate their efforts on future development projects and not be slowed down fielding an increasing need for more education on how to properly utilize the application.  The new model would also employ a day and night shift personnel which is a deviation from standard SIT working hours of day shift only.  To be fiscally responsible, the ideal candidate for the position is a clinician that has part time status.  Since most hospital employees work 12 hour shift (3 shifts a week for full time designation and 2 shifts a week for part time designation), the ideal candidate would be a part time staff, who can continue to work their typical 2 shifts a week, but will now pick up an additional 2 days / 8 hour shift working with the SIT not to exceed 40 hours a week.  This will be a win-win situation for both parties, organizationally not incurring any overtime and the staff being given the opportunity to work extra hours and be introduced to a growing specialty – Healthcare Information Technology.

As a status update to date, this model has been proposed and escalated up to the executive level of the organization for approval.  The original proposal was to hire 6 shared staff (3 for days and 3 for nights) but the leadership decided to take a more conservative route to pilot this new model for effectiveness first, and approved the hiring of 2 shared staff (1 for day and 1 for night).  There will be a formal review in 6 months to evaluate effectiveness at which point it will be decided if this model will continue.  In further review of the same benchmarks used to propose this new model, in 1 month since implementing this new shared staffing model, there has been a significant decrease in training request from 60% down to 48%.   

 References

Hunt, E., Sproat, S., & Kitzmiller, R. (2004). The Nursing Informatics Implementation Guide. New York, NY: Springer-Verlag

McNeive, J. E. (2009). "Super users  have great value in your organization." CIN: Computers, Informatics, Nursing 27(3): 136-9.

Boudreau, M.-C. and Seligman, L. (2003) A Learning-based model of quality of use: Insights from a case study of ERP implementation, Pre-ICIS DIGIT Workshop, Available at http://mis.uah.edu/sigadit/workshops/files/DIGIT_2003_Boudreau.pdf.

While I am unaware of specific laws to reference that are against capitalizing generic drug names, although they may exist.   I do believe however, it is a community standard not to do so.  That is, I believe it is a community standard to use lower case to indicate generic compounds, and capitalization to indicate the Brand or Proprietary names for those compounds.    It’s use is ubiquitous.  Training books for healthcare workers from transcriptionists to pharmacy techs reference this practice.    I have personally never seem an Electronic Medical Record (EMR) or CPOE portion of the system; nor a Pharmacy system to be configured without using lower case for generic names and title case for brand names.   

While not as formal  as law, ISMP has a set of helpful guidelines for pharmaceutical  labels formats that may apply:  http://www.ismp.org/Tools/guidelines/labelFormats/default.asp    Each of these guidelines recommends to “List all products by generic name using lower-case letters as the primary drug nomenclature (unless employing tall man letters as a safety strategy), ensuring that each matches FDA-approved nomenclature.”

Most importantly, using capitalization on generics may inhibit the effectiveness of the ISMP–recommended tall man lettering.    When applied well, the only capitalization would be found on Brand Names and those look-alike and sound-alike areas of the drug names that are accented by this practice.   In fact, the only additional thing I would recommend is for our organization to agree to at least adopt ALL the ISMP-recommended tall man recommended matches found at: http://www.ismp.org/tools/tallmanletters.pdf , and then to add more that prove to be useful here.

This issue defies logic for me.  Why would someone not want to follow a set of proven standards?  Please feel free to chime in and leave your thoughts in the comments!

I was a Google Docs user prior, but Google Docs limited you to very specific file formats. With Dropbox, file type is almost limitless.  This is such a great back up solution as well. I added the Dropbox app on my Android powered device, and it works just as well.

Try it for up to 2gb free with a tiered priocing model for more storage needs.  Refer Dropbox to friends and you will get an incremental increade on your Dropbox file size (max 8gb).  

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…