This is the third in a series of posts regarding how HMS is integrating customers into our product development process. This post focuses on how we are accomplishing this.

Our first step is to identify the projects for which we want additional input. Typically, we focus on larger initiatives that are complex and require an extensive understanding of workflow, such as Physician Documentation.

The second step is to identify participant characteristics. Working with our account management team, we use a variety of criteria to identify candidate organizations, including:

• Bed size
• Geographic location
• Diversity of HMS applications in use
• Length of HMS system use
• Experience with non-HMS systems Number of facilities in the organization (1 versus 10 versus 100…)

This allows us to obtain a cross section of facility types that improve the odds of HMS building and delivering a system that meets the needs of our diverse customer base. Once we select candidates, they are asked to participate in project overviews and demonstrations. From there, they are asked to join online demonstrations to review and provide input at various stages of the development process.

These ongoing relationships allow us to gain insight and feedback over the life of the development project. This also forms an initial pool of potential beta candidates.

As HMS evolves this emerging process, we continue learning how to improve it and make it as effective as possible. Customers who agree to participate are helping us and their peers in other hospitals as we move our product suite to the next level.

The scene: busy neighborhood pub on a Friday night. Glasses clinking, waiters hustling, weary diners welcoming the weekend. Convivial group around the table, old friends and new.

And a hot topic of conversation: electronic health records.

Wait . . . really?

It’s true. One diner has shared the happy news that long after she stopped hoping, she is expecting a baby. Being new to town, she and her husband immediately initiated a search for the right provider for pre-natal care, delivery, and pediatrics.

The really revealing part about the current sea change in healthcare was what came next. The first selection criteria she mentioned were not reputation, or specialty expertise, or a reference from her best friend—it was not how this provider delivers her care, but how they deliver her information.

Everyone at the table listed intently to her description: “Did you know that if you are a patient at (hospital name), wherever you go—to the doctor’s office, for scans or tests, anywhere—they already have all your information? So they don’t ask you to carry your x-rays or lab results around? Even the stuff from my former doctors in my home state—they had all of it, and any of them could see it instantly.”

And the story continued: “The part I like best is that they have a really great website where you can sign in and see EVERYTHING. I got an email that my test results were in, and I logged in to read them. I went to the same site to review all my charges against my insurance bill—it was all very easy to find, right in front of me. It’s great. I love it.”

Another diner whose elderly mother is in need of frequent care responded with this equally telling observation: “Wow. I might move Mom’s care there. I can’t even imagine how much easier my life would be. It would be huge. Are all their doctors connected to the hospital like that?”

Clearly, this hospital successfully delivered two important, interrelated benefits. The hospital chose a good EHR that helped caregivers do their jobs and made the patient aware of that benefit everywhere she turned. The second was equally important: the hospital made her part easy by delivering a patient portal that was easy-to-use, appealing, seamless.

In the highly competitive healthcare market where this dinner took place, those strengths gained the hospital and its affiliated physicians a loyal new customer. In a smaller community, such a strategy could make the difference between local providers keeping a patient in their hometown for care or losing them to out-migration.

A strong EHR strategy has become a highly marketable competitive advantage, but hospitals and physicians will have to tell their EHR story boldly to get the most out of it. Those who ignore that opportunity in this window of time will never be the highlight of dinner-table conversation and gain the patients who come along with those priceless testimonials.

As a professional in the world of training and development, I find that people are constantly coming to me with training needs. “We need a class,” they tell me. Clearly, I love classes; however, I always try to remind people that a class is only one component of the learning process. What happens before and after the class should be every bit as important as what happens in it.

I believe that learning transfer—the process of taking the information learned in a class and applying it to the job—is an absolutely critical component of training. It’s also one of the biggest challenges for instructors: We can try to fill our learners’ heads with knowledge, but how much of that will reach the workplace, where they need to use it? After all, we don’t train people so that they know more, we train them so that they can do more, or better, or differently. The goal of training is to improve performance.

So how can we help make the transfer from the classroom to the workplace happen? One way to facilitate transfer is to make sure our learners are ready to learn. Adult learners need to be motivated. They need to believe that the new skills they will be learning are relevant and will be of benefit to them, and they need to feel confident they’ll be able to use those new skills on the job. Taking some time to make sure learners are motivated, enthusiastic, and understand how the training will help them is a great investment and one that research shows can increase learning transfer by up to 70 percent.

Make sure that the training classes you deliver or attend answer the question: “What’s in it for me?” Structuring training—whether live, online, or at a distance—to reinforce meaningful benefits, both explicitly and implicitly, will help make sure learners stay open to the class content and are ready to use it back on the job, where it matters most.

With the current trends in healthcare IT and the move toward meaningful use, most facilities are currently evaluating their clinical processes and how new clinical features and functions will impact their organizations.

When identifying the key resources who will be responsible for the successful adoption of the clinical function throughout the enterprise, it is vital to understand the change-management process and its impact on the enterprise.

Even before you purchase new IT applications, you should, as stakeholders—M.D.s, nursing, HIM and ancillary (IT is more of an enabler and facilitator in this process)—meet to discuss the areas that will be impacted by the purchase (process, systems and organization structure), the motivation behind the potential change and how the new processes will be governed with the new applications moving forward. Changes of this magnitude will impact all areas of the enterprise. This work will not be easy as many day-to-day operations and processes will be altered, but it’s for the good of the organization.

With any change there are two key components that must be understood before change can actually happen: CHANGE MANAGEMENT and PROJECT MANAGEMENT.

Project Management is the application of knowledge, tools and techniques to meet specific requirements.

Change Management is the process, tools and techniques to manage the human portion of the change to achieve the desired business objectives.

Any change to the processes, systems or organizational structure will have a technical and a human element that will need to be managed, and we need to think of these as separate and distinct. Project management requires you to formulate a set of plans and steps to achieve the desired outcome, and change management requires you to create an enterprise-wide approach to the change to help the people who are most impacted by the change be successful. This hand-in-hand approach will speed the goal of adoption and ultimately project success.

The concept of value-based healthcare purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. In value-based purchasing, purchasers gather and analyze information on the costs and quality of competing providers and health plans. They contract selectively with plans or provider organizations based on demonstrated performance. Ideally, the best-performing plans and providers are rewarded with greater volume of enrollees or patients.

The implementation of VBP
Value-based purchasing marks the beginning of another significant change in how Medicare pays healthcare providers and facilities—for the first time, hospitals across the country will be paid for inpatient acute care services based on care quality, not just the quantity of the services they provide.

According to the CMS press release from spring 2011, “This initiative has the potential over the next three years to save 60,000 lives and save up to $35 billion in U.S. health care costs, including up to $10 billion for Medicare.” “Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,” said HHS Secretary Kathleen Sebelius. “Under this initiative, Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”

The better a hospital does on its quality measures, the greater the reward it will receive from Medicare. For a complete list of quality measures, visit www.HealthCare.gov/news/factsheets/valuebasedpurchasing04292011b.html.

For any of us that remember DRGs and their impact on Medicare and hospital operations, this has the potential to be a similar water-shed event. An estimated $850 million has been allocated for hospital payments in 2013 based on overall performance on a set of quality measures that improve care and patient satisfaction. This funding will be taken from what Medicare otherwise would have spent, and the size of the fund will gradually increase over time, resulting in a shift from payments based on volume to payments based on performance.

For a fact sheet on the Hospital Value-Based Purchasing Program, visit www.HealthCare.gov/news/factsheets/valuebasedpurchasing04292011a.html. To learn more about hospital value-based purchasing, please visit www.cms.gov/HospitalQualityInits.

The final rule establishing the program was placed on display at the Federal Register today and can be found online at: www.cms.gov/HospitalQualityInits.

It’s easy to see how technology is changing our lives every day. Our kids are growing up with technology in ways that we could never have imagined. Obviously technology is more and more evident in our healthcare delivery system and growing in scope each passing day. Access to information for clinicians is easier and more comprehensive than ever, and that trend will only grow over time. Clinicians are completing school with the expectation that they will have access to technology to do their jobs. Patients are gaining more access to their own records and data.

What can’t be lost in this evolution of clinical tools and technology is the human element of delivering patient care. We all want to know that the physician and clinician can relate to our problems and have a servant spirit. As I visited several customers in the last few weeks, I was impressed with the sincere desire of these caregivers to do what is right for the patient. They view the technology as a tool to assist in their mission. While the tools we give them are wonderful in providing timely and accurate information, we cannot view the tools as the goal.

All of us who work in the healthcare technology field would do well to remember that our goal is patient care. We may not be standing at the bedside or talking to a patient, but the work we do directly impacts the patient and those caregivers who are standing there having that important conversation. Giving clinicians a tool that is easy to use and informative helps them take care of someone’s mother, brother or child. If we all focus on doing our job through that lens, then our healthcare delivery systems will become more effective in taking the best possible care of patients.

All of us at HMS are grateful for the opportunity to provide those tools. On behalf of everyone here, I want to share our special holiday greetings to those who will be at the bedside providing care, instead of at home with their own families, throughout the holidays.

Electronic documentation has many benefits, such as legibility, accessibility, improved coordination among clinicians, efficiency and portability of information to other systems. Facilities need to consider how the documentation system is set up, the policies and procedures for documentation and the training of clinicians. Documentation systems allow information to be copied forward or populated automatically from the previous documentation. This may help ease the burden of documentation for clinicians, but clinicians must be diligent in validating the data. With increasing patient acuity and nursing shortages, are clinicians always able to catch when information has changed and update the documentation accordingly?

Some systems allow facilities to determine what information can be copied forward based on a time frame. Others allow users to only copy “their documentation” forward. Some systems may bring forward historical information, so the information is always available. For example, if a patient had a tonsillectomy in 1982, this information does not change. However, if the person previously had “No Known Allergies” documented on the last visit but has since had an adverse reaction to Penicillin, the clinician would need to change “No Known Allergies” to “Penicillin Allergy.”

A common argument against copying documentation forward is the risk of clinicians failing to validate the copied information. For this reason, some facilities have policies that prohibit the practice while others may allow only specific information to be copied, such as surgical history. Removing/not allowing copy forward may cause some clinician dissatisfaction. For example, clinicians may want the IV site documentation to be pulled forward. However, this can be a common cause for inaccurate documentation. Here’s an example: The IV was documented as placed in the left hand for four days, but the site infiltrated on day two, and the IV has been in the right hand for the past two days.

The goal is accurate, timely documentation, and with meaningful use, healthcare providers need to share information between systems, making accurate documentation imperative. Is allowing copy forward a time-saver for your clinicians, or does it enable “bad documentation” by some? These are things to consider when writing policies and defining how your EHR system is going to work best for your clinicians.

It’s that holiday time again. In holiday cheer, let’s explore how to prepare an informaticist.

(Side Note: As healthcare informatics can be very broad, I will be exploring nursing informatics specifically for this. The information can be used for other paths as well.)

Recipe for preparing an informaticist:

Ingredients:

• one motivated nurse
• dash of technology
• pinch of information
• bowl full of patience

Preparation:
Wait, you mean there’s preparation involved?!! I just fell into this role! Choose a way or many ways for your prep:

• Sign up for daily/weekly blogs
• Join a group
  • Join an organization like ANIA-CARING, American Medication Informatics Association (AMIA), Healthcare Information and Management Systems Society (HIMSS)
  • Or a local/regional group such as the Minnesota Nursing Informatics Group (MINING) or the Delaware Valley Nursing Computer Network (DVNCN).
• Explore a master’s program in informatics
  • There are many schools out there with emphasis in nursing informatics, healthcare informatics or medical informatics.
  • Many schools offer part-time programs or online-only programs for the working student.
• Go to a WINI (weekend immersion in nursing informatics)
  • These are held throughout the country.
  • The WINI provides an opportunity to have guided discussion and education in a variety of informatics topics including the systems life cycle, theories used in nursing informatics and professional practice trends and issues. (WINI, 2011)
• Take a 10x10 course
  • These courses are offered through the AMIA. They utilize curriculum content from various informatics programs. These 10-week courses provide a framework for understanding details such as electronic and personal health records, health information exchange, standards and terminology, and healthcare quality and error prevention. (AMIA 10x10 Courses, 2011)

Directions:
1. Mix the individual with technology, information and patience.
2. Come up with a good way to explain to friends, family and colleagues what it is that you do.
3. Find a role or career path you love.
4. Repeat preparation as often as needed.

Works Cited

AMIA 10x10 Courses (2011). Retrieved 11-14-2011 from AMIA: http://www.amia.org/education/10x10-courses

WINI (2011, 11-11). Retrieved 11-14-2011 from Weekend Immersion in Nursing Informatics: http://icce.us/