Healthcare IT News: Nurses blame interoperability woes for medical errors

This article is a must read since 2016 is the year of interoperability!  It was originally posted on http://www.HealthcareITNews.com, and it was written By Erin McCann.  Enjoy reading this shared post below:

interoperability

Each year, a staggering 400,000 people are estimated to have died due to medical errors. What’s more, each day there’s also 10,000 serious complications resulting from medical mistakes. Part of the blame, nurses are saying, can be attributed to the lack of interoperability among medical devices.

That’s according to new data published by the non-partisan Gary and Mary West Health Institute, which sought input from nurses nationwide. The results are telling.
Some 60 percent of registered nurses said medical errors could significantly decrease if hospital medical devices were coordinated and interoperable. Even more marked was that half of them said they actually witnessed a medical mistake due to the lack of interoperability of these devices, which include infusion pumps, electronic medical records and pulse oximeters.
When looking at the crisis from a cost perspective, West Health Institute officials estimate that a connected, fully interoperable health system could save a potential $30 billion each year by reducing transcription errors, manual data entry and redundant tests.
“I have seen many instances where numbers were incorrectly transcribed or put in reverse or put in the wrong column when typed manually, which can cause errors,” said one participating RN in the report.
Indeed, some 46 percent of RN respondents said, when it comes to manual transcription from one device to another, an error is “extremely” or “very likely to occur.”

“As many as 10 devices may monitor or treat a single patient in an intensive care unit,” said Patricia H. Folcarelli, RN, senior director of Patient Safety at the Silverman Institute for Health Care Quality and Safety at Beth Israel Deaconess Medical Center, in a press statement announcing the report.”The nurse not only has to program and monitor the machines, he or she often spends a significant amount of time transcribing data by hand because the devices are not designed to share information,” she added.

Other key survey findings:
  • 74 percent of these nurses agreed that it is burdensome to coordinate the data collected by medical devices
  • 93 percent agreed that medical devices should be able to seamlessly share data with one another automatically
Just last year, healthcare clinicians and researchers convened on Capitol Hill to put their best ideas forward on how to solve the medical error crisis that reportedly claims the lives of 400,000 each year, costing the nation a colossal $1 trillion annually.
In terms of how to address this problem, the recommendations put forth by stakeholders were diverse – including boosting the number of registered nurses, supporting AHRQ, CDC and establishing incentives. There did, however, exist common agreement with one thing: information technology is falling short in many arenas.
“Medicine today invests heavily in information technology,” said Peter Pronovost, MD, senior vice president for Patient Safety and Quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins. “Yet the promised improvement in patient safety and productivity frankly have not been realized.”
Ashish Jha, MD, professor of health policy and management at Harvard School of Public Health, also at the hearing, agreed. The potential, he said, of electronic medical records and devices “is not going to be realized unless those tools are really focused on improving patient safety.”
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Executive Perspectives on HIT’s Role in Healthcare Reform

In case you missed the 2014 DFW HIMSS Education Event on “HIT’s Role in Healthcare Reform”, see a quick recap below of the Panelists, the top questions asked of them, and how those questions were answered.

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*Click here to see video!  (Video may take a few minutes to display.)

The Panelists:

What are the top challenges when aligning Physicians with Informatics leaders in your organization?

  • Getting management to understand Informatics and their partnership with Physicians is important and needs to be funded.
  • You have to educate Physicians – things are not as simple to make happen as the Doctor thinks.
  • For all the Physicians that aren’t involved, you have to get them to understand what you are doing so they don’t get frustrated.
  • Create criteria when considering who to ask for participation. Get a Physician that is respected, not yet retired, and match their skill set to your culture. Make sure it is also a Physician who knows what it takes to make things happen.

What are the challenges of integrating non-acute services with an integrated system of acute care?

  • We need a complete history of care with all the information up front.
  • We need to create standards and integrate as much as possible!
  • Different technologies handle data differently, and different people handle data differently.

How have you overcome challenges to support EHR changes including meaningful use and best practices?

  • Develop data capture as a byproduct of workflow, not a separate task.
  • Do not let technology, vendors, or government drive the workflow instead of you when possible.
  • Engage, engage, engage.
  • Own your decisions, and be willing to say “no”.
  • Make your decisions evidence-based.
  • Encourage clinicians as “this is the right thing to do for patient care” rather than “this is required by law”.
  • Hold hospitals accountable as a whole, not just the IT department.

While implementing technologies and making them evidence-based, what keeps you up at night?

  • How do we get clinicians to adopt and find the value? Even when we prove value with evidence, there is still resistance. User groups help because early adopting clinicians can positively influence other clinicians.
  • Do we have the right leadership?
  • Are we thinking long-term?

Healthcare IT Leaders Discuss ICD-10

The Health Information Management Systems Society’s (HIMSS) Dallas-Fort Worth chapter recently held another successful education event.  The event topic:  ICD-10.  In order to tackle such a complex and pressing subject, DFW HIMSS brought in the experts to inform and advise its members on the topic.

*Click picture above to watch the LIVE recording of the panel discussion.  

The 4 panelists for this ICD-10 event  for DFW HIMSS were as follows:

Melinda Costin, CHCIO, FHIMSS, CPHIMS
Vice President and CIO
JPS Health Network
With over 30 years of healthcare experience, Melinda Yates Costin is a pioneer in healthcare informatics.  She is an active industry speaker and has lectured at many well-known healthcare IT events including international events in Frankfurt, Germany; Geneva, Switzerland; and Rio de Janeiro, Brazil.  Melinda is featured on the “Thought Leader Spotlight” page of this blog due to her participation in an Executive Thought Leadership interview, an initiative that helps HealthcareTL.com share industry leaders’ insights to its followers.

Katherine Lusk, MHSM, RHIA
Senior Director of Information Management and Exchange
Children’s Medical Center, Dallas , TX
Katherine Lusk is the Senior Director for Information Management and Exchange for Children’s Medical Center of Dallas.  She received AHIMA’s Triumph Pioneer Award in 2012 for her organizational leadership in the implementation of the electronic health record resulting with her organization being the first in the State of Texas to achieve HIMSS Level 7 Analytics Award.

Debra Hughey
Vice President of Enterprise Applications
Baylor Scott & White Health
Debra Hughey is Vice President of Enterprise Applications for the newly merged organization Baylor Scott & White Health in Dallas, Texas.  In her role, Debra oversees information systems operations for Revenue Cycle, HIM, Regulatory, ERP and Imaging as well as multiple Clinical Applications for our inpatient facilities.

Julie Brandt, MBA, MHA
Information Technology Director of Ancillary Support Applications
Texas Health Resources
THR has 25 acute-care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with the system, and Julie Brandt is responsible for ancillary systems supporting the EHR, primarily Laboratory, Radiology/Clinical Imaging, Cardiovascular, Pharmacy, and Health Information Management systems.

So… what did these well-qualified panelists have to say about ICD-10?  Read the summary below, or watch the LIVE event video to get the full re-cap.

What is ICD-10?

To summarize Melinda Costin’s definition, ICD stands for International Classification of Diseases, and ICD-10 is a coding nomenclature (the devising or choosing of names) used to name and describe diagnoses and procedures.  ICD-10 is the 10th revision of this international classification of diseases.  ICD-9 has been used since 1979, and is scheduled to be replaced by ICD-10 on October 1, 2014.

What is the definition of ICD-10… in layman’s terms?

At the HIMSS event, I heard someone describe the importance of ICD-10 in a very simple way for those with less IT experience:  “Coding to report medical diagnoses and inpatient procedures can be compared to placing an order at a salad bar.  If you placed your order with ICD-9 coding, you may only be able to indicate that you would like a large salad.  If you placed your order with ICD-10 coding, you would be able to indicate that you would like a large salad with tomatoes, croutons, and Italian dressing.”  This simple description actually painted a clear picture for me of why we need more advanced coding.  It will help us give a more specific diagnoses as well as more specific inpatient procedures.  When dealing with the growing worldwide population and combining that with the growing number of diseases as well as the growing number of diagnoses and procedures based on advancements in medicine and technology, it is clear that it is time to make the transition to a coding system that can record, transfer, and provide more specific and efficient data.

What is the benefit of ICD-10?

Better quality of care will be provided with ICD-10 due to the fact that healthcare providers will be receiving more information and in more detail.  As diseases and procedures continue to increase and become more complex, ICD-10 will give us enough room for new coding to accommodate more advanced coding in the future.  We will also be able to compare our nation’s quality of care with that of the rest of the world.  The countries leading the world in quality health care have already been using ICD-10, the first of those countries beginning use in the year 2000.  Once our country standardizes on the newest and most robust ICD coding alongside with the best healthcare providers in the world, we will be able to measure ourselves against the best and see where we can improve.  Once we recognize areas with improvement opportunities, we can make impactful changes that will significantly increase the quality of care in the United States.

“You can’t improve until you standardize.  Once you standardize, you can measure.  Once you measure, you can improve.”  – Melinda Costin, VP & CIO, JPS Health Network.

What are the biggest challenges in transitioning to ICD-10?

In regard to ICD coding and its meaning, everything you have ever learned is changing.  No ICD codes will remain the same, which makes it difficult to transfer our existing data.  Some crossover codes do exist, but there are many codes without an equivalent.  Because of the expanded size of the ICD-10 codes which will be used to communicate more information,  every system that currently speaks/talks to ICD-9 codes must change to be bigger.  The code length and numeric format will require software maintaining ICD codes to change for all vendors and payers.

“We are going to have to learn a whole new language.”  -Katherine Lusk, Senior Director of Information Management and Exchange, Children’s Medical Center   

Which areas need to collaborate the most in order for ICD-10 to successfully replace ICD-9 in October 2014?

  1. Physicians
  2. IT
  3. HIM/Clinical Documentation
  4. Finance/Billing
  5. Vendors/Vendor Products

What are some tips for a successful transition to ICD-10 from the 4 Healthcare IT Leaders on the panel who represent 4 of our region’s largest health care organizations?

As with most challenges, it is important to have a plan of action, a timeline associated with that plan, and goals set for each significant event on the timeline.  This timeline should include events such as Plan, Design, Develop, Test, Analyze, Integrate, and Analyze again.  Collaboration among departments within the healthcare provider organization is key, as well as collaboration among health care providers and vendors.  A great deal of training for all, and an appropriate use of resources.  Some tools available online that were identified at this DFW HIMSS event are:  GEMS (Medicare), a complete tabular list of codes, an Alpha list of codes, a table of drugs, a table of neoplasms, external causes of injuries, etc.

For more details regarding these action plans that are being executed by the Healthcare IT Leaders on the panel at this event, check out the LIVE recording from this excellent event.  The speakers really go into detail on what has helped them successfully transition to ICD-10.  This concludes the summary of yet another extremely influential event for the Thought Leaders in our region.  We are all in this together, and we will all succeed together for the advancement of quality care in our region and in our country.

Northeast Texas hospitals among 2,000 to be penalized for readmissions

Hospitals are losing funding due to readmissions even though they have initiatives in place to decrease these incidents.

Some hospitals being penalized have been calling patients regularly after discharge to make sure they are taking their medications and continuing to recover.  If a doctor visit is needed, they arrange the appointment for the patient.

Making sure patients are being educated on the recovery process is important, but hospitals can only do so much.  Part of the responsibility for recovery is on the patient, but it seems the hospital is made 100% accountable for results.

Click on the link below to read an article that describes other ways hospitals are tackling the challenges of readmission prevention.

Northeast Texas hospitals among 2,000 to be penalized for readmissions – Longview News-Journal: Longview News-Journal: Local Business

CNO’s Discuss Healthcare Reform: Part 2

Great information was shared at the Health Information Management Systems Society’s (HIMSS) Dallas-Fort Worth Chapter’s Q2 Educational Event.   Mary Stowe, VP and CNO at Children’s Medical Center Dallas, and Claudia Wilder, VP and CNO at Baylor University Medical Center, were the speakers on the panel for this event, and they provided so much knowledge to those in attendance.  Click on the video below to view a live recording from the event which will also be available for viewing soon at www.dfwhimss.org

Live Recording:  CNO Panel Discussion at DFW HIMMS Event

Live Recording: CNO Panel Discussion at DFW HIMMS Event

DFW HIMSS CNO Panel Discussion Summary: Part 2

As a CNO, what is your experience with patients’ expectations of technology?

Patients are becoming more informed, and they are striving to be more educated consumers when it comes to healthcare.  They often come to the hospital after visiting Google to research their condition.  They believe they know what they have and what treatment they need, and they don’t understand if care isn’t instantaneous and matching what they found on the web.  Being informed is a good thing, but the internet does not always provide accurate information.  Fortunately, patients and families have been flexible in understanding this issue.  Also, patient portals are also becoming the norm because patients want to be able to complete hospital paperwork at home and have the doctor know what their condition is once they arrive.  Lastly, patients always want the best technology available when it comes to their care.  Patients are becoming more and more informed and want the best, fastest, most advanced technology and care.

What is the key difference between a CMO and a CNO?

These two roles are becoming more similar over time, and their partnership regarding patients and practice is vital.  CMO’s used to focus more on medical practices alone, and they were basically trained as entrepreneurs.  Now, they are evolving into business partners instead.  They are becoming more educated on the business aspect and becoming more focused on best practices.  Lastly, they are becoming more actively involved in the clinical care of patients.  For instance, approximately 90% of physicians were involved in the recent, clinical care based GoLive roll out at Baylor University Medical Center.

What keeps you up at night as a CNO in the midst of healthcare reform?

Leadership has to wonder if everyone on staff can and will keep up with technology.  Some embrace it and some don’t ever remember life without it, but this is not always the case, especially with the older generation.  Technology is going to continue to move forward, and we hope that everyone involved in patient care can keep up.  If anyone in this industry resists technology, they will suffer greatly as a result.  Another thing that will keep a CNO up at night is the issue of integration.  Will new technologies be able to integrate with the older technologies we have in place?  Moving forward, integration is key!  Lastly, CNO’s worry about healthcare reform causing a financial hardship on hospitals.  The government payers have changed and healthcare consumers will change accordingly.  Consumers are becoming more informed, and they want the best care and most advanced technology available, but they want it all at the lowest price the industry can offer.  To make things worse, Dallas is about 5 years behind on “fee for service” and charges are not taken for all services, which hurts the bottom line.  Like any business, it is difficult to provide the best technology and care while maintaining the cheapest price.  Consumers will need to understand this basic business model.  Also, Medicare simply does not pay enough to keep us in business, and that is certainly a concern.

Where are Informatics taking nursing?

To be most successful and effective, Clinicians need to run Informatics, not IT.  Clinicians should communicate issues, and IT should resolve those issues.  Collaboration is key!   Clinicians have been in “Informatics” a long time, but now the government has begun to force the issue and put the pressure on.  It is essential to partner with the IT experts by telling them what we need.  Furthermore, it is important for clinicians to be able to accept if there is a better way to do something than the way the clinicians have created.  Honesty and open communication between IT and Clinical is imperative.  “That’s not possible” is not a good answer, and solutions need to be found for resolution of issues.  Where there is a will there is a way, but it might not be what you had in mind, so stay flexible.  The ultimate goal is to make informatics work for patients by improving their care.

How are CNO’s using Informatics to improve patient care?

Data keeps us informed, accurate, and most effective.  It drives quality and best outcomes and allows us to track and fix errors quickly.  We can’t fix everything at once, so we are focusing first on the top initiatives, and then we will go from there.  People become complacent with too many initiatives being driven at once.  If we stick to one or two streamlined data alerts that are most important, it will help us move forward at a workable pace.  Development of clinical informatics teams will help make data information relevant and useful.

From a CNO’s perspective, how do you see nursing changing as a result of electronic charting?

Real-time information is key.  Clinicians must collaborate with IT to create Real-time processes.  This will enable us to access more relevant information than ever before.  This has allowed us to standardize care as needed and individualize care as needed.  Clinicians are starting to learn the value of accurate information, and real-time information is even better.  Real-time charting will cause a revolution!  It is anticipated that free-text charting will go away or be very minimized within the next 5 years.  Clinicians need to be able to use 1 device, such as an iPhone, for coding, billing, EMR, etc.  Electronic charting will also help any patient be able to track and access their healthcare history when needed.

What best prepared you for the role of Chief Nursing Officer?

Education played a large a part in preparation for the role of CNO.  Continuing education and being a life-long learner are important.  Always volunteer to help with projects and tasks when you can so that you can stay involved and stay tuned in.  It can certainly be beneficial to have experience working in non-profit facilities as well as for-profit facilities, and even facilities or companies that are merging.  This will teach you so much about financial responsibility.  Experience working on diverse teams and learning how to work with all types of people will prepare you for a leadership role and help you learn how to negotiate, resolve conflict, listen effectively, and more.  Having great mentors and co-workers will prepare you for a successful future as well, and on a personal note, having the support of your family as you grow in your career is priceless!

This sums up another great event held by the Dallas-Fort Worth Chapter of HIMSS!  A special “Thank You” to the panelists Claudia Wilder and Mary Stowe for sharing your knowledge and expertise, and also to the Board of DFW HIMSS for all of your hard work and for hosting another outstanding event!

CNO’s Discuss Healthcare Reform

The Health Information Management Systems Society’s (HIMSS) Dallas-Fort Worth chapter recently hosted an event at Embassy Suites in Grapevine, TX on April 5, 2013.  The event received rave reviews from its attendees, mostly because of the quality of speakers at the event.  Healthcare reform was discussed in detail by Mary Stowe, VP and CNO at Children’s Medical Center Dallas and Claudia Wilder,  VP and CNO at Baylor University Medical Center.  Their biographies from the DFW HIMSS Event promotional piece are below:

    • Mary Stowe, MS, RN, NEA-BC

Vice President and Chief Nursing Officer – Children’s Medical Center Dallas

Mary has served as the VP/CNO at Children’s since June of 2006.  Children’s is a 595 bed pediatric hospital with two campuses, which received Magnet Accreditation in January of 2010. Prior to Children’s, Mary has held a variety of clinical, leadership, and quality roles across Texas.  Mary also serves as a Director for the North Texas Consortium of Professional Nursing Programs and Practice Partners. Mary facilitates and enhances professional nursing education by identifying current trends and issues in education and practice and intervenes accordingly with policy recommendations for the pediatric population.  Mary received her Bachelor of Science in Nursing (BSN) degree from Baylor University and a Master of Science in Nursing Administration (MS) from Texas Women’s University. She maintains Nurse Executive, Advanced-Board Certified (NEA-BC) credentials, from the American Nurses Credentialing Center (ANCC).  Mary is an active member of the American Nurses Association, Texas Nurses Association, and the Texas Organization of Nurse Executives.  As a transformational leader, Mary’s philosophy of patient care centers on the synergy between the patient, family, and the clinician. To accomplish this, the all aspects of clinical informatics are critical. Under Mary’s leadership, bedside caregivers have a plethora of clinical tools to optimize quality patient care.

    • Claudia Wilder, MSN, RN, NEA-BC

Vice President and Chief Nursing Officer – Baylor University Medical Canter

Claudia Wilder serves as VP/CNO of Baylor University Medical Center in Dallas, overseeing approximately 2000 nurses. She is responsible for nursing practice, education and research.  Claudia received her Bachelor of Science in Nursing from Ohio University; Masters of Nursing Science from Wright State University and will complete her Doctorate of Nursing Practice in May 2013.  Claudia led various clinical areas throughout her career and served as Interim Chief Nursing Officer at Riverside Methodist Hospital in Columbus, Ohio before coming to Baylor University Medical Center in December 2007.  Claudia is a member of ANA, TNA, AONE and Sigma Theta Tau. Claudia is a J&J Wharton Fellowship Nurse Executives.

DFW HIMSS CNO Panel Discussion summary:  

What is the role of the CNO in healthcare reform?

The role is multifaceted and includes nursing education, best practice expansions, advancement of the role of nurses in general, focus on prevention and then keeping patients out of the hospital after discharge.  Healthcare reform opens opportunities to improve, have more access to care, and helps us to learn to be good financial stewards.  Challenges are seen, however, in areas that are not clearly defined.  For example, different states have different regulations, and it is unclear how to handle patient care when the patient comes from another state to be seen at your facility, but then goes back to their home state after discharge.  In regard to post-care, prevention of readmission, etc, does the state where the patient was treated have the final say based on their state regulations, or do regulations of the state the patient returns to after discharge apply instead?  If we can’t manage patient care once the patient has been discharged, how can we be held responsible for readmission occurrences?

What key strategies are CNO’s forming to meet the demands of healthcare reform?

Technology is going to help drive reform.  CNO’s are working diligently to identify the right technologies that should be used to best meet requirements, challenges, and expectations.  Access centers with all the information in one place and real-time locator systems (RTLS) are very helpful.  Technology increases efficiency.  CNO’s are also meeting challenges by collaborating with all teams in their organization to focus on the patient and advance better care.  Collaboration is key in order to create the most effective solutions.  Also, since consumers have become more educated and have the right to choose, they are more informed as to what they have, what they need, where they should go for best treatment and to be seen as soon as possible.  They are also much more aware of the cost of care, therefore cost of care must be managed carefully.

What are the biggest challenges CNO’s face, and how are they overcome?

There are thousands of initiatives to be accomplished, and there is always a strong sense of urgency with each one.  This can be overcome by taking time to prioritize which initiatives you want to focus on and in what order based on the outcomes expected from accomplishing the initiative in consideration.  There are so many different technologies available, but it is hard to find the best one for your hospital.  Of course, you also always want to be sure that the technology you select will integrate with your existing technologies that you already have.  Integration is key.  It is critical to stay up-to-date with new technology and clinical practices.  In fact, you need to stay 10 steps ahead.  Lastly, there must be a focus on finding quality technology at an affordable price.

What are the current challenges regarding integration of new systems?

Double-tracking of data is an issue.  We need to get enough data, but we don’t need the same data twice.  Furthermore, different technologies may produce varying data for the same report.  Which one is the source of truth?  It is not necessary to have the same software in a package as what you already have, just provide the pieces of software that we need while integrating what we already have.  Data is at risk when one system affects another.  Again, integration is key and will be necessary for technologies moving forward.

Claudia Wilder and Mary Stowe are two industry leaders who have a great deal of experience and expertise, and this led directly to one of the most successful education events I have attended in the DFW region. 

View upcoming DFW HIMSS events