...A Case Review of EHR Implementation in a Pediatric Emergency Department Jennifer Juif Southern New Hampshire University A Case Review of EHR Implementation in a Pediatric Emergency Department Organizations face many challenges when implementing an electronic medical record (EHR) system. Quality, safety, and efficiency need to be maintained during implementation. The case study reviewed: Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department (Kennebeck, Timm, Farrell, Sooner, 2012) attempted to quantify the effects of offloading low acuity patients and its impact on length of stay. Length of stay and volume of patients in an emergency department are correlated. The study was conducted in a pediatric emergency department (ER) in Cincinnati, Ohio. Prior to implementation, a plan was utilized to off load patients to a different area in the ER due to a surge from the H1N1 flu virus. This was successful in decreasing patient numbers and length of stay. The organization decided to use the same template for the EHR implementation. Despite its prior success, offloading patients did not improve efficiency or length of stay (LOS) during EHR implementation. The primary issue identified was the failure of offloading patients. The study stated, “During implementation only 5% of patients were diverted. During the H1N1 surge, 10-20% of patients were diverted.” (Kennebeck, Timm, Farrell, Spooner, 2012). The...
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...Sentinel Event: Sentinel events are a subset of medical adverse events. Events that require immediate attention are called Sentinel Events. Joint Commission defines a sentinel event as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Sentinel Event identified by Joint Commission also include infant abduction or discharge to the wrong family. Summary of the Sentinel event in the Case Study: Sentinel event presented in the case study involves discharge of a minor to the wrong family. Joint Commission requires immediate attention to such matters so that it may be avoided in the future. The summary of the event is that a 13 year old teenager, Tina, was admitted for day surgery. Tina was accompanied by her mother. After dropping Tina for the surgery at the hospital, her mother left to run some errands. Before leaving, she left her contact phone number with the pre-op nurse. After the surgery, Tina was inappropriately released to her father when her mother was delayed in returning to pick-up the daughter from the hospital. The hospital staff had no awareness of the family situation. Upon arrival at the hospital after the errands, mother was informed that Tina’s father had picked up Tina from the hospital because...
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...University of Maryland Medical Center The University of Maryland Medical Center (UMMC) is one of the biggest medical institutions in Baltimore, Maryland. Its biggest competition is John Hopkins Medical Center, which is famous for the work of Heart Surgeon Ben Carson. Much of UMMC’s external organizational structure revolves around competitive factors. UMMC originated in 1823 and over the years has changed its name from the Baltimore Infirmary formed by the faculty of the University of Maryland School of Medicine and in 1998 to what is now known as University of Maryland Medical Center (University Of Maryland Medical Center, 2012). UMMC provides patient care, education, and research. UMMC offers patient care for emergency visits, pediatric, geriatric care, obstetrics, shock trauma, and all other health and medical related issues. University of Maryland Medical Center also houses the University of Maryland School of Medicine. This school offers career in different medical fields and all of the teachers at the school are the practicing residents in the hospital. Some 656 beds are maintained by the Center, which includes the R Adams Cowley Shock Trauma Center; the Marlene and Stewart Greenebaum Cancer Center; and the University of Maryland Hospital for Children. The hospital and the school’s organizational design are run as a corporation and answers to a Board of Directors, Shareholders, and Stakeholders (University Of Maryland Medical Center, 2012). With UMMC being in constant...
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...Connecting with Patients J. Scott Joslyn, PharmD, MBA ABSTRACT Electronically connecting with patients is a challenging frontier at which technical hurdles are probably exceeded by political, legal, and other barriers. The rise of consumerism, however, compels a response focused more on revenue and strategic advantage than on pure cost savings. Among the difficulties faced by providers is choosing among various models of connectivity and component function. Emerging models include “freefloating” personal medical records largely independent of the office-based physician, systems with compatible and intertwined physician and consumer relationships using an application services provider office practice system, and systems that connect patients and providers through e-mail, office triage, prescription refills, scheduling, and so on. This article discusses these and other combinations of technology that significantly overcome the barriers involved and that may be woven together to provide solutions uniquely suited to various competitive situations. KEYWORDS • Consumerism • Patient-provider relationship • Data ownership • Application service providers • Time and cost savings The Internet has created both opportunities and threats that providers of all stripes must eventually confront to remain viable businesses in the new economy. Although business-to-business (B2B) innovations offer great hope in reducing costs and providing other efficiencies, electronically connecting with patients is a particularly...
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...nearly collided with Lee Schwamm, MD. Knowing that Dr. Schwamm’s overfull schedule as Vice Chairman of Neurology and Director of Acute Stroke and TeleStroke Services meant he had little time to chat, Farrell used the near-collision as an opportunity to quickly mention a recent conversation with a nurse from Falmouth Hospital on Cape Cod. An active participant in the TeleStroke service, Falmouth Hospital was regularly honored for its adherence to best practices in stroke care. “Recently some Falmouth nurses asked how we can convince other MGH departments—such as in critical-care pediatrics—to provide similar telemedicine consultation services,” Farrell stated, adding “Their nurse stroke coordinator, Jean Estes, is a huge cheerleader for TeleStroke.” Dr. Schwamm continued moving toward his office as he replied, No tC Shawn, don’t we already have too much to do? I need to see patients, complete the analysis for a study I am working on, submit a grant application. Next week I will speak at an international neurology conference. Telemedicine can certainly be invaluable in many clinical domains, but there just are not enough hours in the day for us to get involved beyond stroke care. Before entering his office and shutting his door, Dr. Schwamm added one last remark: “We can’t do everything, Shawn—but we can do TeleStroke very well.” Shawn Farrell was not a medical doctor. A graduate of the Boston University School of Management, he had worked as an operational...
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.../202/MH01799/new74598_disk1of1/0073374598/new74598_pagefiles FROM PATIENT TO PAYMENT: UNDERSTANDING MEDICAL INSURANCE KEY TERMS Step 1 S te St ep 10 Follow up payments and collections Preregister patients p2 Establish financial responsibility St ep 3 S te p 9 Generate patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement. S te p4 Medical Billing Cycle Prepare and transmit claims 1 accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed...
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...Office of the National Coordinator for Health Information Technology (ONC) Federal Health Information Technology Strategic Plan 2011 – 2015 Table of Contents Introduction Federal Health IT Vision and Mission Federal Health IT Principles Goal I: Achieve Adoption and Information Exchange through Meaningful Use of Health IT Goal II: Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT Goal III: Inspire Confidence and Trust in Health IT Goal IV: Empower Individuals with Health IT to Improve their Health and the Health Care System Appendix A: Performance Measures Appendix B: Programs, Initiatives, and Federal Engagement Appendix C: HIT Standards and HIT Policy Committees Information Flow Appendix E: Statutes and Regulations Appendix F: Goals, Objectives, and Strategies Appendix G: Acronyms ONC Acknowledgements Notes 3 6 7 8 21 28 36 49 51 65 67 70 74 77 77 78 Goal V: Achieve Rapid Learning and Technological Advancement 43 Federal Health IT Strategic Plan 3 Introduction he technologies collectively known as health information technology (health IT) share a common attribute: they enable the secure collection and exchange of vast amounts of health data about individuals. The collection and movement of this data will power the health care of the future. Health IT has the potential to empower individuals and increase transparency; enhance the ability to study care delivery and payment systems; and ultimately achieve...
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...PHYSICAL ASSESSMENT EXAMINATION STUDY GUIDE Nursing Assessment 1. Part of Nursing Process 2. Nurses use physical assessment skills to: a) Obtain baseline data and expand the data base from which subsequent phases of the nursing process can evolve b) To identify and manage a variety of patient problems (actual and potential) c) Evaluate the effectiveness of nursing care d) Enhance the nurse-patient relationship e) Make clinical judgments Gathering Data Subjective data - Said by the client (S) Objective data - Observed by the nurse (O) Document: SOAPIER Assessment Techniques: The order of techniques is as follows (Inspect – Palpation – Percussion - Auscultation) except for the abdomen which is Inspect – Auscultation – Percuss – Palpate. A. Inspection – critical observation *always first* 1. Take time to “observe” with eyes, ears, nose (all senses) 2. Use good lighting 3. Look at color, shape, symmetry, position 4. Observe for odors from skin, breath, wound 5. Develop and use nursing instincts 6. Inspection is done alone and in combination with other assessment techniques B. Palpation – light and deep touch 1. Back of hand (dorsal aspect) to assess skin temperature 2. Fingers to assess texture, moisture, areas of tenderness 3. Assess size, shape, and consistency of lesions and organs 4. Deep = 5-8 cm (2-3”) deep; Light = 1 cm deep C. Percussion – sounds produced by striking body surface 1. Produces different notes depending on underlying mass (dull...
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...Technology in Healthcare Crystal Waters HCA 320-01 Healthcare Service Management Fa11 2013 10/31/13 Jackson State University College of Public Service School of Health Sciences Technology in Healthcare Technology, coming from the oxford dictionary meaning “machinery and equipment developed from the application of scientific knowledge.” and Healthcare also coming from the oxford dictionary meaning “the maintenance and improvement of physical and mental health, especially through the provision of medical services.” With these two word together it changed healthcare tremendously. The use of technology evolved in healthcare as early as in the 20th century. With technology emerging into healthcare there is a lot of research that goes into it before it is released. McGrady, E., Conger, S., Blanke, S., & Landry, B. L. (2010) explained how it is done while the researched three technologies they stated “The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and...
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...Medtronic, Inc. Dana Lindley HCA459: Senior Project (BGM1046A Instructor: Kristin Akerele November 18, 2010 Medtronic, Inc. Is changing the face of chronic disease. By working closely with the physicians around the world, they create therapies to help patients do things they never thought possible. Their medical technologies help make it possible for millions of people to resume everyday activities, return to work, and live better, longer. They are able to do this with the help of some very special people around the world: 38,000 dedicated employees who share a passionate purpose to improve lives, thousands of medical professionals who share their insights and ideas, and hundreds of advocacy associations that help us share information so people with debilitating diseases know relief is possible. MEDTRONIC PURPOSE Medtronic is one of the largest medical technology companies that manufactures implantable biomedical devices, with sales in over 120 countries. The Company treats chronic diseases by offering products including bradycardia pacing, heart failure, atreal fibulation, coronary vascular disease, heart valve replacement, etc. They operate Cardiac Rhythm Disease Management, Spinal and Biologicals, CardioVascular, Neuromodulation, Diabetes, and Surgical Technologies. Medtronic, Inc. was founded in 1949 by Earl Bakken and his brother in law Palmer Hermundslie out of their garage in northeast Minneapolis, Minnesota. They...
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...How do new technologies impact on workforce organisation? Rapid review of international evidence Report developed by The Evidence Centre for Skills for Health Contents Key Themes ............................................................................................................................................ 3 Scope .................................................................................................................................................................... 3 How are teams being organised?.......................................................................................................... 7 Substituting grades and roles ............................................................................................................................... 7 Reducing staff or team size .................................................................................................................................. 8 Empowering patients............................................................................................................................................. 9 Changing the place of care ................................................................................................................................. 10 Working across organisations ............................................................................................................................. 10 Working across regional areas .........................
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...A.1: Description of the Sentinel Event At about 12:30 PM on Thursday, September 14th, a sentinel event occurred that involved a potential child abduction. Tina, a 3 year old child, was scheduled for a routine, same-day surgery at Nightingale Community Hospital to have ear tubes put in both ears. Tina was brought to the hospital by her mother, who had recently been divorced from Tina’s biological father; Tina’s mother has full custody of the children, including Tina. After Tina was registered and taken to the pre-op area of the hospital, the pre-op nurse informed Tina’s mother that the actual surgery would take approximately 45 minutes, and then Tina would need to stay in recovery for at least an additional hour. Tina’s mother informed the pre-op nurse that once Tina had gone to the operating room, she would be leaving the facility to run an older sibling on an errand, but she would be back to pick up Tina after she was released from recovery. The mother gave her cell phone number to the pre-op nurse, who wrote the phone number down on a note-pad the nurse carries in her pocket. Tina’s mother asked for the nurse to call her on her cell phone if Tina’s procedure was completed sooner than expected. When Tina was taken into surgery, the mother left the facility to run her errand. After the surgery was completed, Tina was taken to post-op to recover. The recovery nurse paged Tina’s mother, but did not receive a response. Tina was transferred to the Ambulatory Care nurse...
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...Systems E-Health in Greece compared to EU/US and the impact of Big Data in healthcare Prepared by: Athina Klaoudatou Christos Panagiotou Abstract The aim of this report is to describe the eHealth market. The focus is the Greek business landscape, current trends in the market, industry growth, drivers, and restraints, the technologies and the players in various aspects of the field. Data are presented about the evolution of the market and there are descriptions of what Greek companies offer. Moreover implementation measures are presented, along with progress achieved with respect to national and regional eHealth solutions in EU and EEA Member States. Table of Contents 1. The National Health System 1 1.1. Organizational structure 1 1.2. Some facts & figures 1 2. What is eHealth, definitions, areas of application, benefits 5 2.1. What is eHealth 5 2.2. Forms of eHealth 5 2.3. Benefits of eHealth 6 3. eHealth framework in European Union countries 7 3.1. eHealth Action Plan 2012 - 2020 7 3.2. eHealth in the European Countries 8 4. Application of eHealth practices 10 4.1. Electronic Health records (EHR) 10 4.1.1. Examples of current EHR use 10 4.1.2. Electronic Health Record in Greece 12 4.1.3. Summing up 14 4.2. Interoperability 15 4.2.1. Defining Interoperability in Healthcare Systems 15 4.2.2. Most widely used contemporary Interoperability standards in Healthcare 16 4.2.3. EPSOS (European Patients Smart Open Services)...
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...Organizational Leadership and Inter-professional Team Development The Patient and Family Care Organizational Self-Assessment Tool (PFCC) for current practice setting will be completed as well as the organization in its entirety. The results will be analyzed based on a one to five scoring system with one being the lowest. The areas where the organization could improve its PFCC care will be discussed. The analysis of how business practices and regulatory requirements impact patient family centered care. A strategy will be created that includes goals and an operational plan to increase PFCC of the organization by improving one of the gaps that’s identified. I will discuss financial implications that this strategy may have on the organization. I will identify potential members for the multidisciplinary team who could assist in improving the identified gap. I will discuss the purpose and scope of the team to include the member’s roles, and importance of diversity within the team. The team will focus in a meaningful way using self-assessment, and awareness of self-reflective techniques. I will use PDAC to monitor whether the strategy was effective in increasing patient and family centered care. Self-Assessment Tool The PFCC tool was used to evaluate Medical Center Health System (MCHS) see attached. Setting Description Medical Center Hospital System (MCHS) is an acute care, not for profit regional 402 bed Level II Trauma Center, located in West Texas of the...
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...methods to overcome communication barriers. Kristina L. Guo is an Assistant Professor of Health Services Administration in the Stempel School of Public Health at Florida International University in Miami, Florida. Professor Guo graduated from Florida International University with a PhD in Public Administration in 1999, and she holds a Masters in Public Health from the University of Miami. Prior to joining the Florida International University faculty, Dr. Guo accumulated extensive experience in the healthcare field. She was the Assistant Director of the University of Miami’s intellectual property division, where she conducted market and patent research and analyses. As the manager of several physician practices, she was responsible for formulating and implementing strategies to increase the organization’s viability and growth potential. She teaches health services management, organizational behavior, and health policy. Her primary areas of research are healthcare policy and management, where she has developed a managerial roles and skills assessment tool. Her current research focuses on the healthcare needs of elders. Yesenia Sanchez is a contracting specialist for Neighborhood Health Partnership, a five-star health maintenance organization in Florida. Ms. Sanchez holds a Master’s in Public Health from Florida International University. She is an adjunct professor for the College of Health & Urban...
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