CHIME Foundation Firm Features:

By: Lee Shapiro, President of Allscripts, the leading global provider of technologies essential to creating a Connected Community of Health™

Our healthcare system is suffering from systemic information gaps that make it next to impossible for providers to collaborate across care settings. As a result, physicians often make decisions based on snippets of information when a more complete picture could help prevent medical errors, redundant tests and other problems that contribute to 100,000 preventable deaths and $700 billion in waste each year.

Key healthcare stakeholders have proposed several solutions that fall under the general heading of Value-Driven Healthcare. The federal government's leadership in this arena began in 2009 with the HITECH Act (part of ARRA), pilots for Patient Centered Medical Homes, and the recent pronouncements on Accountable Care Organizations. Each addresses critical areas including improving transitions of care, still the weakest link in the healthcare chain, and developing the optimal course of treatment for each patient type. The Electronic Health Record is a required element to make these improvements a reality.

An innovative new framework, the Connected Community of Health, takes the EHR to its logical conclusion. The connected community utilizes an open technology platform centered on the EHR to securely share information between providers in all care settings, no matter which Health IT systems they use. Not only does this facilitate seamless care coordination between providers inside their own organization, but also with affiliated physicians and other independent stakeholders outside their organization. The goal is to create a "single source of truth" about a patient – a unified community record – to deliver effective and economical care.

Building Connected Communities of Health across America will take time but the government can help by focusing on a key enabler: Interoperability. Walls between systems only create chaos. The government should require healthcare IT companies to provide open, interoperable systems that can integrate with any third-party application.

But CIOs need to do their part as well. They must develop a strategy that accommodates all the regulatory changes and tectonic shifts in reimbursement – all of which lead to a Connected Community of Health based on IT systems that can exchange information in a vendor-neutral, value-based fashion. Very soon, the seamless care coordination and demonstration of value that these systems enable will no longer be a nice-to-have. It will be the prerequisite for doing business.

The Way-Paver Awards recognize individuals and organizations that have paved the way for a safer point of care in hospitals worldwide. Integrating with smart infusion pumps, Cerner launched the infusion management system at WellSpan Health's York Hospital Medical-Surgical ICU. This is the first I.V. clinical integration system in the world to accomplish true bidirectional communication, closing the loop on the infusion medication management process.

Powered by Cerner CareAware® device connectivity architecture, clinicians at WellSpan Health are able to automatically send data from Hospira's Symbiq™ smart infusion pumps utilizing the company's proprietary Hospira MedNet™ safety software to the Cerner Millennium®electronic health record (EHR), without needing a nurse or other staff member to transcribe titration data or volumes infused. Clinicians are now able to automatically program infusion pumps with patients' order information and aggregate real-time infusion and medical device data into the EHR. This information is available in an organized dashboard view that gives a summary of all relevant health information and enables caregivers to spend less time manually entering device data into the EHR and spend more time at the patient's bedside providing quality care.

"At one time, infusion pumps were totally separate from the electronic health record. This solution enables the pump and the EHR to communicate so that the staff can focus their time on taking care of people," said R. Hal Baker, M.D., vice president and chief information officer at WellSpan.

Smart pump integration and management at WellSpan Health has produced remarkable benefits, including:

• 27 percent reduction in nursing time required to start a new infusion
• 50 percent reduction in nursing time required to titrate an existing infusion and document it
• One code blue witnessed took 5 minutes to document instead of the estimated 120 minutes it took prior
• Integration with pump safety software resulted in prevention of an estimated 30 potential adverse drug events

To learn more about to learn more visit www.cerner.com/careaware.

By: Celwyn Evans, Senior Partner Greencastle Associates Consulting

The convergence of ICD-10, Meaningful Use, and Accountable Care Organization (ACO) will continue to place increasing demands upon the IT department and the healthcare organization overall. If you experience any of these situations, you may be in need of a "Governance Tune-up."

• Initiatives such as MU, ICD-10, ACO are viewed by the organization as an IT project
• Decision making from clinicians and leadership is slowing down progress
• Clinical Adoption of new applications is lagging
• Existing governance meetings are not consistently well attended

Governance needs to continually evolve at a rate which keeps up with the changing environment. The first step in this Tune-up is to develop the case for change that resonates with the stakeholder groups.

Changes in the governance structure, participation composition, meeting agendas, decision making process can all be viewed as a threat or failure of current leadership. That is why developing the case for change must take into account individual personalities, egos and agendas along with the organizational culture itself. This can be done through a non-bias third party (an internal or external facilitator). The fastest, least difficult and most widely accepted approach to developing the case for change is through group self identification. A technique to achieve this is to conduct a formal lessons learned session at the end of a meeting. Items that are identified as "not working" could be used to restructure your governance process and organization. Another popular technique is to interview participants and synthesize the results into "Themes of Change". An assessment of the current governance structure, however detailed, must have buy-in from the stakeholders within the organization itself, one of the fundamental principles for change management.

It is only natural that with the changing regulatory, economic and technical environments; that stakeholder expectations and needs also change. The key to successful IT Governance is having a structure and process that meet the needs and expectations of IT and Clinical leadership as well as the organizations Senior Executives.

For more information contact evansc@greencastleconsulting.com or visit www.greencastleconsulting.com.

By: Lora Baker, NextGen Healthcare

A March 2011 HIMSS Analytics study (sponsored by NextGen Healthcare) asked 117 senior IT executives about interoperability and Accountable Care Organizations. Nearly 90 percent of respondents identified themselves as CIO or Vice President of IT/IS.

Though only 11 percent of respondents participate in ACO pilots today, nearly three quarters plan to in the future. For these initiatives to be successful, providers must be poised to share data through a health information exchange (HIE) and other means. Thankfully, the majority of respondents (87 percent) also expect to participate in an HIE. In fact, sixty-two percent are already part of one today. HIEs are a critical part of the solution to common data sharing challenges, such as technical discrepancies among providers, varying abilities to share within a local environment, and limited access to protect privacy.

With regard to ACO plans, 58 percent of respondents indicated a desire to participate in the creation of an ACO, while just 13 percent preferred a developed ACO. Only 9 percent said they had no interest in participating in an ACO.

While only a handful of organizations take part in an ACO right now, it is clear that number will grow substantially. Whether planning for the near or distant future, providers should actively engage in ACO discussions with area stakeholders now. It is critical to gain an understanding of what HIE and ACO opportunities are available to you, and how to maximize their impact on your patients and practices. It also offers the opportunity to help define the ACO in your region, ensure you own interests protected, and exchange ideas and best practices with others.

Beginning today to develop an interoperability strategy and gain a voice at the table during ACO development will help practices and hospitals alike more effectively approach the end goal of transforming healthcare delivery.

For more information, visit www.nextgen.com.

By: Louann Reilly and Heather Haugen PhD, The Breakaway Group

As healthcare leaders face the challenge of EMR adoption, another mandate looms. On October 1, 2013, organizations must submit coding according to ICD-10 or risk nonpayment. A transition heralded by some as the most encompassing for healthcare to date, the move to ICD-10 touches all healthcare provider roles, with significant implications for healthcare delivery, contracting, claims processing, reimbursement and reporting. (See Figure 1)


There are many parallels between EMR and ICD-10 adoption. Both initiatives are wide-reaching; both require changes to workflows, policies and procedures, and technology applications; and both support enhanced data capture, consistent with the objective of meaningful use. Most importantly, both require the deep-seated commitment of leadership.

ICD-10 adoption presents many of the same barriers as EMR adoption: resistant clinicians, constrained resources, disengaged leadership, and a lack of measurement to assess both clinical and financial outcomes. The transition to a new classification system is further complicated by additional complexity that weaves clinical diagnostic and procedural standards together with the provider-payer relationship, a relationship commonly marked by misunderstanding. For clinicians, true adoption of the new standards requires them to process care documentation differently and calls for a major shift in responsibility for coding accuracy.

Healthcare leadership should develop one agenda that addresses ICD-10 standards integration with EMR adoption, uniting the two initiatives with a single approach to sustaining organizational change. Leaders who understand the critical components for EMR adoption will have an advantage, because these components are vital for successful adoption of both ICD-10 and EMR adoption.

For more information on EMR adoption and the ICD-10 transition, contact Heather Haugen at hhaugen@thebreakawaygroup.com.