Clinical

Iowa- and Illinois-based Genesis Health Systems has joined forces with visibility and analytics provider, STANLEY Healthcare, and nurse call platform provider, Critical Alert, to streamline clinical workflows using STANLEY'S RTLS platform and Critical Alert's Nurse Call tool, the companies announced last week.   Using the native integration from Critical Alert and the staff workflow function of STANLEY's RTLS platform, the staff at Genesis can locate clinicians and respond to bedside patient alerts and requests. Maureen Nylin, nursing clinical informatics specialist at Genesis Health System told Healthcare IT News that Genesis expects the implementation will improve HCAHPS scores and staff and patient satisfaction.   "The implementation was a collaborative approach," Nylin said. "Alarm management is a hot button issue from everyone across the board; it's getting tongue-in-cheek. It's not about managing alarms, but making sure what you're doing is meaningful."   "For our clinicians, when they're getting messages, they know exactly what the patient needs," she added. "Trying to overcome alarm fatigue is about getting the right message to the right person, at the right time."   Implementation began in June of 2015 at Genesis' DeWitt Community Hospital. According to Nylin, one of the greatest improvements is that patient calls are canceled as the nurse walks into a room, which frees up time for the clinician.   Furthermore, the data is being collected for a knowledge base to "see the low-hanging fruit," Nylin said. "We'd like to use the analytics to see where we can improve efficiencies."   The Critical Alert tool captures data from clinical workflow, allowing staff to analyze the data points into the nurse call system, according to Josh Troop, marketing director for Critical Alert.   "We're working with companies like STANLEY, to create something much more valuable than two equal parts," Troop said. "In this case, we were able to leverage the STANLEY investment that Genesis already made to ramp up our tools already. Our systems work together seamlessly in the background."   For STANLEY, it's about making sure "clinicians have more time to spend with the patient to improve the care arena," Nadav Barkaee, product manager for integrations, STANLEY Healthcare said. "One of the major benefits of being able to offer an enterprise-grade RTLS solution is to make sure the investment can be used across multiple solutions for staff efficiencies and workflow."   Genesis plans to implement the systems at four more of its hospitals in the near future.

An experimental program called Independence at Home saved an average of $13,600 per patient during its first year. 

The pressure to shift to value-based care means providers must understand their patients more deeply than in the past. Achieving that as part of a population health management program demands rethinking existing processes.

The number of chief nursing informatics officers has increased in health systems over the past five years, with more designated CNIO-positions than ever before. The bump comes at a time when the need to bridge the gap between clinical and informatics increasing, according to a recent report commissioned by the workforce search firm Witt/Kieffer.   The research team surveyed 100 respondents from medical centers, independent hospitals and hospitals part of a larger health system to examine the evolving role of the CNIO and whether organizations are recruiting for the position to support the informatics landscape. These results were compared to a similar survey conducted in 2011.   Overall, there are 10 percent more CNIOs in place in organizations than compared to 2011, according to Chris Wierz, principal, Witt/Kieffer Information Technology Practice. While some organizations have created the position of CNIO, others have modified roles to incorporate the CNIO title.   "CNIOs now have a 'seat at the table," Wierz told Healthcare IT News. "From a CNIO perspective, it's so much about collaboration and consensus building; getting those groups of people together when it comes to IT. It's always been about trying to bring disparate groups together to understand the workflow around the electronic medical records and today's IT."   "Communication is a very large role, as well," she added, "acting as a translator between IT and my clinical staff. The ability to articulate your knowledge of IT and clinical is critical in this role."   Depending on the organization, the CNIO is responsible for EMR implementation, clinical IT, optimization of nursing strategy as it relates to IT, and creating a picture of day-to-day operation on clinical IT matters, Wierz said.   Despite the need to bridge these departments, Wierz said there are still many barriers to overcome before the role becomes more commonplace. "One of the reasons this role isn’t gaining enough traction is that there's an IT resistance to it."   Some organizations are lacking the funding for establishing the CNIO position, while other hospitals indicated their organization wasn't big enough to require one, according to the survey.   "Some people will say the reason why they're not implementing a CNIO is because then are you going to need even more "chief" roles," she added. "It's going to be interesting to see whether the CNIO turns into a chief clinical role to help with daily operations."   Twitter: @JessieFDavis Email the writer: jessica.davis@himssmedia.com

Decisio Health, a startup that aims to help acute-care provider organizations continually improve their clinical processes, launched the Decisio Health Clinical Intelligence Platform Tuesday and also announced $4.5M in Series A funding.

The center deployed predictive clinical decision support to save diabetic patients’ lives as part of a move to become a data-driven healthcare organization. 

Veterans are still waiting to see a doctor. Two years ago, vets were waiting a long time for care at Veterans Affairs clinics. At one facility in Phoenix, for example, veterans waited on average 115 days for an appointment. Adding insult to injury, some VA schedulers were told to falsify data to make it looks like the waits weren’t that bad. The whole scandal ended up forcing the resignation of the VA secretary at the time, Eric Shinseki. Congress and the VA came up with a fix: Veterans Choice, a $10 billion program. Veterans received a card that was supposed to allow them to see a non-VA doctor if they were either more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them. The problem was, Congress gave them only 90 days to set up the system. Facing that deadline, the VA turned to two private companies to administer the program — helping veterans get an appointment with a doctor and then working with the VA to pay that doctor. It sounds like a simple idea but it’s not working. Wait times have gotten worse. There are 70,000 more vets waiting at least a month for an appointment than there were at this time last year. The VA claims there has been a massive increase in demand for care, but the problem has more to do with the way Veterans Choice was set up. It is confusing and complicated. Vets don’t understand it, doctors don’t understand it and even VA administrators admit they can’t always figure it out. Veterans face delays and worry This is playing out in a big way in Montana. That state has more veterans per capita than any state besides Alaska. This winter Montana Sen. Jon Tester sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He’s a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy. “The VA can’t do it in seven months, eight months? Something’s wrong,” he said. “Three hours on the phone,” trying to make an appointment. “Not waiting,” he said, “talking for three hours trying to get this thing set up for my new hearing aids.” [See also: GAO: Veterans finding VA care hard to access.] Tony Lapinski, a former aircraft mechanic, has also spent his time on the phone, with Health Net, one of the two contractors the VA selected to help Veterans Choice patients. “You guys all know the Health Net piano?” he said. “They haven’t changed the damn elevator music in over a year!” That elicits knowing chuckles from the audience. Later during an interview, he said when he gets through to a person, “They are the nicest boiler room telemarketers you have ever spoken to. But that doesn’t get your medical procedure taken care of.” Lapinski has an undiagnosed spinal growth and he’s worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he said. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ” Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he said. “You get your procedure done, and you find out that two months later the people haven’t been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!” said Lapinski. “No wonder I can’t get anyone to take me seriously on this program.” He said he gets it. He used to do part-time work fixing cars, and he would still take jobs from people who had taken more than 90 days to pay him or bounced a check. But he did so reluctantly. “I had a list of slow-pay customers,” he said. “I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?” Hospitals, clinics and doctors across the country have complained about not getting paid, or only paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana’s largest health care network, Billings Clinic, doesn’t accept any VA Choice patients. Not cool, said Montana Sen. Jon Tester, of Health Net and other contractors. “The payment to the providers is just laziness,” Tester said. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.” The VA now admits the rushed timeframe led to decisions that resulted in a nightmare for some patients. Health Net declined to be interviewed for this story. But in a statement, the company said that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient’s medical records be returned to VA before they pay. Meanwhile, though, veterans continue to wait. “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” said Bobby Wilson. “I see how they treat their veterans when they come home.” Scheduling lags also irk the doctors’ offices and the VA And there’s another whole side to the coin. Doctors are frustrated in dealing with another government health care bureaucracy. In Gastonia, North Carolina, Kelly Coward dials yet another veteran with bad news. “I’m just calling to let you know that I still have not received your authorization for Health Net federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates,” she told a veteran. Coward works at Carolina Orthopaedic & Sports Medicine Center, a practice that sees about 200 veterans. Dealing with Health Net has become a consuming part of her job. “I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” she said. Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches — that’s part of the deal with health care — but she’s never seen something like this. She said it takes, “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don’t have anything on file. But the last time we called about it they had it, but it was in review. You know, that’s the frustration.” It can take three to four months just to line up an office visit. The delays have become a frustration within the VA, too. Tymalyn James is a nurse care manager at the VA clinic in Wilmington, North Carolina. She said Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James said the opposite is happening. “The fact is that people are waiting months and months, and it’s like a, we call it the black hole,” she said. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.” The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care. At least 30 doctors’ offices across North Carolina are dealing with payment problems, some that have lasted more than a year. Carolina Orthopaedic’s CEO Chad Ghorley said his practice is getting paid after it provides the care. It’s the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He’s a veteran himself. “The federal government has put the Band-Aid on it when there’s such a public outcry to how the veterans are taking care of, all right?” he said. “Well, they’ve got the Band-Aid on it to get the national media off their backs. But the wound is still open, the wound is still there.” Those experiences for both veterans and providers are typical. Congress is now working on a solution to the original solution, a bill is expected to clear Congress by the end of the month. This story is part of a partnership that includes Montana Public Radio, WFAE, NPR’s Back at Base project and Kaiser Health News. The article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The Agency for Healthcare Research and Quality will dedicate nearly $2 million for the creation of the PCOR Clinical Decision Support Learning Network, aiming to address the barriers hindering the incorporation of patient-centered outcomes research into CDS tools.

The HIMSS Innovation Center is presenting a display to Florence Nightingale on the anniversary of her birthday, May 12, which is also Nursing Informatics Awareness Day. She was born in 1820. Nightingale is considered to be the founder of modern nursing, and many people in the field of healthcare look to her as having built the foundation for nursing informatics. The display features a letter signed by Florence Nightingale, as well as a book she owned, donated by Maureen Mitchell, RN, associate professor, graduate program director, School of Nursing, Cleveland State University. The items are on loan to HIMSS for two years. Learn more about Nighingale’s life and contributions to nursing: "Florence Nightingale’s focus on hygiene and cleanliness was vital to patient safety," said Joyce Sensmeier, RN, vice president, informatics, HIMSS North America. "Her methods resulted in drastically lowered mortality rates, and improved overall hospital performance. Her ideas and reforms changed healthcare on a global scale. HIMSS strives to emulate Nightingale’s dedication to patient care and the advancement of healthcare." Learn more about the background of the artifacts donated by Mitchell. Listen to Mitchell’s discussion about Florence Nightingale and nursing informatics.

Patricia Flatley Brennan, a professor at the University of Wisconsin at Madison, and a former practicing nurse with a Ph.D. in industrial engineering, will take the lead as director at the National Library of Medicine. The NLM is the world's largest biomedical library and the producer of digital information services used by scientists, health professionals and members of the public worldwide. National Institutes of Health Director Francis S. Collins, MD, announced the pick today. Brennan is expected to begin her new role in August 2016. "Patti brings her incredible experience of having cared for patients as a practicing nurse, improved the lives of homebound patients by developing innovative information systems and services designed to increase their independence, and pursued cutting-edge research in data visualization and virtual reality," Collins said in a statement. For seven years, Brennan worked in both critical care and psychiatric nursing. As Collins sees it, Brennan's combination of skills makes her ideally suited to lead the NLM in the era of precision medicine. She will take charge of the library as it becomes the epicenter for biomedical data science, not just at NIH, but across the biomedical research enterprise, he noted. At the University of Wisconsin-Madison, she is a professor at the School of Nursing and College of Engineering. She also leads the Living Environments Laboratory at the Wisconsin Institutes for Discovery, which is developing new ways for effective visualization of high dimensional data. Brennan is recognized as a pioneer in developing information systems for patients.   She designed ComputerLink, an electronic network to reduce isolation and improve self-care among home care patients. She directed HeartCare, a web-based information and communication service that helps cardiac patients at home to recover faster, and with fewer symptoms. Brennan also directed Project HealthDesign, an initiative designed to stimulate the next generation of personal health records. She also conducts external evaluations of health information technology architectures, and works to repurpose engineering methods for healthcare. She received a master of science in nursing from the University of Pennsylvania and a Ph.D. in industrial engineering from the University of Wisconsin-Madison. Following seven years of clinical practice in critical care nursing and psychiatric nursing, Brennan held several academic positions at Marquette University, Milwaukee; Case Western Reserve University, Cleveland; and the University of Wisconsin-Madison. NLM Acting Director Betsy L. Humphreys led the NLM over the past year, after Donald Lindberg, MD, retired having served more than 30 years. Twitter: @Bernie_HITN Email the writer: bernie.monegain@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn