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January 6, 2012 Readers Write 6 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Building a Successful EMR Dress Rehearsal Program: Why it Matters
By Kathy Krypel

1-6-2012 7-08-37 PM

EMR implementations are not technology-only projects. They are care process redesign efforts enabled by technology. To that end, it is critical to engage care providers early in the planning and design process and throughout implementation and support. Dress rehearsals, in particular, let them to see how their decisions made during the build process “come to life” prior to actual go-live.

Dress rehearsals are detailed scripted care events that interweave complex processes from various members of the care team with the new EMR technology to simulate real care delivery experiences. There are different approaches to dress rehearsals, so picking the right one depends on the scope of the interactions, risk level, and process complexity. The most common ones are:

  • Departmental. Scope is narrow, detail is deep. There are some significant procedures that do not happen frequently, but are so complex that organizations want to develop a dress rehearsal to make sure all roles and possible outcomes are addressed (e.g. transplants).
  • Day in the Life. Scope is wide, detail is shallow. Day-in-the-life rehearsals are typically short (less than one hour) to perform and focus on workflows nurses, physicians, and other clinicians follow during their day.
  • Integrated. Scope is wide, detail is deep. Integrated dress rehearsals are the most common type and usually last two to four hours. They focus on common workflows with multiple integration points.

The keys to successful dress rehearsals are preparation and participation. When the application teams, site leadership, and super users are fully engaged in both planning and execution, there’s greater buy-in up front, and there are fewer calls to the help desk after go-live.

Questions often come up during the planning phases concerning timing, issues communication, and degree of authenticity. While there’s no one right answer, the following responses to FAQs are based on our experience with successful dress rehearsals:

Timing: “Match timing with approach”

Day-in-the-life dress rehearsals can start as soon as some basic nursing and physician workflow(s) are built and ready for all to see. “Lunch and learn” sessions often offer end users a chance to see and interact with the system prior to go-live.

Integrated and department-specific dress rehearsals should be held as close to go-live as realistically possible. They are led by super users and attendees who have already been through training and practice sessions, so they are familiar with the system. This type of dress rehearsal offers end users one more chance to interact with the system before go-live and to follow their workflow through the care process.

Authenticity: “Keep it real”

Whenever possible, use the equipment and follow workflows accurately. However, make sure all of the pieces work in the dress rehearsal environment. The use of interfacing technology, when working smoothly, greatly contributes to end user confidence. When it doesn’t work, it adds to end user anxiety and impacts confidence in the technology.

Issue Resolution and Communication: “Write it down and follow up”

The dress rehearsal scribe needs to record any questions and concerns, and assign due dates for resolution. Consider using the time at the end to address issues. Often, the needed expertise is already attending/ participating, so problems can be readily resolved and changes approved.

Done at key points during the implementation project, dress rehearsals identify issues early on, so adjustments in technology and process can be made in time to retest and refine. This in turn increases the likelihood of a successful EMR implementation. Equally important, dress rehearsals engage care providers prior to system go-live, mitigating pre go-live anxiety and gaining their buy-in – all critical for achieving Meaningful Use.

Kathy Krypel is a senior associate with Aspen Advisors of Denver, CO.

VNAs and Enterprise Archiving – A Stepping Stone To Healthcare Data Management?
By Tim Kaschinske

1-6-2012 7-19-25 PM

At the same time that PACS are proliferating beyond radiology and into other disciplines (such as cardiology and orthopedics, for example), the responsibility for archiving and storing all of this DICOM data is moving away from individual departments (that have traditionally managed these environments) to a hospital’s central IT department. Healthcare CIOs have rolled up their sleeves and embraced the concept of a Vendor Neutral Archive (VNA) or Enterprise Archive as the best approach to managing this data storage challenge.

However, PACS is only one of many systems that a hospital has to manage; and healthcare data encompasses content from all manner of applications, both clinical and administrative. Consequently, a hospital’s storage systems also need to support everything from video to scanned documents to e-mail. Here are just a few of the activities and data types that need to be incorporated:

  • Sleep Studies – where EEG and EKG waveforms are captured for brain and heart activity during sleep. Often this data is stored in a proprietary format.
    Endoscopy – where videos of the esophagus, stomach, or colon are captured.
  • Scanned Documents – where paper documents that are scanned in and stored as PDF files.
  • Laboratory Results – often transmitted using HL7 messages and stored in various formats.

To cope with these many and varied data types, hospitals need a VNA or Enterprise Archive that can deal with more than just DICOM data. In addition, to facilitate data exchange, these archives are adopting the XDS standard for cross-enterprise document sharing.

Over the next 12 months, more CIOs will adopt XDS-enabled archives as a standardized way to store, query and retrieve clinical and administrative content. In facilitating the registration, distribution ,and access across healthcare enterprises of electronic patient records, XDS enables IT to manage and share any document type. It works with DICOM (XDS-I) as well as multiple repositories indexed by a single enterprise registry.

As healthcare storage evolves, the VNA acronym will almost certainly be replaced with something that more accurately describes hospital storage systems. In reality, hospitals are looking for comprehensive healthcare data management. As such, hospitals need to adopt all the best practices typically associated with managing data across the Enterprise, such as:

  • Data Protection – providing the ability to store additional copies of data to multiple locations and restore that data in the event of a disaster.
  • Multi-media Support  – offering the ability to store and migrate data across different storage devices and media types, all independent of user applications.
  • Data Versioning – enabling version control and management of data that can be restored in case of errors or corruption.
  • Data Authentication – ensuring that data copied between sites or media types remains consistent and is not corrupted during the copy.
  • Business Continuity – for the protection, preservation, and speedy restoration of systems and data during an outage.
  • Data De-Duplication – providing the ability to detect multiple copies of identical data and store only one copy with multiple references.

Throughout 2012, hospital IT will be challenged to transform their PACS-centric storage into holistic healthcare data management systems. In the process, they will need to adopt a vendor neutral approach to their hardware and a data-agnostic approach to content. Just what we’ll end up calling it remains to be seen.

Tim Kaschinske is a consultant, healthcare solutions with BridgeHead Software.

2012 New Year’s Resolutions
By Vince Ciotti

Listed in order by their annual revenue, here are Vince Ciotti’s 2012 New Year’s resolutions for each of the leading HIS vendors:

  1. McKesson:  Series will be sunset and Horizon announced as the go-forward product. Whoops, I’m sorry, that I meant to say Star is being sunset and Paragon is… oh, never mind!
  2. Cerner: “ProFit” to be re-named “LossLeader” and targeted to hospitals whose CFOs and CIOs have a combined IQ of under 25 beds.
  3. Siemens: will begin work on a new ERP suite for Invision which will allow them to automatically deduct monthly invoices from the AP system. The new system will be called Invasion.
  4. GE: any hospitals that buy Centricity in 2012 will receive a free GE refrigerator for the first 30 patients registered in Centricity.
  5. Epic: will sell to 100-bed and under hospitals provided they agree to send all inpatients to Verona for a two-week vacation to learn their EHRs. Epic will send one of its rookies to outpatient’s homes for training, but this will not earn them “good” maintenance rates on their EHRs.
  6. Allscripts: will announce the complete integration of all of Eclipsys and Allscripts’ sales brochures, advertisements, PowerPoints, proposals and contracts. Work on disparate data bases and reports to commence in 2013.
  7. Meditech: now that the Release 6 implementation line has reached 36 months from date of contract signing, orders are being taken for Release 7.
  8. NextGen: announces an integrated solution combining their Opus, Sphere, and Prognosis HIS systems, to be called “Opusphernosis.”
  9. QuadraMed: is renaming the integrated version of Affinity and QCPR as “Infinity,” the time it is estimated it will take to complete the project.
  10. Keane: NTT wants its money back from Caritor, claiming that Optimum was not fully developed despite the many demos they observed, extensive marketing literature provided, written RFP response attached to the contract, and personal assurances they received from executives.
  11. CPSI : is targeting the 500+ bed and up hospital market with a powerful new system that will run on two servers!
  12. HMS: their new MedHost ED system is now being offered to hospitals without an ED at a special reduced price during the first quarter 2012.
  13. Healthland: is planning a name change to Dairyland to emphasize their Midwest roots, strong service ethic, and diverse industry experience.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

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Currently there are "6 comments" on this Article:

  1. Ha – good stuff Vince! My laptop is relieved I wasn’t sipping coffee when I read the Epic resolution. There may even be a little truth in there for at least one of the big, lower-cost, market share leading Massachusetts-based vendors – not mentioning names though.

  2. Vince

    I sent you an email and have forwarded the link to several friends in the industry. I do not normally have that much laughter at 5am in the morning.

    Thanks for the post,


  3. For years, many other industries have been calling the “VNA” product (about which Mr. Kaschinske of Bridgehead Software discusses) an Enterprise Content Management System (ECMS). An ECMS manages all the “content” (i.e., the “unstructured” data as well as the structured data) across the enterprise and includes all the best practices listed above – from the hardware agnostic archive to the data version control. Finally the healthcare industry recognizes the need for ECMSs or VNAs (or whatever term is used), interestingly spearheaded by the proliferation of DICOM and non-DICOM data as essential components of the electronic patient record.

  4. Wonderful predictions Vince,
    Here’s a few of mine..

    – HIS Talk will air only nice vendor stories during 2012 in order to catch up with all the other ‘pseudo’ vendor blogs and magazines
    – Health Systems CIO will only post consultant position papers now that all their blogging CIOs are consultants or pseudo vendors since all their employer hospitals sell an Epic SaaS to smaller facilities
    -CMS’ HIT Buzz Blog will cease publication by the end of 2012 since all providers will have either attested to MU – or gone bankrupt installing EMRs.
    – HIMSS will announce the HIMSS 2020 meeting will be on Mars since there are no cities left on earth big enough to handle all the city sized booths their sponsors want.
    – CMS will announce that support for EHR/EMR MU programs will stop at 2013 since chips will be imbedded in each person in 2012 (as they are born or make their next physician visit) that can diagnose and prescribe whatever is needed two weeks before you get sick.
    – AMA will close it’s doors now that all independent practioners are employed by ACOs
    – All the health insurance firms will run hospitals and stop payment to themselves since they can’t agree on a true objective QA measures criteria

    – and the after the massive federal budget cuts hit providers the few MDs left practicing medicine will do only house calls but only accept pigs and chickens as barter payment!

    Happy New Year…

  5. Another aspect of Enterprise Archive/VNA/ECMS that can’t be overlooked, is Data Lifecycle Management. Keeping everything forever is not a viable strategy, Risk Management wants to get rid of it as soon as it is legal to do so, end users want to keep it virtually forever. Each facility will need to determine their own middle ground so that data can be managed and protected as long as needed, then removed when appropriate. Each data source has it’s own lifecycle requirements for access and longevity, so the ability to create extremely granular rules needs to be considered.

  6. Excellent VNA discussion, couldn’t agree more that these systems are much more about content management, I like to refer to this as “Clinical” content management, with focus on workflow and integration at the point of care.
    I also want to be sure we keep focused on the business model associated with VNAs or Clinical Content Management systems. Namely how can a VNA or independant clinical content management system be provided by a PACS vendor?

    In my view a VNA greatly simplifies the process of storing and managing all patient medical content and images, regardless of its origin, format or vendor orientation, making it readily available across the healthcare delivery spectrum. VNAs provide an essential foundation for efficiently delivering a comprehensive, image-enabled view of the patient. In my opinion PACS vendors see their control over the healthcare customer’s data slipping away and are creating confusion in the marketplace by incorrectly labeling their solutions as “vendor neutral.”

    The hype and confusion created by mislabeling PACS solutions as VNAs is likely to continue. The bottom line, however, is that PACS vendors, by and large, do a good job with medical image acquisition, display, departmental communication and workflow – where they are focused and should remain focused. The data management and enterprise interoperability aspects of PACS, however, is problematic for healthcare providers and government institutions that need to assemble a complete picture of the patient from many disparate and proprietary silos of patient data. The vendor neutral archive is an innovation whose time has come as our industry moves to the next level of technology-enhanced healthcare delivery and outcomes.

    I recently attended a panel where VNA vendors and PACS vendors (SIIM 2012) where talking about how each work together and differentiating the platforms. I was intrigued that one of the PACS vendors actually noted he felt the “A” in PACS should stand for “Access” leaving archiving to an independent VNA ISV, where they focus on data integration and mobility vs. access and display. What was most intriguing to me is that he represented a vendor that also markets their back end as a VNA, even though they primarily focus on PACS.

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