Monthly Archives: February 2018

IAQ in Healthcare Environments

As the economy heads further down the slippery slope of what promises to be a deep recession, and our healthcare infrastructure continues to grow and age, it is a natural progression to see more and more IAQ professionals turn to what some believe is a recession resistant market. From ambulatory facilities to long term care, the buildings that make up our healthcare infrastructure are constantly in need of renovations and repair. This new and promising opportunity for IAQ pros offers many long term rewards but is not without new and complex challenges that must be addressed.

Every IEP realizes the importance of appropriate use of antimicrobials, containment barriers and personal protection. Though often times IEPs find the regulations and guidelines they encounter in healthcare facilities to be daunting to say the least. In traditional remediation environments the focus is to ultimately provide an environment free of dangerous pathogens or contaminants. While attention is give to the methodology, often times the end results dwarf the means of acquiring those results. With a host of accepted methods to address indoor air quality in businesses, homes and public spaces the contractor finds themselves able to select from a variety of methods to deal with each issue. In the end it is the air clearance that counts, not so much which method was used to obtain it.

While the end results are just as, if not more important in healthcare environments; far more attention must be paid to the processes used. As many occupants of a healthcare facility cannot be moved and are highly susceptible to infection, there are very specific guidelines in place that govern all maintenance, repair and renovation work in a healthcare facility. Organizations like CDC, APIC and JCAHO have placed standards that apply to all activities that may have an impact on a healthcare environment. This is done with good reason considering the number HAIs (Hospital Acquired Infections) reported annually due to airborne pathogens like Aspergillus, which is disturbed during common daily maintenance. Nosocomial infections caused from routine maintenance reach into the hundreds of thousands each year. These guidelines and regulations are enforced in a facility by ICPs or infection control professionals.

Hospitals continually adapt to new, more stringent CMS guidelines limiting what medical treatments are reimbursable through Medicare or Medicaid, this has caused hospital administration to look more closely at every aspect of infection control in their facility. Beginning in October of 2008, Medicare and Medicaid began limiting payments made to facilities for the treatment of preventable nosocomial infections or conditions. These new CMS guidelines are driven by Section 5001(c) of the Deficit Reduction Act, which could mean that as deficits climb the list of non-reimbursable conditions are likely to grow. Infections like Aspergillosis, which is caused by airborne A.Fumigatus, are common in healthcare facilities. Aspergillus is one airborne pathogen that is commonly disturbed and distributed throughout a facility after maintenance work or renovations. The argument could be made that Aspergillosis is a preventable condition by ensuring appropriate containment and disinfection of disturbed areas.

Infection control professionals in healthcare environments have become increasingly diligent in monitoring the actions of contractors that work in their facilities. It is ICP’s responsibility to ensure all components of the infection control risk assessment are adhered to. While these key people can complicate the lives of the contractors working in healthcare facilities they are also actively saving lives by doing so. ICP’s will monitor and log details about each project to ensure that all compliance issues are being addressed. Two primary issues that impact infection control and prevention in healthcare settings are disinfection of contaminated surfaces with broad spectrum EPA registered disinfectants and appropriate containment of airborne particulate and pathogens.

Choosing the best disinfectant is one way to ensure the best possible level of microbial control during any abatement project in a facility. Healthcare facilities present the IEP with a unique set of challenges in regards to pathogens beyond the standard fungal and bacterial flora. Many of these pathogens can be highly infectious as well as drug resistant making them far more dangerous to the many immunocompromised patients housed in a healthcare facility. When selecting a hospital grade disinfecting it is imperative to keep several things in mind.

Does your disinfectant have sufficient kill claims to address the microbes you might encounter?
While no disinfectant can list every possible organism, it is important to find a disinfectant with the most possible EPA registered kill claims. Look for efficacy data. Disinfectants that do not show efficacy & testing data often have few or irrelevant kill claims and are not sufficient for the challenges found in healthcare facilities. It is also a positive if your disinfectant has EPA approved efficacy in the presence of 98% soil load as opposed to 5% which is required by the EPA. This higher soil load represents real world conditions. Beyond fungicidal kill claims, other claims that you might require involve infectious pathogens like MRSA, E-coli, HIV, Salmonella and Avian Influenza. You may also want to look for a product that can be used on both porous and non-porous surfaces and has disinfectant and sanitizing claims.

Understand what the active ingredients are in your disinfectant
It is essential to know what type of disinfectant is appropriate. Most common disinfectants are formulated using Alcohol, Phenol, Chlorine or a Quaternary Amine Base. There are arguments for each type of disinfectant and it is important to know the facts about the products you are working with. Each has advantages, but some have dramatic disadvantages that might make you think twice about using them.

Quaternary Ammonium Chloride (Quats) –
Examples Shockwave Disinfectant/Sanitizer, IAQ 2000/2500
Quats are often considered easier to use and safer than other disinfectant bases because they are less corrosive, non-carcinogenic and maintain efficacy for extended periods of time. Not all quat based disinfectants are equal though. There are a variety of products with EPA registered kill claims ranging from just a few all the way to over 130. In a healthcare environment it is important to seek out the latter, as the spectrum of microbes likely encountered in a hospital will be much broader than in common remediation situations. Unlike many other disinfectants quats based disinfectants are excellent cleaners making them ideal for surfaces with a large amount of biomaterial like fungi, blood or human waste. As many MDROs like C-DIFF, MRSA and VRE are transmitted by contaminated bodily fluids and waste this is an important factor in the equation to finding the ideal disinfectant for healthcare environments. Quats are highly stable and maintain efficacy even in the presences of high soil load. This makes them ideal for mold remediation as well as blood or bodily fluid spills.

Many IEPs as well as ICPs prefer the use of a quats because they not only offer a broad spectrum of kill claims, but are easy to work with and more cost effective than other options. In addition most quats do not have the drawbacks associated with chlorine, alcohol or phenol based products on the market.

Alcohol
While not as user friendly as quats, alcohol based disinfectants are considered by many to be easier to use than chlorine or phenol based products. High concentration alcohol based disinfectants can however be dangerous in a healthcare environment because of its tendency to open pores and dry skin. This can create openings for microbes to enter the body if not properly protected.

Though high concentration alcohol based disinfectants are generally highly effective against lipophilic viruses they are less active against non-lipid viruses and ineffective against bacterial spores. Generally alcohol disinfectants are not used for equipment immersion due to diminishing efficacy as the alcohol volatilizes. Alcohol disinfectants cannot be used as cleaners thus making them less effective for practical use on many surfaces. Even though some Alcohol based disinfectants can offer a broad spectrum of kill claims, it can be difficult to maintain appropriate wet contact time due to the rapid evaporation rate.

Chlorine
These corrosive oxidizers are known for cidal action against a wide variety of gram-negative and gram-positive bacteria as well as many viruses. Difficult to work with, these disinfectants are rapidly neutralized in the presence of organic matter making them less than ideal for healthcare and remediation environments.

While chlorine disinfectants are currently used in many facilities, future use of halogens is expected to decline as options like quats and alcohols become more abundant with appropriate kill claims. Sodium hypochlorite is known for causing significant corrosion to metals and other common materials. Chlorine disinfectants are considered toxic, and in 1994 the Clinton Administration called for the ban of all chlorine and chlorine based products.

Phenol
Phenol is one of the oldest known disinfectants still in use today and is both commercially manufactured and naturally occurring. Phenols are often effective for use on vegetative bacterial, lipid containing viruses and Mycobacterium tuberculosis but have limited or no efficacy for use against spores or non-lipid viruses. While these disinfectants are effective over a relatively large PH range, their limited solubility makes product residue difficult to clean. These disinfectants cannot be used on food contact surfaces and often require additional PPE like goggles, face shields gloves and protective clothing for application. Phenols cannot be used in many parts of a healthcare facility like neonatal, pediatric ICU or any infant contact surface due to toxic residue. Reports of eye irritation, contact dermatitis/utricaria, and depigmentation of the skin have been tied to phenol and phenol residue contact.

Phenols are commonly found in a host of consumer products and are not dangerous in very low concentrations. Disinfectant strength phenols however are considered a health risk by EPA and NIOSH. OSHA recommendations state that employee exposure to phenol in the work place should be controlled to less than 20 mg/cu m in air determined as a time-weighted average (TWA) concentration for up to a 10 hour work day or 40 hour work week. The NIOSH guidelines also limit exposure to phenols to 60 mg phenol/cu m of air as a ceiling concentration for any 15 minute period. Phenols generally enter the blood stream via ingestion, respiration or skin contact. NIOSH recommendations are just one indicator of the need for PPE when using Phenolic disinfectants. Disinfectants with a concentration of 1% phenol or greater are considered an extreme skin and inhalation hazard and are moderately combustible.

Containment plays a key roll in infection prevention.
While disinfection of surfaces, equipment and touch points plays one of the most critical roles for infection control in a health care facility; another primary responsibility of the IEP working in a healthcare facility is containment. The containment of harmful pathogens and particulate during work in a healthcare facility is essential, especially when working in areas near immunocompromised patients.

Regulations set by CDC & Joint Commission are clear in dictating specific criteria for the elimination of airborne Aspergillus, asbestos and dust. A term that IEPs will hear all to frequently as they make their transition into a healthcare environment is ICRA or infection control risk assessment. These operating guidelines are critical to any maintenance work done in a healthcare facility. APIC has developed guidelines assisting healthcare facilities in developing their ICRA to specifically mandate that dust and airborne particulate must be contained under negative pressure in Kontrol Kube like containment or by using other solid barrier methods.
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For many years hospitals were forced to either temporarily close an entire wing or build temporary solid barriers during mold remediation or asbestos abatement jobs to prevent airborne particulate from escaping the work area. In recent years a new method of mobile containment has been made available making daily remediation, repair and renovation faster and far more cost effective. Kontrol Kube type containment essentially revolutionized the way hospital maintenance was being done by allowing an IEP to quickly roll tools, ladders, chemicals and other equipment into a location and then isolate that area for the duration of the work.

Infection control professionals prefer contractors to use methods like portable containment when possible for several reasons. Mobile containment units are easy to set up and inspect, this not only makes use of the unit easier for the IEP but also makes the inspection process much faster and efficient for the ICP. Knowing that all materials are fire rated and meet NFPA 701 is also important with any sort of temporary barrier material you use. Fire codes and standards are extremely critical in healthcare situations and are a focal point during Joint Commission inspections.

When selecting a mobile containment unit be sure to consider if the unit is made of durable components that will hold up under rigorous daily use. It is also important to know that the unit is easily cleaned and is capable of providing all the functionality needed. Will the unit accommodate an eight foot ladder effectively? Does the unit have a solid yet mobile working platform? Is it highly adjustable, durable and lightweight?

Disinfectants and Kontrol Kube type containment are used in almost every type of daily work an IEP might encounter in a healthcare facility; both are key components to any comprehensive infection control plan. For the individual contractor working in a healthcare facility, understanding what is expected of you could make all the difference between winning a bid and being passed over. The knowledge and expertise shown while in the facility can also ensure future jobs in that facility.

As IEPs progress into the healthcare arena to reap the benefits of this relatively protected market they are not only assuming the role of IAQ professional; they are also assuming the role of infection control professional helping to maintain safe, clean and infection free environments. While the challenges they face are unique and in some cases daunting, the benefits exceed a simple increase in business. When we stop to consider the impact of the work they do in the facilities that care for our sick, our elderly and our very young we can see how each of us does our part to win the battle against infection and disease. With proper education and training, IEPs can make the leap from the private or public sector into the highly lucrative and relatively stable market of healthcare remediation, abatement and repair with ease. Knowing the facts about not only the rules and regulations in healthcare facilities, but also the tools available can help ensure a successful transition into IAQ in healthcare environments.

Healthcare Administration Degree

A career in healthcare has long been associated with doctors and nurses in their crisp white uniforms delivering care to patients. But there is an entire workforce that functions tirelessly, away from the glaring lights, to support these primary care givers and ensure the smooth delivery of healthcare.

Among these men and women are the healthcare administrators or managers on whose shoulders rests the responsibility of managing and running a healthcare organization.

The Department of Labor describes the day to day function of a healthcare administrator as planning, directing, coordinating, and supervising the delivery of healthcare. In other words, they are the ones who take care of the administrative and business aspects of running an organization, so the healthcare providers can do just that – provide care to the patients.

Why Healthcare?

If you are the crossroads of choosing a career, then this is as exciting a time as any to get a healthcare administration degree and enter this profession. Pages after pages have already been written about how an aging population has led to a sharp increase in the demand for healthcare professionals.

According to the Department of Labor, 10 of the 20 fastest growing occupations are related to healthcare. Now, that is a staggering figure by any measure of standards.* Healthcare administration itself is projected to grow at a faster than average pace and the employment of healthcare administrators and managers is expected to grow 16 percent by 2018.**

But excellent job opportunities and attractive compensation are not the only reasons to pursue a healthcare administration degree. The industry is also going through an exciting phase as innovate technology gets integrated with the healthcare delivery system and regulatory environment becomes more complex. The job of a healthcare administrator has become more challenging in the recent years.

Education & Training

If you thought that you need to put in six to seven years of college education to become a healthcare administrator, think again. The good news is that interested candidates can enter the profession with a bachelor’s degree in healthcare administration.

Since healthcare managers need to be familiar with management principles and practices, a bachelor in healthcare degree is designed to teach students the clinical and business aspects of managing a healthcare facility by training them in management principles, strategic planning, resource management, leadership skills, and other office procedures and medical terminology.

Graduates with a bachelor’s healthcare administration degree begin their careers as administrative assistants or assistant department heads in larger hospitals. Small hospitals or nursing facilities may hire them as department heads.

Employment Opportunities

With so many healthcare facilities springing up to provide care to an aging population, healthcare administrators may find employment in a wide range of settings. These include hospitals, clinics, office of physicians, nursing care facilities, residential care facilities, home healthcare facilities, federal healthcare facilities, community care facilities, rehabilitation centers, etc.

The Department of Labor has classified healthcare administrators as either specialists or generalists. Specialists are in charge of a specific clinical department and are called clinical managers. They are trained or experienced in the specific clinical area that they manage.

Generalists, on the other hand, manage an entire facility or a system within a facility. In large facilities, they work as assistant administrators aiding the top administrator in the running of various healthcare departments.

In smaller facilities like nursing homes or doctors’ offices, healthcare administrators are usually responsible for carrying out the day to day operations like managing personnel, handling finances, recruitment, etc.

As far as remuneration is concerned, it depends on a variety of factors such as level of responsibility and the type and size of healthcare facility. According to the Labor Department, the average annual income of a healthcare manager was $80,240 in May 2008.**

So, if you think your shoulders are strong enough to take on the responsibility of running a healthcare organization, then a career full of opportunities and personal gratification is waiting for you!

Healthcare Schools Online

As demand for healthcare services continues to increase, it takes a specially trained person to run the oft-overlooked position that some people don’t think much about – that of a healthcare manager. That’s where healthcare schools online come in: they offer courses that train a person to be management material when the time comes for a promotion or a new job. Healthcare managers are the brains behind the operation and they ensure that things run smoothly. Healthcare schools online are a great resource for a person that needs the training, but may not have the convenient hours that other less demanding jobs can afford.

Those in healthcare management keep the day-to-day operations of any type of patient facility running efficiently. They make decisions on patient healthcare and treatment. They also work in conjunction with nurses and other administrative workers to ensure that the quality of healthcare is up to regulations and medical records and reports are accurately kept or given. These men and women must always be ready for new healthcare implementations – anything from new technology to new methods of patient care. They are typically very busy and may be called upon at all hours for advice and/or assistance in a problem. They also travel to attend healthcare conferences, or to meet with the government or private affiliates and owners of a company.

Healthcare managers work in all sorts of environments. Anywhere there is a facility that treats patients, no matter old or young, in-patient or out-patient, there is a manager that makes sure everything is carried out in a respected and efficient manner. Managers can work in hospitals, for example, but there is probably one that works in every ward who also answers to the manager in charge of the entire hospital. In a nursing home, there is one main manager, and a few managerial assistant managers to help keep the workload manageable. This type of management system is seen in all aspects of healthcare.

On a day-to-day basis, the variety of people whom a healthcare manager works with is vast. They work with nurses and nurse’s aides, medical recorders and information analysts. Every day brings a whole pack of problems to solve, but also an equal amount of reward. A great hospital with satisfied patients and workers is a sign of a great healthcare manager, who at the end of the day, is a people-person that aims to make everyone happy while keeping care effective and up to standards. Healthcare managers also have to answer to their own bosses. They must attend conferences that inform and advise them on new and effective ways of managing and on the developments that constantly happen in the healthcare industry.

Getting into this oft forgotten administrative job usually requires a master’s degree at minimum. It can be in healthcare administration, but there is also a combination of other degrees that could put the candidate in the right spot for a promotion. This could be an MBA with combined experience in the nursing field, for example. Another good example is experience and an advanced degree in a specialized field, combined with a graduate certificate in healthcare administration.

This combination of degrees and experiences places a candidate in a good position. Another common route is earning the Masters in Healthcare Administration (MHA) through an accredited college. Nowadays, more people than ever are turning to the benefits of healthcare schools online to gain this degree. With the work load and schedule of a normal healthcare employee often times unusual and demanding, many, if not all, healthcare employees would not be able to attend a traditional ground school without having to cut hours (something they may not want to do for financial reasons). Healthcare schools online offer healthcare management degrees at the graduate level for these ambitious, but time-pressed, individuals.

The New Approach to Healthcare

Introduction –

The lack of a healthcare specific, compliant, cost-effective approach to Enterprise Information Management (aka EIM) is the #1 reason integration, data quality, reporting and performance management initiatives fail in healthcare organizations. How can you build a house without plumbing? Conversely, the organizations that successfully deploy the same initiatives point to full Healthcare centric EIM as the Top reason they were successful (February, 2009 – AHA). The cost of EIM can be staggering – preventing many healthcare organizations from leveraging enterprise information when strategically planning for the entire system. If this is prohibitive for large and medium organizations, how are smaller organizations going to be able to leverage technology that can access vital information inside of their own company if cost prevents consideration?

The Basics –

What is Enterprise Information Management?

Enterprise Information Management means the organization has access to 100% of its data, the data can be exchanged between groups/applications/databases, information is verified and cleansed, and a master data management method is applied. Outliers to EIM are data warehouses, such as an EHR data warehouse, Business Intelligence and Performance Management. Here is a roadmap, in layman terminology, that healthcare organizations follow to determine their EIM requirements.

Fact #1: Every healthcare entity, agency, campus or non-profit knows what software it utilizes for its business operations. The applications may be in silos, not accessible by other groups or departments, sometimes within the team that is responsible for it. If information were needed from groups across the enterprise, it has to be requested, in business terminology, of the host group, who would then go to the source of information (the aforementioned software and/or database), retrieve what is needed and submit it to the requestor – hopefully, in a format the requestor can work with (i.e., excel for further analysis as opposed to a document or PDF).

Fact #2: Because business terminology can be different WITHIN an organization, there will be further “translating” required when incorporating information that is gathered from the different software packages. This can be a nightmare. The gathering of information, converting it into a different format, translating it into common business terminology and then preparing it for consumption is a lengthy, expensive process – which takes us to Fact #3.

Fact #3: Consumers of the gathered information (management, analysts, etc) have to change the type of information required – one-off report requests that are continuously revised so they can change their dimensional view (like rotating the rows of a Rubik’s cube to only get one color grouped, then deciding instead of lining up red, they would really like green to be grouped first). In many cases, this will start the gathering process all over again because the original set of information is missing needed data. It also requires the attention of those that understand this information – typically a highly valued Subject Matter Expert from each silo – time-consuming and costly distractions that impact the requestor as well as the information owner’s group.

Fact#4: While large organizations can cope with this costly method in order to gather enough information to make effective and strategic business decisions, the amount of time and money is a barrier for smaller or cash strapped institutions, freezing needed data in its silo.

Fact #5: If information were accessible (with security and access controls, preventing unauthorized and inappropriate access), time frames for analysis improve, results are timely, strategic planning is effective and costs in time and money are significantly reduced.

Integration (with cleansing the data, aka Data Quality) should not be a foreign concept to the mid and smaller organizations. Price has been the overriding factor that prevents these tiers from leveraging enterprise information. A “glass ceiling”, solely based on being limited from technology because of price tag, bars the consideration of EIM. This is the fault of technology vendors. Business Intelligence, Performance Management and Data Integration providers have unknowingly created class warfare between the Large and SMB healthcare organizations. Data Integration is the biggest culprit in this situation. The cost of integration in the typical BI deployment is usually four times the cost of the BI portion. It is easy for the BI providers to tantalize their prospects with functionality and reasonable cost. But, when integration comes into play, reluctance on price introduces itself into the scenario. No action has become the norm at this point.

What are the Financial Implications for a Healthcare Organization by maintaining the status quo?

Fraud detection is the focal point for CMS in their EHR requirements of healthcare organizations, Let’s take a deeper, more meaningful look at the impact of EHR. Integration, a prominent component of Enterprise Information Management in the New Approach, brings data from all silos of the organization, allowing a Data Quality component to verify and cleanse it. The next step would be to either send it back to its originating source in an accurate state and/or put it into a repository where it will be accessible to auditing (think CMS Sanctions Auditors), Business Intelligence solutions, and Electronic Health Records applications. With instantly accessible EHRs, hospitals and their outlying practices can verify patients with payors, retrieve medical histories for diagnosis and treatment decisions, and update/add patient related information. What impact to treatment does a review of a new patient’s history have for both patient and practice? Here are some elements to consider:

1. Diagnosis and treatments that are based on previous patient dispositions – reducing recovery time, eliminating Medicare/Medicaid/Payor denials (based on their interpretation as to fault of the practitioner in original treatment or error incurring additional treatment).

2. Instant fraud detection of patients seeking treatment for the same malady across the practices within the organization. Prescription abuse and Medicare fraud saves money not only for the payors, but the healthcare organization as well.

3. The Association of Fraud Examiners states that 9% of a Hospital’s revenue each year is actually lost to fraud.

One overlooked but common impact is in the cost of managing patient records. Thousands of file folders in storage with new instances being added each time a new patient enters into the system. Millions of pieces of paper capturing patient information, payer data, charts, billing statements, and various items such as photo copies of patient IDs, are all stored in those folders. The folders are then stored in vast filing cabinets – constantly being accessed by filing clerks, nurses, practitioners and assorted staff. Contents of the files being misplaced or filed incorrectly. Hundreds, if not thousands, of square feet being consumed for storage. The AHA projects that an enterprise leveraging Electronic Health Records will recover no less than 15,000 square feet of usable space. That space can be used for additional services, opening up new channels of revenue. The justification is easy: how much would it cost the hospital to build out 15,000 square feet for a new service? The average cost to build space utilized for Health Services is $65 per square foot, or $975,000 total. An EIM solution through the New Approach would be less than 20% of that. Not only has the EIM solution reduced dollars lost to fraud, lowered the days for payor encounters to be paid, increased cash on hand, but it will also open up new services for the patient community and revenue back to the healthcare organization.

Electronic data is costly in its own way. Bad aka “Dirty” data has enormous impact. Data can be corrupted by error in data entry, systems maintenance, database platform changes or upgrades, feeds or exchanges of data in an incompatible format, changes in front end applications and fraud, such as identity theft. The impact of bad data has a cause and effect relationship that is pervasive in the financial landscape:

1. Bad data can result in payor denials. Mismatched member identification, missing DRG codes, empty fields where data is expected are examples of immediate denials of claims. The delay lowers the amount of Cash on Hand as well as extends the cycle of submitted claim to remittance by at least 30 days.

2. Bad data masks fraud. A reversal of digits in a social security number, a claim filed as one person for the treatment of another family member, medical histories that do not reflect all diagnosis and treatments because the patient could not be identified. Fraud has the greatest impact on cost of delivering healthcare in the United States. Ultimately, the health system has to absorb this cost – reducing profitability and limiting growth.

3. Bad data results in non-compliance. CMS has already begun the architecture and deployment of Sanctions Data Exchanges. These exchanges are a network of data repositories that are used to connect to health healthcare system, retrieve CMS related data, and store it for auditing. The retrieval will only be limited to the patient encounters that show a potential for denial or fraud, so the repository will not be a store of all Medicare and Medicaid patient encounters. But, the exchange has to be able to read the data in its provider data source in order for CMS to apply certain conditions against the information it is reading. What happens when the information is incomplete or wrong? The healthcare system is held accountable for the encounters it cannot read. That means automatic and unrecoverable denials of claims PRIOR to an audit, regardless of claim legitimacy.

The Price Fix by Big Box Healthcare Technology Firms

Are the major healthcare software and technology vendors (Big Box) price gouging? Probably not. They are a victim of their own solution strategies. Through acquired and some organic growth (McKesson, Eclipsys, Cerner, etc), they find their EIM solutions lose their agnostic approach. This is bad…very bad for health systems of all sizes. With very few exceptions, the vast majority of healthcare organizations DO NOT BUY all applications and modules from a single stack player. How could they? Healthcare systems grow similarly – some organic, some through acquisition. When a hospital organization finds over the course of time, an application that is reliable, such as a billing system, there is tremendous reluctance to remove a proven solution that everyone knows how to use. Because the major technology providers in the healthcare space act as a “One Stop Shop”, they spend most of their time working on integrating in their own product suite with little to no regard to other applications. Subsequently, they find themselves trapped: they have to position all products/modules to maintain the accessibility and integrity of their data. This is problematic for the hospital that is trying to solve one problem but then must purchase additional solutions to apply to areas that are not broken, just to be able to integrate information. That is like going to the hardware store for a screwdriver and coming back with a 112 piece tool set with a rolling, 4 foot cart built for NASCAR. You will probably never use 90+% of those tools and will no longer be able to park in your own garage because the new tool box takes up too much space!

IT resources – including people – must be utilized. In today’s economy, leveraging internal IT staff to administer a solution post-deployment is a given. If those IT resources do not feel comfortable in supporting the integration plan, then status quo will be justified. This is the “anti” approach to providing solutions in the healthcare industry: the sales leaders from Big Box technology firms want their sales people in front of the business side of the organization and to stop selling to IT. While this is a common sense approach, the economy in 2010 mandates that IT has to at least validate their ability to administer new technology solutions. The prospect of long-term professional consulting engagements to follow post installation has been shrinking at the same rate as healthcare organizations profit margins.

Empowering the healthcare organization to utilize its existing IT staff to administer and develop with the new products is not part of the business plan when Big Box players market to the industry. It is the exact opposite – recurring revenue from lengthy, and sometimes permanent, professional services consulting engagements is part of the overall target. The initial price quote for a Big Box solution is scary enough, but the fact remains that it is still not representative of what the ongoing cost to maintain through consulting arrangements. This is a variable cost, which is difficult to predict, and drives finance managers and executives crazy.

Solving the Dilemma – A Better Solution through a New Approach at a Fraction of the Cost

When Healthcare Business Experts combine talents with Technology Architects, EIM Solutions cost drop dramatically. This is the New Approach to Healthcare EIM, providing the way health organizations will be able to provide successful solutions at significantly reduced costs – opening the door for health systems of all sizes.

The EIM Firm (using the New Approach) versus Big Box Healthcare Technology Providers:

Smaller, more agile firms bring many benefits to Healthcare Organizations of any size. The benefits:

1. They are focused on specific verticals – just like the Big Box Health Technology providers. Subject Matter Experts (SME) in the smaller firms typically are industry veterans with years of experience and success in their approach who see their resume as a service offering better utilized when they are able to apply their methods for successful strategy planning as opposed to learning the methods of a Big Box player. Their income is better since their revenue is applied into a smaller operating cost, extending lower pricing for solutions that are MORE EFFECTIVE and offering stronger client/vendor relationships as the SME limits themselves to a certain number of clients.

2. Solutions built on proven approaches and strategies. Again, the firm’s SMEs are able to define a methodology that can be re-used or re-configured in each client instance. This saves time and money for the client as delivery is accelerated and the cost of architecting is eliminated.

3. The firms themselves develop solutions and methodologies agnostically. Their understanding of the diversity of systems that exist in the technology of a healthcare organization allows them to not only develop adaptable solutions but also add a Business Process Management Plan (BPM). The BPM will define for the organization EXACTLY how information is received, processed, cleansed, stored, shared and accessed. It also will define an action plan for training IT for administration and support as well as end users at all levels on how they will leverage it going forward. BPM planning in a healthcare organization is a low six figure investment with an outside consulting group. The EIM firms will include it in the cost of the solution. Basically, it is the difference in being told what is wrong and here are the recommendations to fix it versus here is what is wrong and this is how it will be fixed with the new solution.

What is a typical EIM Firm solution?

1. Solution Assessment, noting the current systems, data sources and methods of sharing information as well as business processes, key personnel identification that are gate keepers if information, timeliness of providing information and overall effectiveness in leveraging enterprise information for strategic business planning. See figures 1 for an example of the information process flow visual component of an actual assessment.

2. EIM solution that contains an integration engine that accesses all data sources – reading and writing back to the database or application, providing data quality services and maintaining HIPAA as well as HL7 requirements. See Figure 2 for a diagram.

3. EHR Data Warehouse. A repository to build Electronic Health Records through the integrated data flow.

4. EHR Portal for patient entry (when additional information needs to be added) via a browser.

5. Business Intelligence Dashboards for metrics, AD Hoc analysis and Performance Management Scorecards on organizational goals and objectives.

6. Onsite implementation and integration of the EIM solution.

7. Onsite training during installation for IT and end users. Ongoing training provided via webinars, documentation and technical support staff.

8. Relationships maintained by the Subject Matter Experts for the life of the solution.

9. Stimulus “HITECH” Act pays $44,000 per physician for an EHR solution implemented. The SME creates the grant request to be submitted so the healthcare organization receives Stimulus funds to pay for the total EIM solution

Key Element of the Solution

Onsite Delivery and full time support are key. But, the most important element is training. Why? As noted earlier, it is paramount that existing IT investments, namely personnel, be able to not only administer but also conduct development as the need arises. In Healthcare, CMS managed Medicare/Medicaid is already margins that are in the negative. As private payers follow suit, the number of uncollectable encounters will increase, impacting current profitability models and increasing future cost for treatment. By mitigating IT costs, the Total Cost of Ownership (TCO) qualifier should actually evolve to a Return on Investment (ROI). ROI is immediate for this solution approach, but it is sustained year over year by leveraging internal IT to support and develop. Now, the Healthcare Organization has eliminated costly professional service consulting engagements and re-investments into new feature licensing. This takes a variable cost every year and makes it a fixed, yet smaller amount – a sensible financial approach to accomplish a proven strategy.

Summary –

Why EIM? Whether it is Omnibus, “Obama”-care or an edit (not overhaul) of the Healthcare industry, Healthcare Organizations know these truths:

1. Electronic Health Records are necessary for the Fraud detection unit of CMS. Each organization must comply with accessibility, HIPAA and format. Fraud reduces overall revenues for a hospital by 9% (ACFE)

2. EHR/EHR have proven to be highly effective in eliminating internal waste, patient fraud, practice fraud and paper overhead. Vast amount of space within the facilities that had been used to store patient records in hard copy can now be utilized to provide additional services and open new revenue streams.

3. Bad or “dirty” data in electronic or hard copy format is costly. According to the AHA (September, 2008), the average cost of a patient record with good or accurate information is $343 annually. The annual cost of a patient record with bad information is $2,054 annually. On average, 18% of patient information within a healthcare organization is bad.

4. Strategies developed by healthcare organizations without 100% of the information they own that is also timely and relevant are ineffective. Objectives cannot be defined, successful processes cannot be identified and improvement plans have little to no metrics in which to determine success.

5. Stimulus/HITECH Act pays $44,000 per physician when EHR is part of the EIM solution. With the smaller EIM firms, Stimulus pays for the entire solution.

Why a New Approach EIM Firm?

1. Subject Matter Expertise from consultants that have proven methodologies.

2. Agility to adapt to the client need instead of the Big Box approach of the client adapting to their product limitations.

3. A Better Solution at a Fraction of the Cost. Their solutions are based on needs and not features.

4. Relationships with the vendor, resulting in improved services, maximum values from vendor solutions and a focused approach to the client needs and goals.

5. A Return on Investment as opposed to a Total Cost of Ownership. Clients need to see solutions that immediately pay for itself and then recover lost revenue while offering channels to new profit centers.

A Must Have For Today’s Healthcare Industry

IT solutions have found its root in each and every field and healthcare sector is not an exception to the rule. Till date, the healthcare industry was going very slow in the implementation of healthcare it solutions for the very reason that the industry depends more on individual knowledge and judgment. It is true that information technology can not be a substitute for human brains; however, it can prove to be a very useful tool or aid in performing various tasks.

Healthcare it solutions can prove to be of great help all across the entire healthcare industry:

Healthcare Diagnostics – Proper and timely diagnosis plays a very important role in the treatment and recovery of the patient. If a diagnostic tool is available to the healthcare professional that is equipped with advanced healthcare software, the task of diagnosing a disease would become much easier. Healthcare it solutions are playing a very crucial role in the field of healthcare diagnostics, the trend is catching up and there is lot to come.

Healthcare Treatment – Once the disease is diagnosed it has to be treated in the right manner. Availability of advanced new age tools can make the task of treating a patient much easier. Advanced radiation, surgical and other medical equipments that are equipped with cutting-edge software is providing a new route to the over all treatment process. Use of healthcare it solutions has made possible the treatment of a no. of diseases till date that was not available to the mankind.

Healthcare Billing – Healthcare it solutions not only plays a crucial role in the diagnosis and treatment of the patient. However, it also plays an important role in the healthcare billing sector. Once the services are provided the patient needs to be billed by the healthcare professional / hospital. The process may seem to be very easy, however, in real practice it involves a step ladder process to be followed including providing codes and various formalities. The task is tedious and time consuming, the manual process often results into a no. errors, here comes the role of healthcare it solutions in the billing process.

A fully-functional billing system especially designed for the healthcare industry, taking into consideration the industry requirements, can prove to be of great help and support to the medical professionals as well as hospital setups. The billing system makes the overall process of entering data as per the guidelines, data processing and bill generation an easily manageable task.

Healthcare Claims Processing – Healthcare costs are rising and so is the need for health insurance. Entering data, forwarding claims and getting them processed is a time consuming process… it is believed that healthcare professionals spend maximum time on this issue, which otherwise could be utilized for providing quality service to the patients. Healthcare it solutions like an advanced claims processing system could come handy in this situation. It ensures to speed up the over all process and helps to make it an easily manageable task.

Healthcare Record Maintenance – Once the healthcare services are delivered including billing and claims processing, it is not an end to the road. The most important task starts from here – patient record maintenance is a very important activity that every healthcare professional has to take care of. Patient records are maintained for future use by healthcare professionals. In case of any ailment in the future, the patient records are referred by doctors that help them to diagnose the disease. In case patient records are not maintained in the right manner or they can not be accessed under circumstances of emergency; it could be a life threatening condition for the patient.

Healthcare it solutions by way of an advanced emr system is making life easy for both healthcare professionals as well as patients. The system helps to store the patient data in a systematic manner, which can be accessed at any point of time by any registered healthcare professional. The availability of detailed patient data at the right time ensures better diagnosis and timely treatment.