Alcohol Screening Tools

India B. Carson, RN, MSN
Clinical Product Specialist

Primary care providers often screen their patients for a variety of conditions, including alcohol use.  Screening is not the same as diagnostic testing, which can establish a definite diagnosis.  Instead, screening is used to identify people who are likely to have a disorder, as determined by their answers to certain questions.  Evidence suggests that even if patients are not meeting the requirements for alcohol dependence or abuse, they may be consuming alcohol at levels which place them at risk for increased problems.[1]  A variety of screening tools are available to identify these at-risk patients to ensure that they can be helped through the necessary interventions.

The Alcohol Use Disorders Identification Test (AUDIT) is a screening tool that was developed in 1982 by the World Health Organization.  This screening tool accurately classifies 95% of people as either alcoholic or non-alcoholics by asking ten questions related to alcohol use.  A resulting score of eight or more indicates harmful drinking behavior[2].  This tool offers a simple way to screen and identify patients who may be at risk for developing problems related to their alcohol consumption and can be found here:  https://www.integration.samhsa.gov/AUDIT_screener_for_alcohol.pdf[3].

The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) is a very simple three-question screening tool for harmful drinking which can be administered alone or as part of a lengthier survey or assessment.  At TCS, this tool is utilized as part of our Health Risk Assessment (HRA), as it is only three questions in length and can be easily incorporated into a longer assessment.  A copy of the AUDIT-C can be found here:  https://cde.drugabuse.gov/sites/nida_cde/files/Audit-C_2014Mar24.pdf[4].

The CAGE AID is a commonly used screening tool for both drug and alcohol use.  However, it can be used to determine whether a more comprehensive alcohol assessment is needed.  A copy of this tool can be found at:  https://www.integration.samhsa.gov/images/res/CAGEAID.pdf[5].  These questions can also be adapted to include drug use.

As previously mentioned, there are quite a variety of screening tools available.  If you are searching for one, please consider reviewing the Substance Abuse and Mental Health Service Administration (SAMHSA) website and look for specific recommendations.  Lastly, you can find additional reference material at the National Institutes of Health section on National Institute on Alcohol Abuse and Alcoholism.

[1] National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert. Retrieved from: https://www.niaaa.nih.gov/alcohols-effects-health  Retrieved on March 4, 2020.

2 SAMHSA-HRA Center for Integrated Health Solutions.  Screening Tools.  Retried from: https://www.integration.samhsa.gov/AUDIT_screener_for_alcohol.pdf on March 4, 2020.

3 SAMHSA-HRA Center for Integrated Health Solutions.  Screening Tools.  Retrieved from: https://cde.drugabuse.gov/sites/nida_cde/files/Audit-C_2014Mar24.pdf on March 4, 2020.

4 SAMHSA-HRA Center for Integrated Health Solutions.  Screening Tools.  Retrieved from: https://www.integration.samhsa.gov/images/res/CAGEAID.pdf on March 4, 2020.


PACE Programs Amid COVID-19

Audrey Ward, RN, MBA
Clinical Account Executive

As we roll into the third month of COVID-19, the world is becoming a very different place, and moving at a very different pace in all manner of speaking.  One area particularly affected by the Novel Coronavirus, is a program that serves the most vulnerable population, the Program of All-Inclusive Care for the Elderly (PACE).   Participants in the program are 55 years or older and are typically frail elderly still living in the community but needing comprehensive medical and social services that might otherwise be provided in a nursing home. This puts the population of program participants in the highest risk category for exposure and infection with COVID-19.

PACE programs across the country are striving to stay open and continuing to provide the necessary services amid quarantine, lack of resources, and risk of exposure and transmission for both the participants and the providers of care and services. Recognizing that these organizations are dependent upon up-to-date information to better serve and protect program participants, the National Pace Association (NPA) has established an information hub where community providers can access the tools and resources needed to serve the frail and vulnerable.

The information hub located at https://www.npaonline.org/coronavirus-disease-2019-covid-19 provides easy to find, valuable information including the following:

  • Summaries of CMS COVID-19 Communications
  • PACE Organizations’ Responses to COVID-19
  • COVID-19 Resource Links
  • Telehealth Resources
  • Personal Protective Equipment (PPE) Information
  • Emergency Preparedness e-Community
  • COVID-19 Clinical and Quality Resources
  • Webinars on COVID-19
  • COVID-19 Weekly Updates

The Emergency Preparedness e-Community is the designated location for NPA member PACE plans to exchange information related to COVID-19. If not already a member, PACE plans are encouraged to create an account to access this critical information. In addition, the NPA is monitoring regulatory and congressional activities and providing links to State Policy Updates, Federal Assistance Programs, and Federal Policy related to COVID-19.

In a publication by Health Dimensions Group (HDG) Skilled Nursing & Senior Living COVID-19 Response & Resource Guide, community providers will find additional guidance on communication, workforce planning and support, surveillance and preparedness plans, financial resources, policy changes, and rapid response teams.

Life for both participants and providers of PACE has changed. Technology such as tablets, tools and training are being leveraged for e-visits, and residents are experiencing more in-room and hallway activities with overhead speaker games and interaction rather than group interactions.

There are more than 260 PACE centers located in 31 states, and many ways that the community at large can aid and support. On a larger scale, consider starting a PACE Program, or financially supporting an existing program with a donation of any amount. Ask Congress to support PACE programs, especially during the COVID-19 pandemic, by contacting your U.S. Representative and U.S. Senators. The gesture need not be grand to make a big difference. Giving encouragement to participants and providers by sending cards, letters, puzzles, books, and other small gifts can bring a positive change of PACE, if even for a moment.


National Nurses Week Is Extra Meaningful This Year

Deborah Keller, RN, CMCN, CCM, CPHQ
Chief Executive Officer 

Each year, May 6-12 is designated as National Nurses Week, a time to recognize, celebrate and honor all
the dedicated caregivers who are the heart of healthcare. This year was already shaping up to be
something special since 2020 has been declared to be the Year of the Nurse and Midwife to coincide
with the 200 th birthday of Florence Nightingale.
Then the world changed, and suddenly we all found ourselves with a whole new appreciation for what
being a nurse is all about.
Consider that all that is being asked of most of us in the battle against COVID-19 is to wash our hands, sit
on our couches and eat our home-cooked meals while watching Netflix. And yet, we are frustrated, and
we complain. We want our “normal” back.
Nurses on the front line have a different perspective. They must deal with the ravages of COVID-19 in
strangers every single shift even stepping in to hold a dying patient’s hand while in their other hand they
are holding a mobile phone soothing a family member. Nurse case managers in the hardest hit areas
are seeing their patients who had been getting control of their chronic conditions suddenly die of a
virus. All the while, these nurses also worry about all the same things the rest of us worry about, such as
how to home school their kids, whether their aging parents are doing ok and if the products they’re
purchasing at the grocery store contain traces of the virus.
When most of us are done working from home we shut down our computers and spend time with our
families. When a 26-year-old nurse finishes her shift, she has to completely decontaminate, treat the
bleeding behind her ears and the bruising from 12 hours of wearing a mask. That nurse then has to
decide whether to go home to her baby and take a chance on exposing her family to any residual traces
of COVID-19 or stay away for the duration. Either way, it often feels like a no-win proposition.

Nurses in 2020 are rushing headlong into a virus where there are still many unknowns. Many don’t have
all the personal protective equipment (PPE) they need so they are improvising as best they can and
hoping for the best. Because stopping and waiting until more PPE arrives simply isn’t an option.
With all the social distancing rules in place nurses are being called upon to do even more. In normal
times they can count on families to shoulder some of the load for patient care, such as walking the
patient to the bathroom, pouring a cupt of water, or helping patients adjust their pillows. None of that
help is available now.

They are also going above and beyond in other ways. Here’s a personal example.
Recently my mother-in-law fell as she attempted to navigate some stairs in her home when a tornado
raged through her town. She broke her hip, requiring surgery. My husband and I weren’t able to come
to the room to find out what was going on, and when we called her a young nurse answered.

The nurse asked where we were and we told her we were in the parking lot. She told us to stay there
and she would came out totalk to us. , Still dressed in her PPE, she came to stand in the rain 6 feet from
our car to explain what was happening. Since then she consistently called us with updates and helped
my mother-in-law call us on her cell phone.
They don’t teach that level of compassion in nursing school. It’s just something that is inside of these
special people that proves nursing isn’t a job but a calling.
So yes, this year we have even more reasons than usual to honor these heroic caregivers – although
most of them will probably still be too deeply involved on the front lines of the COVID-19 fight to notice
when their special week occurs. But that shouldn’t stop us from honoring them more than ever this
year.
As someone who was a practicing nurse for many years here’s what I suggest. For us nurses who have
been away from clinical practice for a while, consider preparing yourself to step back in and offer
support. Many states are offering to cover the cost of clinical refresher courses and several nursing
schools are waiving fees. For others, during this National Nurses Week send a few boxes of chocolates
to the nurses at your local hospital. Order a few pizzas or a couple of those giant sandwiches for
everyone to share. Brighten up the nurse’s station with some flowers or colorful balloons.
Believe me, any gesture of kindness – especially one that reminds them that someone is thinking about
their welfare – will be greatly appreciated. It is the least we can do.


What is a PACE program?

India B. Carson, RN, MSN

Clinical Product Specialist

The PACE Model of Care began in the early 1970’s when the Chinatown-North Beach community of San Francisco saw a need for long-term care services by people.  The Balanced Budget Act of 1997 established the PACE model as a permanently recognized provider type under both the Medicare and Medicaid programs.  PACE, or the Program of All-Inclusive Care for the Elderly provides comprehensive care (both medical and social services) to certain frail, elderly participants still living in the community.  Many of the PACE participants are eligible for both Medicare and Medicaid.

Eligibility for PACE.  Participants must be 55 years or older and live in the service area of a PACE center.  They must require a nursing home level of care and be able to safely live in the PACE community.  PACE is not available in all states.  If you think you are eligible, you can call your local Medicaid office to determine your eligibility and to help you find a PACE plan in your area.[i]

What are the benefits?  The benefits of PACE include:  adult day care; dentistry; emergency services; home care; hospital care; laboratory/x-ray services; meals; medical specialty services; nursing home care; nutritional counseling; occupational therapy; physical therapy; prescription drugs; primary care; recreational therapy; social services; social work counseling; and transportation.  PACE also includes any other services deemed to be necessary to maintain a person’s health.  Services are provided mostly in adult day health centers and are often supplemented by in-home and referral services in accordance with the person’s needs.  Individuals who need end-of-life care will receive the appropriate services, however, if the person wants to elect the hospice benefit, they must voluntarily disenroll from the PACE program.

What services are provided?  An interdisciplinary team assesses an enrollee’s needs, develops care plans, and delivery all services.  Minimally the team consists of a:  dietician; driver; home care liaison; nurse; occupational therapist; PACE center supervisor; personal care attendants; physical therapist; primary care physician; recreational therapist or activity coordinator; and a social worker.

Application and Enrollment Process.  If someone meets the eligibility requirements and elects to have PACE, a voluntary enrollment agreement is signed.  Enrollment continues if desired by the person regardless of any changes in health status until they voluntarily disenroll.

Quality of Care.  The PACE organization is required to develop, implement, maintain, and evaluate an effective data-driven quality assessment and performance improvement (QAPI) program.  PACE organizations have the flexibility to develop to QAPI program that best matches their services so they may meet the needs of their members.  The desired outcome of the QAPI requirement is that the data-driven quality assessment serves as the engine that drives and prioritizes continuous improvements for all PACE organization services.

[i] Centers for Medicare & Medicaid Services.  Programs of All-Inclusive Care for the Elderly (PACE). Retrieved April 30, 2020 from: https://www.cms.gov/Medicare/Health-Plans/PACE/Overview.


Rapidly Transitioning to a Remote Workforce

Steven Michaelis

Director of Client Success

“I’ll see you on the other side of this thing,” I said to a few colleagues on my way out of the office last week. Like so many other organizations, TCS Healthcare Technologies has temporarily shuttered our offices in California and North Carolina. Following our States’ applicable guidelines and recommendations to maintain social distancing in response to the COVID-19 pandemic, we have transitioned to a fully remote workforce.

Making this transition so quickly, out of necessity, has highlighted both the strengths and weaknesses of our technology infrastructure and tools as they are today. Below I will aim to distil our recent experiences into meaningful tips and ideas that may be of use to other organizations making a similar transition. In particular, I will focus on three specific technology areas – VPN services, Communication, and Asset Management.

 

VPN: The Lifeblood of Telecommuting

Virtual Private Networks (VPNs) are at the center of your ability to support a rapid transition to a distributed workforce. For many organizations, as was the case for us, this technology is already in place and in use by a select group of employees – such as remote workers in other states or ad-hoc use by employees normally in the office. But, can that same backbone accommodate a jump from serving 15% of your employees to serving 100%? The key items to consider in answering this question are licensing, bandwidth, and address space.

First and foremost, your licensing will likely need to increase. Often, as a cost saving measure, organizations do not maintain 100% licensure for VPN services across their employee base. This makes perfect sense during normal operation – but needs to be drastically increased to support a fully remote workforce. Some firewall manufacturers also offer “spike” licenses, allowing for a short-term increase in usage.

For smaller to mid-sized companies, bandwidth and address space are additional key considerations. Pay particular attention to your upload speeds at endpoints that VPN users will be connecting to, as significantly more data will be flowing that direction. Also, assess your address space defined for your VPN connections (i.e. 10.0.0.1/24), ensuring you have the IP’s to support the increase in volume of consistent connections.

 

Communication: When you can’t shout over the cube wall

With the removal of in-person communication, tools like email and chat transform from important services to essential services. To mitigate the impact this change will have you should place a strong emphasis on the reliability of communication tools, as well as their availability if access to your local resources is lost.

One method of dealing with this is to decouple your communications platforms from your primary company infrastructure. That is to say, leverage cloud solutions for VoIP, Instant Messaging, and Email, from providers with very high up-times and reliability. This ensures that a loss of VPN connectivity does not break standard channels of communication.

A final note on communication: ‘embrace the face,’ and turn on that camera! Many of us (myself included!) often prefer to join conference calls with our web cameras turned off, disabled, or physically blocked. While ultimately this is a personal preference, numerous studies have highlighted the importance of facial expressions in communication and those will be lacking when operating in a fully distributed workforce without the use of cameras.

 

Asset Management: More Important than Before

            Similar to communication, Asset Management is another key area that is important for normal business operations, yet takes on even greater significance when transitioning to a remote workforce. You should work to ensure you have a strong system in place, accessible to those that need it, and flexible enough to accommodate change. This will directly impact your ability to bring on new resources as a company, at a time when you may need precisely that – new resources!

This extends beyond simple device provisioning and, ideally, incorporates elements of automation to ensure ease of administration, scalability, and reliability. How quickly can you deploy all the devices, resources, and accounts that a new employee will need? What barriers do you have in following those processes when the administrators performing the work are themselves distributed geographically? These key questions can reveal areas of potential issue and change.

 

            As I have written this post, my ‘coworkers’ have been busy nearby: my Wife, Tiffany, working on remote lesson plans for her students and home-baking dog treats while Abbey, our 9-year-old German Shepherd, and Charlie, our 10-year-old mixed breed, put in a hard afternoon of napping and fetch (I’ve snuck in more than one or two toy-tosses this afternoon.) The distractions and barriers to working remotely from your home are plentiful and unique, to be sure. Don’t let technology be another barrier for your team!

We’ve certainly felt some growing pains and will continue to learn lessons throughout this temporary but important time. Still, TCS Healthcare Technologies has been successful in transitioning rapidly to a fully remote workforce by focusing on key areas like VPN Services, externalized communication channels, and a flexible and adaptive asset management and provisioning process. I hope what we’ve shared today proves useful to other organizations working to adapt rapidly at this time.


New Innovative Medical Breakthroughs that Are Changing Healthcare

Pat Stricker, RN

There are so many changes in healthcare that it is hard to keep up with all the new treatments, therapies, medications, procedures, and medical equipment that are being developed. Many of these are the result of new technologies, but others are innovative ways to use simple, known techniques in a new way to make significant changes. This article will review some of the current and future technologies that are changing or will change the healthcare landscape.  Hopefully you will find some that you were not aware of or some that might be helpful for some of you patients.

Now let’s take a look at what may be in store for us in the near future. The following are only a small list of some of the unbelievable  advances and innovations that are being worked on. As technology and computerization continue to advance there will be more amazing treatments and procedures available.

  • A promising Alzheimer’s drug – The use of Aducanumab resulted in less cognitive decline (about 15-27%) on memory and cognitive tests after 18 months of treatment. It is being re-studied and FDA approval will hopefully be obtained by early 2020.
  • A blood test to detect breast cancer – It screens for auto-antibodies produced in reaction to cancer cells and may be able to detect cancer up to 5 years before a lump is noticed or symptoms occur. The tests are less expensive and easier than mammograms. They are currently being studied in the U.K. and may be available within 5 years. A similar test is being studied in Scotland for lung cancer.
  • A new cystic fibrosis drugThis drug, Trikafta, provides “significant improvements” in lung function and respiratory health. It is now available to about 90% of the patients 12 or older with the most common cystic fibrosis mutation (about 27,000 people in the U.S.).
  • Crispr for Gene Modification—The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) gene-editing tool is the most advanced gene-editing technology. It works by harnessing the natural mechanisms of the immune system to then “cut out” infected DNA strands, giving it the power to potentially transform the way we treat disease. It allows DNA and genes to be modified in the early stages to study and treat sickle cell disease, multiple myeloma, sarcoma, cervical cancer, and non-Hodgkin’s lymphoma, as well as malaria, superbugs, and HIV. By modifying these genes, these threats could potentially be overcome in a matter of years. However, there are concerns about its use, mostly in relation to “playing God” and worries that gene-editing could produce “designer” babies. CRISPR is still a first-generation tool and its full capabilities are not yet understood.
  • Peanut Allergy Promise — A study using the antibody, Etokimab, has shown promise. People with severe peanut allergies were able to eat peanut protein within 2 weeks after just one injection of the antibody. A larger study is planned to determine dosing, timing and potential opportunities to treat other food allergies.
  • A Sickle Cell Breakthrough — A gene therapy, based on 20 years of research, uses infusions of a patient’s own bone marrow to produce normal red blood cells. Clinical trials are being conducted in various locations and patients have been symptom free after a year of treatment.

 

The following innovations are based on suggestions from a panel of doctors and researchers at Cleveland Clinics that identified medical innovations for 2019 that would transform the medical field and change healthcare.

  • Alternative Therapies for Pain — Genetic testing is being used to predict an individual’s ability to metabolize drugs and identify drugs that work for a patient, thereby eliminating ineffective and unnecessary drugs and adverse reactions. This personalized approach to identify and prescribe appropriate medications for individuals has the potential to help end the opioid crisis.
  • Artificial Intelligence (AI) — Artificial intelligence is being used in decision-making support in patient triage, at the point of care, and in improving the analysis and accuracy of patient scans. AI is helping to make caring for patients quicker, easier, and more accurate. It will be responsible for major innovations in healthcare in the near future. AI has already significantly altered the healthcare landscape. It was used in a study to recognize forms of cancer. AI was taught to recognize forms of cancer by using algorithms that Google uses to identify objects online. It then found two forms of cancer in a tissue sample as accurately as a human could, but in just a matter of seconds. AI has also been used to model the precise dosage of a cancer drug to shrink tumors while causing only minimal toxic side effects.
  • Cardiac Percutaneous Valve Replacement and Repair — Many cardiac procedures performed percutaneously, via a catheter through the skin, have replaced open heart surgery. Examples include mitral and tricuspid valve replacements and repair that have shown very positive outcomes. This innovation has the potential for changing the future of cardiac care.
  • Immunotherapy for Cancer Treatment — Immunotherapy, a technique that uses the body’s own immune system to fight cancer, has been used for years, but new and innovative therapies are showing very promising results. It is hopeful that effective therapies will soon be available for all tumor profiles.
  • Robotic Surgery — Today minimally invasive robotized surgery provides precise and effective surgeries with improved outcomes. Robots are used in numerous routine surgeries and have resulted in the shortest and least invasive surgeries, with less recovery time and limited pain after surgery. They are also used in more complex procedures that are highly difficult or near-impossible. The robots will not take the place of a surgeon in the future, but rather assist and enhance a surgeons’ work.
  • RNA-Based Therapies — Ribonucleic acid (RNA) based therapies, which are similar to DNA-based gene therapies, provide the ability to intercept genetic abnormalities before they cause problems. These new therapies have shown immense potential and are being explored for rare genetic diseases such as Huntington’s, as well as cancer and other neurological conditions.
  • Robotic Support – Scientists are developing robotics that enfold and support like an exoskeleton for patients with severe mobility problems, such as partial paralysis. The devices are programmed to guide the body through motions, such as helping a stroke victim walk, by rebuilding posture and strength.
  • Acute Stroke Treatment Timeframe — A stroke can cause irreversible damage and disability due to a prolonged lack of blood flow, therefore a timely response is critical. However intervention has only been recommended within a limited timeframe. Now new stroke guidelines expand the timeframe for treatment, which will allow more future stroke patients to receive treatment, while improving recovery and reducing the risk of disability.
  • Prehospital Stroke Visor — Hemorrhagic strokes are responsible for nearly 40% of stroke deaths, even though they are less common than ischemic strokes. The uncontrolled bleeding from the ruptured blood vessel must be controlled as quickly as possible. A new hemorrhage scanning visor using low-energy frequency waves can be placed on a patient’s head and used in prehospital settings to quickly detect hemorrhagic strokes. The device is 92% accurate and has cut treatment time, thereby saving more lives.
  • 3D Printing – 3D printers are an amazing technology and have become one of the hottest topics. Prosthetics are increasingly popular because it provides unprecedented levels of comfort and mobility by matching an individual’s measurements down to the millimeter. This specificity also provides more advanced, specialized care, minimizes complications, and improves outcomes. 3D is primarily used currently for prosthetics, cranial and orthopedic implants and joints, and stents for narrowing airways. It has also been used in heart surgeries and a total face transplant. In April, 2019 the world’s first 3D “printed heart” with cells, blood vessels, ventricles and chambers, was produced at a lab in Tel Aviv. Fatty tissue from patients was reprogrammed into stem cells, which were then differentiated into cardiac and endothelial cells that make up the lining of blood vessels. The next step will be to train the printed heart to act like a human heart by transplanting them into animals and eventually, humans. It is the hope that “printed hearts” will eventually be able to be used to save patients who are waiting for a heart donor. Surgeons are also working on creating organs for transplant from stem cells. They have been able to create blood vessels, synthetic ovaries and even a pancreas. These artificial organs then grow within the patient’s body to replace original faulty ones. The ability to supply artificial organs that are not rejected by the body’s immune system would be revolutionary, saving thousands of patients that depend on life-saving transplants each year.  Burn victims are also finding relief with 3D “printed” skin created from production material from the patient’s own plasma and skin biopsies. 3D printing is also taking 2D x-rays and CT Scans and turning them into 3D models, providing more comprehensive views in order to better diagnose issues. 3D printing can also “print” pills that contain multiple drugs, which help patients with the organization, timing and monitoring of multiple medications.  3D printing is a truly amazing technology that seems to be able to do almost anything. It has great promise for numerous future applications.
  • An “EpiPen” for Spinal Cord Injuries — Immune cells typically work to clear out dead or damaged cells after an injury, as well as increase the body’s defense against infection. However an over-active immune response can sometimes occur, which can cause numbness and even paralysis in some cases. An “EpiPen” like device, using nanoparticles, is being studied to see if it can suppress immune cells without side effects common with pharmaceuticals. If this works it may be able to provide a quick, readily available treatment for spinal injuries, as well as other types of trauma, cancer, and inflammatory diseases.

 

Other innovations that are on the horizon to revolutionize medicine include:

  • Bionic Prosthetics — A 3D printer can create a bionic eye within an hour. While it is not fully designed and working yet, the promise of seeing a prosthetic bionic eye is much closer to reality.
  • Contact Lenses That Track Glucose Levels – Researchers have been able to attach transparent, flexible electronics to contacts so that glucose levels can be checked, using tears, and then wirelessly relaying the results back to a computer program or app. And none of the electronics or sensors block the vision.
  • A Patch that Measures Blood Pressure — A patch, smaller than a postage stamp, can be worn and it can measure blood pressure deep within the body by emitting ultrasonic waves that pierce the skin and bounce off tissues and blood. The blood pressure data can then be sent back to a laptop.
  • A Musical Milestone — In Geneva Switzerland music is folded into the care plan for some preemies. This NICU music program features 3 specific songs, which babies listen to through special headphones. This ongoing study’s goals are to understand how music affects a preemie’s brain and how well it can recognize melody, tempo, and pitch-skills related to language processing. The songs were composed to help the infants fall asleep, wake up, and interact. MRIs are taken of the babies’ brains as they listen to the music, comparing it to babies who were not exposed to the music. The MRI scans reveal improved brain connectivity and the songs appear to support the daily rhythm of sleeping and waking, which is key to thriving in a noisy NICU.
  • Deep Brain Stimulation — Electrodes implanted in the brain deliver deep brain stimulation (DBS). These “brain pacemakers”, which have been used to effectively treat conditions like obsessive/compulsive disorders and Parkinson’s disease, are being tested in Alzheimer’s patients to improve focus, memory, and judgment. Another stroke recovery study has shown promising results, allowing a woman who was paralyzed on her left side to regain function after months of physical and occupational therapy and DBS.
  • Identifying Jaundice — A smartphone app is able to check the whites of our eyes for signs of jaundice. This could help diagnose pancreatic cancer by identifying elevated bilirubin levels.

·         Smart Inhalers – Inhalers, if used correctly, are effective for 90% of patients however research shows that as many as 94% of patients do not use their inhalers properly and only about 50% of patients have their condition under control. Bluetooth-enabled smart inhalers have been developed to help patient gain better control over their condition. A small device attached to the inhaler records the date and time of each dose and whether it was correctly administered. It then sends that data to the patient’s smartphone so they can track and manage their condition. Patients who used this device used less medication and had more reliever-free days.

·         Wireless, Absorbable Brain Sensors – Bioabsorbable electronics can be placed in the brain to measure brain temperature and pressures and then dissolve when they are no longer needed, thereby eliminating the need for another surgery to remove them.

  • Precision Medicine – Pharmaceuticals are becoming much more personalized to individual patients with the advent of gene therapy. The trend is moving away from having one standard, general way to approach treatment protocols and moving towards providing personalized treatment and prevention based on each individual’s genetics, lifestyle, and environment. Treatment is determined based on diagnostic and molecular genetic testing. Physicians can now select specific medicines and therapies to treat diseases, such as cancer or rheumatoid arthritis, based on an individual’s genetic make-up. This provides a more effective treatment plan since it attacks tumors based on the patient’s specific genes and proteins, causing gene mutations which make it easier to destroy the cancer cells. Precision medicine has shown many early successes and will be an ever-increasing concept in tomorrow’s healthcare environment.

 

The following are cutting-edge medical super-tools that were included in “2019 Medical Breakthroughs: Move Easier, Feel Better, Live Longer” article by Jacqueline Detwiler that was in the October/November, 2019 issue of the AARP Magazine, page 44. They are arranged in groups of like-topics.

Bone Grafts — Researchers have found a way to add calcium-rich eggshells to a hydrogel mixture that allows them to form a frame where new bone can develop from bone cells, making bone grafts more effective in treating osteoporosis and other skeletal damage.

Cancer

  • Prostate Urine Risk (PUR) Test — Researchers in the U.K. have developed a Prostate Urine Risk test that can identify patients who will require treatment for prostate cancer within the first 5 years after diagnosis. This test could eliminate the need for biopsies and lessen the risk of impotence or incontinence.
  • Skin Cancer Diagnosis Using Infrared Light — Infrared light is being used to map a potential skin cancer by blasting it with sound waves to measure its density and stiffness as a way to diagnose cancer with doing a biopsy. Researchers expect FDA approval next year.
  • Some cancers live by the same daily clock as we do. Understanding this rhythm helps physicians determine when it’s most susceptible to treatment. Researchers used a protein that makes fireflies glow to light up glioblastoma cancer cells whenever they were active. They discovered that oral anti-cancer drugs could be more effective if they hit the tumor at that exact time. Participants are being treated at different times of the day to identify the best times for attacking the cancer.

Chronic ConstipationThis condition may be treated in the future with pills that vibrate while moving through the GI tract. The vibrating pills induce natural peristalsis, moving stool through the body without chemical action.

Circadian-Rhythm Tests and Treatments

Circadian rhythms affect us and our bodily functions more than we realize, as evidence by some of the following studies on mood, sleeping, activity, eating, taking medications, the importance of light, etc. There is now a cell phone app called myCircadianClock that can help you identify your circadian rhythm and how to synchronize your body clock with the outside world. Check it out at mycircadianclock.org.

  • Circadian Rhythm Blood Test — During a 24-hour period about ½ of your genes are activated. Researchers have developed a blood test that measures your personal internal rhythms and determines a “time signature” that allows them to identify the absolute best times for you to eat, exercise, work and receive medications or other therapies when your body is most receptive.
  • Body Clock Tune-Ups — Circadian clocks are weakened by difficulty sleeping through the nights and daytime sleepiness often associated with Parkinson’s. Researchers have found that exposing subjects to bright light twice a day can reset sleep patterns and reduce early symptoms.
  • Adjust Your Daily Clock — The toxic effects of late night eating and all-day snacking is similar to those of “lead and asbestos”. Almost all genes, hormones, brain chemicals, neurotransmitters, digestive juices, and enzymes are programmed to turn on and off, or go up or down, every 24 hours. Eating when the stomach, pancreas, liver, and other organs are unprepared leaves the body less time to repair itself. Over time this can lead to chronic diseases. Re-establishing your circadian rhythm can fix these problems. Not eating at night and getting morning sunlight can help synchronize our body clocks with the outside world. New science shows that food should be eaten within an 8-12 hour window each day, beginning about an hour after you wake up. Researchers found that when overweight people restricted their eating to a 10-hour window they lost 4% of their body weight in four months without any changes in their diet.
  • Circadian Rhythm Lighting — Companies have developed lighting for hospitals and elder care facilities that mimics the movement of the sun, with light that grows gradually brighter toward midday and darker as sunset arrives. This helps counteract the effects of continuous fluorescent lights and the disruption of normal daily rhythms.

Depression:  A Mood Adjusting Spray Depression treatments frequently work for a time and then stop or are less effective as time goes by. A nasal spray called Spravato (Esketamine), recently approved by the FDA, can be used with an oral anti-depressant for patients with treatment-resistant depression. Some participants have found that there was no “off” time and it is still working after 2 years.

Diabetes

  • An Operation That Improves Blood Sugar — A study for diabetics in Holland included diet and lifestyle recommendations but also an outpatient procedure known as duodenal mucosal resurfacing (DMR) that used heat to destroy the topmost layer of the duodenum, the first portion of the small intestine. The idea was to destroy the layer of cells that prevent insulin from functioning optimally and replacing them with regenerated, healthy cells. Six months later, 85% of the patient had better blood sugar control and were no longer using insulin. The study is now being replicated in the U.S.
  • Afternoon Exercise for Type-2 Diabetes — A study showed that high-intensity interval training helps control blood sugar in people with type-2 diabetes, especially when it is done in the afternoon. In fact, it was not only better than exercising in the morning after breakfast, but the two patterns actually had different effects. When exercising after breakfast the participants’ blood sugar spiked, but the blood sugar remained lower throughout the day for those who exercised in the afternoon.

Exercise Can Help Prevent a Second FallA study of 345 men and women 70 and older showed that participants cut their risk of a second fall by 36% by following the Otago Exercise Program, a series of 5 strengthening and 12 balance moves with increasing levels of difficulty. The program focuses on knee, hip, and ankle strengthening and overall balance.

Heart Disease: A Whole-Life Longevity PlanA program developed by Dean Ornish, the developer of the Ornish Diet, has created a holistic 9-week lifestyle intervention course to help people reverse serious heart disease. It includes four rules: eat a low-fat, plant-based diet; get regular exercise; manage stress with yoga and meditation; and maintain love and intimacy. Within one month of completing the pilot study, the ten participants showed cardiac function improvement. One, who had been evaluated for a heart transplant, had a 27% reduction of his blocked arteries and has made amazing overall progress. The program is available in 18 states and is being approved by some insurance companies.

Light Therapy

  • Blood Pressure Light — Patients in a study were exposed to 30 minutes of whole-body blue light, a dose comparable to daily sunlight. The light reduced the systolic blood pressure by almost eight points, similar to what is seen with blood pressure lowering drugs.
  • Light-Box Therapy — Light-box therapy has been used for years to treat seasonal affective disorder, which leads to a low mood in the winter. Now the same therapy is being used to treat depression, including treatment-resistant depression and bipolar depression. Patients sit near a light box during morning hours to reset their circadian rhythm, resulting in improved mood. A study also showed that patients hospitalized for depression who had rooms that faced the southeast (more sunlight each day) were discharged an average of 30 days earlier than those in rooms facing the northwest (less sunlight each day).

More Comfortable MammogramsNew mammogram machines allow patients to control the compression of their own breasts, which can result in clearer pictures with less stress and pain. One study showed that 91% of the patients gave themselves equal or greater compression over the previous year’s scan, which improved the images.

Parkinson’s – Less Invasive Treatment for Tremors  — Deep brain stimulation, the gold standard for treatment of patients with Parkinson’s tremors that don’t respond to medication, is effective about 90% of the time. However, it requires a surgery to implant the electrodes in the brain. Last year the FDA approved a safer, noninvasive MRI Exablate Neuro treatment that guides ultra-sound waves directly to the most affected areas of the brain and destroys misfiring cells without requiring surgery.

Robotic UndergarmentsAn undergarment with robotic muscles that was originally designed to enhance soldiers’ endurance, can augment core strength by about 25%. Each garment is customized to fit an individual’s lifestyle and issues, providing support to core muscles, legs and hips, and back. They are available in the Seattle area and some elderly communities and companies are providing them to members and employees to lease for $1,000 to $1,500.

10,000 Steps a DayThe standard goal of 10,000 steps a day isn’t based on science. It was related to a 1964 Tokyo Olympics marketing effort. Researchers worked with 17,000 women (average age: 72) to determine how many steps are needed in older adults to lower their risk of dying from all causes. They were asked to record their steps for at least 10 hours a day, four days a week. They found that mortality rates began to drop at 4,400 steps and leveled off at 7,500 steps. So you can rest a little and not feel like you have to push yourself to get to 10,000 steps – 7,500 may be enough.  However, the more you do, the better it is for your health.


Tips on How to Successfully Select and Implement an Electronic Health Record

Pat Stricker, RN

Selecting and implementing a new electronic medical record (EMR)  or electronic health record (EHR) is a huge project for any organization. These are large systems used throughout the organization with detailed information about the patient and their treatment. They are integral to the daily operations of the organization, so organizations must think carefully about exactly what they need and be sure the system will help them achieve their organizational mission and goals. They also need to choose the right vendor – one that aligns with their organizational goals and strategies, is willing to be a “partner” with the client, and has a good reputation for successfully completing implementations and launching the system as promised and on-time.

 

While the terms EMR and EHR are often used interchangeably, there are differences according to the Office of the National Coordinator for Health Information Technology (ONC).

  • EMRs were developed in the 1960s and were primarily digital medical (clinical) records used by physicians to diagnosis and treat their patients. They took the place of paper records and, in addition, provided the ability to monitor and track patient data and improve the quality of patient care. However, the information did not travel outside the practice group. The patient record still needed to be printed and mailed to specialists and other members of the care team.
  • Over time the EMRs evolved into EHRs as the health care industry started to develop standards to allow other health care data to be collected and shared with all care team members. EHRs provided a broader view of the patient record that could be shared outside the practice group with specialists, hospitals, therapists, outpatient care, post-acute care facilities, home care agencies, laboratories, etc. EHRs also began to define and drive workflow processes, as well as provide evidence-based decision-making tools, order entry, plans of care, documentation templates, and detailed monitoring and analytical capabilities. EHRs became total patient health records that can be accessed by the patient or any health care provider caring for them to assure the most up-to-date, coordinated, patient-centered care.

An electronic health record is defined by the Healthcare Information and Management Systems Society (HIMSS) as: “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter – as well as supporting other care-related activities directly or indirectly via interface – including evidence-based decision support, quality management, and outcomes reporting.”

So even though the terms EMR and EHR are used interchangeably, they are very different. We will be using the term EHR.

 

Last month’s article, Physician and Nurse Involvement Is Critical in EHR Selection and Implementation, focused on why EHRs are important and why physicians and nurses need to be part of the selection and implementation process. This article will focus on how to select the right EHR and vendor and how to make sure the system is implemented in a way that meets your needs and those of your patients.

 

Selecting an EHR

Selecting the “right” software for any project is not an easy task. There are numerous EHRs available, each with its own capabilities and processes. On average it takes 6 months to over 2 years for organizations to select an enterprise software. So you must make sure you take the time to find the one that fits your unique goals and needs (requirements). The following are some key steps that you should consider when selecting an EHR or other software for your business needs.

  • Planning
    • Create a Selection Committee comprised of representatives from management and line positions from all functional areas that will be using the system or interacting with it. This is critical so ideas, input, and feedback are obtained from all interested parties.
      • Assign an executive champion to provide guidance and clear roadblocks
      • Assign a full-time project manager with experience implementing large software projects
    • Define your organization’s business, operational, and expected outcome goals and how you envision the system can help achieve them.
    • Define “ideal” processes and workflows
      • Review all current and planned workflows carefully. Identify what works/is needed and what doesn’t work/isn’t needed. Eliminate all unneeded steps and those that are not being tracked or reported on.
      • Spend time re-designing workflows so you have streamlined, automated workflows that you can use to define your workflow requirements. Include steps you think may not be possible (it never hurts to ask!).
    • Define requirements that are critical to your processes (efficiency measures, documentation standards, performance consistency and standardization, etc.).

NOTE: On average a requirements document such as this will consist of over 275 requirements. Sites like SelectHub provide templates to help you develop the requirements.

  • “Must Have” – mandated requirements that are essential
  • “Needed” – requirements that are necessary. They are needed to make workflows and processes easier or improve efficiency and performance, but not mandated.
  • “Like-to Have” – ideas that seem improbable or impossible, but would be great if they were available, such as auto-documentation, automated integration with other applications, etc. (They may not be available but it never hurts to ask!)
  • Analytic – Quality, analytic, and quantitative tracking, monitoring, and reporting
  • Research software products that meet the needs identified above.
    • Conduct an internet search for a product that meets all your identified requirements.  NOTE: An average of about 10 software products are typically researched, but that number should be reduced before scheduling demonstrations.
      • Using a site like SelectHub may help reduce your time and effort. It provides a software selection platform that lets you identify the type of product needed, determine the requirements you are looking for, set priorities, and compare products that meet your needs. It also provides templates to help you develop the requirements.
    • Seek input from surveys, client recommendations, or other rating services.
    • Make sure the product is flexible enough to fit your defined needs. You should not have to change your workflows to fit the software.
    • All data in the system should be reportable, measureable, and able to be analyzed to show how workflow benefits the patients, providers, organization, and entire healthcare system.
    • Consider the user experience and ability of the patient to access their record.
    • Consider the way the system is deployed and what IT resources are needed to maintain it.
  • Research software vendors to find a “partner”, not merely a service provider or vendor. Selecting the “right” vendor is just as important as selecting the “right” software. The vendor needs to be aligned with and able to support your strategic goals and expected outcomes. And the two organizations need to have similar company cultures so they can develop a true collaborative partnership in which each is willing to help the other. Conducting a detailed vendor assessment is key! It is just as important as assessing the product.
    • Conduct an internet search for a vendor that has a proven track record in the industry.
    • Seek input from surveys, client recommendations, or other rating services.
    • Consider whether the vendor aligns with your clinical, administrative, revenue, population health and analytic goals.
    • Ask for statistics on their success rates for implementation and launching on-time. Ask if they have ever failed an implementation. They should have these statistics available. NOTE: Under-performance and project failures can be an issue. Statistic show that for all IT projects more than ½ fail and 3% under-perform.
    • Make sure they have a defined implementation process (with timelines) to share with you and that they have a dedicated implementation team to work with your team.
    • Ask for references and speak to or visit them to see how the system works for them. Also ask what the system is not able to accomplish for them.
    • Develop a list of vendor requirements based on the above.
    • Schedule an on-line overview demo to see if the product is what you are looking for. It does not need to be detailed at this point in the process.
  • Develop a Request for Information (RFI) and/or Request for Proposal (RFP) Document based on the product and vendor requirements that you have already defined.
    • An RFI is an initial communication document sent to numerous vendors that describes your organization; the need, scope, and purpose of the proposed project; and higher level requirements. It may also include expected pricing, delivery methods, and other business information. An RFI provides the organization with summarized information from each vendor in order to determine which vendors should be reviewed in more detail.
    • An RFP is a formal, comprehensive request that is sent after an RFI or in place of an RFI to elicit detailed information from vendors an organization is interested in. It includes detailed information about the project, its timeline and budget, and detailed requirements that a vendor must meet. It allows the organization a chance to compare all vendors using the same criteria.
    • A list of detailed “Must Have”, “Needed”, and “Like-to-Have” requirements should be listed giving the vendor as much information about what you are looking for and what the system needs to be able to do.

NOTE:  The Smartsheet website provides free business templates designed to assist organizations in building RFI, RFP, and requirements documents for projects.

  • Evaluate RFIs/RFPs to Determine Vendors for Demonstrations
    • Develop a Demonstration Checklist based on the product and vendor requirements.
    • Each type of requirement in the RFI/RFP should be listed with a scored ranking. Quality, analytic, and quantitative tracking, monitoring, and reporting requirements would be listed under one of these categories and scored accordingly. Using a point system for scoring will make it easier to objectively compare all products and vendors. The scoring system could be similar to this for the system requirements:
      • “Must Have” – mandated requirements, so no points awarded                 0
      • “Needed” – necessary, but not mandated. They make workflows and

processes easier or improve efficiency and performance.                                       + 1

  • “Like-to Have” – ideas that seem improbable or impossible, but would be

GREAT to have                                                                                                                           + 2

  • “Available” with Customization (extra cost)                                                 –  1
  • “Not available” – requirements are not available                                 –  2
  • Add a vendor requirements section to the checklist.
    • Score their requirements in a similar fashion
    • Also consider adding or subtracting points based on your interactions with the representatives from each vendor. Were they responsive, friendly, and helpful? Did they anticipate your needs? Did they understand your business needs and goals? Do they have a dedicated team to work with your team? Does their culture seem to fit in with your organizations culture? How do they handle issues and delays? Do they have good implementation and launch statistics? Have they ever had a failed implementation? Also add other things that are important to your organization.
  • Tabulate the scores for each vendor and choose the top 3-6 for further evaluation.
  • Manage the Demonstration Process
    • Select no more than the top 3-6 vendors for a demonstration based on the product and vendor scores.
    • Schedule a demo – It can be an initial online demo, if that has not been done, or a full product demo at your site.
    • Schedule a defined timeline for the demo – Schedule the same amount of time for each vendor (e.g. 2-4 hours) and stick to the timeline. Do not allow vendors to go over the time allotted, as it is not fair to other vendors. It also shows that the vendor may not be organized enough to conduct the demo within the specified timeline.
    • Schedule all demos within a short timeframe (e.g. 2-3 days or up to 1 week). This makes it a little difficult time-intensive for the Selection Committee during that time period, but it reduces the confusion of trying to remember vendors and products that were presented over a long time period.
    • Ask for customized case scenarios to be presented – Send the vendor case scenarios for key processes or functions you want them to demonstrate. Vendors should be asked to develop these scenarios in their system and show them during the demo. Those that do not take the time to develop these scenarios should have points deducted from their score.
    • Ask vendors to show other “Must Have” and “Like-to-Have” requirements – Ask them to show as many as possible in their demo. They should not be allowed to just tell you that they can do something. Insist that they show you how it is done.
    • Develop a Demonstration Checklist that includes all product and vendor requirements. Also include Comment Sections so the committee can provide non-solicited feedback.
      • Provide each committee member with a checklist at the beginning of each demo and ask them to rate each requirement as it is demonstrated.
      • Require committee members to complete the checklist at the end of each demo to assure their observations are fresh. Allowing them to wait until the end of the entire demo process to fill out the checklists leads to confusion about what each product/vendor demonstrated. It is best to collect feedback immediately.
    • Tabulate the results of the Demonstration Checklists after all demos have been completed.
    • Hold a committee meeting to discuss the demo results. Gather input from all areas and try to reach a consensus on a chosen product/vendor.
    • Select a “Partner” and product.
  • Contracting would be the last step in selecting a software.

 

Implementing an EHR

The next step is to implement the chosen software. This task will now be taken over by the Implementation Team. Some of these team members may have been on the Selection Committee, but many others were not, so all team members need to be brought up to speed on the product and its goals for the organization. The goals and strategies for the project need to be reviewed, as well as the requirements, and expected outcomes. A demo of the system is also needed, so everyone is familiar with its capabilities.

The vendor’s project manager oversees the implementation project, working in conjunction with the client’s project manager. Weekly status meetings should be scheduled for the implementation team, as well as monthly or bi-monthly governance meetings with senior leadership to discuss the project’s progress and outstanding issues.

 

While each product will have its own steps in the Implementation Process depending on the nature of its processes, they usually include steps similar to these:

  • Initial Implementation Team Meeting – this can be done by conference call, on-line, or in-person at the client site to introduce the client and vendor management and implementation teams.
    • The client should present an overview of the goals and strategies for the project, as well as the requirements, and the expected outcomes.
    • The vendor should present an overview demonstration of product, the implementation process, and review a draft implementation plan explaining: all key steps, expected timeframes, training schedules, and expected responsibilities and time commitments for implementation team members.
  • Installation of the System – The two technical teams should begin to install the system.
  • Initial On-site Meeting – should include:
    • An initial overview training for the implementation team focusing on the features of the system and “hands-on” practice in navigating it.
    • An in-depth assessment and discussion of current and expected workflow processes for all functional areas should be conducted, if this has not already been done. The goal should be to revise and optimize the workflows and processes, not use the current ones. This is an essential step that drives how the system will be configured to meet the client’s unique needs and helps the vendor finalize the implementation project plan with realistic tasks and timeframes.
  • In-depth training for the client’s implementation groups: technical, clinical, reporting, etc. These sessions focus on specifics related to their key responsibilities.
  • The technical team will install the system, set-up network connections, create processes for data loads and exports, build interfaces, etc.
  • The analytics group will work on developing reports, audits, and data analytic needs.
  • The clinical team will set up workflow processes and configure the system.

These trainings can be done on-site or in on-line sessions. Due to the cost of on-site visits, more implementation steps are being done using on-line conference sessions. These sessions, which continue throughout the implementation, are part training and part “hands-on” work, with tasks assigned between meetings. Intermittent on-site work sessions are also scheduled.

  • Re-designing Processes – Old, convoluted processes and work-arounds should not be brought over to the new system. Workflow processes need to be simplified, optimized, and automated as much as possible. Automated workflows based on business rules and evidence-based data should be added whenever possible. All stakeholders should have input into the re-design of the workflows that affect them. Third-party applications should also be reviewed to see if they are still needed or if the processes can be done in the new system, thereby eliminating extra work.

Health care leaders agree that streamlining, automating, and optimizing processes is a critical step that allows the system to provide value and efficiencies. One even joked that “if you don’t (redesign workflows first), you’re just moving garbage at the speed of light and magnifying inefficiency.”  Another said, “When we redesigned the system around (a workflow process)…it streamlined so much, and from a quality point of view it also took out a huge number of errors and potential errors.”  Clearly, process redesign is a critical step that requires time and attention!

  • Development of a Practice System – Each team needs to have access to a practice system where the implementation staff can test data loads, configuration, reports, etc. The vendor should offer a process that allows each team their own system that can be used by them and not interfere with other groups. For example a vendor may offer to set up three databases: one for technical group to use for data loads, interfaces, etc.; one for configuring the workflows and processes; and one for training and practice used by all groups.
  • User Acceptance Training – Prior to the final training, the data load and configuration databases that contain all the new processes and integrations can be combined to produce a database for User Acceptance Testing. Realistic case scenarios should be developed for all workflows and processes. Team members should enter these into the system to assure they are accurate. If not, they should make needed changes and test again. Once the team is convinced the workflows and processes are accurate, the database can become the End-User Training database.
  • End-User Training – This is usually conducted within one to two weeks before Go-Live. The timing will be determined based on the number of staff to be trained and the availability of training facilities. The goals should be to train for comprehension and retention of basic skills and to observe the students and offer suggestions. Ideally, each trainee should have their own computer, not a shared computer, so they can get as much “hands on” practice as possible. The class should be taught by the vendor and the client, with the vendor providing basic features and navigation and the client teaching client-specific workflows and processes.

After the training a training room should be available for the staff to continue to do more individual practice or have 1:1 training with an instructor or mentor before Go-Live. They should be encouraged to enter real-life, case scenarios that test the various workflow processes that are included in a normal workday or to replicate actual cases they performed the previous day. This has been identified as a key need, as studies have shown that in problem implementations about 85% of the staff members were missing basic skills at Go-Live. Extra practice time also provides further User Testing of the newly designed workflows and system changes.

  • Go-Live! – The implementation team and vendor should be available for the staff at Go-Live and during the first week to offer assistance and keep logs depicting all issues, suggestions and requests for changes. At the end of each day, the implementation team should review what went well and things that need revision. This continuous improvement quality process is critical, so that issues are identified and addressed on a timely basis.
  • Post-Implementation Support – Weekly team status meetings should continue for the next three to four weeks or until all issues and revisions are resolved. An ongoing Change Management Process should be put in place to identify and resolve all quality issues that continue to arise. The client should be reviewing the system, utilization, performance, and workflow issues and results.

About four to six weeks after Go-Live, the vendor should schedule a meeting with the client’s leadership and implementation teams to get input on the overall implementation project:  what worked, what could have gone better, etc. This information should be used by the vendor to improve their implementation processes.

Lastly, about six to nine months after Go-Live, the vendor should conduct another on-site visit to determine how the system is working, reassess the client’s needs, review ongoing configuration needs, provide suggestions for improvements, provide additional tips and hints for better use of the systems and assist the client in determining how to add additional programs or processes, if needed.

 

It’s hard to know if a software system will work the way you initially envision, until you actually work with it for a while. Defining exact requirements at the beginning of the project is a crucial step, but it still needs to be followed by a continued process to monitor and revise issues and problems as they arise. You can’t just implement a system and then forget it and move on to the next project.

 

I hope this article has provided some insight into the most important factors to consider, if you are looking for a new system. Knowing how to choose the “right system and vendor” is extremely important, which then makes the actual implementation much easier. Any implementation takes a great deal of time and resources, but it is definitely worth it, because of the improved effectiveness, efficiency, productivity and clinical outcomes that it can provide. Taking the time to choose the “right system and vendor”, re-design and optimize workflow processes, and train the staff on basic skills are critical keys to achieving a successful implementation.

But the most important thing is to “get a seat at the table” – to become part of the selection and implementation process. If you know this type of project is being planned, volunteer to be on a committee, don’t wait to be asked. Your input is invaluable. You work in these systems every day. You know what is needed. You know what works and what doesn’t. You know what new processes are needed and what could be eliminated. If you are not chosen for a committee, document your ideas and suggestions in a professional, positive, succinct format and submit them to the selection committee. That way, even if you don’t have a seat at the table, you will be at the table and you’ll have a chance to offer input.


TCS Healthcare Technologies Releases ACUITYnxt 1.6

ACUITYnxt is “The Managed Care System Designed by Case Managers”

AUBURN, Calif.Nov. 26, 2019 /PRNewswire/ — TCS Healthcare Technologies is excited to release ACUITYnxt 1.6.  ACUITYnxt is a secure, cloud-hosted solution providing risk-bearing organizations the ability to improve the health of their member populations while reducing avoidable healthcare costs.

This release includes advanced population risk stratification, deeper workflow automation, expanded clinical content, and an embedded data integration engine.  These enhancements provide the capability to use multiple external data sources to stratify members, automate program enrollment, and auto-schedule follow up actions.

TCS CEO, Deborah Keller, states, “Designing and operationalizing population health programs that truly impact health requires far more than data collection.  We understand that our clients need technology that helps them leverage their own resources in the most efficient way possible to positively impact as many lives as they can.  That translates to overcoming interoperability challenges and fully utilizing all data points in the member experience to decrease inefficient processes and eliminate dangerous blind spots.”

Keller notes, “We are so excited to offer this latest release of ACUITYnxt.  There is simply nothing else on the market that provides the flexibility to operationalize innovative population health programs while also supporting end users with an intuitive experience.  I am constantly humbled by the ability of our clinical and technical teams to collaborate in a way that results in software that is simply unmatched.”

To request an ACUITYnxt demo, email us at info@tcshealthcare.com.

About TCS Healthcare Technologies:

TCS Healthcare Technologies (TCS) is a leading provider of software designed to support health plans, TPAs, ACOs and other risk-bearing organizations. The TCS team of US-based clinicians and developers are recognized for their best-in-class managed care expertise and customer support.

TCS Healthcare Technologies is an HCAP Partners portfolio company.


Post Fall Managed Care Forum (FMCF) 2019

Deborah Keller, RN, BSN, CMCN, CPHQ

Chief Operating Officer

As a provider of managed care software, each year I determine which conferences TCS will participate in as a vendor. This is a difficult decision as there are so many high-quality conferences from which to choose and I am personally energized by nearly every conference I attend.  Having clients in every sector of managed care including Medicare and Medicaid health plans, third-party administrators, self-insured plans, and ACOs; conferences not only provide TCS with sales and marketing opportunities, but more importantly, they help keep us connected to users in each of these sectors.

 

After researching the Fall Managed Care Forum (FMCF) and understanding the relationship between the American Association of Managed Care Nurses (AAMCN), the NAMCP Medical Directors Institute, and the American Association of Integrated Healthcare Delivery Systems (AAIHDS), TCS decided to become an exhibitor at the FMCF in Las Vegas.  Since 2014, TCS has exhibited at the conference every year.

 

In 2017, I was fortunate enough to partner with one of our clients to present on Social Determinants of Health at FMCF. Attendees of the presentation may remember the lights going off and on during the presentation and Dr. Jonathan Burke’s hilarious improv as it was happening.  Despite this very minor snafu, the feedback on the session was incredibly positive.  The appreciation, encouragement, and follow-up information requests from that presentation have been wonderful.  Several of you have reached out to let us know how you incorporated the SDOH visual model we provided into your own programs and education campaigns.

 

The variety and quality of presentations at this year’s FMCF, like previous years was solid.  It is exciting to hear directly from presenters how their programs are maturing and progressing operationally.  After so many years of speaking of treating the whole person, it is inspiring to see SDOH so heavily factoring into how members are being managed.

 

As for TCS, over the past five years, we have enjoyed every aspect of participating in this event as a vendor.  We enjoy seeing our own clients, our vendor partners, and all the attendees who stop by our booth to say hello.  In the spirit of continuing to drive our products directly from the expert user community, this year I brought along Matt Fahner, our VP of Engineering.  This allowed Matt to hear directly from attendees what they think of our latest software offering, ACUITYnxt.  The feedback was better than we could have ever hoped for.  We absolutely appreciate the time that many of you spent answering our questions and we deeply appreciate learning from you all.

 

Over the next two months, I have a few events coming up that I am very excited about.  I am looking forward to moderating a session about innovative approaches to effectively managing social barriers to care at the Social Determinants of Health Action Forum on November 14th and 15th in Miami, Florida and participating at the Transformation Today & Tomorrow Conference on December 4th and 5th in Pinehurst, NC.

To join us at a discounted rate, please use the code: H121TCS

At website: https://www.insightxnetwork.com/product/social-determinants-of-health-action-forum-nov-2019/

If I don’t see you at one of these events, I look forward to seeing everyone at FMCF 2020!


TCS Healthcare Announces the Release of Acuity Connect v7.32

AUBURN, Calif., October. 4, 2019 – 

What’s New in this Release of Acuity Connect™ v7.32

This release improves overall security and addresses vulnerabilities that have been discovered since the last release.  Updates to the Java®, Apache Tomcat®, and Apache HTTP Server™ platforms are included.

 

Security Improvements

Acuity Connect v7.32 includes the following fixes to address vulnerabilities and security concerns:

  • Implemented the AllowedMethods method in Apache HTTP Server to prevent malicious actors from obtaining server configurations through an insecure use of the OPTIONS method.
  • Fixed a bug that could allow a malicious actor to access the Apache HTTP Server environment’s as well as any new directories that were added after implementation.
  • Updated HTML doctype directives to ensure a malicious actor cannot downgrade sessions from the browser’s modern “standards mode” to a more insecure “quirks mode”.
  • Deprecated support for version 1.1 of the TLS connection protocol to prevent malicious actors from downgrading a session’s encryption algorithm to an older, rarely used, and potentially less secure protocol. Acuity Connect will now only support connections using TLS version 1.2. ·
  • Updated the jQuery® implementation used by Acuity Connect from 2.2.4 to 3.4.1 to address several vulnerabilities. A detailed change log can be found at the following website:  https://github.com/jquery/jquery/compare/2.2.4…3.4.1

Platform Updates

Acuity Connect v7.32 also includes significant updates to the supplied software platforms. ·

  • Java: This release moves Acuity Connect from a 32-bit (x86) Java 8 Runtime Environment (JRE) platform to the most recent LTS 64-bit Java 11 Development Kit (JDK) release.  This update includes a JDK software package as Oracle® has deprecated standalone JRE releases.  For detailed upgrade instructions, refer to the Acuity Connect v7.32 Installation Guide.

o    For a list of changes, refer to the Java 11 release notes.

  • Apache Tomcat: This release moves Acuity Connect from a 32-bit (x86) Apache Tomcat 8 environment to a 64-bit Apache Tomcat 9 environment.  This new version fixes several bugs and known vulnerabilities.  For details instructions on backing up and replacing Apache Tomcat installations, refer to the Acuity Connect v7.32 Installation Guide.

o  For a list of changes, refer to the Apache Tomcat 9 change logs.

  • Apache HTTP Server: This release moves Acuity Connect from a 32-bit (x86) Apache HTTP Server 2.4 environment to the latest 64-bit version of the server software.  This new version fixes several bugs and known vulnerabilities.  For detailed instructions on backing up and replacing Apache HTTP Server, refer to the Acuity Connect v7.32 Installation Guide.

o  For a list of changes, refer to the Apache HTTP Server 2.4 fixed vulnerability list.

Bug Fixes

Acuity Connect v7.32 also addresses the following functionality issue: ·

  • Fixed a bug that prevented Auto Approval Rules from accepting and saving changes to the Assessment Form checkbox.

 

 

Copyrights and Trademarks

ACUITY Advanced Care, ACUITY, Acuity Connect, AcuPort, AcuStrat, AcuPrint, and AcuCare are trademarks of TCS Healthcare Technologies.  All rights reserved.

Microsoft SQL Server and all Microsoft Windows products are registered trademarks of Microsoft Corporation of the United States.

CPT five-digit codes, descriptions, and other data only are copyright American Medical Association.  All rights reserved.  Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.   The AMA does not directly or indirectly practice medicine or dispense medical services.  The AMA assumes no liability for data contained or not contained herein.  CPT is a registered trademark of the American Medical Association.   Applicable FARS / DFARS; restrictions apply to government use.

Oracle and Java are registered trademarks of Oracle and/or its affiliates.  Other names may be trademarks of their respective owners.

Advanced Installer is a trademark of Caphyon software.  All rights reserved.

Apache, Apache HTTP Server, Apache Tomcat, and the Apache feather logo are either registered trademarks or trademarks of the Apache Software Foundation in the United States and/or other countries.

jQuery is a registered trademark of the JS Foundation in the United States and/or other countries.

This product includes software developed by the OpenSSL Project for use in the OpenSSL Toolkit. (http://www.openssl.org).   Web user interfaces and PDF technologies in Acuity Connect utilize components from Kendo UI by Progress.  Progress, Telerik, and Kendo UI are registered trademarks of Progress Software Corporation in the U.S. and other countries.  All rights reserved.