Delivering the highest quality health care in today's world requires and creates a great deal of information and data. Managers in this field must be able to make decisions around the use of a wide variety of information systems, which are used to store, use, and analyze this data. In order to be effective at managing a complex health care organization, leaders must understand the information technology that their organization uses, and the connections between different health care information systems.

In this activity, you will gather information related to the needs of various departments within the hospital in order to conduct a needs analysis.

Health Information Technology Needs Analysis

Vila Health is a medium-sized system of health operating facilities in the Minnesota and Wisconsin area. Vila Health is growing and has recently acquired two smaller systems in Iowa and North Dakota: Delaware County Regional Health System, which consists of Independence Medical Center and Delaware County Hospital, and Red River Rural Health System, which consists of Valley City Hospital and several small clinics.

Leaders at all three organizations are now focused on providing a smooth transition for both staff and patients. Transition teams tasked with analyzing and evaluating the IT needs and current health information systems in use have been formed and the first team will focus on Independence Medical Center, Delaware County Regional Health System's rural referral hospital. The information gathered by the transition team will be used to make strategic decisions about health information systems not only at Independence Medical Center, but throughout the entire Vila Health organization.

Email #1

HIM Transition Team

From: Evelyn Unger, HIM Transition Team Project Manager

Welcome aboard! I understand that you are going to be on the HIM transition team that is tasked with identifying current status and needs for our health information technology here at Independence Medical Center. As a rural referral hospital, we have had to address technology needs that other, smaller hospitals haven't.

I have set up a folder for you to use on the network and I uploaded some information about the hospital which I think will help you to get a sense of our organizational structure. You'll probably want to talk to various key people – not necessarily just managers – to get a handle on which information systems they use and what problems they're having with them. Go ahead and familiarize yourself with our team.

Touch base with me again when you know who you want to talk to and I will help with scheduling times for everyone.

Evelyn

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About Us

Independence Medical Center is a rural referral hospital in Waterloo, Iowa, and we provide a broad range of emergency, medical, surgical, outpatient, and psychiatric services to the citizens of Black Hawk County and beyond. We have a rich history of caring for our community, starting in 1927, and nearly 80 years later we're still going strong.

Our Services

Our services include inpatient and outpatient surgical care, intensive care, primary and specialty medical care, pediatrics, and imaging services. We specialize in many types of services, including neurology, physical therapy, oncology, hematology, cardiac and pulmonary rehabilitation, ophthalmology, and more.

Our Women's Health practice is second to none, with care for breast health, gynecological services, infertility, menopause prevention, and many other offerings.

Our fully-staffed Emergency Room is open 24 hours a day, seven days a week, and we strive to keep patient wait times as short as possible.

Our Team

Our dedicated team of health care providers and support staff includes active medical staff and registered nurses, and we offer the best care from highly trained specialists.

Independence Medical Center - Organization Chart

Administration

Like our nurses and doctors, the leaders of Independence Medical Center work day and night to deliver the best possible care while making sure that the hospital runs as efficiently and effectively as possible. Whether it's developing better ways to deliver quality care, installing better systems for more advanced diagnostic testing, or upgrading billing systems for simpler, easier-to-read medical bills, the hospital's leaders are always trying to find ways to better serve the patient and the community.

Independence Medical Center's leadership:

· Chief Executive Officer: Norman Reynolds

· Chief Financial Officer: Jarvis Norwood

· Chief Medical Officer: Patricia Deering, MD

· Chief Nursing Officer: Diane St. John

· Chief Operating Officer: Gwendolyn Zimmer

· Chief of Therapeutic Services: Anne Berg

· Chief of Diagnostic Services: Shawn Hayden

Business Services

Admission Services

Independence Medical Center maintains a qualified staff of admissions counselors who help patients with both elective and emergency admissions. For elective admissions – planned stays at the hospital for procedures or surgery – counselors gather necessary insurance and other information, answer patient questions, and provide information regarding the hospital stay. They also confirm admitting privileges for visiting physicians, get signatures for legal consents or releases, and assign patients to beds while notifying nursing units that the patient has arrived.

These same counselors help patients with discharge and connect them with necessary resources. For example, for patients who need physical therapy at home or skilled nursing after discharge, admissions counselors connect them with hospital caseworkers. They also help patients who know they will have trouble paying their bills to apply for financial assistance from the hospital.

Human Resources

Independence Medical Center hires only the most talented people to take care of our patients, and our competitive salaries and benefits attract a large number of candidates. Our staff of human resources generalists works hard to recruit, screen, and recommend for hire the best possible candidates for each role.

The Human Resources department educates our more than 225 employees about their benefits and continuing education opportunities, and also provides training and resources for bringing new employees on board and getting them up to speed on hospital procedures, policies, and practices.

Medical Records

Every patient's medical records include a wide variety of information about their health: contact information, allergies, insurance information, medicines, test results, and other data. Because these data can be very sensitive, HIPAA regulations dictate what hospitals are allowed to do with medical records. Our medical records staff protects patent medical records and helps them to safely and confidentially share that information with physicians, clinics, or others they designate.

To release medical records, patients need to fill out the Authorization to Disclose Protected Health Information/Medical Records. When the hospital has the signed authorization, it will send the records to the designated recipient. If a medical record contains information about the following, patients will need to initial the appropriate section:

· Alcohol/Drug Treatment

· Mental Health Treatment (except psychotherapy notes)

· HIV/AIDS Related Information

Diagnostic Services

Audiology

For pediatric to geriatric patients suffering hearing loss or difficulties with balance, Independence Medical Center's Audiology department offers sophisticated diagnostic equipment and techniques to diagnose many hearing- or balance-related conditions.

Our board-certified audiologists can perform many diagnostic tests and treatments for hearing and balance-related problems, including tests of electrophysiology, auditory brainstem response, electrocochleography, and more. They are trained in working with patients whose special needs might make diagnostic tests difficult, such as patients with head injuries or dementia. One of our audiologists is also certified by the American Institute of Balance.

To prevent a conflict of interest, Independence Medical Center does not sell hearing aids, so patients can trust that the diagnosis they get is the right one.

Among the services our audiology department provides are:

· Adult hearing evaluations

· Pediatric hearing evaluations

· Otoacoustic emissions testing

· Balance assessments

· Auditory processing assessments

· Videonystagmography (dizziness evaluation)

· Tinnitus evaluation

Clinical Labs

Laboratory testing plays a crucial role in the detection, diagnosis, and treatment of disease, and more than 65 percent of all decisions regarding a patient's diagnosis and treatment are based on it. That's why the lab at Independence Medical Center is staffed with highly trained and dedicated technologists, technicians, and phlebotomists who put the patient first. Our lab performs more than 100,000 lab tests each year, and we perform over 175 different procedures. Results from procedures that we cannot perform in-house are usually available within 24 hours from Medlabs in Cedar Lakes, Iowa.

Just a few of the tests we perform on site include:

· Hemoglobin A1C

· Glucose tolerance

· Renal function panel

· Protime

· Influenza A and B antigen

· Urea nitrogen, 24-hour urine

· ABO & Rh type

· Basic metabolic panel

These and all other tests done at Independence Medical Center can be completed at a doctor's order and results reported the same day.

Imaging and Radiology

Precise, high-quality medical images can make the difference between a wrong diagnosis and a right one. At Independence Medical Center, we offer state-of-the-art diagnostic imaging, including MRIs, bone density tests, CT/PET scans, mammograms, and more. Our highly skilled medical imaging technicians keep patients' comfort and concerns in mind while taking accurate images for diagnosis.

Our board-certified radiologist is highly qualified in medical imaging technologies, and is on staff three days a week to consult with physicians to determine the meaning of the image and the best available course of treatment. When our on-site radiologist is not available, we send images digitally to Cedar Valley Radiology for consultation.

Some of our imaging services include:

· DXA/bone density testing

· CT/PET scans

· Colonoscopy

· Digital mammography

· Electro/echocardiograms

· Fluoroscopy

· Mobile nuclear medicine

· Ultrasound

· X-rays

Neurology

Patients with diseases of the brain, spinal cord, or central nervous system can expect expert care from the neurologists at Independence Medical Center. Carefully trained and board-certified in both general neurology and such specialties as vascular neurology, our neurologists can diagnose and treat a broad array of neurological disorders.

For patients suffering from stroke, neuromuscular diseases such as multiple sclerosis, ALS, dystonias, and peripheral neuropathies, movement disorders such as Parkinson's disease, seizure disorder or epilepsy, migraines, or dementia, Independence Medical Center is the place to get the most modern treatments from physicians whose dedication to continuing education is critical to their dedication to delivering the best patient care. Among the diagnostic tests and treatments available at Independence Medical Center's Neurology department are:

· Botox injections for movement disorder

· Baclofen administration via pump therapy

· Electromyagram

· Nerve conduction testing

· Deep-brain stimulation

· Vagal nerve stimulation

· Tissue plasminogen activator (tPA)

Pharmacy

The medications doctors order for patients are provided by the hospital pharmacy, and Independence Medical Center's pharmacists are important members of the health care team. Our pharmacists and technicians work closely with doctors and other caregivers to meet each patient's specific health care needs and to explain medications and interactions to patients.

Pharmacists will explain what each medication does, what side effects may be expected, and what to avoid while on each medication. They will also evaluate patient prescriptions in terms of other over-the-counter or herbal medications the patient might be taking, and suggest ways to reduce possible side effects and ensure that medications are working at their best. Our pharmacists are highly educated in detailed drug information, and they can help nursing staff to educate patients about the safe and effective use of their medications.

Medication Formulary

Like most hospitals and health plans, Independence Medical Center a list of drugs that are routinely available for dispensing to patients (the formulary). Most of the medications a doctor orders will be on our formulary.

Financial Services

Billing and Coding

Questions about bills go to our staff of billing specialists, who help patients understand the services they received and the cost of those services.

Patients must present all insurance cards at the time of service to make sure that claims will be submitted promptly. This includes private insurance, Medicare, Medicaid, Medical Assistance, commercial insurance, and worker's compensation.

· Online bill pay: Patients can pay their bills online with MasterCard, Visa, or Discover.

· Refunds: Independence Medical Center will verify any reported errors, and if an overpayment is discovered, will issue a refund within 30 days.

· Financial assistance: For patients with low incomes or significant bills, the hospital offers financial assistance.

· Address changes: Address changes can be made online or in person.

Budget Administration

The Budget Administration department reports to the Director of Financial Services. Budget analysts gather information from C-level executives at the hospital to develop and maintain annual operating and capital budgets for Independence Medical Center. They project and allocate both revenues and expenditures, and analyze utilization, patient volume, and other trends to make short-term and long-term projections.

Based on input from executives, analysts also do budget reallocations throughout the year to address surpluses, shortfalls, and overruns. They review expenses and conduct cost-flow analyses to monitor spending.

Budget analysts report to the Director on all of these matters, so that the Director can report to the hospital's CFO and participate in the strategic planning process for the hospital.

Information Technology and Data Services

IT Team

Independence Medical Center is at the cutting edge of today's technology, and our IT Department helps us to stay that way. All of our software and hardware is installed and maintained by a staff of highly qualified IT professionals with certifications in networking, databases, and many other types of technology.

These professionals build install, maintain, and troubleshoot all in-house hospital systems. They run regular maintenance and perform upgrades on these systems. They also work with vendors to install and maintain third-party applications. User training and support are also part of their responsibilities.

Among the systems our IT professionals maintain:

· Electronic medical record

· Formulary database

· Building/environmental system

· Patient flow software

· E-mail

· Medical billing

Medical Services

Independence Medical Center is proud to provide caring and comprehensive health services designed to meet the needs of all our patients. With an emphasis on quality care, our staff of highly trained professionals will treat you with the compassion, care, and understanding patients expect. We are pleased to offer a variety of services including primary and specialty medical care, pediatrics, inpatient and outpatient surgical care, imaging services and a fully staffed Emergency Department able to provide the community with 24/7 emergency medical care.

At Independence Medical Center we strive for excellence on every measure and our nursing services are a direct reflection of that focus. Our nurses are compassionate, highly skilled, and culturally competent professionals. They are the key to delivering outstanding patient care and at Independence Medical Center, that is always our number one goal.

Ambulatory Care

Our ambulatory care registered nurses interact with patients who need care or treatment but do not need to stay overnight in the hospital. They conduct initial assessments of patients' condition, perform procedures, educate patients about their health and next steps, advocate for patients' needs, coordinate care with the hospital and with outpatient clinics in the area, and follow up to make sure patients' needs are being met. The focus is on the patient's well-being and on how outpatient clinics can be the next step in the healing process.

Behavioral Health

Independence Medical Center offers both inpatient and outpatient assessment and treatment for behavioral health issues. Our on-staff psychiatrists are available 24/7 for emergency admissions for psychiatric disturbances, such as suicidal depression or psychotic episodes, and help stabilize patients in our inpatient mental health center. They provide individual and group therapy, as well as family assessments and recommendations for after-care action.

Psychiatrists also provide short-term counseling and treatment, as well as consultations regarding psychoactive medications for patients whose diagnoses are less acute. When appropriate, they refer patients to social workers, counselors, and off-site psychologists or psychiatrists for long-term treatment.

Conditions treated by our Behavioral Health clinic include:

· Substance abuse and chemical dependency

· Eating disorders

· Mental health disorders such as schizophrenia, OCD, depression, anxiety, and bipolar disorder

· Detoxification (through the Emergency Room)

Cancer Center

In the event of a cancer diagnosis, Independence Medical Center is the place to go.

Prevention

The Cancer Center at Independence Medical Center provides cancer screenings on a regular basis throughout the year for breast, cervical, colon, rectal, and other cancers. The Women's Health Center also provides breast exams and annual Pap smears.

Detection

The Cancer Center is equipped with state-of-the-art MRI, PET and CT scanning technologies and on-staff radiologists interpret images in consultation with our board-certified oncologists.

At the Cancer Center, we offer:

· Positron Emission Tomography (PET)

· Computed tomography (CT)

· Magnetic resonance imaging (MRI)

· Ultrasound

· Mammography

· Nuclear medicine

· Stereotactic breast biopsy

Diagnosis

Independence Medical Center's board-certified pathologists work with Cancer Center oncologists to determine whether a patient's biopsy suggests a cancerous mass. They also help to determine how advanced a detected cancer is, and consult with oncologists and surgeons on treatment plans.

Treatment

Oncologists at the Cancer Center will explain every aspect of the patient's treatment plan, whether it includes surgery, radiation, chemotherapy, or a combination of methods. Radiation and chemotherapy can be administered on site at our infusion area, and oncologists monitor patient progress throughout treatment while continually educating patients about their options and symptoms.

Emergency Department

If you or a family member is experiencing a life-threatening injury or illness, call 911. Independence Medical Center is the place to go in time of crisis. Our 24/7 emergency room can handle everything from critical injuries to life-threatening illnesses to mental health crises.

Emergency Medical Team

Our team includes highly qualified nurses, nurse practitioners, emergency medical technicians, and doctors who are skilled in high-pressure situations. We also have specialists on call for emergency consultation, diagnosis, and surgery if needed.

Situations We Handle

Here are just a few of the conditions that are considered medical emergencies:

· Broken bones or dislocated joints

· Severe pain, particularly in the abdomen

· Persistent or severe chest pain

· Difficulty speaking, altered mental state or confusion

· Head or eye injuries

· Loss of vision

· High fever or fever with rash

· Persistent shortness of breath or wheezing

· Weakness or paralysis

· Deep cuts that require stitches

· Rape

· Suicidal Behavior

· Chemical dependency or mental health crises

ICU

Independence Medical Center's Intensive Care Unit is staffed with a 35-member Critical Care team with specialized skills in caring for critically ill or injured patients. For renal or pulmonary complications, trauma, overdoses, and other life-threatening conditions, the ICU has the personnel and technology to safeguard the lives of its patients.

Some of the equipment in the ICU:

· ventilators for invasive and/or non-invasive ventilation

· hand ventilating assemblies

· airway access equipment

· vascular access equipment

· monitoring equipment, both non-invasive and invasive

· defibrillation and pacing facilities

· equipment to control patient temperature

· chest drainage equipment

· infusion and specialized pumps

· portable transport equipment

Each patient in ICU will have a physician in charge of the case, who will work with consultants from other specialties, such as cardiologists or respiratory specialists, when necessary to determine the best course of action. For continuity of care, a nurse will be assigned to each patient to deliver daily care, and other specialists, such as respiratory therapists, will be on hand to help patients who require ventilation, medication, or other treatment.

The ICU is located strategically in the hospital for easy access to the emergency room and operating rooms.

Medical/Surgical Care

St. Anthony Medical Center's 30-room medical/surgical unit takes over when patients of all ages come out of the post-operative ward but still need care before they go home. The unit also cares for patients with acute and chronic illnesses or conditions who don't need to be in the ER but need treatment before they go home.

The unit's 31 registered nurses, licensed practical nurses, and nursing assistants provide heart monitoring, post-surgical observation, rehabilitation, and other services. They work with each patient's physician to determine an appropriate care plan, and educate patients and their families about their options and how to care for themselves after they go home.

Neonatal ICU

Independence Medical Center provides care throughout patients' life cycle, and that starts with premature or sick infants. Independence Medical Center's Neonatal Intensive Care Unit can care for infants up to 17 weeks premature, and our neonatologists care for endangered infants with a wide variety of presenting conditions.

The NICU is equipped for specialized, around-the clock care with cutting-edge diagnostic and treatment equipment, including oxygen hoods, a CPAP system, neonatal ventilators, incubators, pulse oximeters, and an ECG monitor with defibrillator.

With pharmacists, respiratory therapists, lactation consultants, and other support staff on the NICU's interdisciplinary team, families with sick infants can stay in one place to get all the treatment their baby needs. After the infant is discharged, specialists help families with post-hospital care to make sure the newborn grows and develops appropriately

Operative Services

Independence Medical Center offers a wide range of surgical care.

Our surgical specialties include:

· Bariatric surgery

· General surgery

· Trauma surgery

· Neurosurgery

· Gastroenterology

· Cardiology

· Ear, nose and throat

· Gynecology/obstetrics

· Ophthalmology

· Oral and maxillofacial

· Cancer

· Orthopedic Surgery

· Pulmonology

· Transplants

· Urology

We provide elective and emergency surgeries for adults and children in our operating suite, which offers four operating theaters and the latest medical technology. Each patient will receive expert pre-op and post-op care. Pre-op nurses help coordinate the patient's needed medications, lab tests, and arrival, while post-op nurses assist with medication management and discharge either to the medical/surgical unit or from the hospital. They also help get services, support, and necessary equipment or supplies for post-surgery care.

Pediatric ICU

Independence Medical Center's Pediatric Intensive Care Unit offers the specially trained pediatric intensivists and highly specialized nurses to provide comprehensive, multidisciplinary care for critically ill or injured children ages 0 to 18. We provide acute surgical-medical care, monitoring, diagnostic procedures, and a wide variety of therapies. Our PICU has the most advanced equipment, including ventilators, specialized beds and cribs, specialized syringe pumps, and intra-cranial monitoring equipment. Our child-friendly rooms help children and their families to stay together during treatment and recovery.

Among the many conditions the PICU can treat or monitor are:

· Respiratory diseases

· Endocrine or metabolic diseases and abnormalities

· Neurological diseases or seizures

· Hematological conditions

· Cancer-related or cancer conditions

· Renal, cardiac, and multi-system diseases

· Trauma

· Burn care

Sports Medicine

Athletes who need a clean bill of health, preventive care, or treatment for an injury can come to Independence Medical Center's Sports Medicine clinic for the best orthopedic and sports medicine in the county. Our Sports Medicine clinic is staffed with an orthopedic surgeon, other sports medicine physicians, physical therapists and a certified athletic trainer.

The clinic's physicians work with each patient's primary care doctor and provide treatment for common sports injuries, such as ankle sprains, torn tendons, and ligament injuries. They consult with Independence Medical Center's specialty physicians, such as neurologists, on more complicated injuries involving the head or spine, or for exercise-related conditions such as exercise-induced asthma. For each injury or condition, physicians and physical therapists work together to decide on the best course of treatment and rehabilitation to return the patient to full strength and flexibility. The clinic has a pool for aquatic therapy.

Conditions we treat include:

· Sprains and strains

· Stress fractures

· Anterior cruciate ligament (ACL) or other ligament injuries

· Meniscus tears

· Knee chondrosis

· Adhesive capsulitis

· Exercise-induced asthma

· Impingement syndrome and rotator cuff tears

· Overuse injuries, such as tennis elbow

· Shin splints

· Shoulder instability and superior labral (SLAP) tears

· Chronic exertional compartment syndrome

· Tendonitis

· Patellofemoral disorders

Our services include:

· Sports physicals

· Preventive care

· Physical therapy and rehabilitation

· Joint replacement rehabilitation

· Home exercise programs

· Aquatic therapy

Women's Health

At Independence Medical Center, we want to meet all of our patients' health needs. The Women's Health Center at IMC is a place where patients with health issues specific to women will get personalized, knowledgeable attention.

A dedicated gynecologist, nurse practitioner, and midwife staff the Women's Health Center, and they work with other specialty physicians at the hospital to provide additional care or consultation as needed. They provide routine health screenings and exams as well as treatment for many conditions or transitions, such as menopause, osteoporosis, and chronic pelvic pain. Among the services we offer are:

· Annual exams

· Cervical cancer screening

· Patient education

· Routine prenatal and obstetrical care

· Postpartum depression treatment

· Minor surgical procedures

· Perimenopause and menopause

· Newborn and well child care

· Osteoporosis screening and treatment

· Pelvic floor disorder and chronic pelvic pain treatment

· Physicals

· Preventative health care

· Social service referrals

Nursing Support

Nurse Credentialing and Development

Independence Medical Center couldn't function without the hard work and specialized knowledge of its nurses. So it's mission-critical to keep Independence Medical Center nurses fully credentialed, and to give them opportunities to expand their nursing skills. Our Nurse Accreditation Manager and staff of nursing support specialists track the continuing education and licensing requirements for each of Independence Medical Center's registered and licensed practical nurses, and helps nurses with periodic license renewal.

They also work with nurses who wish to pursue further certification. They help nurses pursuing bridge programs, such as the transition from licensed practical nurse (LPN) to a master of science in nursing (MSN). And they work with nurses who seek specialty options like intravenous therapy, gerontology, foot care, and others, helping them to find the correct training and track subsequent certification renewal requirements.

Nursing Informatics

To keep nurses doing what they do best – caring for patients – while still documenting the care they provide, our professional staff of informatics specialists works to develop or improve systems of documentation for Independence Medical Center's nurses.

Doctors and nurses use a combination of handheld devices, tablets, and laptop computers to update patients' medical charts at Independence Medical Center. Our informatics specialists regularly survey all health care providers to find out what's working and what isn't, and analyzes monthly chart data to determine under what circumstances providers are not charting as effectively as they could. Based on this information, they roll out regular improvements to the hospital's charting system.

The department reports on its progress to Independence Medical Center's chief nursing officer, chief medical officer, and chief operating officer. They also work with the hospital's Nursing Informatics Council, which includes nurses from across the hospital's medical specialties, to register complaints, learn about bugs, and test new systems before implementation.

Operations

Central Supply

Independence Medical Center can't function without sterilized equipment and instruments, and that's the job of the Central Supply department: to make sure that surgical instruments, medical devices, and other equipment are sterilized and stored properly so that they're ready for use when they're needed.

The department collects surgical instruments and medical devices and decontaminates them in the hospital's autoclaves, automatic washers or other decontamination equipment. Then our sterile processing and distribution technicians inspect each item after decontamination and assembles them into packs for various operating theaters and treatment areas.

Our technicians keep detailed records of each item that has been cleaned, sterilized, and stored. They also deliver sterile supplies wherever they are needed, and order supplies monthly based on use and forecasts. They stock crash carts, organize medical supplies, and maintain inventory control so that sterile supplies don't expire, and so that the proper supplies are billed to patients.

Environmental and Dietary Services

Environmental Services

Independence Medical Center couldn't remain a clean, well-lighted place without the efforts of its Environmental Services department. Our environmental professionals take pride in keeping the hospital clean, stocking its medical supplies, removing its medical waste, and keeping it supplied with fresh, clean linens for patients and staff.

The efforts of our Environmental Services professionals don't only maintain a clean, attractive environment that helps patients recover. They are on the front lines of making the hospital look good, but also making it operate well and safely. By enforcing proper cleaning standards in high-touch areas and other medical-related standards (such as handwashing), our Environmental Services department helps Independence Medical Center to control the rate of staphylococcus infections and other metrics.

Facilities workers in the Environmental Services department maintain the hospital's vast array of equipment, as well as the hospital's physical plant, so that everything in the hospital is in working order.

Safety

Along with quality of care, safety is Independence Medical Center's top priority. Every hospital is a hazardous place to work, and whether it's a slip in a hallway that has just been mopped or an accidental needle stick, the hospital's safety department investigates every safety-related incident at the hospital to determine procedural changes that will help prevent similar incidents in the future. Our safety specialists are always on the watch for new ways to make sure that safety for patients, staff, and visitors is never compromised.

The safety department works with Environmental Services, the Quality Assurance department, and any other department whose operations might be affected by safety concerns. They are responsible for investigating worker injuries and for creating emergency plans for events such as natural disasters, infectious diseases, security incidents, and others. Finally, they report to the hospital's senior leadership, both on the hospital's internal security record and on comparisons between Independence Medical Center and other similar hospitals in the area.

Security

Independence Medical Center maintains an open-door environment so that patients, visitors, and practitioners can move about freely. This creates security challenges, as open-door environments can become opportunities for criminal behavior. To protect patients, employees, and property, our security department employs security staff and technology.

Entrances open to the public and the parking ramp are monitored 24-7 by security staff and surveillance video. Using a network of cameras in hallways, the entire hospital is monitored daily from a central command center near the front desk. Security officers make regular sweeps of public areas, sensitive areas, and high-risk areas, and monitor the hospital's loading docks and receiving areas both in person and via surveillance video.

The security department also analyzes reported incidents of theft and other crimes to detect patterns and devise countermeasures or policy changes to prevent further crime.

Quality

Accreditation

Independence Medical Center is accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), which means that we meet the Joint Commission's rigorous standards of quality and patient safety and we continually work to make our care and services better. These standards include such measures as infection control, documentation of care and treatment, transplant safety, and many more.

Our Accreditation specialists analyze hospital data related to the Joint Commission's standards, and identify areas where we could make improvements. They also measure the hospital's performance against national standards set by healthcare professionals across the country, so that our quality of care and patient safety is second to none. Finally, they work with Joint Commission regulators who may survey the hospital at any time to evaluate its compliance with JCAHO standards.

Patients may contact our Quality Department if our care has in any way compromised safety or quality standards, or contact the Joint Commission itself calling (800) 994-6610 or writing to:

· Online: http://www.jointcommission.org/report_a_complaint.aspx

· E-mail: [email protected]

· Fax: Office of Quality Monitoring, (630) 792-5636

· Mail: Office of Quality Monitoring

· The Joint Commission One Renaissance Boulevard Oakbrook Terrace, IL 60181

Credentials and Privilege Review

To ensure that all of our physicians stay in compliance with Medical Staff bylaws, rules, and regulations; state and federal accreditation standards, and other required certifications, our credentials coordinators work with regulatory agencies, universities, hospitals, and internal departments to track relevant data on all Independence Medical Center physicians. They manage pre-application, application, and reappointment processes for all physicians, and report to the hospital's Credentials Committee for their analysis and approval.

Therapeutic Services

Dental

Tooth problems don't always wait for the dentist to be in the office. The Dental Clinic at Independence Medical Center helps adult patients with preventive and emergency dental services.

On an emergency basis, the clinic provides the following services, among others:

· Diagnostic x-rays

· Repair of lacerations

· Pain management

· Infection management

· Extractions

· Oral pathology

· Palliative treatment of dental nerve pain

· Moderate sedation for suitable patients

· Management of medically compromised dental care

· Dental swelling and/or bleeding treatment

· Tooth or mouth trauma

The clinic also performs dental maintenance procedures, including cleanings, extractions, fillings, and crowns. For low-income patients who do not have dental insurance, the clinic provides regular cleanings, preventive fluoride treatments, and fillings at steeply discounted costs.

Nutritional Therapy

As the United States faces an obesity epidemic, researchers are discovering more information all the time about the connection between diet and disease. To support the healing work that physicians and nurses do every day at Independence Medical Center, the Nutritional Therapy department works to educate and consult with patients on food-related problems and nutrition choices that will better support healing from their conditions.

For inpatient admissions, the Nutritional Therapy department creates menus for patients based on their specific nutritional profile, and educates both the patient and family about the importance of nutritional support for healing.

Our registered dietitians also help patients on an outpatient basis with such food-related disorders as obesity, food allergies, eating disorders, and blood sugar disorders. In consultation with the patient's physician, they also help patients to come up with personalized meal plans that will support healing with such conditions as renal insufficiency or failure, gastrointestinal problems, complications of chemotherapy or radiation treatment, high blood pressure, and irritable bowel syndrome.

Occupational Therapy

Injuries, disabilities, and repetitive stress conditions can change how patients move, work, and live, as do motor, physical, and mental conditions. To help patients adjust to new physical realities or live more independently with their conditions, Independence Medical Center has two occupational therapists (OTs) on staff. The OTs assess, treat, and educate patients so that they can make the changes they need in their work and home to live with their condition more fully.

Both OTs help patients to:

· Live independently

· Dress, groom, and feed themselves, as well as other daily activities

· Improve their hand-eye coordination and fine motor skills

· Increase function with splints or casts

· Improve visual and motor skills

Physical Therapy

Physical therapists work in departments throughout Independence Medical Center to help patients recover from surgery, injuries, and other interruptions of normal physical functioning.

Operative Services

After surgery, many patients need to sit up, stand up, and walk with some assistance to rebuild strength and keep injured areas mobile. Our licensed physical therapists come to the bedside and consult with physicians to create a course of activities that will restore range of motion and strength as patients recover. They also teach patients how to get out of bed, go to the bathroom, and do other daily tasks safely while they recover from surgery.

Specialty Consultation

Neurological disorders, balance and gait problems, and other conditions often have a mechanical component. Physicians in specialties such as neurology, orthopedics, spine, occupational therapy and others consult with physical therapists to treat patient conditions and enhance recovery.

Emergency Room

Therapists help patients admitted to the ER with broken bones, sprains, joint injuries, vestibular disturbances, and accident-related injuries or conditions.

Respiratory Therapy

For relief from diseases of the chest, lungs, and respiratory system, Independence Medical Center's Respiratory Therapy Department is second to none. Our respiratory therapists teach patients breathing techniques, apply interventions such as chest physical therapy, nebulizer treatments, and oxygen therapy, and assess breathing problems with a number of diagnostic tests.

Among the respiratory or pulmonary conditions we treat are:

· Asthma

· Bronchitis

· Chronic obstructive pulmonary disease

· Emphysema

· Pneumonia

· Respiratory complications from heart attacks, trauma, cystic fibrosis and lung cancer

Speech Therapy

Independence Medical Center's Speech Therapy department features experienced speech language pathologists who perform diagnostic tests and assessments to determine the nature and extent of a patients' speech and language disorders. They have extensive education and experience in an extensive list of disorders.

Whether the condition is physiological or neurological, developmental or acquired, our speech pathologists are trained in many interventions to improve patients' speaking and swallowing:

· Augmentive/alternative communication

· Neuromuscular stimulation

· Flexible endoscopic evaluation of swallow (FEES) testing

· Modified barium swallow study testing

· Alaryngeal communication

Our speech pathologists have worked with patients presenting with speech problems related to stroke, aphasia, stuttering, dysarthria, and many others.

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Click any department to learn more about its function within the hospital, then select the candidate(s) you want to interview. While you can select all available candidates, you are not expected to interview everyone before checking in with Evelyn. However, you must conduct at least one interview before moving on.

Click on an employee within a department to add them to your interview list. Click Review Interviews to review your current interview selections and make changes. Click on any you'd like to remove, and click Add more employees to select other employees from other departments. When you're ready to start your interviews, click Begin Interviews. (Note: after starting your interviews, you will not be able to make changes to your schedule.)

Begin Interviews - This will begin your day of interviews. Once you begin you will not be able to make changes to your interview schedule. Are you sure you want to begin the interview? If so, click yes, and then click the first person that you'd like to interview.

Interviewee: Norman Reynolds, CEO, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Well, I'm responsible for the hospital's physical and financial operations. The Chief Operating Officer and the Chief Financial Officer report to me. They need technology that helps them keep track of what we're doing and how we're doing it. The Environmental Services, Safety, and Security divisions need monitoring systems and databases for tracking what we consume and the operational realities of the hospital. Ditto the Quality Assurance division. As far as financial technology needs, we obviously need accounting software so we can prepare financial statements and track expenses and forecast revenues; and we need billing and admissions software that lets us keep track of who we serve and what to charge them. Finally, we need the EHR for medical information.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The EHR for sure, as well as the PACS, the CPOE, a few others. Gwen and Jarvis can tell you more about the specifics.

Question 3:

What do those systems do?

Answer 3:

They capture every detail of what this hospital does on a day-to-day basis, so we can keep doing it.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

On a high level, yes. They don't always overlap well, though. I'm afraid we got sold a bill of goods on that one. In hindsight, we should not have allowed ourselves to get swept along in the selection process for the EHR. The vendor told us everything would talk to everything else and it would all be seamless – well, nope. And now we've got some pretty slow support coming from them. Not that I want to go through that whole process again, but I talk to Jarvis and Patty all the time about what we'll do when that SLA expires, and they seem receptive to a different system. They just don't want to do it until 2030 or so. [Laughs.]

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I'd say we've got a barrier between what happens clinically and how that information trickles down to the financial and business side of things. We're working hard on getting a handle on that.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Not enough, which is why we've got a barrier. Or barriers. The hospital hums along but the board doesn't like it when we eat into our profit margins with inefficiencies.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Technological. We've got the best medical personnel in Iowa at Independence Medical Center.

Interviewee: Gwendolyn Zimmer, COO, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

We need solid inventory control systems, and then the full range of administrative tools. Being able to interface with the EHR would be useful in that it would allow us to integrate operational functions more efficiently with medical needs. For example, May Nichols is head of Environmental Services. She's responsible for sending housekeeping to the different unit for cleaning, linen supply, and that sort of thing. So having a module in the computer that allows the medical units to input their needs would improve her ability to respond to those needs quickly. I suppose it isn't necessarily the EHR that we need access to, but having an integrated system where housekeeping or transportation or central supply communicates seamlessly with the units would be extremely helpful. My teams are responsible for inventory… for security monitoring … for providing meals to patients … and for transporting patients from one place to another.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The Central Supply system; the building management system in Security; and the EHR in safety, for the most part. Scheduling and the hospital intranet. I think that's all.

Question 3:

What do those systems do?

Answer 3:

The Central Supply system tracks all supplies that come into the hospital and what department they're charged to. The building management system controls electronic access to secure areas, video surveillance, and security coverage.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Yes, but our needs are not very high-tech at this point.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

We need more wireless access points, more bandwidth, and a data security audit. None of those are Operations issues, though, so I prefer to let those who are more affected speak to those issues.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Not really a major issue, to the best of my knowledge.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Again, not my issue. I don't mean to sound like I don't care, I just don't have a dog in that particular race.

Interviewee: Albert Lynton, Operations Manager, Operations

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

My departments are all about people movements and the response the hospital has to make. When patients come into the hospital, the admissions people need to know where a bed is open, and we need to provide that information. When they leave, we need to know that they've left so the room can be restocked and cleaned. When people have accidents in the hospital, we need to gather the who, what, when, and where, so we can analyze for the why and recommend needed changes. And we need to keep an eye on the whole hospital so we know who's coming and going and so we know that the materials, equipment, supplies, and everything are secure.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The Environmental Services department has a materials information system and a cart management system. The Safety department mostly uses other departments' systems, like the EHR. Security has its own building and access monitoring software.

Question 3:

What do those systems do?

Answer 3:

The MIS and CMS help Environmental Services to keep track of the supplies they order, the tools they sterilize, and the carts and rooms they need to restock. The building software integrates the video surveillance with the access monitoring so we know who's going in what door and when at all times.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

I'd say so.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

None, at least in my departments.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

The one problem is that neither of Environmental Services' systems can capture what supply should be billed to what patient. How many of a supply, and where does it go? No problem. Who did it go to and how can we bill? Not happening.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Technological, definitely.

Interviewee: Paul Hartwell, Director of Information Technology Services, Information Technology and Data Services

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Mostly, they're the usual: bandwidth, server space, that sort of thing. They're expanding now that we're trying to offer more telemedicine, so now that includes video chat and other health-related communications technologies.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

None, really. Again, we're the support function.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I'm familiar with the barriers we face with the information systems, but Jason is in charge of Information Systems Support so I'll defer to him on those. As far as the rest of the hospital's utilities, they're mostly communications problems – how do we get the information we need when something's broken on the EHR and a nurse in the ER is the one who discovered it? We miss a lot of opportunities.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No, and it's my understanding that's the top priority in terms of getting this system functioning the way it ought to.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Technological, in that we've got both capacity and security problems; people-centric, in that we can't get the budget to solve them.

Interviewee: Jason Rodriguez, Information Systems Support Manager, Information Systems Support

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

In my area of responsibility, we meet other people's technology needs.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

I've got people allocated to each of the departmental systems, like the RIS and PACS in imaging and the PIS in pharmacy. Their main responsibility is to provide user support, and in consultation with me and Paul, do the patches and upgrades that each system needs. My responsibility is the EHR.

Question 3:

What do those systems do?

Answer 3:

They're the systems that the different departments use to keep track of their own activities, record patient data and healthcare information, and communicate those things to departments.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Well, any system can be improved. Which we do, all the time. On the whole, I'd say yes, with the exception of the EHR.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Sometimes maintaining the EHR feels like Whack-a-Mole to me. You make one department happy with a fix, then a week later some other department pops up, all upset. I try to be understanding, because I know the EHR didn't get the attention it needed in the design phase. Because of that, it doesn't map well to the way care gets delivered here…particularly the nursing workflows. But it's hard to have to explain, week after week, that no, we can't make that change this page or that template, because somebody higher up says you need to document care the way it's set up so we can document our meaningful use compliance. Or to explain that no, we can't make that change until the next version rolls out, and no, I don't know when that will be.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

My department is fine. … but only because interoperability doesn't affect us. Now, [chuckles sadly] the rest of the hospital has some issues with it.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

They're mostly process-centric, I'd say. It's not like people don't want nurses and doctors to have systems that work. It's just that different populations at the hospital have different needs, and sometimes those needs dovetail – but sometimes they really, really don't.

Interviewee: Jarvis Norwood, Chief Financial Officer, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

As CFO, I need to be able to tell the CEO and the board about our financial condition. So I need to be able to aggregate information from all over the hospital wherever it touches finances. My direct reports, Matthew Wolfe in Financial Services and Leticia Craig in Business Services, have to pull together data from every department and unit. And, of course, I need technology that will respond to queries around both our current state and our forecasts.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

Other than our accounting software, predominantly the billing and coding systems, the admissions software, and the EHR.

Question 3:

What do those systems do?

Answer 3:

The billing and coding systems give us a window into what services we're providing with what frequency, while the admissions software tells us how many patients we're seeing and where.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

I believe so. There are some other systems that aren't giving us what we need, though.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Probably Matthew and Leticia can give you a better sense of that. The one thing I do know is that they're looking into why we're seeing more billing errors, and it seems to be related to systems that don't interface with the EHR.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No, not entirely.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

I'd call the problems with the systems themselves technological, and the resistance to using them properly people-centric. Some of the billing errors we're seeing have been traced back to simple user error with the EHR.

Interviewee: Felicia Guzman, Billing and Coding Manager, Billing and Coding

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Medical billers and coders use the EHR systems to justify financial reimbursement from insurance companies and maintain a legal record of medical events. So, we need the EHR to provide a full record of patient care from tests and procedures to diagnoses. We use that record to generate the bill that's sent to the insurance provider.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

Our billing system, the EHR, and sometimes some of the diagnostic systems.

Question 3:

What do those systems do?

Answer 3:

We use the billing system to generate the bill, to ensure procedures are correctly coded, and we go to the EHR to ensure everything done has been billed appropriately. Occasionally, important information hasn't been captured as structured data because it was entered as text in the Notes field. That can cause problems.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

We do our best to make them do so, but overall, I'd say no. We spend a lot of money doing redoing things manually. The system could be catching more of these errors.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

The connection between the EHR and other systems is a big barrier. The problem is that, not being able to trust the system, we have to assume there are things being missed.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Only a million times, if by "addressed" you mean "unproductively discussed." My guess is the only thing that's going to get this hospital on the road to true interoperability is a Medicare audit.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Both. People don't make it a priority to fix the problem. The technology causes problems and people make them worse.

Interviewee: Tina Harris, Billing clerk, Billing and Coding

Question 1:

What technology do you need in order to do your job?

Answer 1:

I need coding software, billing software, claims management software, and access to electronic patient data – both administrative and medical.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR, for the most part, and of course our claims software. Less often I use the RIS, the LIS, a couple of others.

Question 3:

What do those systems do?

Answer 3:

The EHR stores all of the patient data I need – what we did, what we sent them home with, that kind of thing, and of course all their contact information for billing. The RIS stores data about images we took while they were here, and the LIS is for data about lab tests we did. But …not every test and image that gets ordered actually gets done.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

They would if people used them right.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

The biggest one is capturing everything that should get billed. In theory, every supply, every lab test, every image, every procedure should get billed to a specific patient. But a lot of supplies go missing every month. We know they came into the hospital, we know they went out to a particular room or cart, but we don't know which patient they were used for. So the hospital eats that, and the reports that show that reflect badly on me. But what am I supposed to do? Dale just shrugs his shoulders, and I'm not his boss. And he's got a point. If we don't have a process for capturing every supply, what's he supposed to do?

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Kind of. I can get what I need on patient administrative data. The EHR works just fine for that, and as long as the admissions people actually do their jobs, everything I need is usually right there. But sometimes it's faster to just call Imaging and Radiology or the lab, because their systems don't populate to the EHR. The scheduling is there – usually – but it often doesn't have enough detail. I can't just bill for an MRI; I have to be specific, like MRI, lumbar, with or without contrast. We've had some problems where we haven't billed for images correctly and had to go back and do it manually, and it's a huge waste of time.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Both, I guess. Only people can figure out a process, but in order for that information to get to me, the technology has to be there.

Interviewee: Leticia Craig, Director of Business Services, Business Services

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Well, the people in admissions need to gather all the information about incoming patients, whether they are being admitted through the ER for an emergency or for outpatient care in one of the clinics or ancillary departments. And my medical records people need to be able to access medical records and they need a way to transmit those records to the requestor.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The EHR; the other information systems throughout the hospital, such as the RIS or the PACS; and the patient scheduling software.

Question 3:

What do those systems do?

Answer 3:

The EHR captures all our patient administrative and medical information; patient scheduling communicates workflow to the different departments. Mostly these systems need to be able to capture information, store it, and then deliver it when people request information or reports.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

They do, but they don't always have the data we need in them.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I'd say the gap between use and proper use, and the gap between old systems and new ones.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No, and that's what I mean by the gap. Some of what comes out of the departmental systems makes it into the EHR, but not all of it and not always.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

The gap between old and new is technological, the gap between use and proper use is people-centric.

Interviewee: Alex Moody, Human Resources Manager, Human Resources

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

We maintain the personnel records for all permanent medical center staff. That includes payroll data, performance, training, accreditation records, and so forth. We also are responsible for maintaining job descriptions, information about staffing levels, clearances, the like. We need to have a window into what the nursing units are doing, so that we can keep staffing at the appropriate levels. With shortages in nursing, particularly in some of the specializations, that can sometimes be an issue.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The standard office tools – word processing and spreadsheets, as well as the personnel management system and the payroll and timekeeping applications. Occasionally, we might be looking at the staff scheduling software, but that's not common.

Question 3:

What do those systems do?

Answer 3:

The personnel management system does just that – it maintains personnel records, keeping track of benefit enrollment, health and life insurance, PTO, that sort of information. Scheduling just lets us know where the gaps are and what kind of certification the temps we bring in need to have.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Absolutely. We put a fair bit of time into analyzing our processes and making sure that the personnel management system we moved to would work well with those processes. I don't mean to sound smug, but we did our homework and it paid off.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

It's not so much a barrier as a redundancy which leads to errors and duplication. The medical services track accreditation, which includes certain kinds of training and documentation for licensure for the nursing staff and other health care workers. We also keep that information in the individual's personnel record. But their system is completely separate from ours. Totally stand-alone, despite my best arguments. So information is entered twice, and predictably, not everything gets communicated to us.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Well, while I know that interoperability is a major issue for IT, it doesn't affect us directly.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Both. The problem with duplicate tracking is a data governance issue. There should be one source of truth for important data and by allowing two different systems, we create problems.

Interviewee: Angela Thornton, Medical Records Supervisor, Business Services: Medical Records

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

My clerks need to be able to access and write to patient medical records, at least at the billing or administrative levels. They need a way to send the pertinent records to patients or doctors or clinics, and to limit requests from medical providers only to what the patient has granted permission for.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

They use the EHR a great deal.

Question 3:

What do those systems do?

Answer 3:

The EHR is the medical record. So, it's where all the records are maintained. It organizes all the information about a patient's care, conditions, history…. Everything. This is where anyone would go to pull patient records. Because of HIPAA regulations and the way records may need to be accessed, the EHR needs strong encryption as well as mechanisms to preclude access to identifying information – say in the case of an audit. The auditor needs to be able to access the record, but they aren't allowed to access identifying information.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Yes. The one problem I worry about is that because our system has some components that were… well, for lack of a better word, retrofitted for the Affordable Care Act … that there could be gaps in the protections that we haven't identified. As electronic medical records become more complex, that complexity makes it more possible that we have vulnerabilities that we are unaware of. The goal is to keep those records secure, and I'm not sure we're doing that. It's not that I think we aren't; it's that I don't know, and HIPAA breaches are not something you want to blunder into.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Access barriers, I guess. There are issues with EHR access and wireless devices, which some departments use. I think it was supposed to be a nod to workflow, but the devices don't always access the wireless system and that can be a problem. There aren't many departments using them – physical therapy, I know and a couple others, but they've had mixed results. Otherwise, just the standard litany of interface or interoperability issues.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

It's certainly discussed a lot, but we haven't solved all the issues around interoperability. It is a known problem that several of the applications used in the hospital do not integrate or communicate well with the EHR. So we sometimes have issues around the record not being populated with the right information or people not being able to access basic information like lab results. So… it's been discussed, but I wouldn't say it's been addressed.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Technological exacerbated by people problems. Isn't that always the case?

Interviewee: Emily Strickland, Business Services Supervisor, Business Services: Admissions

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

The admissions specialists gather information from patients as they're being admitted, or in the case of elective admissions, beforehand. If the record is being created prior to the admission, the specialists provide information to the patient. Things like what prep they should do, what they can or might want to bring, whether they should have someone with them, in the case of an outpatient procedure, for instance. That sort of thing. And often they are the ones to gather discharge instructions for the patient or the caregiver when the patient is ready for discharge.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

They're in the EHR or the patient scheduling system usually. If things are slow, the admissions specialists help with data entry, so they might be working with other systems, but the EHR is their primary tool.

Question 3:

What do those systems do?

Answer 3:

The EHR is the record for whatever patient information has been created or imported. It has to allow the admission specialist to create new information or records and it should – but doesn't – import information in from other systems.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Oh … I suppose it does.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

It's not a barrier; in fact, it's the absence of one. But I don't think enough attention is given to whether or not the EHR is secure. I carpool with one of Jason's techs. With all the new technology – tablets especially, but even laptops and jump drives – people walk out of this hospital with confidential patient records all the time. Remember that case where a contractor at a hospital in DC had his laptop stolen? He hadn't encrypted the patient data he had on it, and he had something like 34,000 files.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

It is a topic of conversation, and I know we're working on it, but I don't believe we have a solution or strategy in place yet.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

IT talks about doing a data security audit, but I think they're thinking more about hackers than about poor data practices. So I'd call it both. We don't know what we're doing and we haven't deployed the resources to find out.

Interviewee: Karen Bailey, Admissions Specialist, Business Services: Admissions Services

Question 1:

What technology do you need in order to do your job?

Answer 1:

I need access to the EHR and to some extent to the patient scheduling system.

Question 2:

What systems do you use regularly?

Answer 2:

Hands down the EHR the most, but also email and scheduling.

Question 3:

What do those systems do?

Answer 3:

I use the patient scheduling software to get patients set up in the right medical or diagnostic or therapeutic unit, and the EHR… well, that's like the master record for the patient. What I'm doing is mostly administrative, getting their information, address and date of birth and contact information and obviously insurance. Other people use the EHR for other information, but me… it's admin.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Mostly. The nurses I talk to tell me the EHR doesn't match up well with work flows … that's why most of the nurses aren't fans. There's one thing – it's only happened a couple times to me, but sometimes it freezes. You can't imagine how frustrating that can be. And of course, both times, it happened just when I'd written a bunch of information to a patient's record. All you can do is reboot the computer, but of course, you lose the whole record.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

For us, not many. It's the nurses who think of the EHR as a barrier. ER nurses in particular, talk about trying to do a bedside admission. They can't focus on both the patient and the computer – they're trying to get a history, but it's hard to be focused on the patient when you're going through all the fields and stuff. Even I have trouble with that.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Not really. I kind of hope they leave it alone, though. The patient scheduling and admissions software work. Even if they don't have all the bells and whistles I know how to do what I need to do. But a new system … I don't even want to think about how much disruption we'd be dealing with … and for what? Would it really be that much better?

Question 7:

Are those barriers technological or people-centric?

Answer 7:

The nurses would say technological; I say people. Some of the older nurses spend more time on complaining about the EHR than they do on learning how to use it better.

Interviewee: Patricia Deering, MD, Chief Medical Officer, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

In order to provide the best care, physicians and the rest of the care team need a complete patient record. Our current EHR struggles with integrating the many different kinds of information that makes up a patient record and so we continue to have health information in multiple locations – some digital and some physical. That's just not acceptable any more. We need to be able to get all the information integrated into one record. That, however, is a massive undertaking..

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

Just about all of them. Other than the personnel and payroll systems, that is.

Question 3:

What do those systems do?

Answer 3:

Broadly, they serve as the record for whatever patient information has been created or imported. They need to integrate scheduling, test results, and whatever content there is for a given patient – and they need to do it while maintaining the highest levels of patient privacy. Compliance with HIPAA guidelines is an absolute necessity. That means only authorized people are able to access records and that only the information that has been requested is delivered on the screen. So …the systems need to allow for creation of information, entering non-standard information, searching the system and some fairly robust sorting and reporting features.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

At the most basic level, yes. As well as possible, not yet. The system that I receive the most complaints about is the EHR. There are two reasons for that: One, the EHR doesn't communicate with the existing systems the way we were led to believe it would, and two, between the system outages and network slowdowns, and the substandard support we've received, the EHR simply doesn't work very well. I have to admit, I'd give anything to be able to scrap it and start fresh.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I'd say the main barrier is that the EHR interferes with how medical professionals want to do their job. The biggest complaint is that physicians, nurses … pretty much the gamut of our health care providers … feel that the EHR takes too long and interferes with patient care. Some of that, obviously, is a tendency to resist change, but for the most part it's true. The system is not user friendly and the training has been sub-standard.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No. We talk about it, but that's one of the biggest weaknesses of this system. With its inability to handle unstructured data, I don't know how they're going to resolve that issue, either.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Sadly, they're a reflection of our failure to perform due diligence. We thought we did, but we rushed into a solution and didn't get the product we needed. You can't make everybody happy all the time, but we could have done much, much better in terms of finding a system that would truly meet our needs.

Interviewee: Shawn Hayden, Chief of Diagnostic Services, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

My area of responsibility is the diagnostic departments: Imaging, lab, pharmacy, audiology, neurology. Those departments all need to be able to schedule tests, and a way to communicate the results to the doctors or other providers who need them. They need regular maintenance or replacement of the equipment they use, and a way to communicate their needs if equipment stops functioning.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

Each of my departments has its own tracking system for patients and tests, or in the case of the pharmacy, for patients and meds. These tie into the EHR so my people have to check there to see what else has been ordered.

Question 3:

What do those systems do?

Answer 3:

They take in orders and track what test or image or med is required for which patient. In many cases the actual image or test is being accomplished digitally and the results are stored within these systems.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

I'd say so. We've worked hard to get all of them working for us.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

One barrier I hear about is that people downstream can't access the results of the diagnostics. They can see that the tests are complete but they can't view the results. Digitally, that is.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No. It would be great if the PACS could dump images right into the EHR, but I can't get a straight answer on whether the EHR is just not capable of that or if that functionality will be in a later version.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Good question.

Interviewee: Charles Ortiz, Clinical Laboratory Manager, Diagnostic Services: Clinical Laboratory

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

We need to be able to order lab supplies in order to do tests; get orders from the clinical people for tests; schedule them; and communicate the results. We need an integrated way to track all that. Finally, we need to be able to install new lab equipment and integrate it with the hospital's systems, and get regular maintenance and repair or replacements when necessary.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The LIS and the EHR are probably the main systems.

Question 3:

What do those systems do?

Answer 3:

The LIS lets us track all our samples, tests, results, and related information. The EHR is the system that tells us that a test has been ordered, and afterward the EHR stores the fact of the test (although, unfortunately, not the full result).

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

The EHR doesn't, in that it provides summaries of tests done but we can't publish the results to it.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

We occasionally have people show up when there's no order in the system. I don't know how that happens, and I can usually make adjustments so the techs aren't even bothered with the confusion. But I'd really like it if that kind of thing didn't happen. We're very careful, but mistakes can happen that way, possibly even resulting in the wrong results being posted to a patient's chart.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Sort of. IT knows about the results issue, but I assume we have to wait for the next system upgrade to address it. Apart from the occasional hiccup, the EHR works pretty well for what my people need.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

I don't know. It could be a failure of those systems to talk to each other, or it could be operator error.

Interviewee: Matthew Allen, Laboratory Technician, Diagnostic Services: Clinical Laboratory

Question 1:

What technology do you need in order to do your job?

Answer 1:

The lab equipment, mostly, and then whatever systems we're entering data into from the actual analyses we've done.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR, our LIS, and and the various admin systems. I do depend on e-mail and the Internet for working with the lab in Waterloo.

Question 3:

What do those systems do?

Answer 3:

They provide information about what tests or blood draws I need to do. They contain the patient record, and the lab systems contain information about normal ranges and what out of range results indicate. Oh … and I know that billing and coding uses the EHR for billing all the procedures to the appropriate insurance or to the patient. That's a big part of what the system has to do.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Yeah… it's all actually pretty smooth. Well, except not having the full report in the EHR sometimes causes problems for the billing and coding people. They don't always have everything they need for coding the test and that can get billing kicked if they don't enter the information.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I know the billing people sometimes get annoyed that they have to track down what tests we did.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

I have no idea. That's not something I would be involved in.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Technological. It's an issue of the system the billing and coding people use not getting fed the information it needs by other systems.

Interviewee: Aaron Johnson, Pharmacy Manager, Diagnostic Services: Pharmacy

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

We need to be able to keep track of every single medication that comes into the hospital, what and how to compound them, and every medication that goes out to a medical unit. We also need to be able to communicate what medications we have on site so doctors aren't prescribing something we don't have, and to get prescription orders from the medical units.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The formulary; the pharmacy system; the EHR; and the medication management system, which is a subsystem of the main pharmacy system.

Question 3:

What do those systems do?

Answer 3:

Basically – tracking what's been ordered, where it's going and who ordered it.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

I'd say so. I wish they were more integrated with the EHR.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

They exist after my department, actually. We have no problem getting orders, filling orders, and delivering orders.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No – that's the big issue that causes problems with our system and the EHR.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

I assume they're technological. We document everything the way we're told to and I believe the units are using the EHR as intended. The systems just have compatibility issues.

Interviewee: Emma Young, Pharmacist, Diagnostic Services: Pharmacy

Question 1:

What technology do you need in order to do your job?

Answer 1:

I go to the computer to see what orders need filling, to review the patient's record and med list to make sure there are no incompatibilities, and to get instructions for compounding if necessary. We have a dispensing system here, so that technology is part of doing my job. Yeah, that's pretty much it.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR and the pharmacy information system. Oh, and the hospital's admin systems – the intranet, email, the timesheet.

Question 3:

What do those systems do?

Answer 3:

They provide information about the drugs, they maintain inventory and security controls, and they provide information about the individual patient.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Yes, I'd say so.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

None that I'm aware of personally. I mean, I know there are a slew of tech issues in the hospital, but nothing that affects what we're doing.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Now that is a problem spot… and no, it hasn't really been addressed. We're still doing too much via fax or hardcopy scrips. So, yeah, I hadn't even thought about that.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Tech, for sure.

Interviewee: Diane St. John, Chief Nursing Officer, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

All of my nursing managers need to be able to schedule 24/7 coverage for their units, and get help if their coverage isn't complete. They need to be able to see doctors' orders for patient treatment so they can deliver medications, do bedside blood draws or deliver the more ambulatory patients for lab tests or images, and check vital signs relevant to those orders. They need maintenance for whatever on-site equipment they have in their unit, including replacement or repair, and they need a way to communicate their needs beyond the routine restocking of surgical tools and supplies when they come up. They need access to discharge instructions when patients are ready to go.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The CPOE, the EHR, the patient scheduling software, and Central Supply's supply request system, whatever that's called. Oh … and the transportation scheduling system. That's an outlier, but used all the time.

Question 3:

What do those systems do?

Answer 3:

They use the CPOE to find out what meds they're supposed to be delivering and when, and the EHR to document that they did so, as well as other treatment that's been ordered. Patient scheduling tells them where patients are supposed to be or where they're going next, and of course the supply request system lets them get more antibacterial gel or gloves or whatever they need.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Some of the nurses tell their managers that the EHR works fine, and others say it's a disaster. So I guess it's in the eye of the beholder. I think so. We've worked hard to improve it. The CPOE is fine, and so are the others.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I think on-site care goes pretty well with the systems as they stand. We're not doing so well with telemedicine. Our patient satisfaction surveys on that are pretty abysmal, in fact. It's a problem for us, too, because we haven't figured out the reimbursement part yet. We can't set up all that technology and not bill for it, but the state's Medicare policies won't reimburse for anything that isn't face-to-face video interactions between patient and provider. That's one of the many services our network isn't up for, at least not consistently. So the one service where we have the worst record is the only one we can get reimbursed for – and patients don't like it because the video and audio are frequently out of sync.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

It has been addressed. It is being addressed. Not perfectly, but we're working on it.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

The network problem is a matter of bandwidth. But convincing the CEO and the board that we need a lot of infrastructure upgrades in addition to a data risk audit, better technical support, and on and on isn't easy. So is that a tech problem or a people problem?

Interviewee: Linnea Eckert, Nurse Manager, Nursing: Ambulatory Care

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

We need technology that tells us which patients are coming in and why. We need technology that keeps all the information about a patient in one place. We need technology that allows us to provide patients with instructions and guidance about their conditions. We need technology that alerts us to drug interactions or other warnings. We have all kinds of needs… and theoretically the system is supposed to help meet those needs.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The EHR, the scheduling software … some of the imaging or lab systems. That's it.

Question 3:

What do those systems do?

Answer 3:

The EHR is our repository for all patient records, including doctors' orders and such. The scheduling software tells us what patients we have and who they're seeing.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Of this department? Yes. Of individual nurses? Not necessarily.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Lack of integration is a real headache. It means that instead of having one record to go to, we have to pull records from a couple different sources. That's not always an issue, but it does interfere with workflow and efficiency. And, quite frankly, the EHR isn't easy to use. It isn't intuitive or geared to how we actually interact with patients.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

No, but we just deal with it. I know it's being discussed at higher levels.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

People-centric, I think. The technology is there, but the leadership isn't.

Interviewee: Brenda Turner, Nurse, Nursing: Ambulatory Care

Question 1:

What technology do you need in order to do your job?

Answer 1:

I need to be able to see previous notes, put in prescriptions or other orders for doctors, and document what I've done for the next nurse. What I really need is less technology and more time with the patients.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR, almost exclusively.

Question 3:

What do those systems do?

Answer 3:

For me, it's a repository for patient records and notes to nurses on the next shift. I don't know what else it does. Everything? Nothing?

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Um, no. They sure don't meet my needs, I'll tell you that.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

The problem list is a huge barrier. The CNO keeps telling us how it's the most important thing and it has to be current and accurate. I understand that, but I don't know how we're supposed to wade through all the places we have to click… drop down this and menu that – I don't know. I do try to review the problem list, because there's so much emphasis, but not understanding the system is my biggest barrier.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

That's an IT buzzword in my opinion. I'd rather we were talking about workflow, if we're going to talk about any buzzwords.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Both. The technology is horrible and people don't want to use it, and voila! Barriers.

Interviewee: Evan Schmidt, Nurse Manager, Nursing: Cancer Center

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Well, we're primarily concerned with accessing orders, since a large part of what we're doing is chemo and radiation for patients in active treatment. We have to see who is scheduled to come in for treatment, and whether it's chemo or a biopsy or surgery. We have to know as much as we can about the nature of the patient's case so we have the best chance of keeping them comfortable as they're getting treated, and to educate them about self-care. And I need to be able to schedule for coverage or request temporary staffing if I don't have enough.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

For the most part they use the EHR to review the orders and meds of the day, and to generate the case notes that tell the next nurse on shift what's been done and what needs doing.

Question 3:

What do those systems do?

Answer 3:

We get instructions for treatments, and background information from the EHR.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

The EHR, well, yes and no. It has the capacity to meet our needs, but the way it's been designed sometimes precludes that.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

It's not so much the systems as the way things are done. The problem list is a great example. I mean … obviously, the cancer diagnosis will be on the list, but there are other issues – say a problem swallowing, that come out of cancer and cancer treatments. If a patient we're seeing comes into the ER, the staff there needs to know what the current issues are for that person, not just the general diagnosis of pancreatic cancer. But if the problem list isn't completely up to date, they might miss a sign that something's going wrong. It's a missed opportunity and it's a wasted opportunity.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Not when it comes to being able to see lab or test results in the EHR, instead of having to call or e-mail or try to navigate the diagnostic systems.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

It's a little from column A and a little from column B. But probably more people than technological. It's not like it's hard to add a problem to the list.

Interviewee: Cathy Petters, Nurse, Nursing: Cancer Center

Question 1:

What technology do you need in order to do your job?

Answer 1:

My own two hands.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR. But not because I want to. I know there isn't any point to complaining, but I hate the EHR. A lot of the nurses hate that thing, and use it as little as they can. It doesn't work, the information in it is untrustworthy – at least in that it's incomplete – and we do more of our work around it than in it, if you see what I mean.

Question 3:

What do those systems do?

Answer 3:

Ask for information we don't need and throw roadblocks up that make charting take far too long?

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

It should be obvious that no, it does not.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

How about the barrier between nurse and patient? The amount of time we have to spend using technology to document what we do is starting to outstrip what we actually do. How am I supposed to make a patient comfortable or attend to her needs when I'm busy clicking boxes that show I treated her?

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Whatever. Probably not. Probably it would work better if it had, so I assume not.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

The technology itself, and being forced to use it, is a barrier.

Interviewee: Peter Boyd, Nurse Manager, Nursing: Emergency Department

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

When we treat an emergency patient, things happen fast. The diagnostic equipment plays a big part of our ability to triage and we need to be able to communicate orders for lab tests or images from the docs to those departments. We need to be able to see the results, too. We have to coordinate emergency transport and often transfer to a different unit like ICU or Behavioral. And we need to be able to communicate our needs for new equipment or repair, supplies, tools, meds, materials…you name it.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The CDS, the EHR, the MIS…most of the health information systems in the hospital at one time or another.

Question 3:

What do those systems do?

Answer 3:

CDS is clinical decision support, the EHR is the patient record, and the MIS is the Central Supply system.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Kind of. Sometimes we're not getting what we need from the CDS because the patient's problem list isn't always current. But otherwise, sure.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Other than the fact that the EHR is a train wreck, I don't see too many barriers. our needs are actually pretty simple. We treat as fast as we can, stabilize, and either let them go or send them somewhere else.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

As much as it can be, I guess. I do wish we could see not just lab tests but results in the EHR, but whatever.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Technological, I assume.

Interviewee: Ruby Martindale, Nurse, Nursing: Emergency Department

Question 1:

What technology do you need in order to do your job?

Answer 1:

Since I have to document what I'm doing, both for later nurses or docs and the meaningful use business, I need a way to do that. Preferably one that actually works, unlike our EHR. And of course I need to see the orders for the patients on my shift, including meds and if they're moving somewhere else or going home.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR, of course; the CPOE; the pharmacy's formulary. And of course, the patient scheduling software. Occasionally I'm the charge nurse for the day, so I might have to bring in temporary staff if we're short.

Question 3:

What do those systems do?

Answer 3:

They allow me to see patients' records, what tests or images have been ordered, and what meds we have on hand. The docs write the prescriptions but they need the nursing staff to know if we're out of something, or if a different medication for one reason or another is recommended. We need to stay current with the formulary, that's all.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Mostly, and when they don't, we just find a way to get it done anyway.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

I'd say the way people use the EHR is a problem, and I include myself in that. I don't feel I'm wrong to find a shortcut when I'm dealing with an emergency, but I know that billing and other departments sometimes don't have what they need because of my shortcuts. But it takes forever to get small things changed, and sometimes we have to ask repeatedly. I don't think it's Jason's fault, and he keeps us in the loop, but he can't make the vendor respond faster.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

It's not really a factor in our department, but nurses in other departments who actually have patients for longer complain about it.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Probably both. If the technology doesn't work, people are going to work around it. Which is going to get us in trouble. We got chosen for one of those meaningful use audits, and I hear that the administrators are finally seeing how wide the gap is between how we care for patients and how we click boxes in the EHR.

Interviewee: Stephanie Foster, Nurse, Nursing: Emergency Department

Question 1:

What technology do you need in order to do your job?

Answer 1:

Not much.

Question 2:

What systems do you use regularly?

Answer 2:

I guess I use the EHR the most, followed by the diagnostic services' databases when I have to.

Question 3:

What do those systems do?

Answer 3:

The EHR is the chart, the patient's record. It keeps the charting we do, the orders, test results, that sort of thing. The Diagnostics Services System's IU is for getting results on diagnostics that were ordered... or for historical information.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

I guess.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

It's too hard to get the good drugs! [Laughs.] Just kidding. No, things work fine, I guess. We move patients in and then we move 'em out. Staffing can be a problem, but... I don't know if that's what you mean.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

I don't know. I guess so.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Admin-centric! They're so worried about budgets that they'd rather stretch coverage thin and maybe kill someone than spend the money for more nurses.

Interviewee: Debra Green, Nurse Manager, Nursing: ICU

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

In the ICU we need significant monitoring for people whose conditions are acute – heart monitoring, repeated blood tests for a whole range of stuff, that kind of thing. So we need more monitoring technology than the other nursing units have, and we probably need to generate more orders for tests or images. Other than that, we have the same needs the other nursing units have: scheduling, supply ordering, maintenance, etc.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

Mostly the EHR, and of course Central Supply's system. We can't look at their inventory, but we can request what we need through the clinical-facing side of their system.

Question 3:

What do those systems do?

Answer 3:

The EHR captures patient data, and Central Supply's system tracks our requests for sterilized tools or syringes or whatever we've run out of.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Sort of. The problem list often isn't updated when we see patients. Maybe they've got angina on their list when they come in for a heart attack, but they don't yet have myocardial infarction on there.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

There are times when we can't even log on to the EHR, never mind add to it. It's not often, but it does happen. Jason tells me it's an infrastructure problem; we got all this money for installing an EHR and didn't spend it on the network capacity to make it work optimally.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

I've heard they want to integrate the telemetry and other monitoring equipment with the EHR, but good luck with that. It can't even hold test results and they want to add cardiac monitoring data? Please.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

I'd say people-centric. Support is really slow, and when the problem is something more substantial, all we hear is that it's on the list for the next update. Which, who knows when that's coming out?

Interviewee: Beverly Marshall, Nurse Manager, Nursing: Medical/Surgical

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

We need monitoring equipment for diabetic complications – we see a lot of diabetics –telemetry for cardiac patients, and equipment for treating people whose emphysema or other COPD problems are acting up. We liaise with Respiratory Therapy a lot so we need to communicate with them regularly, and with the pharmacy for refills on inhalers and such. Then like probably every other nursing unit, we need to read orders, document care, and do charting.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The EHR, the scheduling system, and the pharmacy, mostly.

Question 3:

What do those systems do?

Answer 3:

They all track various aspects of patient care. The EHR is the central point for patient information, but because we have some older systems that aren't interfaced well with the EHR, there's more than one central point.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Basically, they do. They could be better, but they meet our needs.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Buy-in – from leadership and also from the nursing staff. That's the biggest problem, in my opinion.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Not at all.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

People-centric. Well … the technology is going to throw some people, but the barrier to success is that we don't have a clear strategy for implementing an informatics-based practice.

Interviewee: Heather Taylor, Nurse, Nursing: Medical/Surgical

Question 1:

What technology do you need in order to do your job?

Answer 1:

Mostly just the CPOE, EHR, and scheduling software.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR is probably what I use the most, for patient records and orders and other information.

Question 3:

What do those systems do?

Answer 3:

The CPOE tells me the orders, the scheduling software tells me who's coming in and where they're headed.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

The CPOE and the scheduling software do. The EHR does not.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

How about the huge gap between the EHR and the real world? I can't tell you how useless it is. It doesn't help that nobody likes it, because that means nobody bothers to use it and I have to track down orders or notes. But it also doesn't follow the flow of our work, and it takes so much time to get to the right pages that it takes me away from the most important thing, which is caring for my patients. We're not treating skin rashes or broken fingers here. We're helping people who have had strokes, heart attacks, head injuries, you name it. I'm supposed to spend valuable time checking boxes and clicking the Next button when I could be helping someone to get better?

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Couldn't tell you. In my opinion, none of it works together the way they said it would.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

People-centric, in that we're stuck using this thing that's so poorly designed and all we get when we complain is talk of meaningful use. What about meaningful treatment??

Interviewee: Portia Murphy, Nurse Manager, Nursing: Women's Health

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Well, we need ultrasound equipment for ultrasounds, fetal monitoring equipment, various other OB/GYN specific equipment. In terms of the information systems, we need to be able to coordinate with the delivery suite scheduling and the ORs, so we need to connect with the scheduling systems… other systems around staffing, supply coordination, lab test results, and image results.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The EHR, the patient scheduling system … and all the information systems that aren't 100% part of the EHR like the lab or imaging.

Question 3:

What do those systems do?

Answer 3:

Capture data that we're entering about patients, provide information about bed availability or openings in other clinics or services; provide information about the patient's course of treatment – what was done and when; and what the results were.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

For the most part, yes. I know the hope is that we can get the whole system working as one, but overall, I think we're doing well.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Well, the more we see a particular patient, the more cluttered the problem list gets in the EHR. And that's a problem. I consider that a people problem – we don't have a good process for keeping it up to date.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Somewhat, but we still can't just go to the EHR for everything, which is the ultimate goal – one patient, one record is the mantra from another hospital I've worked with and it's a good goal.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

I'm tempted to say technological, because I know the EHR is hard for a lot of people to use. But I think it's people-centric.

Interviewee: Elizabeth Velasquez, Nurse, Nursing: Women's Health

Question 1:

What technology do you need in order to do your job?

Answer 1:

The EHR. That's the patient's chart and so it's central to my work. I mean … do I need it to provide nursing care? Probably not, if I wanted to play devil's advocate, but in this day and age, it's not realistic to say that nursing can cut itself free of technology and go back to pen and paper.

Question 2:

What systems do you use regularly?

Answer 2:

The EHR, every single day and then the imaging systems … the RIS and PACS fairly often. The scheduling software and the hospital intranet – the timesheet.

Question 3:

What do those systems do?

Answer 3:

The EHR has all the patient data – history, care notes, meds, labs, you name it. That's the patient chart. The RIS and PACS have any imaging that's been done. The other systems I mentioned, they're administrative systems – I go to them to get my schedule, to enter my time, that sort of thing.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

I guess so. Not well, but I suppose the EHR does meet the basic needs. It's just frustrating to have technology getting in the way of delivering care and interacting with people.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Support and training. Jason does his best and he's walked a lot of people through a lot of stuff, sometimes more than once. But he has a hard time getting a response from the vendor on more complicated problems. And the training we have is optional – if you have questions, there are self-paced modules available, but who has time to sit and do some online training? If we are going to use these systems, we really should be getting the training needed to understand all the capabilities of the software … and, in an ideal world, we'd have some way to contribute to discussion of how we do our work and how the EHR could help without getting in the way.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Forgive me, but it seems like interoperability is more of a buzzword than anything else. I know that we have trouble importing records from outside our system, so we just have the record faxed over or scanned and sent that way. But when that happens, the records come in as images, so our EHR can't extract any data from them. Technically they've addressed it, I guess, but there aren't any solutions that I know about. We just work around it and waste time, which I guess they're fine with.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

People. Even an imperfect system can work if people know how to use it – and even the perfect system won't if they don't.

Interviewee: Gabrielle Grayson, Informatics Nurse Manager, Nursing: Nursing Informatics

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

I need the systems to produce reports on the queries I present. As long as it does that, I can do my job.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

Primarily the EHR and the underlying database.

Question 3:

What do those systems do?

Answer 3:

The EHR is the repository for the patient record… so, basically (and this is where I show my lack of tech knowledge) it's a big database. At least from my perspective.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Yes, basically. We're always working on tweaking it so we can be doing different kinds of analysis, but yes.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

Getting the units to see the value in data analytics is my biggest barrier…but we're getting there. Certainly in terms of newly minted nurses, there's more understanding of how data can improve our clinical practice.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

Everyone seems to know it's a problem, but we haven't really turned the corner on solving it.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Ultimately, I'd say it's people-centric with technological ramifications. These are problems that can be fixed, but we need a stronger strategic direction if we're going to solve it.

Interviewee: Anne Berg, Chief of Therapeutic Services, Leadership

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Sometimes, the therapy departments need decision support when they're handling tougher cases. Otherwise, they need the same patient scheduling, supply request, and equipment maintenance systems that other departments probably do. They need to interface with Billing and Coding to make sure all their therapies are getting appropriately charged. Respiratory Therapy needs the treatment equipment for COPD problems.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

The EHR is the main one. Some of them use our decision support software, but not too many.

Question 3:

What do those systems do?

Answer 3:

They document treatment and progress in the EHR, and provide help on more difficult cases with the decision support software.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

They do when they're accessible!

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

There's a bit of a problem in physical and occupational therapy. When it comes to the standard involving routine reporting of clinical quality measurements, we're not hitting the sweet spot on our documentation. I know therapists are asking patients how they're doing in each appointment, but they're not capturing it in language that works for meaningful use. It's a slow process to get medical professionals to do anything differently.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

It hasn't been a factor for my departments.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Both, I guess. People resist doing anything new unless they buy into the reason why, and the therapists are more focused on how they treat patients and interact with them. I can't fault them for that. These are educated people with tons of experience and you can't just push them around when it comes to patient care. But we have to have them update the problem list and document their care in a way that actually complies with the new standards. And we have to make it possible for them to do that easily. That is, if we give them a tablet to help them document it, it has to connect to the EHR in their offices and not lose the signal when they walk into the main treatment room! If the technology doesn't work for them, we need to change the technology.

Interviewee: Dale Ashmore, Central Supply Manager, Operations: Central Supply

Question 1:

Tell me a little about the technology needs of your area of responsibility.

Answer 1:

Ordering and inventory… that's it in a nutshell, right? Security, too, I suppose. There's a lot of stuff here we don't want just wandering off in someone's backpack at the end of a shift. Sharps and expensive equipment … yeah, so inventory control is big.

Question 2:

What systems are used regularly by the people in your area of responsibility?

Answer 2:

We've got a materials information system and a cart inventory management system, and of course our ordering software.

Question 3:

What do those systems do?

Answer 3:

The MIS handles our inventory for what we're ordering and distributing, and the CIMS tracks where people need supplies and where we've sent them.

Question 4:

Do those systems meet all the needs of this department?

Answer 4:

Yeah, I think we're in good shape overall.

Question 5:

What barriers exist either within the systems themselves or the way things are done in your department?

Answer 5:

We're good. We get the supplies and the surgical tools to people on time, and we have a good turnaround time when one of the services needs more of some item or needs something outside of the routine. Billing and coding has a problem, though, and they need to solve it.

Question 6:

Has interoperability been addressed in terms of your department's needs?

Answer 6:

That comes up a lot when we're talking about these billing problems, but I'm not sure that's the issue. Maybe. It's sort of more an IT issue than a materials issue.

Question 7:

Are those barriers technological or people-centric?

Answer 7:

Let's say technology. I mean, why not? I don't want to point fingers at anyone in particular, even if Felicia does try to throw me under the bus whenever she can.

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