Health Care Information Management

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P r i n t

MHA Vila Health™ Activity

Information Systems Interfacing and Interoperability

Vila Health Challenge Information Systems Interfacing and Interoperability Email #1 PDF Document Interview Selection Email #2 Conclusion Credits

Vila Health Challenge

Analyze the key characteristics of di�erent health information management (HIM) systems, including applications, department-speci�c functions, and capabilities. Accurately identify the components, infrastructure, and investment needs for the HIM systems at each hospital. Accurately identify the pros and cons of maintaining the current systems, interfacing the current HIM systems, or replacing all systems with a single new HIM system. Make recommendations based on best practices in HIM, supported by current literature.

Health care organizations use many types of information systems in addition to electronic health record systems. These systems enable providers and professionals to access and analyze needed data and to exchange data with each other in the process of providing health care to patients. Because data exchange is a crucial part of treatment and many other operations at healthcare organizations, the degree to which information systems interface and interoperate with each other is crucial to the delivery e�cient, e�ective health care.

In this activity, you will practice researching the information systems at one of Vila Health's hospitals, and determine the degree of interoperability between those systems. You will analyze whether one hospital's systems are su�ciently interfaced and interoperable, or whether upgrades are needed to those systems. You will make recommendations, based

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on information about Vila Health's newly acquired hospitals, whether those hospitals should be transitioned to the current hospital or left on their old platforms.

Information Systems Interfacing and Interoperability

Vila Health is a medium-sized system of health operating facilities in the Minnesota and Wisconsin area. They have recently acquired two smaller systems: Delaware County Regional Health System and Red River Rural Health System. The leadership teams from all three organizations are now focused on providing a smooth transition for both sta� and patients.

St. Anthony Medical Center is considering whether to invest in interfacing its current health information management (HIM) systems. Determining the hospital's current HIM state will be essential to deciding whether to transition the newly acquired hospitals to Vila Health's system before or after interfacing the current system.

Email #1

HIM Transition Team From: Evelyn Unger, HIM Transition Team Project Manager

Hello again! I hope your Independence Medical Center site visit went well. From what the transition team tells me, they're sending you o� to St. Anthony Medical Center to �nd out about the state of interfacing between the di�erent information systems.

From what I understand, that hospital is already considering whether to leave things as they are, with point-to-point interfaces between pairs of systems, or to invest in an interface engine that will take incoming tra�c from all systems and translate it so that all systems are able to talk to each other. So the transition team needs to know whether they should proceed with the interface engine. They need to make the decision about whether to transition the new rural hospitals o� of their old systems and onto the one at St. Anthony Medical Center, or to leave them on their legacy systems, so be on the lookout for information that would apply to that decision.

The department heads and other leaders at the hospital are happy to talk to you, so just let me know who I need to follow up with to get some interviews scheduled.

Evelyn

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About Us

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Recognized both nationally and locally for its expertise and dedication to patients' health, St. Anthony Medical Center is a key element in Vila Health's mission to be the premiere system of health in the Twin Cities metro area. We work with over 150,000 individuals each year as they face illness and other challenges to their health and wellbeing. We o�er not only the traditional specialties you would expect from a state-of-the-art healthcare facility but also complementary or alternative services you can't get anywhere else. We are consistently ranked as one of U.S. News & World Report's Best Hospitals in the U.S.

Our Services Whether patients need inpatient care, outpatient treatment, post-surgical care, or behavioral health services or referrals, St. Anthony Medical Center can help. We o�er the following services and many others:

AIDS/HIV care Cardiac/vascular care Endovascular care Integrative health Joint replacement Kidney care Mental Health Neurological care Oncology Orthopedics Reproductive medicine

Leadership President: As president and CEO of St. Anthony Medical Center, Geo�rey Vaughn oversees St. Anthony's strategic direction by working with the Board of Trustees to shape and implement the mission and values of the Vila Health organization within St. Anthony Medical Center's entire system. CFO: Owen Welch oversees all hospital �nancial matters, including revenue cycle, supply chain, �nancial planning, accounting, taxation, reimbursement, and contract negotiation and management. Vice President of Operations: Carla Neustadt brings over 25 years of health care leadership to her role as Vice President of Operations. Responsible for both logistical and administrative operations, Carla has led key initiatives in upgrading St. Anthony Medical Center's ability to maximize the e�ectiveness, security, and integration of electronic health record and business information systems. Vice President of Medical Support Services: Christopher Hewitt oversees the administrative and management support services, which provide support with credentialing, continuing medical education, orientation, and other related policy, regulatory, and legal requirements in support of not only the medical sta�, but also our nursing and allied health professionals. Vice President of Medical Services: Harold Liss provides oversight and guidance to the inpatient and outpatient clinical services found at St. Anthony Medical Center. Harold brings a deep knowledge and understanding of best practices to the role. He has been particularly involved in supporting the integration of electronic health records at all levels of St. Anthony's medical services.

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Director of Clinical Operations: George Fink oversees diagnostic and therapeutic services at St. Anthony Medical Center, which includes diagnostic services such as clinical or pathology laboratory services as well as therapeutic services such as physical, occupational, or speech therapy. Vice President of Specialty Services Bringing over 30 years of health care experience to the position, Thomas Hayes helps ensure that St. Anthony's Centers of Excellence and other specializations deliver exceptional quality of care, comprehensive services, and an indisputably patient- centered system of health.

St. Anthony Medical Center Foundation With the generous charitable gifts of donors across Minnesota, St. Anthony Medical Center Foundation invests in medical advances, technologies, and facilities, and funds new programs for the overall wellness of patients and the community at large.

Donors may make an unrestricted gift, or if they prefer, the following programs and centers can be targeted for donor gifts:

The Institute for Alternative Medicine: The Institute o�ers alternative treatments like reiki, massage, acupuncture, and others to patients who want to reduce their stress, diminish their symptoms, and heal faster after surgery or other treatment. The Bariatric Surgery Center: The Bariatric Surgery Center at St. Anthony's Medical Center o�ers hope to patients who have struggled with obesity and weight loss, in the form of surgical options like gastric banding and gastroplasty. As a Bariatric Surgery Center of Excellence, our medical and surgical teams work with patients to create a comprehensive solution to weight-loss. The Cardiovascular Center: Using cutting-edge diagnostic equipment and treatments, the Cardiovascular Center is the premier choice for patients with a wide variety of heart or vascular conditions or disease in the Twin Cities metro area. Clellan Card Cancer Center of Excellence: Drawing from a broad team of cancer specialists, the Clellan Card Cancer Center strives to provide the best and most advanced care possible for our patients, to access and contribute to the latest scienti�c knowledge, and to translate that knowledge into demonstrably improved experiences for our patients in the Twin Cities, Minnesota, the Midwest, and the world. Diabetes Care and Education Institute: St. Anthony Medical Center's Diabetes Care and Education Institute is a recognized leader in innovation around diabetes treatment, management, and education. With a focus on creating a system of health in which the patient is an active agent in his or her care, the Diabetes Care and Education Institute focuses on creating strong links between the latest research and day to day diabetes care and education.

Medical Services St. Anthony Medical Center provides a full range of inpatient, outpatient and emergency care services more than 135,000 patients annually. Founded in 1913, St. Anthony Medical Center has been serving the Minneapolis/St. Paul and surrounding communities for over a century. We employ more than 1150 people and o�er a wide variety of medical services to our patients.

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Medical interventions Our highly experienced and quali�ed team of board-certi�ed specialists o�ers informed consultation and state-of-the-art treatments to residents of the Twin Cities and greater Minnesota. Heart and vascular care, neurological care, orthopedic care, and many other specialties are available at St. Anthony Medical Center. For every major organ and organ system, we strive to provide a system of health by o�ering the tools and knowledge patients and their families need in order to be active participants in determining the best outcomes for their circumstances. Rehabilitative interventions Our world-class Rehabilitation Services include comprehensive rehabilitative consultation and treatment for both short-term and long-term conditions and disabilities. This includes both inpatient and outpatient physical therapy, occupational therapy, speech therapy, amputee rehabilitation and more. Specialty services As part of our commitment to providing the best treatment options and a holistic patient experience, St. Anthony Medical Center's specializations o�er innovative medicine and compassionate care to the patient, family and other involved individuals.

Medical Services: Inpatient Clinics St. Anthony Medical Center is part of the Vila Health system of health and is committed to meeting patients where they are in the health continuum. Whether you are facing serious medical challenges or seeking ways to improve your current health, St. Anthony Medical Center and Vila Health want to be your partners in meeting your health needs.

Specializations:

Behavioral: As part of the Vila Health system of health, St. Anthony Medical Center o�ers access to a wide range of services designed to meet immediate and long term needs. Our sta� will work with you to create a treatment plan designed for your needs and circumstances.

Behavioral Health St. Anthony Medical Center takes pride in its compassionate, educated approach to all types of behavioral health needs. Patients who su�er from eating disorders, psychiatric conditions, chemical dependency or abuse, and co-occurring disorders have found relief at St. Anthony Medical Center.

Assessment. We provide phone or in-person assessment for patients who come to the Emergency Room, 24 hours a day, 7 days a week. We assess each patient's need and create a care plan that may include any or all of the following. Inpatient treatment. Adults, adolescents and children can get treatment from our on-sta� psychiatrist, psychotherapists, chemical dependency counselors and other helping professionals, such as:

Group, individual and family therapy Medication management Crisis services After-care planning Substance abuse assessments

Network: As part of the Vila Health system of health, St. Anthony Medical Center o�ers access to a wide range of services designed to meet immediate and long term needs. Our

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sta� will work with you to create a treatment plan designed for your needs and circumstances.

Emergency Department St. Anthony Medical Center is a Level I trauma center with facilities for responding immediately to cardiovascular emergencies, neurological emergencies, and all manner of health crises, from prevention through rehabilitation. Our Emergency Department's professional medical and health care workers responds quickly to each emergency, including but not limited to:

Broken bones or dislocated joints Severe pain, particularly in the abdomen Persistent or severe chest pain Di�culty 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

For conditions that require immediate but not emergency attention, you are encouraged to utilize our Urgent Care Clinics, located in and around the Twin Cities and the surrounding communities.

Endocrinology

The diagnosis and treatment of metabolic disease is the province of St. Anthony Medical Center's Endocrinology clinic, and our endocrinologists have the experience and training to identify, diagnose, and treat a wide variety of metabolic and endocrine disorders.

Diabetes The most well-known and common metabolic disorder is diabetes, and our physicians work with nurse and dietitian educators to not only treat patients but also educate them in how they can treat themselves and improve their blood glucose management with changes in their diet and lifestyle. For patients who require insulin to manage their diabetes, the care team teaches patients about their disease and how to use insulin, count carbohydrates, and use an insulin pump. Non-insulin patients receive education about managing their weight and glucose, and any medications that their physician recommends. Metabolic Bone Disorders For patients with metabolic bone diseases like osteoporosis, our physicians collaborate with primary care doctors to diagnose and e�ectively treat these conditions. Dynamic endocrine testing is available on site, and the clinic has the capacity to administer intravenous therapies or other drug infusions on site as well. Tumors For patients who are diagnosed with thyroid, parathyroid, or adrenal tumors, our endocrinologists will consult with the patient's primary care doctor and with surgeons at St. Anthony Medical Center to determine the best course of treatment.

St. Anthony Medical Center's Diabetes Care and Education Institute is a recognized leader in innovation around diabetes treatment, management, and education. With a focus on creating a system of health in which the patient is an active agent in his or her care, the

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Diabetes Care and Education Institute focuses on creating strong links between the latest research and day to day diabetes care and education.

Geriatric

For specialized elder care for the whole patient, St. Anthony Medical Center's Geriatric Services o�er treatment and care for the conditions that often accompany aging. Our medical sta� and health care professionals have extensive experience with the problems of aging, including immobility, speech di�culties, cognitive limitations, and other special concerns that aging patients often present with. The clinic o�ers primary care, consultation and education about speci�c conditions, and other medical services to seniors. For seniors who need referrals for skilled nursing facilities, the clinic helps to coordinate care with physicians at those facilities.

Maternal and Fetal Medicine

The miracle of life can sometimes need a little help. At St. Anthony Medical Center's Maternal and Fetal Medicine department, we o�er the best and most comprehensive care for pregnant women and their unborn babies, from conception to newborn care. Perinatologists at the clinic work hand in hand with patients' trusted OB/GYN or primary care physicians. Among the services we provide are:

Preconception care Genetic counseling Prenatal diagnostics Ultrasound Specialized testing First trimester screening

For mothers and unborn babies facing complications, our medical sta� has extensive experience and can support families through a broad variety of needs that may occur during and after pregnancy and childbirth.

Medical/Surgical

St. Anthony Medical Center's medical/surgical unit cares for patients who no longer need to be in the Emergency Room, post-op care, or other acute care units, but who need more recovery time or treatment before they can be discharged.

Services available in the medical/surgical unit include:

Bedside physical therapy Cardiac monitoring Post-surgical observation Post-trauma observation Occupational, speech, and massage therapy Specialized wound care Rapid response to dramatic changes in heart rate, breathing, blood pressure, or other vital signs

The unit's nursing sta� provide these and other services to patients who have chronic conditions, recent trauma, or recent surgeries or procedures.

Nephrology

As diabetes and high blood pressure become more common, problems of the kidney do too. Nephrologists, nurses, dietitians, and other medical and healthcare professionals

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coordinate care and education for patients who present with kidney issues. With on-site diagnostic tests such as glomerular �ltration rate, urine protein, or albumin-to-creatinine ratio testing, St. Anthony Medical Center nephrologists can determine the best course of treatment for patients who present with kidney problems.

Neurology

For patients with diseases or injuries of the brain, spinal cord, or central nervous system, the neurologists at St. Anthony Medical Center have the experience and rigorous training to provide the best in diagnostic and treatment. Our neurologists can diagnose and treat a broad array of neurological disorders, whether patients su�er from movement disorders, migraines, dementia, cognitive de�ciencies, or other brain-related problems. The treatments they o�er include:

Botox injections for movement disorder Baclofen administration via pump therapy Nerve conduction testing Deep-brain stimulation Vagal nerve stimulation Tissue plasminogen activator (tPA)

After assessment and evaluation, St. Anthony Medical Center's neurologists will design a care plan that includes all necessary treatment, recovery, and follow-up care. For those patients with brain or spine tumors, they coordinate treatment plans with the Cancer Center. Our on-site diagnostic technologies for neurological disorders include:

CT scanning PET scanning PET scanning EMG (electromyography) EEG (electroencephalography) MRI (magnetic resonance imaging) Evoked potentials Myelogram Ultrasound

Operative Services

St. Anthony Medical Center o�ers a wide range of surgical care. Our surgeons are board certi�ed and represent the best that the Twin Cities medical community has to o�er.

Among our surgical specialties are:

General surgery Trauma surgery Neurosurgery Gastroenterology Cardiovascular Ophthamology Oral and maxillofacial Cancer Spine and peripheral surgery Orthopedic Surgery Pulmonology Transplants Urology

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Gynecology/obstetrics Bariatric surgery

We provide elective and emergency surgeries for children and adults in our six-operating theater suite. Each patient receives expert pre-op consultation and care, as well as post-op and medical/surgical care if more recovery time is needed. The hospital's pre-op nurses coordinate each 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.

Orthopedics

Patients with musculoskeletal conditions like arthritis, joint injuries, and bone fractures can get top-notch care at St. Anthony Medical Center's Orthopedics clinic. The clinic has 36 private rooms for patients recovering from knee or hip replacements, and the clinic o�ers hand/elbow, foot/ankle, and other orthopedic care. For patients who require joint replacements (conducted by St. Anthony Medical Center's Operative Services), the clinic o�ers group therapy and activities, because research has shown that support is critical to successful healing after a joint replacement. The hospital's physical therapists and occupational therapists deliver therapeutic treatment and education at the bedside, and can continue to deliver therapy and home exercise programs after the patient has been discharged.

Among the procedures our orthopedists can perform:

Knee replacements Hip replacements Total, partial, and reverse shoulder replacements Hip resurfacing Pain management Endoscopic surgeries Carpal tunnel release Hand and wrist fracture treatment Foot and ankle fracture treatment Morton's neuroma excision

Pulmonology

The Pulmonology clinic at St. Anthony Medical Center o�ers comprehensive care for patients with lung diseases and breathing conditions. The diagnostic and therapeutic capabilities of our care team, which includes pulmonologists, a chest radiologist, and two lung cancer experts, are known across the Twin Cities and Minnesota. The care team evaluates each patient and uses the following diagnostic tests to determine their condition and the best course of action for improved breathing or lung health:

Cardiopulmonary exercise tests Exercise stress tests Heart catheterization Methacoline challenge tests Pulmonary function tests Sputum induction

Our pulmonologists are skilled in traditional pulmonological procedures but have also studied interventional pulmonology, a relatively new and less invasive set of diagnostic and therapeutic procedures. These procedures include:

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Airway stent Balloon bronchoplasty Bronchoalveolar lavage Flexible or rigid bronchoscopy Indwelling pleural catheters Pleurodesis Pleuroscopy Thoracentesis

The team works with the hospital's Respiratory Therapy department to coordinate immediate and ongoing care for patients with lung and other breathing problems.

Reconstructive surgery

Patients who survive traumatic and disease-related injuries often need reconstructive surgery to restore the a�ected area to normal (or close to normal) appearance or function. For these patients, the expertise of St. Anthony Medical Center's reconstructive surgeons is often the best answer.

Some of the most common reconstructions conducted at St. Anthony Medical Center are:

Breast reconstruction: for patients who have a congenital condition that requires reconstruction, or for patients who have had a mastectomy due to a cancer diagnosis. Cleft lip and palate reconstruction: for pediatric or adult patients with cleft lips or malformed palates. Craniofacial reconstruction: For patients who have su�ered damage to the head or face, usually in traumatic injuries, or patients with congenital facial deformities or tumors. Hand and wrist reconstruction: for patients with damage to arteries, nerves, veins, or the musculoskeletal structure of the hand or wrist from repetitive stress, injuries, osteoarthritis or rheumatoid arthritis.

Stroke Care

From the emergency event to restoring to the fullest functioning possible, St. Anthony Medical Center has the expertise and technology to handle strokes. Our Emergency Room is equipped for immediate response to a stroke, including intravenous medication and 24/7 availability of hospital neurologists who specialize in stroke. Treatments like clot removal, and cerebral angioplasty are immediately available, and the hospital's imaging department is available 24/7 to create images that help with diagnosis, not only of the immediate problem but also contributing factors. Once the patient is stabilized, neurologists coordinate a plan of care with the patient's primary care physician and other specialists at the hospital. This might include further treatment, such as stents or other interventions to address narrowed head or neck arteries. Physical, speech, and occupational therapy are available at the bedside and on site so that rehabilitation begins the moment the patient is ready.

Urology

Urinary troubles can create havoc in a patient's life, and the most advanced treatments and interventions for common urological problems are available at St. Anthony Medical Center's Urology clinic. Men and women with urological disorders can �nd relief from their conditions from the on-sta� urologists at the clinic. Among the more common conditions we treat are:

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Genitourinary cancers Kidney and bladder stones Voiding dysfunctions and incontinence Prostate-related diseases (e.g. cancer and enlarged prostate) Neuro-urology Female urology Erectile dysfunction Urinary tract infections Inguinal hernia

For prompt diagnosis of presenting conditions, the clinic has on-site capability for tests like X-rays, CT scans, blood tests and urine tests. Whether the needed intervention is surgical or pharmacological or both, our highly quali�ed urologists will work with primary care physicians and any other needed specialists to treat the problem e�ectively.

Vascular Medicine

Aneurysms, varicose veins, and deep vein thrombosis are all examples of vascular diseases that can be treated at St. Anthony Medical Center's Vascular Medicine clinic. These diseases can a�ect many systems of the body but are primarily problems with veins, arteries, lymph vessels, and the blood. Specialists in the Vascular Medicine clinic can collaborate with cardiovascular and other specialists to make sure that each patient's condition is accurately diagnosed and appropriately treated with the most advanced interventions available. They con�rm their diagnosis or theory with diagnostic tests such as:

CT scans Abdominal aortic ultrasound Carotid artery ultrasound Peripheral arterial evaluation Peripheral venous evaluation

If blockages or narrowing of vessels is causing other symptoms, physicians will use such treatments as angioplasty or stenting. They also educate patients about any lifestyle changes that could help ameliorate the condition.

Medical Services: Outpatient Clinics Allergy and Asthma

Allergies, asthma, and other immune-related problems meet their match at St. Anthony Medical Center's Allergy and Asthma clinic. Our board certi�ed allergists work with each patient to minimize symptoms and determine their source, then create a detailed care plan to address the cause.

Allergies St. Anthony Medical Center allergists will test patients experiencing allergies to determine which allergens are causing their symptoms, then inform them about their best options, whether it's a course of allergy shots, recommended changes in lifestyle or environment, or changes in diet.

Asthma

St. Anthony Medical Center's physicians work with nurses and respiratory therapists to help patients understand how asthma works, the signs, triggers, and symptoms to watch for, and ways to control asthma once episodes begin. They also consult with the Emergency Room to treat patients who present with severe asthma symptoms.

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Immunology For patients with disorders related to their immune systems, the immunology team works with other disciplines to diagnose such conditions as:

Immunode�ciencies Crohn's disease Osteoporosis Rheumatoid arthritis Lupus

Audiology

Di�culties with hearing can be isolating, and St. Anthony Medical Center's Audiology department has the experienced, board-certi�ed audiologists and diagnostic equipment to treat patients with a wide variety of hearing disorders. Our audiologists evaluate each patient to determine whether the cause of the hearing loss is congenital or acquired, and what treatment or treatments will help to correct the problem. The department's state-of- the-art equipment allows pure tone air and bone conduction testing, otoacoustic emissions testing, tympanometry, acoustic re�ex testing, and more.

Among the services our audiology department provides are:

Adult hearing evaluations Pediatric hearing evaluations Otoacoustic emissions testing Auditory processing assessments Tinnitus evaluation

St. Anthony Medical Center does not provide hearing aids, but provides patients with referrals to local providers.

Dermatology

For common and uncommon skin problems, St. Anthony Medical Center's Dermatology clinic has state-of-the-art treatment facilities and experienced dermatologists who can handle simple to complex conditions for adults and children. Besides treating common problems such as rosacea, dermatitis, acne, and the like, dermatologists are also expert at determining whether a troubling skin spot is actually skin cancer. If a patient gets a diagnosis of skin cancer, the dermatologist will work with the patient's primary care doctor and, if needed, other St. Anthony Medical Center specialists for comprehensive care.

Ear, Nose, and Throat

St. Anthony Medical Center o�ers comprehensive care for disorders of the ear, nose and throat. Not only do our ear, nose, and throat (ENT) physicians have extensive experience and training in diagnosing and treating these disorders, they have a wealth of consultative experience to draw from other departments, including Audiology, Reconstructive Surgery, Allergy and Asthma, Sleep Medicine, and more. Among the conditions our ENT physicians treat are:

Hearing loss Dizziness Balance issues Nose and sinus disorders Larynx disorders Lesions or tissue masses in the head and neck

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Sleep apnea

Our ENT physicians are skilled in diagnostic testing and treatment of these disorders. The clinic features advanced equipment for balance testing, MRIs, electrocochleography, electroencephalography, scratch-and-sni� testing for smell and taste disorders, and many other diagnostic tests. After diagnosis and/or treatment, physicians will make referrals for speech therapy, swallowing therapy, sleep studies, or other needed services to make sure the patient makes the most complete recovery possible.

Internal Medicine

The Internal Medicine clinic focuses on the prevention, diagnosis, and treatment of adult diseases, and St. Anthony Medical Center internists have a long course of study in adult medicine. Clinic sta� include internists and residents who are rotating through the clinic. They work with nurses, social workers, and physical therapists at the hospital and elsewhere to coordinate the best possible care for adult patients who are at least in their teens.

Each of our internists has spent at least three years learning about diseases that occur in adults. They act as primary care doctors, seeing patients for ordinary preventive care as well as conditions that need treatment.

Our internists and residents treat patients for a wide variety of conditions, including common ones like:

Hypertension (high blood pressure) Diabetes Cardiovascular disease Osteoporosis Chronic pain Migraine

Podiatry

For patients with disorders, congenital conditions, and injuries of the foot and ankle, St. Anthony Medical Center's Podiatry clinic o�ers state-of-the-art diagnosis and treatment. Our podiatrists have the skills to diagnose many foot-related problems and to deliver the appropriate treatment, whether surgical or nonsurgical. They create a plan of treatment and recovery, and coordinate with physical therapists at the hospital to direct the patient's rehabilitation. For more complex treatments or conditions, our podiatrists can consult with orthopedic and other surgeons at St. Anthony Medical Center as necessary, or refer patients to the hospitals Prosthetics and Orthotics department for orthotic supports and other interventions.

Conditions our podiatrists treat include, but are not limited to:

Arthritis Bone spurs Broken bones Bunions Calluses Claw toe Corns Deformities and �at feet Fungal infections Hammertoe

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Mallet toe Morton's and other neuromas Plantar fasciitis Plantar's warts Sports injuries

Prosthetics and Orthotics

Traumatic injuries, debilitating illnesses, chronic conditions, and other problems can sometimes be addressed with prosthetic or orthotic devices. With a huge array of specialists throughout the hospital to consult with, the Prosthetics and Orthotics department at St. Anthony Medical Center is the best place in the Twin Cities for pediatric and adult patients who need a device designed and fabricated for their particular issue. Our prosthetists, orthotists, and technicians are certi�ed in orthotics and prostheses, and they help patients with such conditions as Morton's neuroma, cerebral palsy, amputations, spina bi�da, scoliosis and many more. They constantly build on their experience working with the most modern, lightweight materials through continuing education on myoelectrics, suction sockets, graphite systems and other technologies. Each patient receives a support or prosthetic speci�cally tailored to their physical needs and lifestyle, and St. Anthony Medical Center prosthetists and orthotists work with each patient to make sure the �t is comfortable and the function is acceptable. They make any modi�cations necessary.

Among the procedures the clinic can do are:

Custom foot orthoses Knee, ankle, and foot orthoses Bracing (sports, post-polio, spinal, post-op, scoliosis) Prosthetic designs Microprocessor knees Graphite composites Thermoplastics Trans-femoral anatomical suction sockets Trans-tibial silicone suction sockets Prosthetic feet Ultra lightweight prostheses Myoelectric prostheses Cranial helmets

Rheumatology

Rheumatic and autoimmune disorders can be life-threatening and cause chronic pain, fatigue, and other unpleasant symptoms. The physicians at St. Anthony Medical Center's Rheumatology clinic care for patients with all kinds of these disorders. They also consult with specialists at the hospital to manage rheumatic conditions' e�ects on multiple organ systems.

Commonly treated disorders include:

Arthritis Rheumatism Ankylosing spondylitis Behcet's disease Dermatomyositis Gout and pseudogout Lupus (SLE) Marfan's syndrome

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Psoriatic arthritis Mixed connective tissue disease (MCTD) Polymyalgia rheumatia Polymyositis Reiter's syndrome Rheumatoid arthritis Sjogren's syndrome Scleroderma Temporal arthritis Vasculitis

To relieve patients' symptoms and restore them to higher function, St. Anthony Medical Center's rheumatologists deliver treatments like joint aspiration, plasma exchange therapy, and other cutting-edge interventions. Physical and occupational therapists augment treatment, and physicians coordinate with nurses and patients' primary care physicians to educate patients on how to live with their rheumatic conditions.

Sleep Medicine

For relief from insomnia and other sleep-related disorders, St. Anthony Medical Center's Sleep Medicine is the place to go for sleep-deprived patients. Each patient receives a thorough evaluation and history of their sleep disturbance, and physicians at the clinic use both pharmacological and behavioral interventions to address the problem. Physicians are familiar with the physiological conditions that can cause sleep disturbances, but also the psychological ones, such as depression, anxiety, PTSD, and others.

Conditions we regularly treat include the following, but St. Anthony Medical Center physicians have knowledge of and experience with many more:

Restless leg syndrome Sleep apnea Narcolepsy Periodic limb movement disorder Insomnia

In cases where cognitive-behavioral or pharmacological interventions are ine�ective, patients can come to St. Anthony Medical Center's Sleep Center for sleep studies that help diagnose sleeping problems.

Therapeutic Services Occupational Therapy

A stroke, a car accident, or a congenital condition can profoundly a�ect the way a patient walks, writes, or performs many of the daily tasks of living. To help patients lead safe, independent and productive lives, St. Anthony Medical Center has �ve occupational therapists on sta�. These therapists evaluate each patient and develop a plan that incorporates pain control, in�ammation management, and sensitivity management, as well as treatments and home exercises to build strength, improve range of motion, or relearn function.

Whether a patient has a stroke or tendonitis, our occupational therapists use many methods and adaptive equipment to make each patient as mobile and functional as possible, including the following interventions and evaluations:

Alternative communication devices

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Constraint-induced movement therapy Neurodiagnostic testing (such as electromyography) Mobility equipment and seating evaluations Feeding evaluations Splinting and casting Functional vision retraining Sensory stimulation

Eye Care

Tests, treatment, and corrective lenses for all kinds of vision problems are available at St. Anthony Medical Center's outpatient Eye Care Clinic. The clinic is sta�ed with 12 board- certi�ed physicians who can test and examine patients' eyes for the purpose of prescribing glasses or contacts. They also routinely screen patients for common eye problems like glaucoma and macular degeneration. They provide the following services on a regular basis:

Eye health assessment Vision screening Retinal assessment Glaucoma testing Macula assessment

Three of our physicians are also board certi�ed opthalmologists who can provide comprehensive care for all manner of eye disorders. Our optometrists refer patients whose routine eye exams reveal emerging problems like cataracts or glaucoma, and patients can see our opthalmologists without a referral. Among the conditions we treat are:

Eye infections Glaucoma Cataracts Cornea, ocular surface, and external eye disease Uveitis Strabismus Orbital lymphoma Retinoblastoma Eyelid cancers Retinitis pigmentosa Cone-rod dystrophy

Pharmacy

At St. Anthony Medical Center's pharmacy, we don't just �ll prescriptions. We o�er experienced pharmacists whose many specialized services help patients to take charge of their medications and get the maximum bene�t from them. Before patients leave the hospital, our pharmacists can visit them at bedside to deliver and explain their medications. Especially when patients are receiving treatment from multiple providers, pharmacists review patients' medication lists, then consult with physicians to make sure that unnecessary, duplicate, or potentially con�icting medications can be removed or modi�ed. For conditions with more complex medication regimens (such as organ transplant protocols or blood-thinning medications), pharmacists answer patients' questions and give specialized advice for how to get the most bene�t.

Our pharmacy also o�ers the following services:

Prompted re�lls

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Prescription mail delivery Medication management program Unused medication donations Expired or unwanted medication disposal Prescription assistance program for low-income patients

Physical Therapy

To help patients rebuild strength, range of motion, and �exibility after surgery or injuries, physical therapists at St. Anthony Medical Center work in each department to deliver bedside therapy and educate patients about post-discharge self-care. After surgery, many patients rebuild their strength and keep injured areas mobile to prevent scar tissue and limited range of motion. Our licensed physical therapists consult with physicians to create a plan for therapy and home care, which might include teaching stretches or strengthening exercises or activities to avoid until recovery is complete. They also teach patients how to get out of bed, go to the bathroom, and do other daily tasks safely while they continue their recovery.

Our therapists provide care at the bedside or in the hospital's physical therapy clinic. They use the following techniques to speed healing and encourage mobilization:

Heat Cold Ultrasound Electrical stimulation Soft tissue mobilization Therapeutic exercise

Respiratory therapy

Patients with lung diseases and breathing problems know that St. Anthony Medical Center has the expertise to assess and determine the best possible course of treatment. Each of our pulmonary care specialists has extensive knowledge of the common lung diseases, such as asthma, emphysema, cystic �brosis), and many more. They evaluate and treat on an inpatient and outpatient basis. For more complicated cases, such as lung diseases that may lead to a needed lung transplant, our pulmonary specialists can consult with physicians in other specialties across the hospital.

Common diseases we treat include:

Interstitial lung disease Acute respiratory failure Sleep disorders Pulmonary hypertension Emphysema Asthma Cystic �brosis Chronic obstructive pulmonary disease (COPD

Our Respiratory Care department provides pulmonary function, spirometry, and other diagnostic tests, and plan care for each patient. Once treatment is determined, our sta� of registered and certi�ed respiratory therapists provide services including:

Ventilation management Gases delivery Airway care

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Medication delivery Sleep studies Pulmonary rehabilitation

Speech Therapy

St. Anthony Medical Center o�ers speech therapy services for the assessment, evaluation, and treatment of speech and language disorders. Our experienced speech language pathologists perform many diagnostic tests and assessments to determine the nature and extent of a patient's speech or language problem. They have extensive education and experience in such disorders as:

Swallowing disorders Facial droop Voice disorders Cognitive disorders Dysarthria Aphasia

Whether the condition is physiological or neurological, developmental or acquired, our speech pathologists are trained in using the following interventions and assessments:

Augmentive/alternative communication Neuromuscular stimulation Flexible Endoscopic Evaluation of Swallow (FEES) testing Modi�ed Barium Swallow Study testing Alaryngeal communication

Diagnostic Services Clinical Lab

Our highly trained, professional sta� of technologists, technicians, and phlebotomists can perform a vast array of diagnostic tests in our 50,000-square-foot facility to help properly diagnose patient conditions. These tests take place on site as soon as possible after a doctor's order. With 600 lab professionals and 15 pathologists on sta�, the more than 150 tests o�ered by St. Anthony Medical Center include:

ABO & Rh type Adult food allergy pro�le Blood urea nitrogen Fungal antibody panel Hemoglobin A1C HIV-1 proviral DNA LDL cholesterol Pancreastatin Potassium White blood cell count

These tests, and the many other tests done at St. Anthony Medical Center, can be completed and reported to your practitioner the same day. For specialized tests, we send specimens to the Mayo Medical Laboratory Laboratory, and in these cases turnaround time may be longer.

Imaging

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St. Anthony Medical Center o�ers comprehensive, state-of-the-art diagnostic imaging, with same-day appointments available when needed. Our highly skilled medical imaging technicians keep patients as comfortable and informed as possible while creating high- quality images. Once images are ordered by physicians, the Imaging Center schedules the appointment and produces images within 24 hours to be read in consultation with the hospital's sta� of 12 on-site, board-certi�ed radiologists.

Some of our imaging services include:

Cardiovascular imaging Vascular angiography Angioplasty Bone density testing Bone densitometry DXA scans CT scans Colonoscopy Mammography Electrocardiogram Fluoroscopy MRI Nuclear medicine PET scans Cardiac stress tests Bone scans Lung scans X-rays

Specialty Services Bariatric

For some patients, weight loss can be a matter of life and death. Patients who struggle with their weight often develop related conditions, such as high blood pressure, diabetes, sleep apnea, and joint pain. That's why St. Anthony Medical Center's Bariatric Surgery Center has been o�ering bariatric surgeries since 2001.

The Bariatric Surgery Center has four bariatric surgeons who can perform several weight loss procedures for patients who are at least 100 pounds overweight or have a body mass index of 45. Together, they've performed more than 7,000 of these surgeries, and they're dedicated to helping patients live healthier, happier lives.

A few of the surgical options that our surgeons o�er are:

Sleeve gastrectomy surgery to reduce the size of the patient's stomach. Gastric bypass surgery to alter the patient's stomach and limit their caloric intake. Vertical banded gastroplasty surgery to change the path of food through the patient's stomach. Adjustable gastric banding to limit a patient's ability to eat food at one time.

St. Anthony Medical Center's support doesn't end with surgical recovery. Our nurse clinicians help patients prepare for surgery and heal afterward. Our registered dietitians and exercise specialists take over from there, working with patients to help them create a diet and exercise plan that will allow them to maintain the weight loss they achieve after surgery.

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Clellan Card Cancer Center

A cancer diagnosis means it's time to bring out the A team, and that's what patients get at St. Anthony Medical Center's Clellan Card Cancer Center. We bring together experience, technology, and compassion to create the most healing environment possible for cancer patients. Once a tumor has been detected, our oncologists evaluate the patient's medical history and orders further diagnostic testing if necessary. The Cancer Center has on-site CT, PET and MRI scanners for same-day imaging and complete localization of the tumor. With that information, the oncologist creates a complete treatment plan, including the type of therapy, frequency, amount, and method of delivery. The Cancer Center's experienced physicians use specialized equipment to deliver radiation treatment, chemotherapy, and more advanced treatments such as CT stimulation, high dose rate brachytherapy, stereotactic radiosurgery, and volumetric arc therapy.

Rehabilitation The center's nurses, nurse clinicians, and social workers help patients to recover from treatment and/or surgery and to gather necessary resources for the journey from diagnosis to remission.

Our oncologists have a combined 90 years of experience with the following cancers (among many others):

Breast cancer Brain cancer Gastrointestinal/esophageal cancer Liver cancer Lung cancer Lymphoma (Hodgkins and non-Hodgkins) Pancreatic cancer Prostate cancer

Cardiovascular

St. Anthony Medical Center's Cardiovascular Center is the Twin Cities choice for the best in heart and vascular care. With services for everything from preventive cardiology to valve replacements and heart transplants, the Cardiovascular Center is equipped to handle almost any kind of heart or vascular problem.

Prevention Patients with previous cardiovascular-related health problems or risk for them can be evaluated for their level of risk and receive nutrition and exercise counseling for ways to minimize their risk. Diagnostic tests are available on-site, and the Cardiovascular Center can also refer patients to stress management and other services that help address the psychological aspects of heart disease.

Diagnosis The Cardiovascular Center o�ers a full range of imaging and testing services for the detection of heart conditions. These include:

Calcium scoring tests Angiograms Echocardiograms Electrocardiograms Nuclear imaging MRI Chest x-rays

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Treatment St. Anthony Medical Center's Emergency Room is equipped to handle heart and blood vessel emergencies, and so is the Cardiovascular Center. But the Center also o�ers preventive and responsive treatments to many cardiovascular diseases.

Our surgical team has the experience to handle cardiac, thoracic, and transplant- related surgical services for conditions such as aortic aneurysms, cardiac valve repair, heart transplants, and more. Our electrophysiology physicians diagnose and treat patients with heart rhythm issues such as �brillations, tachycardias, and premature contractions. Our cardiologists use catheter-based devices to repair structural problems like artery disease and defects.

Integrative Medicine (Alternative)

A great deal of research is being done into the e�ectiveness of complementary and alternative medicine, or CAM, and that research helped lead to The Institute of Integrative Medicine at St. Anthony Medical Center. The Institute is a place for patients who want to augment traditional interventions and therapies with alternative medicine.

Whether patients are looking to reduce the stress and anxiety of medical problems, diminish the intensity of their symptoms, or enhance the healing process, the Institute o�ers a wide variety of alternative treatments.

Institute patients have used alternative therapies in the following ways:

Yoga: to rebuild strength and increase �exibility after chemotherapy Chiropractic: to reduce pain and increase mobility after surgery Acupuncture: to reduce pain and swelling after knee surgery or to reduce nausea after chemotherapy Massage: relief of postoperative pain Reiki: to reduce stress and anxiety for cancer patients Aromatherapy: to reduce nausea-related chemotherapy

For patients who are looking to improve their overall quality of health, the Institute also o�ers wellness coaching, mindfulness training, and nutrition counseling.

Spine

St. Anthony Medical Center is second to none in delivering the most advanced treatment of injuries and conditions that a�ect the spine. For common conditions like low and upper back pain, or more complicated injuries to the spine and nerve roots, St. Anthony Medical Center's care team includes a physiatrists, nurse practitioners, nurse clinicians and physical therapists.

Our physicians will evaluate each patient's spine condition and draw from other disciplines to create a complete treatment, rehabilitation and physical therapy plan. The center o�ers imaging, electromyography, and injection therapy services on site, and if surgery is indicated, the care team provides education to each patient about proper pre- and post-op care.

The Spine Center has dealt with the following conditions and many more:

Arthritis and osteoarthritis Disc degeneration Fractures Herniated discs

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Kyphosis Lordosis Nerve root injuries Osteoporosis-related spinal fractures Sciatica Spondylolisthesis Spondylolysis Stenosis

Patient Services Medical Records

Vila Health uses an electronic medical record system so that patients can access their entire medical history and speci�c information (such as test results) quickly and easily. St. Anthony Medical Center and all hospitals and clinics in the Vila system use this system, so that all providers can access patient contact information as well as details about medical history, medications, allergies, test results, and other pertinent health information. The system allows providers across Vila Health System, including nurses, physicians, and pharmacists, to access patient information and coordinate care. In the event that patients need to send their health records to hospitals, clinics, or providers outside of the Vila Health System, our records specialists help patients with printing and/or sending records.

Admissions and Discharge

St. Anthony Medical Center maintains a quali�ed sta� of admissions counselors who help patients with admissions. For elective admissions – planned stays at the hospital for procedures or surgery – counselors answer questions about the online pre-registration process or conduct the process via telephone. They gather necessary information, answer patient questions, and provide information regarding the hospital stay, including such details as where to park, what to bring, and more. These counselors help patients when they leave the hospital, including connecting them with resources and referrals within the hospital and in the larger community.

Billing and collections

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

Our customer service department can answer questions about:

Hospital bills Home health, medical laboratory, hospice, emergency, and medical equipment bills Online bill pay Refunds: If there is an error in a bill pay transaction. St. Anthony Medical Center will verify the error. If an overpayment is discovered, a refund will be issued within 10 to 30 days. Financial assistance: If patients are having trouble paying for services, the hospital o�ers �nancial assistance programs. Address changes

Dietary

Food and dining options at St. Anthony Medical Center include the cafeteria, a café, and vending machines throughout the hospital. The cafeteria is open from 6 a.m. to 6 p.m. and serves:

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Breakfast 6:30-9:30 a.m. Lunch: 11-1 p.m. Dinner: 5-7 p.m. Soup/salad bar, deli, grill: 11 to 5 p.m.

St. Anthony Medical Center also o�ers education and counseling for patients with nutritional health needs. Our experienced dietitians meet with patients on an outpatient basis to explain how their diet can support healing and health, and which foods may undermine their recovery.

Social Services

At St. Anthony Medical Center, we understand that health is more than getting treated for symptoms. Access to health care, good discharge planning, education, and other support services are crucial for patients to fully recover. Our Social Services department coordinates all of the psychosocial aspects of healing. Our case workers help patients in all areas of the hospital with their needs after discharge, which may include food, shelter, follow-up care, or help with grief and loss. They work with patients and their families to design an appropriate post-discharge plan, which takes into account their physical healing, medication management, basic needs, and needed resources such as medical supplies or outpatient therapy. Finally, our case workers intervene on behalf of patients when necessary to protect their access to health care or their rights where insurance companies or other entities are concerned.

Support Services Biomedical Technology

Our Biomedical Technology department is sta�ed with experienced technicians and information system specialists who install, calibrate, operate, repair, and maintain that equipment. They coordinate system installations and upgrades, and make modi�cations to make sure that the equipment adheres to medical standards and hospital guidelines. They design equipment and support systems that the hospital needs, and test all equipment on a regular, documented schedule so that information is always available about the equipment's last test, calibration data, repair record, and more. Technicians and specialists participate in the planning process for buying new equipment, advising hospital leadership about which equipment is necessary and the requirements for integrating it with the hospital's information systems. They also design and provide user training and support.

Central supply

A steady supply of sterilized equipment and instruments is crucial to any hospital's function, and St. Anthony Medical Center's Central Supply department works 24/7 to make sure that surgical instruments, medical devices, and other equipment are sterilized and stored properly to maintain that sterilization.

Decontamination After use, all surgical instruments and medical devices must be decontaminated in the hospital's special automatic washers and other decontamination equipment. Our sterile processing and distribution technicians inspect each item after decontamination to make sure it is clean, then assembles and organizes items into the right instrument trays and sets for later use. Sterilization For items that require sterilization, our technicians run the autoclaves and other

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sterilization equipment. They also keep detailed records of each item that has been cleaned, sterilized, and stored. Distribution Our technicians deliver sterile supplies wherever they are needed, and pick up used ones for decontamination and sterilization. They stock crash carts, organize medical supplies, and keep inventory control so that sterile supplies don't expire.

Information Technology

The Information Technology department at St. Anthony Medical Center keeps the hospital's [number] employees connected to each other and to the resources they need to deliver the best patient care possible. Our IT professionals build, install, maintain, and troubleshoot all in-house hospital systems, managing regular maintenance and upgrades for these systems. The help desk provides 24/7 user support, and the department also conducts formal and ad hoc training in the proper and safe use of the hospital's network and applications.

The hospital's users rely on the following systems maintained by IT:

E-mail Electronic medical record Formulary database Building/environmental system Patient �ow software Medical billing Accounting Medical equipment networking

For third-party applications the hospital needs, the IT works with those vendors to install, monitor, and maintain those applications.

Safety

It's ironic but true: Hospitals, which exist to help improve health, can be hazardous places. Infectious organisms, sharp instruments, and other dangers can threaten the safety of employees and patients alike. That's why safety is St. Anthony Medical Center's top priority. The hospital's safety department investigates every safety-related incident at the hospital, including falls, infections, accidental needle sticks, equipment-related injuries, and incidents in the parking ramp, to prevent similar accidents from happening in the future.

Safety analysts work with the Accreditation Department to analyze how St. Anthony Medical Center is complying with The Joint Commission's Physical Environment of Care standards. They also monitor the hospital's compliance with local, state, and federal regulations regarding safety in hospitals. Finally, they conduct safety tours of all areas of the hospital, and when changes in procedure become necessary, they deliver training to related personnel to ensure compliance with new safety measures.

The safety department analyzes safety data across the hospital and benchmarks St. Anthony Medical Center's performance to national hospital safety statistics. The department's reports on St. Anthony Medical Center's safety record, which compare its performance to that of other, comparable hospitals, go to the hospital's vice president of operations.

Security

St. Anthony Medical Center maintains an open-door environment so that patients, visitors, and practitioners can move about freely. This creates security challenges, as open-door

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environments can become opportunities for criminal behavior. To protect patients, employees, and property, our security department employs technology and human presence to monitor open areas, employee-only areas, and the parking ramp.

Patients and visitors can enter through various exits during daylight hours, but in the interest of safety, they may only enter the hospital through the Emergency Room between the hours of 7 p.m. and 6 a.m.

Our security personnel are on duty 24/7 to make sure that visitors, patients, and sta� are safe. All loading docks and receiving areas are monitored by surveillance video and security personnel to prevent theft of valuable medical supplies and equipment.

All employees are issued badges that allow them access to the areas they need to reach for patient care. Alarmed doors prevent anyone from entering sta�-only areas without the proper credentials. Finally, a campus-wide building security system allows our security personnel to monitor all entrances and exits in a central location and deploy a response when needed.

Environmental Services

Our Environmental Services professionals take pride in keeping St. Anthony Medical Center clean, organized, and safe.

Supplies Medical supplies, clean linen, and other needed supplies are restocked regularly by Environmental Services. They assemble medical supplies into packs according to di�erent departments' needs, and deliver emergency supplies when needed. Cleaning Environmental services professionals conduct regular cleaning of furniture, woodwork, �oors, walls, windows, vents, fan �xtures, and doors in every area of the hospital. They also clean patient rooms and get them ready for the next patient. Waste removal The regular removal of ordinary trash falls under Environmental Services, but they are also responsible for removing and disposing of medical waste using speci�ed bags and containers. Equipment Facilities workers in the Environmental Services department maintain the hospital's vast array of equipment, as well as the hospital's physical plant, documenting their regular schedule of inspections and repairing or replacing any malfunctioning equipment.

Operations Finance

To make sure the hospital is guided by sound �nancial principles, St. Anthony Medical Center's budget analysts create an annual budget that dictates the funds each department gets for its day-to-day operations and special projects or investments. They examine volume and utilization patterns, look for developing trends, and conduct long-range forecasting and �nancial modeling. Using this data, they participate in the strategic planning process of the hospital.

Financial professionals conduct the hospital's �nancial operations, including paying salaries, paying suppliers, and working with the billing department to collect on unpaid bills.

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Accountants analyze the actual �ow of funds in and out of the hospital, including accounts receivable, accounts payable, and other functions. Accounting guidelines they establish govern how the departments report their �nances and control their spending. On a quarterly basis, the hospital's accountants prepare �nancial statements and other related documents for review by the Board of Trustees and C-level leadership.

HR

At St. Anthony Medical Center, our Human Resources department knows that people are our most important resource. Great patient care is delivered by great people who have a great place to work. We achieve that mission by making sure that our employees have the background, training, and resources to be their best.

The Human Resources team provides the following services:

Recruitment and Talent. Employee and Labor Relations. Organizational E�ectiveness. Workforce Development. Occupational Health Services. Volunteer Services. Human Resources Operations.

Medical Support Services Accreditation

St. Anthony Medical Center is accredited by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO). The hospital meets or exceeds the Joint Commission's rigorous standards of quality and patient safety. These standards include such measures as infection control, documentation of care and treatment, transplant safety, and many more.

Joint Commission regulators may survey the hospital at any time to evaluate its compliance with JCAHO standards, and the accreditation department works with regulators to gather all requested data or other materials.

Patients or family members may contact our Quality Department if they believe our sta� or policies have in any way compromised safety or quality standards, or they can contact the Joint Commission itself by calling (800) 994-6610. Further information on the JCAHO complaint process can be found online at: Online: http://www.jointcommission.org/report_a_complaint.aspx

Credentials and privileges

To ensure that all St. Anthony Medical Center physicians are approved to practice both at St. Anthony Medical Center and at other hospitals and clinics, the Credentials and Privileges department provides administrative support for applications from physicians and medical sta�. Working with regulatory agencies, universities, hospitals, and internal departments, credentialing specialists manage pre-application, application, and reappointment processes for all physicians.

They also verify the education, training, work experience, licensure, and other information for each physician and licensed independent provider, such as physician assistants, advance practice nurses, and non-physician providers such as psychologists. The specialists also prepare required reports for St. Anthony Medical Center's Credentials Committee.

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Quality Assurance

St. Anthony Medical Center's Quality Assurance Department is responsible for continual review of our processes and practices in an e�ort to identify opportunities to improve current care. Working in partnership with the Quality Assurance Committee, the Quality Assurance Department identi�es cases for internal and external review. Data from these reviews is used to determine whether changes in policy or procedure would improve quality of care. When policy changes are necessary, the Quality Assurance department communicates those changes to the sta� through a variety of channels.

Nursing Support Services Credentials and development

St. Anthony Medical Center's Department of Nursing supports the development of the nursing sta� through ensuring that continuing education opportunities are available and that these opportunities adhere to principles of adult education, evidence based practice, research, and professional development as well as ensuring that these programs meet current standards and requirements. Additionally, our nurse credentialing program is intended to ensure that credentials for all nurses are objectively evaluated to ensure the very best care and safest environment to our sta� and patients.

Nursing informatics

St. Anthony Medical Center knows that the increasing use of data and computer technology is transforming healthcare. Clinicians, particularly nurses, are key components of any strategy to use health informatics to assess, evaluate, and improve processes, work�ows, and knowledge. St. Anthony Medical Center's Nursing Informatics department assists in this process by serving as a liaison between the IT department and nursing through participation in the development of training, identi�cation of areas of improvement, and reporting on St. Anthony Medical Center's compliance with meaningful use and other requirements of the A�ordable Care Act.

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Interviewee: Abby Hirschbaum, Manager of Bariatric Services, Specialty Services: Bariatric Services

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Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Well, there have been issues with billing and coding. Bariatric surgery is often covered by insurance, but we have to be very careful about how procedures are described or they can be kicked. Many of our procedures could be considered elective individually, but if they are done as part of the overall process, they are covered. Nutritiional counselling, for example. Anyhow, the patients need to coordinate with their insurance company but we also need to coordinate with billing and coding to make sure we document things in a way that will line up with what the insurance company wants. Awhile back, during a procedure, one of our surgeons discovered an asymptomatic hiatal hernia and made the repair. He considered it a completely separate issue and wanted us to bill for the hernia repair separate from the bariatric. [laughs to self, remembering] Oh no! When billing and coding saw the record, they got on the phone to us IMMEDIATELY. Apparently, hiatal hernia repair is considered an integral part of bariatric surgery and cannot be separated out.

Question 2:

Can you describe any expectations you had about the EHR which were not met?

Answer 2:

Not really. We didn't have high hopes and that was probably for the best. Don't get me wrong, overall, I think the EHR is a good thing. There's a lot more information accessible to all of us because of it, but in terms of work�ow, the system is tolerable at best.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

Well, if we could get an interface between the EHR and billing that could help us to research coding issues, like what I was talking about earlier, that would cut down on the time we spend talking to the billing people.

But better yet, it would be helpful to have a more seamless interface between us and Behavioral Health. We have to schedule pre- and post-op psychological assessments for our patients, and it would be great if their system and ours were better integrated. I know that behavioral isn't part of the whole meaningful use incentive model and I suppose I understand why, but the fact that they aren't means that all that documentation that is required for our work has to be scanned or integrated into the patient's record manually. Even something as simple as getting the patient the appointments they need – two totally di�erent systems.

Interviewee: Alan Richardson, Director of Support Services, Operations: Support Services

Question 1:

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Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

The gap I'm most familiar with is the problem sometimes with integrating medical devices with the EHR, which is a problem with Biomedical's system. But it's also something of an industry-wide problem. We've done a lot of work on integrating the most critical equipment - heart monitoring, other physiological monitoring – and the nurses love the smart pumps… but they are frustrated by the fact that the pumps aren't better with the EHR. And in the meantime, we still have a lot of work to do on less critical equipment that we haven't yet integrated - ventilators, balloon pumps, all kinds of other technology.

Question 2:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

From a Support Services perspective, any solution we put in place will obviously tax IT's resources, and it probably won't solve the problem with device integration, so from my perspective, what's the point? I know there are more considerations than the device integration, though.

From an operational perspective, if we cut down on billing errors and reduce supply usage, those are real costs that we recoup. That said, you still have to factor in the IT costs that nobody thinks about … are we going to need to add network gear or access points to make the new solution work? What about cabling? Jay in IT can go into this more, but we de�nitely need to think those out before we make a decision.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

It's probably a good idea, heck, it's probably inevitable, but again, you've got to think about the hidden costs. If we do transition them to our EHR, are they going to suddenly have their own set of interface and interoperability issues to worry about? What about their legacy systems - will those need to be upgraded in order to work with our EHR? What if they can't upgrade those systems? Will they have to replace them? Then you're starting to get into some real costs. We might have to ask ourselves if sticking with their current system is better from a cost-bene�t perspective – particularly if they're on track with meaningful use.

Interviewee: Ana Nguyen, Behavioral Health Supervisor, Inpatient Services: Behavioral Health

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

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Obviously the EHR, but it's a little complicated in that Behavioral has its own EHR. It integrates with the main EHR, but they are actually two separate systems. We also have to work with a number of di�erent systems for reporting purposes – there are state and federal programs we're mandated to report to – HIV interventions… child welfare … the prescription drug monitoring program. Quite a few systems and they often require a lot of duplication on our part.

Question 2:

What are the capabilities and limitations of these systems?

Answer 2:

For the most part the in house systems are well integrated, though there are some limitations, but that's as much due to the unique requirements of behavioral health documentation and patient privacy.

Nonetheless, I can go to the EHR and see what medical and behavioral treatments, the person's history, and of course all their medications. There are some breakdowns in communication, though … social services has no good way of knowing when we're releasing patients and that can interfere with their ability to set up a continuity of care plan before the patient is discharged.

Another biggie isn't so much about the patient's record or the health information systems. It's more that I wish other services understood how to use the PMP … the PMP is a multi- state Prescription Drug Monitoring Program and we lobbied very hard to get St. Anthony using it. The trouble is that it's separate from the EHR and so it is admittedly very clunky to use, but it is an amazing tool in the control of prescription drug abuse, which is an epidemic here in the Twin Cities.

Question 3:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 3:

No more than what I've already described. It isn't speci�cally St. Anthony … it's more an issue with how to get behavioral health data into the system while at the same time protecting the patient's privacy rights. The bene�ts of health information systems are bypassing us if you ask me.

Interviewee: Caleb Harvey, Emergency Department Supervisor, Inpatient Services: Emergency

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

We've got an overall hospital health information system and an ER-speci�c system that interface with each other so that what goes in one can be seen in the other. That's our repository for all patient records, and most of what we capture goes in there. And all the

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nurses in the ER use the lab and pharmacy systems, particularly the eMAR, for tracking labs and delivering meds.

Question 2:

Can you describe work�ow issues you have noticed in your department that, for better or for worse, are a�ected by the EHR?

Answer 2:

Don't get me started on work�ow. We've talked a lot about it on an organizational level, but we haven't even attempted a serious assessment of work�ow in the Emergency Department. I'm sure its that everyone thinks we're in crisis mode all the time – and to be honest, we often are. But we need to know what we're working with if we're going to ever solve these problems. I know that everyone has their own ways of doing things, but if that means that information isn't being recorded correctly, that's a problem. Or if, say, there's a problem in the system but everyone has some sort of workaround they use instead of letting anyone know the problem exists.

For instance, the EHR has boxes on the med schedules that are green, and they go red if you miss a dose of medication. But I'm only going to see that if I'm looking at the medication schedule in the EHR. It can go unnoticed for hours if the next nurse doesn't open that particular screen.

Or this … this is a good one… each hospital within the Vila Health system has its own order- sets. Typical, yes… but every hospital in our system can see all the order-sets. And it's not uncommon for us to have docs or nurses from other facilities working here – �oating nurses, in particular, who go to put in an order and then get a call from Pharmacy telling them "nope, that's not on our formulary" and of course the person who ordered it is all "then why does the system let me order it in the �rst place!!?!?"

Good times… right?

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

If the system could force doctors to actually say what they want, so I don't have to call and ask, that would be enormous. I'm always having to call the pharmacy because the start times don't make sense. Apparently, if the doc doesn't include a start time, it just defaults to the nearest start time to when they put in the order. So even if the doc has ordered it for 09:00 AM daily, if he orders it at 10:00 PM, it populates to 10:00PM. So if the pharmacy gets an order at 5:00 PM, they don't necessarily know if the doc wants it to start immediately, tomorrow morning, or what. That's crazy!

Interviewee: Carla Neustadt, Vice President of Operations, Operations

Question 1:

Can you describe any expectations you had about the EHR which were not met?

Answer 1:

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I think I was expecting a certain amount of time where things would be in �ux and then we would get down to business as usual. Unfortunately, we haven't gotten to that settle down period, in my opinion. There are far more recommended upgrades than I was expecting and in general, it seems that there's always something new, some change in how we do things. I get that this is a particularly volatile time for the industry, but it feels like … well, don't laugh at me, but it's like Facebook constantly tweaking their interface. Just leave it alone already!

Question 2:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

I'm all for solutions, but I have a couple of concerns. Beside the issue I mentioned with the seemingly endless upgrades, I'm also concerned about storage. I know there is a lot of talk about going with a cloud based storage system, but that raises a lot of red �ags for me in terms of data security.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

I'm torn, I guess. On the one hand, the same storage requirements we face a�ect them too, and most likely if they upgraded to our system they'd have to upgrade their storage as well, or at least add more capacity to compensate for bigger �les. And you can't do that without o�ering archive support so they can still reach the data in their legacy systems.

But on the other hand, if they stay on their own systems, that's duplicate environments that are likely to be a drain on Vila's overall IT budget. If the costs of migration are less than the costs of maintaining multiple environments – taking into account storage and other issues – it might be better for the company in the long term.

Interviewee: Christopher Hewitt, Vice President of Medical Support Services, Medical Support Services

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

You know as well as anyone that there are still plenty of small bugs and problems associated with the health information systems at any health care facility. Ours has some known problems, but I'd say we're better than many. One area that I don't hear people discuss much is a usability issue – documenting how a patient's record has been accessed. We're required by law to provide that information in an easily understood format – well, I can provide the information, but it surely isn't easily understood.

Question 2:

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Can you describe any expectations you had about the EHR which were not met?

Answer 2:

For the most part, the EHR really is a one-stop shop, or at least that's what I hear. But my QA folks tell me that, contrary to what the vendor told us, the multiple places to put in narrative notes in the EHR are not a good thing. They're �nding some clinical variances and outright errors because there were contradictory narrative notes in di�erent areas.

When asked about it later, providers hadn't even seen the note that contradicted the one they actually read. I realize this is a work�ow issue and we'll need to have input from the clinicians, but to the best of my knowledge, we're nowhere near resolving it.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

It seems like a good idea to me. Both Delaware and Independence are having some problems with billing. Between that and other health information management issues they're having, I am not sure how ready they are for Stage 2. Valley City did �ne in attesting for Stage 1, but if they're like everyone else, the focus was on getting the technology in place. There are far too many people who think meaningful use is simply about buying the "right" technology and once they have it, life will be a bed of roses. That kind of thinking is misguided. It's not about the technology; it's about how our people use that technology.

As I've said before, our system is better than most. Imperfect, but good. It will be a lot more cost e�ective to develop the training and work�ow documentation processes and so forth that we're all going to need if we're all using the same system.

Interviewee: Cornell Reed, Imaging Supervisor, Diagnostic Services: Imaging

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

Sure... my department uses the PACS and the EHR. And we also have a radiology information module of the EHR that tracks our schedule and the images we've taken. The images themselves, and the data about them, are stored in the PACS, and I get orders for images from the EHR.

Question 2:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 2:

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If we could add the ability to attach a patient photo to images and scans, that would be a huge advantage. I don't know if it would save us buckets of money directly, but I've read that radiologists tend to feel more empathy and examine images more thoroughly when they see an image of the patient with it. The techs are there with the patient, they interact with the person – touch them, talk to them, and so forth. But the radiologists… well, sometimes I look at their notes and I am struck by the distance that comes through. When I read that there have been studies that show that the radiologists are more thorough and more compassionate when they see the patient's image, I thought it would be something we could do fairly easily.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

The only thing I think of is the notes. When radiologists look at the images we've captured, they make notes and attach them to the patient's record. But when it's an audio �le, the voice recognition software doesn't always capture what they've said for the transcription. So now someone has to go back and listen and transcribe the parts that it missed.

I've also heard about systems where you can attach the transcription of the radiologist's notes, even an audio �le of them, to the image in the PACS. I know the notes go into the EHR, but it could be helpful if they could also be attached to the actual image. I'm not sure if that's an interoperability issue or not, but I think it would be helpful.

Interviewee: Cory Armstrong, Nephrology Supervisor, Inpatient Services: Nephrology

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

The EHR is our primary system. It provides one central place for entering or retrieving data. Dialysis nursing sta� access treatment and drug prescriptions as well as any notes and comments and they use that information to make necessary adjustments to the patient's treatment, which then is recorded in the EHR.

Additionally, the EHR provides reminders, and recommendations, based on the information in the record and our established protocols. For example, lab results are logged in the EHR, and when the system sees certain preset values in the lab results, certain protocols are triggered and a noti�cation in the patient's record will recommend a particular course of action, such as recommending the patient receive a vaccination for hepatitis B.

Question 2:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 2:

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Internally, I would say not. The system isn't perfect, but it is much better than when everything relied on paper records. However, we do have problems in that we can't always get data electronically for patients who've received treatment at o�site dialysis centers. That can be a real problem.

It would also be nice to see better interoperability between the pharmacy's system and the medication tracking tab of the EHR. Let me explain. Sometimes the pharmacy rejects an order we submit, but because this is all being done electronically, we don't know why it's been rejected. If I call the pharmacist, I'm told that he or she put a note in the record. And I've walked down to the pharmacy and they've shown me… it's perfectly well documented in their system.

However, in the clinician view the only noti�cation I saw as a clinician was a tiny red �ag in the medication tracking tab. The note isn't linked to that tiny red �ag – I have to leave the medication tracking tab and go through a whole slew of tabs to �nd where it was saved. Asinine. Just asinine.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

The more we can align the technology to the way clinicians are working, the better. There is so much data being captured that could be used to improve our processes, but if people see the system as a black hole that they dump data into but never extract information from, then it's not worth the investment. The solution is to make the system serve the needs of the people using it and one way to do that is to make sure that it works with the way health care providers think and act.

Interviewee: Demarcus Flood, Clinical Laboratory Supervisor, Diagnostic Services: Clinical Laboratory

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

The lab's system covers clinical pathology, surgical pathology and cytology. It's a stand- alone system, but is made by the same vender as our EHR and the integration with the EHR is very smooth. We use bar-codes for all our processes, which improves our ability to track specimens and ensure accuracy of results reporting. And, it's designed to support the billing and coding department's needs as well.

Question 2:

What are the capabilities and limitations of these systems?

Answer 2:

Capabilities, as I described, are the integration with the EHR and with Billing and Coding's system. Our system can also generate a wide range of reports, which is quite useful. These

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are baked in – not something we need to request through Data Services. And so far as limitations, there's nothing really jumping out at me.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

The advantages are that you would quiet a lot of the nay-sayers and EHR haters. The labs are a perfect example of what you'd gain. The system is designed to work with the EHR and it does. It's designed to work with Public Health and other legislated reporting systems and it does. It's designed to complement and support the work�ow of a clinical lab and it does.

I don't think any disadvantages of cost or training needs outweigh the potential gains. Do it right – get a truly integrated system in place and improve the interfaces – and it will be worth it.

Interviewee: Derrick Holden, Manager of Diagnostic Services, Diagnostic Services

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

The people who report to me mostly use the lab information system, the PACS, and the EHR. They refer to the EHR for patient records, the PACS for images, and the lab information system for scheduling and tracking lab tests.

Question 2:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 2:

The nursing units would probably say yes, but I don't think there are for my people. The LIS and the PACS interface nicely with the EHR, and we don't get the requests for lab tests and images that we used to because people can just go to the EHR to get them.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

Oh, boy. From our perspective, it ain't broke, so I hope they don't try to �x it. I'm all for change if it actually makes things better, but we've had our share of failed IT projects here. I know they're talking about investing in an interface engine, but my question is: Do we have to use the same vendor as the EHR? They've been �ne, but you don't want to be locked into

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anything when you're investing in an expensive system like this. And you don't want to be locked out of anything, like say a better interface engine from another vendor that we can't have because our EHR won't interoperate with it.

Interviewee: Emily Parker, Social Services Supervisor, Patient Services: Social Services

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Let me start by saying that I don't use the EHR the say the clinical sta� does. We do use it in Social Services, of course, but not in the same, way, which is where the problem lies. We don't have a view or dashboard that makes sense to how we work, so we have to take a good chunk of time in the morning reviewing what went on with our patients. If things change after we do that, though, we won't always be aware of it … so, if for example, we're assuming that a patient is not being discharged until Wednesday, but for whatever reason, the doctor decides to discharge him on Monday … we might not know until we get a phone call from the unit.

Question 2:

Can you describe any expectations you had about the EHR which were not met?

Answer 2:

That our department would be considered? That there would be some way to customize the view to better utilize the system? Sorry – I was looking forward to having all that information available to my team and I am frustrated that it isn't particularly useful to the way we work.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

Overall, I don't know enough about the system to have an opinion on that.

Interviewee: George Fink, Director of Clinical Operations, Clinical Operations

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

For the most part, I believe that we've got a pretty well integrated system here. Lab results and images are available in the EHR; patient data is available at all levels and doesn't

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require duplicate entry; and when services chart for patients, other services can see that data as well as what they input themselves. Now, I know some of the therapeutic professionals don't care for the templates – or maybe they don't care for having to document as much as we need to – but for the most part, I think we're in good shape.

Question 2:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

Hm. Well, there's always room for improvement. Maybe there are ine�ciencies that I don't know about, since I'm not in charge of the clinics. But I know that some folks in IT talk about wanting an interface engine so that every system can talk to every other system without needing a point-to-point interface. That sounds good on paper, but I worry about an interface like that becoming a bottleneck. Right now, with di�erent systems talking to each other, there's no one choke point where a systems failure would take the whole thing down. But what's the redundancy going to be? If this interface engine goes down, is the whole hospital going to be paralyzed?

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

I know there's been talk about that, and again, maybe it makes sense on paper. But especially the smaller ones don't need as complex a system as we need. Does a hospital in rural North Dakota need as many bells and whistles as a larger system in a metro area?

They might be better o� going with a cloud-based EHR if they aren't getting what they need from their current system. Independence, on the other hand, has a more similar operation to St. Anthony Medical Center's, and might bene�t from a system like ours – unless, of course, it's going to complicate their meaningful use attestation. If, say, they're in the middle of the two-year reporting period, they'll have to be able to access data from their old system and document their usage. So it's about timing as well as �t.

Interviewee: Harold Liss, Vice President of Medical Services, Medical Services

Question 1:

Can you describe any expectations you had about the EHR which were not met?

Answer 1:

I guess I've been disappointed that di�erent departments still need their department- speci�c systems, although there aren't that many. The Maternal and Fetal Medicine clinic has their own Maternal Care Information System, and the Emergency Department does too. It all interfaces with the EHR, but when we were �rst taking proposals the vendors made it sound like you'd never need another system. Maybe that's true of a small practice but it's not true of a big hospital.

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Question 2:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

More seamless operation always sounds like a good idea, but there would be a lot of question marks. For instance: Meaningful use. Our EHR is certi�ed right now, but is our system still certi�ed if, say, data from it gets passed to the interface engine and on to a data warehouse that isn't certi�ed? When they're not connected, it doesn't a�ect the certi�cation, but once they are…? And for that matter, does the interface engine itself need to be certi�ed?

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

On the face of it, it sounds like a good idea. Valley City is having some problems capturing supply billing. Delaware and Independence are a little better o�, but they do have some gaps, mostly between diagnostic and therapeutic services. But it seems like it's mostly in buy-in and proper usage that's causing their issues, not so much IT problems. I mean, it might be a better investment to push out some training to the problem areas than to mess with a big upgrade. So I think not. It's 2015 now. Sometime in the �rst half of the year, the government will announce Stage 3 Meaningful Use criteria. Do we want to be in the middle of a huge migration before tangling with that? And what about the rurals? They're going to be attesting for di�erent stages, and do they need to adjust to a new system while they do? How might it a�ect their attestation if they switch to a new system in the middle of the reporting period? I just think it's a lot to take on all at once.

Interviewee: Helen Palmer, Internal Medicine Supervisor, Outpatient Services: Internal Medicine

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

We use the lab and Imaging's systems pretty frequently, to track and schedule tests and images for patients. Well … we're not really using their system. We use the EHR, which draws information from their systems into ours. I think that's how it works. I just assume the EHR is the system, but I think that's actually not the case – there are actually di�erent systems, yes?

Question 2:

What are the capabilities and limitations of these systems?

Answer 2:

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They all work pretty smoothly, so far as I can tell. For the most part, I'm able to �nd what I need when I need it. That said, sometimes we do need to have medical records pull older information that hasn't been migrated into the EHR. That can be a pain.

The eMAR is another thing, though. For the most part, this is one aspect of electronic health records that makes so much sense. The eMAR de�nitely reduces errors. There's no arguing with that. But … there is one thing that drives me crazy. The eMAR was customized for all of Vila Health and so when it's suggesting order sets, it o�ers order sets from the whole system. But we have order sets that are di�erent from the ones they have at Oxbow Regional Hospital and vice-versa.

Well, the system allows me to enter these order sets, even if they aren't ours. Then I get a call from the pharmacy saying that they don't have that drug or that's not the protocol or whatever. Why does it let me order that if the hospital doesn't even have it? It's really annoying, and a waste of time. And another thing. Passwords. Nurses really aren't all that into computers, by and large, and we have to change our passwords every quarter. I know a lot of nurses who write their passwords on their badges, which is a security no-no, but where else can they store them? And of course, it's not just one. Our timesheets are one system and one user ID and password, the EHR is a separate system with a di�erent user ID and password, and the online library is a third one. It would be so much better if we had one user ID and password for everything in the hospital. Or... I've heard some hospitals have a system where they can scan their badges to log in. That would be wonderful.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

I hope that any solution they chose would �x the eMAR issue. But at the same time, what I really want is for them to leave things alone for a while! Maybe other clinics have bigger problems with this, but we don't; it �ts our process. Plus, we �nally got everybody trained and on board. Before anyone monkeys with it, I hope they have a really good reason.

Interviewee: Jay Phillips, Information Technology Manager, Support Services: Information Technology

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

De�nitely. But I think they're smaller gaps than they used to be. Before we upgraded to the latest version of the EHR, we had real problems with lab and imaging results not being visible in the EHR, with poorly functioning decision support because of free-text entries rather than drop-down boxes—all kinds of issues. Now that we've built the interfaces we need between those systems and upgraded the EHR, the gaps are smaller. So, for instance, you can see all but certain images in the EHR by pulling them through from the PACS. You can track where your lab test is in the process without having to bug the lab about it … actually, that isn't true is the tests we do o�-site, but there aren't many we do o�-site.

Question 2:

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What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

I've been arguing in favor of an interface engine, because from an IT perspective, it will be a lot easier to maintain than our current interface approach. Those interfaces work, but they're a drain on our resources and everything is a one-o� solution. Not good. An interface engine, on the other hand, would relieve us of that particular burden so we could focus on being more proactive and responsive to other kinds of problems. It would also make it easier to o�er more data to patients through the portal, without requiring as much system- speci�c customization.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

From an IT perspective, it's all about numbers. You take whatever pro�ts or savings you're going to get from making the transition, and subtract whatever costs you face in implementing the new system. But there can be a lot of costs. Will they need more physical space? How will a�ect their demand for power? What about rack space, cooling, cabling? Then you have to think about your infrastructure and your di�erent networks – VPN, wireless, all of them – and whether you've got enough capacity to handle the new system. And what's your redundancy? Your storage strategy? Those considerations are going to be very di�erent at, say, Valley City than they're going to be here. And I don't think you can take a cookie-cutter approach, either. It might make a lot of sense from an IT standpoint to transition Independence Medical Center to our system, but not Valley City. Or vice versa! Maybe Valley City wouldn't face the infrastructure and cabling and capacity costs that even Delaware would.

Interviewee: Kathy Bell, Billing Manager, Patient Services: Billing

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

My billing people use the EHR and our billing and coding software to generate and submit insurance claims. Once the claim comes back, they bill for the patient's portion.

Question 2:

What are the capabilities and limitations of these systems?

Answer 2:

Oh, they both work �ne. Generally, my billing clerks don't have any problem generating bills or claims, because almost everything they need is right there in the EHR and the interface between the two systems lets them pull the info right out of the EHR into the claim. But we have a problem with overbilling here. I don't want to point �ngers – say, at the physical

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therapy department – but there are plenty of providers at this hospital who use auto-�lled templates and copy and paste, and they make mistakes. Patients get billed for services they didn't get because of copying or auto-�ll errors in the templates. I know those folks want to cut down on their documentation time, but if it weren't for these types of errors, we'd have a pretty solid billing operation.

Question 3:

Can you describe any expectations you had about the EHR which were not met?

Answer 3:

Not so much about the EHR, but de�nitely about the way it's used. And I don't mean the providers. I mean the fact that the audit logs are not set up to capture when people use copy and paste. We have a policy that people should use copy-paste wisely, and check for errors, but it clearly isn't working. If I had my way and we upgraded anything about the EHR, it would be to set up that audit log so we could identify who the repeat o�enders are and get them either re-trained or reprimanded.

Interviewee: Kenneth Dunn, Central Supply Manager, Support Services: Central Supply

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Nothing that a�ects me directly.

Question 2:

Can you describe work�ow issues you have noticed in your department that, for better or for worse, are a�ected by the EHR?

Answer 2:

[Chuckling] Inventory control. This is one thing the new system does that's pretty slick. When some type of supply gets used on a patient – the ER nurses crack open an airway kit – well, there's a barcode on the item that gets scanned. The EHR interfaces with our materials management system, and we get noti�ed that the ER is down one airway kit. Next time we come by, boom! Restocked! It didn't used to be that way, but I'll tell you, it makes life a lot easier. For me, for the docs and the nurses … you've gotta assume it's making things better for the patients, too.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

Sounds like Independence could use this kind of a system! They've called to ask what we do, because they apparently don't have a good way to capture supplies that aren't covered

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by insurance, and it's a big problem for their billing department. They could probably cut that kind of thing down by half or more if they had our system.

The others, I don't know. I'm guessing that the di�erent hospitals have di�erent needs, so even if you did transition them all to our system, there would probably have to be a lot of customization.

Interviewee: Lori Stout, Admissions and Discharge Manager, Patient Services: Admissions and Discharge

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

I'm sure there are gaps, but in terms of the systems I work with and my own experience, not really. It wasn't pretty getting the EHR up and live here, but I think hospital leadership committed to doing it right and they tried really hard to take everyone's needs into consideration. Something like this has to be seen as a work in progress, but I think we're on track.

Question 2:

Can you describe any expectations you had about the EHR which were not met?

Answer 2:

This is just me, but I had hoped that the EHR would allow us to be completely paperless. Now I understand that we never will be. We're able to scan unstructured content – the paper, forms, and faxes – into the record – but I had naively thought we'd be able to eliminate those kinds of things… not eliminate them, but to have that kind of documentation be electronic to start with.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

Better interoperability would allow us to get away from having to send hard copy records with certain patients. That would be a major improvement. Just the thought of a patient having a truly transferable record … just think how that could improve their care and save time and redundant e�ort.

Interviewee: Maria Norman, Medical Records Manager, Patient Services: Medical Records

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

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Answer 1:

Well... the current system is pretty e�cient in terms of capturing information that is being created right now. Where I see the biggest gaps is in integrating legacy systems and old data – particularly some of our paper and �lm records. We keep medical records for 20 years after a patient's last treatment or visit, so there are records that are archived that would be a problem to incorporate.

Question 2:

Can you describe any expectations you had about the EHR which were not met?

Answer 2:

I don't think so. I know the clinicians don't love the system, but to be honest, I don't think they would like any EHR. I had hoped we'd be able to get more of the archival data converted, but there was a speci�c window of time to convert paper records to electronic and so only records of current patents were done. I guess I thought eventually we'd circle back and start working on the archives.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

The advantages are clear – it would improve training and accuracy in using the systems. The interface should be invisible… people shouldn't ever think about the interface. If they are thinking about it, it means it's getting in their way.

I know there are serious costs associated with improving the interface and addressing interoperability, but those costs are not going to go down. We might as well �gure out a plan to solve these problems and commit to it now.

Interviewee: Randy Richter, Physical Therapy Supervisor, Therapeutic Services: Physical Therapy

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Yes. Doctors and physical therapists don't need to document the same things, but the EHR is more set up for doctors. The 8-minute rule, the skilled time distinction—the templates we're given don't �t what we do very well.

Question 2:

Can you describe any expectations you had about the EHR which were not met?

Answer 2:

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You know, the EHR was supposed to make charting easier, but that's hardly the case. The sad truth is that a lot of people still think it was faster to chart by hand than with the EHR. I'm certain that if we could customize the templates and forms, it would deliver. But right now, I have people who are putting in an hour or two beyond their shift trying to catch up on their charting.

Question 3:

Can you describe work�ow issues you have noticed in your department that, for better or for worse, are a�ected by the EHR?

Answer 3:

The charting problem is a work�ow issue. We do encourage therapists to chart as they go, but if things are busy, it's not unusual for people — particularly new PTs—to take notes and then do their charting. One issue is that the computers in the exam room aren't' mobile, so while you can chart during the initial patient exam, when you leave the exam room, you can't document what you're doing. Wireless laptops or tablets would be an improvement.

Interviewee: Sigrid Kohl, Manager of Alternative Medicine, Specialty Services: Alternative Medicine

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

We use the EHR almost exclusively, although an awful lot of the treatments and order sets we routinely use aren't in its databases.

Question 2:

What are the capabilities and limitations of these systems?

Answer 2:

The EHR we have does have some rudimentary complementary/alternative medicine order sets. But it isn't impressive. There's also no knowledge base of clinical documentation, which is a problem in that we either have to spell out what we do or use codes that no other doc or nurse in the hospital understands. If we do acupuncture on a post-surgical patient, say at the 67th point of the bladder meridian on both the left and right sides, we chart that as B-BL67. But nobody else at the hospital knows what that means, and there's no knowledge base available in the EHR that tells them, so they have to call us. Which they may or may not do; not all of the doctors take us seriously.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

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We're missing some signi�cant opportunities because we don't have an interface between our system and the surgical or the maternal care systems, or really any of the specialties. There are signi�cant bene�ts of acupuncture in post-surgical pain management, and prenatal care, just to name a couple, and yet we don't have a good process in place. If we did, new patients could get a visit from one of our consultants when the person is �rst admitted. So, for instance, if the decision support software prompted types of complementary treatments appropriate to the condition the doc is diagnosing, that would be one way to get us more top of mind with the doctors and nurses in other departments.

Interviewee: Thomas Hayes, Vice President of Specialty Services, Specialty Services

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Maybe there aren't for the standard practices – emergency, internal, that kind of thing – but there are for us. Especially in units like Bariatric and Alternative Medicine, the templates just don't capture what we need to. There are EHRs for bariatric practices, of course, but the point is to have one overarching system to collect data. How that played out, however, is that we were set up with some customization for the specialties within a system that's more geared toward the needs of a medical center. It's working all right. But it could de�nitely be better.

Question 2:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

I don't know what they would be, but I'll tell you this – nothing comes free from IT. What do I mean by that? I mean that no matter how shiny a new interface engine might be, it takes a lot of work to make sure you get a system that actually works, �ts with work�ow, does what it's supposed to, sends out the alerts, and all that. The only way you get a good system is if you work for it, and you work for it by analyzing and documenting how people do their work and making it match that work. It takes time, it takes money, it takes e�ort on the part of the doctors and nurses and IT... and you just can't cut corners. We have in the past, and we've paid for it. We �nally got it right with the EHR, and even then we still had to do a lot of tweaking to customize templates for the specialties. So unless we're going to do it right, it's probably not worth doing at all.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

Similar thoughts, I guess. I assume that the work�ow at Valley City is similar but not the same as Delaware County. You'd have to do a very careful cost-bene�t analysis and know exactly what you're hoping to improve by transitioning any hospital to our system. If it takes

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up a ton of resources but still doesn't reduce the billing errors, is it really worth it? Especially if it makes it harder to attest for the next Meaningful Use stage?

Interviewee: Willie Ramirez, Biomedical Technology Manager, Support Services: Biomedical Technology

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Not from my perspective, other than devices we haven't yet integrated. If we integrate a device and the data it collects can't populate to the EHR, I suppose that's a gap, but we haven't had that problem yet.

Question 2:

Can you describe work�ow issues you have noticed in your department that, for better or for worse, are a�ected by the EHR?

Answer 2:

Kind of. I say that because while we can see the problem in the EHR, it's not the EHR's fault. If a nurse uses a dedicated blood pressure monitor on multiple patients, that data stream can go in one patient's record instead of all the patients' records. And we have some blood pressure monitors that don't set clock times, so the EHR can't collect a time stamp. The EHR and the middleware are at the mercy of the device in instances like that, so I think we need a more coherent device strategy that prevents unsolvable variances like that.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

One advantage would be that more integration would eliminate the lag time between monitoring and charting. Nurses are run o� their feet most days, and there might be a lag between when they check a patient's heart monitor and when they chart that data in the EHR. Now, we've got a lot of the more common monitoring devices integrated, but what about infusion pumps or renal dialysis or �ow meters? When that data goes straight into the EHR with no delay, with no transcription errors, nurses can focus on treating patients instead of documenting how they treated them.

Interviewee: Sonja Christensen, Manager of the Cancer Center, Specialty Services: Cancer Center

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

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We use the radiology and lab's systems, the pharmacy system, the EHR – especially the oncology system, which is a specialized module within the EHR. I think it was an add-on. I think that's everything.

Question 2:

What are the capabilities and limitations of these systems?

Answer 2:

The EHR is great for capturing a ton of information about our patients, which is critical for us because oncology is the most complex and data-driven discipline in medicine. So we can capture chemotherapy �ow sheets, lab results, vital signs, blood administration, orders, all that and more. The problem is that there's not a good way to get a snapshot of a patient and see it all at once. Doctors have to click through a whole slew of screens to get a complete picture, and this isn't a broken arm we're talking about. We need a way to see that information in its totality.

Question 3:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 3:

We don't have a good system for integrating paper based physician records with the EHR. Some of our patients come here from a signi�cant distance and their primary physician may or may not be using an EHR. They may arrive carrying records or the physician's o�ce may fax records to us – which, while I know it used to be the norm is now something of a dinosaur.

Interviewee: Vickie Brown, Operative Services Supervisor, Operative Services: Inpatient Services

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

We use the EHR and the eMAR a lot, when we're charting and checking on med orders, but we also use devices like smart pumps that are integrated with the EHR. Well, sort of.

Question 2:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 2:

Yes! The smart pumps are fantastic—they can tell us how much intravenous �uid has been dispensed since the bag was hung. But even though they're integrated with the EHR— theoretically—we still have to punch in hourly rates instead of just pulling from the pumps. When you've got a lot of drips going, that can be really challenging, not to mention tedious.

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A better interface for that so we could just pull numbers from the pumps would be great. And if the eMAR and the EHR interfaced better, that would be awesome. See, you get a warning if a patient has an allergy when you order a med, but not when you chart that it's being prepared or given. So if the provider misses the warning or ignores it, the nurse can come very close to giving something to a patient that they're allergic to!

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

Honestly, I like to think there would be many advantages, but the fact is that we won't realize them unless the training is good and there are consequences for poor use of the system. Nurses aren't computer people. Well, I take that back. Not all of the older nurses are computer people. I know, computers are our world now, but you take a nurse who's been practicing since 1980 and tell her that she has to spend half the time she spends with patients clicking boxes? I have one nurse who calls the pharmacy constantly because she's trying to order a drug and can't remember that she needs to press enter in order to see all of her options. She's not stupid, she just hates the system and doesn't want to spend so much time on it. But meanwhile, she's annoying the pharmacy and annoying IT because she can't do basic things that the system calls for.

Interviewee: Sheila Goodman, Reconstructive Surgery Supervisor, Inpatient Services: Reconstructive Surgery

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

Several, actually. The PIS, the LIS, and imaging. And unlike most departments, billing. The �rst three we use to check on meds, labs, or images – we do a lot of repeat surgeries over here. We check with billing to make sure we've got the right codes for the procedures we do, which because of the impending switch to ICD-10, can be confusing.

Question 2:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 2:

It's a little ine�cient to have to check the codes, but we'd rather do that than have errors. We may do the same surgery several times on a patient, so getting it right the �rst time is important.

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

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Answer 3:

Well, I don't know if this would actually happen, but if some new system would �x our pain problem, that would be great. The problem is this: The nurses have between 15 and 30 minutes to reassess the pain score after they've given a pain med. But they get �agged in the EHR if they don't assess exactly at 30 minutes. It's not always possible, and it's unnecessary to do it on the minute like that. It's a pain.

Another thing? In this day and age, why are we relying on text-based descriptions for the complex wounds and skin condition we see in reconstructive? We should have some kind of camera or imaging capability so we can store up-to-the-minute images of what the patient's progress actually looks like.

Interviewee: Robert Cantwell, Pharmacy Supervisor, Therapeutic Services: Pharmacy

Question 1:

Can you describe the health information systems you work with most often, particularly in terms of functions speci�c to your department?

Answer 1:

The formulary, the pharmacy system, and the EHR are the systems I work with the most. The formulary tracks what we've got and the pharmacy system tracks our progress in �lling med orders.

Question 2:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 2:

You bet there are. I think it's partially a training gap, but since they never seem to be able to solve it, it's also a technology gap. People can complete drug orders with details missing, and it drives me nuts. They leave out the strength, the rate for an IV bag, things that are a little important and that of course I have to call to get. The system shouldn't let them do that!

Question 3:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 3:

There would be massive advantages in eliminating redundancy, ine�ciency, and probably errors, potentially life-threatening ones. Here's an example: Nurses sometimes just skip the allergic reaction when they input allergies. Allergies have symptoms, people! Rash, headache, nausea, anaphylaxis, there's no reason they should be able to skip that documentation. If there is, like the patient's unconscious, they should say that. Meanwhile, doctors skip alerts for allergies or contraindications or interactions all the time, and they don't give an explanation. Those bypasses are probably intentional, maybe because the bene�t outweighs the risk, but why can't the system force them to say why they bypassed?

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It's not safe to just assume that they did it intentionally; there are sometimes so many pop- ups that both doctors and nurses click through them without even reading them.

Another advantage, assuming it was possible, would be if we could document faster or remotely program IV medication orders. But I don't know if a system upgrade or whatever they're considering would include that.

Interviewee: Tara Jennings, Nursing Informatics Analyst, Nursing Support Services: Nursing Informatics

Question 1:

Can you describe work�ow issues you have noticed in your department that, for better or for worse, are a�ected by the EHR?

Answer 1:

Not in my department, exactly, but in the nursing units. I hear from a lot of nurses who say that the most stressful part of their job isn't responding to emergencies—it's feeling all day like they're forgetting something. Whether it's two-hour patient turns or intake and output documentation for IV drips, nurses have to remember to do it, do it right, and document it —on top of emergency response or meds and everything else. They often say, if the EHR is so great, why can't it remind me to do these things? I spend so much time charting, can't it prompt me to check for allergies or do my turns? The problem is that once you get too many pop-ups, you start ignoring them, so what we need is to be able to customize pop- ups so they only get them for the stu� they frequently forget.

Question 2:

What would be the advantages or disadvantages of implementing some kind of solution to the inoperability/interface problems that our health information systems have?

Answer 2:

Anything that leaves the nurse with fewer tasks to do and fewer things to remember is going to be extremely helpful. Another example would be a solution that carries information over to other, identical �elds. For instance, when the nurses in Cardiovascular Care chart capillary re�ll and nail bed color or the patient's current weight, that information should populate to the same �elds under Skin as they do in Cardiovascular screens.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

Hmmm. I think of this in terms of data security, both system-wide and individually. It sounds like all three of the new hospitals, especially Delaware, have some question marks around their security posture. So if our system helped to solve those question marks, it makes sense to transition them. But if it doesn't, it might be best to keep their data isolated from the rest of Vila Health.

But I also think of this in terms of meaningful use. I don't know what the other two hospitals are up to, but I know Independence is conducting an internal meaningful use

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audit. Depending on what that reveals, it might make sense to transition to our system if theirs isn't cutting it. But either way, I don't think it should be done until that audit is done.

Interviewee: Terry Morgan, Manager of Therapeutic Services, Clinical Operations: Therapeutic Services

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

Probably no more than at any other hospital. For the most part, the therapeutic departments can get the information they need from the EHR, although I know the nurses on the units sometimes can't get what they need from the departments. The Respiratory Therapy department gets a lot of calls from nurses who can't see patients' forced expiratory volume numbers. We're waiting for our spirometers to be integrated with the EHR; I guess it's on the to-do list.

Question 2:

Can you describe any expectations you had about the EHR which were not met?

Answer 2:

I didn't expect the physical therapists to have so much trouble adjusting to the templates. Randy almost had a revolt on his hands, and we paid some signi�cant overtime before we got that under control.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

Based on our experience, no. I'd say it's better to let them upgrade the system they currently have, or just leave it alone. Valley City isn't even used to their �rst-ever EHR yet, and unless they're really having problems that our EHR would �x, I doubt the commitment to thorough work�ow analysis is going to be there. Independence is a rural referral hospital, so most likely – even though it's counterintuitive – they would need a more complex EHR than Vila's.

Interviewee: Troy Holland, Director of Patient Services, Patient Services

Question 1:

Are there gaps between various health information systems here at St. Anthony Medical Center that cause ine�ciencies or work-arounds?

Answer 1:

The short answer is yes. The biggest problem area we have is integrating non-standard data, particularly as it arrives from non-Vila Health providers. There are work-arounds, but

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we could be much closer to a one patient-one record reality if we had better interoperability.

Question 2:

Can you describe work�ow issues you have noticed in your department that, for better or for worse, are a�ected by the EHR?

Answer 2:

Several of our departments have developed their own strategies and solutions for document and records management to manage the information speci�c to their work. That's how information has been handled for years, but the problem is all those separate systems create bottlenecks.

For example, even if a patient had registered at one of Vila Health's clinics this morning, if she then goes to a di�erent location she's going to have to go through a basic registration – providing insurance cards and other information to their admissions personnel.

Question 3:

What thoughts do you have about whether or not Vila Health's most recent acquisitions should be transitioned to Vila Health's system?

Answer 3:

Absolutely. It's going to be as much a problem to keep them using their own systems as it would be to upgrade them, but if they are part of Vila Health, we need them in our system. That's my opinion, at least.

Consider this – the new health care systems are now part of Vila Health. However, they use two di�erent online health portals. It's great that they even have online portals, though I have some critiques about the systems they're using, but the bottom line is that patients can access at least some information about their health care. However... those patients are now part of Vila Health but we are not going to be able to o�er them the services we o�er patients who are admitted through existing Vila Health partners. That is going to be a problem.

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Email #2

Interview Update? From: Evelyn Unger, HIM Transition Team Project Manager To: Learner

How did your interviews go? I hope you got what you needed. If you have, some members of the transition team would like to get some of your initial thoughts on the EHR and other systems at Independence. I think they're mainly interested in what systems the departments already have, and whether those systems are adequate for what they need to do.

Let me know if I can help!

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Evelyn

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Conclusion

Activity Complete! Having met with a wide variety of employees at Independence Medical Center, you should now have a solid understanding of what health information systems are in use, who uses those systems, and how well those systems are meeting the needs of their users and the hospital as a whole. You should be able to use this information to identify (at a high level) users, information systems, functionality, and problems with those systems.

The choices you've made at each step of this activity have been logged for you.

If you would like to see how di�erent decisions a�ect your outcome, you may try this activity again. Doing so will reset your activity log.

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Credits

Subject Matter Expert: Christopher Miller DHSC Doctor of Health Admin

Interactive Design: Mark Bune, Justin Lee, Matt Taylor

Instructional Design: Felicity Pearson, Anne Geske

Project Manager: Catherine Baumgartner, Amanda Holman, Tom Kapocious

Licensed under a Creative Commons Attribution 3.0 License.