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Merger Expands Health Information Exchange in Michigan

EAST LANSING, Mich. — A merger between two electronic health records providers in Michigan will provide access to health information for more than 5 million people in the state, making it one of the largest health information exchanges in the country.

Michigan Health Connect and Great Lakes Health Information announced Monday they will combine to form Great Lakes Health Connect (GLHC). Network members of the merged organization cover more than 80 percent of the hospital beds in the state and include more than 20,000 independent and employed providers. These health care providers serve more than half of the state’s 10 million people.

“Michigan Health Connect and the Great Lakes Health Information Exchange recognized that our missions were essentially the same and that we could better achieve our vision for a healthier Michigan together, rather than independently,” said Brian McCardel, M.D., orthopedic surgeon and chairman of the Great Lakes Health Information Exchange board of directors, in a statement.

GLHC will coordinate the exchange of electronic health records (EHR) between more than 120 hospitals. The company will also be able to provide real-time notification to providers for admissions and discharges from hospitals, nursing homes and other facilities.

“The depth and breadth of our network means we have the experience, resources and connections to initiate industry-leading advances in health information exchange on behalf of Michigan citizens,” said Doug Dietzman, executive director of GLHC and former executive director of Michigan Health Connect, in a statement.

The merger is in line with one of health care reform’s key requirements for technology to play a central role in containing costs, improving access and improving the health of patients. There is a 2015 deadline for health care providers that have not adopted a certified EHR system or can’t demonstrate “meaningful use.” If providers have not adopted a system and are eligible for Medicare reimbursements, their reimbursements will be reduced by 1 percent in 2015, rising to 4 percent in 2018.

“We look forward to advancing an integrated platform of services across the state and making Michigan a leader in the nationwide move to health information exchange and improved health status,” added Patrick O’Hare, chairman of the Michigan Health Connect board of directors, in a statement.

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Google Glass Comes to Boston ER

BOSTON — Google Glass has been introduced into the emergency department at Beth Israel Deaconess Medical Center in Boston. Though the first in the nation to implement the Google technology, the medical center’s pilot program has been welcomed by hospital staff.

“For us, getting the right information at the right time has always been the challenge,” said Dr. Steven Horng, an ER doctor at the hospital and an instructor at Harvard Medical School, in an interview with eWeek. “We run around a lot in the emergency department. We get interrupted all the time, and that’s kind of part of our job. Every time that you go to a computer, you go through interruptions.”

The program began in December, and 10 emergency room physicians are currently sharing four Google Glass devices. Physicians are able to directly access medical record stored electronically since 1997 using the secure app Wearable Intelligence. The hospital’s IT staff built the back end for the app.

"Being able to access [patient] information very quickly and not have to access a computer is very helpful," he said. "Being able to simplify the workflow is fantastic. Now, without having to look it up, the information is delivered to Glass as needed."

ER physicians can pair Google Glass with iPhones using Bluetooth, giving doctors the ability to speak hands-free. Doctors can easily view a of the list of upcoming patients, as well as updates on when X-rays, CT scans and other imaging results are available for diagnostic purposes. In an environment where every second is critical, these available visuals greatly benefit medical staff, Horng said.

“A lot of these are really small things, but small things add up,” Horng said. “It gives us more situational awareness. When you can take care of 50 or 60 patients in a shift, you have to keep track of it all. This really helps see things as soon as they come back.”

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Designing for Electronic Health Records in the 21st Century Facility

Thirty years ago, predictors of innovations in health care delivery and communications included the widespread adoption of Electronic Health Records (EHRs). Because the design of health care facilities incorporates a wide array of medical technologies, many organizations have evolved to incorporate new iterations of EHRs into their architecture, technological systems and work processes. Still, the adoption of electronic health records has varied widely among providers. Many organizations may have started with electronic imaging and slowly integrated more complicated EHRs as the systems technology advanced.
In the past five years, however, health care facilities that haven’t yet integrated current EHRs into their infrastructure have met with a new sense of urgency due to the national implementation. This year, of the Affordable Care Act (ACA) mandates all health care organizations must have fully operational EHR system standards by the end of 2014. Failure to comply by 2015 could result in fines. Some organizations adopting EHR systems have gotten a boost from the American Recovery and Reinvestment Act (ARRA), which supplied them with funds specifically for this purpose.
As such, many health care facilities today are faced with new architectural and technological challenges as they evolve to incorporate – perhaps for the first time – comprehensive EHRs to meet the ACA’s federal mandates. Health care facilities are now looking at comprehensive solutions that may fully integrate mechanical-electrical, and fires safety and security systems, in addition to medical equipment and communication networks to support patient safety and operational efficiencies. At this crucial turning point for these hospitals, it becomes important to ensure that the newer systems are incorporated successfully with minimal hindrances, and thus they may have to turn to engineering consultancy services for design and technological help.
In addition, codes on the federal, state and local levels regulate nearly all aspects of a facility’s design and construction. EHRs add another level of complexity to systems integration. Guidance from an architect knowledgeable about and experienced in the intricacies of EHR integration can substantially ease the process. Following are three approaches to ensuring the sound design or redesign of health care facilities with current EHR systems.

Designing an Implementation and Process Map
Integrating a new, comprehensive EHR system starts with designing a well-planned implementation and process map. To begin, the map should be mutually agreed upon by the facility owner, architects, engineers, contractors and other stakeholders, as it helps everyone involved successfully schedule the implementation process, from planning through design, construction, and system activation.
The process map includes comprehensive documentation of all required project steps. It starts with a building analysis, which can help minimize cost escalation and surprises as a project progresses. Next steps include code compliance; the selection of general contractors; costs of design, construction and technologies; detailed EHR construction documentation; safety-permit construction documents; clear identification of locations for new or renovated IT rooms; and comprehensive schedules incorporating work processes managed by owners, architects, contractors, and design/build trade partners.
Another element to consider is a campus-wide analysis of existing architectural and engineering systems and their mechanical, electrical, wireless, and data conditions. Facilities may also identify flexible spaces for use during phased construction, so that neither the patient experience nor caregiver workflow is disrupted. Flexibility is key, in order to accommodate unforeseen complications or surprises.
Staff training to ensure buy-in with the new EHR system, and to enhance work processes and decision-making, is also suggested. The implementation and process map also needs an attainable go-live date for the EHR system.

Instigating Infrastructure Upgrades
Developing an integrated, facility-wide EHR system includes infrastructure upgrades. These upgrades usually begin with routing new cabling and wiring, installing power and data outlets, and enabling Wi-Fi access. IT rack rooms or closets, located and identified in the implementation and process map, are moved and/or renovated.
Most health care facilities are already complex, multichannel organizations incrementally built over the years. Thus, existing systems should be leveraged wherever possible. Still, some existing infrastructure can create renovation challenges, even to simple cable updates. For instance, state and Federal codes often stipulate that if a new system touches an older system, then the older system (or room) and path of travel must be upgraded to meet current codes.
Also, as the architect identifies appropriate locations for new or renovated IT rooms-whether in offices, utility closets, or storage spaces-careful consideration must be given to other systems currently in use or nearby. For instance, is computer modeling reveals a potential increase in heating or cooling loads, HVAC upgrades may be necessary.

Measuring Success
A well-integrated EHR system is based on common-enterprise computer architecture, data standards, and privacy and security guidelines. Included in the system are such features as information model, standards and configurations; secure data exchanges; user identification and authentication; access management; clinician-access channels and event notification; and business intelligence enablement.
Thus a health care facility’s EHR implementation and process plan shouldn’t end with go-live activation. The new EHR system, in complement with additional technological infrastructure upgrades, should include a program for measuring the EHR system’s success with regard to health care quality, safety and security, and productivity.
As the evolution of tablets and smart phones ensures technology becomes more mobile, the patient and physician benefits of EHR systems will grow. In large health care facilities, for instance, patients may already be accessing their personal health information from their smart phone. At home, using a laptop, they will literally tap into the organization’s EHR system in order to easily communicate with their doctor, specialist, or pharmacist from a remote location.
Conversely, physicians and other medical personnel can share patient statistics across locations to ensure proper diagnosis and care. Outside of urban hubs, in more suburban or rural locations, EHR systems virtually bridge distances between locations, so that patients can remain safely in their homes while receiving consultations and care. For these reasons, new protocol for measuring the success of EHR systems is critical.

Conclusion
Such sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, also the U.S. population becomes more mobile, national health care networks are increasingly used to facilitate the sharing of health care-related information among various stakeholders and participants.
EHRs add another level of complexity to systems integration. But the benefits of EHRs to health care organizations and their patients – secure access that eases communication between caregivers, specialists, and patients – will grow as mobile technologies continue to drive advances in communications within the health care industry.

About the Authors
Joey Kragelund, AIA, is associate vice president and health care principal with HGA Architects and Engineers in Los Angeles.

Beth Young, AIA, LEED-AP, is project manager with HGA Architects and Engineers in Sacramento.

About HGA
HGA is an integrated architecture, engineering and planning firm. With offices in Los Angeles, San Francisco and Sacramento, California; Minneapolis and Rochester, Minnesota; Milwaukee, Wisconsin; and Washington DC, the nationally recognized firm has developed expertise in the health care, corporate, government, arts, community, education, and science/technology industries since 1953. Our culture for interdisciplinary collaboration, knowledge sharing and design investiga¬tion helps prepare our clients for the future with responsive, innovative and sustainable design. Visit www.HGA.com or follow the firm on Facebook or Twitter.

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Designing for Health Care Technology

In response to smaller reimbursements, greater operational costs and more demanding record-keeping requirements, the delivery of health care is becoming increasingly tied to technology. Because technology is now setting the pace in a large number of new construction and renovation projects, facility owners are finding themselves having conversations with architects and designers about technology much sooner in the building process. Technology such as wireless communications, medication bar coding, electronic medical records and RFID tracking will influence the design of a building. As the importance of health care technology grows, so does the interior design process required to incorporate that technology into a visually pleasing and highly functional way.
Begin at the Beginning
The most important step a facility owner can take to successfully integrate technology, architecture and interior design is to talk early and often about technology requirements. No longer can owners afford to treat technology as an afterthought. During new construction or a renovation, a facility’s IT department and technology planning team should have direct and regular input as design unfolds. This significant time investment up front will reap the rewards of a more seamlessly designed technology infrastructure and greater avoidance of expensive change orders.
Chief Areas of Integration
While technological innovation is now apparent wherever you look in a health care facility, there are a few areas where interior design is especially affected by technology.
1. The Hardware Store
The proximity and ubiquity of technology hardware drives a large amount of design decisions. Proper ventilation of computers, printers, charging stations and other hardware is critical for safety and maintenance. Counter space cannot be completely sacrificed for storage, and cabinet size will largely be limited by the ceiling and by accessibility requirements. Satisfying all these demands and arriving at a design that isn’t an eyesore is a challenge, to say the least. Facilities have had to get creative; one hospital tried multiple strategies to satisfy its hardware storage needs, finally deciding to install shower drains in the casework that were painted the same color to allow for ventilation and be aesthetically pleasing, too.
While some hardware can be stored inside a cabinet, some has to be readily accessible. To properly plan for monitors, input stations and other such devices, this kind of hardware should be known as far in advance as possible and measured so that it can be incorporated into counter and desktop configurations to allow those spaces to effectively service their other needs. With hardware storage planning, coordination with the project equipment planner is a necessity.
As the size and amount of A/V equipment and OR integration equipment has expanded, the size of its corresponding casework has also grown. To keep the equipment and its casework from eating up so much of the working space, some hospitals have created separate storage space with proper environmental control, adequate power and enough space for maintenance.
2. A Paperless Environment? Not Yet.
Although health care is moving toward a paperless environment, providers still rely on paper consent forms and other legal documents. A home for this paperwork and an adequate place for clinician and patient when these forms are signed may be overlooked in the planning phase.
3. Electronic White Boards
Electronic white boards are commonly used to track patient status, OR schedules and other rapidly changing data. When placing an electronic white board, the most important points to consider are workflow and visibility for the staff that reference the displayed information. Designing the interior space with staff visibility and functionality in mind can eliminate repositioning them after the facility opens.
Will multiple boards display the information, or will it be one board that scrolls? Will the boards be recessed or not? Having clinicians involved during the planning phase is key to minimizing repeat work — a point that speaks not just to this area, but all areas of health care technology planning. If possible, a 3-D model of the space will help clinicians advise the best placement of these screens.
4. The Key to Keyboard Placement
The placement of wired and wireless keyboards for staff and patient use require proper storage and easy access. Many systems in place today are not user-friendly or aesthetically pleasing. Working with the vendor selection and paying attention to details and accessories will pay off in the end.
5. Visitors Are Customers, Too
It is a given now that patients and family members will have some type of smartphone or laptop with them and will expect connectivity through Wi-Fi. Another expectation is that it will be possible to recharge personal devices in waiting areas and family-centered areas. Therefore, it is important to plan for ample outlets, logically placed near public sitting areas. Many facilities are specifying furniture that includes charging ports and outlets for electronics. Be mindful of future areas that might be converted to public waiting areas and plan for electrical outlets there as well.
6. Headwall Review
When considering headwall design and specialty casework, it is important to understand the functionality and power/data requirements necessary to create intentional placement and coordination with the architect, construction manager and technology project manager. Accessibility, ergonomics, functionality and emergency power are topics that need to be discussed when designing the outlets, data and electrical components of the headwall.
Many facilities are incorporating ceiling booms to hold outlets and equipment near the headwall. Equipment discussions and coordination will determine the space available at the headwall, and because the size and location of the equipment may change according to the specialty unit, having these discussions early will be valuable.
7. Access Versus Art
Placement of signage, artwork, donor plaques and the like can be difficult because they compete for wall space with access control devices like card readers and video intercoms. Similarly, modern nurse call systems have terminals that are mounted on the walls and provide challenges for the interior designer to incorporate them into the overall design of the room.
With so many items that are placed on the common area and patient room walls (clocks, artwork, casework, sharps containers, hand sanitizers), early coordination is necessary to implement an organized and thoughtful wallscape. It helps to fully understand the space requirements and workflow for all access control devices and nurse call systems, as well as getting input from clinicians on the most useful locations for such devices.

Behind the ceiling is a highly active community of wireless access points, paging speakers, nurse call dome lights, nurse call zone lights, RFID tracking sensors, air intake, exit signage and lighting and the community continues to grow. Careful planning is necessary to coordinate these systems in a cohesive and functional way, and in a way that doesn’t result in an unsightly and uncoordinated mess of a ceiling.
Looking Ahead
Understanding technology integration from an interior design viewpoint will keep you continually thinking about how your facility’s appearance and your facility’s performance can coincide. Because technology is changing at warp speed, and facility owners cannot possibly be expected to rebuild their facilities at the same rate, it’s important to plan with a high degree of flexibility.
It’s also a good idea to gaze down the road with regularity and consider how your existing facility will incorporate new technology without a renovation. Some trends to track include smartphone and tablet documentation and dictation, telemedicine, more “smart equipment,” more wireless ceiling access points and larger technology storage rooms.

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Popular or Not, Electronic Medical Records March Forward

CHICAGO – The transition to electronic medical records (EMRs) has been less than seamless on a national level. Our last two presidents have been relatively unanimous in their support of the change. President George Bush signed an executive order in 2004, calling for all Americans to have their medical information stored electronically by 2014. President Barack Obama’s Affordable Care Act codified that goal into law. The medical community has been less united in embracing the change.

Despite all of the uproar, Zeline Howard, an instructor with the medical office program at Coyne College in Chicago, believes EMRs will be accepted and appreciated by the medical community and patients in the long run.

The Coyne College Medical Billing and Coding diploma program provides students with hands-on training in medical billing and collection, records management, medical insurance claims processing, and CPT and ICD9 Diagnostic codes. Medical billing is essential to any healthcare system, whether that be medical coding and billing in NY, NY, or the medical coding and billing on our doorsteps, so ensuring that it’s done correctly is vital. Most medical centers don’t directly handle billing themselves. Instead, they will outsource to a medical billing service, like Precision Medical Billing, to collect the bills for them.

Coyne College also offers diplomas and associate’s degrees for other healthcare programs, including Medical Assisting and Pharmacy Technician. Like any other profession in the healthcare industry, these roles are just as important as the rest, meaning that extensive study must be carried out in order to employ the best people for the job. Luckily, trainee Pharmacy Technicians can prepare for your PTCB exam with this practice test on sites like Medical Hero to give you a head start in this exciting and invaluable career.

Howard has worked in the medical record field long enough to remember a time when there wasn’t a single computer in your average hospital room. She explained that those days are long gone now. On a recent visit to an emergency room, Howard was struck by how much her profession had changed.

“All the doctors and nurses were sitting behind computers,” she explained, “Then when I went into the emergency room, it was all computers in there and while I’m talking they’re typing. No one carries around charts anymore, everything is computerized.”

Even for someone who teaches classes about EMRs, it was a surreal experience and symbolic of the changes in the industry.

Howard felt that most of the resistance to EMRs came from two areas, the fact that the change is mandatory and fears that medical information will be easier to steal if stored on a computer.

The instructor explained many hospitals were already making the change to EMRs; the pushback came from having a mandate with a specific deadline. Medical care providers are required to use EMRs for at least one 90-day contiguous period during 2013 and fully adopt the system by 2014.

An additional requirement, known as “meaningful use” creates a strict structure of rules an organization must follow to prove that it is actually using the EMRs and didn’t just set up a system to meet the mandate, with no plans to use it. The meaningful use requirement is specifically applied to organizations that accept government funding to help make the transition to EMRs. Groups can apply for either $44,000 in federal funding if they accept Medicare or $63,375 if they accept Medicaid, but they can only choose one.

Concerns about computer hackers or employees using the new system to steal information about patients is the other main issue lowering public opinion of EMRs, according to Howard. The instructor added that there had already been documented cases of organizations being sued for fraudulently accepting federal funds and of hackers stealing information, which isn’t helping matters.

Despite these challenges, Howard predicted the changes would be accepted in the long run and the trend towards more high-tech solutions in health care would continue, “as far as man can take technology.”

She said one of the main benefits of the law would be the increased ability for law enforcement, pharmacists and doctors to share information on prescription trends for patients or employees who appear to have a problem with prescription medication abuse. Some states have attempted to set up different levels of information sharing, but Howard felt the increased standardization of EMRs would make a large impact.

The instructor added that part of the problem was that the current generation of medical professionals were raised into a more hands-on approach of dealing with patients and were dubious about the effects of putting more technology in between them and the people they serve.

“It’s my understanding that RNs really do not like sitting behind computers. You know they were trained to be a registered nurse and to care for patients and that’s true for doctors too,” Howard explained.

The instructor said this was changing a little for the younger generation of students in her classes, who have a different view of technology.

“They love my class,” she added with pride.

Howard concluded that the general trend in the medical field, and elsewhere, was that the hunger for new technology would win out in the long run over some of the fears associated with the changes it will bring. At every step of technological advancement, people voice concerns and fears, but the trend towards the cloud, the tablet and the smart phone appears to march forward nonetheless.

Located on two campuses in downtown Chicago, Coyne College offers individualized instruction, flexible class schedules and large, furnished labs. Coyne offers diploma and associate degree programs in a variety of fields including Heating, Air Conditioning and Refrigeration, Electrical/Electronics and HealthCare. To learn more, visit www.coynecollege.edu or call (800)707-1922.

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Emerging Technologies in Health Care Delivery

Managing one’s health in the future will involve an app, a “smart” device or a patient portal. The explosion of the mobile technology industry is fast and furious, and health systems are scrambling to keep up. These changes create both opportunities and risks; but by far the positives outweigh the negatives. The impact of this technology-driven era will provide more analytics, accountability and accessibility.
The emerging technologies that are changing the way we deliver health care include:

Smart Phones and Tablets Physicians have readily adopted the iPad as part of their medical practice, enabling them to securely search for lab values and X-rays, and to communicate with staff and patients. These consumer-grade devices are entering the hospitals most rapidly by way of patients and family, and from a facility utility standpoint, the need for electrical outlets for charging inpatient and family areas is a priority. Patients and family have an expectation of Internet access, and the growth of personal Internet devices is driving hospitals to provide more Wi-Fi access. Clinicians are slower to adopt mobile technology; they soon will follow. The tablets’ lightness, affordability and ability to be customized through apps make them ideal tools for the health care environment.

Health care Apps Mobile device apps provide rich information and health management tools. Among the custom apps that health systems are developing are a “wait time” app for the emergency department, a contractions monitor for patients in labor and delivery and facility maps with wayfinding to make it easy for patients and family members to navigate the hospital. Patients are monitoring their own blood pressure, air quality, blood glucose and weight loss, and these apps will only become more sophisticated, as will the consumers using them.

Electronic Medical Records EMR’s have been a large capital expense for health care facilities in recent years. Federally mandated requirements for clinical documentation have captured everyone’s immediate focus and budget, often derailing or postponing other critical facility needs and improvements. The EMR establishes a standard across all health care practices to enable data gathering, accessibility and eventually information exchange. Foundational to the EMR is that patients have access to their own health records and can access them through a hospital’s patient portal. A note to forewarn: as soon as the cloud of urgency passes and the electronic charting platform is in place, those projects that were postponed will manifest a new level of importance, and the demand may outstrip supply when the floodgates are initially opened.

RFID Tracking Radio Frequency Identification Tracking is being deployed across health systems to manage assets and staff. The return on investment has proven to be significant and immediate. According to the RFID Journal, Tufts Medical Center’s Cardiovascular Center in Boston saved $1.5 million for inventory management within its catheterization, electrophysiology and interventional radiology laboratories with the use of RFID labels. As more hospitals verify ROI and demonstrate various applications, RFID tracking will be an accountability necessity.

Operating Room Integration The advancement of video integration and image capture has set a new standard in the OR suite. This technology enables access to a full complement of video and data during a case to fully enable a surgeon’s ability to make decisions and act on the most relevant real-time data, as well as consult remote specialists via high-definition video conferencing. Further, a hospital’s ability to recruit surgeons today is largely based on the innovation and technology these systems offer. These high-tech OR suites command massive coordination between clinical staff, IT staff, clinical engineering, equipment vendors, design and construction staff and many others.

Wireless Medical Grade Utility Look for this term to become more common in the health care space. The West Health Institute, a non-profit medical research organization, recently formed the West Wireless Health Council and announced the creation of a medical-grade wireless open framework that effectively turns wireless into a common utility. Using best practices, the council developed a reference architecture that enables a wireless infrastructure to be incorporated into any health care system or hospital, much like air conditioning, heating, plumbing or electricity. Many health systems are beginning to adopt this architecture, paving the way for development of non-proprietary, lower-cost wireless devices and solutions along with improved management and performance of the wireless ecosystem.

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