Sunday, September 11
2:30 - 3:30 p.m.
Clinical Track

Implementing CPOE at Duke University Hospital: Content Delivery, Impact Analysis and Lessons Learned
Computerized provider order entry (CPOE) is a near-term goal of a growing number of hospitals with the recent attention on regional and national initiatives promoting the use of health information technology. In Fall 2004, Duke University Hospital implemented inpatient CPOE in its cardiology wards, to be followed by the other branches of internal medicine and the surgical services in subsequent months. A host of issues revolve around such an implementation, ranging from reconfiguring workflow processes and training personnel to the development and approval of clinical content. Expected benefits of the system include improved compliance with formulary medications, standardization of clinical practices in compliance with guidelines, reduced turnaround time for phlebotomy and pharmacy services, and improved accuracy of both order selection and diagnostic coding. Uncertain impacts on work processes include time of order entry and patient contact, staff satisfaction, and educational value.

Session Objectives:

• Describe the impact of CPOE on clinical care and work processes at a major academic hospital.
• Design a clinical content development effort.
• Describe the challenges encountered during implementation.
• Discuss the benefits of a design/building/implementation team composed of primarily clinical staff.

Clayton Musser, MD (Duke University Medical Center) & Leslie Mackowiak (Duke Health Technology Solutions)

Sunday, September 11
2:30 - 3:30 p.m.
Technology Track

A Unique Healthcare Identifier: The Discussion Continues
The issuance of a unique healthcare identifier for the U.S. has long been a controversial topic. In fact, the HIPAA legislation initially required a thorough review of this topic with the thought that a national identifier would evolve. The U.S. public, as well as Congress, felt strongly in the mid 1990s that a national identifier would not be issued, largely due to privacy and security concerns. In the almost ten years following this debate, some international communities that are investing heavily in healthcare technology, such as Canada, have stopped pursuing a national identifier, and others, like the United Kingdom, have embraced its pursuit. This presentation will discuss the current U.S. positions regarding the potential need for a unique healthcare identifier. Positions from major consulting groups, the federal government, collaborative privacy groups, consumer groups and researchers will be represented.

Session Objectives:

• Discuss various opinions and issues regarding a unique healthcare identifier.
• Describe how patient data linkage at a local, regional and federal level is affected by the lack of a unique healthcare identifier.
• Explain how technology, such as probabilistic algorithms, can assist in patient identification and data linkage.
  

Michael Competiello (Initiate Systems)

Sunday, September 11
2:30 - 3:30 p.m.
Compliance Track

Real World Standardization for Healthcare EDI: A Report from the Convergence Project
Begun in September 2004, the HIPAA Transactions Convergence Project has been actively seeking to identify common data requirements for the majority of payers in the industry. Participating in the initiative have been leading standards development organizations including the National Uniform Billing Committee, National Uniform Claim Committee, American Dental Association Dental Content Committee and National Council for Prescription Drug Programs. Additional participating organizations include the American Academy of Family Physicians, the New Jersey Department of Banking and Insurance, and the Medical Banking Project. The intent of the project has been to discern the elements that a majority of payers hold in common, providing the standards development organizations with valuable information regarding what should become new implementation guide requirements. The initiative also provides payer organizations with a means to compare their own requirements with those of their peers as they work toward convergence.

Session Objectives:

• Describe the progress the industry has made toward standardization and convergence in the past year.
• Discuss what we can expect over the next 1-2 years.
  

Kepa Zubeldia (Claredi)

Sunday, September 11
3:45 - 4:45 p.m.
Clinical Track

Enhancing Patient Safety through the Implementation of an Advanced Clinical Information System
Alamance Regional Medical Center (ARMC) is a not-for-profit, private community healthcare system serving Burlington, NC, and the surrounding area. Recently recognized with an Award for Excellence from the Healthcare Delivery Solutions Congress as the "Best Example of Innovation in Quality Care and Patient Safety in a Hospital/Health System," ARMC was the first community-based hospital in North Carolina to embrace CPOE, knowledge-based orders, and an electronic medication administration record (eMAR) known to reduce the incidence of medication errors and drug interactions.

With CPOE as the foundation for its strategies to improve workflow, cost efficiency and patient safety, ARMC has achieved the following:

• A high rate of voluntary physician adoption: 87% for order entry, 100 % for results retrieval.
• 72% reduction in potential medication errors.
• Decrease in medication order processing cycle time from 86 to 3 minutes.
• 58% reduction in duplicate lab orders.
• 90+ Medical Logic Modules developed and implemented to enhance practice/patient safety.
• Elimination of 15 manual steps by automating the medication administration record and decrease in lost charges through the use of the eMAR.
  

Session Objectives:

• Describe the role clinical decision support plays in reducing potential medication errors.
• Discuss ROI studies that impact patient safety and clinical practice.
• Explain the teams needed to support the implementation of advanced clinical solutions.
  

Terri Andrews, RN & Marie DiFrancesco, RN (Alamance Regional Medical Center)

Sunday, September 11
3:45 - 4:45 p.m.
Technology Track

Leveraging Technology to Support Collaborative Community Health in Durham County
This presentation deals with the beneficial results of a collaborative effort by Duke University Health System (DUHS), Duke University Medical Center and Lincoln Community Health Center (LCHC) to support the care of indigent patients in Durham County. Speakers will discuss how the relationship evolved, current joint initiatives and future ventures, and how they are leveraging IT such as network connectivity, application access, system interfaces, access to DUHS clinical data, and on site clinical services to support community health at LCHC.

Session Objectives:

• Discuss the benefits this collaborative effort has brought to the community.
• Describe how technology has enabled these benefits.
  

Philip Harewood (Lincoln Community Health Center), Frederick Johnson (Duke University Medical Center) & Terry Mears, RN (Durham Regional Hospital)

Sunday, September 11
3:45 - 4:45 p.m.
Compliance Track

Business Continuity and Disaster Recovery Plans: Lessons from the Trench
One of the key compliance requirements contained in both the HIPAA and Sarbanes-Oxley legislation is the establishment of a sound Business Continuity Plan (BCP) and Disaster Recovery (DR) plan. Once the plans have been developed, organizations must test them and make adjustments based upon the results of those tests. Many provider organizations are still struggling with the implementation these two requirements. This presentation will address the compliance requirements for BCP/DR planning and provide an overview of the NIST methodology. Also discussed will be the lessons learned from myriad provider organizations, including large hospitals and physician groups.

Session Objectives:

• Distinguish between a Business Continuity Plan and a Disaster Recovery Plan.
• Organize an effective BCP/DR team comprised of the impacted provider functions.
• Predict the risks and pitfalls associated with BCP/DR development and testing.
  

Clyde Hewitt (CTG)

Monday, September 12
10:30 - 11:30 a.m.
Clinical Track

The DOQ-IT Project: Advancing EHRs in North Carolina
CMS has asked the nation's Quality Improvement Organizations (QIOs), like Medical Review of North Carolina, to participate in the Doctor's Office Quality - Information Technology (DOQ-IT) project. The DOQ-IT project is designed to improve outcomes for patients with chronic illnesses by promoting the adoption of electronic health record (EHR) systems and health information technology in small- to medium-sized physician practices across the country. QIOs, in partnership with the American Academy of Family Physicians, will work to provide practices with assistance in workflow analysis and redesign of practices, selection and implementation of EHRs, and improved care management through the use of the EHR and the quality improvement model. This session will provide specific information pertaining to the implementation of the DOQ-IT project in North Carolina and what the future holds for providers on a local, state and national level.

Session Objectives:

• Identify three aspects of the DOQ-IT project offered in NC.
• Describe the changes in technology that impact the physician office setting.
• Identify three possible barriers to a physician implementing EHRs in NC.
  

Ann Lefebvre (Medical Review of NC)

Monday, September 12
10:30 - 11:30 a.m.
Technology Track

Using Business Intelligence to Improve Healthcare Delivery, Outcomes and Evidence-Based Decision-Making
In too many healthcare organizations, the financial bottom line continues to take precedence over quality of care, patient satisfaction and employee development. This imbalance can lead to strategic misalignment, suboptimal decision-making, and patient and staff dissatisfaction. It is essential that we provide business intelligence tools to healthcare leaders and frontline care providers to empower them to use data to drive performance and outcomes. This session provides insights and strategies to assist you in using business intelligence solutions to achieve evidence-based decision-making. Real life examples of successful hospital business intelligence solutions and performance management models, scorecards, and strategy maps are shared as are lessons learned along the continuum of hospital performance management. The impact of a variety of methodologies on healthcare leaders and care providers is also explored.

Session Objectives:

• Describe how technology can facilitate measurement, communication and evidence based practice across complex healthcare delivery systems in order to enhance quality, safety, employee satisfaction and financial outcomes.
• Measure return on investment (ROI) and success when implementing a multi-tiered business intelligence and performance management infrastructure.
• Discuss case studies of healthcare organizations that are achieving success using technology to become more evidence based in their decision-making and their strategies, obstacles and lessons learned.

Monday, September 12
10:30 - 11:30 a.m.
Compliance Track

Interoperable EHRs: The Legal Landscape
This session will address various legal issues in establishing and maintaining a system of interoperable electronic health records. These issues include: privacy, security, anti-kickback and Stark II law, non-profit taxation, malpractice and other liability, antitrust, intellectual property and state regulation of medical records.

Session Objectives

• Describe how various legal issues may affect business and clinical implementation of interoperable electronic health records.
• Discuss important considerations in addressing the impacts of these legal issues.
  

Michael Hubbard, JD (Smith Anderson) & Donald Horton, Jr., JD (LabCorp)

Monday, September 12
1:00 - 2:00 p.m.
Clinical Track

Patient Safety: Moving from Paper to CPOE - One Organization's Journey
Novant Health initiated a patient safety-related medication error reduction program in 2002. The goal of this program was to reduce adverse drug events (ADEs) related to several medications including anticoagulants, Digoxin and Potassium, as these were the leading medications involved in inpatient ADEs. Initially, the program was based upon data files generated from the standard lab and pharmacy systems to identify the triggers which would then identify patients for evaluation. The system required significant manual manipulation but was still able to reduce ADEs by 50%. Through the early course of the project, the team involved was able to leverage more and more IT-based solutions despite still not having access to a true CPOE system. By the end of 2004, the overall reduction in ADEs was 55% and the organization's progress towards a fully implemented CPOE module was underway. This next phase of the overall system's IT implementation allowed for the ADE project to trial the integrated rules-based triggering and alert functionality of the CPOE system to come. This resulted in even more comprehensive and earlier interventions in preventing ADEs.

Session Objectives:

• Describe how positive results can be achieved without sophisticated technology support.
• Explain how technology can even more positively influence performance improvement activities within healthcare organizations.
• Discuss methods and solutions which can help bridge the gap in "older performance improvement" methodologies and newer technology-based solutions.
  

James Lederer, MD (Novant Health)

Monday, September 12
1:00 - 2:00 p.m.
Technology Track

EMR at UNC: Inpatient and Outpatient CPOE, e-Prescribing and Health Maintenance/Disease Prevention Alerts
The electronic medical record ("WebCIS") at UNC Health Care system has been developed and in use for the last 13 years. It has resulted in the paperless practice of medicine in many areas within the system. An average of 2,650 unique users access the system daily and generate over 1.5 million data requests per day. Over the past two years we have implemented inpatient and outpatient CPOE in almost all units, instituted direct electronic prescribing for all outpatient areas, and have included a robust Health Maintenance/Disease Management module within the WebCIS. In this session we will demonstrate the system, discuss the integrative technologies used to create the WebCIS, and describe the process and pitfalls involved in transitioning a large institution from paper to electronic ordering and prescribing.

Session Objectives:

• Describe the administrative and technical structures used to accomplish system wide adoption of electronic record keeping.
• Describe techniques used to gain physician acceptance of electronic prescribing and ordering.

Robert Berger, MD, (UNC Health Care), JP Kichak (UNC Health Care) & Todd Hardman (SureScripts)

Monday, September 12
1:00 - 2:00 p.m.
Compliance Track

The Ongoing Security Program: Holistic, Standards-Based, Business Driven
HIPAA gave us a general set of security requirements and a specific time frame to meet them. Now we must maintain an effective security program on an ongoing basis. That program must be driven by our institutions' continuing clinical, research, educational and business needs, and by evolving regulatory requirements. It should capture the benefits of technological advances, while defending us from new technical threats. Most of all, it must communicate technical risks to senior management in a manner lets them compare the cost of further mitigation to the benefit of reducing the risk. Specific reference will be made to Duke Health Enterprise's efforts to implement such a program.

Session Objectives:

• List the components and activities of an ongoing information security program.
• List examples of business drivers to an ongoing information security program.
• Explain the role of Risk Analysis in the budget development process for information security.
  

Donald Sweezy, CISSP (Duke Health Enterprise)

Monday, September 12
2:15 - 3:15 p.m.
Clinical Track

Using Research to Improve Patient Care: One Practice's Experience
The Practice Partner Research Network (PPRNet) is made up of over 88 practices across the country that use a common electronic medical record (EMR) and pool data for quality improvement and research projects. Because all of the practices use the same EMR, the data can be easily mined for information and trends. The PPRNet is currently involved in a project that addresses practice guidelines for priority conditions and improvement approaches advocated in the recent Institute of Medicine (IOM) report and Healthy People 2010 activities. The goal is improved adherence with 76 practice guidelines in eight clinical areas. Learn how one small practice, Family Practice Partners, has drastically increased the number of indicators better than PPRNet benchmarks by using an EMR.

Session Objectives:

• Describe how one can use an EMR to improve patient healthcare.
• List techniques that can be used to change practices.
• Explain how a research project can help improve quality indicators.
  

Susan Andrews, MD (Family Practice Partners)

Monday, September 12
2:15 - 3:15 p.m.
Technology Track

Implementing A Statewide Immunization Registry in North Carolina: An Initial Step to Moving RHIO-like Activities Forward
As North Carolina considers efforts to promote the use of health information
technology through the development of networks for sharing clinical data as well as projects for planning, implementing and demonstrating the value of health IT, policy makers, purchasers and providers will look to one of the initial projects for lessons learned and potential success factors. The NC Division of Public Health leadership in contracting for the development and implementation of a CDC-certified system that is operational in other states as an example of how to take national standardization and make it work at the local level. Issues around such an implementation, ranging from design to training personnel, along with update on current receptivity, potential use and impact on efficiencies and effectiveness.

Session Objectives:

• Describe the design and process for the development of the North Carolina Immunization Registry (NCIR).
  
• Describe the impact of the NCIR on the state, providers and consumers.
• Explain the challenges encountered during the design and implementation of the NCIR.
• Discuss the lessons learned that will help in other RHIO-like activities.

Patricia MacTaggart (EDS), Mary Ivers (NC DHHS DPH), Walter Kemper (NC DHHS DPHH), Judy Lawrence (Cabarrus Health Alliance), Diane Evenson (EDS) & Bobby Minish (EDS)

Monday, September 12
2:15 - 3:15 p.m.
Compliance Track

The CHS Model of a Collaborative Compliance Program
The compliance program at Carolinas HealthCare System (CHS) is carried out by the President, Senior VPs, mid-level staff and the Compliance Matrix, which consists of over 200 people who, in addition to their individual jobs, have facility/risk area-specific compliance roles. The Privacy department is a key component of the program, with responsibility for ensuring that all HIPAA requirements are met using a reasonable, cost-effective approach. A team of experienced Compliance Specialists work directly with physicians and physician practices to provide education and training. The Internal Auditing department works with the management at each of CHS's 22 facilities to develop an audit plan that addresses the high risk areas of their operations.

Session Objectives:

• Describe the importance of an integrated compliance program with representatives throughout multiple facilities.
• Discuss the essential elements of an effective compliance program.
• Explain the functionality and effectiveness of using a matrix to manage the breadth and scope of a large compliance program.
  

Eugene DeLaddy (Carolinas HealthCare System)

Monday, September 12
3:30 - 4:30 p.m.
Clinical Track

The Use of IT in Measuring the Results of Pediatric Quality Improvement Projects
The Center for Children's Healthcare Improvement (CCHI) at UNC-Chapel Hill employs an array of information technology methods in implementing its local and national pediatric quality improvement projects. The use of this technology allows the results of quality improvement efforts to be measured and feedback given to participants. Results are reported back to participants in run chart format using an interactive data exploration tool, which allows participating providers to view their results in graphical form, charting their progress on the various project goals and measures. These technologies were recently used in the Cystic Fibrosis, Healthy Development, Access and Efficiency, and Medical Home projects.

Session Objectives:

• Describe the QI process as employed by CCHI and the various technologies that can be used to facilitate the process.
• Explain the requirements gathering process for developing IT tools for the QI process.
• Discuss a case study of a current project where IT tools were used for gathering data, reporting results, and facilitating the QI process.
  

Don Hopkins, PhD (Ursalogic Corporation), Stephanie Pierson (UNC Center for Children's Healthcare Improvement) & Divvie Powell, RN (Center for Children's Healthcare Improvement)

Monday, September 12
3:30 - 4:30 p.m.
Technology Track

Making It Easier to Practice Medicine: Riverside Health System Case Study
To further improve physician workflow and enhance patient care and safety, Riverside Health System wanted to provide its physicians with convenient, mobile access to patient information from mobile devices. During its planning phase, the southeastern Virginia-based hospital system decided on implementing a mobile data system utilizing cellular signals and smartphone technology to provide real anywhere, anytime access to patient data. This presentation will show how Riverside progressed through the planning stages to the successful implementation of its mobile data system. The presenters will describe how the system works, the results from the implementation, what it takes to encourage successful user adoption, and the wealth of benefits delivered by mobile data systems.

Session Objectives:

• Describe the impact of the technology development at Riverside Health System.
• Determine aspects of the Riverside technology deployment that could be duplicated at your organization.
• List the benefits of deploying an effective mobile data system.
• Describe the key factors for a successful technology deployment.
  

Charles Frazier, MD (Riverside Health System) & Alan Ying, MD (MercuryMD)

Monday, September 12
3:30 - 4:30 p.m.
Compliance Track

Holding Hands with Information: A Methodology for Success
Postoperative visits (POV) at Duke University Health System (DUHS) are required to occur within 48 hours after anesthesia administration. In October 2004, CMS mandated the POV be documented. DUHS' POV data collection applies web-based wireless technology and is sent directly to the CDR. Batch files are run every fifteen minutes allowing the POV note to be documented in the patient record. The mode (handheld PC or workstation) of data capture utilized by the practitioner can be identified via an audit tool providing strategies for enhancements. The POV success has lead to the expansion of other wireless handheld applications. Resident case logs for credentialing and peripheral nerve block tools are available. Future applications include incorporating the outpatient population, conducting research, and collection of quality improvement data to define best practices.

Session Objectives:

• Describe the benefit of web-based wireless technology in the healthcare setting.
• Describe the value of readily available clinical information for decision-making.
• List examples for future applications of web-based data collection tools.
  

Jeanellen Newkirk, RN (Duke Health Technology Solutions), Bill Gilbert (Duke University Health System) & Donna Nobles, RN (Duke University Health System)

The Next Generation of Mobile Computing Applications for Health Care
Advances in PDA and tablet PC technologies and improvements in handwriting recognition and conversion software enable health care providers to conduct truly paperless data collection. This presentation illustrates several applications for PDAs and tablet PCs in hospital and clinical settings, including: medical histories and intake questionnaires; quality assurance monitoring; emergency room patient management; and accreditation/licensure reviews. Live demonstrations of several applications will be integrated into the presentation. Issues to consider in the integration of mobile computing systems with legacy systems will be discussed, as well as data sharing, security and communications.

Session Objectives:

• Describe the features and benefits of various mobile computing hardware and software technologies.
• Assess the potential for applying mobile computing to improve operations and performance.
• Estimate the savings of staff time in information recording and reporting.
  

Colleen Hirschkorn, RN, MPA (The Lewin Group)

Tuesday, September 13
9:00 - 10:00 a.m.
Technology Track

Medication Management Effectiveness: Capturing and Assessing the Impact of Pharmacist Interventions
Medication Management requires an overall assessment of an individual's health, validation of their drug regimen, and tracking of their personal health outcome over a period of several years. This is particularly important in the senior population, where it is not uncommon to see individuals with multiple chronic illnesses and a lengthy, costly list of prescription medications. The methods for assessment, action, and follow-up are not standardized and rely on the experience of multiple individual providers. Evaluating overall program effectiveness remains difficult without a functional data collection and analysis system. The North Carolina Health and Wellness Trust Fund (NCHWTF) and its Medication Assistance Program (MAP) grantees chose to attack this problem starting in 2004. NCHWTF worked closely with the MAP at Alamance Regional Medical Center to define a structured approach to this process and develop software to support it. The MS Access-based software is an example of getting the most out of low cost, existing technology.

Session Objectives:

• Describe the methods and challenges associated with maintaining an effective drug regimen, particularly in seniors.
• Explain how to apply simple, proven technology to a complex problem.
• Discuss how public and private organizations can conduct a collaborative, low cost technology initiative with a significant payback.

Michelle Fritsch, PharmD (Alamance Regional Medical Center) & Paul Timmins (NC Health & Wellness Trust)

Tuesday, September 13
9:00 - 10:00 a.m.
Compliance Track

Business Continuity: The Disaster after the Disaster
To protect systems and processes, most providers still utilize historical Disaster Recovery (DR) plans which project system restoration within 36-72 hours. Continuity planning at the operations level is typically non-existent and very few providers plan for supplier disasters (e.g., reference lab systems are inoperable). With Board and auditor pressure, current and pending legislation, as well as regulatory agency requirements, DR/Business Continuity planning has become more visible. Unfortunately, it is considered only an "IT issue" and by default, becomes the responsibility of IT. This presentation will focus on the process, lessons learned and best practices for developing a DR and Business Continuity plan, especially the need to include executives and business owners in the process. The components of a Business Impact Analysis (BIA), which identifies the potential impact of unforeseen events on the organization's processes, and a Business Risk Analysis (BRA), which prioritizes potential business disruptions based on severity and likelihood of occurrence, will be addressed.

Session Objectives:

• Explain the differences between Disaster Recovery and Business Continuity Planning, and the impact on HIPAA regulations and SOX compliance.
• Discuss the growing importance of Business Continuity in IT and healthcare, especially as organizations move to an EMR.
• Describe DR/Business Continuity challenges faced by healthcare organizations, including "push-back" by non-IT executives.
• Discuss"real-life" scenarios of providers and other businesses that have experienced disasters and "lessons learned."
• Explain how to formulate, execute, test and maintain a DR/Business Continuity Plan.
  

Jack Hueter, CPA (Catholic Health East) & Gail Hinte