Session Descriptions

Monday September 24
10:30 a.m. - 12:30 p.m.

Interconnecting Healthcare: Application of IHE and the EHRVA Interoperability Roadmap
Join members of the HIMSS Electronic Health Record Vendors Association (EHRVA) for a demonstration of vendor collaboration and progress toward system interoperability. The demonstration will feature a real-world application of the Integrating the Health Enterprise (IHE) infrastructure and processes, showing vendor interoperability in action. Participants will observe the seamless passage of personal health information among patient care providers and settings that begins with a personal health record and flows from the primary care provider's office to the emergency room. This scenario will illustrate the different levels of patient care - where the patient is admitted, discharged, and returned to the primary care provider for follow-up treatment. Witness first-hand how information and images flow securely through the patient care process end-to-end using the latest Healthcare Information Technology Standards Panel (HITSP) standards.

The session will conclude with an open-panel discussion that includes Robert M. Kolodner, MD, National Coordinator for Health Information Technology, as well as members of NCHICA (CIOs from Moses Cone Health System and Morehead Memorial Hospital) and the EHRVA. The panel will discuss the opportunities and challenges of advancing EHRs to interconnect healthcare and accelerate the adoption of health IT. You will also learn how vendors and your peers are supporting national interoperability initiatives to establish healthcare standards and certify EHRs, and the relationship of these efforts to the IHE infrastructure.

Monday, September 24
Technology Track
2:20 - 3:20 p.m.

Duke University Affiliated Physicians: A New IT-Focused Culture for Healthcare Providers
The Duke University Affiliated Physicians' (DUAP) primary care physicians are part of a network of clinics and a continuum of care in the Duke Medicine system. The network formed in 1994 and now covers 19 locations in eight counties serving the Greater Triangle area. Over 100 providers, including physicians and physician extenders, provide health care. The DUAP network offers full service primary care including family medicine, general internal medicine, and pediatric medicine practices. The numerous services offered by DUAP practices include diabetes treatment, gynecology, hypertension treatment, minor surgery, on site x-ray and laboratory services, physicals, preventative and wellness care, and sports medicine. There are also two urgent care centers that provide extended hours, 7 days a week including holidays. These centers complement DUAP and other Duke Medicine primary care services by treating and managing urgent medical conditions and minor trauma events when a patient's primary care physician is unavailable.

While the EMR project is just starting and we are still using paper charts, the way that information is stored, accessed, and communicated to our patients (e.g., lab results and x-rays) as well as the way providers use reference material (e.g., Duke Medicine-wide clinical applications, PDA applications, the Internet, etc.) has changed dramatically, forcing our physicians and other clinical staff to rely very heavily on their workstations and underlying connectivity infrastructure. This presentation will review the specific IT changes involved and address how the clinicians have responded to them to improve productivity and enhance patient safety and care.

Session Objectives:

• Describe the impact of different information technology initiatives on primary care practice
• Discuss how primary care providers in non-hospital clinics have adapted to health system IT initiatives implemented in their practices
• List the benefits of IT system initiatives in a clinical setting from a provider's perspective
  

Susan Engelbosch, MBA (Duke University Health System), Jennifer Jo, MD (Duke University Affiliated Physicians) & Kathy Pettiford (Duke University Affiliated Physicians)

Monday, September 24
Compliance Track
2:20 - 3:20 p.m.

NGA State Alliance for eHealth & the NC HISPC Project: Potential Impact on NC
Under the leadership of the National Governors Association (NGA), the State Alliance for e-Health is developing strategies and models for healthcare policies that will have a major Impact on NC and other states. State-level decision makers (governors, legislators, attorney generals, etc.) are confronting challenges to state-level interoperable health information exchange and developing best practices and state-level consensus-based solutions to address state-level privacy arid security issues, state-law practice of medicine barriers, and state-level health information organization issues in governance, sustainable financial models, the role of payers, and the integration of public health and benefit programs.

NCHICA members have collaborated under the North Carolina Health Information Security and Privacy Collaboration (NC HISPC) contract with RTI International to articulate variations in laws, regulations, and business practices that inhibit the exchange of health information for treatment purposes and then to develop solutions and implementation plans to overcome inappropriate barriers while strengthening protections of information. The continuation of this effort is anticipated to include collaboration with other states in 2008.

Session Objectives:

• Discuss best practices related to addressing privacy, security, barriers and governance in state-level interoperable health information exchange
• Present the activities and outcomes of the NC HISPC Project
• Describe the potential impact of these national initiatives on NC

Angie Santiago (TM Floyd & Co.), Michelle Lim Warner, MPH (National Governors Association) & Holt Anderson (NCHICA)

Monday, September 24
Clinical Track
2:20 - 3:20 p.m.

Outcomes Analytical Framework: Getting Ready for Evidence-Based Health Care Decision Making
Traditional data warehouse and business intelligence approaches focus on collecting and organizing bits of data for possible later use to support or enable decision making. Depending on the robustness and quality of implementation, this approach may result in more consistent reporting and improved data quality. If the effort is not closely tied to corporate goals or strategies, however, relevance and sustainability is questionable. A focus on results and outcomes is needed.

The outcomes analytics framework combined with data warehousing and business intelligence concepts can be visualized as a synthesis of process improvement, quality improvement and performance measurement enabled by full-service analytic capability. This cyclical approach involves internal collaboration to decide what to measure and how to measure with consistent interpretation and communication of results. This presentation will describe an informatics-based approach with the goals of:

• Greater consistency in the accuracy, timeliness and effectiveness of analysis and reporting for outcome measurement;
• Higher performing clinical organization with dependable measures of progress toward clinical outcome, satisfaction and patient safety goals; and
• Providing explanatory and predictive analytics for the details behind outcomes enabling analysis of causes and more informed creation of plans of action.
  

Session Objectives:

• Describe the components involved in developing actionable performance metrics
• List key steps required to build a knowledge base in strategic areas across an organization using an outcomes focused framework
• Identify technical and organizational challenges in implementing a sustainable process

Robert Phelps, MA (Novant Health)

Monday, September 24
Technology Track
3:40 - 4:40 p.m.

POC3: Plan of Care at the Point of Care Brings the Power to Change
Hospitals and physician practices, as well as skilled nursing homes and assisted living facilities, struggle with financial, staffing and other impediments to EMR adoption. One organization, a continuing care community which has both onsite medical centers and skilled nursing care, chose to demonstrate its commitment to the care of its residents across the continuum of care with an aggressive, costly, strategic and tactical EMR. The speakers will discuss the steps to implementation and the benefits of the EMR, with focus on nursing documentation under the direction of the IT team, across residents of skilled and assisted living centers from seven sites and six states. Additionally, speakers will discuss how they addressed the challenge of involving and inspiring nurses across diverse settings, over multiple states, in skilled versus non-skilled facilities, with diverse sets of compliance and regulatory standards, to embrace the use of electronic nursing documentation and to have a interdisciplinary use of all electronic documentation.

Session Objectives:

• Discuss the unique challenges of implementing electronic nursing records as part of the EMR across multiple state facilities with varying regulatory issues
• Identify at least three techniques used to overcome obstacles in implementation of electronic nursing information as part of the EMR and be able to apply those techniques to any industry
• Describe the scope and practice of EMRs and their benefits across various disciplines and practice types
  

Daniel Wilt, MBA (Erickson Health), Annette Fleishell (Erickson Retirement Communities) & Beth Muthig, MSN (Erickson Retirement Communities)

Monday, September 24
Compliance Track
3:40 - 4:40 p.m.

Electronic Records Management Demystified: Adjusting to the New eDiscovery Rule
With the December 1, 2006 eDiscovery Federal Rules of Civil Procedures published by the U.S. Courts, healthcare organizations face additional challenges of capturing, cataloging, protecting, and if necessary, producing electronic records for litigious clients. Healthcare organizations should be aware of the strict penalties for non-compliance, as they cannot afford to make mistakes handling either electronic medical records or other sensitive data. This challenge is difficult in the mainframe environment, but as the information age has expanded the number of systems, the task becomes daunting without a good plan. Add to that the explosion of mobile computing and the challenge of knowing where records are created, stored and eventually retired, and the task becomes burdensome. Finally, as multiple healthcare organizations join together in RHIOs, information "ownership" versus "custodial care" blurs the lines of management responsibility.

The presenter will discuss differences between an official medical record and other types of records that are subject to discovery under the eDiscovery Rule. This session will also address how to develop and implement comprehensive, effective and executable Records Retention Policies that will allow a healthcare organization to better protect its reputation and minimize cost during an eDiscovery action.

This presentation will also focus on the steps needed to address records retention, including the necessary cultural changes that an organization should promote to ensure compliance with the policies. Session attendees will receive a draft high-level project plan that covered entities can use to address records retention issues (including assignment of roles and responsibilities, tasks and deliverables) as well as a sample records management policy.

Session Objectives:

• List the requirements of a sound records management program
• Describe the impact of the new eDiscovery Rule on your organization
• Outline the programmatic steps required to organize a project team to address records management
• Create a records management policy based upon the sample provided during this session
  

Clyde Hewitt, MS (Forsythe Solutions Group)

Monday, September 24
Clinical Track
3:40 - 4:40 p.m.

Collaborative Models to Improve Quality Care
Novel artificial intelligence-based software systems are becoming available to improve the quality of patient care by measuring clinician behavior and targeting interventions to improve performance and reduce medical errors. When combined with business intelligence and statistical applications, these systems have demonstrated an ability to:

• Measure clinical performance and adherence to guidelines and evidence-based medicine;
• Predict medical error rates and their financial impact; and
• Improve clinical performance through the implementation of preventative measures.

The presenter will review collaborative models whereby expertise and best practices can be captured, tested in a competitive research environment, and applied to patient care through both simulation and clinical decision support software systems. Also discussed will be the quality and economic impact of artificial intelligence-based healthcare training, monitoring and management systems for healthcare providers.

Session Objectives:

• Describe the effectiveness of clinical performance management tools in influencing future clinical behavior in diagnoses and treatment
• Discuss strategies for managing healthcare provider risk and optimizing reimbursements for healthcare delivery organizations without compromising patient quality
• List ten steps in building and implementing clinical performance management systems
  

Charles Coleman, PhD (SAS Institute) & David Hadden (TheraSim)

Tuesday, September 25
Technology Track
8:30 - 9:30 a.m.

ORView: An End-to-End Perioperative Information System
ORView is Duke's award-winning Perioperative Information System. It overlays off-the-shelf, best-of-breed systems for OR scheduling and anesthesiology clinical information, and enables new capabilities and enhanced functionality neither system could manage on its own. With ORView, Duke now has an integrated, end-to-end system that provides enhanced preoperative screening. Reports are available electronically throughout the application, from airport-style big screens which integrate data from several systems into one comprehensive at-a-glance view, to post-operative visit follow-up evaluations, with results reported back to the hospital common data repository. In addition, it improves care by enabling providers to review schedules and exam results from anywhere on the Internet the day before surgery, and improves productivity by reducing paper flow and actively assisting with data entry to enable fast, accurate choices for providers.

Session Objective:

• Describe the improvements possible by integrating best-of-breed commercial OR systems with custom-built applications

Bill Hansley (Duke University Health System)

Tuesday, September 25
Compliance Track
8:30 - 9:30 a.m.

Driving Value in Healthcare: IBM's Patient-Centric Vision
Learn how a large employer and health plans are collaborating to address control over the escalating costs in healthcare. IBM's current focus on patient-centric primary care will empower employees to make informed healthcare and lifestyle choices, help physicians to provide higher quality care, and enable health plans to provide greater information transparency.

Presenters will discuss the strategies that IBM and other employers, partners and health plans are taking to engage employees, members and healthcare providers in accelerating the transformation of healthcare. In addition, learn how IBM has worked with its health plans to create innovative programs that enhance collaboration and improve the quality of healthcare benefits and outcomes received by their employees.

Session Objectives:

• Describe how employers and health plans are working to control healthcare costs
• Discuss what patient-centric primary care means to health plans, providers, patients and employers

George Chedraoiu (IBM)

Tuesday, September 25
Clinical Track
8:30 - 9:30 a.m.

CPOE in an Academic Medical Center: A 20-Year Journey
As one of the earliest pioneers in CPOE, VCU Health System (aka: Medical College of Virginia Hospital) has accumulated a wealth of information and experience that delves into the benefits, pitfalls and methodologies of applying CPOE to a large and complex enterprise. From the initial TDS-7000 tribulations with a highly resistant medical staff 20 years ago, to a lengthy and challenging Cerner conversion three years ago, VCU has continued to both evolve and refine its CPOE system. At the same time, it continues to derive real and measured value around improved patient safety and quality. Along the way they have learned important lessons that can benefit any provider organization that decides to take the plunge into CPOE. VCU is now starting on an additional three-year effort to complete the EMR, including advanced nursing and physician documentation, device integration, ambulatory use and closed loop medication reconciliation.

Session Objectives:

• Describe the business case for CPOE
• List the pitfalls and impediments to CPOE deployments
• Discuss ways to ensure CPOE success
  

Rich Pollack, MS (VCU Health System)

Tuesday, September 25
Technology Track
9:50 - 10:50 a.m.

If We Build It, Will They Come? Developing a Community-Wide EHR
HealthSpan was created by University Health Systems of Eastern Carolina (UHS) to develop partnerships to connect patients and their health care providers with the information they need to promote and sustain better health. HealthSpan's goal is to build a community-wide electronic medical record (EMR) that will provide health information to any appropriate caregiver, independent of space and time. Expected benefits will include increased patient safety, improved health maintenance programs and improved disease management.

While several providers have already expressed interest in being part of this collaboration, HealthSpan's success will largely depend on something UHS cannot fully ensure - the fiscal commitment from providers that share the overall vision of a community-wide EHR. This presentation will detail UHS's approach to developing a community-wide EHR, including risks, benefits and cost models, highlighting the strategies to gain provider commitment and adoption, and providing "lessons learned" for other organizations considering similar initiatives.

Session Objectives:

• Discuss the business elements, including costs, benefits and risks, associated with a community-wide EHR
• Describe the marketing, communication and fiscal initiatives required to gain and retain broad participation by community providers

Stuart James, MBA (UHS of Eastern Carolina), Gail Hinte, MPA (HIMformatics) & Cathy Morris (HIMformatics)

Tuesday, September 25
Compliance Track
9:50 - 10:50 a.m.

NHIN Phase 2 and NC Health Information Exchange: Building a Statewide Capability from Local Communities Outward
Meeting privacy and security compliance requirements and having a solid business case are necessary components for a statewide health information exchange for North Carolina. This session will describe the lessons learned from NHIN Phase 1: Architectural Prototypes and the key drivers in developing the proposal for NHIN Phase 2: Trial Implementations. Also highlighted will be a broad-based governance council that will provide the needed statewide coordination capability for North Carolina.

Session Objectives:

• Describe how the lessons learned from NHIN Phase 1 relate to the upcoming NHIN Phase 2 Trial Implementations, and how these may relate to the NC HIE.
• Discuss the business cases, and the various cost and revenue models that can help HIEs achieve self-sustainability.
• Describe the issues that must be solved by community, statewide and regional HIEs, such as privacy and security compliance.
  

Tuesday, September 25
Clinical Track
9:50 - 10:50 a.m.

Using Technology to Enhance Patient Outcomes and Caregiver Safety
Improving patient outcomes is of critical importance to healthcare providers. Doing so requires the ability to optimize people, process and technology in order to drive continuous and sustained improvement. This session provides insights and strategies to assist providers in using technology solutions to improve clinical outcomes and patient and caregiver safety. Real-life examples of improved clinical outcomes and best practice methodologies are shared for you to use in your organizations.

Session Objectives:

• Discuss 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.
• Describe case studies of healthcare leaders who are achieving success using technology: discuss their methodology, obstacles and lessons learned.
  

Melissa Fitzpatrick, MSN (Hill-Rom)

Tuesday, September 25
Technology Track
11:10 a.m. - 12:10 p.m.

Implementing CPOE in a Community-Based Hospital Focusing on the Order Set Development Lifecycle
Durham Regional Hospital (DRH) is a 369-bed acute care community hospital serving the residents of Durham County, NC and is a member of the Duke University Health System. It successfully implemented CPOE, including a "closed loop" for medication orders, utilizing Siemens products. Through aggressive planning, clinician involvement and utilization of the order set development cycle, they were able to bring the first unit live within six months of taking delivery of the software.

Until recently, most CPOE implementations have occurred primarily in academic medical centers. Within the past two years, community hospitals across the country have gradually begun to implement CPOE. DRH is one of a few community-based hospitals in North Carolina to bring up CPOE. It is also one of a very small number of hospitals (any size) across the Siemens customer base that has implemented the triad of CPOE, medication barcoding and administration, and pharmacy bi-directional interfaces to "close" the loop and fully automate the entire medication process.

Presenters will review their workflow process with focus on the Order Set Development Life Cycle and how to achieve collaborative physician involvement in the process. They will discuss the unique challenges of getting buy-in and participation from community-based physicians and share some of their strategies and success stories (and some of their not-so-successful approaches).

Session Objectives:

• Describe the workflow structure used to implement CPOE, including the involvement of nurses and physicians in the workflow analysis, development of policies and procedures, and marketing
• Explain the Order Set Development Life Cycle
• Share "lessons learned" in implementing CPOE in a community-based hospital.
  

Reba Beavers BSN, MBA, MHA & Debbie Zanes (Durham Regional Hospital)

Tuesday, September 25
Compliance Track
11:10 a.m. - 12:10 p.m.

Deidentified Data: What Every Privacy Professional Needs to Know
Privacy laws apply to the privacy of identified or identifiable persons. HIPAA speaks most directly to de-identification in the compliance context. De-identified data under HIPAA are not protected health information ("PHI") and therefore not regulated under HIPAA. HIPAA de-identification standards are squarely based on decades of U.S. government research and applications and related law. These same HIPAA de-identification principles, strategies and technologies also apply to determining and ensuring that information outside of the health care sector is de-identified.

Data mining of de-identified data helps to design more effective clinical protocols and health plan wellness programs. Market research professionals in health industry organizations can have access to data to meet their business needs, including at a de-identified individual person level or a "record level" without the information being personally identifiable information ("PII") or PHI. De-identification strategies also have significant utility in cross-border and onward transfers of data.

Session Objectives:

• Describe how HIPAA deidentification works
• Discuss how deidentified data can be used to improve quality and outcomes
• Explain how deidentified data furthers national security interests in biosurvelliance

Mike Hubbard, JD (Womble Carlyle Sandridge & Rice, LLC) & Fritz Scheuren, PhD (National Organization for Research)

Tuesday, September 25
Clinical Track
11:10 a.m. - 12:10 p.m.

Making Personalized Medicine a Reality through Clinical Decision Support and Risk Assessment Technologies
There is broad agreement that Personalized Medicine is the healthcare delivery model of the future, but little consensus on how to make it a reality. In addition, there are a wide variety of approaches to personalizing medicine. This presentation will put forth a vision of what truly personalized medicine looks like, the benefits it will offer, and how it will change the healthcare system from the point of view of the provider, payer and consumer.

Central to enabling true care delivery that is personalized are Clinical Decision Support systems. The rationale for Clinical Decision Support will be discussed, as well as the barriers to adoption. A holistic approach that shows benefits for patients, providers and payers will be proposed and real-world examples presented. Finally, leading-edge Risk Assessment technologies will be discussed. The presentation will tie together the role of risk assessment in personalizing medicine and clinical decision support as a delivery vehicle for these capabilities.

Session Objectives:

• Describe aspects of personalized medicine and list the advantages of a personalized healthcare system compared to a population-based system
• List the benefits of Clinical Decision Support systems as well as articulate a strategy for ensuring adoption by all stakeholders in a clinical setting
• Discuss risk assessment technologies and how they can be used to deliver personalize care
  

Quentin Spencer (Proventys, Inc.)

Tuesday, September 25
Technology Track
1:10 - 2:10 p.m.

Profiles in Courage: A Project Journal of a Continuity Implementation
You've done it, you've decided to make the jump and address enterprise-level continuity planning in your clinical environment. Wouldn't it be great if you weren't a lone pathfinder discovering, at great length, what strategies will accelerate your project, and which ones will bring the project to a crawl? It's a journey, to say the least, and this presentation will serve as a guide as you begin, or restart, your continuity journey. The presenter will explore a real-world example of one organization that recognized the value of a care-based approach to its continuity planning, ensuring that its clinicians always have access to the processes required to deliver care. Learn what went well, what didn't, and how to tell the difference before your project is in trouble.

Healthcare organizations must provide services that are secure, confidential and available to their care-delivery teams. The increasing complexity of processes, systems and integration has created an environment in healthcare that organizations cannot address with traditional disaster recovery or business continuity. As healthcare organizations automate more of the care delivery process, there comes a moment of realization that clinical operations have become more than technology dependent: they are dependent upon the processes that leverage technology. This is the project journal of one organization's experience.

Session Objectives:

• Describe what worked, and what didn't, during a continuity planning engagement for a large mid-western healthcare organization
• List the criteria and drivers required for successful continuity planning in a clinical environment
• Apply techniques to review your own organization's continuity needs
• Identify weaknesses inherent in your organization's existing continuity planning activities, and strategies to address those weaknesses

William Hudson (CTG Healthcare Solutions)

Tuesday, September 25
Compliance Track
1:10 - 2:10 p.m.

eHealth Initiative Washington Update and the Impact on Sustainability for HIEs
Presenters will provide an in-depth, inside-the-beltway look at current Congressional and Administration initiatives related to improving the quality, safety and efficiency of healthcare through health information technology and health information exchange (HIE). Topics to be discussed include: Has the 2006 election partisan switch in Congress and committee leadership made a difference? What impact are Congressional and Administration initiatives having upon HIEs at the community, state and federal levels? What programs are poised to expand or diminish?

Within the context of the Congressional and Administrative activity and direction, what has changed at the local level for HIEs? All health information exchange efforts face a similar set of challenges and opportunities. This session will highlight critical success factors and case studies, and provide participants with applicable HIE tools from the eHealth Initiative Connecting Communities Toolkit. This interactive session will explore the impact of important decisions regarding the governance, clinical outcomes, security and privacy, financial considerations and technical architecture for an HIE. These decisions, when made appropriately, have a complementary effect on all stakeholders in the affected community.

Session Objectives:

• Develop a map of Congressional and Administration activities currently underway and expected to impact HIE in the U.S.
• Identify the critical success factors for sustainable HIE within a community
• Evaluate the key decisions to be made as a sustainable local, regional or statewide HIE is designed
• Describe how to ensure collaboration with existing governance, clinical and technology approaches

Christine Bechtel (eHealth Initiative) & Andrew Weniger, CPA (eHealth Initiative)

Tuesday, September 25
Clinical Track
1:10 - 2:10 p.m.

Understanding the Small Medical Office: Factors Affecting Quality, Practitioner Performance & EHR Adoption
The small medical office, staffed by fewer than four providers, is the entity that delivers most of the medical care in the United States. In order for any health information exchange system to be successful, adoption of electronic health records (EHRs) by these offices is critical. This presentation will attempt to evaluate EHR adoption from a provider's point of view. The economic, political, legal and social difficulties unique to this group will be discussed in order to help businesses understand how to develop and market products to these practices. Ideas for incorporating systems into practice workflow will be discussed. The use of existing technology to enhance the quality of medical care and ideas for future products will also be presented.

Session Objectives:

• Describe the special considerations present for EHR adoption in a small medical office
• Explain how electronic health information exchange can be incorporated to improve workflow and efficiency in a small office
• Discuss ways to improve quality using existing and future technology
  

Edward Ermini, MD

Tuesday, September 25
Technology Track
2:30 - 3:30 p.m.

Medication Management in Ambulatory EMR: A Recipe for Patient Safety
The annual cost of drug-related morbidity and mortality is nearly $177 billion in the United States, with 7,000 deaths. The main causes of medication errors include incorrect diagnosis, prescribing errors, drug-drug interactions, dose miscalculations, and lack of patient education. UNC Health Care System developed its own electronic medical record system, called Web Clinical Information System (WebCIS), which incorporates functions to alleviate some of these common medication errors.

The medication list in WebCIS is all coded based on the FDA's NDC codes. The clinicians have the ability to create their own favorite list of coded medications, called myRx list, that enable them to quickly add medication to a patient's list. They are also able to record any drug allergies to the patient's allergy list from a similar coded list. This enables clinicians to check any drug-allergy interactions, and alerts them at the time of updating meds or allergies. The patient's drug profile is automatically checked for drug-drug interactions as well. Clinicians are able to generate a prescription from the list just by the click of a button, or send e-prescriptions directly to the area pharmacies, thus totally eliminating handwritten prescriptions. They are also able to print drug monographs for the patient just at the click of a button. WebCIS has an inbuilt simple rules engine to check problems and medications, and alert the physician if any drug classes are missing.

Session Objectives:

• Explain the value of point-of-care decision support related to medications in an ambulatory EMR
• Discuss how easy-to-use tools and decision support align well with workflow in an ambulatory care setting

Robert Berger, MD (UNC Health Care System), Raj Gopalan, MS (UNC Health Care System) & John P. Kichak (UNC Health Care System)

Tuesday, September 25
Compliance Track
2:30 - 3:30 p.m.

Mandatory Public Reporting of Healthcare Associated Infections: The Good, the Bad and the Ugly
Healthcare associated infections (HAI) remain one of the most serious patient safety concerns, complicating 5% of all hospital stays and resulting in thousands of preventable deaths annually. Despite national and local safety initiatives, HAIs continue to be the most common adverse outcome in healthcare. In response, consumer advocacy groups have pushed for political change by lobbying several state legislatures to enact mandatory public reporting laws. In 16 states, these laws require healthcare institutions to publish infection rates, theoretically allowing consumers to shop for the safest healthcare delivery.

Because of a lack of scientific evidence, the Healthcare Infection Control Practices Advisory Committee (HICPAC) did not recommend for or against public reporting of HAIs in a position statement. HICPAC did recommend that states establish public reporting systems to ensure data quality so that HAI rates are comparable between and among healthcare institutions and that reports are understandable by the public. In NC, a public reporting law may conflict with peer review statutes which protect certain health outcomes data from discovery. In addition, the surveillance and reporting of HAI rates to a central repository may impose significant new costs to healthcare institutions and to state government. Ultimately, experience from other state mandatory reporting laws will drive a national consensus on this movement. Presently, NC ought to learn from these experiences, and if shown to reduce HAI rates, NC should speedily enact new legislation.

Session Objectives:

• Explain the impact, surveillance and measurement of HAI rates
• Describe mandatory public reporting of HAI rates and issues related to data quality and management
• List the pros and cons of mandatory public reporting of HAI rates for overall health policy

Jeffrey Engel, MD (NC Department of Health & Human Services)

Tuesday, September 25
Clinical Track
2:30 - 3:30 p.m.

Real-World Clinical Transformation
You've heard all about clinical transformation, but how can you actually make it work? What is clinical optimization? Which is right for your organization? What can this do for patient care, provider satisfaction and regulatory compliance? What are the barriers to successfully transforming care? Where do you start and what needs to be considered?

This presentation will cover the following:

• "Context" definitions of Clinical Transformation and Clinical Optimization
• The healthcare leader/manager role
• New NQI developments and how they drive efforts
• Past experiences and lessons learned
• New challenges and possibilities for transformation, and how you can use them to your advantage
• Transformation vs. optimization, and the whole system vs. incremental approach
• How to focus efforts to get the best possible results, including successful strategies, and
• How you can prepare your organization to be transformed, and execute a comprehensive approach.

Session Objectives:

• Deveolop a high level roadmap for clinical transformation planning and execution
• Explain the importance of preparation to spread the operational impact of clinical transformation projects

Joe Thompson (CTG Healthcare Solutions)

Tuesday, September 25
Technology Track
3:50 - 4:50 p.m.

Reengineering Clinical Processes in an Ambulatory Care Specialty Practice
Vendor and implementation solution strategies must provide for component, phased or full ambulatory electronic medical record (AEMR) adoption in concert with physician practice management integration. Clinical practice reengineering must address individual physician practices, practice groups and communities to ensure the impact of technology adoption into the clinical environment to support patient care delivery with minimal reduction in productivity or disruption in business operations.

Successful implementation of an AEMR requires a systematic approach for managing change across an enterprise that includes physician practices located in multiple facilities and communities across a given geographic region. The implementation strategy in this environment requires redesign to a standard of key care delivery processes that specific vendor technologies must support and a rigorous, disciplined project management methodology. The successful reengineering project plan requires identification and resolution of key clinical and business decisions and other change management issues on the front end of a system deployment.

Session Objectives:

• Describe an AEMR model that supports long term implementation success
• Identify a set of benefits realization for reengineering clinical processes within an ambulatory care specialty practice
• Discuss methods to manage organizational change to achieve physician and staff adoption of technology and workflow reengineering initiatives.

Richard Snow, MSN, PA (Healthlink)

Tuesday, September 25
Compliance Track
3:50 - 4:50 p.m.

ICD-10: The Good, the Bad and How to Prepare
The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Classification System (ICD-10-PCS) have both been proposed, by the National Committee on Vital and Health Statistics and others, as replacements for ICD-9-CM and ICD-9-PCS, the existing HIPAA code sets for reporting clinical diagnoses and hospital procedures, respectively. While a rapid transition to ICD-10 has been passionately advocated by some groups, such as the American Health Information Management Association and the American Hospital Association, other groups, including the Blue Cross and Blue Shield Association, the Medical Group Management Association and the American Clinical Laboratory Association, have advocated a longer transition period. To help explain the rationales behind these differing public policy positions, this presentation will provide an outline of the perceived benefits of ICD-10 in comparison to ICD-9 and also explain many of the significant implementation challenges that the health care industry will face in the transition, using independent clinical laboratories as a case study. In addition to providing an update on the legislative and regulatory status of ICD-10, the presentation will also provide practical steps that can be taken by stakeholders to prepare for the transition.

Session Objectives:

• Describe the perceived benefits of transition from ICD-9 to ICD-10
• Explain many of the significant implementation challenges that the health care industry will face in the transition to ICD-10
• List practical steps that can be taken to prepare for ICD-10
  

Donald Horton, Jr., JD (LabCorp)

Tuesday, September 25
Clinical Track
3:50 - 4:50 p.m.

Developing a Community-Based Chronic Disease Management Program
Since 1995 NorthEast Medical Center in Concord, NC has been developing and implementing a community-based chronic disease management program using an internally developed registry. Disease pathways and outcomes for diabetes, congestive heart failure, dyslipidemia, hypertension, asthma, COPD and osteoporosis are currently in use. Pathways for chronic kidney disease and testosterone will soon be introduced. Currently, over 10,000 patients managed by 70 physicians are enrolled in the program. Every three months each physician receives a report outlining outcomes for their patients.

Session Objective:

• Discuss how to set up a registry to evaluate and improve outcomes for chronic diseases
  

Douglas Kelling, Jr., MD (NorthEast Medical Center)

Wednesday, September 26
Technology Track
9:00 - 10:00 a.m.

Wireless Communication and Messaging for the Healthcare Enterprise
Sampson Regional Medical Center (SRMC) is a 150-bed rural acute care facility located in Clinton, NC. SRMC recently partnered with a wireless solutions company to implement a comprehensive campus-wide wireless network using their suite of tools. In Phase I of the project, all hospital staff obtained phones, pagers or alert devises to streamline communication between nurses, physicians, and ancillary and support staff. Completion of the phase resulted in the elimination of many communication errors and gaps between caregivers. Patient care was immediately provided in a more efficient, timely and safe manner.

In Phase II of the project, SRMC integrated the communication of the phones and pagers with several Meditech clinical and financial modules, as well as patient monitors, nurse call, building maintenance, PACS and fire alarm systems using an integrated communication gateway. Completion of Phase II allowed for real-time communication of any alarm, alert or event throughout the hospital to be transmitted immediately to any phone or pager. Communication included not only the phones and pagers within the SRMC campus, but also integration with SRMC's nationwide paging service. Examples of Meditech integration include the transmission of lab results to clinical caregivers and notification to appropriate ancillary staff when an order is entered.

Session Objectives:

• Describe the core technology and infrastructure included in the project as well as the challenges (and solutions) of enterprise-wide integration
• Explain the ROI and other benefits of implementing this wireless solution and key items to obtain senior management buy-in
• Discuss results of SRMC's January Joint Commission Laboratory Survey
• List next steps and lessons learned from the project

David Ziolkowski, MBA, MHA (Sampson Regional Medical Center)

Wednesday, September 26
Clinical Track
9:00 - 10:00 a.m.

Improving the HIT Contribution to Public Health: An Initial Report
Local public health leaders agree that there is great promise in using health information technology (HIT) to improve the public's health. Doing so involves reengineering many of the traditional local public health functions to take advantage of HIT in a way that results in better public health. Local public health leaders must adopt modern business process reengineering (BPR) skills in order to make these improvements. This session will focus on the work in two NC regional public health collaboratives and their community partners to gain these skills and use them to plan for the business process change. The work is supported by two generous grants from the Robert Wood Johnson Foundation. One group, the Southern Piedmont Partnership for Public Health and its partners, is focusing its initial work in this area on extending new and improved public health services to the public using consumer-empowering HIT elements such as personal health records and person-controlled health data exchanges. This group is also contributing to forming a national model for BPR in public health. The other group, the South Central NC Partnership for Public Health, is focusing its initial use of BPR skills on improving the effectiveness and efficiency of environmental services by integrating HIT elements that take advantage of geographic information systems. Both groups expect to go beyond these initial BPR projects by planning their other processes using this technique.

Session Objectives:

• Describe the types of skills involved in modern business process reengineering as applied to public health functions
• List three objectives in extending new and improved public health services to the public
• Describe how the use of GIS-based systems can improve efficiency and effectiveness in a public health environmental service

David Kirby, MS (Kirby IMC)

Wednesday, September 26
Technology Track
10:20 - 11:20 a.m.

Maximizing the Benefits of an EHR System
A physician from Carolina Internal Medicine Associates in Asheville, NC will discuss and demonstrate the benefits of EMR/EHR and the specific steps necessary in having a successful implementation and adoption. His presentation will focus on:

• The importance of understating how to maximize EHR benefits and important rules for records retention;
• The benefits, specifically quality and quantity of time with patients, reducing medical errors and improving patient safety;
• Solutions to manage moving to a paperless practice without challenging behavior or affecting workflow;
• How to identify proper tools to evaluate EHR vendors, and the importance of decision support; and
• Barriers and myths that hinder successful EHR deployment, and preparing for pay-for-performance.
  

Session Objectives:

• Explain how to reorganize workflow to maximize potential with an EHR
• Discuss how structuring your practice for an EHR system will impact forward-thinking motivations
• Develop an EHR system that is transferable for organization expansion
  

Kenneth Kubitschek, MD (Carolina Internal Medicine Associates, PA)

Wednesday, September 26
Clinical Track
10:20 - 11:20 a.m.

The Advancement of the NHIN and How It Affects You
The healthcare business model has not changed in several years; however, business factors and technology have changed. Today, more emphasis is being placed on the electronic availability of patient clinical records as advances in technology continue. In prior years, being able to send or receive a fax in a couple of days was considered advanced technology, and with practice management products, physician offices were able to leverage fax software technology. Speed and convenience became an asset for physician offices.

Today, the availability of current data from hospitals to providers to patients and to large employers, such as Wal-Mart, is becoming critical in order to keep prices down for employers and patients, and services need to be kept current for payers and provider organizations. What is the difference between today's delivery of medicine and that of the 1990's? Technology and interoperability. We have the Federal drive for interoperability, and the technology allows this to happen in near real-time.

Technology and interoperability are the keys to enabling hospitals and providers to lead advancements in patient care. This session addresses the level of service benefits being provided to patients, the opportunities available through advancements in technology and interoperability, and why hospitals, providers, patients, employers, and even payers need to buy in to a nationwide health information network.

Session Objectives:

• Describe the technology value points of interoperability
• Explain what to look for in software and how to stay current in delivering competitive medical services
  

Dave McCord (TM Floyd & Co.) & Jim Hazelrigs, MBA (TM Floyd & Co.)

Wednesday, September 26
Plenary Session
11:45 a.m. - 12:30 p.m.

Connecting Patients, Providers and Payers
National efforts on standards, architecture, privacy and certification are resulting in interoperable electronic health records and personal health records. In this lecture, Dr. Halamka will describe the 2007 standards efforts to harmonize quality measurement, e-prescribing, and PHR/EHR standards. He will describe the latest RHIO efforts to share data using these standards and new possibilities offered by the evolving PHR marketplace.

John D. Halamka, MD (New England Health Electronic Data Interchange Network & MA-Share)