Monday, September 8
Track 1
9:00 - 10:00 a.m.

Clinician Adoption of an EMR in a Public Health Care Teaching System
Harris County Hospital District (HCHD) is the fourth largest public health system in the U.S., composed of three hospitals, two specialty hospitals, and 34 community health centers and school-based clinics representing approximately 43,600 inpatient admissions and 1.9 million clinic and outpatient visits. It serves most of the uninsured and underinsured in the Houston, TX area. Baylor College of Medicine and The University of Texas Health Science Center faculty and residents serve the hospitals and community centers. HCHD has approximately 6,800 employees and 2,500 medical providers.

HCHD recently implemented the Epic Electronic Medical Record (EMR) system. The EMR implementation has had a profound affect on HCHD's ability to provide care for its patients through overwhelming adoption and acceptance from physicians, nurses and clinicians. Presenters will share the success and lessons learned and discuss the approach, project management methodology, and team partnership that made the project a resounding success through the acceptance of the EMR within the healthcare system. The HCHD was named one of the "25 Most Improved" hospitals in the "Most Wired Survey and Benchmarking Study" for 2006 and 2007 by Hospitals & Health Networks, the Journal of the American Hospital Association.

Session Objectives:

• Identify successful clinical adoption strategies that impact morale and customer service
• Identify implementation challenges associated with a community tax-supported integrated healthcare system
• Identify areas that align implementation outcomes with strategic business objectives in a clinical teaching setting
  

Monday, September 8
Track 2
9:00 - 10:00 a.m.

The Convergence of Physical & IT Security in Healthcare
Hospital risk managers and security officers must develop strategies to protect patients, equipment and infrastructure. The nightmares of infant and pediatric abduction, behavioral health elopement, and the theft of high-value medical equipment have historically been addressed through stovepipe systems deployed by disjointed efforts. This has resulted in point solutions which inhibit integration and create security gaps in the physical perimeter. Technology has matured to the point that it supports a convergence of information technology and physical security. This presentation will address how one hospital district is addressing the physical security requirements using an integrated approach. This approach addresses how technology cannot only track infants and pediatric patients, but also biomedical devices and staff. The resulting increase in asset and staff visibility not only increases efficiency, but also provides additional protection against infant and/or pediatric abduction, reduces wander, and increases patient safety.

Session Objectives:

• Describe how IT and physical security convergence can increase patient safety, reduce costs and improve staff efficiency
• Explain managerial and policy issues associated with the physical and IT security convergence
• Develop strategies for moving to a convergence security model

Clyde Hewitt (Forsythe Solutions Group)

Monday, September 8
Track 3
9:00 - 10:00 a.m.

VAP Free in MICU: It Takes a Team to Make a Bundle Work
The nurses in the Medical Intensive Care Unit (MICU) at WakeMed Health and Hospitals in Raleigh, NC, in conjunction with the physicians and ancillary staff, have been more that 690 days without an incidence of ventilator associated pneumonia (VAP). In 2004 the management of Wake's MICU attended the Institute for Healthcare Improvement (IHI) Conference and was introduced to the 100,000 Lives Campaign and ventilator bundling. A bundle, according to IHI, is a structured way of improving the processes of care and patient outcomes. Research has proven that sets of practices that are performed collectively improve outcomes. This began the journey in MICU to educate and implement the ventilator bundle.

The process for implementation of the bundle began with mandatory education of all staff, revision of the Critical Care Admission orders to include the bundle, daily goal sheets and interdisciplinary rounds. In June, 2005 MICU added Chlorhexidine and Hi-Lo endotracheal tubes to the bundle. Audits are conducted monthly and the progress is posted for the staff to see. The objective in starting the bundle process was to improve patient outcomes, decrease patient mortality and decrease VAPs. The team in MICU has achieved excellence as a group by eliminating VAPs for 690 days and counting. This nurse-driven protocol has come full circle in our quest to be VAP free. Without teamwork and the initiative to improve outcomes, this quality improvement process would not have been successful.

Session Objectives:

• Define what a bundle is
• List the elements in a ventilator bundle
• Describe the steps involved in the implementation of a ventilator quality improvement process
  

Lou Ann McLamb (WakeMed Health and Hospitals)

Monday, September 8
Track 1
10:20 - 11:20 a.m.

Achieving Safe Medication Administration and Nursing Documentation with Point-of-Care Technology in Critical Access Hospitals
Patient safety and the reduction of medical errors are at the forefront of public concern. There is, also, certainly a push to modernize healthcare to improve human health. However, it is often extremely expensive. Additionally, healthcare entities vary greatly from entity to entity regarding information technology infrastructure so that development and integration is often slow and sometimes, seemingly, impossible. These existing systems differ in hardware quantity and sophistication, network structure and capabilities, data storage and information flow, interfacing capabilities and various standards, and end-user software applications. More specifically, Critical Access Hospitals (CAHs) often lack the necessary IT infrastructure and capital to invest and support solutions to reduce medication errors and increase patient safety. There is a compelling need for a cost-effective, easily implemented, adaptable, and compliant point-of-care solution that provides safe medication administration, nursing documentation, decision support, and so much more.

Pungo District Hospital (PDH), a CAH in Belhaven, NC, and PharmaSys, Inc., a healthcare solutions vendor in Cary, NC, made the impossible happen. Through innovation, cooperation and a dedication to patient safety, the two entities collaborated to provide a uniquely designed and carefully implemented state-of-the-art, point-of-care Patient Care Verification System specifically designed for the unique needs of smaller hospitals. The panel presentation will focus on key design, development and implementation factors when deploying a Patient Care Verification System. The panel will present both clinical and engineering perspectives in efforts that other healthcare organizations can deploy similar technology successfully and affordably.

Session Objectives:

• Describe cost-effective, point-of-care systems planning, project management and implementation methods and techniques that work for the successful deployment of point-of-care technology for CAHs and larger institutions as well
• Describe major obstacles that exist in upgrading Health Information Technology in CAHs to current standards and solutions to interfacing concerns
  

Lou Montana (Pungo District Hospital), David Roth (PharmaSys, Inc.) & Patrick Harris (PharmaSys, Inc.)

Monday, September 8
Track 2
10:20 - 11:20 a.m.

Use of HIT for Area Free Clinics
MedVirginia was awarded $250,000 in June, 2007 by the Commonwealth of Virginia to build an infrastructure to support health information technology for Central Virginia free clinics. With the funds MedVirginia will: Provide the five area free clinics with access to the health information exchange; provide a practice management system to each free clinic; implement a community pharmacy at CrossOver (the largest free clinic); build an eligibility screening tool into the Practice Management System; and provide e-prescribing capability.

Session Objectives:

• Describe the information needs of safety net providers
• Identify the benefits of deploying sophisticated health IT to the free clinic practice environment
• Discuss the importance of health IT connectivity among free clinics and other community providers (e.g., hospitals, specialists, labs and pharmacies)

Jean McGraw (MedVirginia)

Monday, September 8
Track 3
10:20 - 11:20 a.m.

Consent to Participate in a Health Information Exchange: North Carolina and National Perspectives
States have varying laws and regulations about what consent is needed to enter patient information into, and disclose information through, an electronic health information exchange (HIE). Some states require no consent for entering and disclosing information under these circumstances, while others have strict consent requirements. Obtaining patient consent, where required, is a fundamental prerequisite to building an electronic HIE that includes sufficient patient information to achieve the improvements in quality, decreases in medical errors, and increased efficiency (lower costs) for which electronic HIEs are touted.

In 2007 and 2008, North Carolina participated in the HISPC 3 and NHIN 2 projects and investigated what consent is needed in North Carolina and other states for patient information to be entered into and disclosed through an electronic HIE. Once the state-level consent requirements were identified, the project participants began focusing on whether and how states with varying consent requirements could use a common or similar consent methodology for these purposes.

This presentation will address North Carolina's consent requirements for participation in an electronic HIE and will provide background information on the differences in state consent requirements and the emerging recommendations of the HISPC Intrastate and Interstate Consent Collaborative for a national comment consent methodology. It will address situations in which special or additional consent must be obtained (e.g., mental health, substance abuse, genetic information) and how to obtain such consent. It also will describe how these findings on consent efforts have been instrumental to the HISPC Inter-Organizational Agreements Collaborative and to North Carolina's NHIN 2 use cases.

Session Objectives:

• Identify what consent is required in North Carolina for entering patient information into an electronic HIE and for disclosing that information to third parties through the electronic HIE
• Describe the national common consent methodologies being evaluated
• Identify situations in which special or additional consent must be obtained, and how to appropriately obtain patient consent for disclosure of information through the electronic HIE in those circumstances
  

Patricia Markus (Smith Moore LLP)

Monday, September 8
Track 1
1:00 - 2:00 p.m.

CPOE from Alpha to Omega
Computerized Physician Order Entry (CPOE) is not just an implementation but an evolution. Durham Regional Hospital will present how it evolved from infancy to a full-grown CPOE process with a focus on patient safety. System enhancements were put in place to supplement provider workflow which provided several key success factors. In any evolution there are lessons learned and opportunities for improvement. Presenters will highlight the challenges tackled and overcome. Focus will be on several enhancements that were necessary to allow the provider to place orders in a way that takes into account the provider's workflow and patient safety. These enhancements include titration of drugs, how to handle orders approaching expiration and the cosign process. Making electronic order entry work within the provider's workflow continues to offer challenges and successes. Education is also crucial to success. Keeping education sessions short and easily accessible is a very large endeavor. Providing sufficient training on the critical pieces of CPOE continues to be a challenge. Flexibility and creativity are important components to any education and communication Plan. Presenters will also provide before and after metrics to show their progress. The goal is to provide other facilities with the information needed to implement CPOE in a way that works within the provider workflow but does not increase risk to the patient.

Session Objectives:

• Identify metrics to be used for measuring success in CPOE implementation
• List approaches for successfully combating issues associated with CPOE implementation including enhancements to the electronic order entry workflow
• Discuss the importance of nursing and ancillary support for CPOE both during implementation and ongoing

Debbie Zanes, Reba Beavers & Sheba Smith (Durham Regional Hospital)

Monday, September 8
Track 2
1:00 - 2:00 p.m.

A Risk Management Approach to HIPAA Security Governance
Duke Medicine's Information Security Operations Planning (ISOP) system guides system design, procurement and operations to ensure management focus on the balance between security, risk and the other potential uses of scarce resources. This presentation will describe Duke's approach to security governance, system security planning, standards and regulatory compliance, with examples of risk assessment and reporting techniques.

Session Objectives:

• List three problems that result from a strict standards-based approach to security governance
• Explain the traditional risk assessment formula: R=Lp(L)
• Discuss the importance of risk acceptance in the allocation of resources for security
  

Donald Sweezy (Duke University Health System)

Monday, September 8
Track 1
2:20 - 3:20 p.m.

Automating Discharge Processes by Physician Online Creation of Discharge Summaries with Integration to Nursing Electronic Discharge
The UNC Health Care System EMR (which has been presented in various dimensions over the past few years at the NCHICA Annual Conference) now encompasses electronic nursing documentation. For some years they have had almost all physicians at the institution directly enter inpatient H&Ps, Progress Notes, Consultations and other notes into the EMR electronically. They provide templates which bring forward other information already in electronic format such as Meds, Allergies, Labs, Radiology and Problem Lists, making these forms easy and quick to use. In the last year they have installed a complete electronic nursing application (from a commercial vendor) that encompasses all nursing notes, care plans, charting by exception, flow charts, task lists and alerts. This application is directly linked to WebCIS, their main home-grown EMR application. They created both a full discharge summary template for direct electronic entry (multiple user input) by the discharging physicians and a direct entry brief discharge summary template (also allowing multiple user input) which they mandated to replace their previously handwritten brief discharge form. They pass the information from this brief electronic discharge summary (such as discharge meds adjudicated from CPOE, nursing instructions, F/U appointments and other information) immediately upon physician signature to the nursing electronic discharge forms that serve as documentation for the nurses and communication to the patient. They have 100 % compliance with this process, nursing has been very satisfied, and patient discharge has been expedited with increased safety. To their surprise, though the full discharge summary was not mandated to be directly entered (i.e, could still be dictated by a single physician), 85% of the full discharge summaries are now being directly entered by their physicians. In this session, presenters will demo the live system, discuss the technology, and discuss how they approached and successfully implemented this major operational process change.

Session Objectives:

• Explain techniques to bring major operational change through electronic record keeping
• Describe the components necessary for a paperless inpatient chart
• Discuss the technology to integrate disparate electronic EMR proucts
  

Raj Gopalan, MS & Tracy Parham, MSN (UNC Health Care System)

Monday, September 8
Track 2
2:20 - 3:20 p.m.

Managing Sensitive Electronic Information on Mobile Devices and Removable Media
Today's technology allows Sensitive Electronic Information, or SEI, to be accessed, stored and transmitted from just about anywhere using devices that are becoming smaller in physical size but can store gigabytes of data. Hospitals and other covered entities are pushing information into the hands of an increasingly mobile workforce that must have immediate access to data in order to increase efficiency and patient safety. The challenge is that as data is moved to smaller devices, protecting that data becomes more difficult. Encrypting the hard drives on laptop computers is not enough, as removable media poses an equally challenging task. Recently, NCHICA's Mobile Device Task Force published a white paper addressing the policy, standards, procedures and managerial challenges surrounding mobile devices and removable media. This presentation discusses the findings of the white paper and the Request for Proposal Template for selecting an encryption vendor.

Session Objectives:

• Explain the regulatory and compliance drivers for protecting mobile devices
• Discuss the need for a cross-functional management structure to address the mobile device and removable media security issues
• Implement a process for documenting specific organizational requirements which drive the selection of a vendor to supply both technology and implementation assistance
  

Clyde Hewitt (Forsythe Solutions Group) & Larry LaBanc (Novant Health)

Monday, September 8
Track 3
2:20 - 3:20 p.m.

Infection Control Practitioner Use of NC DETECT
The Joint Commission IC.6.10 hospital accreditation standard related to emergency management requires hospitals to "keep abreast of current information about the emergence of epidemics or new infections" and to identify "resources in the community (through local, state and/or federal public health systems) for obtaining additional information." Reports available through the Web-based North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) allow users to monitor and investigate potential infectious disease threats in their jurisdiction(s) and to compare these trends to regional and statewide views. While NC DETECT is used regularly by many local, regional and state public health officials and hospital-based public health epidemiologists in the 11 largest hospitals, the majority of infection control practitioners (ICPs) in NC hospitals are not regular users. This presentation will describe efforts underway to work with ICPs to train them on the use and benefits of NC DETECT and to solicit feedback for additional reports to improve ICP access to statewide infectious disease information.

Session Objectives:

• Describe NC DETECT and the reports available to hospital ICPs
• Explain how NC DETECT can help hospitals with JCAHO Hospital Accreditation Standards for Emergency Management Planning
• Provide NC DETECT developers with suggestions on additional reports that would be of benefit to ICPs
  

Monday, September 8
Plenary Session
3:40 - 4:40 p.m.

Game Plans for Victory: The "Fearsome Foursome" Tackles the EMR
Most healthcare organizations will implement an inpatient and ambulatory Electronic Medical Record (EMR), including CPOE. However, varying plans exist to achieve this vision based on facility type, vendor, executive and physician commitment, available funds and resources, and primary drivers (e.g., improve care, reduce costs, improve efficiency, compete for clinicians). CIOs recognize that implementation of the clinical vision is one of the most important, complex and costly initiatives to be undertaken, and understand the need to mitigate any potential clinical and financial risk. This panel of four CIOs - representing community hospitals, multi-hospital health systems and academic medical centers - provides a wide spectrum of experiences for planning and achieving an EMR. Panel members will share their "lessons-learned" - including successes and "unexpected" obstacles and issues - as well as validate any early impact on patient care and other anticipated benefits. In addition, the CIOs will provide recommendations and critical success factors necessary for a successful EMR install based on actual experience.

Session Objectives:

• Discuss the successes, challenges and risk mitigation strategies to implement the EMR, based on actual experiences
• Apply successful "game plans" to your own clinical vision

Tuesday, September 9
Track 1
9:00 - 10:00 a.m.

Medication and Chronic Disease Management Tools for Consumers
CapMed and Kerr Drug are leading innovative efforts to promote health management for consumers in North Carolina. During this session you will learn about two programs that address medication management and chronic disease management.

CapMed and Kerr Drug, along with several other organizations, developed a replicable Personal Health Record (PHR) program designed to evaluate the impact a PHR could have with patients regarding medication adherence, healthcare utilization, clinical outcomes, patient education and awareness of relevant disease states. Presenters will discuss the overall objectives of the program and describe the participant selection process and rollout, from introduction to education and promotion. CapMed will also highlight the research results, lessons learned and overall program success.

Kerr Drug is working with Confidant to deploy a diabetes management solution that extends the pharmacy-based caregiver model. It uses patients' personal mobile phones as a communication link to manage their condition with support from their pharmacist. Presenters will discuss results of a recent pilot study incorporating cell phone technology to capture patient reported data and return motivational feedback and coaching. Barriers to implementation will also be discussed, including the practical limitations of the current technology and difficulties in obtaining third-party reimbursement.

Session Objectives:

• Describe the benefits of a PHR-based medication management program
• Discuss key factors that determine consumer acceptance, behavioral change, and effectiveness of cell phone technology as part of a practice-based model
  

Mary Ellen Zipper (CapMed) & Ronald DeVizia (Kerr Drug)

Tuesday, September 9
Track 2
9:00 - 10:00 a.m.

The Uses of Commercial Healthcare Databases in Biosurveillance
This presentation will explore the current and potential uses of commercial healthcare databases - principally national prescription and medical insurance claims - in bioterrorism and related public health surveillance. The recent history of syndromic surveillance systems since 9/11 will be examined, with a focus on RODS, Biosense and other initiatives of the CDC. The presenter will analyze technical and scientific challenges to the use of the commercial databases for national security and public health purposes, as well as privacy issues. Recent Executive Orders directed both the CDC and the Department of Homeland Security to aggregate existing databases. Progress on their respective paths will be analyzed. Finally, the presenter will touch on the international scope of the monitoring challenge. Bioterrorism is a global phenomenon requiring agreed data sources and cooperation of nation states. Tracking global epidemics, such as flu viruses, can be aided by enlisting the reach of commercial databases now utilized by pharmaceutical companies to track sales and direct marketing efforts.

Session Objectives:

• Provide an overview of current and projected national security biosurveillance systems with public health applications
• Describe the permitted uses of protected health information in public health and national security settings
• Discuss the benefits and challenges in global healthcare data sharing
  

John Russell (Center for Global Initiatives, UNC-Chapel Hill)

Tuesday, September 9
Track 3
9:00 - 10:00 a.m.

A Novel Approach for the Integration, Interpretation and Dissemination of Public Health Surveillance Data: NC's Hospital-Based Public Health Epidemiologist Network
Public health disease surveillance has undergone a major evolution from the door-to-door surveys conducted in the late 1800s to the current advent of automated electronic data collection from laboratories, emergency rooms and hospital visits. Aberration software designed to flag clusters of cases that have exceeded a statistical threshold has also been developed recently to aid in the analysis of these data. However the analysis, interpretation and dissemination of these surveillance data cannot be accomplished using automated computer programs alone.

The Hospital-Based Public Health Epidemiologist (PHE) Network in North Carolina (NC) offers a novel approach for careful and meaningful integration, analysis, interpretation and dissemination of these electronic data that are becoming more widely available. Since May of 2003, 11 PHEs have been employed at large healthcare systems in NC and funded by the Centers for Disease Control and Prevention Cooperative Agreement for Public Health Preparedness and Response. These hospital-based epidemiologists use an electronic surveillance system as a tool to guide their detailed epidemiological investigations for disease events of concern to the community. This PHE network combines the use of technology with trained personnel in order to enhance surveillance and communication of disease events between clinicians, hospitals and the public health system.

Session Objectives:

• Describe the novel Hospital-Based Public Health Epidemiologist network in North Carolina
• Discuss the role that the Hospital-Based Public Health Epidemiologist network has in integrating and interpreting healthcare data for public health surveillance and investigations
  

Emily Sickbert-Bennett (UNC Health Care System)

Tuesday, September 9
Track 1
1:00 - 2:00 p.m.

CPOE and Its Impacts on the Medication Use Process
Computerized Physician Order Entry (CPOE) team members from Durham Regional Hospital (DRH), a mid-size community-based hospital, will present how CPOE implementation has impacted errors in the medication use process. DRH utilizes a closed-loop CPOE system, and is house-wide with the exception of the Emergency Department. DRH has experienced positive effects of CPOE on certain errors commonly seen in the medication use process, such as order transcription errors, and the six rights of medication use. DRH has also encountered negative effects of CPOE on other errors such as therapeutic and generic duplications and errors related to timing of the first dose of medication. CPOE is still in its infancy at this institution. The error rates are expected to decrease across the board as the system is modified to meet workflow, education is improved, and familiarity with the system increases.

Session Objectives:

• Identify metrics to be used for measuring success in CPOE implementation
• Discuss the positive and negative impacts of CPOE on patient safety measures
• Describe the role of CPOE in reducing errors in the medication ordering process
  

Tuesday, September 9
Track 2
1:00 - 2:00 p.m.

A National Data Use Agreement
As healthcare providers implement electronic health records, federal and state government and private entities are working towards sharing that data in ever-broadening spheres. The Nationwide Health Information Network (NHIN 2) project is an important step forward in creating a nationwide network of health information exchanges (HIEs). The NHIN 2 Data Use and Reciprocal Support Agreement (DURSA) workgroup is developing a form data use agreement to address legal issues in the sharing of information. Building on this work, the Health Information Security and Privacy Collaboration (HISPC) project includes the Interorganizational Agreement Collaborative, which will be drafting language for use within and between HIEs throughout the country.

As the HISPC Interorganizational Agreement Collaborative's DURSA Coordinator, the presenter will update the audience regarding the exciting work being undertaken for the nationwide sharing of health information, as well as address the legal issues that arise in such sharing of information. Potential subtopics include: the contractual sharing of risk (most notably, with governmental entities that cannot provide indemnification); disclosing records regarding mental health and substance abuse; federal laws regarding the sharing of information by agencies such as the Centers for Medicare and Medicaid Services, Indian Health Services and Veteran's Administration; and assuring compliance with differing state laws.

Session Objectives:

• Describe recent developments in the sharing of electronic health records among HIEs
• Explain issues that limit the ability to share electronic health records across state borders
• Describe potential solutions to these issues
  

Tuesday, September 9
Track 3
1:00 - 2:00 p.m.

The Cancer Biomedical Informatics Grid (caBIG): Providing Interoperable Links from Research to Care
The Cancer Biomedical Informatics Grid™, or caBIG™, is a virtual informatics infrastructure that connects data, research tools, researchers and institutions to leverage combined strengths and expertise in an open environment using common standards. caBIG™ develops software tools collaboratively through a community of experts and informaticians from academia, government agencies, standards-developing organizations and industry. One goal of caBIG™ is to deliver answers to research questions more rapidly, more efficiently and more accurately by providing access to larger, richer data sets from those that have been available. This approach promises to accelerate progress in all aspects of research - from etiologic research to prevention, early detection and treatment. Data standards provide the foundation for caBIG™ principles of interoperability. Workflow and processes that invite members of the community to submit new content have been tested and improved over the past three years. Content from Healthcare Information Technology Standards Panel, the Clinical Data Interchange Standards Consortium, as well as standards from the Centers for Disease Control and Prevention and other groups are now housed in an ISO 11179 metadata registry that provides access to the community-at-large. caBIG™ has successfully completed a three-year pilot phase, during which it has successfully delivered on its stated goals. As caBIG™'s enterprise phase begins, its mission continues to span the entire 360-degree spectrum of cancer research, from bedside to bench and back again.

Session Objectives:

• Describe role of caBIG™ in the acceleration of biomedical research
• Identify at least two ways in which caBIG™ data standards can be identified and used
• Define the steps used to vet and approve a data standard as a caBIG™ standard
  

Dianne Reeves (National Cancer Institute, Center for Bioinformatics)

Tuesday, September 9
Track 1
2:20 - 3:20 p.m.

The Value of IT Clinical Rounding
This presentation outlines a plan for implementing an IT Clinical Rounding program and discusses the value proposition and critical success factors. The presenters will describe the process of marketing and operationalizing the program and the benefits achieved from the program at both Durham Regional Hospital and Duke Raleigh Hospital. Topics include: the genesis of the IT Clinical Rounding program at Durham Regional Hospital; the collaborative efforts employed to extend the program to Duke Raleigh Hospital; the implementation strategy employed, critical success factors and lessons learned at both hospitals; and the benefits and value proposition for investing in an IT Clinical Rounding program.

Session Objectives:

• Describe the process of IT Clinical Rounding
• Explain the value proposition of IT Clinical Rounding
• Discuss the critical success factors of IT Clinical Rounding
  

Billie Kennedy-Hutchinson (Duke Raleigh Hospital) & Terry Mears (Durham Regional Hospital)

Tuesday, September 9
Track 2
2:20 - 3:20 p.m.

Challenges Facing Lab Result and Evidence-Based Medicine Programs
While clinical data is always critical to patient management, integrating data about the patient at the provider level is not a simple task at a disease management or evidence-based program level. While laboratory results are a key element in patient diagnostics, they can have a substantial positive impact on plan/employer sponsored programs. However, getting laboratory data to these programs is not easy. This presentation will examine the "life cycle" of a patient lab result from the delivery to the ordering provider to integration with disease management, wellness, predictive modeling and evidence-based guideline programs. Issues including legal clearance, member identification, timeliness of data, integration of multiple lab sources and data formatting will be reviewed.

Session Objectives:

• Identify clear value propositions for laboratory data results in wellness and evidence-based disease management programs
• Describe the "life cycle" of laboratory services from order entry to results
• Discuss the necessary legal and technological challenges and solutions of laboratory data consolidation and integration with community, payor and employer-based clinical management programs

David Pfeil (LabCorp)

Tuesday, September 9
Track 3
2:20 - 3:20 p.m.

Improving the Health IT Contribution to Public Health: Progress and Prospects
A set of public health initiatives in North Carolina has emerged in the last few years to support improving the public's health through better use of information services. The work has been pursued by local and state public health officials supported by grants from private foundations and the state. One group, the Southern Piedmont Partnership for Public Health and its partners, is focusing its continuing work in this area on extending new and improved public health services to the public using consumer-empowering health IT elements such as personal health records and person-controlled health data exchanges. The initiatives include changes in public health staff skills in the area of business process management, changes in organizational and collaborative arrangements in public health, and technology deployment and operation. In 2008 the work includes significant partnerships with the Nationwide Health Information Network (NHIN 2) project, the FCC Rural Health Care Pilot Project, and the Robert Wood Johnson Foundation's CommonGround Project. This session will focus on the progress that these initiatives have made towards the larger goal of improving public health with health IT-based services, lessons learned, and prospects for the next phase of work in this area.

Session Objectives:

• Describe how business process management matters in providing useful new health IT-based public health services
• Describe at least two ways in which health IT-based services support the involvement of members of the public in improving their health status
• Describe the top three priorities in pursuing the next phase of work in this area
  

David Kirby (Kirby IMC)

Tuesday, September 9
Track 1
3:40 - 4:40 p.m

Using Interoperable EHRs to Connect Care

Imagine current patient information available to healthcare professionals in a beneficial form for individual patient care and for the common good. This is our vision. In today's session, the HIMSS Electronic Health Record Vendors Association (EHRVA) will convey our plan and progress towards supporting it.

It is well known that having accurate, current patient health information, such as medications, allergies, lab results, imaging studies, and their potential treatment options makes taking care of patients safer, more efficient, and less complex. Electronic health records (EHRs) offer the promise of up-to-date patient information. However, in our fragmented care delivery system, where a typical Medicare patient sees up to 6 different providers, this promise can only be fulfilled if data is securely interchangeable among the various electronic systems that capture patient health information.

It takes significant leadership, resource commitment, and perseverance to accomplish data sharing in a domain as complex as healthcare. This presentation will share HIMSS EHRVA's leadership role and commitment to shaping the future direction of interoperable EHRs to connect care. It will explain who the association's members are, why there is a focus on interoperability, and how to use the EHRVA Interoperability Roadmap, which is a collaborative effort developed in response to the national call for interoperable health records. The presentation will also show how vendors are implementing phases of the roadmap today. Following the presentation, a panel including ambulatory and enterprise vendors will discuss specific product plans to incorporate standards into their products and highlight customer experiences when implementing these standards.

Session Objectives:

• Describe HIMSS EHRVA plans and commitment to interoperable EHRs
• Discuss how interoperable EHRs will support the interchange of electronic health information
• Desribe where vendors are today in implementing support for interoperable EHRs
• Identify enablers and barriers to interoperable EHRs
• Explain the value of connected care

Moderator: Charlene Underwood (Siemens Medical Solutions)
Panel: Jason Colquitt (Greenway), Barbara Hobbs (MEDITECH), Dan Pollard (Misys) and Michael Stearns, MD (e-MDs)

Tuesday, September 9
Track 2
3:40 - 4:40 p.m.

WakeMed's Mobile Emergency Command Center Vehicle
WakeMed's Mobile Emergency Command Center Vehicle was developed by WakeMed Health & Hospitals with the support of several grant funding and donating partners (VHA, Cisco, IBM and others). The mission of the vehicle is to provide the state and region with a mobile command center post that can go to a disaster or other emergency situation and provide an on-site (or near site) communications center to manage the medical, healthcare and other needs that arise. To deliver on its mission, the vehicle is outfitted with satellite communications, servers and a PC that can be used to manage the situation from the event site. Consider the status of southern Mississippi and Louisiana in the aftermath of hurricanes Katrina and Rita: in those events, communications in and out of the regions was greatly limited as was the ability to have "eyes" on the ground and a care command post from which to operate. This mobile command center will fill that void. It is also available for use throughout the state, region and even nation as problem situations arise.

Session Objective:

• Discuss the unique issues that arise in a disaster situation and how this mobile command vehicle will help bridge these problems for the first responders at the disaster site.
  

Bill Atkinson (WakeMed)

Tuesday, September 9
Track 3
3:40 - 4:40 p.m.

Update on the Health Information Security and Privacy Collaboration Project
Nationwide electronic health information exchange (HIE) will represent a critical shift in the U.S. health care system to improve quality by reducing medical error and health care costs. However, to accomplish this goal and to reap these benefits, the American public must accept and embrace nationwide electronic HIE. Consumers need to know that their information is appropriately protected. Much variation currently exists in the practices, policies and laws that govern private and secure data exchange. To develop interoperable systems, some of this variation must be harmonized by adopting common policies so that organizations can meet consumers' needs for privacy, confidentiality and security. At the same time, organizational business interests must be protected to minimize risk for the organization and develop trust between organizations.

In 2006 and 2007, 33 states and one territory participated in the Health Information Security and Privacy Collaboration (HISPC) project through funding provided by the Agency for Healthcare Research and Quality and the Office of the National Coordinator for Health Information Technology. State teams have assessed variations in practices, policies and laws that govern private and secure data exchange, developed solutions, and implemented plans to reduce variation and facilitate interoperability while preserving or enhancing the protection of privacy and security. In the second half of 2007 they were joined by 11 additional states and territories and formed seven multi-state collaborative work groups, each of which developed plans to address multi-state or inter-state privacy and security issues, with the goal of harmonizing across states on common policies. The seven topic areas being addressed in 2008 are Provider Education, Interorganizational Agreements, Adoption of Policy Standards, Harmonizing Privacy Law, Consent Data Elements, Consumer Education and Engagement, and Consent Policy Options.

Session Objectives:

• Describe the HISPC project's methods
• Discuss the HISPC project's results
  

Wednesday, September 10
Track 1
9:00 - 10:00 a.m.

What Will It Cost to Implement Electronic Health Record Capability? Applying Best Practices from the Private and Federal Sectors
One of the most important issues in electronic health record (EHR) implementation is determining the total cost of ownership of the system. Poor cost estimation will lead to false expectations for the return on investment. The end result is often frustration and a failed initiative. Some of the drivers for an EHR include: regulatory compliance, data quality, data conversion, data privacy and organizational change resistance. The private and government sectors have faced similar obstacles as they automated their business processes. From this experience, these industries have developed best practices and benchmarks that can serve as a foundation in providing insight for the healthcare sector. Presenters will identify financial and government best practices for determining the total cost of ownership of enterprise system implementation. They will also demonstrate how these practices can be applied to the implementation of EHRs.

Session Objectives:

• Describe the requirements for effective and accurate estimates of total ownership costs for EHRs
• Discuss best practices and benchmarks from the private and government sectors to determine the total cost of ownership of EHRs
  

David Seaver & Joseph Ingemi (PRICE Systems LLC)

Wednesday, September 10
Track 2
9:00 - 10:00 a.m.

Privacy and Security Components of Health Information Exchange
The exchange of health information is set to expand to a larger context with the impending Nationwide Health Information Network and Electronic Health Record initiatives. As these initiatives expand, protecting personally identifiable private health information will become more complex, especially as the impetus increases to share records across the Internet and to allow more involvement, if not control, of personal information by the patients themselves. Protecting this information begins with entity organizational privacy and security schemes, but the exposure to the Internet and the potential dilution of control introduce additional challenges to the classic protection schemes. Models of data-sharing in non-health care settings may offer new considerations to crafting the protection scheme for health information exchange. Adapting these models and other concepts to health care information will involve the identification of objects (data/information characteristics, time-related delimitations), subjects (persons, rights, and obligations), and processes (usage activities, rules, continuity controls).

This presentation will: Describe the challenges to protecting data exchange across networks, internal and external, including selected regulatory limitations; characterize the nature of the exchange by examining models of information exchange in other settings, and identifying components of the exchange that affect its protection; and suggest a conceptual implementation model for health information exchange (HIE) that accounts for the components and addresses the challenges for protecting the exchange.

Session Objectives:

• Discuss the challenges to the privacy and security of exchanging health information
• Identify the components (subjects objects, and processes) of HIEs
• Describe a model for addressing the complexities of privacy and security of the exchange process
  

Wednesday, September 10
Track 3
9:00 - 10:00 a.m.

The Secured Three-Factor Authentication Multi-Level Medical System
The Secured Three-factor Authentication Multi-Level Medical System is a robust and yet simple authentication and encryption methodology that provides organizations with a powerful system to enable patient information security. It enables them to protect, direct, audit and manage every aspect of their personal health information (PHI) through an empowering, multi-tiered authentication model. Clearly the core issue of privacy is central to the success of healthcare IT. It is vital that organizations take the necessary steps to instill and maintain patient confidence that their data can and will be protected. Patients will not participate in the NHIN unless they are convinced that they will be able to control who may and may not have access to their PHI.

Session Objectives:

• Explain the importance of patient empowerment and how to achieve it
• Describe how patient data will be secure in this system

Alain Sadeghi, PhD (eTechSecurity) & Hamid Nemati, PhD (UNC-Greensboro)

Wednesday, September 10
Track 1
10:20 - 11:20 a.m.

CPOE: Two Roads to Successful Implementation and Post Implementation Outcomes
One of the driving forces behind the Computerized Physician Order Entry (CPOE) movement is to improve patient safety, particularly as it relates to medication processes (orders, verification, dispensing and administration). Improving the medication process electronically is complex, and requires close team work between the physician, pharmacist and nursing. The panel will represent the physician, pharmacy and nursing perspectives from two organizations: Childrens' Hospital of Orange County (CHOC) and Virginia Commonwealth University Health System (VCUHS). Their approach to implementation was different, but both organizations experienced successful implementations, and continue to sustain a high rate of clinician adoption. CHOC implemented clinical documentation for nursing and the majority of the ancillary departments two years prior to the CPOE implementation. VCUHS was a very early adopter of CPOE, and went through a significant conversion from one vendor to another in conjunction with some nursing and ancillary document, vital signs, allergies, electronic MAR and discharge instructions. The organizations also share some common success factors such as the commitment of executive and physician leadership. The panel will discuss the transition from paper to electronic, the challenges with adoption, training approaches, compromises and lessons learned. They will also share how they are monitoring the impact of CPOE on patient care, specifically as it relates to patient safety.

Session Objectives:

• Identify critical success factors and pitfalls for CPOE initiatives
• Develop metrics for post CPOE monitoring and tracking
  

Wednesday, September 10
Track 3
10:20 - 11:20 a.m.

Issues Related to Adoption of IT by African-American Physicians in NC
While the introduction of information technology (IT) does not eliminate health problems, many healthcare managers consider electronic health records (EHR) and interoperable health information exchange (HIE) to be a key part of organizational strategy. Numerous studies have shown how information system usage translates into medical and financial benefits including fewer medication errors, increased financial gain, better quality of care, improved practitioners' performance, and enhancement of diagnostic accuracy. IT use by African-American physicians is an important issue because of healthcare needs in the communities that many serve. In 2007, according to the American Medical Association, only 2.3% of all physicians in the United States were African-American. Understanding the obstacles that African-American physicians are having to technology adoption could help promote health care improvements and professional diversity. Furthermore, attempts to remedy a health care IT "divide" might be informed by approaches that considered African-American physicians' needs. The presentation will report on the results of a 2008 study in the School of Library and Information Sciences at NC Central University of issues related to the adoption of IT by African-American physicians in North Carolina. The research methods applied were a written survey and personal interviews with NC physicians in the Old North State Medical Society and associates. Questions include: What is the current status of IT use among African-American physicians in NC? What are the significant obstacles to technology adoption? What do the participating physicians require to apply IT in their practices?

Session Objectives:

• Describe the issues affecting IT adoption for African-American physicians
• Cite data on the status of technology adoption among African-American physicians in NC
  

Deborah Swain (NC Central University)

Wednesday, September 10
Plenary Session
12:30 - 1:30 p.m.

Aspirations for a Nationwide Health Information Network
The Nationwide Health Information Network (NHIN) is the critical portion of the U.S. health IT agenda intended to provide a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers and others involved in supporting health and healthcare. The NHIN will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care to improve health. North Carolina has been a participant in phases 1 and 2 of this project.

Topics Include:

• HIE: Enterprise or Nationwide? Communities and enterprises across NC are facilitating health information exchange (HIE). The CIO from Morehead Memorial Hospital in Eden, NC will compare and contrast the costs and benefits associated with proprietary enterprise level point-to-point HIE versus a standards based HIE as being deployed in the NHIN Trial Implementations.
• Business Plan for HIE in NC: The NHIN 2 project is developing a first iteration Business Plan for HIE in NC. We will review the primary initiatives and assumptions included in this plan including the efforts to leverage community, nationwide and medical home movements in the Business Plan.
• Consent Requirements for HIE: The NHIN 2 project is evaluating and developing consent policies for participation in HIE within NC. The NCHICA Legal Work Group and NC HIE Council are contributing to consent policy development built upon existing practices, laws and regulations with an intent to enable and encourage private and secure HIE in NC.
• A National Data Use Agreement: The NHIN 2 project is developing a standard Data Use and Reciprocal Support Agreement (DURSA) to address legal issues in the sharing of information through HIE. We will outline progress and plans for providing useful agreements to enable HIE in NC.
• Building upon NHIN 1 and NHIN 2: NC has participated in two phases of the NHIN project. In addition to the policies, procedures and business plans being developed in NC as described above, the opportunity exists to leverage HIE across the state. Architectural, technical and organizational developments underway as a result of NHIN and other parallel projects provide a strong platform for HIE in NC. What’s next, and how does NC take advantage of this opportunity?

Panel: Geoff Lawson, Director of Information Systems, Morehead Memorial Hospital; Patricia Markus, JD, Partner, Smith Moore Leatherwood LLP; Jean McGraw, Chief Operating Officer, MedVirginia; Ginny Wagner, NHIN Project Executive, IBM; Andrew Weniger, NHIN & HISPC Project Manager, NCHICA; and Roy Wyman Jr., JD, Partner, Williams Mullen