Healthcare Information Technology (HIT) Strategic Planning

Early adaptors of the Electronic Health Records (EHR) process are discovering that they have to prepare for a wave of change, which will impact the entire organization, long before they bring in an IT specialist. The Health Information Technology (HIT) component of the American Recovery and Reinvestment Act (ARRA) was signed into law on February 17, 2009. A specific goal of Medicare and Medicaid HIT provisions is to provide incentives for the adoption of certified Electronic Health Records (EHR).

Over a five year period health care providers can be reimbursed a total of ,000 if they show meaningful use of Electronic Health Record (EHR) technology. Eventually, by year 2015, there will be penalties for medical professionals that do not adopt EHR.

Healthcare

To maximize HIT payments, providers must begin to submit for incentive payments during the 2011 and 2012 calendar year. This is good news for organizations that have been contemplating an ERH process, as they can benefit from these lessons learned from others that have jumped in and implemented the process through trial and error.

Consistent with any major change management process, it is essential that the leadership be aware of the disruptive effect the EHR process will have throughout the organization.

The strategic planning processes provides a format for developing specific strategies, converting those strategies into a business planning process and establish measurable and attainable organizational goals. It is a process that not only determines where an organization wants and needs to go, but also, how it is going to get there

HIT Strategic Planning:

Health Information Technology (HIT) payments are spread out over a 5 year period. This is the time to seize the opportunity to develop a five-year strategic plan with short and long term goals that coincide with the HIT planning process and the organizations mission.

At the start of the process, creating and communicating a compelling vision is the powerful directional force. The vision sets the strategy for the next 5 to 10 years and positions the future success of the organization, its migration to EHR technology and the resulting improved patient information and care.

An effective planning process needs to include an external assessment and an internal appraisal. The external assessment considers the organizations customer or market segments, along with a competitive and trend analysis. A formalized internal appraisal should objectively review the organizations structure & functions, resources, strengths and limitations. A survey assessment tool from a third-party, not affiliated with the organization, will generate unbiased results

Collaboration: It is essential that the HIT team truly represent the organizations clinical leadership, in addition to administrative and IT leadership teams. Before EHR implementation begins, consider completing a comprehensive work flow analysis to review the current efficiency of the organization prior to IT intervention

It has been early adaptors experience that organizations are never fully prepared for the loss in productivity that accompanies the EHR planning and implementation process. Allow enough time for the EHR team to complete the selection, planning and implementation process (24 to 36 months is recommended).

Communication: A clear and upfront communication of the organizations vision, and how HIT will fit into the mission, needs to be determined by the leadership team before beginning the EHR process.

Update policies and procedures to inform staff, with clear and concise documentation, on how roles, responsibilities and processes may have been changed.

Implement a standardized orientation process to insure consistency.

Cross-fertilization of department staff within orientation, training & development sessions has been a helpful strategy in learning the big picture. Leadership support for an environment of trust and open communication was found to foster honest feedback on the system and the EHR implementation process, which points to the increased buy-in that is necessary for successful HIT initiatives.

It is inevitable that EHR will begin to transfer an organizational culture that may be founded on yesterdays paradigms and ideas. Among the lessons learned by early adapters of electronic healthcare technology is leadership teams who develop a strategy that includes collaboration, communication and cooperation before beginning the process create an environment in which people are prepared and excited about operationalizing the vision.

Aligning resources and establishing guidelines for effectively leading people across the organization, before beginning the EHR selection process, will ultimately lead to a higher level of performance.

Medical professionals can take full advantage of the ARRA HIT timeline and the maximum payment schedule by beginning the EHR development process in 2011 or 2012 and submitting for reimbursement. Now is the time to create a strategy which determines the future direction of the organization and what organizational resources will be needed to determine that success.

Healthcare Information Technology (HIT) Strategic Planning

Kevin Danaher is President of Danaher Development International, LLC, a strategic planning consulting company, focusing on aligning strategy, people and processes around measurable and attainable, customer-centric goals. Danaher has successfully used the strategic development process to reposition health care organizations create brand alignment and shift the organization's focus on profitable, customer relationships. Danaher can be reached at http://www.DanaherDevelopment.com.

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Human Resource Planning for Healthcare

The WHO defines HRH (Human resource for health) planning as "the process of estimating the number of persons & the kinds of knowledge, skills, & attitudes they need to achieve predetermined health targets & ultimately health status objectives".

HR planning is a dynamic process, involves 3 stages; stocktaking, forecasting, & designing temporary workforce. In the first stage of stocktaking, recruitment & selection of key types of employees align with strategic business plan to achieve specific targets. The second stage of forecasting is subdivided into two phases, forecasting future people needs (demand forecasting) & forecasting availability of people (supply forecasting). The third & final phase involves flexible strategy to recruit temporary employees as per need assessment & cost-effective benefits.

Healthcare

1. Stock-taking: - The principle is to identify how many people are needed at every level of the organization to achieve business objectives- in line with overall strategic plans - & what kind of knowledge, skills, abilities & other characteristics these people need.

The optimal staffing of modern health services requires many different types of staff. These include; -

1. Clinical workers - doctors & nurses.

2. Technical staff for diagnostic services, such as laboratory & radiology, pharmacy staff.

3. Environment health workers, such as health inspectors.

4. Preventive & promotive staff, such as community health workers, administrative staff, etc.

In a healthcare organization, traditional quantitative approach are used to make enumerative judgments based on subjective managers prediction to allocate certain budgets for employee's payroll expenditure & need assessment of key employee potentiating responsive to organizational system & design. Resource allocations are best executed with the help of activity based cost management, that controls cost & labor required for specific job/event & reduce wastage.

For example: Comparative rates of healthcare activity: -

Inpatient care bed days per capita

Acute care bed days per capita

Acute care staff ratio - staff per bed

Acute care nurses ratio - staff per bed

Inpatient admissions per 1000 population

Acute care admissions per 1000 population

Doctors consultation's per capita.

The types of health staff in a particular country are dictated by the kinds of health services provided & level of technology available.

For example: -

Nature of health organization: primary, secondary, & tertiary.

Types of sector: public, private, non-profit funded organization.

Infrastructure: size of the hospital (200 beds, 400 beds, 1000 beds).

General (multispecialty) or specific care providers (cardiovascular, cancer).

2. Forecasting: -

Demand forecasting: - Planning for the medical workforce is complex & determined by relatively mechanistic estimates of demand for medical care. Dr. Thomas L. Hall (1991) proposed 5 generic methods for estimating demand for health care, such as

1. Personnel to population ratio method: - This method calculates ratio of number of health

Personnel as compared with the population count. However, with inappropriate data available, it has serious limitations, such as it is only applicable with acceptable health conditions, a stable health sector, & a limited capacity for planning.

2. The health-needs method: -This method requires & translates expert opinion about people's health needs to staff requirements. Health needs are derived from the determination of disease specific mortality & morbidity rates. The staff requirements are evaluated from the norms for the number, kind, frequency, & quality of services,& staffing standards that convert the services into time requirements by a certain category of health workers to perform the services. This method initiates the need for sophisticated data system & survey capabilities, & a high level of planning expertise which are not readily available.

3. The service -demands method: -This method accounts the numbers & kinds of health services people will use at an anticipated cost of obtaining them, rather than their professionally determined need for such services. This specifically provides data about economical regression pertaining to utilization of private healthcare sector as compared to government funded health sector.

4. The managed healthcare system's method: - The managed health care system's entails a known client population who would have reasonably good access to health amenities. But flexible socio-political trends & economical recession influence healthcare reform policies.

Supply forecasting: -

Forecasting HR supply involves using information from the internal & external labor market. The calculation of staff turnover & workforce stability indices measures internal supply for HR Planning. External labor market gives detailed spectrum on tightness of supply, demographic factors, & social/geographic aspects.

Internal supply: - The evaluation of the gross number of people needed for a specific job & arrange for other provisions of HR processes, such as training & developmental programs, transfer & promotion policies, retirement, career planning, & others have crucial importance in maintaining constant supply of HR in an organization.

1. Stock & flow model: - This model follow the employee's path through the organization over time, & attempt to predict how many employees are needed & in which part of the organization.

a)Wastage analysis; - This analysis refers to the rate at which people leave the organization, or represents the turnover index.

The number of people leaving in a specific period

Wastage analysis= x 100

The average number employed in the same period

b) Stability analysis ( Bowey, 1974): - This method is useful in analyzing the extent of wastage in terms of length of service.

Total length of service of manpower employed at the time of analysis

Stability analysis=x 100

Total possible length of service had there been no manpower wastage

2. Replacement Charts: - Replacement chart is a list of employee's for promotion, selected upon the opinions & recommendations of higher ranking people ( Mello, 2005). Some replacement charts are more systematic showing skills, abilities, competences, & experience levels of an employee.

3. Succession Planning: - An aging workforce & an emerging "Baby boom" retirement waves are driving the need for new management process known as succession planning that involves analyzing & forecasting the talent potentials to execute business strategy.

Will Powley,senior consulting manager for GE Healthcare's performance solutions group says, that the first step in effective succession planning is a quarterly talent review that begins with an examination of the hospital or health system's organizational chart.

In a 2008 White Paper on succession planning, GE Healthcare identified a few best practices for healthcare for succession planning:

1. Identify & develop talent at all levels

2. Assess top performer's talent rigorously & repeatedly

3. Link talent management closely with external recruiting

4. Keep senior management actively involved

5. Emphasize on-the-job leadership & customized employee development

6. Create systematic talent reviews & follow-up plans

7. Maintain dialogue with potential future leaders.

External supply: - HR managers use outside information, such as statistics concerning the labor market from the organization & external labor market, in other words external & internal statistics.

External statistics: - Graduate profile

Unemployment rates

Skill levels

Age profile

Graduate profile: - There is substantial public sector regulation of all health care markets, & entry to labor market is highly constrained by licensing & professional regulations.

Unemployment rates: - There is lack of economic principles, the role of incentives is largely ignored & supply elasticity in the labor market is mostly unknown & poorly researched.

Skill levels: - Higher education (specialization & super-specialization) are proportionally restricted to limited seats of admission governed by medical regulatory bodies.

Age profile: - The organizational charts of recruitment gives details of rates of recruitment, retention, return & early retirement of employee's, which helps to enumerate future vacancy rates, shortages, & need for replacement.

Internal statistics: - Demographic profile

Geographic distribution

Demographic profile: - Demographic changes (e.g. the number of young people entering the labor force) affect the external supply of labor. Age composition of workforce will force to review recruitment policies. The trend of increasing proportion of women in employment has lead to progressive development of both organization & country.

Geographic distribution: - The attraction of workforce to urban areas are influence by following reasons; employment opportunity, access to facilities - transportation & technology, & others.

3. Temporary workforce planning: -

Herer & Harel (1998) classifies temporary workers as: temporary employee's, contract employees, consultants, leased employees, & outsourcing.

High social costs has initiated work sharing strategy which are flexible & provides more benefits, such as

1. Part- time temporary workers numbers & hours can be adapted easily with low maintenance cost to meet organizational needs,

2. Employees possessing appropriate/ specialized skills benefits functional areas within & outside the organization.

3. No responsibility for exclusive benefit enrollments, such as job security, pension plan, insurance coverage, etc.

In today's work environment, outsourcing can be added as a temporary worker planning technique. Outsourcing requirement is assessed & evaluated on cost & benefit decision. Ambulatory services, pathological or diagnostic testing services, laundry, catering, billing, medical transcription, & others are most commonly outsourcing services promoted in healthcare organization.

Human Resource Planning for Healthcare

I am medical professional & studied MBA in healthcare. I devote myself writing articles on topics of health & healthcare industry.

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Planning For Medical Emergencies at the Day Care Center

Medical Security in schools is surely one of the most important issues on the minds of parents and school staff. What are some of the medical safety issues that really need to be addressed to ensure a proper line of defense? What pre-planning can be established so that the staff who first encounters a problem will know how to respond.

Realistically speaking, most early childhood programs are populated by two rather defenseless populations: young children and the women who are caring for those young children. School is a fun place where children come to play and learn. And school is a dangerous place where slips and falls, and different substances such as cleaning supplies or ordinary food could become deadly. We need to help teachers become competent and diligent in recognizing areas where prevention can help. We also need to ensure teachers are adequately trained to handle the specific emergencies that commonly arise in a child care center.

Health Care

First, let the school begin with an emphasis on prevention. Providing a safe environment for children to prevent medical emergencies from happening is everyone's responsibility. In this area, safety training for staff and parents can go a long way to improve safety standards. Toward that end, teachers can begin with routine inspections.

All areas of the classroom and equipment are checked for broken toys, splintering blocks, uncovered electrical outlets or dangling window blind cords.

Each day, before each play session, the outside play area is inspected for broken equipment, broken glass, or other foreign objects that may cause an injury.

Areas around classroom sinks and toilets are inspected so slipping accidents may be avoided from spilled water.

Food safety is ensured by keeping refrigeration temperatures in the safe zone through the use of an inside refrigerator. Suspicious food is discarded. Food that is cooked or heated is served only after checking it will not cause a burn.

A list children with known food allergies, and the food they are allergic to, must be posted in the classroom so that all staff members are aware of dangerous food items for those children. This list is not public information. It contains medical information that must be protected under HIPPA laws. Privacy is maintained by simply placing a blank cover sheet over the allergy listings.

Dangerous cleaning materials are locked and out of a child's reach.

Many schools have established a routine safety check list for teachers to use each day. The classroom opener is responsible for going through the check list and signing off on it that day. The daily safety check lists are filed away for possible future reference should an incident occur.

Second, let the staff be completely trained in emergency care. While the entire teaching staff needs to be aware of the importance of preventive measures, sooner or later, a true emergency will present itself. At that time, the staff will be expected to respond appropriately. This means that all staff members must be trained to respond to the most common emergencies.

In this arena, staff members can prepare by taking CPR (Cardio-Pulmonary Resuscitation), First Aid, and MAT (Medication Administration Training) classes. These classes certify teachers for a specified period of time. Upon the certification expiration date, it is imperative staff members take the certification renewal class.

Staff members can familiarize themselves with common products and plants that can be poisonous to small children. The National Poison Control Number can be posted in the classroom and at all telephones in the center.

Staff members can familiarize themselves with child abuse and neglect recognition information. They need to know their legal obligations in this area. The National Child Abuse & Neglect Hotline number can be posted in the classroom and at all telephones in the center.

It is an excellent idea for each school to have developed their own emergency plan and to practice that plan. For example:

Who will remain with the injured child?
Who will make the call for emergency services?
Who will call the parent?
Who will go to the hospital with the child?
If the building needed to be evacuated, where will the children and staff go?

And after the immediate crisis has passed, who will be responsible for documenting the incident for the record?

There is no doubt that if you work with small children there will be some type of emergency that develops. It can be a scraped knee, a head injury, a seizure, an asthma attack, or an allergic response to a bee sting. There is nothing like having an advance emergency plan in place along with emergency training to help staff meet the challenge of assessing the emergency and getting the help that is needed.

Planning For Medical Emergencies at the Day Care Center

Elaine S. Rexdale earned a BA in Elementary Education from Augustana College in Rock Island, IL and an MA in Early Childhood Education from Teachers College at Columbia University in NY. She has been an early childhood educator and administrator for the past 30 years and has served in public and private schools in IL, LA, and NY. Her website is http://www.ElaineRexdale.com

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Care Plan 101 - An Introduction to Care Planning For Activity Professionals

Creating and implementing individualized care plans for residents in long-term care facilities is a very important responsibility of activity and recreation professionals. The activity assessment determines the content of the care plan. Not all residents will have an "activity-care plan", but most care plans should have "activity-related interventions" found in the comprehensive care plan. Care plans may be written regardless if a resident triggers on the MDS 2.0.It is important to set realistic, measurable goals, interdisciplinary interventions, and create care plans that are individualized and person-centered.

What is a Care Plan?
The RAI user manual defines care planning as, "A systematic assessment and identification of a resident's problems and strengths, the setting of goals, the establishment of interventions for accomplishing these goals."

Health Care

Why write Care Plans?
- Document strengths, problems, and needs
- Set guidelines for care delivery
- Establish resident goals
- Identify needs for services by other departments
- Promote an interdisciplinary approach to care and assign responsibilities
- Provide measurable outcomes that can be used to monitor progress
- Meet federal and state requirements
- Meet professional standards of practice
- Enhance the resident's quality of life and promote optimal level of functioning!

What is a Care Plan Meeting?
A forum to discuss and review a resident's status including any problems, concerns, needs, and/or strengths.

Who usually attends a Care Plan Meeting?
- MDS Coordinator
- Nurse(s)
- CNA's
- Dietician
- Rehabilitation Therapist(s)
- Recreation Staff
- Social Worker
- Resident
- Family Member/Guardian

When are Care Plans written?
- A minimum of seven days after the MDS completion date
- Some care plans warrant immediate attention
- As necessary
- Must review at least quarterly

The Role of the Recreation/Activities Department
- Identify the resident's leisure/recreation needs
- Identify barriers to leisure pursuit and help minimize these barriers
- Identify the resident's leisure/recreation potential
- Provide the necessary steps to assist the resident to achieve their leisure/recreation goal/s
- Provide interdisciplinary support by entering a variety of recreation interventions on various (non-activity) care plans
- Monitor and evaluate residents response to care plan interventions

Components of a Care Plan
- Statement of the problem, need, or strength
- A realistic/measurable goal that is resident focused
- Approaches/interventions the team will use to assist the resident in achieving their goal
- Important dates and time frames
- Discipline(s) responsible for intervention
- Evaluation

Target areas for Recreation/Activities
- Cognitive Loss
- Communication
- ADLS
- Psychosocial
- Mood
- Nutrition
- Falls
- Palliative Care
- Activities
- Recreation Therapy
- Pain Behavior
- Restraints

Activity/Recreation Care Plan Samples
These are just a few samples. Remember, the most important aspect of care planning, is INDIVIDUALIZATION!

Statements (the resident's name is usually used instead of the word "resident")
- Resident has limited socialization r/t to depression
- Resident prefers to stay in room and does not pursue independent activities
- Resident is bed-bound r/t to stage 4 pressure ulcer and is at risk for social isolation
- Resident demonstrates little response to external stimuli r/t to cognitive and functional decline
- Resident enjoys resident service projects such as changing the R.O. boards
- Resident becomes fearful and agitated upon hearing loud noises in group activities r/t to dementia
- Resident has leadership abilities
- Resident prefers a change in daily routine and wishes to engage in independent craft projects

Goals
- Resident will respond to auditory stimulation AEB smiling, tapping hands, or vocalizing during small group sensory programs in 3 months
- Resident will actively participate in 2 movement activities weekly in 3 months
- Resident will remain in a group activity for 15 minutes at a time 2x weekly in 3 months
- Resident will accept in room 1:1 visits by recreation staff 2x weekly in 3 months
- Resident will socialize with peers 2x weekly during small group activities in 3 months
- Resident will respond to sensory stimulation by opening eyes during 1:1 sessions in 3 months
- Resident will actively participate in Horticultural Therapy sessions in the green house, 1x monthly in 3 months
- Resident will continue to assist other residents in writing letters on a weekly basis in 3 months
- Resident will exhibit no signs of agitation during small group activities 3x weekly in three months
- Resident will engage in self-directed arts and crafts projects 1x weekly in 3 months

Interventions/Approaches
- Provide a variety of music i.e. Big Band and Irish
- Utilize maracas and egg shakers to elicit movement
- Provide PROM to the U/E during exercise program
- Involve resident in activities of interest i.e. singalongs, adapted blowing and trivia
- Offer 1:1 visits in the late afternoon to discuss recent Oprah episode
- Seat resident next to other Korean speaking resident during groups
- Provide tactile stimulation i.e. hand massages and textured object i.e. soft baseball
- Provide olfactory stimulation i.e. vanilla extract and cinnamon for reminiscing
- Utilize adapted shovel and watering can during HT sessions
- Provide easy grip writing utensils and a variety of greeting cards/stationary
- Involve resident in small sensory groups i.e. SNOEZELEN and Five Alive
- Sear resident near a window
- Provide a variety of independent arts and craft projects
- Provide adapted scissors and paint brush

Exercise
Imagine that you are a resident in a long-term care facility and you are bed-bound for a health-related condition and are at risk for social isolation and inactivity. Write a goal and at least seven interventions/approaches that are relevant to you.

Care Plan 101 - An Introduction to Care Planning For Activity Professionals

Kimberly Grandal, Founder and Executive Director of Re-Creative Resources, Inc., is a strong advocate for the field of Therapeutic Recreation and Activities, with over fifteen years of experience working with the elderly in numerous management and consultant positions. She is an Activity Consultant Certified and a Certified Therapeutic Recreation Specialist. She is a recipient of the Kessler Institute of Rehabilitation 1997 Triumph of the Human Spirit Award.

Kim is a member of NJAPA, NJ/EPA-TRA and NAAP and serves on the NJAPA board as the Chairperson for the Legislation Committee. She is an NCCAP reviewer and is an active member of the NCCAP and NAAP Government Relation Committees.

Kim is a speaker for various national, state and local activity associations, the Society of Licensed Nursing Home Administrators of NJ, colleges, and community groups. She also provides consultation and support to numerous facilities in the state.

Kim is the editor and writer for the "The Rec-Room", a monthly newsletter published by her company. In addition, she writes monthly articles for Activity Directors Today newsletter, and has contributed articles to Creative Forecasting Magazine, Current Activities in Long Term Care Magazine and The Continuing Care Insite newsletter. For more information visit http://recreativeresources.com

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