Dear Healthcare Professional,
Happy Holidays and welcome to the December issue of the Indidge Advantage newsletter. The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
By Christina Torode, Senior News Writer
SearchWinIT.com
As the chief security officer of the oldest stock exchange in the United States, compliance audits are old hat for Allan Pomerantz.
Philadelphia Stock Exchange, like all others, has been under the watchful eye of the Securities and Exchange Commission long before Enron Corp. caused sweeping changes in how executives account for finances in the form of Sarbanes-Oxley regulations.
In his five years at the exchange, Pomerantz has learned that a successful audit comes down to one word: documentation.
"One thing for sure that an auditor is going to look at is your written policies and procedures for IT, and they will audit you against your own written policies and procedures," Pomerantz said.
Whether they are called security polices, compliance controls, or risk management procedures, these are the areas where most companies trip up before and during an audit.
At the level of IT administrator, snafus often take the shape of change management -- not necessarily with the IT systems in place but with the processes, especially with how they are documented and managed.
The good news is that if IT shops take the time to document their system change management controls and policies, they can check off a major requirement for a majority of regulations, including Sarbanes-Oxley, Gramm-Leach-Bliley, Health Insurance Portability and Accountability Act, and Payment Card Industry compliance.
Emphasis on policies and controls is also why there is so much buzz around ITIL and COBIT, which offer a framework of best practice recommendations in such areas as change management, incident management and the help desk.
Tech-savvy auditors asking for more
Auditors with greater IT knowledge are digging in and asking for specific reports on any changes made to the server or network devices that took place in a given timeframe, according to Alex Bakman, founder of change and compliance reporting software maker Ecora Software Corp. in Portsmouth, N.H. They are also asking for proof that IT shops track what users were added when, who left the company, whether user IDs were revoked and which IT administrators have access to critical systems, he said.
"When asked if they have proof of such changes, the answer from IT is often 'No, not really,'" Bakman said. "Auditors want to see documented proof," he said.
Part of the issue with change management is changing the mindset of the IT staff, said Joseph Fleming, IT manager with Blue Cross Blue Shield in Helena, Mont. After his company started implementing change control processes about a year ago and jumped on the ITIL bandwagon, his staff started to bombard him with questions and complaints.
"I have developers saying, 'Why do we have to do this,'" said Fleming, whose company uses several Altiris systems management products for capturing change instances and producing reports. "You have to sit down with them and explain that this is what we need to do to stay in business and that, in the end, having good processes does have its payoffs for IT."
Even with reassurances that change is necessary, buy-in from IT was a battle, said Fleming. "They don't like the feeling that their work is being watched, that you can see what they did and who caused a flaw in the system."
Auditors have not only asked Bill Grigonis, IT manager of the American Bible Society in New York, to show them how his department physically makes a change to a system, but they are also asking the IT staff to produce change management reports.
A shove from above for IT compliance
The American Bible Society is a prime example of how regulatory compliance can have an indirect impact on a company. Although the $1 billion nonprofit isn't required by law to meet every guideline of a given regulation, many of their corporate partners are. The nonprofit also needs to comply with privacy laws connected to donor information.
Even with these reasons to comply, it came down to a nudge from above. "Many of the people who sit on our board of directors are from Wall Street firms or bigger public companies," Grigonis said. "They have the compliance mindset and believe that we should also be compliant."
One thing the auditors did recommend was automation. The nonprofit cut down on its paper-intensive auditing process by using Ecora's software to automate configuration, change and patch management reports. On the storage side, the company uses EMC's data archiving software.
"Automation is key -- it eliminated so much time," Grigonis said. "We used to dread audit time. We'd have to sort through all these documents, and it was very stressful. But now we just run some programs," he said.
Anticoagulant therapy linked to high rate of errors
Media Contact:
Ken Powers
Media Relations Manager
630-792-5175
kpowers@jointcommission.org
(OAKBROOK TERRACE, Ill. - September 24, 2008) A number of recent high profile errors related to commonly used blood thinners highlight a safety issue that too frequently results in harm or even death to patients, according to a Joint Commission alert issued today that offers solutions to this medication safety issue.
The Joint Commission's new Sentinel Event Alert urges greater attention to the dangers associated with anticoagulants, life-saving medications that also present serious risks when administered incorrectly or in error. Patients being treated with these medications must be closely monitored and screened for drug and food interactions, given that commonly used anticoagulants such as heparin and warfarin have narrow therapeutic ranges and a high potential for complications. Adding to the problem is a lack of standardized naming, labeling and packaging of anticoagulants that create confusion and lead to devastating errors.
Anticoagulant medication errors are such a serious patient safety issue that The Joint Commission addresses these types of errors in the 2008 National Patient Safety Goals, with full implementation of the requirements expected by January 1, 2009 for hospitals, outpatient clinics, home care and long term care organizations across the United States. In addition, The Joint Commission's medication management standards require organizations to pay particular attention to high-risk drugs such as anticoagulants in order to improve safety.
"Anticoagulants are vital to maximizing the effectiveness of many medical treatments and surgical procedures that benefit patients, but the systems necessary to ensure that these drugs are used safely are not adequate," says Mark R. Chassin, M.D., M.P.P., M.P.H.., president, The Joint Commission. "The strategies contained in this Alert give health care organizations and caregivers the tools to make a difference in preventing anticoagulant medication errors."
The Joint Commission's Alert highlights factors that contribute to anticoagulant medication errors, including lack of standardized labeling and packaging, failure to document and communicate patient instructions during hand-offs, and inappropriate dosing for pediatric patients.
To reduce the risk of errors related to commonly used anticoagulants, The Joint Commission's Alert recommends that health care organizations take a series of 15 specific steps, including the following:
- Assess the risks of using anticoagulants.
- Use best practices or evidence-based guidelines regarding anticoagulants.
- Establish standard dose limits on anticoagulants and require that a doctor confirm any exceptions.
- Clearly label syringes and other containers used for anticoagulants.
- Clarify all anticoagulant dosing for pediatric patients, who are higher risk because these drugs are formulated and packaged for adults.
Other strategies for reducing the errors related to anticoagulants include staff communication and collaboration; patient education and participation; designating pharmacists to manage anticoagulant services; and use of computerized physician order entry (CPOE) and bar coding technology, if available.
The warning about preventing errors related to commonly used anticoagulants is part of a series of Alerts issued by The Joint Commission. Much of the information and guidance provided in these Alerts is drawn from the Joint Commission's Sentinel Event Database, one of the nation's most comprehensive voluntary reporting systems for serious adverse events in health care. The database includes detailed information about both adverse events and their underlying causes. Previous Alerts have addressed wrong-site surgery, medication mix-ups, health care-associated infections, and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found on The Joint Commission's website.
What it means to our customers:
If you are in the budgeting process and many of you are this time of year, consider allocating your purchasing dollars to companies that not only save you money through operating efficiencies but also are dedicated to continual product refinement.
The new version of our popular policy and procedure management system features a dashboard where users can perform all their daily activities from one screen. We also made our policy manager easier to use by developing a screen that shows a list of documents people use the most. Now you can visually track a documents status and there are customizable work flows for different departments, an example of a feature that some customers had asked for. The quiz feature now has the ability to randomize questions and their answers to make this knowledge retention tool more demanding. For the technically inclined, there are enhanced security features and integration with Active Directory and Novell LDAP. There are more refinements and it is not practical to list them all here, however, there is a very easy way for you to see why compliance officers, risk managers, CFOs, CEOs and chief nursing officers among others are moving to this system. Let us show you why this system earns a place in your budget! Send Tom Reid an email at tom.reid@indidge.com or call him now at (480) 829-0479 Ext. 138 to schedule a convenient web demo.
For a FREE educational webinar on policy and procedure management Wednesday, January 7, 2009 from 11 am - 12 Noon MST.
By Bernie Monegain, Editor
Healthcare IT News
December 2, 2008
CHICAGO - Portable CT scanners can make the difference between life and death for stroke patients treated at small community hospitals, new research shows.
The research on the availability of eight-slice computed tomography (CT) scanners was released Tuesday at the annual meeting of the Radiological Society of North America.
Stroke is the third leading cause of death in the United States, according to the National Institute of Neurological Disorders and Stroke. More than 700,000 cases are diagnosed annually, according to the organization.
Most stroke victims are treated at small community hospitals where access to CT scanners may be limited, notes the study, which was conducted at North Shore Medical Center-Salem Hospital in Salem, Mass.
"The hospital's acquisition of a portable CT scanner facilitated more rapid assessment of acute stroke patients and is anticipated to increase the number of patients to whom thrombolytic therapy can be administered," said the study's lead author, David B. Weinreb, MD. Weinreb is now a resident physician in the Department of Radiology at the Hospital of Saint Raphael in New Haven, Conn.
The most common kind of stroke, ischemic stroke, occurs when a blood clot blocks a blood vessel in the brain. Such strokes can be treated with thrombolytic therapy using a drug called tPA that dissolves the blockage. However, the window of opportunity to safely administer the medication is generally considered to be just three hours. Also, it is important to determine there is no bleeding in the brain before administering tPA.
One of every six strokes is caused by bleeding rather than clotting, Weinreb noted.
"tPA is usually the only shot we have at clot-induced ischemic strokes," Weinreb said.
"But it needs to be administered in a closely monitored situation, because the drug can have extremely adverse effects in those patients whose strokes are instead due to bleeds."
Before a patient receives tPA, a head CT must be performed to ensure there is no bleeding in the brain. The National Institute of Neurological Disorders and Stroke recommends that patients who arrive in the emergency room with signs of acute stroke undergo CT imaging within 25 minutes.
For the study, co-authored by James E. Stahl, MD, Weinreb and colleagues began using a portable CT scanner to assess stroke patients in the ER of NSMC-Salem Hospital. During the month prior to the acquisition of the portable scanner and for a four-month period following its installation, researchers measured how much time elapsed between a physician's order for a head CT and the scan.
The availability of the CT scanner in the hospital's ER reduced the time between the order and exam from 34 minutes to 15 minutes, a reduction of 54 percent. Based on simulation modeling, the researchers estimated the improvement would increase by 86 percent the number of stroke patients able to be treated with thrombolytic therapy within the three-hour window.
"A portable eight-slice CT can be easily added and used to accurately identify a head bleed in a stroke or trauma patient," Weinreb said. "This new technology is able to solve a very important problem for a community hospital, where the majority of stroke victims are being treated."
Magic Words
As the crowded airliner is about to take off, the peace is shattered by a five-year-old boy who picks that moment to throw a wild temper tantrum. No matter what his frustrated, embarrassed mother does to try to calm him down, the boy continues to scream furiously and kick the seats around him.
Suddenly, from the rear of the plane, an elderly man in a Marine uniform is seen slowly walking forward up the aisle. Stopping the flustered mother with an upraised hand, the white-haired, courtly, soft-spoken Marine leans down and, motioning toward his chest, whispers something into the boy's ear. Instantly, the boy calms down, gently takes his mother's hand, and quietly fastens his seat belt. All the other passengers burst into spontaneous applause.
As the Marine slowly makes his way back to his seat, one of the cabin attendants touches his sleeve. "Excuse me, sir," she asks quietly, "but could I ask you what magic words you used on that little boy?"
The Marine smiles serenely and gently confides, "I showed him my pilot's wings, service stars, and battle ribbons, and explained that they entitle me to throw one passenger out the plane door on any flight I choose."