Why Professional Practice?

The hope of technology is to elevate clinicians to their fullest practice potential as well as creating an integrated health care experience as an interdisciplinary team including the patient and family.  Without technology this would be impossible to achieve in its highest form – one that brings a professional practice platform that is as equally significant as a healthcare technology platform.  Why Professional Practice?  Because without clarity on the professional practice of nurses we are at risk as a profession to ensure technology captures the professional value-added contributions we make as the largest healthcare provider in the U.S.  If we are not clear on “professional practice” we are at risk to perpetuate “institutional practice” – where technology can reduce nursing professional services to tasks and routines. 

My nursing mentor and colleague, Bonnie Wesorick said this well:  “Technology has the potential to humanize or dehumanize care, enhance or interfere with professional scope of practice, interdisciplinary partnership and clinical integration.  It can ensure evidence-based practice or lead to institutional, task-driven practice.  It has the potential to transform education of nursing students and bridge the gap between the desired practice reality and the inadequate present-day institutional realities loved at the point of care.  It has the ability to assure that health care, not just medical care will be available for this society”. (2011) – Bonnie Wesorick, MSN, RN, FAAN founder; CPM Resource Center, Grand Rapids, MI USA

The Emerging Role of Nursing Informatics

The past year has also been a year where we have seen great momentum behind the role of the nurse in informatics. I recently had the opportunity to summarize the momentum and significant events in the field in an article, Informatics & the Future of Nursing Practice: How technology will be integrated into every area of healthcare http://nursing.advanceweb.com/Features/Articles/Informatics-the-Future-of-Nursing-Practice.aspx.  Nurses that choose careers in informatics need to be strong advocates for professional practice as well as interdisciplinary integration of the professional processes of care.  May 12th has been designated Nursing Informatics Day by the American Nurses Association and the HIMSS Nursing Informatics Community.  To recognize the significant role of nursing informatics, HIMSS will also be hosting daily stories this week on the HIMSS Blog. 

So, in celebration of the over 3,000,000 nurses in the USA and even more world-wide, I wish you a wonderful nurses week! May you find time to reflect on why you chose nursing as a career and on some of the patients and families that gave you your biggest lessons.  If you are not a nurse, I hope you celebrate with a special nurse in your life as well as the joy of “partnership” when it comes to healing the body, mind and spirit.

CPM Consortium Summit 2012

I look forward to continuing the celebration with many of you at the CPM Consortium Summit 2012 next week in Arizona http://www.cpmrc.com/cpm-consortium-summit/.  We will be sharing our collective progress on Dreams to Reality: Culture and Practice Transformation. 

Cheers!

Michelle

 Wesorick, B. (2011) – Beyond Technology: Making Machines the Servants of Health Care in The Power of Ten: Nurse Leaders Address the Profession’s TEN MOST PRESSING ISSUES (pgs 18 & 25).Sigma Theta Tau International, Indianapolis, IN.

Grand Rapids, MI – May 2, 2012 – Elsevier, a world-leading provider of scientific, technical and medical information products and services, has appointed Hajo Oltmanns as the new President of Elsevier CPM Resource Center (CPM), a leader in developing clinical decision support (CDS) tools for healthcare.

Hajo will lead the continued development and expansion of CPM’s clinical decision support tools and the engagement of the CPM International Consortium, an organization composed of hundreds of CPM’s client hospitals and health systems.  Hajo is also responsible for the development of Elsevier’s new Order Sets, which is expected to launch in late 2012.

Hajo’s appointment comes as CPM and our other CDS groups work together to transform healthcare,” said Jay Katzen, Managing Director, Elsevier Clinical Decision Support and Payer Solutions.  “Hajo’s experience and understanding of healthcare will help grow this business, empowering our customers to achieve measureable, sustainable success through the implementation of evidence-based CDS and professional practice expertise.”

At Elsevier Health Sciences, Hajo previously served as the Senior Vice President of Strategy & Business Development, focusing on the CDS group.  Hajo joined Elsevier in 2007 and served as a member of the executive strategy team, working across all international businesses units while based in Amsterdam.

Prior to Elsevier, Hajo was a manager at the Boston Consulting Group in Chicago, where he focused on strategy, development and customer understanding across several industries, including healthcare.

Originally from Germany, Hajo has an MA from the University of Edinburgh and an MBA from Northwestern University’s Kellogg School of Management.

Perhaps knowing about polarities can help you with this dilemma. Polarities are seemingly unsolvable issues that are really interdependent pairs that need each other over time in pursuit of a common purpose. In this case, the common purpose is a healthy life! These polarities can be placed on a four quadrant map that contains upsides and downsides. All four quadrants must be acknowledged and acted upon. If you do not pay attention to both sides of the polarity (in this case activity and rest), there is 100% predictability you will end up in the downside, just like our weekend warrior.

Here is what the activity-rest polarity looks like when it is “mapped” (the paradoxes are placed on the four quadrant map). The content of the quadrant, the action steps (keeping you in the upside or moving you there), and the early warning signs (telling you that you are in the downside) can be specific to you.

Fill in your own map and “tap” the oscillating energy to keep you BOTH off the couch AND active in a healthy way.

Next time, I will map a healthcare polarity for you to SEE-MAP and TAP!

To learn more about Polarity Thinking for Healthcare we have some workshops and free webinars available. You can download this flyer for more information.

• Competent & Savvy Professionals: They know all about food and nutrition and how it impacts your overall health.
• Educated: They must have at least a Bachelor’s Degree in food and nutrition; complete an extensive, intense internship; and pass a national registration exam. This gives them the initials RD after their name.
• Employable: Work in a multitude of settings that include large corporations, food and restaurant industry, healthcare systems, fitness organizations, private practice and consulting services.
• Specialize: Many choose a specialty area and obtain certifications in diabetes, weight management, sports nutrition, pediatrics, renal disease and nutrition support. To obtain a certification one must have experience, in depth knowledge and pass a board  examination.
• Members: Several belong to the world’s largest organization of food and nutrition experts called the “Academy of Nutrition and Dietetics”, formerly known as the “American Dietetic Association”.

What is the difference between a “registered dietitian” and a “nutritionist”?  A “nutritionist” does not necessarily mean they are a “registered dietitian”, and to date there are no established national educational standards or requirements to be a “nutritionist”. Be aware some dietitians like to call themselves “nutritionists” just because it is a more recognizable term to the public. To be certain you are speaking to a registered dietitian, just be sure they have RD after their name and you will know they are the real thing. To learn more about food and nutrition experts, visit the national organization’s website www.eatright.org.

Happy Eating!

Connie Kohler

Over the past two months, we’ve been exploring the Measures for Use in establishing Quality Performance Standards that Accountable Care Organizations (ACOs) must meet for shared savings.  Last month, we discussed the Patient/Caregiver experience and this month I want us to explore the Care Coordination/Patient Safety area.

This section still lies in the aim of Better Care for Individuals and has six tenets which must be followed:

1. Risk-Standardized, All Condition Readmission
2. Ambulatory Sensitive Conditions Admissions:  Chronic Obstructive Pulmonary Disease
3. Ambulatory Sensitive Conditions Admissions:  Congestive Heart Failure
4. Percent of PCPs who successfully qualify for an EHR Incentive Program Payment
5. Medication Reconciliation:  Reconciliation After Discharge from an Inpatient Facility
6. Falls: Screening for Fall Risk

As we start to look into the next section of Better Health for Populations, the above listed areas are all in the reporting stage and will switch to the performance stage in year 2 and year 3.  With AONE’s upcoming conference in March, Elsevier CPM and our other business units will be talking with conference attendees and sharing client stories on what success looks like for these measure titles.

Please feel free to comment on your own successes below, or post on our Twitter or Facebook accounts.

Thank you for all that you do for health care and I look forward to seeing everyone during my conference and speaking travels.

My mother was a wonderful person. She was funny, generous, loving, attractive, creative…and one of my best friends. Alzheimer’s disease changed everything.

As an RN, I have been prepared to take care of patients and respond to physical, emotional and spiritual needs. I was not prepared to be a daughter losing her mother over a period of 10 years to a cruel disease. I cannot adequately describe what it feels like to watch someone you love lose all of those special qualities that made her the person that she was. I was grieving her loss while she was still alive. As a nurse, I knew that this disease was following the expected course. However, the daughter part of me struggled. It was devastating the first time she forgot my name. As time went on, she forgot how to do even the simplest things…changing her clothes, brushing her teeth, taking a shower. She forgot that she was a mother and looked at me as a rival…not as her daughter. She forgot that she was married and did not remember my father. Home was no longer a comfort for her…it was unfamiliar. She came to refuse my efforts to help her and care for her. Although I knew it was the disease, the pain was still there for me.

One thing she did not lose was her love of God. Even in her last months of life, she retained that love and talked about God. It was pretty amazing. Our faith has been a central part of all of our lives. God provided strength for my father and I to be on the journey with my mother and He continued to care for her. I lost my mother to this dreadful disease in 2010. I still miss her, but she is at peace. I would never wish her back as she was in the later years of her life, but I am so thankful and blessed to have had her as my mother…and one of my best friends.

Michelle has been employed by CPM for nearly 7 years. She is a graduate of Butterworth School of Nursing, holds a BSN from University of Detroit/Mercy and a Master’s Degree in Management from Aquinas College. Michelle’s clinical experience has been in several different areas of Obstetrics, including Antepartum, Antenatal Testing, Labor & Delivery and Postpartum.  She also has experience in case management within the ambulatory OB/GYN clinic setting.  Michelle contributes her expertise to many evidence-based content development projects with her specialty focus being Obstetrics and Newborn care. She currently holds the position of Product Director for both CPM CarePoints Guidelines™ and CarePoints Emergency™ products.

Last month, I promised we would be delving into the 33 Accountable Care Organization (ACO) requirements that CMS put out this year in an effort to gain shared savings from its participating hospitals.  This month, we’ll be looking at the Patient/Caregiver experience and what the seven (7) standards under the better care for individuals aim is looking to accomplish.

1. Getting Timely Care, Appointments and Information
2. How Well your Doctors Communicate
3. Patients’ Rating of Doctor
4. Access to Specialists
5. Health Promotion and Education
6. Shared Decision Making
7. Health Status/Functional Status

Each of these standards are scored with a Consumer Assessment of Healthcare Providers and Systems survey (CAHPS).  These surveys, formally known as the Consumer Assessment of Health plans have both a print and web based option to help health systems provide what’s best for patients.

Some of the sample areas health systems can explore to meet this criteria are:

• Helpfulness of provider’s use of computers during a visit
• Getting timely answers to medical questions by e-mail
• Helpfulness of provider’s website in giving information about care and tests
• Getting timely appointments through e-mail or a website

While these survey items only scratch the surface of what can and should be done to meet these standards, at least it gives organizations a jumping off point to help get them started in meeting their savings requirements.

Good luck in starting down this road.  CPM looks forward to helping be a part of your journey.  Tune in next month as we examine the Care Coordination/Patient Safety sections of the ACO performance standards.

The guidelines are segmented into eight (8) domains:

• Patient/Caregiver Experience (7 measures)
• Care Coordination/Patient Safety (6 measures)
• Preventive Health (8 measures)
• At Risk Population – Diabetes (6 measures)
• At Risk Population – Hypertension (1 measure)
• At Risk Population – Ischemic Vascular Disease (2 measures)
• At Risk Population – Heart Failure (1 measure)
• At Risk Population – Coronary Artery Disease (2 measures).

Our 2012 blog discussions and educational opportunities will focus on these guidelines.  I and our other specialists will be working to help create understanding on what health systems need to do in order to be compliant with these new regulations.   We welcome your comments, questions and opinions as we all venture on this new journey together.

Michelle

In getting ready to put 2011 away as another successful year, we at CPM are excited about what 2012 will have in store for the field of health care.

Looking at McNickle’s article regarding EMR usability, we believe, wholeheartedly, in the statement that “usability should be considered more than just user satisfaction”.  With the upcoming ARRA Stage 2 and 3 criteria, the movement for health care provider and hospitals to realize that their current systems may not be perfect is facing many organizations.

The parallel benefits of supportiveness, flexibility, ease of learning, effectiveness and efficiency, all mentioned by McNickle, are tenets we hold to be true at CPM.  It’s been said that quality is in the patient’s eyes and with our business supporting humanity; we have not only a great opportunity to deliver this quality, but also a great responsibility.

With the EMR evolution lying in the users’ hands, we at CPM look to have all of the intended audiences work together to make the future; consumer and quality driven.    Realizing that EMR implementation and the CPM Framework are just tools to help healthcare organizations accomplish their patient care goals I would like to draw attention to what Dr. Steve Waldren, MD states in a recent Healthcare IT News article:

“Most people think an EMR solves problems, but an EMR will only amplify problems that already exist in the practice”.

CPM has based the intentional design of the EMR on knowing, at a deep level, the professional practice and workflow needs of an interdisciplinary care team, and has continued to evolve the depth and breadth of that design as the needs of patients, clinicians and organizations evolve.  As 2012 approaches we look forward to a great year for us in terms of continually supporting our consortium clients and welcoming new hospitals and other healthcare settings into our transformation science methodology of creating better usability and care coordination across the continuum of care.

We support this week’s announcement by Health and Human Services which moves the start date for Stage 2 of the meaningful use program from 2013 to 2014.  While this decision will relieve burdens for those who attested to meaningful use in 2011, it also provides more time for vendors and providers/hospitals to prepare to meet the new proposed rules (Stage 2 meaningful use Notice of Proposed Rulemaking (NPRM) which is scheduled to be published in February of 2012.  At CPM, it is our hope that this delay will also help us, our consortium, and our HIT partners focus on improved usability to best support clinicians and patients thereby creating meaningful care.  There is no question that we all want to “get it right”.

We hope the rest of 2011 will be good for everyone and we look forward to being a part of your 2012.  For those of you that will be attending Institute for Healthcare Improvement’s (IHI’s) 23^rd Annual National Forum, please stop by our Storyboard Presentation Achieving Meaningful Use in Healthcare: The Road to Meaningful Care.  The CPM Consortium has been an active IHI National Node since 2005 and I look forward to seeing many of our consortium members there who are sharing in the mission to create the best practices to improve quality in healthcare.

Blessing to you and yours,

Michelle

Grand Rapids, November 15 2011 - Elsevier (www.elsevier.com), the leading global provider of scientific, technical, and medical information products and services announced that Bonnie Wesorick, Founder and Chairman Emeritus, Clinical Practice Model Resource Center (CPMRC), is this year’s recipient of the Edith Moore Copeland Award for Excellence in Creativity. CPMRC is an Elsevier-owned company that has brought healthcare providers together to co-create and sustain the best places to practice and receive care.

“Bonnie is a true visionary and her creative models, conceptual frameworks and strategies have been ahead of their time, providing future direction in healthcare quality improvement,” said Michael Hansen, Chief Executive Officer of Elsevier Health Sciences. “It’s great to see Bonnie recognized for helping to create the movement toward point of care integration and scope of practice clarity in the clinical setting.”

The Copeland Award is one of six Founder’s awards bestowed by The Honor Society of Nursing, Sigma Theta Tau International (STTI) and is one of the highest honors bestowed by STTI. The award celebrates the advancement of nursing through creativity in education, practice and research. Award criteria include demonstrating creative activity in nursing education, practice or research, participating in creative activity that serves as a stimulus for research, practice and education; and fostering creativity in people such as colleagues, students, clients and other health care providers.

Bonnie received the award for creating a Clinical Practice Model (CPM) Framework to help guide advancements in nursing. She soon expanded the Framework to include other disciplines and the entire care team at a time in healthcare when hospital organizations were accustomed to working in silos. With the CPM Framework, core beliefs, principles, theories, and healthcare best practices have all been synthesized into concise models that help clinicians and leaders affect sustainable change across the healthcare organization. Hallmarked at the award ceremony was Bonnie’s leadership and vision for bringing the first evidence-based automated clinical documentation system to healthcare designed to serve patients and clinicians. This transformation leads to positive outcomes for patients and their families, caregivers and the healthcare community at large.

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About CPMRC

The CPM Resource Center (CPMRC) offers content, processes, tools and services that support practice advancement, cultural transformation, infusion of evidence-based care, and interdisciplinary integration at the point of care. CPMRC’s evidence-based products and professional services assist healthcare organizations in creating a healthy work culture and interdisciplinary integration using the CPM Framework™ that supports cultural and professional practice for sustainable healthcare transformation. The International Consortium of over nearly 300 rural, community and university settings connects clinicians and leaders to advance clinical scholarship and research. Practice-Education Partnerships bridge the transition from education to practice in schools of Nursing and Allied Health focusing on interprofessional education (IPE) and interdisciplinary collaborative practice. CPMRC is a business unit of Elsevier. For more information on CPMRC, please visit www.cpmrc.com.

About Elsevier

Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet (www.thelancet.com) and Cell (www.cell.com), and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include SciVerse ScienceDirect (www.sciencedirect.com), SciVerse Scopus (www.scopus.com), Reaxys (www.reaxys.com), MD Consult (www.mdconsult.com) and Nursing Consult (www.nursingconsult.com), which enhance the productivity of science and health professionals, and the SciVal suite (www.scival.com) and MEDai’s Pinpoint Review (www.medai.com), which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier (www.elsevier.com) employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC (www.reedelsevier.com), a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).