Biting the Hand That Fed a Bad Decision

Speaking about government financial incentives to help healthcare organizations acquire Electronic Medical Records, EMR, evokes a lot of passion.  Social media, blogs, online magazines, hard copy – the comments range from full support to total rejection of government being involved in any such efforts.

The focus of this post is the particular argument that Federal EMR incentives has led to dissatisfaction and debacle.  Personally, I can see how “Meaningful Use” may have been the hand that fed an organization's bad acquisition or deployment decision.  However, I do not believe that government structured the program that made a bad decision the default outcome.  If physicians are not happy with the product selected, is that the government’s fault?  Or is that the result of a poor acquisition and or deployment strategy?

I look forward to your comments.

Censis, Instrument Tracking

Jim Creason, COO of Censis Technologies, Inc., discusses Censis instrument level tracking with me.
- 2D tracking for surgical instrument level tracking
- RFID for trays and scopes

Censis® Technologies, Inc.
377 Riverside Drive
Suite 300
Franklin, TN 37064

PLUS Location Systems, I2 Build 2012

Nathan Duun is the CEO of PLUS Location Systems, located Level 13, 56 Berry St. North Sydney, NSW AUSTRALIA, 2060.   For North America, the address is Cummings Research Park, Suite 310, 6767 Old Madison Pike, Huntsville, AL, USA, 35806.

PLUS is involved in: 
-Healthcare
-Retail
-Manufacturing
-Hospitality

I found Nathan's discussion on retail very interesting as well.  PLUS tags carts and hand baskets to collect data on shopper behavior and works with the brands to develop strategies and layouts based on that behavior. 

Coogi Men Buffalo Ausi L/s Rugby - Shirts (Google Affiliate Ad)
How to Watch a Game of Rugby (Google Affiliate Ad)

In Need of A New Mobile Device

 I'm looking for a new mobile device
- 4G
- Call clarity mandatory
- Gotta have Quality Video and Photos for mobile uploads
- Gotta have Dependability
- Needs easy navigation through apps.
Any recommendation?

I2 Build 2012 - Haldor Advanced Technologies

Haldor Advanced Technologies Ltd. provides software and hardware that tracks surgical instruments and sponges.  Their U.S. Office is located in Cherry Hill, NJ.  Small radio-frequency identification tags are applied onto surgical instruments. Their system, ORLocate®, reads multiple instruments at a click of a button.  Instrument tags can withstand over 2000 sterilization cycles.

Though a count is important to the operating room and sterile processing/distribution environments, Haldor’s ORLocate® solution is not just about a count.  It’s their solution in the context of overall surgical services that’s most important. Haldor promotes that ORLocate® efficiently provides usage patterns, flow management, and many key data points.  This is why Yaron Shanas, the VP of Site Management, came to I2 Build 2012. 

In other words, I2 establishes communications between its software applications and other vendor’s applications.  Laboratory Information System, Hospital Information System, Clinical Information Systems, Electronic Medical Records, Radiological Information Systems or, in this case, Haldor’s ORLocate® surgical instrument  management system – likewise, I2 and Haldor have built an interface that allows the healthcare facilities to view sterile processing and availability in context with other perioperative services.

  

I2 Build 2012, Sonitor

Jørn S. Husemoen, the Chief Executive Officer of Sonitor, flew into join us at InSites Build 2012.  Sonitor is based in Oslo, Norway and makes active RTLS hardware built on ultrasound technology.  In the U.S., they are located in Reston, Virginia. Husemoen spent several years at Ericsson in Europe, India, and China markets and has held financial and other leadership positions.  He is focused on further increasing the accuracy of their active hardware down to millimeter resolution. 

I first came in contact with Sonitor years back at a trade show in Baltimore, MD, USA.  In my book, Covering Your Assets by Exposing the Butt-Ugly Truth, I wrote about the presentations I attended and the impressions they left on me.   Sonitor gave one of those presentations.   They presented the case for ultrasound, especially when sub-zone resolution was needed.  A path to patient and staff tracking became part of my planned trajectory – assets tracking to decrease expense; temperature monitoring to insure compliance reduce loss, and save time; patient transport to improve dispatch and response; then to the operating room.   The operating room would have been our 1st attempt to of applying RTLS mostly for the purpose of increasing revenue.

A sub-zone is an area within an area, a space in which you want to distinguish from with a larger space.  For example, an open cafeteria can be sub-zoned into a salad station, a hot bar, a grill, a desert station, etc.  The particular case Sonitor presented was for the Emergency Department.

Treatment rooms or triage areas can be one room separated by curtains.  Each curtained area may contain a stretcher or exam table.   
- Tag the staff
- Tag the patient
- Create a sub-zone (patient’s space) in each treatment area
- Track each person entering into each patient space
- That allows matching the purpose of each visit to the patient’s treatment
- Interface that information into the patient record
- Use the information to reinforce and influence process.
More to Come

Range Finder                                           
       


More to Come

I2 Build 2012 - The Analyst Panel

The Analyst panel from left to right: Paul Frisch, PhD;  Ann Grackin, Owner ChainLink; Al Hardy, Author and Owner Hardy Asset Management Consulting;  Marcus Ruark, Vice President of Marketing for Intelligent InSites and moderator of the panel.  Each session was filmed. The outlook for RTLS and RFID was positive but there were cautionary concerns as well. 
- Promises made during the sale
- Support after the sale

  

I2 Build 2012 - Mingle

Connecting Personally To Connect Electronically 

Behind the scenes of integrating healthcare solutions

You may not remember what you bought her. But she will.

Al Hardy's Webinar with E-ISG
We had a good turnout.  Click on the link above and listen.  


Happy Holidays

I2 Build 2012 - A Lesson in Lean

Improving healthcare as seen through the eyes of the people doing the work.  Cindy Jimmerson gives a lesson in lean.  "Engaging people who do the work."  

  

I2 Build 2012 Plains Art Center

The Plains Center for the Arts provided another informal venue to meet and get to know others interested in using hardware and software to provide real-time information to improve patient care at reduced cost.

I did get a couple of questions concerning the Veterans Administration.  I kept the information close of course because it is available in my ebook.  

I received comments about my blog and books.  Thanks again to my readers and fans!

                          

I2 Build 2012 Icebreaker

The reception was a good icebreaker.  I made some great new connections and met some old friends and acquaintances.  

Many of the developers here already have installs with IntelligentInsites (I2), some working with them for a while.  These independent companies and corporations (developers) offer their own products and services.  They may sell their own software.  They look to the I2 platform and guidance to enhance their own applications and to add flexibility and value to their customer-base.

As part of the reception, we toured the Family HealthCare Center, an important community clinic  in which IntelligentInsites has an install.

The clinic provides needed primary care and dental services for Medicare, Medicaid, and uninsured patients... basically, anyone in need.

If that wasn't awesome enough, the clinic is also part of a refugee resettlement program.  The clinic helps with health, language, and even dietary challenges (building a diet from unrecognizable food choices).

Happy Holidays

                              

Fiscal and Physical Visibility

This post follows up on 3 previous articles: The Best Capital Playbook Ever! (published by About.com)
- Capital Programs and the Cost of Doing Business (published by Asset Management for Healthcare)
- Asset Management and Equity (published by Asset Management for Healthcare).

The Best Capital Playbook Ever! pokes fun at what seems like a norm in hospital capital programs.  The process tends to result in creating problems rather than solutions:  excess equipment, poor utilization, and inconsistent reporting. 

Capital Programs and the Cost of Doing Business, takes a look at the philosophical reasons these occur.   I believe leadership often sees asset management functions as expense centers instead of centers that increase equity.

Asset Management and Equity gives an example of a project guided by an asset manager which decreased expenses and increased revenue. The project included every phase of the asset life cycle: acquire, maintain, utilize, and dispose.  I left off with a Key Performance Indicator for capital programs.

E-ISG, an Asset Management application providers, is hosting a webinar on November 14, 2012, 12:00 Eastern Time.  The webinar will outline how to build fiscal and physical visibility with assets management programs.  Fiscal and Physical Visibility - clear and continuous snapshots of key and strategic indicators for capital programs.

One of the challenges covered is the various places in which the corporate data resides.   Applications may abound.  These applications are sold to the customer as solutions but seem to never really make it to the point of helping to solve problems.  I have seen situations where every time leadership changes the application changes.  By the time the data starts to take shape, the executive and the application are on the way out, another $500K -$1M gone - which may explain why many just rely on consultants to provide data without addressing their data problems.  The answer is to work on key data needed to meet the strategic and operational objeatives both physically and financially.  Then, for assets, move to one EAM platform.

InSites Build 2012

Fiscal and Physical Visibility meets up with InSites Build 2012: Following the release of my ebook, "The Veterans Administration RTLS, Recommendations for Success", I received and invitation to sit on the Analyst panel for  InSites Build 2012.

See you in Fargo! 

How to Buy a Vision Pt. 2

In part 1, I wrote of President Barack Obama’s appointment of General Eric Shinseki as Secretary of Veterans Affairs in 2009.  General Shinseki’s vision allowed the current RTLS initiative to come to the forefront.  

I indicated that federal regulations could hinder the VHA’s approach.  Specifically, I stated that guidance may be taken as mandates to ensure that the solicitation is written in accordance with the law. 

Click Here to Preview

Before I re-familiarized myself with acquisition law, I examined documents as far back as the mid-80s. The reports reflected investigative findings from Quality Programs and Supply Distribution and Processing inspections by the General Accounting Office and the Veterans Inspector General’s Office. 

For example on June 27, 1985, the General Accounting Office published GAO/HRD 85-57,  VA Has Not Fully Implemented Its Health Care Quality Assurance Systems.  Senators Frank Murkowski, Alan Cranston, and Alan Simpson set the investigations into motion.  These 3 Senators were mentioned by name or signed the letters requesting the investigations.   The mission was quite clear.  Senator Simpson wrote December 21, 1983:

    I am writing as Chairman of the Senate Committee on Veterans' Affairs to request that the General Accounting Office review the Office of Medical Inspector and Evaluation which was established July 30, 1981, by the Administrator of Veterans' Affairs to monitor and report on the quality of care within the Department of Medicine and Surgery - Appendix I

The GAO’s mission was further described as to determine if facilities had implemented quality programs that included five mandated quality assurance functions.  The GAO team visited 13 facilities that represented a “cross-section” of the VA Medical Facilities. - Page i

The inspectors from the GAO wrote of very methodical approaches in all instances.  The inspectors went as far as looking into budgets, those who had external oversight of the quality programs, explanations of how the program should work and who had organizational responsibility.  The findings were clear and often very detailed.  

There were not many outright recommendations in this reports.  The inspectors’ comments are woven into each chapter.
  
One thing I find particularly interesting, the detail of the 2nd request coming from the Senate Committee.  The 1st request, December 21, 1983, shows a very general request.  The 2nd request, September 6, 1984, contained very detailed areas in which the GAO was requested to review - 22 bullets, some with multiple questions.  Either the Senators understood or a staffer understood what should have been happening.  It was probably both.  More can be found in The Veterans Administration RTLS, Recommendations for Success 

Contracts and Politics

A colleague and I were having a conversation about shared business interests.   As the conversation closed, it seems that my colleague’s spouse was recently asked about the political party associations of their family as part of a contractual deal.

The job has no political purpose whatsoever.  On the other hand, the owner (who asked about the political party associations) appears not to make his political leaning evident to customers.

This is the 3^rd time I have heard such an event.  

 1. As an independent consultant or small business owner, have you experience this? 

 2. How would you respond?

    All comments are moderated.  If you want your comments posted, please answer the questions.  

The Veterans Administration RTLS, Recommendations for Success

The Veterans Administration RTLS, Recommendations for Success - Available on Amazon 

The paper examines 2 main issues.  The first is developing a solicitation based on the Secretary’s vision.  The Secretary of Veterans Affairs has a transformational vision.  The acquisition plan has to prompt vendor proposals which reflect that vision.  With this type project, from my experience, there is a tendency to treat the acquisition process just like any other: purchasing or acquisitions collects requirements from the end-users, pulls together technical specifications from Information Systems, then assigning the lead to the Information System Department and calling it a day.

The other issue is specific to government acquisition rules when undertaking such a process involving RTLS solution providers in a healthcare environment.  Contracting officers contend with so much that it can be hard to tailor an acquisition process that results in returning distinguishable solution-focused responses.  In the case of the capable and versatile Real-Time Location System solution providers, not putting out the right solicitation can lead to a less than optimal scenario upon award.

The context of Supply Processing and Distribution was chosen because of the history of problems in the area. 

Asset Management Webinar with Al Hardy

This webinar covers getting the best value out of your capital equipment.  CFOs, COO, Maintenance Managers, and Small Business Owners can get a better idea of how to work collaboratively to plan for capital replacement, financing options, maintenance, utilization, and disposition.  Find out more and register at  E-ISG Webinar Registration.

 Available from Amazon in Kindle and Paperback/

Available from Barnes and Noble on Nook

          

Part 2, Huawei, As Its International Employee Base Grows

The October 16, 2012 blog post reopened the discussion in regards to Huawei being “wholly owned” by its employees.

According to Huawei’s Corporate Governance:

- The employees elect representatives.

- The representatives choose the Board of Directors

-  As with any other corporation, the Board of Directors:

-- Hires/Promotes a CEO

-- Decides on a compensation package for the CEO

-- Appraises the CEO's performance

-- Approves other key hiring decisions and appointments

As Huawei's international/multinational employee base grows, at what point should the number of their representatives have an effect on the Board?  If this occurs, it should bring more diversity into key leadership positions.  So, no matter no what accusations are leveled at Huawei, security, intellectual property, corporate ownership, etc., seems one answer would be growth that results in diversity.  Supporter or detractors may finally get a chance to say I told you so.

One last thought, growth could lead to  multinational employees owning and playing a significant role in controlling their Chinese capitalistic corporation through elected and representative appointed leadership.  To me, there is some significance to that possibility.  

The Veterans Administration RTLS, Recommendations for Success

Abstract:

The paper examines 2 main issues.  The first is developing a solicitation based on the Secretary’s vision.  The Secretary of Veterans Affairs has a transformational vision.  The acquisition plan has to prompt vendor proposals which reflect that vision.  With this type project, from my experience, there is a tendency to treat the acquisition process just like any other: purchasing or acquisitions collects requirements from the end-users, pulls together technical specifications from Information Systems, then assigning the lead to the Information System Department and calling it a day.

The other issue is specific to government acquisition rules when undertaking such a process involving RTLS solution providers in a healthcare environment.  Contracting officers contend with so much that it can be hard to tailor an acquisition process that results in returning distinguishable solution-focused responses.  In the case of the capable and versatile Real-Time Location System solution providers, not putting out the right solicitation can lead to a less than optimal scenario upon award.

The context of Supply Processing and Distribution was chosen because of the history of problems in the area. 

alfordhardy@gmail.com

VA RTLS - New Approach Recommended

 This detailed paper addresses:
1. Developing an actionable plan for a visionary transformation
2. Getting distinguishable proposals from a talented community
3. Focuses on developing an acquisition plan around surgical instruments, endoscopes, and dental tools
4. Points to how vendors should respond to a solicitation based on these recommendations

Send inquiries to alfordhardy@gmail.com

How to Buy a Vision - Pt. 1

President Barack Obama appointed retired General Eric Shinseki as Secretary of Veterans Affairs in 2009.  The President charged this visionary with transforming the Veteran's Administration.   The Veterans Health Administration, VHA, is a major sector of that transformation.

General Shinseki has expressed his vision and ideals for that transformation.  In turn, this allowed the current RTLS initiative to come to the forefront.  

As he applies Be Know Do leadership principles to the environment, federal regulations outside his area to control present a problem for the end-result.  

First though, a comment about transformation: 
From Covering Your Assets by Exposing the Butt-Ugly Truth,  "The implementation of EAM and RTLS within one year didn’t mean just a quantum leap for us. It meant we successfully folded space to take a 30-year step from the 1980s into the 21st century, a relatively easy step at that."  
The book was specifically written for those managing a project like the VHA's RTLS project, transcendent, transforming, and very high risk.  The back cover clearly states this point.


About those federal regulations: one example is federal acquisition law.  I have noticed a significant governmental effort to address visibility, access, and to shift toward a problem-solving approach in these areas.  The VHA and the General Accounting Office have been responsive and professional in handling my inquiries. 

There are mandates and there is guidance in acquisition law.  Parts of the regulations have great guidance on the acquisition strategy and the structure of the request for proposal.  Other parts seem to have limiting mandates.  I believe the problem is such an emphasis on adherence to the regulations leads to guidance being treated like mandates - as to not cause any conflicts.  Writing an effective acquisition plan becomes a problem when buying a vision of the future.  Fair trade, fair play, and avoiding even the appearance of impropriety are very important.  But, being able to craft specific and creative approaches can't be lost in the process.  

How to Buy a Vision, Part 2.

New Face Book Page

My book has its own Face Book page.  Click here Covering Your Asset by Exposing the Butt-Ugly Truth.

Thanks

Clean India Journal

Thanks to the managing editor of Clean India Journal, Mohana, for publishing Poor Kid’s Bearer Bonds.

The article discusses the responsibilities of healthcare facilities in disposing of medical and information technology equipment.  

There is a personal testimony as well of how commercial and government interest helped keep land and water tables clean.  Please take a look at Poor Kid's Bearer Bonds at Clean India Journal.  See how bearer bonds relate to trash.

Asset Management Webinar

Please join me in the E-ISG Asset Management Webinar.
Click here to find out more and register

What are the key mistakes in each stage of the asset management life-cycle?

• Lease v.s. buy
• Compliance and data capture for maintaining asset
• Why asset utilization information is important
• Value assessment when disposing assets

Why do organizations make these mistakes?

• Why do companies fail to maintain physical and fiscal visibility to their assets?
• Do companies have the information to maintain their equipment?
• Do companies track how equipment is utilized
• Do companies know the cost of disposal?

How to define the requirements for a solution?

• How to get buy-ins?
• How to write RFPs?

Huawei, As Its International Employee Base Grows

On May 12, 2012, Asset Management for Healthcare posted  CISCO vs Huawei.  The post was followed up on March 14, with Huawei’s Corporate Governance. 

Available E-book, paperback on Amazon and

Barnes  and Noble - International Shipping Available

This blog is not about to get into the fray concerning Huawei and the investigative news report that aired this week.  The blog seeks to reopen the discussion in regards to Huawei being “wholly owned” by its employees and what that may mean as its employee base grows in other countries.

- The employees elect representatives

- The representatives elect the Board of Directors

This is nothing new.  Other organizations operate this way.   But, are there particular short-term and long-term implications for Huawei and its employees? 

Guest Columnist Spot - Fiscal and Physical Visibility: A Challenge to the Status Quo

Thinking out of the box implies that you are in the box.  Please checkout my latest article for the Intelligent Hospital Today.  Here is the link, Fiscal and Physical Visibility: A Challenge to the Status Quo.


Also, 2 reasons to buy my book, Covering Your Assets By Exposing the Butt-Ugly Truth.

1. How often do you get a chance to experience the point of view of someone who has worked (and I do mean worked) almost every stage of an RTLS solution - Ship builder, Navigator, Deckhand, stood at the wheel, manned the lookout,  cleaned the cannons, repaired the rudders, patched the holes, and served as captain.
2. The reader gets a chance to experience the central character doing more than his share to battle the Hordes of Debt.  Return on investment, Acquisition Strategy, Project Management, IT concerns, expansions, maintenance and support,  decision-making by using RTLS data along with Capital Planning and Maintenance, the ship is pretty much covered.    

It's Official! VA118A-12-RP-0118, IBM Bid Protest Sustained

IBM-U S Federal
Solicitation Number: VA118A-12-RP-0118
Agency: Department of Veterans Affairs
File Number: B-406934.3  Outcome: Sustained  Date Decided: Oct 3, 2012

IBM-U S Federal
Solicitation Number: VA118A-12-RP-0118
Agency: Department of Veterans Affairs
File Number: B-406934.2  Outcome: Sustained  Date Decided: Oct 3, 2012

IBM-U S Federal
Solicitation Number: VA118A-12-RP-0118
Agency: Department of Veterans Affairs
File Number: B-406934.1  Outcome: Sustained  Date Decided: Oct 3, 2012

I found articles listing the GAO's (General Accounting Office) recommendations for courses of action but I haven't seen any documentation directly from the VA.