Monthly Archives: June 2017

Recruiting Health For Physical Therapy

Healthcare recruiting for physical therapy is gaining prominence as many studies have shown that there are shortages throughout the physical therapy profession as well in healthcare facilities that employ physical therapists. The structured healthcare recruiting services of dependable healthcare staffing solution providers enable medical care facilities to recruit qualified physical therapists.

Recruit Talented Physical Therapists

Several reputed healthcare staffing agencies in US offer competent recruitment services based on the requirements of healthcare employers. The recruiting agencies maintain regular contacts with the various healthcare facilities. They are therefore well informed about vacant job positions in these facilities.

To fill the physical therapy job positions existing in premium healthcare centers, these recruiting service providers make every effort to identify hardworking, dynamic and skilled candidates. The entire recruitment procedures including preliminary evaluation, candidate sourcing and interviewing are handled by skilled professionals. Moreover, they also help healthcare facilities to save the money, time and effort needed for putting out placement advertisements and conducting the recruiting process on their own.

Placement Services for Domestic and Foreign-trained Candidates

Healthcare recruiting agencies enable domestic and foreign trained physical therapy professionals to secure permanent, temporary, part-time, full-time, long-term, short-term or travel jobs in well-known healthcare facilities, and public and private organizations. These include rehabilitation clinics, hospitals, physician’s offices, acute care clinics, nursing homes, long term care centers, government organizations, home healthcare agencies and educational institutions.

Healthcare recruiting agencies provide physical therapists the opportunity to gain know-how and experience by placing them in challenging job environments. Successful candidates enjoy remuneration packages which include benefits like:

• 401(k) retirement savings plan
• Paid housing
• Professional liability insurance
• Section 125 Cafeteria plan
• Short-term disability insurance
• Continuing education programs
• Immigration processing assistance (for foreign candidates)
• Additional state licensure

Locate Eminent Service Providers

Competent healthcare agencies make hiring easier and better. With the use of advanced technology, targeted searches and experienced recruitment team, they are well-equipped to provide healthcare facilities with qualified and experienced physical therapy professionals.

Mental Health Reform

As healthcare reform is becoming a reality, there is much to celebrate within the mental health community. This includes passage of a healthcare reform package that includes parity for mental health and addiction services, expansion of Medicaid to 133% of Federal Poverty Level, inclusion of behavioral health organizations and individuals with mental illnesses in the new Medicaid medical home state option, and authorization and increased funding for grants co-locating mental health treatment and primary care. These and a host of other provisions expand the opportunities for individuals with mental illnesses and addictions to obtain and maintain insurance coverage and access needed services.

But this is not the end of the mental healthcare battle. Simply put, mental health advocates must be ready to play in a new game, in a world where increasing numbers of individuals – by virtue of Medicaid expansion, the emerging Health Insurance Exchanges, and parity regulations – will have access to behavioral health services. We expect to see an additional 15 million individuals – an increase of 43% – eligible for Medicaid alone, with more than 30 million individuals overall who will, in the not too distant future, have insurance coverage.

But this is far more than a matter of numbers – it’s about working smarter. Advocates of mental healthcare anticipate that healthcare reform-driven service delivery redesign and payment reform will unfold at a rapid pace. In order to bend the cost curve, payment reform and service delivery redesign will change how health, mental health, and substance use services are integrated, funded, and managed. Providers must learn to practice healthcare the way healthcare will be done.

As mental healthcare providers and advocates, we must become savvy about positioning ourselves to take advantage of new markets and new opportunities to help control the design and delivery of healthcare services. We must begin to build relationships within and across the entire healthcare sector. As we revisit the concept of “managing care” for individuals and whole populations, we have to be certain that our focus on person-centered, recovery-focused treatment and services is not subsumed by the drive to “bend the curve” in healthcare costs. We must be able to demonstrate our value not only to our customers, but also as key players in these new healthcare consortia.

We must become accountable for efficient and effective services that show results across all health domains. We believe fee-for-service reimbursement will slowly become a thing of the past. So, too, will be the ability to claim that caseloads are full with no-show rates of 50% and more. We risk being left on the sidelines if we don’t move with deliberate speed to ensure continuity and timely access to care; comply with third-party payer requirements; coordinate care with a full range of health providers; and if necessary take on payers that refuse to honor the spirit and letter of the parity regulations.

We must become increasingly customer-focused, from the way we greet individuals who come through our door to the way we market our services. We should expect that with more money available in healthcare – particularly for mental health and addiction treatment – that new and well capitalized players will find behavioral health, traditionally a financially unattractive healthcare sector, far more appealing.

People will be insured and will have an increasing range of options available to them. What differentiates our mental healthcare services? Why should an individual choose to receive treatment and support from us? Are we offering services that will help them meet a full range of healthcare needs? Are our services culturally appropriate for the communities we serve? Can we help them understand and make appropriate use of their insurance coverage? We must retool our organizations with the knowledge that all individuals will now become true “consumers” of healthcare services.

At the same time, we must also be aware that our work is far from over at the state and federal level. Forty eight of 50 states are experiencing severe budget shortfalls. The threat is very real and the mental healthcare advocates are fighting hard to hold on to current funding as legislatures see an opportunity to continue to withdraw needed funds. This is surely a bad idea – even the most generous healthcare benefits will likely not cover the full range of wraparound supports that people with mental illnesses and addictions need to fully recover.

Eleanor Roosevelt once said, “It takes as much energy to wish as it does to plan.” All of our planning, advocacy, and leadership to date have borne fruit, but we must not be content to wish it all works out well. We must fight for our future – and the future of the individuals we are privileged to serve – by acting as key players in the brave new world of healthcare.

Issues and Opportunities Your Health Environment

The healthcare industry affects the lives of virtually everyone in the United States. According to the Centers for Medicare and Medicaid Services (CMS), healthcare expenditures will account for approximately 17% of the Gross Domestic Product this year. Many activities in the healthcare industry result in land, water or air pollution. Much of the waste is recyclable and consists of paper, cardboard, glass, plastic and metals. There are two other types of solid waste in healthcare: regulated medical waste and hazardous or chemical waste. Additionally, hospitals discharge large amounts of wastewater and release air emissions from their facility operations.

Oftentimes, hospital services are decentralized, departmentalized, or even managed by contracted services. There may be little or no centralization of efforts. There may be minimal regard, knowledge or control over minimizing waste or environmental impact. If healthcare organizations really want to decrease costs and reduce their carbon footprint, they must embrace sustainability with the full support of top management. They must pay close attention to what they purchase and what they discard.

There are many variables affecting healthcare waste minimization:

* The types of products and materials purchased

* The types of waste segregation systems

* The degree to which wastes are identified

* The locations of the waste generation

Healthcare wastes can be categorized as:

* Municipal

* Recycling (Pennsylvania Act 101, for example)

* Regulated medical waste (Bio-hazardous or Red Bag Waste)

* Hazardous waste (listed and characteristic waste, commingled waste, pressurized containers and ignitable gas, and universal waste)

* Universal Waste (Batteries, Fluorescent Bulbs, Electronics, Mercury-containing Equipment)

* Waste water, Storm Water and Air Emissions

Municipal Waste:

The United States healthcare industry generates 6,670 tons of waste per day, most of which is solid or municipal waste. Of this solid waste, more than half is composed of paper and cardboard. Hospitals with excellent recycling programs recycle over 40 percent of their total municipal waste.

Recycling:

Many states mandate commercial and residential recycling of a wide range of materials. For example, Pennsylvania Act 101 mandates recycling in Pennsylvania’s larger municipalities and requires counties to develop municipal waste management plans. The goals of the Act are to reduce Pennsylvania’s municipal waste generation; recycle at least 25% of waste generated; procure and use recycled and recyclable materials in state governmental agencies; and educate the public as to the benefits of recycling and waste reduction.

Municipalities must collect at least 3 of the following materials: clear glass; colored glass; plastics; aluminum; steel and bimetallic cans; high grade office paper; corrugated paper and newsprint. Commercial, municipal and institutional establishments are required to recycle aluminum, high-grade office paper and corrugated paper in addition to other materials chosen by the municipality. Leaf and composting are required to be separated from municipal waste. Businesses, including hospitals, are encouraged to help reduce waste by purchasing products that are durable, repairable, recycled, recyclable and/or have minimal packaging, and to find other uses for surplus goods instead of throwing them away.

Regulated Medical Waste:

Industry best practices for red bag waste are between one and three pounds of red bag waste per patient day, yet many hospitals still treat 25 to 30% percent of their total waste stream as infectious. Bio-hazardous waste includes sharps, pathological waste, blood and blood products, blood-soaked items, and non-regulated chemotherapy waste. Most patients in medical-surgical rooms generate little, if any, infectious waste, however, there may still be reluctance on the part of hospitals to “source-separate” the bio-hazardous waste at the patient’s bedside or at the place of treatment. Some healthcare organizations still consider all waste generated in a patient’s room as red bag waste even when the waste contains no visible blood. Hospitals may fear that they will be cited with a violation should an item of trash be discarded improperly.

Progress in pharmaceutical technology has reduced the need for surgical interventions. Changes in healthcare reimbursements have decreased the length of stay in hospitals and increased home care and outpatient healthcare. Healthcare products are being packaged more efficiently and the use of plastics instead of glass has lessened the weight of many products. Despite all these advances, the widespread purchase and use of “disposables” in healthcare has created large amounts of waste that cannot easily be recycled. Many “single-use” medical devices can be safely sterilized and reprocessed and used many times. This can save healthcare organizations significant dollars by minimizing their need to purchase single use items.

Hazardous Chemical Waste:

The healthcare industry generates only small quantities of hazardous chemicals relative to the amount of municipal solid waste or bio-hazardous waste. Hospitals that own research laboratories generate greater volumes and more diverse types of hazardous chemicals. Healthcare laboratories that perform diagnostic testing often use a large volume of a few chemicals such as xylene, alcohol and formalin in their processes. Some labs recycle and reuse chemicals to avoid the cost associated with hazardous waste disposal and repurchase of new materials. Other labs are equipped with chemical analyzer systems with reagent reservoirs that reduce the total amounts of chemicals used and waste generated.

Wastewater Discharge:

Most healthcare facilities discharge wastewater to Publicly Owned Treatment Works (POTW). Dischargers are classified as major based on an assessment of six characteristics: (1) toxic pollutant potential; (2) waste stream flow volume; (3) conventional pollutant loading; (4) public health impact; (5) water quality factors; and (6) proximity to nearby coastal waters.

Healthcare Wastewater Best Practices include:

* Limit the use of water discharged through conservation and reusing water wherever possible.

* Train employees to use water more efficiently.

* Post signs at all floor drains and sinks to discourage employees from using drains to dispose of oil, vehicle fluids, solvents, and paints.

* Use non-toxic floor cleaners or “Green Chemicals.”

* Consider capping off unused floor drains.

* Prevent any spills and drips from reaching the drain.

* Know where your floor drains discharge.

* Set up a preventive maintenance program for inspecting and cleaning floor drains, traps and oil/water separators.

Air Emissions:

Hospitals may generate air emissions from boilers, emergency generators, sterilization chemicals (ethylene oxide), air conditioning and refrigeration, paint booths, and laboratory fume hoods.

Boilers: Many hospitals operate industrial boilers, which generate criteria pollutants (NOx, SO2, particulates, CO) as well as hazardous air pollutants. NOx emissions from boilers are the most serious criteria air pollutant generated by the healthcare industry. Click here for information regarding EPA’s new HAP regulations for boilers.

Incinerator emissions: As a result of the Medical/Infectious Waste Incinerators HMIWI rule, most facilities no longer have on site-incinerators.

Healthcare Sustainability:

Through training, education, source-separation, environmental purchasing, energy conservation, recycling initiatives and waste minimization, a green initiative will have a major impact on reducing waste and pollution. Healthcare facilities should organize a multi-disciplinary team of healthcare professionals and establish a sustainability program if they haven’t already done so. A Green Team will reduce waste from healthcare operations while saving money. Paying attention to the little things pays big dividends. It is also an important component of any organization’s public relations and marketing arsenal.

Decision Support System in Health

IT Efficiency: Ontology Programming Holds the Key

The seamless integration of knowledge and data is indispensible to today’s modern healthcare decision support systems (DSS). A healthcare organization that thoroughly understands its patients and is able to respond quickly to their needs, scores highly with them-and this has become an extremely important competitive component in today’s ever-more interconnected world where patient feedback can positively or negatively affect an organization’s reputation and bottom line.

The patient care world is complex, with various information systems being utilized to streamline and automate patient care processes.Fortunately, there is a new approach to IT efficiency vis-a-vis ontological engineering-or ontology programming-that is possibly the most significant benefit to ensuring accurate data integration, which fosters a better understanding of patient needs, thus resulting in better patient care and excellent patient outcomes.

Ontological engineering excels at extracting knowledge and critical information from the various information systems within a healthcare decision support system (or its organizational databases). Ontology programming reduces often difficult data integration issues and promotes data reuse, data sharing, and common vocabularies between the information systems, from patient intake to patient discharge.

For healthcare organizations to understand their patients better, data across the entire organization or spectrum of information systems involved in patient care must to be analyzed. Knowledge from different areas or “domains” (e.g., the patient-entry process domain, hospitalization and treatment domains, and billing and insurance domains) must to be extracted in order to accurately interpret quality of care.

Detailed knowledge is also required to interpret patient responses to the various care options exercised from the time of entry into the healthcare facility through final discharge. In addition, quality healthcare organizations strive to improve their existing processes and analyze post-care data in order to determine areas of improvement and initiate appropriate programs. Therefore, the accurate compilation and correlation of patient data is essential during the care process-both individually and in aggregate with other patient data-to determine potential process improvement steps.

As mentioned previously, healthcare organizations also benefit from their patients’ recovering better and more quickly as a result of higher quality care. This is, in no small part, driven by efficient information systems. Patient care results are reflected in quality reports issued by premier organizations such as JCAHO (Joint Commission for Accreditation for Healthcare Organizations). As of 2009, JCAHO reports include patient satisfaction data, as well, thus making it even more important to understand patient information effectively and utilize to it to render care that leads to better patient satisfaction.

Accurate knowledge across intra-organizational domains can only be extracted when healthcare decision support systems are able to exchange relevant data with each other-which is not always possible with current configurations.Even if the numerous systems within an organization can connect to each other through common computer interfaces, they may have stored patient data differently,rendering information exchange virtually impossible and creating a silo effect. Additionally, the context in which the information is used may vary from system to system,making it even more difficult to correlate data across various platforms and systems within the organization. Finally, data consistency and data integrity issues arise as each silo information system is further customized to optimize the information system’s performance.

Therefore, to achieve a comprehensive and accurate individual patient view across the entire patient care spectrum of an organization, different information systems-based reports may have to be compiled separately with data correlated between them. The results will then need to be represented in a single, coherent report. This type of data correlation may include the mapping of various customer names for a single patient, as an example. Obviously, this type of system is not only vulnerable to error and to data integrity and consistency issues, but it is also quite inefficient and, therefore, needlessly costly.

Data correlation, integrity, and integration issues are not confined within an organization’s systems only. Health care organizations rely on HIE (Healthcare Information Exchange) to communicate with external entities. HIE is used to move clinical information between different information systems from various providers (i.e. test labs, insurance companies, and other healthcare facilities) without losing the meaning of the information exchanged. These systems typically use established standards for data exchange, such as SNOMED CT, ICD-9 and -10, and other HIE standards.

Periodic updates are required, and organizations must ensure that they are in compliance in order to participate in data exchanges with other providers. Naturally, whenever any data changes occur, the cost and time required to modify multiple systems within an organization can be staggering, but without the use of ontological engineering, the higher costs must be borne, as system modifications are mandatory.

Whether the data reside internally or external sources are employed for HIE, a healthcare organization faces the common issues of data mapping, data integration, reuse, and data sharing.  Whenever data change, or new relationships between data are discovered, organizations expend valuable resources in time and money adjusting databases across various systems in an attempt to keep them aligned with each other. This absorbs important resources, taking them away from the core focus and value proposition of the organization-that of providing quality patient care.

When data change, especially internal organizational data, conventional technologies (as in “relational” databases) require changes to their database structures and schemas, potentially leading to major regression testing of the systems after the changes have been completed.  This must be accomplished in order to ensure that nothing is deleted or corrupted after the changes are made, and is quite naturally, another costly step-both in terms of time and resources.

Information Technology departments have tried to respond to data integrity and data integration issues across various systems within an organization by building a data warehouse that acts as a central repository for most, or all, of the inter-related systems. However, the solution is only partially successful. Often times, competing interests from various internal “stakeholders” in different information systems can lead to data that is stored in a manner is favorable to some information systems, but not others. This, of course, potentially compromises data access and reuse by other systems.

In addition, since the entire organization’s data cannot be migrated to a data warehouse simultaneously, some systems are migrated before others, and the entire migration process may take as long as a year or more to complete in a large health care organization. In the interim, data across the enterprise changes, and the whole cycle of re-aligning data must start anew. There have been proposed solutions to address this and other related problems, but they each leave something to be desired.

Ontology programming can help reduce data integration, sharing, and reuse pains to quite an extent. By definition, ontologies are a formal representation of knowledge by a set of concepts within a domain. They not only store data in a database, but also store relationships, including hierarchical relationships, between data.

This ability distinguishes ontological engineering from standard relational databases and provides the flexibility of updating data and relationships between them. Ontologies are also able to add newly discovered relationships without the necessity of significantly changing the core database or requiring extensive programming efforts-unlike typical databases currently in use.  They also excel at removing term confusion and providing data mapping capabilities, which vastly promotes improved data share and data reuse across an organization’s information systems.

For healthcare organizations, as well as other large business enterprises, the practical, time-saving applications of a system built on ontology programming are quite extensive. We know that ontological engineering provides the ability to extract knowledge contained within applications and information systems across the various domains within an organization, but it is also very useful for capturing “real world decisions” made by humans and converting it into computer format. The result of this capturing of knowledge across domains by SMEs (Subject Matter Experts) and healthcare providers leads to much more consistent query results whenever similar conditions are encountered in the future.

Such information system architecture can significantly reduce medical errors and enhance patient care. This can be accomplished, for instance, by the capturing of a healthcare professional’s diagnosis of a particular medical condition and other relevant data. Once the data are entered into the ontological system, it will consistently provide the same results for similar conditions in the future and offer the diagnostics and conclusions as an aid to other healthcare professionals.

Subsequently, a healthcare professional may choose to exercise the same diagnostics (or treat the patient differently according to differences in patient circumstances), but the healthcare decision support system’s information can now provide an important, relevant checkpoint based upon the previous diagnostic information.

In conclusion, the use of ontology programming in the healthcare field provides a significant reduction in data integration issues and-because these technologies are superior extractors of knowledge across multiple information systems and can add new relationships between such systems with relative ease-they provide the flexibility to change data with far less effort and cost than standard systems now require.

Consequently, ontological engineering is able to provide an invaluable component to improved patient care and outcomes by supporting critical healthcare processes and decision-making. The superior integration of knowledge and data within healthcare organizations may at first appear prosaic, but it is nothing short of revolutionary in its potential to affect organizational performance and quality care.