Monday, July 25, 2011

Tech Training for Staff and Patients

From iPhone applications that enable remote access to electronic health records to tablet PCs with voice recognition software to Web-based portals that let patients check-in, schedule appointments, and get lab results online, medical practices these days have become high-tech operations. Implemented properly, of course, new software can enhance both productivity and the patient experience. But done poorly, it can be tens of thousands of dollars down the drain — not to mention a hassle factor of epic proportions.

Indeed, practices looking to reap the benefit of their investment in medical technology must be willing to commit the time, money, and resources to train their team on its use, says Derek Kosiorek, a technology consultant with the MGMA Health Care Consulting Group. "Your success with technology has a lot to do with the amount of time you put into it, which can be difficult because physicians often see the amount of training required as adversely effecting productivity," he says. "But we see a lot of complaints about a lot of systems being used in practices and anytime there's an issue it's more often than not the vendor's fault in the mind of the user — when really it usually could have been avoided by better training."

Here is an overview of "best practice" training methods for bringing the end users in your office — doctors, staff, and patients — up to speed.

Skills assessment

The first step to implementing new technology, be it EHR, mobile medical apps, or practice management software, is to assess the computer literacy of your team, says Peter Polack, an ophthalmologist with Ocala Eye in Ocala, Fla., and founder of, a practice management consulting firm. "You have to assess your employees' basic computer skills and bring them to a certain level of competency before they can even begin training on a new program," he says. "You can start by setting up a couple of computers in a spare room, designing a simple test, and rotating a few people in at a time." Ask them to create a Word document and save it into a specific folder, print something to a default printer in a different part of the building, and log on and log off successfully using secure passwords, Polack suggests. You can also create a questionnaire about basic computer terminology and ask your staff what programs they've used before. Younger employees and physicians are generally the most tech savvy, notes Polack, while older workers with less computer experience may need more hand holding.

During the skills assessment phase, be sensitive to the fact that some employees may get flustered by computer jargon or fear their job will become redundant after the new system goes live. It's your job to reassure, says Jeffery Daigrepont, a senior vice president with the healthcare consulting firm The Coker Group in Atlanta. "We think that best practices for training staff is to do everything in phases and stages," he says. "In some smaller practices that have not yet modernized a lot of times the staff just doesn't trust technology, so getting them some tools that are a little more mobile, and encouraging them to use e-mail and verify eligibility on the Internet can help get them acclimated."

Tailor your training

Next, establish a training plan, including the appointment of an in-house project manager, a realistic timeframe for implementation, and a customized set of goals for each end user, says Sue Zumwalt, administrator of the 8-provider Pediatric Associates of Stockton, in Stockton, Calif., and a columnist for the Professional Association of Health Care Office Management. Before going paperless in 2006, Zumwalt sent her 25 employees to six one-hour online training sessions (more if they requested it) on their new EHR and tablet PCs. "Before the new system even arrived, we had them go into a quiet room one at a time, which we called the 'university,' to complete a training program that helped them become familiar with the screens and how the EHR was set up to their specific job needs," she says. "The front desk person had a different training module than the back office person."

That's good strategy, says Eric Fishman, owner of in Palm Beach Gardens, Fla., adding one of the biggest pitfalls of tech training is overwhelming your staff with material they don't need. While everyone should know how to perform basic functions using your new system, such as scheduling appointments and updating charts, don't force your back office personnel to learn the digital ropes of processing claims if that's not part of their job description. Instead, provide a basic orientation for everyone and then rotate in different departments for more tailored skill building, he says.

Fishman notes, too, that the most effective learning takes place when end users aren't preoccupied with their work, which is especially significant when implementing a complex system like an EHR. "I would strongly recommend closing the office for a day or two to get your staff trained," he says. "The initial introduction of the system should happen when there are zero patients in the office." Or, you can also ask your employees to come in early or stay late to complete their training, but that will cost you extra in overtime. If you must hold sessions when the office is open, consider blocking or reducing schedules that day, says Fishman.

While all staff members should be proficient on the ins and outs of new technology in your practice, Polack says it's important to designate one or two of your more tech savvy employees to become "superusers," providing them additional training at a higher level. "If you're a smaller practice you may not have a full-time IT person, so you need to have some people in your office with a higher level of expertise who can assist your other employees and troubleshoot if there are any problems with the equipment," says Polack. Those same superusers should also train any future hires and handle the inevitable support calls to the vendor, he says.

After your training phase is complete, it's time for a mock launch. Either before or after hours, have someone in your practice pretend to be a patient and test run the system for both a sick and well visit. "The front desk should be able to put them in as a patient, the medical assistants should be able to get demographic information entered into the system, and the physician should be able to see them and generate a report," says Fishman. "Was that patient able to be seen in an appropriate fashion?" If not, determine where the hang-ups lie and get them fixed before you go live.

When you flip the switch for good, it's critical that you have outside trainers on hand, says Zumwalt, who had five full-time trainers in her office during their first week of EHR implementation. She reduced to one and a half trainers for the beginning of the second week and eventually moved to none. "That's huge," she says. "You need to have a live person on site for all those little questions and glitches that come up. We had people there holding our hand and that was huge." One word of caution, though: Be sure you screen the trainers that your software vendors provide. "You're spending a lot of money to bring someone out and you don't want them learning on your nickel," says Daigrepont, who is also a faculty member of the American Academy of Medical Management. "They may have just started last week. If they're not as experienced as you would like, the unintended consequence is that they could deliver bad advice or they could set the system up poorly. You want to screen that person and check references. "The best software vendors not only have a knowledgeable stable of trainers," he says, "but provide user manuals embedded within their software, which automatically update as necessary and allow your staff to help themselves as new questions arise."

Just for patients

It's not all about your staff, however. Many of the latest technologies being unveiled for healthcare practices are targeted to the patients themselves. Waiting room kiosks enable patients to check in, verify insurance information, fill out forms, and pay copays and past due amounts with the swipe of a card. Patient portals, meanwhile, allow patients to make and change appointments, check lab results, request prescription refills, confirm their profile information, and interact with providers via e-visits in a secure online setting.

Most software vendors strive for ease of use, creating intuitive programs that are self-explanatory and mitigate the need for patient education. But some are better than others. "The amount of training you'll need to give your patients is largely predicated on whether the solution you select has prompts built in that instruct the consumer or patient as they interact with the software," says Daigrepont. "Generally, resetting their password is the biggest thing you need to worry about, but most systems can automatically reset them."

Either way, be sure your staff is prepared to answer the most frequently asked questions about your patient-centric technology, and include your practice phone number on your Web portal so patients can contact your front desk if they hit a snag. The more challenging IT questions, of course, can be directed to the vendor, says Fishman. For many practices, e-mail communication, which can be used to disseminate written follow-up information and educational material, is a good point of entry for patients who may not feel comfortable using kiosks or portals, he notes.

In its "Guidelines for Physician-Patient Electronic Communications," however, the American Medical Association suggests your staff explain to patients that their messages should be concise; they should use the auto-reply feature to acknowledge reading a clinician's message; they should put their name and identification number in the body of the e-mail; and they should include the category of transaction on the subject line of the e-mail, e.g., prescription, appointment, medical advice, billing question, etc. Be sure, too, that your staff instructs patients to never use e-mail or messaging for emergencies, the AMA notes. (Likewise, instruct your staff never to use such tools for time sensitive issues such as conveying bad news or sending group e-mail where recipients' names are visible to each other.) Finally, the AMA recommends practices develop a patient-clinician agreement of informed consent for the use of e-mail correspondence. "This should be discussed with and signed by the patient and documented in the medical record," it notes, adding patients, in turn, should be given a copy of the agreement.

When it comes to implementing new technology, the amount of training you provide your employees can make or break its long-term success — and help you stay the course during those first few weeks that are filled with inevitable setbacks. "Implementing a new system [or] technology will always feel more difficult at first and there is even the temptation to go back to old ways," says Daigrepont. "This is where training can help by getting the staff prepared in advance so these challenges are minimized."

In Summary

Practices that are looking to reap the benefit of expensive investments in medical technology must be willing to commit the necessary time, money, and resources to train their team to be efficient end users. If done poorly, it can be tens of thousands of dollars down the drain. Here are some of the basics:

• Start with an initial assessment of staff skill level
• Begin with basic training for all staff, and then focus on more specialized skill development based on individual users
• Train "superusers" who can assist your staff and troubleshoot problems
• Schedule a mock launch before you fully implement a new system

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on,, and She can be reached via

This article originally appeared in the July/August 2011 issue of Physicians Practice.

New HIPAA rule would show who sees health information

A proposed change to the Health Insurance Portability and Accountability Act would give people the right to see who has electronically accessed their protected health information.

The change is proposed by the U.S. Department of Health and Human Services' Office for Civil Rights (OCR). "We need to protect peoples' rights so that they know how their health information has been used or disclosed," says Georgina Verdugo, OCR director.

People would obtain the information by requesting an access report that would disclose who saw their information. The office is taking comments on the proposed rule until August 1.

Wednesday, July 13, 2011

10 Reasons Teachers Love Blended Learning

Teachers have tough jobs -- lots of kids and lots of responsibility -- and budget cuts are making things worse. They have administrators telling them to boost achievement and personalize learning, but most of them are on their own without tools. But that is beginning to change as schools are beginning to blend traditional teaching with online learning.

Blended learning is a shift to an online environment, for at least a portion of the student day, made to improve learning and operating productivity. In two important ways, this definition is different than layering computers on top of how we've always done things. First, this definition of blended learning means that technology is core to instructional delivery and it incorporates some student choice over time, location, and/or rate. Second, it requires differentiated (different levels) and distributed (different locations) staffing.

Blending the best of online and on-site learning can work better for students and teachers. Here's ten reasons that blended learning makes teaching a better job:

1. You teach students ready for your lesson. At School of One, when students participate in small group instruction, it's the right lesson, on the right day, in the right modality for each student -- and that's magical. Success for All has attempted to do something like this for twenty years with performance grouping.

Competency-based policies, dynamic scheduling, and smart recommendation engines will make it easier for more schools to incorporate these strategies. What a gift to teachers to be able to work with small groups of student that share specific instructional needs.

2. Motivate hard to reach kids. We all know that kids learn in different ways for different reasons. Blended learning makes it easier to provide multiple learning strategies. The new developmental math courses from the National Repository of Open Content feature a variety of strategies for each sub-skill including instructional videos, tutorials, voice-over-text, and games. More engaging and more personalized content will help more kids learn difficult topics.

Like Big Picture schools have done for more than a decade, blended learning is making it easier to leverage individual student interests through internships and projects.

3. Focus on deeper learning. At Rocketship Education, students spend about two hours each day doing online skill building exercises. That allows teachers to spend more class time on critical thinking and problem solving.

Blended learning makes it easier to 'flip the classroom' and send home a playlist of instructional resources that deliver content so that class time can be spent solving problems

4. Extend the day. Rocketship features an eight-hour student day -- something they could only do by incorporating a two-hour learning lab. Another option is an after-school blended learning partnership with a community-based organization.

5. Extend the year. Blended learning can help extend the school calendar. If a school operates with two fewer teachers and spreads pay over the other 18 teachers, they may be able to shift to a 195-day school year. They can also extend the school calendar and add more breaks that become periods for extra academic time and/or enrichment -- some of which can be provided by community-based organizations.

The After School Consortium (TASC) is hosting a conference in New York on the 27th to explore how community based organizations can help extend the day and the year. The combination of CBO extensions and blended learning have the potential to double productive learning time for the students that need it most.

6. Achievement analytics. Teachers that have signed up for MangaHigh can assign free middle grade math games as homework and review a full achievement dashboard in the morning. Students that Write to Learn get instant writing feedback and the teacher gets a standards-based gradebook full of evidence. In addition to extended access and more variety, the shift from print to digital curriculum will includes embedded assessments and powerful dashboards that will allow teachers to more easily monitor student progress.

7. Advanced diagnostics. Adaptive testing, like NWEA's MAP, can quickly zero in on
learning levels. Scantron can turn a quick math diagnostic into a customized tutorial. Aided by lots of content-embedded assessment, comprehensive portable learner profiles will share information with everyone involved in promoting an individual student's growth -- providing similar benefits to electronic health record in medicine.

8. Teaching in teams. Blended learning is a team sport. It allows an instructional team to work together to support 1000 math students moving at their own pace. It allows a great physics teacher to reach hundreds, perhaps thousands of students. Blended learning can make learning more social and more transparent.

9. Earn more. New staffing patterns, new roles, and extended learning time will allow many teachers to earn more.

10. Work at home. In some cases, teachers will be able to work remotely. My friend Mike Shumake teaches English online to kids in North Carolina and Washington State. The first online teacher of the year, Teresa Dove, lives in Virginia and teaches kids in Florida. Speech therapists for Connections Academy can live anywhere and work when they want.

Teachers appreciate that blended learning makes a difficult job more doable.

This article was originally posted at

Thursday, July 7, 2011

Two OSHA Meetings to Discuss Infectious Agents Standard

OSHA announced it will hold two stakeholders July 29 to hear from stakeholders as it considers whether to develop a standard meant to control workers' exposures to infectious agents. The tasks it would address might or might not be direct patient care, and the announcement listed examples: housekeeping, food delivery, facility maintenance; handling, transporting, receiving, or processing infectious items or wastes; maintaining, servicing or repairing medical equipment that is contaminated with infectious agents; conducting autopsies; performing mortuary services; and performing tasks in laboratories that result in occupational exposure.

The meetings will take place from 9 a.m. to noon and from 1:30 to 4:30 p.m. The deadline to confirm registration is July 22, and OSHA said only about 30 participants will be allowed in each meeting. OSHA staffers will be present to take part, and Eastern Research Group, Inc. of Lexington, Mass. will manage logistics for the meetings, provide a facilitator, and compile notes summarizing the discussion that will be posted in the docket for the Infectious Diseases Request for Information (Docket ID: OSHA-2010-0003,

OSHA published the request for information in May 2010 and received more than 200 comments were received in response. It said these meetings will center on such major issues as whether and to what extent an OSHA standard on occupational exposure to infectious diseases should apply in settings where workers provide direct patient care, as well as, settings where workers have occupational exposure even though they don't provide direct patient care; the advantages and disadvantages of using a program standard to limit occupational exposure to infectious diseases; the advantages and disadvantages of taking other approaches to organizing a prospective standard; and whether a standard should require every employer to develop a written worker infection control plan.

This article was originally posted at

Safety 2011: Do Americans Care More about Chickens than Workers?

OSHA Administrator Dr. David Michaels and NIOSH Director Dr. John Howard sat down with Diana Stegall of the American Society of Safety Engineers to discuss the focus of the agencies and the role those agencies play in the lives of safety professionals. Believe it or not, the subject of chickens came up.

 During the panel discussion, a short film from OSHA, created to commemorate the agency’s 40th anniversary, was shown. The film included comments from former OSHA administrators – such as Eula Bingham, Mort Corn and Thorne Auchtor – as well as Michaels. In some cases, the timeline of the film made it apparent that some OSHA standards were the direct or indirect result of workplace tragedies that made national headlines.

“We need to raise the issue of workplace safety and health to the national level,” said Michaels.
Commenting on the book The Jungle, Michaels noted that as a result of the public outcry after the book was published, food safety standards were put into place. “Upton Sinclair didn’t write [The Jungle] to improve food safety,” said Michaels. “He wrote it to show the working conditions for stockyards workers. ...Upton Sinclair said, ‘I aimed for their hearts and hit their stomachs.’”

To further make his point that workplace safety and health still doesn’t have the national stage like it deserves, Michaels noted the salmonella outbreak in eggs last year, in which 380 million eggs were recalled.  “Nobody talked about the working conditions on egg farms,” said Michaels. “We need to convince Americans to care as much about workers as they do chickens.”

A large number of workplace injuries and illnesses go unreported, Michaels acknowledged, referring to a study that found that “for every injury reported on an OSHA log, there were three and a half that went through the workers’ compensation system.” Ideally, the numbers on the OSHA log and the number of injuries and illnesses reported for workers’ compensation medical and leave benefits should match up.

This article was originally posted at

Reading, writing, rollbacks as stimulus ends

The public school system in this city hugging the shore of Lake Michigan is running low on money and options for educating its 21,000 students as federal stimulus cash dries up.

Anticipating this summer's end to the $10 million boost it received from the stimulus, Racine Unified held a referendum in April asking to replace some of the lost cash with local property tax dollars. Voters said no.

Facing its own budget troubles, Wisconsin is slashing more than $16 million in state funding for the district, and a state-imposed voucher system could drain even more money if parents pull students out of the district.

With the recession decimating the coffers of states, cities and schools and pushing up the unemployment rate, the government in 2009 began pouring $830 billion into the economy in the hope of creating or saving jobs like those of teachers.

Now that the flood of federal money has ended, cities and school districts like Racine must come up with new ways to cover expenses for the most basic services, including policing, healthcare, schooling and other day-to-day operations.

Racine Unified adhered to a main stimulus tenet of preserving jobs and also made one-time investments with the funds, according to David Hazen, the district's chief financial officer.

But now it must lay off about 60 employees, mostly teaching assistants, as part of its plan to close a projected $25 million budget deficit that depended mainly on salary freezes and higher employee contributions to healthcare and pensions.

"I'm just envisioning the worst," said Michael Anton, president of Racine Unified's parent teacher association council. "What I see is larger class sizes and staff being stretched to the max."

Milwaukee Public Schools, Wisconsin's biggest district, said that in anticipation of state cuts and the end of federal stimulus dollars, its fiscal 2012 budget eliminated almost 1,000 jobs, closed 12 schools, dropped most funding for new textbooks and decreased summer school options. Last week, the school system said it sent out layoff notices to 519 workers, including 354 of its 5,474 teachers.

Parents, teachers and administrators in other districts across the country are having the same negative vision for the new school year starting in a few months. Few places can make up for the loss of the $135 billion state fiscal stabilization fund that was included in the stimulus plan mostly for education and few have other places to turn.

"The end of stimulus funding is now coupled with cuts in state education aid and the decline in local revenues," said Deborah Rigsby, federal legislation director for the National School Boards Association. "You've got those three things going and then, number four, there's the uncertainty of the federal appropriations process."

States contribute 48 percent of funding for primary and secondary education, while the federal government pitches in about 8 percent, according to Fitch Ratings. School districts "have little if any control over revenue raising," the agency said in a report highlighting state aid cuts as a risk to districts, which largely rely on local property taxes for the remainder of their funding.

Even districts with the authority to raise local taxes may not be able to increase revenue due to declines in property values and voter resistance to tax hikes, Fitch added.


"Most of the conversation is about how it impacts teachers, and that's real easy -- they're going to lose jobs," said Dennis Van Roekel, president of teachers union the National Education Association. "The real impact is on students. The educators who are laid off will just not go to work, but the students will still have to go to school."

Ultimately, he said, students will receive less individual attention and instruction, as their class sizes swell and school supports such as nurses and librarians vanish.

"It's a dark picture for school funding," wrote the American Association of School Administrators in a report.

"We're just trying to educate students with high needs with less money than other districts that don't have as many high-need students because poverty is linked to performance unfortunately," Racine's Hazen said about the district, where the unemployment rate is higher than the state average.

He said class sizes in the district's six preschool to fifth-grade schools may rise to 28 from a previous maximum of 25.

The school board is considering a lawsuit against Wisconsin that would claim the state's new two-year budget creates unconstitutionally unequal funding among districts.

"The state budget problem is being borne by urban districts -- they're the ones losing the state aid. Suburban districts that are not losing state aid are afforded property tax relief. The result is disequalizing," Hazen said.

Schools have moved from making more moderate budget moves, such as adjusting thermostats, to "cuts and reductions in budget areas that directly impact student achievement: programs and personnel," according to the school administrators survey.

The group, which represents school system leaders such as superintendents, previously found that a growing number of districts consider themselves inadequately funded and almost all -- 82 percent -- expect cuts in state and local revenues for next school year.


Colorado has slashed public school spending by $227.5 million, dropping the average per pupil funding in the state by $346 to $6,468 in the coming school year from $6,814 in fiscal 2011 when federal stimulus dollars were used to prop up spending, according to Leanne Emm, assistant commissioner for public school finance at the state's education department.

Governor John Hickenlooper recently said the decision was made only after the state had "cut everything that you can cut" in other areas.

"Look, nobody wants to cut education, right? There is not a single governor in America that went through the grief of an election to come in and say, 'All right, we have to make all these cuts.' Well, this is the world we live in," he said.

Some districts are chopping hours or days off schedules. Even in South Dakota, where the recession was relatively mild, many schools will be open only four days a week.

Public education has long inflamed disputes at every level of government, and possibly no fight is more persistent or rancorous than how to fund it. Both primary and secondary education typically take up 40 percent of a state's budget, according to the Center on Budget and Policy Priorities.

States often consider schools sacrosanct in drafting budgets, but as the recession and housing crisis caused an historic revenue collapse almost all had to consider trimming education. According to CBPP, a think tank that tracks their fiscal conditions, at least 34 states have cut funding for schools and 43 for higher education since 2008.

The federal government stepped in with the 2009 stimulus plan. Last summer, as the stimulus money was largely spent, Congress allocated another $10 billion for education jobs.

That money was absorbed quickly and by February school districts were laying off workers. The future of education in America still looks austere.

Nearly three-quarters of school districts in the United States will cut jobs for the Fall term, according to the school administrators group, which projects that 227,000 education jobs for the 2011-12 school term are "on the chopping block."

This article was originally posted at

Tuesday, July 5, 2011

Social Media for higher education ? TrendsSpotting?s Research Report

Following TrendsSpotting’s research work  on youths media behavior (traditional and new media) in 16 countries, we bring you some of the insights we’ve collected on international marketing in higher education together with some relevant case studies.

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TrendsSpotting is working with leading Universities on social media strategy designed to capture youths in Asia, Europe and the US.

You are welcome to contact us for research reports on youths in the following countries:

Asia: India, China, Indonesia, Hong Kong, South Korea, Taiwan, Vietnam, Singapore.

Europe: UK, France, Germany, Belgium, Poland, Turkey, Greece.

Central America: Mexico

This article was originally posted at

Friday, July 1, 2011

Demand for online learning increases

In just three years, the number of high school students who have access to online learning has tripled, while twice as many middle school students are now learning online, according to a new report.

These figures come from the nonprofit group Project Tomorrow and its most recent Speak Up survey on first released data from its this survey earlier this spring, but the organization has teamed up with learning management system provider Blackboard Inc. to dig deeper into the results that pertain to online learning.

Project Tomorrow and Blackboard issued a report on these findings during the International Society for Technology in Education’s annual conference June 28.

More than 40 percent of students now designate online classes as an essential component of their learning experience, with administrators and parents also becoming more supportive of this vision, the report says. In two years’ time, 39 percent more administrators and five times as many parents have incorporated online classes into their vision for the ultimate school.

While support for online learning has grown, so, too, has the untapped student demand for online learning as part of their ultimate school. One-third of middle and high school students say they are interested in taking an online course but have not yet, and 30 percent of third through fifth grade students say they’d like to take an online course, according to the survey.

“Online learning is transformative. We are just starting to see a generation rising through middle schools that demand online learning and have a clear insight into how it can change the future of education,” said Julie Evans, CEO of Project Tomorrow. “These students are moving online learning beyond the basic learning paradigm and taking ownership in their learning process—creating an engaging, personalized, and collaborative learning environment.”

The online-learning report is called “Learning in the 21st Century: 2011 Trends Update.” It’s based on results from the 2010 Speak Up survey, which captured the views about online education and 21st-century learning of more than 379,000 K-12 students, parents, educators, and college students enrolled in teacher preparation programs in the United States.

“Online learning will continue to impact student motivation for learning,” said a Delaware County, Pa., administrator who participated in the study. “I believe collaboration tools will have the greatest impact on