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Steve King

What is a Sankey-Diagram? - 0 views

www.stenum.at/en

sankey methodology software process-improvement

shared by Steve King on 02 Jul 10 - Cached
  • Intro What is a Sankey-Diagram? References Demo version Full version   Know-How Games Software Recommendations Pinchleni Software   What is a Sankey-Diagram? A Sankey diagram is a graphic illustration of flows, like energy, material or money flows. Usually the flows are illustrated as arrows. The width of the arrows is proportional to the size of the represented flow. Sankey diagrams are a better way to illustrate which flows represent advantages and what flows are responsible for waste and emission
Steve King

Umberto - know the flow / Material Flow Networks - The Method - 0 views

www.umberto.de/...index.htm

shared by Steve King on 02 Jul 10 - Cached
  • Complex loops refeeding material or recycling loops can be displayed and calculated within the material flow networks.
  • Steve King on 02 Jul 10
     
    Umberto is expensive but seems to be successful at modeling complex energy and materials flows.. includes library of process patterns with metrics and math for each
Steve King

NEJM -- What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice - 0 views

content.nejm.org/...1632

community-desktop PCMH evidence-based-medicine outcomes-based medicine EHR software healthcare research productivity

shared by Steve King on 03 May 10 - Cached
  • Primary care practices typically measure productivity according to the number of visits, which also drives payment.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      This study is directly related to the TrustNetMD mission, but could also be useful for other EBM-related and OBM-related community desktop solutions.
  • Several studies have estimated the amount of time that primary care physicians devote to nonvisit work.1,2 To provide a more detailed description, my colleagues and I used our electronic health record to count units of primary care work during the course of a year.
  • Greenhouse Internists is a community-based internal medicine practice employing five physicians in Philadelphia. In 2008, we had an active caseload of 8440 patients between 15 and 99 years of age.
  • ...12 more annotations...
  • Our payer mix included 7.2% of payments from Medicaid (exclusively through Medicaid health maintenance organizations), 21.5% from Medicare (of which 14.0% were fee-for-service and 7.5% capitated), 64.7% from commercial insurers (34.5% fee-for-service and 30.2% capitated), and 6.5% from pay-for-performance programs.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      I wonder how this breakdown compares with national/urban averages? Also how are these trending? Is the pay-for-performance increasing dramatically? I would think so based on what we are hearing.
  • Throughout 2008, our physicians provided 118.5 scheduled visit-hours per week, ranging from 15 to 31 weekly hours each. We regard this schedule as equivalent to the work of four full-time physicians, with physicians typically working 50 to 60 hours per week. Our staff included four medical assistants, five front-desk staff, one business manager, one billing manager, one health educator (hired midyear), and two full-time clerical staff. Our staffing ratio was approximately 3.5 full-time support staff per full-time physician. We had no nurses or midlevel practitioners.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      From the little I know this is a typical primary care scenario - very poor leverage of professional staff, meaning no use of nurses or midlevel practitioners to leverage physician time and expertise.
  • We use an electronic health record, which we adopted in July 20043 and use exclusively to store, retrieve, and manage clinical information. Our electronic system came with 24 "document types" that function like tabs in a paper chart to organize documents, dividing clinical information into categories such as "office visit," "phone note," "lab report," and "imaging." Since all data about patients is stored in the electronic record (either as structured data or as scanned PDFs) and each document is signed electronically by a physician, we are able to measure accurately the volume of documents, which serve as proxies for clinical activities, in a given time period.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      Each of these document types could become a "LivingPaper" creating a "LivingRecord" vs. the current EHR... Steve have you discussed something like this with TNMD?
  • The volume and types of documents that we receive, process, and create are listed in Table 1
  • Each physician reviewed 19.5 laboratory reports per day, including those ordered through our office (which are delivered to us through an electronic interface and are automatically posted to the database of the electronic health record as numerical values) and those ordered outside our office (which enter our chart as scanned PDFs and are not posted as numerical values). The work cycle of responding to a laboratory result includes interpretation by telephone, letter, or e-mail. (Our office sent 12,541 letters communicating test results, about a third of which were sent by e-mail.) For noninterfaced laboratories, we must decide which values need to be entered manually into the electronic health record by a staff person; the values of scanned results cannot be graphed or searched without this step. Laboratory results frequently trigger a review or adjustment of a medication, which requires access to accurate, current medication lists with doses.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      How difficult would it be to integrate LivingPaper with existing EHRs and/or lab systems. Since EHRs are still in the "early adopter" phase, perhaps we can address some of the most critical needs making EHR use unnecessary, or perhaps this is a HUGE joint opportunity with Microsoft's healthcare division.
  • Of these calls, 35.7% were for an acute problem, 26.0% were for administrative purposes
  • Physicians averaged 16.8 e-mails per day. Of these electronic communications, 59.3% were for the interpretation of test results, 21.7% were for response to patients (either initiated by patients through the practice's interactive Web site or as part of an e-mail dialogue with patients), 9.3% were for administrative problems, 5.0% were for acute problems, 2.8% were for proactive outreach to patients, and 1.9% were for discussions with consultants.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      60% for interpretation of test results!!! Opinion management ranks as the highest use of electronic communications. THIS IS OUR SWEET SPOT! We need to find this type of data for research scientists.
    • Steve King
      Steve King on 10 May 10
       
      this is a a perfect source document for HC CD
  • Telephone calls that were determined to be of sufficient clinical import to engage a physician averaged 23.7 per physician per day, with 79.7% of such calls handled directly by physicians.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      Wow! I never would have guessed that telephone calls were such a significant part of the physician day. Does the EHR provide a CRM for call-logging?
  • Each physician reviewed 11.1 imaging reports per day, which usually required communication with patients for interpretation. Such review may require updating problem lists (e.g., a new diagnosis of a pulmonary nodule) or further referral (e.g., fine-needle aspiration for a cold thyroid nodule), which generates additional work, since results and recommendations are communicated to patients and consultants.
  • Each physician reviewed 13.9 consultation reports per day. Such reports from specialists may require adjustments to a medication list (if a specialist added or changed a medication), changes to a problem list, or a call or e-mail to a patient to explain or reinforce a specialist's recommendation. Some consultation or diagnostic reports relate to standard quality metrics (e.g., eye examinations for patients with diabetes) and need to be recorded in a different manner to support ongoing quality reporting and improvement.5
  • Before our practice had an electronic health record, we employed a registered nurse. After the implementation of the electronic health record system, much of the work that the nurse performed could be done by staff who did not have nursing skills, and by 2008, we no longer employed a registered nurse. However, on the basis of the analysis described here, we have hired a registered nurse to do "information triage" of incoming laboratory reports, telephone calls, and consultation notes — a completely different job description than what we had before.
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      Most interesting! This is the conclusion we came to and presented to TNMD as a business plan concept -- become the triage service through outsourcing/insourcing RNs supported by the community desktop system.
  • Our practice is participating in a multipayer Patient Centered Medical Home demonstration project7 (which allowed us to hire our health educator). This project is overseen by the Pennsylvania governor's office and funded by the three largest commercial insurers and all three Medicaid insurers in our region
    • dhtobey Tobey
      dhtobey Tobey on 03 May 10
       
      Monetization is with the insurers -- just as we expected.
dhtobey Tobey

AutoMap: Project | CASOS - 0 views

www.casos.cs.cmu.edu/...automap

text-mining software semantic index Carnegie-Mellon

shared by dhtobey Tobey on 26 Apr 10 - Cached
  • AutoMap is a text mining tool that enables the extraction of network data from texts. AutoMap can extract content analytic data (words and frequencies), semantic networks, and meta-networks from unstructured texts developed by CASOS at Carnegie Mellon.  Pre-processors for handling pdf’s and other text formats exist.  Post-processors for linking to gazateers and belief inference also exist. The main functions of AutoMap are to extract, analyze, and compare texts in terms of concepts, themes, sentiment, semantic networks and the meta-networks extracted from the texts. AutoMap exports data in DyNetML and can be used interoperably with *ORA. AutoMap uses parts of speech tagging and proximity analysis to do computer-assisted Network Text Analysis (NTA). NTA encodes the links among words in a text and constructs a network of the linked words. AutoMap subsumes classical Content Analysis by analyzing the existence, frequencies, and covariance of terms and themes. AutoMap has been implemented in Java 1.5.0_07. It can operate in both a front end with gui, and backend mode. Main functionalities of AutoMap are: Extract, analyze and compare mental models of individuals and groups. Reveal structure of social and organizational systems from texts. AutoMap also offers a variety of techniques for pre-processing Natural Language: Named-Entity Recognition Stemming (Porter, KStem) Collocation (Bigram) Detection Extraction routines for dates, events, parts of speech Deletion Thesaurus development and application Flexible ontology usage Parts of Speech Tagging
  • dhtobey Tobey on 26 Apr 10
     
    Could this tool be useful for the knowledge exchange to develop automatic tagging and taxonomy creation?
dhtobey Tobey

University Physicians Healthcare - UPH Executive Bios - 0 views

www.uph.org/...Default.aspx

prospect DTSE BioScience-exchange

shared by dhtobey Tobey on 24 Apr 10 - Cached
  • Lawrence Aldrich President and Chief Executive Officer (CEO) Larry Aldrich is an attorney with over 25 years of proven leadership abilities in diverse business positions. As President and CEO he is responsible for various corporate departments at UPH, including Legal/Risk, Information Systems, Electronic Medical Records, Marketing/Business Development/Contracts Administration and Facilities. Prior to joining UPH, Larry was the founding Chief Operating Officer at The Critical Path Institute (C-Path), a non-profit medical research organization focused on improving the safety and efficacy of the drug development process through the U.S. Food and Drug Administration. He also served as the president and CEO of Tucson Newspapers. Larry received his law degree from Tulane Law School and his civil engineering degree from Georgia Institute of Technology.
    • dhtobey Tobey
      dhtobey Tobey on 24 Apr 10
       
      Aldrich is the former head of Tucson Ventures. Scott is arranging presentation after our presentation development call with Jeanine.
Steve King

The next wave of change for US health care payments - McKinsey Quarterly - Health Care ... - 0 views

www.mckinseyquarterly.com/...r_US_health_care_payments_2585

hc-industry-stats EHR payments

shared by Steve King on 13 May 10 - No Cached
  • We estimate that by 2012, about 80 percent of the projected eight billion core US health care transactions will be in electronic formats,
  • The complexity of clinical data should not be underestimated—a typical patient-level clinical data set can include more than 800 discrete fields, compared with only about 20 to 30 for a financial transaction.
  • Resulting in part from this systemwide complexity, industry administrative costs will grow by about 10 percent annually over the coming years
  • ...2 more annotations...
  • Cross-industry collaboration could finally spur the creation of payment utilities such as full-cycle-payment automation (described in our 2007 article). As noted there, we believe in the potential for cross-industry collaboration to create an at-scale payment-settlement utility that knits together health care transaction processing through clearinghouses, the automated clearinghouse payment network, and card network payments for retail payments.
  • By applying CBO data, we estimate that 55 percent of hospitals and 85 percent of physician practices will reach the basic stages of meaningful use by 2014.
Scott Edelman

CMMI | Tools & Methods | Appraisal Program | CMMI Appraisals - 0 views

www.sei.cmu.edu/...index.cfm

methodology cmmi software certification

shared by Scott Edelman on 19 May 10 - Cached
  • CMMI Appraisals  The Appraisal Program oversees the quality and consistency of the SEI's process appraisal technology and encourages its effective use. Its four main functions include communications to the appraisal community; appraisal quality control; training, authorizing, certifying, and providing resources for Lead Appraisers and Team Leaders; and monitoring and reporting appraisal results.
Scott Edelman

Six Sigma Online Training and Six 6 Sigma Online Certification for Green Belt & Black Belt - 0 views

www.6sigma.us/six-sigma-online-training.php

Six-sigma methodology certification

shared by Scott Edelman on 19 May 10 - Cached
  • Six Sigma Online Training and Six Sigma Online Certification Six Sigma Self-Paced Training Online Courses - Six Sigma Online Certification SixSigma.us, re
  • We now have individual Green Belt course modules like Six Sigma Overview, Process Mapping, FMEA, Introduction to SPC and more available on demand at affordable prices. Pay by credit card and get immediate access for 30 days to each course. Try our Six Sigma Overview course, normally $49.99, for a discounted introductory price of only $19.99!
    • Scott Edelman
      Scott Edelman on 19 May 10
       
      Low-end pricing for basic training. Comprehensive certification courses offer below. 
  • SixSigma.us also offers training courses that teach not only Six Sigma but also how to use other statistical applications. One of those applications is SigmaXL, an Excel-based statistics application.  SigmaXL has many of the tools used by Six Sigma practioners, but is not nearly as powerful as Minitab. Green Belt Black Belt SigmaXL Excel Add-in included ($199 value) $599 > Enroll Now $999 > Enroll Now
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