To better protect workers from hazardous chemicals, the U.S. Department of Labor’s OSHA has revised its Hazard Communication Standard to align with the United Nations’ Globally Harmonized System of Classification and Labeling of Chemicals (GHS). While the original Hazard Communication Standard, HCS 1983, was commonly referred to as the “Employee Right to Know,” the revised standard now provides for the “Employee Right to Understand.” With the goal of increasing worker comprehension about the hazards in their work environment, the revised standard requires companies to employ the use of a standardized format for Safety Data Sheets (SDSs), as well as new labeling elements for chemicals. OSHA is rolling out this change in phases over the next several years, culminating in a final deadline of June 1, 2016.
New Requirements Aimed at Healthcare Worker Safety
The first compliance deadline is December 1, 2013. By this time, all facilities must provide training on new chemical label elements and safety data sheets. In response to this rule, HealthStream has teamed up with MAXCOM to offer 19 GHS specific training modules that focus on every class of chemical an employee might come across in their working environment.
To address the enormous amount of chemicals used in hospitals, OSHA amended the rule to allow chemical training to be provided by groups of chemicals. They write, “where there are large numbers of chemicals, or the chemicals change frequently, you will probably want to train generally based on the hazard categories.”
Hazardous Chemicals Are Common in Health Care Facilities
Chemicals in use in the healthcare environment may be hazardous due to potential for toxicity, corrosiveness, and reactivity. In addition to the usual routes of exposure by inhalation, ingestion, skin and eye contacts, a health care provider can also inadvertently self-inject a toxic drug intended for a patient.
These groups of chemicals include:
- Chemical disinfectants commonly used in health care facilities are often corrosive and/or toxic. Glutaraldehyde, sodium hypochlorite, iodine, phenols, formaldehyde, and quaternary ammonium compounds are all corrosive. In addition to being corrosive and toxic, some disinfectants such as quaternary ammonium compounds (benzalkonium chloride, Zephiran chloride, Rodalon) also cause contact dermatitis. Glutaraldehyde solution has to be freshly prepared every 2 weeks, and due to its volatile characteristic employees often inhale its vapors. Formaldehyde used for cold sterilization of instruments and as a disinfectant not only has noxious odor but also causes dermatitis and has been shown to cause nasal and other cancers in experimental animals.
- Freons such as Freon 12 (dichlorodifluoromethane), Freon 11 (fluorotrichloromethane), and Freon 22 (chlorodifluoromethane) are routinely used in pathology laboratories (to prepare frozen tissue sections), in aerosol cans as a propellant, as a refrigerant gas, and mixed with ethylene oxide (a sterilant). Freons can freeze the skin and eyes and cause depression of the central nervous system resulting in dizziness, convulsions, and irregular heartbeat.
- Methyl Methacrylate, commonly used in operating rooms for securing surgical prostheses to bone, has to be mixed just before a procedure often resulting in inhalation of the product. Methyl methacrylate affects the central nervous system, is an irritant and may cause low blood pressure and cardiac arrest. The product also has been linked to birth defects, though not cancer.
- Peracetic Acid (PAA) or Peroxyacetic Acid is used to sterilize medical instruments, and also present in laboratories, and patient care units. PAA is a severe irritant, and have been linked to skin papillomas (wart-like tumors), and liver, kidney, and heart problems.
- Solvents (such as Dioxane, Xylene, and Benzene) used mostly as cleaning agents in housekeeping are central nervous system depressants and irritants. Chronic exposure to solvents have been linked to effects on blood formation, kidneys, liver, birth defects, and cancer.
- Anesthetic Gases exposure usually occurs in operating rooms, labor, delivery and recovery rooms; and ER. Gases often leak from the instruments, and in the recovery room are present due to the exhaled breath of post-operative patients. Effects of anesthetic gases on health care employees are similar to the one experienced by patients. Although short-term exposure only causes dizziness and disorientation, long term exposure may cause cancer, birth defects, and liver and kidney damage.
- Ethylene Oxide used to sterilize equipment also exposes employees in surgery units and central supply. Ethylene oxide is a corrosive, causes destruction of red blood cells, and inflammation of lungs. It is also a carcinogen and a fire hazard.
- Cytotoxic Drugs (such as cyclophosphamide, chlorambucil, and melphan) used for treatment of cancer, also cause cancer and damage to the reproductive system of health care employees. Accidental injection of a drug such as mitomycin-C can cause loss of function of a hand; and drugs such as mustine hydrochloride and doxorubicin are powerful vesicants (corrosives). Exposure to the smallest amount of bleomycin can cause severe allergic reaction.
- Pesticides ( Mecoprop, Metolochlor), Rodenticide ( Bromaldiolane and Diphacinone) and Fungicide such as Mancozeb are routinely used by hospitals as a biocide. Most are toxic to the nervous system, damage kidneys and liver, and cause allergic reactions.
Safer Substitutes
Less hazardous products can be substituted for many though not all hazardous chemical products in health care facilities. For example:
- For Ethylene oxide in most instances: safer hydrogen peroxide 7.5% solution, peracetic acid or a mixture of hydrogen peroxide and peracetic acid. Even hypochlorite (bleach)is effective in some disinfection systems. Please note that the substitutes are not suitable for flexible GI endoscopes.
- For Glutaraldehyde: Ortho-phthalaldehyde (OPA) in Cidex (contains only 0.55% glutaraldehyde)
- For common toxic chemicals such as chloroform: dimethoxyethane (DME), Ethyl lactate, methyl tert-butyl ether or methylene chloride; benzene can be replaced by benzotrifluoride (BTF), dimethoxyethane (DME); acetone can be substituted by ethyl lactate, or N-methyl pyrrolidone (NMP) etc.
- For toxic chemicals such as formaldehyde: dimethoxymethane (DEM); Phenol by polyethylene glycol (PEG), and pyridine by isopropyl alcohol.
- For flammable chemicals such as ethyl ether: methyl tert-butyl ether (MTBE), n-octyl tetrahydrofurfuryl ether (n-OTE)
- Waste anesthetic gases can be controlled by a scavenging system.
- For powerful pesticides containing pyrethroids: UV light traps; pheromone traps can be substituted for Cockroach pesticides etc.
Although heath care facilities will never be free of hazardous chemicals, it is increasingly possible to use safer alternatives and better procedures to prevent exposure.
MAXCOM’s GHS Training Library provides a basic overview of the hazards associated with every class of chemical a healthcare employee could typically be exposed to and how an exposure to these chemicals could affect him/her in the course of performing their everyday workplace duties. Additionally, this training provides valuable information about the degree of risks or hazard levels associated with chemicals specific to a healthcare environment, and finally employees are provided details about the information contained within each section of the new Safety Data Sheet, GHS label elements and the pictograms recently adopted by OSHA.
Learn more about Maxcom training here.
By Lee Ann Bryant, Associate Product Manager, HealthStream
With small and medium practices in mind, CMS has put together the following checklist of ICD-10 tasks, including estimated timeframes for each task. Depending on your organization, many of these tasks can be performed on a compressed timeline or performed at the same time as other tasks. This checklist is designed to provide a viable path forward for organizations just beginning to prepare for ICD-10. CMS encourages those who are ahead of this schedule to continue their progress forward.
Planning, Communication, and Assessment -- Actions to Take Immediately
To prepare for testing, make sure you have completed the following activities. If you have already completed these tasks, review the information to make sure you did not overlook an important step.
- Review ICD-10 resources from CMS, trade associations, payers, and vendors
- Inform your staff/colleagues of upcoming changes (1 month)
- Create an ICD-10 project team (1-2 days)
- Identify how ICD-10 will affect your practice (1-2 months)
- How will ICD-10 affect your people and processes? To find out, ask all staff members how/where they use/see ICD-9
- Include ICD-10 as you plan for projects like meaningful use of electronic health records
- Develop and complete an ICD-10 project plan for your practice (1-2 weeks)
- Identify each task, including deadline and who is responsible
- Develop plan for communicating with staff and business partners about ICD-10
- Estimate and secure budget (potential costs include updates to practice management systems, new coding guides and superbills, staff training) (2 months)
- Ask your payers and vendors—software/systems, clearinghouses, billing services—about ICD-10 readiness (2 months)
- Review trading partner agreements
- Ask about systems changes, a timeline, costs, and testing plans
- Ask when they will start testing, how long they will need, and how you and other clients will be involved
- Select/retain vendor(s)
- Review changes in documentation requirements and educate staff by looking at frequently used ICD-9 codes and new ICD-10 codes (ongoing)
For the full ICD-10 Implementation Guide for Small and Medium Practices, click here.
If you would like more information on how HealthStream and Precyse can help your organization prepare for ICD-10, click here.
As the healthcare industry draws closer to the go-live date, ICD-10 remains a polarizing topic among healthcare professionals. While some healthcare organizations are actively preparing for a strategic rollout, others are, more or less, bracing for impact. In April 2012, the Centers for Medicaid & Medicare Services (CMS) extended the ICD-10 (the International Classification of Diseases, tenth revision) implementation deadline to October 1, 2014 at the request of some physicians, hospitals, and other industry stakeholders. Since then, the American Medical Association (AMA), in partnership with other groups, has urged CMS to eliminate ICD- 10 implementation altogether due to the significant administrative and financial burden it imposes on physicians. There is no sign this will happen, however, or indication of any further postponement. In fact, the acting CMS Administrator, Marilyn Tavenner, has recently stated, “Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10. Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments.”
ICD-10 Complements Our More Advanced Healthcare System 
There are many differing opinions concerning the transition to ICD-10. But, in reality, ICD-10 is necessary to all levels of a technologically progressive healthcare system. Given the magnitude of change happening in the U.S. healthcare delivery system, ICD-10 is a natural and necessary advancement that will address the critical gaps and operating flaws inherent in ICD-9, which was developed over 30 years ago. Since then, healthcare science and technology have greatly advanced, making ICD-9 inadequate to deal with the advances in healthcare. Moreover, the content of the ICD-9 Clinical Modification (CM) was not designed to be used as a data system for disease management, nor was it intended to support reimbursement of medical services. ICD-9 is an antiquated classification that has a puzzling mixture of code descriptions—some very specific, and others that are so broad they fail to even identify the site of the disorder. Today, we have a system that does not always fully capture the severity of our patients’ illnesses, which prevents physicians from receiving full credit for the care performed in quality reporting.
Implementing ICD-10 is a Physician Challenge. Focusing on ICD-10’s Benefits is Important.
To be sure, implementing ICD-10 is a major undertaking for all healthcare professionals, who are faced with many other challenges, including meeting the requirements of Meaningful Use legislation. ICD- 10 compels greater specificity in documentation practices; it also involves a new coding classification system and an increase from 17,000 to more than 140,000 codes. It is estimated that ICD-10 implementation costs will range between $83,000 and $2.7 million, depending on the healthcare organization or physician practice size, according to the AMA. The Advisory Board Company calculates that the three-year incremental impact of ICD-10 could range from $2.5 to $7.1 million for a typical 250-bed hospital, with coder productivity decreasing by close to 20% and physician productivity taking a 10% to 20% hit due to significant increases in queries.
This white paper includes:
- Clinical Roots: How Physicians Shaped ICD-10
- Why Physicians Should Care About ICD-10
- How ICD-10 Data Will Benefit Physicians
- What’s the Physician Return on Investment (ROI) for ICD-10?
- Case Study: Applying ICD-10 to Crohn’s Disease
- A Guide to Taking Control of ICD-10
- A List of Major ICD-10 Documentation Changes
Download the White Paper Here.
By Lee Ann Bryant, Associate Product Manager, HealthStream
Although nearly all healthcare providers are aware of the October 1, 2014 deadline, studies show that most are unprepared for this transition. Recognizing that these changes require widespread education and planning initiatives beyond just the coding population, CMS (Centers for Medicare and Medicaid Services) provides a timeline for preparation between now and the “go-live” date of October 1, 2014.
Transition and Testing (March 2013 to September 2014 )
- March 1, 2013 – December 31, 2013: Conduct high-level training on ICD-10 for clinicians and coders to prepare for testing…e.g., clinical documentation, software updates (ongoing)
- April 1, 2013: Start testing ICD-10 codes and systems with your practice’s coding, billing, and clinical staff (9 months)
- Use ICD-10 codes for diagnoses your practice sees most often
- Test data and reports for accuracy
- Monitor vendor an
d payer preparedness, identify and address gaps (ongoing)
- October 1, 2013: Begin testing claims and other transactions using ICD-10 codes with business trading partners such as payers, clearinghouses, and billing services (10 months minimum)
- January 1, 2014 – April 1, 2014: Review coder and clinician preparation; begin detailed ICD-10 coding training (6-9 months)
- Work with vendors to complete transition to production-ready ICD-10 systems
Complete Transition/Full Compliance (October 1, 2014)
- Complete ICD-10 transition for full compliance
- ICD-9 codes continue to be used for services provided before October 1, 2014
- ICD-10 codes required for services provided on or after October 1, 2014
- Monitor systems and correct errors if needed
While this timeline is a good high-level guide for what your organization should be focusing on now, it does not provide guidance on the day-to-day task of educating all necessary staff for this transition. With more than 50 affected populations in a healthcare facility, the ICD-10 transition is a great one and shouldn’t be taken lightly. ICD-10 is coming – are you ready?
For more information on how to get your organization and staff on track and ready to succeed from day one, click here!
By Lee Ann Bryant, Associate Product Manager, HealthStream
The decision has been made to move forward with your ICD-10 education and training, but the transition process is just beginning. Some lingering questions might be…
- “Where will we look for our education?”
- “How will we manage all of these changes while ensuring our employees are getting the education required?”
- “What resources are out there than can help us on this journey?”
While improving documentation is at the forefront, it is a mere fraction of what facilities must factor in to this evolution. Adapting to and managing change, providing training and on-going testing, and revenue planning – these are all aspects that must be considered and will feel the impact of the transition to ICD-10. Aside from the actual education, there is so much to learn!
With our growing Resource Library, see how HealthStream and Precyse are quickly becoming your thought leaders when it comes to managing such a transition – from beginning to end. Here you will have access to webinars, white papers, articles, course demos and pricing requests and more!
Click here to check out HealthStream’s ICD-10 Resource Library, and see how it can help you with the ICD-10 journey today!
By Don Larson, Senior Product Director, HealthStream
While release of new survey specifications by the Agency for Healthcare Research and Quality (AHRQ) isn’t typically the stuff of headlines, one component of their Clinician and Group survey (CG-CAHPS) launch may bring welcome news to healthcare providers. Until now, AHRQ’s approach (and by extension, CMS’s approach) with surveys like HCAHPS has remained fairly conservative, favoring traditional methodologies like phone and mail. With the coming of CG-CAHPS, however, the agency has finally approved the use of email and internet-based data collection, or e-survey, as an option.
Could this fundamental change signal a coming trend in CAHPS surveys? Let’s explore some of the industry drivers fueling the change, along with some key findings from HealthStream’s e-survey pilot testing.
CG-CAHPS Survey Background
The CG-CAHPS survey is designed to measure the physician office patient experience. The survey is not yet mandated by CMS. But CMS’s recent proposed rule revising the physician fee schedule included CG-CAHPS in new quality reporting measures, with plans for an initial survey pilot as early as 20131. When the survey is mandated, it could impact more than 700,000 physicians in over 200,000 practice sites nationwide, as well as numerous mid-level providers.
The sheer scale of the survey is likely one reason AHRQ first approved e-survey as an option for CG-CAHPS. A second factor may be the anticipation of pushback from physicians, many of whom are still acclimating to the need for a patient experience survey. So the promise of scalability that e-survey brings is important from the standpoint of both cost and practicality.
For now, the fact that CG-CAHPS is not nationally mandated means that hospitals and physician practices are able to test these new cost-effective options and gain the competitive advantage that early adoption brings.
For e-Survey, The Time is Right
E-survey has historically been passed over as a legitimate data collection platform for good reason. Internet and email adoption rates have lagged behind for some of the key patient populations, namely seniors age 65 and over. But with U.S. overall internet adoption rates now over 80 percent, and over half of seniors now online and using email, the platform is ready for initial use2. Given that email still lacks the ubiquity that phone and mail enjoy, however, it is unlikely that CMS will approve e-survey options that lack follow-up by a more proven methodology. That is why HealthStream has focused our testing on these “mixed mode” methodologies and recommends this approach for our CG-CAHPS clients.
Key Takeaways from e-Survey Testing
HealthStream’s initial testing of the e-survey’s effectiveness as a data collection platform has been highly successful. In one of our initial pilot studies, combining three waves of e-survey followed by a single wave of mail follow-up, we saw an impressive response rate of over 28 percent for the e-survey component alone.
The chart presented here shows the percent of total responses by age segment, with the red bars highlighting e-survey results and the gray bars indicating mail responses. As you might expect, the 64 and under demographics drive the majority of e-survey responses. However, the lower number of e-survey responses from seniors shown here is not adjusted for the relative lack of email addresses collected for that age group in this particular pilot sample.
This leads to the first key takeaway from our initial testing: The e-survey option gives physician practices and hospitals additional leverage in the quality of their survey products. Organizations that collect higher percentages of valid patient email addresses will yield a proportionally higher rate of survey returns – and a lower cost per completed survey.
The second takeaway is that mixed-mode methodologies provide a highly complementary approach to fielding surveys, as demonstrated by the traditional bell curve of the combined e-survey and mail response totals in the chart. This ensures that your organization is reaching a representative sample of your patient population while leveraging more scalable and cost-effective options for deployment.
The final observation is that hospitals and physician practices should start preparing for e-surveys now. Regardless of when you might start your CG-CAHPS deployment, it will take some time to implement the processes and systems needed to collect patient email addresses. Providers should also begin using effective patient communication tools, such as the posters and collateral materials HealthStream provides their clients, to educate your patient base about why it is important for them to provide email addresses.
Will e-Survey Catch On?
It is likely that AHRQ and CMS are using CG-CAHPS as a test bed for the efficacy of e-surveys. If it shows success, as it has in HealthStream’s experience, the platform will likely begin gain approval for use with other patient survey types (except where certain patient characteristics require the use of phone surveys, as is the case with In-Center Hemodialysis survey3). For surveys that are not currently mandated, such as ED and related outpatient surveys, the platform provides a great opportunity to return a higher number of total survey completes at much more affordable price points
The rise of consumerism and the concurrent adoption or patient engagement channels like social media, patient portals and personal health records, will continue to increase the need for patient email addresses – as well as the likelihood that patient will be willing to share their addresses. Additionally, ACOs and patient-centered care will ultimately hinge on the ability of these organizations to manage patient populations across a number of critical segments, requiring meaningful and effective communications with healthy populations as well as sick and chronically-ill patients.
Email and internet communication is already becoming a vital link in this next generation of care delivery. So too will monitoring the patient experience along and beyond the continuum of care, bringing with it a new generation of more sophisticated and integrated survey solutions.
Footnotes
1 Federal Register, July 30 https://www.federalregister.gov/articles/2012/07/30/2012-16814/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-dme-face-to-face
2 Pew Internet, April 2012 http://pewinternet.org/
3 For more info see http://blog.healthstream.com/blog/?Tag=In-Center+Hemodialysis
Click here to Download the free HealthStream CG-CAHPS white paper.
By Kimberly S. Clark, RN, BSN, MBA; Senior Director, Product Management; HealthStream
Most HealthStream customers are accredited by the Joint Commission or another accrediting body. These customers undergo routine reviews, and many report that using the HealthStream Learning, Performance, and Competency Centers has simplified the review process and taken some of the worry out of it for them.
EASY TO ASSEMBLE DOCUMENTATION FOR REVIEWS
The most important feedback customers share about having HealthStream on their side during accreditation reviews is the comfort in knowing that information is always available and easy to find. Instead of sifting through cabinets full of folders and paper, system administrators can quickly access aggregate data through standard reports and information specific to individual employees, such as performance evaluations or compliance with regulatory courses.
Joint Commission reviewers have been "wowed" by how quickly system administrators can access key information critical to the review process. While many organizations are still tracking compliance with paper forms and checklists, HealthStream customers may never have to print a single piece of paper.
DOCUMENTING COMPLIANCE MADE SIMPLE
HealthStream makes simple work of compliance with standards. Customers report record levels of employee compliance with required activities after implementing HealthStream products. Employees find the system simple to use and required activities easy to complete. Because of this, some of our customers have achieved near 100% on-time compliance with educational and performance management requirements. Standard reports make demonstration of this compliance even easier.
STANDARDIZATION MATCHED BY FLEXIBILITY
HealthStream customers report better management of learning, performance, and competency activities across their organizations using HealthStream products. One customer reported having more insight into parts of the organization that previously "fell through the cracks." Joint Commission reviewers can see that management of critical activities is controlled through the appropriate area and that standards are applied uniformly across the organization.
EVIDENCE OF REQUIRED ACTIONS
Incorporating follow-up actions based on incomplete or failed courses, competency assessments, and performance evaluations is an important part of an organization’s commitment to quality and continuous improvement. HealthStream customers have been able to easily show that required follow-up is not only institutionalized through policy but is enforced through the system’s configuration and confirmed through standard reports. HealthStream customers can quickly identify employees who have not met a minimum standard, such as an appropriate level of competency, and then require them to take the subsequent actions required by the policy, such as additional training, mentorship, or removal from their current responsibilities.
OUTSTANDING CUSTOMER SUPPORT THAT UNDERSTANDS URGENCY
HealthStream’s customer support has been there. Many of our customer support team members actually have spent time in your seat, managing HealthStream’s tools for a healthcare organization. They’ve likely been through a Joint Commission review, too. So, when you are faced with a team of reviewers walking through your doors, you can always call us for help. You will get a friendly, knowledgeable team member who understands the situation and the priority of the support you need. In addition, HealthStream supports over 40 very active local user groups with over 4,000 total members. We also have a powerful online community, where users can share their experiences and best practices.
With effective and easy to use products and the support of both HealthStream and a network of your peers, you can feel confident in your ability to meet–and even exceed–accreditation standards. As a result, Joint Commission or other accrediting body reviews could become a welcome opportunity to demonstrate the strength of your organization and the value you provide to the communities you serve.