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8 Epic EHR implementations with the biggest price tags in 2015

Investments in EHR systems are undoubtedly costly, but some implementations appear to carry more costs than others.

Implementation costs vary system to system and hospital to hospital. Prices fluctuate based on what types of additional features and modules a hospital selects. And, according to a Politico report, some EHR vendors charge for additional service fees while others don’t. The Politico report indicates for Epic’s 2014 edition software, the Verona, Wis.-based EHR vendor charges a software licensing fee, implementation costs and annual maintenance costs while OpenVistA, developed by Carlsbad, Calif.-based Medsphere, for example, does not.

Even within the subsector of Epic implementations, costs fall across the board. For example, Duke University Health System, based in Durham, N.C. paid approximately $700 million for its Epic EHR (systemwide go-live in 2014) while Dartmouth-Hitchcock Medical Center in Lebanon, N.H. paid $80 million (go-live in 2011), according to a Forbes report.

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center. said in the Politico report that hospitals selecting Epic’s platform are not just buying a product — they are buying a process. BIDMC does not operate on Epic’s EHR; rather, the hospital earlier this year forged a partnership with athenahealth, which included using the Watertown, Mass.-based vendor’s product.

“Epic is selling a methodology; often a lot of manual processes or heterogeneity and standardizing the work,” Dr. Halamka told Politico. “It’s not that they’re buying expensive software, they’re buying a lot of software.”

No matter where the prices come from, the cost of Epic installations are significant. Here are eight of the most costly Epic implementations reported within the past six months. These are working numbers, with some systems having allotted the indicated amounts to implementation projects and others that have already completed installations.

Partners HealthCare: $1.2 billion
Boston-based Partners HealthCare is one of more recent implementations, going live the first week of June to the tune of $1.2 billion. This is the health system’s biggest investment to date. The implementation process took approximately three years, and in that time, the initial price tag of $600 million doubled.

LehighValleyHealth Network: $200 million
LVHN started its switch to Epic’s platform in February 2015, but the full transition will take between four and six years. Harry Lukens, CIO of the Allentown, Pa.-based system, told The Morning Call the total investment dedicated to the installation includes software, hardware, data conversion and additional personnel.

Mayo Clinic: “Hundreds of millions”
In January 2015, Rochester, Minn.-based Mayo Clinic announced it selected Epic’s EHR and revenue cycle management platforms and planned to drop its Cerner and GE Healthcare contracts to do so. The value of the contract was not disclosed by the health system or the vendor, but stock analysts told The Kansas City Star it is worth “hundreds of millions of dollars over several years.” Additionally, the headline of the Star report reads “Cerner loses Mayo Clinic contract worth hundreds of millions of dollars to Epic,” indicating a ballpark estimate of the new contract’s value.

LaheyHospital Medical Center: $160 million
On March 28, 2015, the Burlington, Mass.-based hospital completed its two-year implementation of Epic’s EHR system. Two months later, Lahey Health said it was laying off 130 people at three hospitals to close the budget gap. In the six months ended March 31, the health system had lost $21 million, partly due to preparatory EHR implementation costs.

Lifespan: $100 million
Providence, R.I.-based Lifespan announced plans to implement Epic’s EHR in March 2013, and the health system went live April 2015. Lifespan initially projected the implementation to cost $90 million, but in a Rhode Island Public Radio report, John Murphy, MD, executive vice president of physician services, alluded to a total closer to $100 million.

Erlanger Health System: $97 million
Chattanooga, Tenn.-based Erlanger Health System signed a contract with Epic in May 2015 nearing $100 million. The health system will invest $91 million in capital expenses, but operating expenses will bring the total to $97 million over the next 10 years. Erlanger was deciding between Epic and Cerner’s platform and ultimately chose Epic because the bid was less expensive, CFO Britt Tabor told Times Free Press .

WheatonFranciscan Healthcare: $54 million
In January 2015, Glendale, Wis.-based Wheaton Franciscan Healthcare announced plans to implement Epic across its hospitals. The system’s affiliated medical group and physician offices have been using Epic’s EHR since September 2012, but providers across the system can only view patient records and not input information. The implementation will create one central EHR platform across the system. Go-lives will begin January 2016. The system expects a return on investment after four years of using the platform.

Saint Francis Medical Center: $43 million
The hospital in Cape Girardeau, Mo. contracted with Epic in February 2015 and expects to go live in July 2016. Saint Francis plans to connect and exchange records with other hospitals in the St. Louis area also using Epic’s system, including SSM Health and Mercy Health.

Worth noting
A handful of other hospitals and health systems reported signing contracts with Epic this year but did not disclose the costs of the IT projects. Some of these organizations include Arlington Heights, Ill.-based Northwest Community Healthcare, SSM Health St. Mary’s Hospital-Audrain in Mexico, Mo. Oklahoma State University Center for Health Sciences in Tulsa, San Diego-based Scripps Health and St. Louis-based BJC HealthCare.

Editor’s note: An earlier version of this article identified Saint Francis Medical Center as being located in Dexter, Mo. We have updated the article to include the correct location, and we apologize for the error.

More articles on EHRs:

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Software Development Life Cycle

Software Development Life Cycle, SDLC for short, is a well-defined, structured sequence of stages in software engineering to develop the intended software product.

SDLC Activities

SDLC provides a series of steps to be followed to design and develop a software product efficiently. SDLC framework includes the following steps:

Communication

This is the first step where the user initiates the request for a desired software product. He contacts the service provider and tries to negotiate the terms. He submits his request to the service providing organization in writing.

Requirement Gathering

This step onwards the software development team works to carry on the project. The team holds discussions with various stakeholders from problem domain and tries to bring out as much information as possible on their requirements. The requirements are contemplated and segregated into user requirements, system requirements and functional requirements. The requirements are collected using a number of practices as given –

  • studying the existing or obsolete system and software,
  • conducting interviews of users and developers,
  • referring to the database or
  • collecting answers from the questionnaires.

Feasibility Study

After requirement gathering, the team comes up with a rough plan of software process. At this step the team analyzes if a software can be made to fulfill all requirements of the user and if there is any possibility of software being no more useful. It is found out, if the project is financially, practically and technologically feasible for the organization to take up. There are many algorithms available, which help the developers to conclude the feasibility of a software project.

System Analysis

At this step the developers decide a roadmap of their plan and try to bring up the best software model suitable for the project. System analysis includes Understanding of software product limitations, learning system related problems or changes to be done in existing systems beforehand, identifying and addressing the impact of project on organization and personnel etc. The project team analyzes the scope of the project and plans the schedule and resources accordingly.

Software Design

Next step is to bring down whole knowledge of requirements and analysis on the desk and design the software product. The inputs from users and information gathered in requirement gathering phase are the inputs of this step. The output of this step comes in the form of two designs; logical design and physical design. Engineers produce meta-data and data dictionaries, logical diagrams, data-flow diagrams and in some cases pseudo codes.

Coding

This step is also known as programming phase. The implementation of software design starts in terms of writing program code in the suitable programming language and developing error-free executable programs efficiently.

Testing

An estimate says that 50% of whole software development process should be tested. Errors may ruin the software from critical level to its own removal. Software testing is done while coding by the developers and thorough testing is conducted by testing experts at various levels of code such as module testing, program testing, product testing, in-house testing and testing the product at user’s end. Early discovery of errors and their remedy is the key to reliable software.

Integration

Software may need to be integrated with the libraries, databases and other program(s). This stage of SDLC is involved in the integration of software with outer world entities.

Implementation

This means installing the software on user machines. At times, software needs post-installation configurations at user end. Software is tested for portability and adaptability and integration related issues are solved during implementation.

Operation and Maintenance

This phase confirms the software operation in terms of more efficiency and less errors. If required, the users are trained on, or aided with the documentation on how to operate the software and how to keep the software operational. The software is maintained timely by updating the code according to the changes taking place in user end environment or technology. This phase may face challenges from hidden bugs and real-world unidentified problems.

Disposition

As time elapses, the software may decline on the performance front. It may go completely obsolete or may need intense upgradation. Hence a pressing need to eliminate a major portion of the system arises. This phase includes archiving data and required software components, closing down the system, planning disposition activity and terminating system at appropriate end-of-system time.

Software Development Paradigm

The software development paradigm helps developer to select a strategy to develop the software. A software development paradigm has its own set of tools, methods and procedures, which are expressed clearly and defines software development life cycle. A few of software development paradigms or process models are defined as follows:

Waterfall Model

Waterfall model is the simplest model of software development paradigm. It says the all the phases of SDLC will function one after another in linear manner. That is, when the first phase is finished then only the second phase will start and so on.

This model assumes that everything is carried out and taken place perfectly as planned in the previous stage and there is no need to think about the past issues that may arise in the next phase. This model does not work smoothly if there are some issues left at the previous step. The sequential nature of model does not allow us go back and undo or redo our actions.

This model is best suited when developers already have designed and developed similar software in the past and are aware of all its domains.

Iterative Model

This model leads the software development process in iterations. It projects the process of development in cyclic manner repeating every step after every cycle of SDLC process.

The software is first developed on very small scale and all the steps are followed which are taken into consideration. Then, on every next iteration, more features and modules are designed, coded, tested and added to the software. Every cycle produces a software, which is complete in itself and has more features and capabilities than that of the previous one.

After each iteration, the management team can do work on risk management and prepare for the next iteration. Because a cycle includes small portion of whole software process, it is easier to manage the development process but it consumes more resources.

Spiral Model

Spiral model is a combination of both, iterative model and one of the SDLC model. It can be seen as if you choose one SDLC model and combine it with cyclic process (iterative model).

This model considers risk, which often goes un-noticed by most other models. The model starts with determining objectives and constraints of the software at the start of one iteration. Next phase is of prototyping the software. This includes risk analysis. Then one standard SDLC model is used to build the software. In the fourth phase of the plan of next iteration is prepared.

V – model

The major drawback of waterfall model is we move to the next stage only when the previous one is finished and there was no chance to go back if something is found wrong in later stages. V-Model provides means of testing of software at each stage in reverse manner.

At every stage, test plans and test cases are created to verify and validate the product according to the requirement of that stage. For example, in requirement gathering stage the test team prepares all the test cases in correspondence to the requirements. Later, when the product is developed and is ready for testing, test cases of this stage verify the software against its validity towards requirements at this stage.

This makes both verification and validation go in parallel. This model is also known as verification and validation model.

Big Bang Model

This model is the simplest model in its form. It requires little planning, lots of programming and lots of funds. This model is conceptualized around the big bang of universe. As scientists say that after big bang lots of galaxies, planets and stars evolved just as an event. Likewise, if we put together lots of programming and funds, you may achieve the best software product.

For this model, very small amount of planning is required. It does not follow any process, or at times the customer is not sure about the requirements and future needs. So the input requirements are arbitrary.

This model is not suitable for large software projects but good one for learning and experimenting.

For an in-depth reading on SDLC and its various models, click here.


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Motorcycle Insurance Rates and Discounts

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Motorcycle insurance discounts we offer

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All About Menstruation

Ever wonder what really happens during menstruation. when a girl enters puberty and has her period? Maybe you’ve wanted to talk to your mom, sister, or dad about it. But each time you said the word “menstruation ,” you stuttered, stammered, and could barely pronounce it.

It’s OK. Everyone is timid when talking about bodily functions, especially one as mysterious as the menstrual period. Perhaps this article can answer some of your questions about this normal time in every girl’s life.

What Is Menstruation?

Shortly after the beginning of puberty in girls, and usually about 2 years after the development of breasts. menstruation starts. While menstruation usually begins between ages 12 and 13, it may happen at a younger or older age. The first menstrual period is called “menarche .”

The menstrual cycle is about four weeks long, starting on the first day of bleeding and ending when the next period begins. However, it can vary greatly when a girl first starts her period. It may skip months or come several times per month in the beginning.

The menstrual discharge comes from the uterus through the vagina. The uterus is a hollow, pear-shaped organ, responsible for maintaining and nourishing the embryo and fetus during a pregnancy. The vagina. or “birth canal,” provides a path for menstrual fluids to leave the body.

During a period, there are usually 2-3 days of relatively heavy bleeding followed by 2-4 days of lighter flow. The fluid during a menstrual period is a mixture of uterine lining tissue and blood .

The total mo nthly menstrual loss varies from about 4 to 12 teaspoons.

What Does a Menstrual Period Feel Like?

A few days before and during your period, you might feel cramping and bloating in your abdomen. The cramps are caused by increased production of hormones. These hormones (called prostaglandins) cause the muscles of the uterus to contract.

Many teens who have cramps also notice aching in the upper thighs along with lower back pain. Some also notice nausea. diarrhea. irritability, headaches. and fatigue. among other symptoms.

To ease cramping, try applying heat to your abdomen with a heating pad or hot water bottle. Taking a warm bath may also help. Some teens find that exercise helps relieve cramps. Exercise improves blood flow and produces endorphins, the body’s natural painkillers.

Continued

Simple but effective non-prescription pain relieving medications can ease symptoms. These include acetaminophen (Tylenol ) and non-steroidal anti-inflammatory drugs (NSAIDs ). NSAIDs include medications like ibuprofen (such as Motrin and Advil ) and naproxen (such as Aleve ). These drugs block the effects of prostaglandin hormones.

Discuss symptoms with your primary health care practitioner, so you can find the best medications and dosage.

Talk to your primary health care provider or your gynecologist if:

  • Your cramps are severe
  • Your bleeding is excessive, lasts longer than 7 days, occurs often or at the wrong time of your cycle
  • If you have not had your first period by age 16
  • If it has been 3 months since your last period
  • You think you might be pregnant
  • You develop fever and feel sick after tampon use

Cramps are normally worst during the first two to three days of your period, then ease as prostaglandin levels in the body return to normal. If cramps stay about the same throughout your period, or if over-the-counter painkillers don’t really work, see a doctor.

Always ask your primary health care provider any questions you have about your period, making sure you clearly and completely describe any concerns.

How Long Does a Period Last?

Your first period may last from two to seven days. Then, there might be 21 to 40 days or even longer before you have another period. Your next period might be heavier or lighter than the first.

Don’t worry if your early periods have longer cycles or don’t follow a schedule. This irregularity is normal for at least the first 2 years.

Your periods should become more regular within two years after you start menstruating. Some teens have a 28-day cycle; some have a 24-day cycle; others have a 30- to 34-day cycle. All of these are normal. For young teens, cycles can range from 21 to 45 days. For adults, it can be 21-35 days. If your period is much shorter or longer, or if your period does not become regular after two years, see your primary health care provider.

Continued

It is possible to skip a month, especially if you have been ill or under stress. (Tell your health care provider at once, however, if you miss a period and are having s exual intercourse. Even if you are using effective birth control. pregnancy is a possibility!) But skipping for more than one month once your periods have become regular is another reason for a doctor visit.

When your period becomes regular, mark the date on your calendar for several months ahead. This will remind you to have tampons or pads on hand and help prevent accidents.

What Is Ovulation?

Ovulation is the release of a mat ure egg from a woman’s ovary. It usually happens around mid cycle (about 14 days from the start of your last period).

Some might feel abdominal discomfort at the time of ovulation. but it’s usually very brief. This discomfort, medically called by its German name mittelschmerz (pain in the middle), can usually be relieved by the same medication used for cramps.

What About PMS?

Premenstrual syndrome. or PMS. happens to many teens right before their periods start. With PMS, you might feel:

  • Mild breast tenderness
  • Fluid retention
  • Anxiety
  • Dietary cravings
  • Irritability
  • Difficulty sleeping or excessive sleeping

When menstruation begins, PMS symptoms decrease.

Some young women find that they cry easily and are more emotional during this time. Understanding the feelings that come with PMS may help you cope with the emotions. If your symptoms are serious and interfere with your life, discuss them with your health care practitioner.

Should I Use Tampons or Pads?

Teens can use tampons, pads, or both during their period. Tampons are worn inside the vagina and come in a variety of sizes (small to large) with different absorbencies (light to super heavy). It’s important to change a tampon at least every four to 8 hours to avoid leakage and serious bacterial infections. According to the company Tampax, you can wear a tampon overnight, but insert a new one before bed and change it first thing in the morning.

Continued

Pads are usually self-adhesive and worn inside the underwear. You can find pads for light days, heavy days, and overnight. Change pads at least every four hours to avoid leakage and odor.

It’s important to understand your body as you decide on tampons or pads. Girls who participate in sports may find tampons less bulky and restrictive than pads. Girls are able to swim with tampons. Still, other girls think tampons are uncomfortable and prefer to use pads. It may take a while to find the right product for you.

Whether you choose tampons or pads, keep extras in your school locker or in a side pocket of your purse. Change the tampon or pad more frequently on heavy days to avoid an embarrassing stain on your clothes.

If you ever have trouble taking a tampon out, see your health care practitioner immediately. Tampons should be changed at least every 4 to 8 hours. Use the lowest absorbency tampon you can depending on your flow. Tampon use increases risk for toxic shock syndrome compared to pad use, especially if you don’t change tampons frequently enough or use highest absorbency tampons on the lightest flow days. Toxic shock syndrome is a life-threatening disease related to toxins from bacteria.

Is It Normal to Miss a Period?

Many things, such as the stress of exams or an illness like the flu. can cause you to skip a period. Too much exercise and low body weight may also cause the loss of your menstrual period. If you continue to miss your period, be sure to talk to your doctor.

What If I’m 16 and Haven’t Yet Started My Period?

If yo u are age 16 and still have not started your period, talk to your doctor to make sure there are no problems.

WebMD Medical Reference Reviewed by Dan Brennan, MD on April 24, 2017

Sources

WebMD Medical Reference: Normal Menstrual Cycle.

Cool Nurse.com: “What You Need to Know About Menstruation.”

American College of Obstetricians and Gynecologists: “Especially for Teens: Menstruation.”

The National Women’s Health Information Center: “Menstruation and the Menstrual Cycle.”

Tampax: Usage questions: “Can I use a tampon overnight?”

© 2017 WebMD, LLC. All rights reserved.