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CLARION Case Questions and Answers


Question:
Are we operating under the assumption that Sunset has already met the criteria for Stage 1 meaningful use? If so, has the reimbursement been reflected in the financial statements for FY11?

Response:
Assume they meet meaningful use criteria but that they are not
participating in HITECH, so reimbursement is not reflected in financials
statements for FY11.

Question:
What is the TNM stage for Mr. LaFleur's lung cancer?

Response:
The cancer is a non-small cell Stage 3B lung cancer. The cancer stage was transcribed as 3B and 3D. 3B is the correct reference.

Question:
How was Jewish Health's cancer treatment plan relayed to Sunset Health for implementation

Response:
CDs of the medical records were hand carried to Dr. Musaki at Sunset.

Questions:
At Sunset Health System
1. How many clinical staff are employed: A. by the Hospital and B.Overall
2. How many non-clinical staff are employed: A.Hospital and B. Overall
3. We were given the staffing breakdown for Loganville Hospital what is the
staffing breakdown for Sunset?

Response:
We provided the mix of physicians practicing at Loganville to provide you with information about what specialists are available at this small hospital that could be relevant for Fred's care locally.

Regarding the number of clinical and non-clinical staff employed by the
Sunset Hospital and overall, if you think this information is important in
arriving at your recommendations, then do some research into what one might
expect to see at a 450 bed hospital that serves as a regional referral
center for smaller rural hospitals, and use your findings as your working
assumptions for how Sunset is staffed.

Questions:
Can we assume that Sunset Health has a reasonable staff of care coordinators, social workers, and clinical pharmacists who simply weren't involved in Fred's case? Or would these staff members need to be hired?

Does the Sunset System employ any social workers?

Response:
You can assume that Sunset Health has care coordinators, social workers, and clinical pharmacists.


Questions:
Does the Loganville Hospital have any type of patient relations department? Does the Loganville System employ any social workers?

Response:
You can assume that Loganville Hospital has some type of patient relations
department and that it employs social workers. If you need more specifics,
contact a hospital about the size of Loganville to learn more about what
they do, how it is organized, etc.

Question:
I had a question about the EHR system at Sunset, are they currently receiving Medicare and/or Medicaid EHR incentive money from the HITECH act?

Response:
They currently are not receiving EHR incentive money from the HITECH act.


Question:
I wish to ask for clarification that any medications ordered by a physician for Fred LaFleur were "verified" by a pharmacist on his oncology team. That is: is a "second-check" system currently in place at Sunset for any new medications ordered for this patient who has access to the patient's current conditions and medications?

Response:
Because the chemotherapy was administered in Sunset's outpatient cancer center no pharmacist was involved. It was prepared and administered by the clinic's nursing staff.


Question:
Is the "EPIC EMR" mentioned in the case the real-live company that can be found at http://www.epic.com/?

Response:
Yes, assume it is the same epic system as that belonging to epic.com


Question:
Can you clarify that Wyoming state is the location of the events of the case?

Response:
Yes, the bulk of Fred's care was in Wyoming, except that National Jewish Health is based in Colorado, as stated on page 8 of the case.


Question:
Can you give us an active provider count by department for Sunset Health System?

Response:
If you believe this is important information for providing recommendations, then as part of your research, you should make reasonable assumptions about what the provider count is by department by talking with clinicians in the field to ascertain what one might expect based on a hospital of this size and scope in the regional market.

Question:
My group is wondering if the focus of the recommendations/implementation plan should be on the errors that occurred at Sunset Health System or if we should be researching/analyzing the errors that occurred outside of the Sunset Health System as well?

Response:
If the mission, vision, and values speak to being integrated and best in class in north central Wyoming region, then coordination of care and handoffs between systems become part of your responsibility if you are to live your mission ,vision, and values.

Question:
On the content on page 9,It is unclear if this is an error, or if this was a mistake made in the explanation to the patient, as a clot secondary to paraneoplastic syndrome, is unrelated to etoposide. "It was determined that his headache was not caused by bleeding, but by a very large clot related to paraneoplastic syndrome, which they explained to Mary is secondary to etoposide therapy."

Response:
The Patients wife, being tired, scared, and overwhelmed, misheard the information. The clot was related to the etoposide. The Providers had been worried about Paraneoplastic Syndrome, But this had been ruled out.