Peter Ragusa

Peter Ragusa, MD, MPH Joins Prista Corporation as Chief Medical Officer / Chief Operating Officer

Dr. Ragusa brings over 15 years of experience in leadership and executive management to Prista’s growth, business development, and strategy

[Austin, Texas]

Prista Corporation, an industry leader in clinical intelligence software for healthcare quality-safety improvement, is proud to announce that Peter Ragusa, MD, MPH has joined the executive team as Chief Medical Officer and Chief Operating Officer.

“Prista is innovating around patient safety and quality and performance improvement, they have a great product and a great team, and I am very excited to be joining them in their mission to lower costs while improving the quality and safety of care that patients receive,” said Dr. Ragusa.

Dr. Ragusa has over 15 years of experience and expertise in healthcare, executive leadership and strategic planning, building and leading multidisciplinary, high-impact teams, full-cycle product development, federal, state, and local regulatory compliance, facilitating corporate partnerships, successful fundraising, and developing intellectual property.

Prior to joining Prista, Dr. Ragusa was the co-founder and CEO of Better Day™ Health, a clinical documentation automation company. He also held positions at the American Medical Association (AMA) and the National Board of Medical Examiners (NBME). Dr. Ragusa is a graduate of Louisiana State University, the University of Minnesota Medical School, and the Yale University School of Public Health.

“Prista is poised for growth, and we will be pursuing an aggressive growth strategy as we come into the new year,” said Dr. Ragusa. As CMO/COO, Dr. Ragusa’s influence will also include other key areas such as cultivating strategic relationships and leading business development.

Don Jarrell, Prista’s President said, “We’re really excited to be bringing Peter on-board as our Chief Medical Officer because he is exactly the right person at the right time to help bring our growth plans for 2020 and beyond to fruition. Peter’s strong experience as a successful founder and CEO of a clinical documentation software company and his business instincts, perspectives, and initiative blend perfectly with the rest of Prista’s Executive Team. This will allow us to rapidly accomplish sales growth, recognition in the marketplace and key relationships with marketing and technology partners.”

About Prista Corporation: Prista’s mission is to help healthcare providers improve performance, both clinically and financially, while creating and sustaining a “Culture of Quality” in their organizations. In other words, Prista helps to facilitate an environment that drives continuous performance improvement in patient care and safety. Prista does this by developing innovative, intuitive, easy-to-use software that goes beyond traditional reporting to provide actionable insights in real-time. Prista’s ActionCue CI platform makes information more readily available, more meaningful, and more actionably insightful for healthcare executives, managers, and clinical staff.

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ActionCue Clinical Intelligence Software

3 Reasons Why “Designed by Clinicians” is Not Going to Save Healthcare IT

A recent article in Medical Economics, “The Promise of Next Generation EHRs” was an interesting read.  It got me thinking, and there were a few parts of the article that left me uneasy, given the challenges in healthcare today.

First, the article cited reports that point to software as the primary administrative burden to physicians’ productivity. The article notes that inefficiencies in software lead to click fatigue and multitasking, which ultimately lead to mistakes.

Indeed, mistakes are very serious problems in healthcare. However, it’s not only physicians who suffer from inadequate software - nurses, clinicians and a host of administrative staff are spending most of their day using various software systems and applications.

Second, and perhaps more importantly, while stressing the need for flexibility and usability in information technology for healthcare orgs, the author specifically advocates that the best software is “designed by clinicians”. Ironically, this “designed by clinicians” paradigm is a major contributor to the dissatisfaction many users have with healthcare software products – including EHRs.

Of course, healthcare application vendors would be silly not to include significant input from current and former clinicians. Clinicians’ hands-on experience is invaluable to clinical in the form of environmental background, workflows, user scenarios, use cases, specific requirements and other types of content.

The much greater concern over healthcare institutions jumping onto the “designed by clinicians” bandwagon is that it quickly leads to the idea that software must be designed, not by just any clinicians, but by their own in-house team of clinicians.

Thus, when considering new software products, healthcare leaders are quick to ask the vendor, “Can we customize it?” (meaning a unique instance of a product, custom-developed for an organization) before they have seen much of the existing product.  That question is where the real trouble begins. It is far from the end of the story, however.

Challenges in Healthcare Software Design

Improving software in healthcare is a noble - and very necessary – goal. But when the rubber meets the road, software designed exclusively by clinicians leads to three major pain points that are already widespread in healthcare organizations.

Problem #1 – Clinicians and Developers working together: mismatched skills match lead to less than optimal products

 The best software vendors use highly trained with a wide breadth of expertise in fields like information engineering, perceptive science, psychology, user interface (UI) and user experience (UX), for starters.

It takes all these skills and more to shape an optimal UX for a software product. Unfortunately, not every software developer is also gifted with design skills. Similarly, clinicians are untrained in the various disciplines of UX employed by a design expert during the product development process. As end-users, clinicians are often better at describing the problem rather then envisioning “clean slate” solutions that could drive the desired results.

In other words, both sides may be operating outside their area of expertise. Thus, having clinicians tell programmers what they want can lead to problems such as:

  • Communication breakdown over terminology
  • Conflicting approaches to both the problem(s) and potential solutions
  • Extra time spent in design and review processes to educate clinicians on UX and design principles
  • Important design features are diminished or omitted

To avoid this scenario, I feel that the best outcomes result from software designed not by, but with clinicians at multiple points during the design, development and maintenance phases of the software lifecycle.

Problem #2 – Customized product development “branches” leads to higher cost, but not necessarily higher performance

In recent years, custom development of healthcare management platforms has become ever more common. Vendors are eager to offer customization because they can charge more for the end product, while simply passing on the additional development costs directly to the customer. For some, in fact, it’s become a major part of their business model.

The more vendors provide custom development, the more customers ask for it, and so begins a vicious cycle. But the ugly truth is, while custom development or “customization” of healthcare IT products is lucrative for the manufacturer, it doesn’t necessarily benefit the customer. Much of customization work amounts to simple personal preferences which have no effect on patient care outcomes. Custom-developed products

Problem #3 - People tend to lean on (and thus design based on) what they know

One of the most important skills professional software designers have is the applied fundamental of design thinking. Design thinking uses a set of defined principles and constructs, combined with a very intentional process, to realize a desirable end product. Design thinking helps product designers fight the (very human) urge to “go with what you know”.

Most of us, when asked how a new system or product should look or work, will describe something very much like what we have used in the past – regardless of how well that product met our needs. People tend to lean on familiarity (often without even realizing it) which results in a “that’s the way we’ve always done it” attitude. It is this attitude that holds back much-needed progress in hospitals, clinics, and other healthcare organizations.

The unintended consequences of this perpetual cycle are:

  • Unintuitive platforms that are difficult to use
  • Software that feels just like a digital version of outdated paper forms
  • Expensive cycles of customization
  • Wariness at trying new products and systems

After a few years and many thousands of dollars, too many healthcare organizations find themselves still encountering the same problems.

Taking steps toward meaningful and effective change in healthcare Performance Improvement Software

So what should healthcare organizations do? It will require a major attitude shift to get out of the rut that’s been dug over decades of stagnation and frustration at ineffective systems. Meaningful change requires buy-in, starting with management on down through all levels of the organization.

Here are some starting principles for effective change:

  • Commit to innovation in selecting, acquiring and using healthcare management software
  • Accept the idea that progress comes with a certain amount of pain
  • Seriously consider newer, smaller vendors because they are the ones best positioned to truly innovate
  • When evaluating a product, focus more on organizational goals and actionable insights needed and less on tasks, processes and reports used in the past
  • Give turnkey products a chance to demonstrate their full functionality before asking about what can be built
  • Focus on whether a product is intuitive, easy-to-use and even exciting to think about using. If it’s not, keep looking

Developing New Approaches in Healthcare Performance Improvement Platform Software

The takeaway here is that optimal product design “takes a village” – a multi-disciplinary team that includes, but is not controlled by, end users (clinicians, physicians, administrative staff).

ActionCue CI is built upon this principle. Our innovative solution was developed in partnership with clinicians, as well as highly trained UX/UI product designers, to address known problems in ways that go beyond what myopic visions of what so-called ”new” solutions can lead to. The dashboard is configurable to meet the unique needs of risk managers, clinicians, and healthcare executives while avoiding the pitfalls of full customization, resulting in a more cost-effective and intuitive product that end users love.  By providing configurability without customization, ActionCue CI delivers an affordable solution that still meets specific users’ needs.

Would youlike to learn more about ActionCue CI and how it can benefit your organization?

 While there, be sure to check out the “Watch It Work!” video and sign-up for brief walk-through of the platform from a Product Specialist.

Performance Improvement in Healthcare White Paper Released By Prista Corporation

Performance Improvement: The Hidden Link to Creating a Culture of Clinical Performance” is available now for download from www.PristaCorp.com

[Austin, Texas]

Healthcare providers are focused on delivering care. That means always seeking better ways to improve patient outcomes, make reporting easier, and meet financial goals. It’s a big job that never ends. That’s why  Prista Corporation Chief Mission Officer Billie Anne Schoppman and Prista’s President Don Jarrell have co-authored a white paper aimed at helping healthcare executives and others in leadership positions develop a performance improvement focused culture of quality.

The paper sets out a powerful, results-based definition of clinical performance, then moves on to the “hidden link” in creating a Culture of Clinical Performance, including six key elements in creating a performance culture and how the right technology can support performance improvement. The white paper is available for download at www.pristacorp.com/hidden-link.

After reading the report, healthcare professionals in leadership roles will be better equipped to inspire and motivate their teams toward developing a true culture of quality and performance improvement that leads to better patient outcomes and improved financial performance. “After all, we didn’t get into this profession to enter data and generate reports. We want to deliver real improvement in patient’s lives,” said Billie Anne Schoppman, Prista’s Chief Mission Officer.

“Managing quality and risk and complying with reporting demand are only two legs of a three-legged stool,” said Don Jarrell, Prista’s President. “The “third leg” is a culture of clinical performance improvement. Without this, although a team might be well within compliance requirements, they are likely not delivering to their full potential and truly achieving performance improvement,” he continued.

Prista’s flagship product, ActionCue Clinical Intelligence (ActionCue CI), is transforming the way hospitals manage incident reporting, risk/quality management and performance improvement. No other software solution addresses all three functions in a single, integrated workflow. Billie Anne Schoppman, has over 35 years of experience in healthcare leadership roles, including patient quality and performance improvement in clinical settings. Don Jarrell has over 35 years of experience in product management and software design for healthcare and telecom industries.

Prista regularly publishes content on their website in the form of blog articles and downloadable white papers. In addition, Prista sends a monthly “quick read” digest of industry items of interest. White papers may be downloaded from the Prista website, and the site also contains a subscription form to get the monthly digest.

About Prista Corporation: Prista’s mission is to help healthcare providers create and sustain a “Culture of Quality” in their organizations. In other words, an environment that drives continuous performance improvement in patient care and safety. Prista does this by developing innovative, intuitive, easy-to-use software that goes beyond traditional reporting to provide actionable insights in real-time. With Prista’s ActionCue CI platform, information is more readily available, more meaningful, and more actionably insightful for healthcare executives, managers, and clinical staff.

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ActionCue clinical intelligence - reduce medical errors - trucks on road

On the Road to Recovery – Using Comprehensive Healthcare Event Reporting to Reduce Medical Errors

In March 2019, a Tennessee woman filed suit against Nashville-based Vanderbilt University Medical Center, claiming surgeons operated on her wrong kidney. As a result, the patient had to have a second surgery to correct the mistake, and she now needs dialysis for life. While this case was both rare and extreme, the fact remains that damaging medical errors are quite common, yet often preventable.

The World Health Organization (WHO) says more than 1 million patients die every year from surgical complications. And, there is a 1 in 300 chance of a patient being harmed during health care.

Clearly, more should be done to improve healthcare safety and quality and reduce risks to patients. Yet to say that the challenges of healthcare risk management are complex would be an understatement. Existing processes for risk management are fragmented and lack standardization. Many healthcare providers continue to use inferior systems that fail to analyze and synthesize data in a meaningful way. And all this in a rapid-fire environment, where threats can materialize in an instant.

Searching for the How and Why

When viewed as an individual benchmark, medical error reports only uncover so much. For example, an incident report of the Vanderbilt case would certainly show that the wrong site was operated on. But the more important question is Why? Perhaps the surgeon had been working too many consecutive hours. Maybe there was misinformation between departments. Or maybe a critical pre-op step, such as marking the operation site on the body, was overlooked. And if it was, why?

The how and why behind an incident are the real agents of change.

Finding the root causes behind errors in patient care is critical if we hope to prevent them from happening again. In fact, the only good that can come of such mistakes is the opportunity to learn from them and make process improvements – ultimately improving the standard of care and saving lives.

Risk Management Software for Increased Patient Safety

Reducing errors in patient care is not about having more medical knowledge, it’s about operational performance. And a basic incident report won’t change much.

When a safety event occurs, the first step is to record the basic facts in a patient’s medical record. While this step is both necessary and required, it excludes the information that is most important for analysis, learning, and operational change in the organization.

When things go wrong, both front line staff and healthcare administrators need access to comprehensive facts and circumstances surrounding the incident – as well as a clear, streamlined, and accountable improvement process. Fortunately, the right performance improvement platform can both identify and offer cues towards effective corrective and preventative actions, or CAPAs.

Hospitals, regional clinics, and surgery centers will benefit greatly from a single, comprehensive system for risk management., particularly one that integrates the many performance measures across the board, and that integrates all these activities into a goal-oriented, coherent whole. In order to keep up with the pace of care, they need analysis and synthesis of data in real-time. And most importantly, they need clear and manageable action plans based on that analysis.

The right platform for quality-safety improvement can provide insight into past incidents, identify existing performance trends, and offer a view of the future. ActionCue CI’s comprehensive dashboard facilitates the collection of information and circumstances surrounding healthcare incidents including planning errors, process errors, and failures to act.

Here are some of the key ways ActionCue CI makes quality-safety tracking and improvement more effective:

  • Anyone on staff can originate an Event Report with little or no training
  • There are 26 categories of events covered including Complaints/Grievances, HIPAA incidents, Abuse, Plant/Facility, Readmission, Sentinel Events, Security and Work-related Injury
  • The distributed workflow not only distributes the workload but obtains inputs from the best people to do so, including those nearest to the time and place of the event
  • Event Reports are passed to the next person in the workflow based on roles, permissions and assigned parts of the organization
  • The workflow, appearance and experience are designed with expertise in several disciplines
  • Individuals or groups have assigned responsibility for each step, but others can observe and review the content, or can be requested to confer on the content
  • Workflow progress is tracked so that stalled reports are identified to managers who can send reminders
  • Content (documents, photos, videos)can be uploaded/attached to the Event Report at any stage
  • Alerts can be immediately sent to select individuals when content of designatedcriteria is saved
  • Those with permission can track, review and research the Event Reports using a range of content filters while they are in progress or after completion
  • Follow-up activities, beyond the primary track of the Event Report workflow, can be tracked in terms of scheduled reminders and information or documents exchanged, with any internal or external organization
  • Built-in analytics and reports provide distribution data (histograms) of content occurrences, weighted analyses, time spent by workflow stage and event category, and much more insight, as soonas the events Reports are finalized, without any time delay or human effort.
  • Certain facts and circumstances are tallied in the Event Reports to form data points used in numerous Performance Measures like Fall Rate, Medication Variance Severity, and many more
  • Event Reports can be linked to Performance Improvement Action Plans, and vice versa, for easy human analysis

While some of these features may be of particular interest or importance to various users, the real power of ActionCue CI is that it was designed for a specific purpose – facilitating all stakeholders having a fundamentally different relationship with the data that allows them to better leverage their time and energy for true improvement.  While the change-averse may initially balk at such a dramatic shift, it is the right approach for long-term gains throughout the organization.  Optimal gains can only be achieved through a platform designed for this purpose.

Mistakes in healthcare have bad consequences for everyone, from injured patients to physicians who may face legal and professional troubles. By working to eliminate medical missteps, healthcare professionals can protect patients and themselves while lowering operational and cost inefficiencies in delivering better care. But if institutional practices do not change, nothing will change.

ActionCue CI Solution Value Based Purchasing

Losing Focus on Value in Value-Based Purchasing

When it comes to discussions about healthcare reimbursement and costs, “Value-Based Purchasing” is a term that gets thrown around quite a bit these days. In fact, many experts say it’s going to be the future for healthcare organizations.

Due to its growing use in hospitals and regional clinics, Value-Based Purchasing (VBP) has become a buzzword in healthcare. But as often happens with buzzwords, the original meaning becomes less salient to most people than their feelings and experiences with the subject. What exactly is the goal of value-based purchasing?

The Goal of Value-Based Purchasing

On paper, the methodology of VBP is simple: pay providers for quality and value, not just volume. Hold healthcare organizations accountable for both the quality and cost of the care they deliver and reward the best-performing providers.

The goal of VBP is to facilitate a high-level of care that is both safe and efficient. To reduce medical errors, lower the rate of accidents, achieve better patient outcomes, and maximize financial rewards. In an ideal world, clinics and hospitals will operate at optimal effectiveness and efficiency – resulting in lower prices for both patient and payor.

The Reality of Value-Based Purchasing

Organizations work hard, month after month, to achieve this noble “value proposition”.  But the everyday reality of succeeding for their organization in a Value-Based Purchasing program is far from simple.

Value-based care goals come with their own elaborate set of rules, metrics, benchmarks, reimbursement adjustment tables, and a million other things. The delay between capturing data and applying benchmarks to a provider’s reimbursement is significant. It’s all too easy for care providers to become immersed in the administrative minutiae of VBP and lose track of the program’s highest goal – better value for patients.

Therefore, whether you’re a front-line staffer or a top-level executive, it’s important to circle back to one basic question: “Does what we’re doing truly improve value?”. If the answer is “No” or, (as is often the case), unclear – then it’s time to evaluate the effectiveness of the task, process or tool on a fundamental level.

Getting Back to the Value in VBP

In order to shift the focus back to “value” in a value-based purchasing system, major changes need to occur in how departments think and work together.

Of course, a VBP-participating provider organization cannot completely ignore the necessary mechanics of the program without losing the reimbursement boosts it can provide. However, when the staff and management can focus on actual performance across the majority of their care-delivery operation, on a real-time basis, VBP success becomes a byproduct of genuinely improved clinical performance across the board.

As we see it, there are some real opportunities for core value improvement in the fundamental way the quality improvement operation is executed. For example:

  • Change the focus from reporting to insight, learning, and change. Lengthy and detailed reports do not improve anything. Make the improvement process the primary core function, make it effective and efficient, and reverse engineer the way the capture, processing, communication, and work on that related information is built to optimize improvement in Quality and Safety.
  • Involve executives by giving them the right lens on the subject matter. ActionCue’s event reports capture the facts and circumstances surrounding each adverse event, while the performance measures and analytics capture a big, coherent picture of the operations. Only by replacing the “too many moving parts” nature of Quality-safety with a complete story can we hope to provide proper executive buy-in and leaders to improve evidence-based outcomes and quality measures.
  • Get away from paper as inputs or outputs. Paper is static information that takes human effort to move, change and work on. ActionCue CI gives uses a workbench to support information work and receive actionable insights in a dynamic way.
  • Don’t be afraid to re-invent the process. Stop throwing more human effort at things that aren’t getting results, just because it’s “the way we’ve always done it.” That includes classes and meetings, that soon fade and impact the work far less than equipping the staff to actually work differently.
  • Think outside the box. The “mandated” way is not always the best way! Don’t let a mandated task, step or artifact chain the organization to an outdated, suboptimal overall process. Look for new and fundamentally more efficient processes that serve goal attainment, even if those small mandated tasks, that deliver less value, seem redundant.

Remember, the most precious things your team produces in running your operation and delivering care are actionable insights to improving value.  If you’re working more and getting less of that, CHANGE. Because the goal, after all, is value. Value for patients and value for care providers.

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