ASOTT - A Slip Of The Tongue

Health Care: Who is going to pay?

2009-03-15T08:42:00.000-07:00

I have been following Paul Levy's work through articles, his blog and his Twitter account. Paul Levy is the President & CEO of Beth Israel Deaconess Medical Center in Boston Mass, a teaching hospital of Harvard Medical school.

This man is going against status quo in a good way and I like that. It takes guts and not being liked. But that's okay. He has many friends, and I am one of them. For instance, he published the central line infection rates at his hospital for the public to see. I like that that philosophy. Transparency makes for greater accountability. Improved accountability will infuse action to issues that weren't being addressed before.

As more and more discussion come to the surface during our crisis with Health Care reform and financial recession, we need new processes, new ideas. New money isn't always the most effective way to improve efficiency in a hospitals state of operation. Making public your hospital acquired infection rates will certainly help improve care and reduce costs. You don't think nursing and providers will be paying attention to the fact that their patient care, or lack of, is being scrutinized? Think again. If we can get our health care providers to reduce Hospital Acquired Infections we can safe millions of dollars a year. One hospitalize acquired infection can cost up to $70,000.

Improved care doesn't need to cost us money.

If you are a health care provider or worker I hope you find a small way in your work or organization to make a difference. It could be you in that hospital bed depending on someone else to recognize the importance of improving their workflow processes and being able to own their improved actions.

Best regards.

Catalog

2008-05-18T12:05:00.000-07:00

The word on the street is the EMR order catalog will be frozen in June. This is in preparation for upload of Cerner 2007.16 code. Actually, the upload has begun. We are going through each individual order for the catalog to spit polish inaccuracies and errors. The med and radiology catalogs are the worse. We should have a solid catalog for go live which I anticipate next year, perhaps March.

These orders are the orders your doctor would write/enter for you if you were at UHC getting care. Anyway, I am behind in all the work I need to get done, so off to Powerchart and Excel file.....

I live with my laptop 24/7.

Cynicism and Truth

2008-03-29T09:56:00.000-07:00

http://histalk.blog-city.com/monday_morning_update_21207.htm

I like the website where all can speak freely for good or bad.
It's inevitable in this industry, Healthcare weds IT, to let ideas/feelings slip off your tongue.

Pending, pending, pending

2008-03-29T09:39:00.000-07:00

I hate the waiting, the pending status of CPOE. I want the second implementation to go through an exhaustive check and balance process. We will need strong systematic direction. My hopes for that are high. There is a new CIO whom came from Denver. His name is Jim Turnbull. Let's see if Mr Turnbull can turn this train on it's tracks and be the direction and exhaustivly compulsive conductor we need. Always remember, it IS about the patient!

Seems Turnbull moves around alot. A man who is hard to please? Maybe that's a good thing, or not? Time will tell:

"I left the organization in 1991 and then ended up working for an outsourcing company that has since disappeared, moved to Cincinnati, and worked as a director of IT at one of the suburban hospitals there. Then, ultimately became the CIO for the four suburban hospitals who were part of the system. The whole consulting company crashed. At about that time, the CIO that I worked with in Portland, Jim Turnbull, had since moved down here to Florida and there was a Director of IT position. So I moved down here in 1995. I was the Director of IS for five years. Jim left in 2000 to go to Denver Children’s. I was promoted to CIO." by Denis Baker.

http://histalk2.com/?s=turnbull

HOE-Short for whoring of orders

2008-03-14T17:15:00.000-07:00

I can't believe it. They are considering having our Health Unit Coordinator, HUC's, transcribe the paper order into the electronic ordering system that would have been, Computerized PROVIDER Order Entry, CPOE. It is a ludicrous plan in my clinical judgement and could not and should not be called CPOE. Order entry by anyone other then the provider is a "basterdized" CPOE process.

http://www.healthimaging.com/content/view/8530/68/

Computerized physician order entry (CPOE) isn’t a quick fix to improve efficiency, workflow and quality patient care. On the contrary, it requires a fairly technologically sophisticated facility and an exhaustive implementation process. But the benefits of adding CPOE are clear and compelling. Two facilities share their experiences in implementing CPOE.

Once she realized how much written orders delay patient care, Angela Nicholas, MD, chief medical information officer at Susquehanna Health System in Williamsport, Pa., was on board with CPOE. It may take less than two minutes for a physician to open a chart and write an order. However, the chart doesn’t get transcribed immediately. The physician probably has it for another 15 minutes or so and then the chart goes to the unit clerk. There’s no guarantee that the unit clerk will address charts with a first-in, first-out policy, which can add up to a significant delay in patient care. “It was very eye-opening to me,” says Nicholas.

She also found that unit clerks and nurses do a lot of interpretation of orders. Physicians order tests that aren’t even conducted anymore or the terminology is outdated. “So, the unit clerk is now trying to figure out the test the doctor really wanted to order,” says Nicholas. “With CPOE, that isn’t an option. Physicians will order exactly what they want.” Imbedded best practices and protocols pave the way.

Welcome to Lost

2008-03-13T19:59:00.000-07:00

Everyone from IT, to nursing to u-name-it are feeling a variety of emotions: paranoid, anxious, depressed, overjoyed, angry, bewildered, lost......

All because of 3 years or more of preparation for CPOE and ka-boom!.....postponment just 2 days before golive! I think it slowly sinking in what a big deal this is. Not to mention the money.

Now, there is no direction, not yet at least. The new CIO of IT, Trumbull, is due to start his new job March 24. Welcome to chaos.

I just think we need to throw out the bath water and the baby. Someone should be admonmished for not have a sound redundant system in place. Geez!

Downtime

2008-03-08T06:11:00.000-08:00

The U Hospital made a decision 2 days before our CPOE conversion to stop the train. It was stopped just before crossing the bridge. It appears that the IT infrastructure track has no redundancy plan. This blogger admits to anger for IT not being ready to prevent all the database from crashing at once. Their security, planning is ludicrous.

Stopping the CPOE conversion is a huge deal. It is going to cost the hospital money, big dollars and we already are losing millions each year from reimbursement funds (medicaid/medicare). We are a state facility.

I am so angry, I have to pause for now.....

Drawing

2007-09-30T17:05:00.001-07:00

We're All In This Together

2007-08-21T21:46:00.001-07:00

A happy little ditty by Ben Lee

The Waiting is Over

2007-08-21T20:30:00.000-07:00

On June 2nd, we converted to electronic Nursing documentation. Next conversion is CPOE and the interfaced ancillary documentation. That's the bigger beast.

For now, we are soothing the sores felt by the change, the loss of paper, the bumps and bruises and the hours it takes to chart. They say it will get better. I believe that, but do they, the bedside nurses? They will come to see it, but they need all the comfort, honesty and encouragement they can get. I hate having to say, "hang in there". That seems so cheap when the nurses are almost slaving to care for highly ill patients in this grand nursing shortage of our generation. Computers just don't seem as important and they are..... so..... discompassionate and cold.

Dear Nurse......Hang in there!

Testing

2006-08-13T08:18:00.000-07:00

There is a layer underneath the type and click of a medication order that most never see. The importance of which can not be overstated no matter how tedious the work is. A team of experts sometimes happy somtimes not are in the process of testing each sentence of an order making sure that the order populates to the correct place. It's similar to methodically sorting 76,001 shuffled decks of cards. Our goal is to accurately test each medication in the order catalog "with the serene confidence which a Christian feels in four aces." (Mark Twain)

Nurse and Pharmacist testing medication orders

Pharmacist and Respiratory Therapist testing medication orders

Error

2006-08-01T19:12:00.000-07:00

http://www.frontsteps.com/movies/animator_vs_animation/

Together We Make Desicions

2006-08-01T06:37:00.000-07:00

Give no decision till both sides thou'st heard.

Phocylides (6th Century BC)

The Trouble With Teamwork

2006-08-01T06:07:00.000-07:00

The Trouble with Teamwork

by Patrick M. Lencioni

http://www.pfdf.org/leaderbooks/L2l/summer2003/lencioni.html

Contrary to conventional wisdom, teamwork is not a virtue in itself. It is merely a strategic choice, not unlike adopting a specific sales model or a financial strategy. And certainly, when properly understood and implemented, it is a powerful and beneficial tool.

The first and most important step in building a cohesive and functional team is the establishment of trust. But not just any kind of trust.Teamwork must be built upon a solid foundation of vulnerability-based trust.

This means that members of a cohesive, functional team must learn to comfortably and quickly acknowledge, without provocation, their mistakes,weaknesses, failures, and needs for help. They must also readily recognize the strengths of others, even when those strengths exceed their own.

Teams that fail to disagree and exchange unfiltered opinions are the ones that find themselves revisiting the same issues again and again. All this is ironic, because the teams that appear to an outside observer to be the most dysfunctional (the arguers) are usually the ones that can arrive at and stick with a difficult decision.

Before deciding that teamwork is the answer, ask these questions of yourself and your fellow team

Can we keep our egos in check?

Are we capable of admitting to mistakes,weaknesses, insuffi-cient knowledge?

Can we speak up openly when we disagree?

Will we confront behavioral problems directly?

Can we put the success of the team or organization over our own?

If the answer to one or more of these questions is “probably not,” then a group of executives should think twice about declaring themselves a team.Why? Because more than structure, it is the willingness of executives to change behavior —starting with the leader of the organization—that should determine whether teamwork is the right answer.

Of course, that would require a different kind of courage; the courage not to be a team.

It Must Be Friday

2006-07-23T21:17:00.000-07:00

Chronic Cubicle Syndorme Study

2006-07-23T21:09:00.000-07:00

Intention Creates Reality

2006-07-22T06:25:00.000-07:00

We'll Even Leave The Light On For You

2006-07-13T05:36:00.000-07:00

DTA's

We reached our goal of 90%
and more.

Feelin' a little blurry ladies?

I have a feeling that this will not be the last of the late nighters.

Serenity

2006-07-12T21:33:00.000-07:00

Keeping Sane In Seclusion

2006-07-11T17:02:00.000-07:00

Stress Relief

1. Picture yourself near a stream.

2. Birds are softly chirping in the cool mountain air.

3. No one but you knows your secret place.

4. You are in total seclusion from the hectic world.

5. The soothing sound of a gentle waterfall fills the air with a cascade of serenity.

6. The water is crystal clear.

7. You can easily make out the face of the person you're holding underwater.

8. See? You're smiling already.

She's really laughing, but I can't tell you the joke. I don't think it 's allowed on the internet.

Cash Cow?

2006-07-08T23:33:00.000-07:00

Hmm? Found a most interesting post. I'm tempted to invest, but at what cost. My conscience?

Click on link below:

http://hitdude.blogspot.com/2006/03/cerner-is-cash-cow.html

Sky-Building Scape

2006-06-20T17:59:00.000-07:00

A meeting is taking place this Friday and I am anticipating an update on EMR. We shall see how all the testing has gone with ITS.

What Is PowerChart?

2006-06-14T08:36:00.000-07:00

The ITS deparment has done a spectacular job with a "How To.." page for our Care Transformation project. If this is a sign to come of our training then we will be in great shape. I am impressed. . .

Check it out!

http://uuhsc.utah.edu/its/training/olympus/howto.html

No Pain, No Gain

2006-06-02T21:19:00.000-07:00

3 Things You Want For Report

2006-06-02T19:55:00.000-07:00

Hey Mister, Got The TIME ?

2006-05-29T22:38:00.000-07:00

" Time is a great teacher, but unfortunately it kills all its pupils"

Hector Berlioze (French composer)

A key place for error is by not charting the CORRECT TIME ! That big green checkmark in the left hand corner begs for attention. Ignore it.

Pay attention to the quiet ones, such as TIME entry.

Remember, IGNORE the green checkmark until the TIME is right!

It's All Good

2006-05-23T08:24:00.000-07:00

Okay, so we hear Sinai fell down with EMR. But it appears they have picked themselves back up.

I found this education tool which incorporates alot of the Cerner tools we are using. Need help practicing after our superuser sessions. Here is a place to go. Just click on the link below.

By the way, when it asks for your login name, put down your Nurse Nancy, Nurse Todd, or swamp thing.....it's all good.

http://www.lifebridgehealth.org/body.cfm?id=3563

Keep checking back. You never know what might come up from the deep

Swamp Thing

2006-05-23T07:47:00.000-07:00

There is a reason why I named my blog what I did. I'm wordy and my fingertips are mouthy.

My tongue slips through my fingers frequently, as it can in email. I don't know, maybe the error of my ways comes from the deep. Subconcious unresolved authority issues. Ever try to get rid of the past? It's not that easy.

No matter the pen, the mouth, the mind, the eyes or ear, I must have been born a patient advocate. Don't get me wrong though. If I could afford to leave nursing and sail on the open seas with my family, I would do it in a

heartbeat . . .

http://www.gslyc.org

Puzzle Time

2006-05-04T15:01:00.000-07:00

The long awaited answer........your life and that of EMR is a complete mystery. You have no choice other than to consider how to put the puzzle together. So follow the link between the photographs and start doing your puzzle work.

Have fun!

http://www.jigzone.com/g.php?0625062E59.4A89E88&z=0

The Report Process

2006-04-28T00:00:00.000-07:00

The wheel has been invented.

It's out there, somewhere.

Here is one wheel I found......

CHANGE OF SHIFT

RN REPORT PROCESS

1. ONE HOUR PRIOR TO SHIFT CHANGE/OFF-GOING NURSE SHOULD:

• Review PAL for: Undocumented Allergies, New Orders (Eyeglass Icons), Overdue or Current Tasks, and remove old Sticky Notes.
• Review Quick Orders for: Duplicate orders and old orders.

2. CHANGE OF SHIFT:

• BOTH OFF-GOING AND ON-GOING NURSES SHARE ONE COMPUTER
• OFF-GOING NURSE IS SIGNED ON TO THE COMPUTER

3. START WITH PAL TAB AND LOOK FOR:

• Undocumented Allergies,
• New orders (eyeglass icons), and
• Overdue or Current tasks not completed(heart icons)
• Remove old sticky notes

4. OPEN PATIENT’S CHART

5. LOOK AT QUICK ORDERS TAB:

• Use yellow banner bar to review name, age, location
• Review orders
• Discontinue duplicate orders by right clicking and cancel D/C

6. GO TO FLOWSHEET RESULTS TAB:

• Review Vital signs, Pain assessment, critical labs
• May use Clinical Notes to review ED triage or Admission Database if more info needed.

7. REPORT SYSTEMS ASSESSMENT AS USUAL

Developed by Natalya Makarevich, 6/1/05

http://www.lifebridgehealth.org/workfiles/erc/Agency_Clinical_Doc_Inpt-Powerforms_brochure.pdf

Soon To Be Things Of The Past

2006-04-27T22:57:00.000-07:00

Paper IS cheaper . . .is it too late to go back?

"Sally, it's for you. IR (interventional radiology) is on line four.

"Hello, this is nurse Sally".

Uh, ya, are you taking care of Mr Doosie?

"Yes."

Uh, ya, does he have a central line?

"No, not yet. It is being placed as we speak."

Well, when those doctors are done, call us back and we will send messangers up.

"Okay, what's your extension? 1-2440. Got it."

30 minutes pass.....what did I do with IR's number?.....oh, here it is. I wrote it on my med sheet.(a thing of the past)

......

"Hello, this is nurse Sally from ICU. Mr Doosie now has his central venous access line. You can send up a messanger. We're ready. Goodbye."

10 minutes pass......

Sally, IR is on the line again. Line two.

"Hello this is nurse Sally."

Ya, uh, we forgot to ask, is Mr Doosie on a ventilator?

"No. He is not and we will transport him in his bed, but you are going to have to give me another half hour. I have to get my other patient out the door right now and I have paper work to do. Send a messanger then. Goodbye."

A typical day in the ICU or on any floor where pieces of information float transparently from one place to another. Time is wasted. Just imagine how many calls will be saved when we go to EMR because of Order Details. Order details is just one tiny piece of information that will be implemented within our new eletronic medical record system. All the stuff that an ancillary department would want to know, they can get online. Saved calls. Fewer interuptions for the nurse. More bedside care for the patient. This is only one of many many things that will change. That will be transformed.

Are YOU ready?

Final transcontinental telephone pole, 17 June 1914 Utah

Dollar Signs vs Vital Signs

2006-04-24T20:45:00.000-07:00

Never once in my collegiate pursuit of nursing did I ever hear anything about patient care or the building where we house the ill, nor the process by which we care for our patients as a model for business. Am I the only one having a problem swallowing healthcare as a business? I would rather chew potassium chloride pills than register with the healthcare-is-a-business club.

The Chief Nursing Officer at the University of Utah Hospital held a Nursing Forum recently and she divided the dollar sign vs vital sign package up this way:

Bedside care is an art.
Nursing is a science.
Healthcare is a business.

These simple sentences actually fit comfortably under my feet. I do understand that money wedded healthcare long ago around the time of DRG's (Diagnostic Related Groups) but, healthcare as a business? How in the world are we going to be able to support these diametrically opposed concepts for the future. There will no doubt, in time, be a fourth sentence:

Death is a blessing.

The invisible nature of bedside care, the art and science of nursing, is as healing as any pill (well, almost) and as comforting as any new building might imagine itself to be. I won't betray my art.

2006-04-17T21:44:00.000-07:00

It's looking alot like Christmas in Spring. Here are photos from my snowy trek into work from the netherlands at the U Hospital today. My car top is buried in there somewhere. Training resumes for Care Transformation next week.

No Lives Saved Today

2006-04-11T20:19:00.000-07:00

The world was not rescued today. No world problems solved.
Brokeback Mountain is out on DVD. Cheney was booed at an opening baseball game in DC. And more loss of life in the middle-east. Hey, how about the immigration rallies? Now that's news.

Today I began to actually strategize my approach to the resource nursing departments EMR training. Gretchen and I sent out an additional "survey" to our 89 plus employees.

Familiarity with Powerchart is vital.

Interesting to note that from the first survey, only a very few staff are novice computer users. Most considered themselves "experienced". (Only a few said they were "experts".) Not surprising to some.

Once upon a time, I considered myself experienced, until I found out how much I really didn't know.

I'm okay with that.

It's In The Mail

2006-04-03T13:10:00.000-07:00

Now you can purchase your very own superuser postage stamps. Send them to your family, add to your scrap book or make them part of your stamp collection. You can find these stamps by going to www.zazzle.com and type in "electronic medical record" in the search/find area.

Or you can click on this link:

http://www.zazzle.com/search/electronic%20medical%20records

Work Flow Show and Tell

2006-04-01T06:11:00.000-08:00

Electronic Medical Record keeping(EMR) and Computerized Physician Order Entry (CPOE) will effect the Work Flow environment in ways which we need to be thinking about, so that we have a semi-measured response when issues arise. What will those issues be? It is hard to tell because there so are many variables.

Take for instance, the time spent searching for a chart. I can't even count the number times I have spent searching for my patient's chart (been there, done that). They are numerous. What happens to you if your chart isn't located in 15 seconds. It is entirely likely that you become distracted by the search which distrupts your work flow.

It's like going to the store for a gallon of milk and you come home with 3 sacks full of items you didn't need, possibly forgetting the milk all together. Same with the search for charts.

Consider this point. You search for Mr. Jone's chart to document an important event, change in condition, and/or medication. The chart is gone from it's usual place. You search your most immediate quadrant that begins within eyesight. Not finding the chart at that point you extend your perimeter within your workspace and by so doing, you begin to lose on five fronts: time, efficiency, accuracy of documetation, continuity of care and job satisfaction. On the search, you answer a call for help, a call light, a phone call. On your search your educator stops to update you on something, your patient's family stops you to ask questions, heaven forbid you use the bathroom.........gads the list is endless.

When you finally find your chart consider the time it took and if what you originally were going to chart either isn't charted or is minimized in it's accuracy. This might not be the only chart in your work day that went missing. Time wasted, charting forgotten or less complete, efficient work flow snaggled, continuity of care diminished and job satisfaction is a thing of the past.

In this regard to EMR and CPOE, we can greatly reduce these workflow issues by having a central location for our chart that is always available to us. Timely charting, accurate charting, greater continuity of care and a sense of satisfaction. Everything is coming up roses, unless of course . . . the server is down!

What Will Be Our Result

2006-03-31T13:52:00.000-08:00

I guess I have jumped onto the wagon and am touring the country with the anticipation of implementing computerized physician order entry (CPOE). I am finding very interesting discussions on the internet. As I review information technology in healthcare I see that there are many variables will effect our goals and end results. I wonder, what will happen to our medical errors and nursing care. Our hope is to improve care and decrease errors.

Pediatrics: the Official Journal of The American Academy of Pediatrics, published research from their hospital about the implementation of Cerner Millenium. You can view their research from their website about the increase in their mortality rate when implementing CPOE. It is strongly mentioned that this research is not a cause and effect summary, rather it is important that the insitutions who purchase CPOE commercial products, monitor how their integration of this product and the human interface does effect mortality.

http://pediatrics.aappublications.org/cgi/search?andorexactfulltext=and&resourcetype=1&disp_type=&sortspec=relevance&fulltext=cerner+cpoe

It is critically important that we not allow ourselves to lose our critical nursing and other professional skills. Just as any computer user in their own home. They still need to get up from their chair, engage in relationships, communicate to their family and friends to avoid the vacum that could suck the life out of them and those around them.

If you are interested in this article from Pediatrics I would encourage you to read the articles written about the study's results. These articles are listed here:
http://histalk.blog-city.com/does_cerner_millennium_kill_children_i_dont_think_so.htm
http://www.healthcareitnews.com/story.cms?id=4165

Who's To Blame

2006-03-30T20:54:00.000-08:00

Coming home from the fourth day of the first week of training, all there was to greet me were the dishes. It took an hour before I realized I was all alone with my dirty dishes. What happened to Monday? Where were my children?

It was obvious something very different happened this week, and I blame my dirty dishes on Cerner.

I was exhausted and this was only 4 days. If I was facing stacks of dishes like this, what has happened to the lives of the IT people this last year.How are they fairing with their housework? Do they recognize their own family?

Be glad for your lives.

Dirty dishes really aren't all they are cracked up to be. And don't forget while you are

multi-tasking your life, remember to take the baby out of the dish water.

Base Training Camp

2006-03-29T20:59:00.000-08:00

It's Being Built

2006-03-29T20:51:00.000-08:00

Today was a long day. We seemed to be getting the hang of electronic charting on Cerner Millenium. In fact, drop in a pill, click and go. Nursing is just that simple! Not.

So, the psuedo-mastery I had accomplished on the EMR was fairly deflated when the programs within the program wouldn't function correctly. It is in the process of being built. I didn't know that we are in the pre-test testing phase. It's really a great opportunity to be doing this at this level and at this point with the ITS folks. It's quite painful sometimes. We, the superusers have been at it three days. ITS has been at this for months. They must love data, that's all I can say.

Brain Trip

2006-03-29T20:38:00.000-08:00

Tell the truth. What screen did you really see at the end of today?

MULTUM Isn't A Pill

2006-03-29T05:45:00.000-08:00

Multum sounds like a huge horse pill. Something I might take when I am 98 and brittle to the bone. Not always satisfied with taking things as fact I began searching. In my search I found that "Multum is a medical information company - not a publishing company. All of [their] content is developed in-house by [their] full-time staff of physician and pharmacist researchers. Multum holds a patent for the methodology used to derive patient specific dosing and ordering based on individual patient characteristics."

Oohh, patents? You can find Cerner on Nasdaq = CERN
Visit www.cerner.com

No More Ink Wells

2006-03-28T19:56:00.000-08:00

My biggest sorrow about going to electronic medical records will be that I won't be collecting really great pens for charting any more. On every trip out of state or country there is always an illusive great writing pen to be had.

One of our fellow superusers, Hope, recalls "here I am in computer classes but can remember in the 4th grade using the dip pens and can well remember the day the boy behind me dipped my long blond braids into his ink well. (I was in the 7th grade when I first saw a ball point pen. The son of the local newspaper editor brought one to school. It leaked all over his hands and clothes!)

Yes, we can look back and how rich our stories will be to the next generation of nurses who will laugh at what we were doing with our paper charting. Our stories will be unbelievable to them. For now, there are laments and losses as we transform ourselves into the unknown of electronic medical records.

One last thought for now, don't become a data entry drone. Remember who and what EMR is about .... One day it could be any of us in that hospital bed. Thank you to the U of U Hosptial for their investment and to the folks at Cerner.

Our Trainers

2006-03-28T19:54:00.000-08:00

I have a feeling we will be seeing alot of these folks.

Care Transformation

2006-03-28T18:58:00.000-08:00

The training for the electronic medical records care transformation at the University of Utah Hospital has begun. The testing ground is a small group of 30 or so "end users"; registered nurses from most areas within the hospital system and ITS employees. We users are being intensively trained so that we can then in turn, train more like us. Very good end-user-soldiers. Marching orders, that is to say, the go-live-date is planned for October. And most of us are psyched!

Today it became more apparent that this care transformation is a big deal. ITS (information tech services) chose theirs words correctly: transformation. We won't be able to recongize ourselves. Gone will be the days of Sumerian-like pictographs on clay tablets. We are in the big time now. I can see us now, still trying to hunt down charts, when they are a password away on the computer.

.

Where It Begins

2006-03-28T18:24:00.000-08:00

I made an all too brief visit to see my husband in Vancouver, British Columbia. He was offered a position with the Vancouver 2010 winter Olympics. Heck ya! Here we go again. I am not sure who is most miserable being apart.

On my return to Salt Lake City, I was asked to participate as a superuser by my manager in resource nursing. Now that my husband was gone I had free time on my hands. So why not start a blog . . .