What Went Wrong with Maine's New Medicaid System?

1. How important are information systems for Maine's Department of Health and Human Services? Analyze the impact of its faulty Medicaid claims processing system.


Information systems are critical to Maine's Department of Health and Human Services. Its new Medicaid claims processing system was rejecting claims much more frequently than its old system had. Due to the rejected and frozen claims, the Bureau of Medical Services could not keep up with the processing and number of phone calls in relation to these claims. Some of the Medicaid providers were forced to turn away patients and even close operations because they were not compensated properly. Several others had to seek financing to maintain operations. Maine's finances became threatened as well due to the large segment of the state budget that Medicaid had in the past. The system created overpayments totaling $9 million. This huge disaster cost the state millions of dollars to fix. Maine became the only state not to satisfy the HIPAA requirements.


5. If you were in charge of managing this project, what else would you have done differently to increase the chances for success?


Well I wouldn't have implemented a brand new information system or I would have only went with a designer that already had created a similar successful system for another state. Considering the time constraint and lack of knowledge in creating such an elaborate system, I wouldn't have taken this risk. If it had been decided to create a new system, I would most definitely have done things differently. I would have appointed a Medicaid expert to work with the designer full-time from the beginning. Communication between the designer and Medicaid team would be highly emphasized. I would have also created some sort of online training session for providers to learn how to fill out the claim forms correctly. This would have greatly reduce several of the claim rejections.

Physicians Get Help in Safe Medication Prescribing

This article informs how Duke University Hospital and McKesson have developed a solution to simplify complex drug dosing. McKesson has announced the introduction of its new Advanced Dosing functionality for Horizon Expert Orders, McKesson's clinical decision support (CDS) and computerized provider order entry (CPOE) system to help increase the accuracy and safety of medication prescribing for high-risk, complex patients.

Duke believes that the Advanced Dosing solution can aid pediatric and neonatal units where specialized approaches to weight and age-based dosing are required. Small miscalculations in these units can cause significant problems. Inputting relevant criteria into the system at the time of ordering reduces the cognitive burden on prescribers. This burden has been created from the increase in number of drugs along with the increasing volume and complexity of drug information. These systems span virtually all settings of healthcare and are used with more than 50 million clinical transactions per week. McKesson has lead major breakthroughs in patient safety and was the first to introduce a point-of-care-bar-code medication administration solution which prevents more than 700,000 medication errors weekly.

As an employee of McKesson, I am a close witness of what amount of energy and focus is directed toward these information systems. We are constantly educated and trained on how these systems can benefit hospitals. I have had a few clients that have purchased these systems and they feel that have made a good investment. Here is a link to where I point my clients in regard to our patient and medication safety products.

http://www.mckesson.com/en_us/McKesson.com/For%2BHealthcare%2BProviders/Hospitals/Patient%2Band%2BMedication%2BSafety/Patient%2Band%2BMedication%2BSafety.html

Our Horizon Expert Orders™ software solution was created by clinicians for clinicians to specifically address the common barriers to physician adoption of computerized physician order entry (CPOE), focusing on the clinical decision-making process instead of order entry. McKesson’s Horizon Expert Orders solution features proven clinical content driven through a simple clinical interface and intuitive workflow that supports the way physicians practice medicine. The benefits from this systems include; overcoming traditional barriers to physician adoption, delivering real-time clinical decision support, and improving patient safety.

Physicians Get Help in Safe Medication Prescribing. (3 March). Business Wire. Retrieved May 14, 2008, from ProQuest Newsstand database.

Can Information Systems Make Your Doctor Better?

1. What problems are hospitals and physicians encountering in diagnosing diseases and prescribing medications? What management organization, and technology factors are responsible for these problems?

Many doctors struggle to identify diseases or misdiagnose patients. Substantial drug errors resulting in injury to over 1.5 million Americans. These drug errors include drug interactions, inappropriate prescriptions and forgetting secondary prescriptions. These preventable drug errors may result in $3.5 billion in additional billing annually to patients. Many of these errors can be attributed to human errors including; poor handwriting, memory lapses, fatigue, distractions and the total volume and complexity of available medications. Some information systems used to prevent these errors actually create new ways of making errors because of their design.


3. What obstacles prevent computer systems from improving the medical industry? How can these obstacles be removed?

One obstacle includes designing the information systems too much for physicians rather than nurses, who feel the greater impact from these systems. Designers of these information systems must acknowledge who will be utilizing the systems most frequently and accommodate these nurses. Another drawback of these systems are that they can be more rigid than traditional paperwork, not allowing a physician to write orders until a patient is admitted. Duke has addressed this problem by adding a new unit to the system that permits virtual admissions of patients.

Doctors and nurses must trust the system and not ignore automated prompts, which can be another obstacle. Many doctors resist the idea of needing help remembering procedures and treatments. To remove this obstacle, medical staff need to be informed of the accuracy of these systems and be educated on the time-saving component of these systems. Finally, some doctors argue that Diagnostic Decision-Support systems have not proved to be more successful than human diagnostics. They also grown at the cost and time involved with these systems. Physicians need to be provided with a ROI calculation and all the data that proves that these systems can prevent errors, which ultimately saves lives and money.

Analysis: Stripping the eBay Mall of Its Community Spirit?

Some users have become upset with eBay's new transition from an "unruly flea market" to a "strip mall". Some have grown so angry, that they have called for a global boycott of eBay. This anger stems from the introduction of a newly implemented policy of not allowing sellers to leave neutral or negative feedback. Before this policy, eBay traders have been able to rate each other, which allows small sellers to build a good reputation, and to respond to buyers' false comments. This new policy change makes it look to favor big sellers. In addition, eBay recently raised the fee payable on sales from 5.25% to 7.25% of the final sales price and reduced the item insertion fee. These new changes are to lower the initial cost of selling on the online marketplace. eBay announced that these changes will enable the trust within the eBay community to flourish again.

Some business critics agree with eBay by stating that its core business is no different from Amazon.com and that allowing sellers to criticize buyers is not a good idea. Buyers don't like to be criticised in the real world. eBay explains that they have leveled out the playing field for buyers and sellers. However, eBay needs to be careful not to lose the sense of community that has made it so popular. Its recent changes may keep it above its competitors, but it must be careful not to alienate its users.

I have experience as both a buyer and seller on eBay. When I closed my massage spa a few years ago, I sold much of the equipment I had in the spa on eBay to reduce my total investment lost. I have also purchased personal items on the online marketplace. I feel that eBay shouldn't have implemented these new changes. The concept of eBay works so well because there seemed to be an even playing field between buyers and sellers. I know that sellers don't often criticise buyers outside of this online marketplace, but most sellers aren't like eBay users. In essence, sellers on eBay are its customers, not the buyers. The sellers are the ones that pay the fees to insert an item online as well as pay a percentage of the sales price. You want to keep these sellers or "customers" happy, so limiting the service for your customer is not a good idea. I realize that all business evolve to sustain a competitive advantage, but these are the wrong changes to implement. If eBay is concerned about sellers criticizing buyers, have a running count of how many negative comments a seller posts, this would indicate if a seller is abusing this feature.

Screenshot of eBay feedback screen:

Analysis: Stripping the eBay mall of its community spirit? (2008, May). Marketing Week,8. Retrieved May 9, 2008, from ABI/INFORM Global database.

Can eBay Continue Growing?

2. What are the problems that eBay is currently facing?

eBay is facing a considerable more amount of problems than what I had imagined.

a. Its growth rates have slowed in the United States and Germany, but that is being offset by the increased revenue received within new markets. However, it is still trying to make an impact in the Chinese online auction market.

b. eBay has had trouble penetrating certain consumer markets including; real estate, travel, new-car sales, and expensive collectibles. It hopes that it's new VoIP technology will allow for better communication between buyers and sellers in these markets. Many top sellers aren't interested in adding voice calls to their sales models.

c. It has become difficult to monitor compliance with the variety of laws and regulations that apply in different jurisdictions. eBay may be liable if its members sell unlawful goods or defame one another in eBay's Feedback Forum.

d. Its largest challenge is to keep honesty and integrity within its auctions. Some buyers have stated that eBay does not do enough to prevent sellers from collecting inflated fees for goods that are not legitimate or do not exist. Other users complain how eBay hasn't tackled the problems of identity theft and fraud on its website.

e. eBay has the continual problem with satisfying two opposite types of users; buyers and sellers. Customer service suffers as a result.

5. Will eBay be successful in the long run? Why or why not?

Yes, I believe that eBay will be successful in the long run. It is addressing the number of challenges it currently faces with probable solutions. Its growth relys on the continual enhancement of technology available. Recent partnerships have offered beneficial technology to the eBay community including eBay Community Wiki and MyCollectibles. eBay also makes a special effort to keep in touch with its users by hosting meetings of buyers and sellers to address issues. Overall, the value of its service bears out the inconveniences and drawbacks. Many users are more comfortable with eBay's name and service over other online marketplaces. eBay has to focus on keeping the eBay community happy and loyal by making them feel secure and providing them with the latest technological capabilities.

How Video Ads Will Change Google Forever

This article discusses how Google is operating a test program that allows certain AdWord advertisers to post video clips with their ads. As of right now, AdWord adverisers must limit their advertisement message to 70 characters. The new video advertisement feature might also change the current cost-per-click payment struture.

I have a Google AdWords account for my business, Baja Tan. It has been a great tool to advertise my business service. You determine the search words you would like your ad to display on after a search. You can ad hundreds of different combinations of words if you like, I chose about 20. Then you set your monthly budget amount and maximum bid amount. You only pay for the impression if a web searcher clicks on your ad. You may log on anytime to view the ad campaign's performance. It records the number of impressions and clicks for each keyword along with the total charge.

Screenshot of my AdWords Campaign:

I think that video would be a nice addition to this service. Yellowpages.com already offers this video advertising service. You pay a monthly fee each month instead of using cost-per-click pricing. It is a directory service, not a search engine. My yellowpages.com ad rep asked if I would like to place a video along my ad and I declined because of the high pricing. Here is a link to my ad on Yellowpages.com, the video would be positioned to the right of the ad.

http://www.yellowpages.com/name/Milwaukee-WI/baja-tan?search_mode=all&search_terms=baja+tan

The photo and link below is a sample provided to me by my sales rep, Ocean Mystique Ink Gallery.

http://www.yellowpages.com/name/VA/ocean-mystique?search_mode=all&search_terms=ocean+mystique+

I also have an account with Yahoo Marketing Solutions. It's not as effective as Google AdWords. However, the same features are included; cost-per-click pricing, display ad, reports, budget and bid setting. Below is a screenshot from my Yahoo account.

I will utilize Google's video feature if it becomes available to everyone because I would be able to set a reasonable budget and pay per click. It's difficult to fit your ad within the 70 character limit and a picture is worth a thousand words. I look forward to this new tool by Google.

Danny Sullivan (2008, February). How video ads will change Google's AdWords forever. Advertising Age, 79(8), 22. Retrieved May 2, 2008, from ABI/INFORM Global database.

Google Takes on the World

2. What are Google's sources of competitive advantage? How does it provide value to its users?


I think that Google has several sources of competitive advantage. The search engine technology that combined the Page's PageRank system and Brin's Web crawler was initially the competitive advantage because Google's searches became so effective. Today, I think there are other search engines that use similar technologies, but Google's IT infrastructure is it's biggest source of competitive advantage. It has 450,000 servers between 25 locations around the world. The servers use inexpensive hardware to run a customized version of Linux operating system, MapReduce, Google WorkQueue, and Google File System. These programs simplify processing, create large data sets, groups queries and schedule them for distributed processing, and keeps copies of data in several places so that the data will always be available even if a server fails.

Google spends a third of what its competitors spend to generate a similar amount of computing power. Its infrastructure is flexible and inexpensive which creates a competitive advantage. Its competitive advantage creates value to its users. Google performs searches at a fast rate and provides its users with many different Web-based services and software tools. Google's Adwords provides value to advertisers by positioning the most relevant ads in the most prominent positions from keyword searches. As a business owner, this has been a great valued service to me. My article discusses this Web-based service further. Other services and software tools that create value to its users include; Google Spreadsheets, Google Apps, Google Toolbar, Google News, Gmail, Google Desktop Search, Froogle, Google Maps, Google Talk, Google Checkout and Google Video.

5. How successful do you think Google will be in the future?

I think that Google will continue to be a huge success in the future. Despite the case study mentioning the possibility of Microsoft taking shares of the market in search technology, Google has several other great services and tools to offer its users. Google can avoid Microsoft's past strategies to overcome competition since its applications are Web-based and not tied to the Windows operating system. Google is a company that is constantly looking for ways to grow through innovation, I think it will be around for quite awhile. I know that I use several of Google's services which Microsoft doesn't even offer at this point. I realize that Google may not provide services that all become popular, but certain innovations will be greatly used. It should also continue to focus on its core competency, the search engine. It needs to focus on Microsoft's "deep Web" searches and determine a way to do the same.