The U.S. government passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. This landmark piece of legislation set forth $27B in Medicare and Medicaid incentive payments to providers for demonstrating meaningful use of certified EHR technology.
The term “Certification” refers to the process of confirming that an EHR technology contains baseline technological capability, functionality, and security needed to achieve meaningful use objectives and measures. “Meaningful Use” (MU) on the other hand, is meant to assess how effectively EHR technology is utilized and its impact to actual patient outcomes. MU addresses not just technical capacity but effective implementation, training, support, leadership, and governance. Certification and MU criteria, as outlined in HITECH, must both be met in order to qualify for Medicare and Medicaid EHR Incentives.

The Challenge:
Our client, a leading patient-centered medical hospital, sought to achieve Stage 1 MU of a Certified EHR within the first years of the program (2011 or 2012). However, the medical center was also simultaneously planning to migrate to a new EHR system in late 2013. The client’s existing EHR platform was a legacy system that the vendor was not certifying for MU. Due to the planned migration to a new system, upgrading its current EHR to a vendor certified version made little business or financial sense.

In order to meet the strategic objective of attaining MU, leadership decided to pursue an innovative new form of certification called self-certification, making it one of the first hospitals in the country to pursue and successfully achieve this approach. Self-certification enabled the client to meet eligibility requirements and accelerate attestation for an estimated $10M in HITECH incentives.

Additional challenges beyond self-certification existed as well. The fast-changing policy environment required a close eye on any legislative changes, a flexible MU strategy, and last minute adaptations. Building strong executive support and system wide buy-in was an important issue as well, because successfully obtaining certification and operationalizing MU requires dedication across both the technical and operational realms of an organization.

How We Helped:
The client initially engaged Xanaxx to evaluate its readiness to achieve MU for both the inpatient hospital and its faculty practice. Xanaxx completed this initial assessment by helping to identify specific risks and mitigation strategies, and next steps needed to achieve MU. The assessment helped the client better understand its eligibility and the total incentives it could potentially expect. The assessment also focused on feasibility for the client to pursue self-certification.

Xanaxx employed a collaborative resource model and collaborated with client team members to complete the assessment, leveraging the results to help develop a high level roadmap of certification, technology, workflows and reporting strategies needed to resolve gaps.

This included recommendations regarding an overall governance framework to drive and align Meaningful Use initiatives across the organization.

Following the assessment, Xanaxx supported the client in its EHR self-certification efforts, working in conjunction with the client’s MU project team and CCHIT, an Authorized Certification and Testing Body.

They worked to obtain certification for the Hospital Inpatient EHR system via the EHR Alternative Certification for Hospitals (EACH) program.

During this phase, Xanaxx provided Meaningful Use experience and overall project leadership, including a MU gap analysis and a client tailored certification work plan.

After certification, Xanaxx advised the client on operationalization of the clinical and technical changes necessary to successfully demonstrate MU and collect MU incentives. This included driving progress and status reporting, as well as leading the MU Steering Committee Meetings.

The project resulted in the successful certification of the client’s inpatient EHR in 2011, making the medical center one of the first hospitals in the country to self-certify its EHR.

As a result of the self-certification, the client was able to attest to MU and be in position to collect its first Medicare Incentive payment. The client is expected to collect close to nearly $5M in 2012, having spent less than $1.1 million in project fees. Additionally, it is poised to receive another $4M in EHR incentives over the next three years.

A large hospital wanted to implement a Web-based image distribution system to improve access to radiological information for its patients across the entire medical center.

The Challenge:
The client decided to move quickly to replace its film-based radiology system and existing Picture Archive Communication System because of the opportunity to realize quality, efficiency and cost benefits.

There were a number of challenges with the film-based system and existing PACS:
The length of time from order to results available was not satisfying for either clinicians or patients.
Film management costs were continuing to escalate (including printing, storage and transportation of films across the medical center and its associated clinics).

The existing PACS system did not allow for effective and efficient distribution of digital images across the medical center because of the need to use specialized workstations and a separate network to handle the large image files.

By moving to an enterprise-wide Web-based solution, the client could:
Shorten the amount of time between the information available from a patient’s diagnostic radiological imaging study and the next clinical decision by providing ready access to a patient’s radiological information—report and image—from any standard workstation on the client’s network
Decrease the cost of film/image management (including decreased printing, storage and transportation costs)

How We Helped:
The implementation of the enterprise-wide Web-based imaging distribution project achieved its goals of providing radiological information, including images and radiology reports, anytime and anywhere for the client’s health care providers. Now, providers could readily access a patient’s radiological information from any one of the many workstations throughout the hospital, including those in the operating room and the emergency department and in 130 specialty and primary clinics.

Additional benefits that were achieved by the implementation of the system:

  • Improved access to images across the medical center. Facilities with ready access include the hospital (the emergency department and the operating room), hospital-based clinics and the primary-care network. This allows for real-time consultation with specialists, as both the referring physician and the other consultant can view the same record simultaneously from two different locations
  • About $1.2 million in annual savings in labor and film costs
  • Decreased costs for copies of images for patients and referring physicians (outside of the client). Cost reduction from the supply chain was achieved by a savings in paper costs ($0.02 per sheet compared with $15/sheet of film) and the price of CDs (less than $1 per CD compared with $15/sheet of film)
  • Decrease by 80 percent in the use of hard-copy film
  • Decrease in the amount of time spent by clinicians gathering film/images for clinic, conferences and procedures
  • Decrease in the number of reprints due to lost films
  • Improved ability to readily integrate digital images into presentations and research papers
  • Improved ability to project images to a larger screen for teaching purposes


The use of high speed access to the Internet, faster desktops and improved search engines are now available at rates that most individuals can afford. Additionally, with the increasing use of the Internet to conduct transactions that contain personal information, such as bank accounts and credit card numbers, and the rising incidence of identity theft, individuals are more aware of the need to safeguard their privacy. Individuals are beginning to demand that their health care organizations meet these challenges.

By using a Web-based imaging distribution system, the client is now able to meet the challenges of providing patient information anytime and anywhere, managing the rising costs of providing health care and ensuring the privacy and security of patient information.

In addition, the client was nominated by its project team for the annual Computerworld Honors program. This program is designed to identify, honor and document innovations in information technology by individuals and organizations. This client’s case study was one of 50 case studies selected from several hundred submitted in the medicine category to receive Laureate recognition. The case study was inducted into the program’s archives, where it can be accessed by researchers and educators worldwide.

Following years of investing heavily in paid online advertising, a fashion retailer’s detailed analysis of search terms, online purchases and customer demographics revealed the opportunity to save millions in advertising costs without hurting top-line sales.

The Challenge:
Selling through catalogs, approximately 200 retail and outlet stores and online, this fashion retailer spent a sizable portion of its annual advertising budget on paid search engine advertising. That is, the company bid for the option to display its ads next to the results for particular search terms. However, the company didn’t know how much return on investment (ROI), if any, this practice yielded.

To measure, and improve, ROI, the company set out to analyze key aspects of online search practices and its customer base. Its goals were to determine the incremental ROI on search advertising and identify those search terms that maximize ROI, identify associations between the search terms and the items purchased, differentiate patterns in unpaid and paid search orders and analyze the demographics of customers buying through different online channels.

How We Helped:
Xanaxx practitioners helped the company analyze 2 million orders from 1.3 million customers to determine the frequency of search keywords that ultimately drove sales. The most profitable orders were found by analyzing the gross revenue per order by item classification, search engine, type of search and new or existing customer status.

To gain a clearer picture of online purchasers, internal customer data was merged with data from external sources containing demographic, socioeconomic and lifestyle information. Based on customer and order data, Xanaxx helped the company develop.

The analysis revealed that “organic” or natural (unpaid) search terms yielded ROI equal to or stronger than paid search terms. This knowledge allowed the company to implement a multimillion-dollar reduction in online paid search advertising costs without negatively impacting top-line sales. Interestingly, the analysis also revealed that while paid search stimulates a relatively small amount of incremental online sales, it does help lift in-store spending.


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