Do You Have a “Culture of Safety” in your Ambulatory Setting?

Safety is no longer a problem just for executives. Much is said at conferences by health organizations and is in the literature about having a “culture of safety.”  This term embodies the application of safety and quality as a primary and overarching goal in the medical practice.  Safety becomes part of the daily work in which leaders and staff proactively solve problems, reduce risk and improve care.  Organizations turn to the safety tools from the “culture of safety” movement.  Using these and other tools, team members of all levels communicate about safety, ask questions and learn without the barriers of title, status or a fear of retribution. In this setting, leaders, physicians and staff are equally empowered to make changes during the course of their work.

One might be surprised to learn that there is a greater risk for harm in a routine office visit than some inpatient admissions. With the number of outpatient encounters significantly growing the risk becomes even more pronounced.  This blog provides guidance to leadership regarding strategies to reduce risk in the medical office by having clearly defined care guidelines and using the tools and tones of the culture of safety.

As you begin thinking about your environment, consider the overall approach to staff training. Review your on-boarding process and consider how you introduce safety principles in your culture.  Practices need to outline expectations early to avoid issues at a later date. Too many offices make the mistake of not having designated staff trainers which leads to inconsistency.  Ensuring physician and staff training is adequate, reduces the likelihood of performance improvement issues, stress from being understaffed, improves quality, as well as staff and provider satisfaction.

Next, consider the value of pre-visit work. Staff should learn a standardized pre-visit preparation process to identify gaps in care.  This will help staff to close all gaps during the office visit.  Ensure staff and providers know and understand the expected testing, the referral circle (internal vs. external) and the process for ordering required studies.  The employee probation period should provide support, coaching and instruction in the employee’s clinical setting.  Augment this training with online and classroom training.  Leaders can review paid claims and use business intelligence tools to analyze the cost and services provided, conduct audits and intervene when care is provided outside of the protocol.

Diagnostic errors can include missed care opportunities, delays in care, or more seriously, an incorrect diagnosis. Patient care should be consistent with evidence-based care guidelines.  A variety of approaches such as, decision support tools, order sets, electronic tasking, pop up messages, care coordination staff and evidence-based protocols, can reduce errors. Certified medical assistants can alert a provider to sign off on a pending order created by them, help to monitor the test that has been performed and the result delivered to the patient.   Encourage staff to use the culture of safety tools to ask clarifying questions to validate the follow-up plan when there is a deviation from the protocol.

Once diagnostic testing is ordered, it is important to provide clear information to the patient regarding the delivery of the result. The follow-up plan should be consistent as expressed by providers, staff and even the ancillary service.  Patients should either have a scheduled follow-up appointment to review the findings, be told they will receive a call or they should expect a letter within a number of pre-defined days.  It’s important to avoid saying to the patient, “if you don’t hear from us, then everything is okay.”

This type of discharge planning can result in miscommunication and delays in care.  Staff could use the culture of safety technique of “STAR” technique (Stop, Think, Act and Pause) to confirm they understand the follow-up plan for each patient and confirm it is consistent with office protocol.

Staff not updating the family history section in the patient record during the history taking can contribute to an important detail being missed. Staff learn differently and training materials may need to be in multiple languages or in various formats such as a written article, a checklist, or a routing slip. Encourage staff to utilize the culture of safety technique of validation and verification to ensure they understand what is required for each patient.

Communication errors may occur if an electronic system is not being used effectively to communicate or if active listening is not occurring, such as when a staff member is rushed or when a practice is chronically understaffed. Best practice includes future appointments being noted on the routing slip or a workflow which includes electronic orders being entered prior to the patient reaching check-out.  Consider if “pod” check-outs would help to ensure the discharge plan is reviewed/activated in the exam room, thus reducing hand-offs.

Errors or delays can inadvertently occur if a specific diagnosis is lacking or an incorrect diagnosis is entered. Using the culture of safety tool, such as practicing with a questioning attitude, staff can help to eliminate/reduce these errors.

With value-based care, the emphasis is on improving quality, safety and patient satisfaction. Practice leadership should continuously review their internal workflows and processes to shine a light on potential quality and safety issues from a variety of perspectives.  Consider holding a daily huddle with your team or identifying a safety coach in the practice to increase recognition, decrease harm to patients and employees while improving care.

Jill Berger-Fiffy , MHA, FACMPE
Senior Consultant

Consultants as Mentors?

Working in any industry, you encounter people with various backgrounds and degrees with little or no knowledge of the business. You run into the young graduate who just entered the workforce, the established employee who is set to retire or the ambitious employee who is thirsty for more knowledge. In a hustle and flow environment, where do you find time to encourage your employees to master their skills, prepare them for management level or assist in adapting to a new environment when the industry changes around them?

Consultants continuously walk into organizations where change is in the midst, an established business is not working as efficiently as it could, or an open position needs an interim replacement. We observe as an outside party and want to help to create efficiency, structure and indicate where we identify the gaps, but we also know we are there for a specific task.  During engagements, it isn’t uncommon to form relationships with the company staff – listening to their concerns, providing limited feedback if necessary and amusing the ones that just want to complain, even when there isn’t anything to complain about.  Many times, we are perceived as a wealth of knowledge – a golden ticket to show them what they want to learn or to help do some of the work no one else has time for.  When we as consultants have the time to share that knowledge and mentor the existing client staff, success is exponential.

In a recent article with Fortune.Com, CEO and Co-founder of AirBNB, Brian Chesky, explains “you’re the average of the five people you surround yourself with. So the question is, how mature are the people you surround yourself with?  If you surround yourself with the right people, you can grow up pretty quickly.”  Imagine making a decision based on just your thoughts rather than thoughts that are inspired by interactions with insightful individuals or groups.  That could heavily impact a place of business, how you interact with staff, and your own psyche.

Consultants that have the skill of mentoring or coaching are able to provide more of a service to the client rather than just the task at hand. This type of consultant will flourish, as they build a rapport with the client which could allow future interaction together, providing knowledge transfer, understanding the client outside of the assigned task, and creates an abundance of new relationships.  Mentoring is a silent skill – some people have it and others don’t, which is perfectly fine.  Consultants are there to provide a service and this is just an added bonus during a client engagement.



Jim Lachner joins Culbert as Regional Executive -Advisory Services

Culbert Healthcare Solutions is pleased to welcome Jim Lachner as the newest member of our business development team. Jim will serve as Regional Executive – Advisory Services, where he will be responsible for supporting clients located on the west coast.

For the past 30 years, Jim has delivered software and service solutions to medical groups, hospitals, integrated delivery networks, and academic medical centers. Prior to joining Culbert, he held senior sales executive roles at Cerner, First Consulting Group and KPMG.


Joel Szymanski Joins Culbert as Regional Executive -Advisory Services

Culbert Healthcare Solutions is pleased to welcome Joel Szymanski as the newest member of our business development team. Joel will serve as Regional Executive – Advisory Services, where he will be responsible for supporting clients throughout the Midwest.

For the past 12 years, Joel has delivered software and service solutions to medical groups, hospitals, integrated delivery networks, and academic medical centers. Prior to joining Culbert, he held senior sales executive roles at Nuance and Allscripts.




How to Make an Impact in the First 100 Days as a New CIO

Starting as a new healthcare CIO, you quickly need to get beyond the optimistic view of your new information technology domain gleaned during your interview process. Wise CIOs take a page from corporate and national leaders and arrive on day one with a plan for how to reach day 100 with a deep awareness of the IT organization you manage, a solid plan with broad acceptance to achieve the corporate strategic goals, and some quick wins already delivered to your stakeholders.

Why 100 Days?

Three months is generally regarded as a reasonable “honeymoon” period for a senior executive to absorb their new organizational environment and be ready to deliver results. The additional ten days provides a measure of extra time to secure buy-in from your stakeholders and communicate your plans broadly to the organization.

How Should You Organize This 100-day Orientation to the New Job?

  1. Devote time and attention to determine the strengths, weaknesses, opportunities and threats of your IT organization. Document current state and incorporate the subjective impressions of your employees and your superiors.
  2. There will be urgent and highly visible issues that require action within a critically short timeline. Determine what you can postpone for deeper analysis and identify actions that can quickly resolve users’ pain points in less than 100 days.
  3. Build your initial IT strategic plan to address the gaps between the current state of IT and a desired future state vision driven by the needs and strategic goals of your organization. Develop alternative approaches to achieve this vision including clear costs and benefits, communicated effectively to the management team.

First 30 Days: Face-to-Face Engagement is the Key Activity in This Timeframe

  • Meet with key members of (non-IT) management. Start with senior executives and medical staff leadership. Ensure that you understand their role in the organization, how they interact with IT, what some of their recent requests have been to IT and how these have been resolved. How can IT help them achieve their strategic vision? What would they consider their most urgent or repetitive IT needs? Prepare questions that are tuned to the individual’s role but also listen to what they want to share. Find out which people in their line of report you should follow-up with.
  • Meet with IT staff, beginning with managers and supervisors. In addition to your regular management and section meetings, meet one-on-one. Seek out issues they wrestle with, whether it involves systems, processes, or people. Review recent performance evaluations, specifically if any behavior or skill gaps are not being properly documented.
  • Become familiar with the organization’s strategic and tactical plans currently in place. Evaluate plans that exist in terms of concurrence with overall organizational goals.

60 Days: Assess Your Systems and Infrastructure Environment While Continuing to Fill in Information About Staff and Shareholder Needs

  • Perform or engage a complete technology assessment
    • Network infrastructure, databases, workstations, data center capacity, etc
  • Evaluate service delivery levels
    • Help desk performance, systems reliability, implementation history, service level agreement review, etc
  • Review budgets (planned vs. actual performance)
  • Develop fast action plans for the urgent, simple issues and begin implementation

90 Days: Transition From SWOT Assessment to Tactical Plan Development

  • Test your perceptions of enterprise SWOT findings with other senior managers
  • Draw up a desired state of IT to meet the enterprise’s current and anticipated needs
  • Prepare a comprehensive gap analysis between the desired state and the current IT assessment
  • Prepare alternatives to address the gaps utilizing peer group, department staff, and expert input. Develop implementation detail around these alternatives
  • Review a draft of the gap summary and tactical plans with senior management including budget costs, KPIs, and benefits expected
  • Review execution of the fast action projects (be sure they are on-track for completion and user goals are being met)

Final 10 Days: Polishing the IT Strategic Plan and Communication

  • Develop an executive summary, describe the evaluation and planning process
  • Define an IT architecture blueprint with guiding principles for future decisions
  • Present tactical alternatives with narrative of the pros/cons of each item in terms of cost, time, and impact on business strategy
  • Describe implementation requirements, including the timeline to accomplish the alternative recommendations
  • Propose realignment of staff to accomplish tasks and define when these changes would need to occur
  • Detail changes to service levels and service delivery


Congratulations! You have arrived at day 100 with your research completed and the tools in hand to be successful in your first year as a new CIO. Now it is time to execute on the IT strategic plan, deploy and motivate IT staff to meet your goals, and monitor progress on meeting your users’ needs.

Executive Consultant-Culbert Healthcare Solutions


Why FSC Consolidation?

A front desk representative stares at the pick-list of Financial Status Categories (FSCs), trying desperately to match one of the myriad choices to a patient’s Aetna HMO plan. Should she choose “Aetna HMO,” “Aetna HMO/POS CAP,” “Aetna HMO/POS Non Cap,” “Aetna Medicare HMO,” or “Aetna Medicare HMO/POS?”  What is the difference between them?  What does all this even mean?  With so many choices, in all probability, she’ll choose the wrong one.

As a result, incorrect edits will be applied, the claim will be routed incorrectly and will be denied. Unnecessary man-hours will be spent correcting the error and resubmitting the claim.  But again, the problem of too many FSCs available remains.  More denials, more man-hours wasted.  Eventually, the patient is billed.  More time is spent in customer care calls before the charges are finally resolved, if they are resolved.  In a worst-case scenario, the patient refuses to pay for services which are covered by their insurance and the invoice goes into collection.  Nasty reviews on social media and bad word-of-mouth could be the least of the trials faced by a good practice that only wants to be able to focus on quality patient care.

All because the organization has too many FSCs.

The most common reply to an entity being informed they have too many FSCs is “So what?” How could having too many financial classes possibly hurt an organization?  The answer is “a great deal.”

The impact of too many FSCs include:

  • Confusion about which FSC to select for registration
  • Increased time needed to register a patient
  • Claims routed to the incorrect payer ID or address
  • Increased rejections or denials creating additional work for A/R staff impacting, productivity, days in A/R, and revenue/cash flow
  • Reduced customer satisfaction due to incorrect billing
  • Increased customer service calls
  • Possible compliance issues, as certain plans have specific regulations associated with them
  • Fines or lawsuits because of an audit or customer complaint
  • Inaccurate reporting reflecting insurance activity

Luckily, it is not difficult to resolve all these issues and reduce FSCs to a manageable number. Common scenarios indicating the need to consolidate are the sheer number of FSCs, poor claims submission resulting in high numbers of rejections/denials and high days in A/R rates.

Once a need for consolidation has been determined, all that is needed is to plan the future state of the organization’s FSC structure and then implement.

Part of setting the future state is determining which FSCs are obsolete. Useful tools for this decision are examining which FSCs have the most A/R, billing rules such as claim forms, state regulations, and payer rules/billing requirements.  Revenue activity, claim production, and payer rules all have direct bearing on determining if a FSC is obsolete or a living, useful component of an organization’s revenue cycle.

Once FSC requirements are determined and broad FSC groups are laid out, individual FSCs can be analyzed and consolidated into a surviving FSC. It is also possible to eliminate FSCs which are completely obsolete and can simply be deactivated.

The overall goal is to have a minimal number of FSCs in the future state. A simple optimization resulting in big payoffs across the full revenue cycle.



Consulting -Life Balance

Have you ever tried to be a road warrior and maintain mental, emotional, spiritual and physical health at home? Typically, it’s challenging because you usually give all you have at the client site and rarely have anything left to give once you arrive home. So, what can be done to maintain a healthy ‘you’ while meeting the needs of family/friends, your firm and the client? Many people try to get their ‘me’ time in on the weekends while at home, but there is only so much you can do with 48 hours (for some 72). Saturdays seem to fly by and Sunday greets you with the bittersweet awareness that you wanted to sleep in, however, you forgot to pack last night. Hopefully these tips will support help you to achieve some resemblance of consulting/life balance.

 Take a look at some helpful suggestions below:

  • Bring home with you on the road! For as much as we live in an age of technology, we sometimes forget to actually ‘use’ the technology in our hands to stay connected with family and friends. A scheduled 10 to 15 minute video call can do wonders for you and those who love you. It will keep you up-to-date with what is going on in their lives and maintains that much needed connection. This can greatly support your emotional and mental health. If you have a spiritual practice, you don’t have to wait for the week to end. Practice what makes sense during your work week, whether that’s reading, meditation, music, etc.

Speaking of bringing home with you, if you are an avid reader, bring your book(s). Do you knit, crochet, etc.? Bring it with you! Play a lot of online games? Many games can be played using your smart phone or other electronic device (not your work laptop please!). Bring whatever makes the most sense with you on the road. You can decompress while on the road – you do not have to wait until you get home.

  • Don’t lose sight of the things you enjoy. While on the road, make sure you don’t leave your passion and fun behind you (at home)! Many areas have similar activities you would engage in at home, right in their own backyard. I’ve experienced some pretty enjoyable painting, fitness, bowling, spa, and other fun activities while traveling. Working out (not in the hotel) has kept me focused and motivated on many assignments!
  • Interested in volunteering? There are many local and not too distant programs and charity locations in most towns or cities. Working long hours at the client site can sometimes be inevitable, but scheduling time for fun, relaxation, or volunteering can help in decreasing your stress level, sense of isolation, and lack of fulfillment.
  • Get chores done before the weekend. Don’t be hesitant to find a local dry cleaner, nail spa, hair salon or other self-care establishment in the town or city of your client. This can decrease the amount of time you (or your family members) have to spend on those weekend errands. You’ll have more time to do those really precious things you can’t do on the road, including absolutely nothing!

Consultant/life balance is achievable, but it requires flexibility, openness and a few moments to decide where you want to engage in your other activities. You’ll be ready to live more and give more to yourself and those around you once at home, all while meeting or exceeding the expectations of your client and firm. Everyone wins with work and life balance!

Melissa L Roberts, Culbert Consultant and Life Coach



Creating and Implementing a Revenue Cycle Management Denials Committee

A denials committee is a necessity for effective revenue cycle management for hospital and physician groups. It is a great initiative to help organizations identify trends and issues surrounding specific denials, whether they are front or back-end denials. It provides transparency and opportunities for improvements, such as reduction in denials, increased cash flow and reeducation opportunities. With the right tools and participation, this can be a very successful endeavor. There are many crucial aspects and key players necessary in order to be effective. In addition, having the necessary reporting tools and analysis to provide the data are also essential components.

Recently, a hospital with multi-specialty departments in Arizona was seeking to implement a denials committee. Once key players were determined, we had to work with the leadership in the central business office to engage the key players or their designees. Initial communication was sent to executive leadership to explain the intent of this committee and what we were trying to help them accomplish with these bi-monthly meetings. The initial meetings were informational and the meetings that followed were considered working meetings in smaller sub-groups. With multi-specialty hospitals the start-up process can be a little more difficult, but not impossible. It is essential that there is a leader from the organization that is able to identify the leadership for each department.

At the first meeting, we gave an introduction as to who we were, our goals and the end result that we were trying to attain. The initial meeting sparked interest and created a sense of eagerness to find out where the denials were coming from and why. Once there is interest and buy-in from the senior leadership, then the meetings can move forward and be effective.

After the initial meetings, training was provided on the reporting tool that was being utilized as a data tool for denials. The training was broken down into separate sessions to ensure that the users had hands-on experience with the reporting tool. It is important for users to look at reports independently and prepare for upcoming meetings. After the training, we demonstrated the denial trending and provided assistance with report review.

Once the working meetings started, specific examples of the top five denials for the client were provided, including eligibility denials and the front-end staff. Detailed audits on hundreds of accounts were performed in order to provide the details on why the denials occurred and to discuss solutions to reduce these denials. We continued to do audits on the top denials to try and reduce the denial percentage for the client, while asking team members to also investigate on their end.

This is a prime example of how to successfully establish a denials committee. Organizations should consider implementing these committees since it is proven to be effective in reducing denials and increasing cash flow. It is important for health systems to also remember to continue the meetings so that no momentum is lost and their revenue cycle can flourish.



Non-technical Considerations Before Beginning an Epic Connect Project

An organization’s decision to extend their instance of Epic to outside practices and/or facilities, known as Connect, offers many advantages to patients, providers and organizations. Used appropriately, the functionalities extended enhance the providers’ understanding of a patient’s clinical results, history and charts. In turn, this enhances the patient experience with an overall better, more comprehensive treatment and understanding of that patient’s particular problems.  A goal of ‘one patient, one medical record’ is more attainable and sustainable and should lead to better outcomes.  Additionally, communication and relationships between organizations and their medical community providers is improved.  It is not difficult to understand why an organization may decide to offer a Connect product to their community.

On the surface, the implementation planning sounds easy. After all, the organization offering their EHR has already done the ‘heavy lifting’ of building workflows and determining best practices.  Oftentimes, the overall mindset in these projects initially is to treat an implementation the same way the project team would treat an internal implementation (e.g., a new department or service line).

As with any implementation, there will always be lessons learned. There are some key areas of potential risk to your ‘customers’ overall satisfaction with a Connect implementation. These items can be easily addressed prior to contracting and can ultimately alleviate or bypass future pain points for both your customers and your project team.  Although not comprehensive, below are some recurring challenges that can be experienced in Connect projects.  Organizations should ensure they have a clearly defined and communicated strategy around them.


  • Everyone is special – Determine your customization thresholds. Just as your organization is different than another in your city or region, your Connect partner is likely different from you. When extending your instance of the EHR, you need to clearly and frequently communicate to your recipients what, if any, customization you will support in their EHR with you. Customization in build is not just limited to clinical workflows but can include interfaces, third party vendor relationships, user security templates, billing/claims workflows and clearinghouses, scheduling templates and reports/reporting, among other items. Any items or areas in which your organization is willing to step away from in an established build and workflow, needs to be clearly defined for all so your Connect partner is aware of what is or isn’t possible and your project team has set parameters. Keep in mind that the more customization of the build you allow (vs. standardization), the more complex and costly your maintenance of that build will be long-term. 
  • No one likes to be ignored – Determine what level of participation your Connect partners will have in your governance and/or clinical content decisions. The quickest way to antagonize your Connect partners is to make them feel ignored. Clinicians, particularly specialty clinicians, will have preferences and suggestions to the clinical content and workflows you have extended to them. Your organization should strongly consider inviting representation of these partners into your governance and/or clinical content infrastructures. Such a strategy not only leverages additional resources to enable better patient care, it also serves to start shifting your organization’s internal culture to include consideration of outside providers and facilities in their deliberations.
  • You may need a culture shift. When you sign on your first Connect partner, your organization is no longer just “your” organization. From that moment forward, everyone from your leadership down needs to be aware that changes to workflows and content in Epic build could now impact your partners, and therefore those entities need to be included in any consideration of such changes. This is particularly important for the Epic team, as they are the ones responsible for your build, as well as any system upgrades and updates. You also may need to incorporate your Connect partners into any communication and/or training protocols you currently use around changes and upgrades in your system.
  • What are your long-term strategies around your Connect partners? How will problems be reported and resolved with your partners? We have seen a variety of solutions to these questions with our clients. Many organizations use their normal help desk operating procedures (call in a ticket, ticket is reviewed & prioritized using organization standards, ticket is assigned and worked by Epic team), but some organizations utilize a dedicated team and phone number for their Connect partners’ requests and problems. Another long-term consideration is new employee on-boarding at your Connect partners since your organization remains subject to your Epic agreement, which includes training requirements prior to access. You should review who/how that training is to be provided and how a partner communicates the need for training. As a corollary, how is your organization to be told of employee terminations for security inactivation?
  • What is the exit strategy? Unfortunately, Connect partnerships do not always work out. This may be due to practice closure or provider dissatisfaction. To protect both your organization and any of your potential Connect partners, it is strongly recommended to ensure you have an off-boarding protocol clearly laid out and communicated prior to contracting. This protocol should include the steps of how a partner initiates off-boarding activities, what the reasonable expectation of deliverables after off-boarding will be (i.e., how does the partner access the patient medical record once they are off-boarded?) and the projected timeline of an off-boarding.

Each of these items is underscored by the underlying theme of communication.  Wherever you land on decision points in your Connect implementations means little if these decisions are not shared clearly and frequently with your partners, your organization and your project team.

Connect projects are exciting opportunities for any organization to better care for patients, both in-house and in the community. Just be sure to look at the entire picture before beginning these partnerships so you can ensure your partners will be  successful using your EHR.


Connecting the Dots- The Value of SSOT Crosswalk Documents

Many healthcare organizations adopt a “best of breed” philosophy regarding their information systems. In many cases, they want the best practice management system for professional billing, plus the best EHR for clinical documentation, plus  the best hospital PM/PA system for technical and facility billing, etc.  Sometimes, they would rather implement one system that can do it all but due to financial constraints or contractual agreements, they are obligated to maintain their multi-system/multi-vendor environment.

In such complex integrated environments, it is imperative to maintain Single Source of Truth (SSOT) crosswalk documents to help the organization’s IT, finance, and operations teams connect the applications together. When integrating new practices or departments into the enterprise, it is especially crucial that the implementation teams understand how not to tangle those connections.

In a recent project, an organization attempted to transition newly acquired physician practices from legacy RCM and clinical systems onto their enterprise solution, which consisted of a diverse environment of practice management, clinical, hospital financial, and ancillary systems. Despite those enterprise systems being in place for several years, it was a surprise to learn that the organization had never taken the time to specifically document how all of their departments and locations in the source practice management system mapped to corresponding values in the downstream systems.  The provider entries in the various systems had also not been reconciled, which sometimes caused interface failures.

As the project manager representing the practice management system initiating the visit/encounter process, I offered to create a catalog of master mapping (crosswalk) documents which would be used to design the application builds and connect each department, location, and provider in system A to the corresponding values in system B, system C, etc.

Once the various IT teams agreed upon the exact values that represented the “dots to be connected” in each system, project sponsors endorsed the mapping documents as the Single Source of Truth (SSOT) to be referenced for all implementation activities. The SSOT documents were then utilized by all teams to correlate application build mapping variables between the multiple RCM, EHR, and ancillary systems.

Armed with the knowledge of how the key data elements for each system reconciled to each other, the implementation teams could formulate detailed future state workflows, business requirements, technical cutover plans, and integrated testing scripts. Whenever interfaced transactions failed during integration testing, most issues could be easily traced back to values that were not in sync with the SSOT documents.

Maintaining current and accurate crosswalks and SSOT documents may seem like a no-brainer in an environment with multiple disparate systems that must communicate with each other. However, it can be tedious and time-consuming work and when time and resources are both limited, many organizations overlook its importance.  Many hours of redesign, rebuilding, and re-testing could be avoided if time was spent wisely by first identifying critical integration points and connecting the dots.