Provider Advisory Group: October 12, 2017

0700-0800 hours CDT


Ravi Damaraju (Sherman) Anupam Goel (corporate)
Sakhie Hussain (Trinity) Chris Jamerson (Children’s)
Sudha Kumien (Advanced Practice Registered Nurse, Cardiology) Elliot Levine (Illinois Masonic)
Shilpan Patel (Good Shepherd) Suneel Udani (Good Samaritan)

Provider Advisory Group new members

Ravi Damaraju (Sherman) and Sudha Kumien (Advanced Practice Registered Nurse) joined the group to represent their constituencies.

Old business

  • Safer process to administer contrast dye for patients undergoing radiology and cardiology procedures: the Clinical Information Systems Enhancement (CISE) Committee approved this project for prioritization. The South Suburban pilot will be expanded to include cardiology. Based on the South Suburban experience, the process including alerts, reports and contrast dye tracking, will be disseminated across the system.
  • Provider Directory consolidation: work is ongoing. There will be a need to develop separate logins for residents who are moonlighting, but all other users should see minimal changes to how they interact with CareConnection.
  • Blood product review: pending CISE review.
  • Voice recognition
    • Dragon Medical One: there are approximately 2000 Dragon Medical One (DMO) licenses that can be distributed across the CareConnection inpatient facilities. In an effort to redistribute licenses to those users who most need them, those users who have not logged into DMO in the last 60 days will have their licenses revoked as of November 1st. The site Vice Presidents of Medical Management (VPMMs) were notified about this change earlier this week.
    • Mobile Mic, converting a user’s mobile phone into a dictaphone: Advocate is considering limiting Mobile Mic to Advocate Medical Group (AMG) users who see patients in both the inpatient and outpatient settings. The group suggested investigating the validity of this approach by validating that a user can access DMO from home using any USB-connected microphone.
    • Transcription reduction efforts
      • Sherman turning off progress note transcription on February 1, 2018. The hospital is planning on turning off H&Ps and consults later in the calendar year.
      • The group agreed that it would make more sense for the organization to develop a system-wide date to turn off specific note types to reduce confusion among independent ordering providers. Anupam to investigate how many current users of telephone transcription by note type would be affected by such a decision. Regardless of what notes are selected, the organization would benefit from a transition plan that includes the technical work of migrating users to DMO or PC Touch and training to help users best use the technology for their own needs.
  • PTCA quality measures: the Illinois Masonic team agreed to limit the alert to those patients who underwent a PTCA as marked within a system PowerPlan. The primary team and cardiologists would receive the prompts to add more information if necessary. The request will be submitted to CISE.
  • Antimicrobial stewardship: the group developed an alert that drives the user to the Medication Management mPage for those patients whose antibiotics are expiring within 24 hours. The request will be submitted to CISE.
  • Charter and policy documents: the group had no further edits to the documents from last month.

Entering notes via PC Touch or Dynamic Documentation

Anupam performed a short demonstration of the PC Touch & Dynamic Documentation workflow. The technology appears to be the most effective when the smartphone is used to track free-text information (e.g., History of Present Illness, Assessment & Plan) and the Dynamic Documentation desktop technology is used to pull in discrete elements from other parts of the chart (e.g., vital signs, laboratory values, medications). Most committee members had not seen this workflow before, but believed it could help several independent ordering providers to complete their documentation in a more workflow-concordant way. To be successful, the group emphasized the need to provide specific education to users about how they might best use the different technologies in the relevant care settings. One committee member can complete a History and Physical in less than two minutes using both mobile and desktop technology.

The principal advantage of this workflow over a desktop-only approach with PowerNote and a tethered microphone is the ability to enter patient-specific information immediately after each encounter rather than waiting until rounds are complete. The focus on capturing physician decision-making appears to the primary reason to make a switch.

Specialty input for order set/PowerPlan consolidation

In an effort to reduce the site-specific content across the CareConnection facilities, Anupam has identified seven specialties (Cardiology, Cardiothoracic surgery, Gastroenterology, Hospitalist, ICU, Nephrology and Neurology) with content that cross hospitals. Committee members will identify champions from each of these service lines at their own sites to serve as users who might review proposed system-wide PowerPlans to replace the site-specific order sets.

Specialty input for EMR educational content

In a recent national KLAS survey of EMR usability, Advocate’s CareConnection ranked in the bottom quartile for clinician satisfaction. One of the major themes from the survey was that users wanted the EMR to be more customized to their specialty workflows rather than a generic experience that required more user manipulation to access and enter information. Advocate’s educational approach has been specialty-agnostic in most cases and could benefit from specialty-specific input. Clinicians identified for order set/PowerPlan consolidation work will also be asked to provide some input into what they think their colleagues might want to know when they first start using CareConnection.

Change requests

  • Educational link within CareConnection: the group discussed the relative value of a link to all of Advocate’s educational resources (Advocate library) versus a vendor-specific link (e.g., UpToDate). The group agreed to include a link to Advocate’s library instead of a vendor-specific link. Anupam to submit the request to CISE.
  • Simplifying the menu bar: as part of the educational link conversation, the group noted how busy the user’s menu bar appears.
    Anupam to investigate what might be done to simplify the menu bar for independent ordering providers.
  • Alerts to notify ED users about patients with possible post-delivery pre-eclampsia: without a robust process to track recent childbirth, the emergency medicine physicians were interested in developing an alert for women of childbearing age with elevated blood pressure. Anupam to refer emergency room physicians to Elliot for further conversation before submitted request to CISE.
  • Displaying flu vaccine in discharge summary: the group determined that the influenza vaccine information should be pulled in on-demand rather than populate each discharge summary automatically. Anupam to submit a CISE request for a flu vaccine autotext if one does not already exist.

Miscellaneous items

  • Radiology decision support: to meet Medicare’s requirement for all advanced imaging (CT scans, MRI, nuclear medicine) to include some form of decision support, Advocate will pilot EMR-agnostic decision support content intended for the emergency department and hospital outpatient departments. There are separate initiatives for AMG outpatient users and independent practices. Based on the pilot results, the program will be adjusted and then deployed across the inpatient facilities well before the official start date of January 1, 2019.
  • ePrescribing of controlled substances: Advocate will be piloting this functionality among a select group of users at Good Samaritan over the next few weeks. If the pilot goes well, Advocate will enroll the top 500 prescribers of controlled substances at Advocate. Those 500 users account for nearly 80% of all controlled substances discharge prescriptions for the organization. If necessary, Advocate could then reach out to additional users upon request.
  • Zero-time downtimes: the CareConnection team is investigating ways to support the application through software upgrades with essentially no downtime. Anupam will update the group as more information becomes available.
  • Migrating to a single EMR vendor across Advocate-owned facilities: Bobbie Byrne, Advocate’s new Chief Information Officer, is investigating the feasibility of moving our inpatient and owned outpatient practices to a single EMR platform. A decision is expected before the end of the year.

Next meeting: November 9, 2017 at 0700 hours CST