Provider Advisory Group: September 14, 2017

0700-0800 hours CDT

Attendees

Anupam Goel (corporate) Sakhie Hussain (Trinity)
Chris Jamerson (Childrens) Julie Miyamasu (Advanced Practice Clinician, Advocate at Walgreen’s)
Shilpan Patel(Good Shepherd) Suneel Udani (Good Samaritan)
Cynthia Zaletel (Advanced Practice Clinician, Advocate at Walgreen’s)

Provider Advisory Group new members

The group now includes Advanced Practice Clinicians and residents. The group’s goal is to focus on issues that affect independent ordering providers primarily in Advocate’s inpatient arenas. There is a separate forum for Advocate Medical Group physicians to review outpatient processes through CliniCare (AllScripts).

Old business

  • Alert for contrast dye: alert is being included with other electronic medical record changes to reduce the risk of contrast media-associated kidney injury as a project to the Clinical Information Systems Enhancement (CISE) Committee.
  • Provider directory consolidation: Clinical Informatics is working with specific groups of providers to combine accounts across the organization. Users seem pleased with having a single CareConnection login across the network. The work will be prioritized based on Advocate’s Cerner registration roll-out schedule.
  • Request to simplify view blood products: Anupam to submit this request to CISE.
  • Dragon Medical One (DMO)
  • Roll-out schedule across hospital service regions

    Site Date
    Advocate Medical Group West (Dreyer) March 1, 2017
    Advocate Medical Group April 8, 2017
    Illinois Masonic April 17, 2017
    Trinity June 7, 2017
    Good Samaritan July 11, 2017
    Lutheran General July 11, 2017
    Condell August 22, 2017
    Sherman August 22, 2017
    BroMenn September 4, 2017
    South Suburban September 12, 2017
    Good Shepherd October 10, 2017
    Christ October 17, 2017
    • Mobile Mic app deployment: Nuance’s Mobile Mic application may be best suited for those providers who
      • Access Advocate’s inpatient and outpatient applications within the same day
      • Generate a significant number of transcription costs, or
      • Use an Android smart device

      Anupam (hospital) and Chris Jamerson (AMG outpatient) to work with Health Informatics and Technology (HIT) to finalize a policy for Mobile Mic deployment across the organization

    • DMO access during clinical application downtime: emergency physicians expressed this concern as they saw DMO deployed at their sites. The HIT teams are willing to deploy a local version of the DMO client on select computers to allow providers to use the software when the clinical applications are not working. Anupam has communicated this with the Emergency Medicine leadership.

Change requests

  • Requests for CISE
    • Explore medication reconciliation across encounters
    • Deploy Camera Capture
  • Requests requiring additional work
    • Cardiology alert to remind users to complete specific tasks for patients with acute myocardial infarctions or who underwent percutaneous coronary intervention (stent placement): Sent back to Cardiology team for additional design work to limit alert, ordering and documentation burden on non-cardiologists
    • Empiric antibiotic guidelines within CareConnection: Sent back to Antimicrobial Stewardship Committee to consider alternative ways of presenting the information in a more workflow-concordant manner

Migrating from PowerNote to Dynamic Documentation (PowerChart only)

Anupam outlined Cerner’s strategy of moving users away from PowerNote toward Dynamic Documentation. The Dynamic Documentation templates are geared toward data entry by voice. The integration within the Workflow mPage allows users to pull information into the note while records are reviewed. Copy-and-paste actions are marked in the document.

The group was concerned about the educational effort to move users from PowerChart to Dynamic Documentation. At least one attendee felt that PowerNote templates were simple enough to enter multiple H&Ps over the course of a day supported by nursing elements being pulled in to complete the documentation.

Anupam to provide a demonstration of Dynamic Documentation to the group next month.

Site-specific order set and PowerPlan consolidation

The CareConnection team has agreed to dedicate specific resources to consolidate the hundreds of site-specific order sets and PowerPlans across the organization to a smaller set of system-wide PowerPlans. The four planned groups are:

  1. Basic procedures and PowerPlan subphases (building blocks for larger PowerPlans)
  2. Surgeries
  3. Admission/Transfer/Discharge
  4. Specialty-specific (e.g., Pediatrics, Emergency Room)

System champions have already been identified for multiple groups (i.e., Emergency Room, Women’s Health, Pharmacy, Pediatrics, NICU, Hematology/Oncology, Hospitalist, Transplant [CMC only], Pulmonary/ICU). Site champions will need to be identified for the following specialties:

Anesthesia Behavioral Health General Surgery Cardiothoracic surgery
ENT Neurosurgery Ophthalmology Orthopedics
Plastics Podiatry Trauma Urology
Vascular surgery Cardiology Electrophysiology Endocrinology
Gastroenterology Infectious Disease Nephrology Neurology/Neuroradiology
Radiology and Interventional Radiology Rehabilitation

Specialty-specific standard work

Much like the PowerPlans, there may be some benefit to developing specialty-specific educational content to help new users become oriented to using the electronic medical record or understand new changes that might affect their work. The educational content may be most beneficial if it includes process steps inside and outside the electronic medical record. Anupam has been working with site Clinical Informatics teams to better understand what content might be generic across specialties and what content might require specialty-specific additions. CareConnection is a Cerner platform, so the software has separate code for some specialties (e.g., OB/GYN, emergency room, oncology). From a content development perspective, there may be more value to developing core content based on general groups (e.g., emergency room, rehabilitation, hospitalist, neurology, radiology, general surgery) and then cluster additional groups based on specialty (e.g., medical subspecialties, surgical subspecialties). We may also need a separate set of workflows for residents and advanced practice clinicians.

Documents to review

  • Provider Advisory Group charter
  • PerfectServe communication policy: There are still some groups who either cannot use PerfectServe or do not use PerfectServe. The policy is silent when a user needs to communicate with someone who is not on PerfectServe.
  • Photo policy: The group stated that there are several practices across our organization (e.g., gastroenterology, surgery) that use cameras and take pictures outside PerfectServe and Camera Capture. Additional work may be needed to incorporate those technologies in this policy. The group also acknowledged behaviors where clinicians were using personal devices to capture patient images to manage a clinical condition. Advocate will not be able to endorse taking or sharing photographs of patients on platforms that cannot be tracked or monitored.

Committee members to review policies and provide any feedback to Anupam before the next meeting.

Miscellaneous items

  • Using PerfectServe to update ordering providers about minor changes to radiology orders: Currently, radiology teams have to ask ordering providers to cancel an existing order and re-enter a radiology order to make a change to the order (e.g., chest CT with contrast instead of chest CT with and without contrast). The radiology group wanted approval to use PerfectServe as a method to communicate with ordering providers and use that communication as approval to make the order change. The group agreed with this request.
  • Reducing the default narcotic discharge prescription quantity: Currently, the maximum number of tablets or capsules of most narcotics that can be ordered on discharge is 40. The pharmacy team is requesting we reduce the maximum to 20. A provider could issue two narcotic prescriptions with a 20 dispense limit on each prescription. The group agreed with the request.
  • Removing the PRN pain reason: Currently, providers can enter pain medications with a “PRN pain” reason. Our regulatory body has asked that we be more specific with our PRN reasons to provide guidance around what medications to prescribe for a given level of pain (e.g., ibuprofen for moderate pain, morphine for severe pain). The PRN options would include “mild pain,” “moderate pain,” “severe pain,” and “breakthrough pain.” The group agreed with the request.

Next meeting: October 12, 2017 at 0700 hours CST