Information Technology Report to Medical Executive Committee

Transcription

1 April 9, 2013 z Information Technology Report to Medical Executive Committee Contents 1 PACS Selection 1 Successful Implementation of Voice Recognition for Radiologists 2 Cerner PowerChart Ambulatory EHR/PM Implementation 2 mpages 2 Medication Reconciliation Rollout Continues 5 Information Security Officer Position 6 XP Replacement Project Enters Phase 2 at University Hospital 7 Appendix 1 Orders Update Effective in March Appendix 2 Planned vs. Unplanned Downtime 10 Appendix 3 Quarterly Chart Search and mpage Usage Graphs 17 Appendix 4 CPOE Adoption Rates by Hospital Quarter PACS Selection Methodist Le Bonheur Healthcare signed a contract with McKesson for an enterprise PACS solution on March 26. The enterprise PACS solution includes radiology PACS, cardiology PACS, Radimetrics (radiation dose tracking), and TeraRecon 3D imaging. The project will begin in May when McKesson assigns a project manager to MLH. The first steps will be a project kickoff and development of a MLH-specific implementation plan. The detailed planning will address questions about timeline as well as how best to stage the implementation. Successful Implementation of Voice Recognition for Radiologists The Nuance PowerScribe 360 Voice Recognition system for radiologists was successfully implemented February 25 March 8 for all MLH hospitals and diagnostic centers. Dr. Davis Moser and Dr. Harris Cohen led the charge for the excellent adoption rates we are experiencing. ED physicians are reporting improvements in radiology report turnaround time. 98.9% of radiology reports were completed through Voice Recognition between March 18 and April 1. In January 2013, before Powerscribe 360 was implemented, Radiology Transcription Services totaled $164, In March 2013 after Powerscribe 360 was implemented, Radiology Transcription Services totaled $25, We are averaging a reduction of 85% of MLH cost of Radiology Transcription. Additional future decrease in cost is expected when all the Mammography Addendums are completed in Cerner for prior cases dictated on Lanier in June This is a workflow requirement because all current cases must be tracked and dictated in Powerscribe 360 before the necessary Addendums can occur in Powerscribe 360.

2 PAGE 2 Cerner PowerChart Ambulatory EHR/PM Implementation In late February, the MLH Board of Directors approved the purchase of Cerner PowerChart ambulatory software for electronic health records (EHR) and practice management (PM) systems. A contract has been signed and the initial scope of the implementation project will include the following clinics: ULPS, UTMP, MTP, and The Sickle Cell Center, comprising approximately 150 physicians and their practice associates. The project is set for official kick-off on June 3, Planning and staffing activities are now underway to ensure a smooth transition from existing systems and allow for integration with the MLH acute care Cerner health information system. mpages The Physician Specialists in Informatics recommended the Inpatient and ED Summary mpages be moved to the first position in the PowerChart and FirstNet menus for physician and related positions in order to increase the visibility and usage of the mpages. This change is planned to go-live May 21, subject to successful testing. Medication Reconciliation Rollout Continues On March 5, Methodist University Hospital became the first facility to implement the enhanced medication reconciliation (med rec) functionality and workflows. The golive went very smoothly from a technical standpoint with minimal technical issues reported. The majority of technical issues reported were related to the pharmacy technician task list. Thanks to the leadership and support of Dr. Robin Womeodu, CMO; Catherin Murphy, CNO; Donna Bryant, CTS; and Shannon Williams, Physician Analyst, University Associates and physicians adapted well to the new med rec workflows.

3 PAGE 3 The University superusers and Shannon worked diligently during go-live to assist physicians with the electronic med rec processes and encouraged them to complete the med rec training on ChexWeb. Low physician training levels at go-live at University resulted in the need for a high volume of 1-on-1 training and increased frustration. The following table reflects the low volume of training at University and for all other facilities. Training has been available for all physicians since February 12, MEDICATION RECONCILIATION TRAINING STATUS as of 4/4/2013 Module: Managing Patient Care Using Medication Reconciliation and Rx Writer 0-49% = Red 50-79% = Yellow >80% = Green FACILITY TARGET GOALS ** # of TARGET COMPLETING MED REC MODULE % of TARGET COMPLETING MED REC MODULE Target MDs University - Physicians, NP, PA % Residents * % North - Physicians, NP, PA % South - Physicians, NP, PA % Germantown - Physicians, NP, PA % Le Bonheur - Physicians, NP, PA % Fayette - Physicians, NP, PA % Target Totals % Non-Target 33 SYSTEM TOTALS 130 * Residents names are recorded on a separate spreadsheet. All Residents are in target. Because residents rotate through systems, the availability for training fluctuates from month to month. ** Target Goals are based on order entry volume exceeding an average of 100 orders per month. Medication reconciliation physician adoption numbers for discharge have been high since implementation at University. The med rec team and University leaders continue to work with physicians to increase the low admission reconciliation adoption numbers. The table below reflects the adoption rates for admission and discharge med reconciliation for University from March 5-31, Transfer orders review/reconciliation adoption numbers are not available yet. Admission Med Rec (University) Inpatient Observation 1233 Encounters 446 Encounters 789 Med Recs Completed 234 Med Recs Completed 470 Completed within 24 Hours 183 Completed within 24 Hours 38.12% Meet Metric for Completion 41.03% Meet Metric for Completion 99.24% Completed by Physician 99.57% Completed by Physician

4 PAGE 4 Discharge Med Rec (University) Inpatient 1230 Encounters 463 Encounters 42 Deceased 0 Deceased Observation 1126 Med Recs Completed 355 Med Recs Completed 91.54% Meet Metric for Completion 76.67% Meet Metric for Completion 1111 Total by Physician 338 Total By Physician 98.67% Completed by Physician 95.21% Completed by Physician In addition, the introduction of RxBuilder/Knowledge Driven Medication Ordering (KDMO) at all facilities made mandatory the requirement to add a stop date/time to acute drug therapies such as PRN and antibiotic medication orders. In response to physician requests to speed the order entry process, the medication reconciliation task force approved hiding the required time field so physicians will only need to enter the stop date. This was effective April 2. The University pharmacy team is doing an outstanding job in onboarding, training, and supporting the pharmacy technicians. Due to higher than anticipated patient census at University, the techs addressed a high volume of home med history requests the first two weeks of go-live. Pharmacy leaders will continue to monitor volume to determine if staffing levels are adequate to meet the need. MUH pharmacists have been tracking cases of patients who have been admitted with potential major medication errors that were identified during the new medication reconciliation process. Common findings/catches by the pharmacy techs include the following:

5 PAGE 5 Duplicate therapeutic class (statins very common, with patients actually taking both at home) and/or wrong frequency. Previous drug list incomplete prior to pharmacy tech updating it (may have drug name but usually no dose/route/frequency present). Duplicate orders - If these duplicates hadn t been caught by a pharm tech, physicians may have restarted the orders. Although it was previously reported that all remaining sites would be implementing the enhanced med rec on April 2, the Med Rec Optimization Task Force has decided to split the remaining go-lives as follows: April 2: Germantown and South April 23: North, Le Bonheur and Fayette The decision to split the go-live was made based on pharmacy staffing challenges at North that could take a few weeks to resolve and the addition of discharge steps to be completed in Depart during the discharge process at Le Bonheur, which is not yet using Depart. South, Germantown, North, and Le Bonheur physicians, please complete the med rec training assigned to you on ChexWeb. To complete the training, go to The online module is eligible for CME credit and takes no longer than an hour to complete. Call and Pam Thompson can assist you If you need assistance with the training. The facilities currently going live may contact the facility Physician Analyst for assistance with med rec. To report technical issues with the onechart system, please call the IS Help Desk physician number at Information Security Officer Position Our audit firm (KPMG) completed a thorough Security Risk Assessment last year and recommended that we hire a full-time Information Security Officer (ISO). This position would be responsible for the development, implementation, and enforcement of information security policies, procedures, strategy and technical systems in order to maintain the confidentiality, integrity, and availability of all MLH s electronic healthcare information systems. After an extensive recruitment process, the final candidates have been selected. In collaboration with the Legal and Compliance departments, Information Technology will be interviewing the ISO candidates in April.

6 PAGE 6 XP Replacement Project Enters Phase 2 at University Hospital The XP Replacement Project team is currently deploying Windows 7 upgrades at University Hospital as part of Phase 2. This phase consists of replacing older computer models with new Lenovo machines as well as upgrading newer Dell OptiPlex 960 PCs with additional memory and Windows 7. University Phase 2 is expected to be completed by mid- April Looking forward, the team will complete Corporate Phase 2 by mid-may 2013 and then move to South, Le Bonheur, North, Germantown, and then Sutherland. We appreciate your patience and partnership as we navigate this project.

7 PAGE 7 Appendix 1 Orders Update Effective in March 2013 Combination Diet Physician & Physician Related Roles Adult Facilities A new order, Combination Diet, was made available to place. There are advantages to using this order as it allows the provider to select up to three diets with this one order, e.g Consistent Carbohydrate, AHA and 4 gram Sodium. The Diet order detail contains a multi-select feature. To select more than one diet in the listing, simply press and hold the Ctrl key when selecting. A diet in the listing is deselected in the same way; press and hold the Ctrl key and click the diet name. Note the Consistent Carbohydrate diet is a new diabetic diet option. Multi Drug Resistant Organism (MDRO) Alert All Clinicians All Facilities The MDRO alert is necessary to ensure the following: Best practice is being followed regarding the most appropriate antimicrobial therapy for these identified patients. Appropriate coordination of patient care occurs with other Physicians, and Departments (Infection Prevention, Infectious Disease Physicians, or Pharmacy), as warranted. When the MDRO alert criteria are met, the alert will display once per day, per clinician, when the chart is opened. Please review the information. Click OK to close the alert. At the adult facilities, and at Le Bonheur, upon re-admission, an Infection Prevention Consult will automatically be placed, if the patient has been identified as being positive for one or more of the identified MDROs within the past two months. If the patient tested positive for one of the following organisms: Adult Facilities: o Carbapenem-Resistant Enterobacteriaceae (CRE) o Klebsiella Pneumoniae Carbapenemase (KPC) o Vancomycin Intermediate Staphylococcus Aureus (VISA) o Vancomycin Resistant Staphylococcus Aureus (VRSA) o Clostridium Difficile (C-Diff) If positive for C-Diff within the last two months, and diarrhea is documented on the current admission, an automatic Contact Isolation order will be placed. Le Bonheur: o Vancomycin Resistant Enterococcus (VRE) Radiation Therapy Consult Eval Order The Reason for Consult order detail options will be updated and the detail will be required.

8 PAGE 8 PowerPlan and Careset Update - New Plans LEB Pediatric Intensive Glycemic Control Plan LEB Med-Surg Intranasal Medications Plan LEB Critical Care Intranasal Medications Plan LEB ED Dental Injury Plan ED Initial Orders ED Nursing Adult Facilities The ED Initial orders placed by the ED nurses will include the word, Protocol, e.g. ED Initial Back Pain Protocol Orders. ED Abdominal Pain Care Sets ED Physicians & Related Roles Adult Emergency Departments The following note will be added to the Caresets: If patient is over 25 years: order Troponin and EKG.

9 PAGE 9 Appendix 2 Planned vs. Unplanned Downtime The following table depicts the Cerner Production system uptime and planned and un-planned downtime in minutes from January 1, 2013 February 28, Note: This table does NOT include network downtimes that may have impacted access to onechart. Total Minutes Planned Downtime Unplanned Downtime Total Uptime % Cerner Uptime % January , % % February , % % Total 84, % %

10 PAGE 10 Appendix 3 Quarterly Chart Search and mpage Usage Graphs

11 PAGE 11 Appendix 3 (cont.) Quarterly Chart Search and mpage Usage Graphs

17 PAGE 17 Appendix 4 CPOE Adoption Rates by Hospital Quarter CPOE INPATIENT ADOPTION RATES BY HOSPITAL January - March % 95.00% 90.00% 85.00% 80.00% University South North Germantown Le Bonheur 75.00% 70.00% Jan-13 Feb-13 Mar-13 MONTH CPOE ED ADOPTION RATES BY HOSPITAL January - March % 98.00% 97.50% 97.00% 96.50% 96.00% 95.50% University South North Germantown Le Bonheur 95.00% 94.50% Jan-13 Feb-13 Mar-13 MONTH