July 9, 2013 z Information Technology Report to Medical Executive Committee Contents 1 Physician Optimization Update 2 Direct Email Protocol Project 2 Patient Portal 2 Cerner PowerChart Ambulatory EHR/PM Update 4 Appendix 1 Planned vs. Unplanned Downtime 5 Appendix 2 Orders Update, Effective June 2013 6 Appendix 3 CPOE and Medication Reconciliation Adoption Physician Optimization Update The Cerner Physician Optimization kickoff event using Physician Experience begins in July with a pilot for Hospitalists. Cerner and MLH IT will conduct a series of pilots for various specialties throughout July and August. Full deployment to all members of piloted specialties will be in October. New features and enhancements designed to streamline the workflow of each specialty will be reviewed by physicians in that specialty before they are implemented. Specialties that have been identified for this first wave of implementation are: Emergency Medicine Intensivist Cardiology Cardiothoracic Surgery Pediatrics Vascular Surgery Orthopedics Cerner will be releasing content and recommendations for those specialties not in the initial pilots over the next year. Physicians that are part of the pilot will participate in 4-6 hours of review and feedback with Cerner physician coaches and MLH Physician Analysts. This will include at the elbow training for the new functionality. Methodist IT is prepared to follow the same model of deployment as new recommendations are released.
PAGE 2 Direct Email Protocol Project MLH has started a project that allows medical staff with MLH hospital privileges to use a new email protocol for sending secure emails that contain personal health information (PHI). MLH has purchased Cerner s Direct, a CMS-approved secure messaging protocol. Direct has also been approved by the State of Tennessee for all medical staff. Direct allows MLH medical staff to send secure messages from the Cerner hospital or ambulatory EMR to other providers or provider organizations if the other provider or provider organization has a Direct email account. MLH Patients, Physicians and provider organizations will also be able to use Cerner Direct through the MLH Patient Portal and their Inbox in the onechart (Cerner) EMR. Direct s projected go live timeline will be September 2013. Patient Portal The Cerner hospital and ambulatory Patient Portal rollout plan starts with implementation at Fayette Hospital in early September. During this pilot additional select MLH Associates will be asked to test. Later in September physicians and associates at North Hospital will be asked to participate. Following the pilots the Portal and Cerner Direct will be rolled out to the rest of the hospitals. More detail on Direct and Patient Portal will be provided in the August Information Technology Report to the Medical Executive Committee. Cerner PowerChart Ambulatory EHR/PM Update The Cerner Ambulatory project officially kicked off in June and will reach a major milestone with a system review session July 24, 2013. The System Review will follow the two-day annual Ambulatory Summit sponsored by Cerner for client groups. Representatives from IT along with Physician Champions will attend the Summit and the System Review. Physicians participating in the Summit and the System Review include: Benjamin Rush Waller III Burton Hayes Catherine Clarke Bateman Deborah Nelson Eunice Huang Kenneth Robertson
PAGE 3 Summit Sessions included for ambulatory leadership and key physician users: ICD-10 Medical Home Interoperability Optimization Meaningful Use Patient Portal Solution Updates Population Health HIMSS Ambulatory EMR Adoption Model Revenue Cycle
PAGE 4 Appendix 1 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 May 2013. 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 2013 44,640 0 0 100.00% 100.00% February 2013 40,320 0 0 100.00% 100.00% March 2013 44,640 0 0 100.00% 100.00% April 2013 43,200 0 0 100.00% 100.00% May 2013 44,640 0 0 100.00% 100.00% Total 217,440 0 0 100.00% 100.00%
PAGE 5 Appendix 2 Orders Update, Effective June 2013 New Orders The new order, Transfer pt within current facility, replaces the Transfer Patient order. The following new transfer orders are synonyms of the Discharge Patient order: Transfer Pt. to Alternate Acute Care Facility Transfer Pt. to Another MLH Facility Transfer Pt. to Non Acute Care Facility These orders, along with the Discharge Patient order, will contain the required order detail, Disposition, which identifies the patient s destination after discharge. New Alerts Admission Medication Reconciliation Alert Physician and Physician Related Roles A new Admission Med Rec alert displays when physicians/lips log into a patient chart through PowerChart if the patient encounter type is observation or inpatient, medication history has been started, and Admission Medication Reconciliation has not been completed 16 hours after the encounter history date. Only admitting physicians, attending physicians, residents, and nurse practitioners receive this alert. Duplicate Blood Culture Alert Physician and Physician Related Roles A new Duplicate Blood Culture alert displays for a 24-hour timeframe from the original Blood Culture order when a second or subsequent Blood Culture order is placed. New PowerPlan LEB Endo Diagnostic Fast Plan
PAGE 6 Appendix 3 CPOE and Medication Reconciliation Adoption 120.00% CPOE INPATIENT ADOPTION RATES BY HOSPITAL January - June 2013 100.00% 80.00% 60.00% 40.00% University South North Germantown Le Bonheur 20.00% 0.00% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 CPOE ED ADOPTION RATES BY HOSPITAL January - June 2013 98.50% 98.00% 97.50% 97.00% 96.50% 96.00% University South North Germantown Le Bonheur 95.50% 95.00% 94.50% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13
PAGE 7 Appendix 3 CPOE and Medication Reconciliation Adoption (continued) Medication Reconciliation Adoption By Facility Through June 2013 METRIC UNIV SOUTH GTWN NORTH LEB FAYETTE Inpatient April 2013 ADM IP Med Recon Adoption Metric % 46.53% 48.23% 43.44% 36.13% 67.88% 50.00% May 2013 ADM IP Med Recon Adoption Metric % 52.42% 59.41% 35.98% 32.75% 68.62% 72.22% June 2013 ADM IP Med Recon Adoption Metric % 54.39% 61.51% 41.41% 39.15% 66.88% 93.33% April 2013 DSCH IP Med Recon Adoption Metric % 92.08% 84.11% 83.33% 91.04% 95.54% 100.00% May 2013 DSCH IP Med Recon Adoption Metric % 98.02% 88.89% 86.32% 92.89% 97.15% 92.86% June 2013 DSCH IP Med Recon Adoption Metric % 96.96% 91.18% 87.71% 93.13% 95.78% 100.00% Observation April 2013 ADM OBS Med Recon Adoption Metric % 38.71% 16.67% 40.16% 3.70% 65.66% 66.67% May 2013 ADM OBS Med Recon Adoption Metric % 38.95% 32.53% 23.31% 11.66% 77.73% 68.42% June 2013 ADM OBS Med Recon Adoption Metric % 42.91% 33.78% 26.03% 14.68% 76.53% 100.00% April 2013 DSCH OBS Med Recon Adoption Metric % 76.71% 50.00% 72.95% 28.57% 96.63% 100.00% May 2013 DSCH OBS Med Recon Adoption Metric % 79.27% 50.62% 78.62% 43.40% 97.14% 94.12% June 2013 DSCH OBS Med Recon Adoption Metric % 76.91% 47.87% 75.43% 38.30% 96.74 90.91 RED = < 69.99% YELLOW = > 69.99% < 84.99% GREEN = > 85.00% On June 11, 2013 an alert was added to the MED REC view giving the physician notice when Medication Reconciliation has not been completed. The impact will be assessed in the July 2013 reporting.