A SIGNIFICANT INVESTMENT WITH A GREAT PAYOFF

A SIGNIFICANT INVESTMENT WITH A GREAT PAYOFF Sometimes apps are not all fun and games. Within Munson s system, about 300 applications service everything from billing to dining. And among those 300, there is an important subset of 20: Ambulatory Applications, among which include eclinicalworks, NextGen, Dragon, and the interfaces that enable these systems to link and talk with one another. In the next 18-24 months, the Interface Team (a subset of Ambulatory Applications) will be working on a large project to integrate the Aaron Matthews hospitals Lab and Radiology systems with physician practices. This will allow electronic orders to populate the hospital systems and have those results match back and show up on patients charts. The upgrade will be a significant investment with a great payoff, said Aaron Matthews, Munson s Manager of Ambulatory Services, whose team provides support for physician offices through implementation, upgrading, and consulting services that support Ambulatory practices. The team will begin with the 47 hosted practices that use eclinicalworks, NextGen, and ARIA to ensure the processes are down pat, said Matthews, adding that non-hosted practices are also included in the rollout. Though the process has already begun with lab results going out to many practices, a chunk of the rollout will center on radiology scheduling, he said. MYHEALTHINFO CERNER PATIENT PORTAL FAQS MyHealthInfo, Munson Healthcare s Cerner Patient Portal, launched February 2014 and is being offered to patients receiving either inpatient or outpatient services. Starting May 19, Radiology and Pathology reports will post to the patient portal. In response to physician questions, below are some frequently asked questions. My patient was an outpatient, why are they seeing their results in the Cerner Patient Portal, MyHealthInfo? Once an inpatient or outpatient signs up for MyHealthInfo Patient Portal, they will see: Laboratory test results (except sensitive labs) Pathology reports (except HPV and Autopsy results) Radiology test results Continued on page 5 Continued on page 6 WEARING YOUR HEALTH ON YOUR SLEEVE? IT COULD HAPPEN As technological capabilities grow, so too grow the possibilities of interacting with patients on a continual not episodic basis. Beginning with the orders rollout taking place over the next 24 months, what comes next is anyone s guess, said Aaron Matthews, Munson s Manager of Ambulatory Services. Simply getting practices connected with lab and radiology orders coming into Munson is definitely a significant step in patient safety and satisfaction, he said. But for the future, there are a number of things that will have a huge impact. Matthews said the following technological needs and advances are coming down the pike: Connecting with the patient and truly understanding what is happening on a day-to-day basis Wearables like wristwatch-type activity trackers could drastically increase the amount of information coming into an EMR Managing/connecting with individual patients vs. a patient population Coordinating care across a continuum The future is new to all of us and frankly no one knows exactly what technologies will catch on, Matthews said. We need practices feedback and guidance to ensure that the patient is at the forefront of the technologies we adopt. The complexity of health care has kept its technological leaps to a minimum when considering what other industries have done, said Matthews. We are only in the infancy of the computerization of health care; it s the biggest pain point currently, he said. We are one of the last holdout industries because we are so complex. Page 1 Practice Pro April/May 2015

NEW, STREAMLINED VOICE PATIENT SAFETY REPORTING TOOL HAS LAUNCHED Five Munson Healthcare hospitals launched a new VOICE system in early April as part of its effort to improve the culture of safety at the hospital. Munson Medical Center Patient Safety Coordinator Lindsey Mack, RN, said the new system replaced the previous version which was used in collaboration with Trinity Health. The VOICE system is an important tool for reporting patient or visitor events, near misses, and good catches, as well as process issues related to safety. The new VOICE system incorporates feedback from physicians and front-line staff. The old system was too lengthy, deterring physicians from filing a report. We d heard from physicians that the old VOICE system was cumbersome and time consuming. We ve simplified and streamlined submitting a VOICE report. In most cases the number of required fields has been decreased by almost half, Mack said. When a VOICE report is submitted, it automatically generates an email alert to managers of the area in which the incident occurred. At Munson Medical Center, all VOICE reports are reviewed daily by Patient Safety, and the medication pharmacist. They have been made part of the Daily Check-In meeting that involves hospital department representatives and executive leadership. This gives hospital leadership real-time awareness of any issues that require immediate collaboration and attention. The expectation is that the VOICE file will be reviewed within 48 hours and followup completed on most incident reports within 10 days. While the reports can be anonymous, Mack said she encourages physicians to include their name. We hope that people feel comfortable putting their name to it, she said. It s helpful for us to follow up on the event and it enables us to contact them for more detail if needed. Currently there are 10 to 15 VOICE reports filed every day at Munson Medical Center. Patient Safety hopes to increase those reports by 7 to 9 percent for the fiscal year. Mack emphasized the importance of reporting near misses and incidents to help track trends. We strongly encourage physicians to submit a VOICE report when they have a patient safety concern to help us improve patient safety throughout Munson Medical Center. In addition to Munson Medical Center, the new VOICE system will include Cadillac Hospital, Grayling Hospital, Kalkaska Memorial Health Center, and Paul Oliver Memorial Hospital. ICD-10 EARLY ADOPTION Munson Healthcare is implementing early adoption of ICD-10, which helps pave the way to ICD-10 readiness. It is an opportunity to focus on clinical documentation improvement and test revised outpatient order forms and processes. Cardiology/Cardiovascular Surgery/Cardiothoracic Surgery When documenting, please be aware that additional detail is required to fully document a cardiac condition. Include terms to indicate severity (acute, acute on chronic, chronic) and exact anatomic site (i.e. anterior wall, lateral wall) in your diagnostic statement. A Cardiology Quick Reference Guide regarding atrial fibrillation is inserted is this issue of Practice Pro. Outpatient Rehabilitation When ordering Outpatient Rehabilitation tests, a reminder to include details regarding anatomy, severity, and etiology. Please be sure to include, as applicable, laterality (right, left, or bilateral) when documenting the diagnosis/reason for referral. It is also very important to describe the condition as acute, chronic, or acute on chronic and to describe the cause of the condition if known. Education Please encourage your physicians to complete specialty-specific optimal documentation courses via HealthStream at https://www.healthstream. com/hlc/munsonhealthcare. If you have any questions, please contact Kelly Whittle, ICD-10 Program Manager, at (231) 935-2697 or kwhittle@mhc.net. Page 2 Practice Pro April/May 2015

WHERE TO SEND PATIENTS FOR LAB TESTING We encourage sending lab patients to non-hospital draw stations (munsonhealthcare. org/lablocations) for ease of access, decreased patient wait times, and general patient convenience while decreasing hospital congestion. However, not all Munson Healthcare lab locations can collect all tests. The following is a partial list of the more commonly ordered lab tests that can only be collected at a hospital: ABG s (arterial blood gases) Ketones Ammonia Levels pro-insulin (M80908) Ascorbic Acid (or Vitamin C) (M8312) PTT (unless transport can be arranged Capillary Gases to meet required stability requirements) Coagulation panels (for those sites Rapid HIV without a Statspin centrifuge) RBC Magnesium Cryoglobulins Renin / Aldosterone Studies D-Dimer Semen Analysis (SEIN, SEPV, SEPR) Group, Type, Antibody screen for Vitamin C (or Ascorbic Acid) (M8312) transfusion purposes (Some sites do not have wristband-making capabilities) For any of the above listed lab tests, please send your patient to a hospital outpatient lab. A reminder that when ordering STAT lab testing, please send your patient to a hospital outpatient lab for specimen collection. Going directly to the hospital outpatient lab facilitates a faster response time for reporting results. If you re unsure whether or not a particular lab location can collect a specific test, or conduct a STAT test, please contact that location prior to sending a patient there. Maps and a complete listing of all lab locations testing can be found online at munsonhealthcare.org/lablocations. ARTC Has Moved to MCHC The Advanced Registration and Testing Center has moved off the hospital s main campus to Munson Community Health Center. Manager Michelle Wonacott said the move is the result of hospital efforts to enhance outpatient experiences by improving patient flow processes at Munson Community Health Center. In addition, the move will provide space to support the relocation of Munson Medical Center s MRI machine as Cowell Family Cancer Center construction moves into a final phase. As part of the move, the Advance Registration and Testing Center will combine with the Pre-op Assessment Clinic to become the Pre-Procedure Services area. The name of the POAC will change to the Pre-Procedure Clinic as a result of these changes, Wonacott said. The clinic and Pre-Procedure nurses will be located in the space right off MCHC s south entrance. The chart preparation functions within this area will be located in the ground floor at MCHC. Staff and physicians within these areas will continue to service the hospital by providing presurgical optimization, patient assessment, presurgical testing coordination, and chart preparation for upcoming Munson Medical Center procedures/surgeries. Wonacott said there will be no change to the Pre-Procedure Clinic scheduling process which is currently initiated by calling (231) 935-2812. All existing phone and fax numbers will remain the same. For questions, call (231) 935-7012. Hospital locations for lab testing are: Kalkaska Memorial Health Center 419 South Coral Street, Kalkaska Hours: Mon. - Sun., 6:30 am - 11 pm Phone: (231) 258-7508 Munson Healthcare Cadillac Hospital 400 Hobart Street, Cadillac Hours: Mon. - Fri., 7 am - 5 pm; Sat., 7 am - 3 pm Phone: (231) 876-7295 Munson Healthcare Grayling Hospital 1100 East Michigan Ave., Grayling Hours: Mon. - Fri., 7 am - 5 pm; Sat. 7 am - 3 pm Phone: (989) 348-0352 Munson Medical Center, Main Lobby 1105 Sixth Street, Traverse City Hours: Mon. - Fri., 7 am - 5:30 pm; Sat., 8 am - 12 pm Phone: (231) 935-6105 Munson Professional Building (behind Munson Medical Center) 1221 Sixth Street, Traverse City Hours: Mon. - Fri., 7 am - 5:30 pm Phone: (231) 935-6105 Paul Oliver Memorial Hospital 224 Park Avenue, Frankfort Hours: Mon. - Fri., 7 am - 9 pm; Sat. 9 am - 1 pm Phone: (231) 352-2204 West Shore Medical Center 1465 East Parkdale Ave., Manistee Hours: Mon. - Fri., 7 am - 6 pm; Sat., 8 am - 12 pm Phone: (231) 398-1153 Page 3 Practice Pro April/May 2015

HELPING PRACTICES MEET MEANINGFUL USE S TRANSITION OF CARE REQUIREMENT The Meaningful Use Stage 2 requirement for Summary of Care (at Transition of Care) has been the most confusing measure so far. There s been a lot of discussion as to what actually constitutes a Transition of Care. To help practices, we checked with M-CEITA (Michigan Center for Effective IT Adoption) and clarified what is and is not considered a Transition of Care. Examples of Transitions of Care: Referral to a specialist or another primary care provider (outside your practice) Referral to Home Care Referral to Palliative Care Referral to Hospice Referral to a rehab hospital Referral/transfer to an extended care facility/assisted living to be managed by a provider from another practice Referring a patient from an ambulatory practice to the Emergency Department Patients who are referred back to their primary care provider after seeing a specialist (and the specialist has completed care of the patient and will not manage/see the patient for this medical issue) Patient leaves the practice NOT Transitions of Care: Ordering lab test Ordering cardiac rehab Ordering diabetic education Ordering physical therapy Ordering radiology test (MRI, X-ray, Cat Scan (CT), Bone Density, Mammogram, etc.) Ordering other diagnostic studies (PFT, EKG, etc.) Scheduling patients for a procedure at another site if the procedure is performed by a referring provider/practice. Examples: o A cardiologist schedules a patient for a cardiac cath to be performed at the local hospital where the cardiologist will be performing the cardiac cath o A surgeon who sees a patient in their office and schedules surgery at the hospital (which they will be performing) Specialist/consultant sending information back to the referring provider but not sending the patient back to them. Often provider will send a courtesy note indicating the specialist saw the patient and for what the patient will be treated. Referral of a patient to another provider within the same practice (using the same EMR) For more information to help your practice prepare for Meaningful Use s Stage 2 Transition of Care Requirement, we recommend watching the recording of a recent webinar on this topic, which is available at munsonhealthcare.org/muwebinars. We will also be providing follow-up webinars for ecw and NextGen offices that will show you how to send a Transition of Care and answer questions specifically on your vendor s method to send Summary of Care (see below). If you have any Meaningful Use questions, please contact Randi Terry at rterry@mhc. net or (231) 935-5199 or Dr. Joe Cook at jcook1@mhc.net. UPCOMING MEANINGFUL USE WEBINARS: Transition of Care for ecw Users: May 20, 12 1 pm Transition of Care for NextGen Users: May 27, 12 1 pm To register for either of these webinars or for recordings of past webinars, go to munsonhealthcare.org/muwebinars. PAHCOM Spring Seminar Tuesday, May 19 8:00 am - 4:30 pm Hagerty Conference Center, Great Lakes Campus, 715 E. Front St., Traverse City Please join your colleagues for the Annual Seminar and Vendor Fair featuring national motivational speaker Jonathan Edison being hosted by the Traverse City Chapter of PAHCOM (Professional Association of Health Care Office Management). Topics include transformational leadership, hot topics in labor and employment, how to leverage change, and preparing for the Medicare physician value-based payment modifier. To register online, please visit www.pahcom.com/chapters/chapter_store.php?id=mi01, or for more information, contact Charly King at (231) 935-0497. Page 4 Practice Pro April/May 2015

MYHEALTHINFO CERNER PATIENT PORTAL FAQS Continued from page 1 MyHealthInfo is populated from Cerner PowerChart and it does not differentiate whether results were from an inpatient or outpatient visit, and the portal is being offered to all patients. Laboratory results available to view in the Cerner Patient Portal dates from 2001 to present. Radiology and Pathology results will only be from May 19, 2015 onward at this time. When are lab test results available to patients in MyHealthInfo? Non-sensitive inpatient and outpatient lab test results are viewable in the patient portal 36 hours after the results are put into Cerner PowerChart. Clinical Laboratory Improvement Amendments of 1988 (CLIA) requires that all lab results be available to patients upon request, without delay, so we are considering removing the 36-hour delay. Sensitive lab results microbiology, STD s, pregnancy, tumor markers, and toxicology will be added to the PowerChart patient portal at a later date. Only discrete lab results are able to display in the portal, so some labs that are resulted in text format will not display in the portal (e.g. some microbiology). Can patients see pathology results? As of May 19, 2015, pathology reports (excluding HPV and autopsy results) will post to the Cerner patient portal with a five-day delay. Can patients see radiology results? Radiology reports are being added to the patient portal as of May 19, 2015. Radiology reports will have a five-day delay. What else can patients see in the portal? Patients who have had an inpatient visit will have additional information in their portal account. This information is updated at their last hospital admission/discharge. Care plan and care team Allergy list Past problem list Medication list and medication history Discharge instructions Patient education Procedures performed during admission Reason for hospitalization Summary of care Vital signs at discharge If a patient does not have information for these items in their PowerChart record, no information will display in the portal. Which Munson Healthcare hospitals are included in the Cerner Patient Portal (MyHealthInfo)? It is being offered to all patients (inpatient, outpatient, and observation) of Kalkaska Memorial Health Center, Cadillac Hospital, Grayling Hospital, Munson Medical Center, and Paul Oliver Memorial Hospital. How do patients sign up? The MyHealthInfo Cerner Patient Portal is being offered to all inpatients, outpatients, and observation patients. Patients who wish to participate will be issued a MyHealthInfo invitation during their encounter. Who can have a patient portal? Any person age 18 and older with an active email address can have a patient portal account. Also, we now offer proxy, which allows: A parent or guardian to access their minor child s (under the age of 13) portal account, A parent or guardian to access their child s (age 13-17) portal account with a signed consent from the child, and/or An adult to grant portal access to another adult (spouse, adult child) with a signed consent What if my patient is also a Munson employee? We have encouraged employees to sign up for a MyHealthInfo account. It is important to note that all employees who have access to Powerchart are able to see their lab results immediately and have been able to do so for many years. MyHealthInfo did not introduce a new element for many employees of Munson Medical Center. Will patients see results from my practice s patient portal? If you offer a patient portal, your patients will need to access that account separately. However, lab results that are resulted in a Munson lab will populate the MyHealthInfo patient portal. Can patients message through the MyHealthInfo patient portal? No, messaging with physicians and providers is not available. Why is the hospital offering a patient portal? There is a Meaningful Use requirement for the hospital to offer a patient portal. Although the meaningful use measure for MMC is based on inpatients, we are offering the patient portal to all patients who receive a service offered by MMC. Additionally, direct release of lab test results to patients is being mandated nationally when requested by the patient. The Department of Health and Human Services issued the final rule in February 2014 which amends the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to allow laboratories to give patients or a person designated by the patient direct access to the patient s completed laboratory test reports. For more information, go to munsonhealthcare.org/myhealthinfo or contact Jennifer Sienkiewicz, Health Resource Specialist, at (231) 935-5872. Page 5 Practice Pro April/May 2015

PWS Education and Support Resources Physician Web Scheduler (PWS) is an online scheduling tool that allows physician practices to schedule some patient tests online instead of faxing an order and then calling to schedule. Available tests in PWS currently include: Advance Registration & Testing Center (3) Pre-Operative Assessment Center (1) Bone Density (1) CTs (52) EEG (5) Mammography (5) MRIs (21) Maternity Prepared Stay (2) Respiratory Therapy (17) Therapy Evaluations (11) Ultrasound (47) A team is currently piloting ordering walk-in Lab and X-rays using PWS look for more information in a future Practice Pro. The Munson Help Desk can also help if you ve forgotten your PWS password. Please call the Physician Liaison Program Heidi Kistler (935-5873) or Deb Kimball (935-3388) for any of the following PWS needs: Launching PWS at your practice Training new PWS user(s) (after submitting a request form to Munson Information Systems) Refresher training for PWS users Adding a new ordering physician/provider to PWS Requesting new tests be added to PWS If you d like to be added to a list of practices interested in piloting ordering walk-in Lab and X-ray using PWS Non-technical PWS process challenges If PWS isn t working or you receive an error message when trying to schedule, please contact the Munson Help Desk at 935-6053 and someone will follow up with you. To help speed issue resolution, it s helpful to provide the following information when calling: Error message Where error message occurred in software Test, Facility, and Date (first available or specific date) Best phone number to contact you A SIGNIFICANT INVESTMENT WITH A GREAT PAYOFF Continued from page 1 Radiology is a big challenge because of the multiple ways practices can schedule a radiology exam, Matthews said. Sometimes the order can t be found or read, making the experience not go so well for patients. The rollout will include multiple stages, beginning with the hosted community, then the non-hosted sites, and finally the practices with a smaller vendor representation. Each practice and each vendor are very different in how they approach getting results and placing orders, so they will have to contact their vendors directly, he said. They need to understand the cost involved in getting connected. Most practices will have some process changes to implement as well. You re going from orders that are printed, for example, but now are electronic, so how will that work? he said. It s really dependent on individual practice s process. As patient care evolves, information delivery must evolve with it, which makes for exciting times at the primary care level, Matthews said. The future is in being able to deliver the right information across the entire care continuum, he said. It puts the primary care physician at the center of the care process. Aaron Matthews: Three Things You Might Not Know About Me 1) I love to ballroom dance, I was on a team in college, but with four kids, I just don t have the chance much anymore. 2) I chose health care because I want to make a difference. 3) A favorite quote that really speaks to me is The question of whether it is possible to maintain a human stance toward any more than a tiny fraction of modern knowledge is not clearly answerable at this stage in our history. It will be answered, if at all, only when men have learned how to store and retrieve all machinable knowledge, freeing themselves for distinctively human tasks. Wayne C. Booth - Knowledge Most Worth Having (1967). Page 6 Practice Pro April/May 2015

Getting to Know...Heidi Kistler Each month in Practice Pro we ll feature a member of MMC s Physician Services, which includes Medical Staff Services, Physician Recruitment, Physician Liaison Program, and Continuing Medical Education. Although originally from Birmingham, Michigan, Heidi has lived in Lake Ann for 22 years. She has two daughters, Tylor (16) and Hannah (11); a dog (Chi); two cats (Oscar Toulouse and Thomas O Malley); and is currently expecting 20 baby chickens. What is your role in the Physician Liaison Program? I work with internal departments to verify and update provider contact information (phone, fax, EMR, etc.) so that it s accurate in multiple databases across the Munson Healthcare system and to make sure that each practice receives patient tests results in their preferred manner (EMR, fax, courier). When a provider leaves your practice, it s very important to make sure that the provider s patients are re-assigned to another provider. A big part of my job is working with physician practices and internal departments when providers retire, change practices, or leave the area to assure we have valid orders, especially as patient orders are no longer valid once a provider retires. I also oversee processes to make sure patient reports are routed to the correct provider at the correct office. Heidi Kistler Physician Liaison Program I m also now leading Physician Web Scheduler (PWS) education and support for offices so please give me a call if you have any PWS education needs or questions (see PWS Education and Support Resources on pg. 6). What are the challenges for physicians and how can you help? It s always a challenge for a practice manager when a physician/provider decides to leave your practice. I m here to help smooth this process on the Munson side of things so please let me know once a provider announces his/her intent to leave your practice so that I can help reconcile any outstanding orders and make sure test results are sent to the appropriate provider. I can also provide a list of patients with outstanding scheduled tests that are scheduled for after a provider s retirement date so that they can be reassigned within your practice or the tests rescheduled with a new provider. Also, please let me know if one of your providers receives a report from Munson Healthcare that was intended for another provider, for example both providers have a similar name, as I can help correct this so it doesn t happen again. What is the most rewarding aspect of your job? I love solving puzzles and resolving challenges. Sometime an issue is technical; sometimes it s human. It s rewarding when I can help practices with a challenge they re facing. What are you passionate about outside of work? I love to garden, cook, bake, and ski. Both of my girls are on the Benzie County Ski Team. I grow and dry organic herbs, and we ve tended a flock of chickens for more than 10 years. What would we be surprised to learn about you? I m an ordained minister and have officiated more than 15 weddings. What words best describe you? Easy going/accommodating. What is the best way to contact you? I can be reached at (231) 935-5873 (phone), hkistler@mhc.net, and (231) 935-5885 (fax). HOSPITAL SIDE ENTRANCES LOCKED 24/7 Helping ensure Munson Medical Center is more secure, the Safety and Security Department has now locked the Sixth Street, the Emergency Department, and Parking Deck entrances to the hospital. Physicians will need to use their badge to enter the hospital through these entrances. Page 7 Practice Pro April/May 2015

1105 Sixth Street Traverse City, MI 49684-2386 PHYSICIAN NEWS Thomas Andrews, MD Thomas Andrews, MD, has joined the staff of Munson Medical Center as a board-certified specialist in cardiovascular disease. Dr. Andrews is accepting new patients. Traverse Heart & Vascular 1200 Sixth St., Ste. 200 Traverse City, MI 49684 (231) 935-5800 phone (231) 935-5799 fax Angela Pohl, DO, Joins Thirlby Clinic Dr. Angela Pohl, internal medicine, is now practicing at Thirlby Clinic. She will also continue to practice at indigo Health Partners. Thirlby Clinic 3537 W. Front St., Ste. I Traverse City, MI 49684 (231) 935-8950 phone (231) 935-8868 fax Providers Who Are No Longer Practicing Dr. Thomas Crosby, Traverse Heart & Vascular, and Dr. Richard Nielsen, Crystal Lake Clinic, have retired. A reminder that the following providers have recently left the area: Peg Dunn, CNM Margaret Moen, MD Rochak Varma, MD For those practices with an EMR, please update your records. For additional information, call HealthLink at (231) 935-5886 or 1-800-533-5520. Page 8 Practice Pro April/May 2015