March 11, 2013 z Information Technology Report to Medical Executive Committee Contents 1 McKesson Cardiology PACS 1 Patient Portal 2 NHIQM (National Hospital Inpatient Quality Measures) 2 Ambulatory Project Update 2 Barcode Medication Administration Go-Live at University and MECH 3 onechart (Cerner) System Performance Update 4 Meaningful Use for Eligible Hospitals 5 Appendix 1 - Orders Updates Implemented in February 2014 6 Appendix 2 - Meaningful Use Changes for 2014 Eligible Hospitals 7 Appendix 3 - Planned vs. Unplanned Downtime McKesson Cardiology PACS McKesson Pediatric Cardiology Echo PACS implementation at Le Bonheur is scheduled for the week of March 24, 2014. McKesson Cardiology Cath PACS implementations are scheduled as follows: Germantown/University - The week of April 21 North/South/Olive Branch - The week of May 12 Le Bonheur - The week of June 23 Patient Portal Patients can now access the Cerner portal through mymethodist, our online health management tool for patients. Patient Portal access became available to patients admitted to the following hospitals on these dates: Fayette Hospital - September 10, 2013 Olive Branch Hospital - September 17, 2013 North Hospital - October 15, 2013 South Hospital - November 15, 2013 University Hospital - January 28, 2014 Germantown Hospital and Le Bonheur Children s Hospital patients will be offered access to the portal beginning on these dates: Germantown - March 11, 2014 Le Bonheur - March 18, 2014 This is the same Patient Portal that will be available to patients whose physicians begin using Cerner Ambulatory in April. These patients will access their office visit information from the same list as their MLH hospital visits. Patients will have access to previous hospital encounters as well as current encounters.
PAGE 2 NHIQM (National Hospital Inpatient Quality Measures) The SCIP (Surgical Care Improvement Project) emeasures will be deployed to all facilities on March 18, 2014. Training materials are now available for review. Ambulatory Project Update The One Chart Ambulatory Project is on schedule for an April 14, 2014 Go Live at UPLS, UTMP, Sickle Cell, MTP and Transplant Clinics. Some of the benefits include: Patient Experience One record shared by the hospital and office. Physicians/clinical staff are able to access recent visits to the ED or admissions and use that in discussions with patient or in planning care. One-stop shopping for Patient access to their health care record. Efficiency Physician documentation supported with voice recognition. Physicians can access system remotely from home and many other locations. Improved communication with referring physicians and consulting physicians through use of Direct email, message center, etc. We could not do this without physician, clinician and practice support Associates. We know our physicians and Associates are essential to making these ideas a reality. We have made a significant effort to involve physician, clinician and operational expertise across the health system to help design many of these ambulatory solutions. Training is underway and will continue till Go Live. Barcode Medication Administration Go-Live at University and MECH University Hospital and MECH became the first Methodist Healthcare facilities to implement Barcode Medication Administration (BCMA) on February 11, 2014. This implementation closes the medication loop as CPOE and emar are already in place. The new BCMA process supports "The Five Rights" by ensuring that the right patient is getting the correct medication in the right dose at the scheduled time: The caregiver brings a computer workstation on wheels (WOW) or other computing device to the bedside. A wireless Bluetooth barcode scanner attached to the WOW or PC is used to scan the patient s armband.
PAGE 3 The caregiver ensures that the patient scanned matches the open chart in PowerChart. The medication is scanned, verified to match the CPOE order as it appears in emar, and administered. BCMA is also a hospital Meaningful Use (MU) Stage II measure, and the Memphis hospitals attestation period begins April 1. The MU requirement is to adhere to the BCMA process for more than 10% of all medication orders entered via CPOE, including all doses in a given order. Until the rollout to North Hospital in July, University s BCMA compliance is supporting all of the Memphis hospitals for this one MU measure. University s compliance with BCMA is 92.0% Medication Doses Scan Rate and 93.4% Patient Scan Rate. With this excellent adoption, University is covering 24% of all of the orders at the Memphis hospitals, well above the 10% requirement. The second BCMA implementation is planned for North Hospital in July. The third BCMA implementation is planned for Olive Branch at a date to be determined. Rollout of BCMA will continue to all MLH Hospitals. onechart (Cerner) System Performance Update The MLH IT Division continues to work with Cerner technology on improving the onechart (Cerner) system performance. Following the install of software fix packages on March 5, 2014, the number of times an application fails (closes on the user) decreased from 140 on March 4 to 92 on March 5. MLH IT and Cerner are closely monitoring all performance issues on a daily basis. Additional software fixes are being researched as potential solutions to the issues. The following actions were performed last month: 1. An upgrade has been installed that appears to have improved the performance of the radiology tab. 2. An issue has been identified that caused significant slowness when signing clinical notes and PowerNotes. The issue is being corrected for the medical staff who are high volume users of clinical notes and PowerNotes. Early performance reports are that the performance of signing notes has been corrected. MLH IT and Cerner continue to monitor performance. 3. MLH IT and Legal Counsel are working through a plan to agree and purge unnecessary tasks such as deleted messages in physician s trash where the trash can had not been emptied in the onechart message center.
PAGE 4 Meaningful Use for Eligible Hospitals Methodist Le Bonheur Healthcare hospitals will begin the attestation period April 2014 for a 90 day period. Methodist Olive Branch will be attesting for Stage 1, while Fayette and the Memphis hospitals will be attesting for Stage II. Meaningful use calculations will be based on observation patients admitted via the emergency department and/or inpatients. Beginning with the 2014 requirements the Problem List must use SNOMED nomenclature to meet the measures. All patients must have at least one problem listed or have no known problems documented. Patients discharged/transferred to another level of care, including PCPs, specialists and other facilities will need to have a Transition of Care document provided to the care giver. This capability exists with the use of DIRECT secure messaging or by providing a written copy. This is only applicable to providers who are not Methodist physicians or facilities. Additional changes associated with the 2014 Meaningful Use requirements are listed in Appendix 2.
PAGE 5 Appendix 1 - Orders Updates Implemented in February 2014 PowerPlan/Careset Changes New Plans, Adult Facilities: Vascular Surgery SDS Plan Vascular Surgery Stent Graft Plan Radiology Thrombolysis Pre Procedure Plan Radiology Thrombolysis Post Procedure Plan ED TIA Orders Hip and Femur Fracture Vascular Surgery Routine Admit Plan GI Bleed Observation Plan Back Pain Observation Plan Probiotic Care Set Germantown, ANES PED PACU PowerPlans and Order Sets changed to accommodate process and order updates All Adult: Heparin Non-Protocol Infusion Orders, Heparin Non-VTE Protocol Orders Heparin VTE Protocol Orders. Total Joint PowerPlan ED SOB with HX of asthma/copd, ED Abdominal Pain Female, ED Abdominal Pain Male. NEURO Intracerebral Hemorrhage Plan Cardiac Surgery Post Op Plan Germantown and South: NICU Osteopenia of Prematurity Plan The heparin concentration for neonatal IVF will be changed to 0.5units/ml in PowerPlans and Caresets in the following fluids: - NS with Heparin 0.5units/ml (250ml bag) - 1/2NS with heparin 0.5 units/ml (250ml bag) - D10W with heparin 0.5 units/ml (250ml bag) - D5W with heparin 0.5 units/ml (250ml bag)
PAGE 6 Appendix 2 - Meaningful Use Changes for 2014 Eligible Hospitals Provide patients the ability to view online, download and transmit information within 36 hours of discharge for Stage 1. For those patients who have the ability to access their information, 5% will actually access the information (Stage 2). CPOE adoption will now be measured for Lab, Pharmacy and Radiology for Stage 2. The Transition of Care document will need to have problem, allergies and medications in order to meet the measure requirements (Stage 2). The Transition of Care (Summary of Care record) is provided for 50% of patients receiving follow up care after discharge for providers/facilities not owned by Methodist Le Bonheur (Stage 2). The Transition of Care (Summary of Care record) must be submitted electronically on 10% of patients for designated population (Stage 2). Multiple measures from Stage 1 will be required to have a higher percentage of performance and increase of performance. For example, Smoking Status in Stage 1 is 50%, but in Stage 2 it is 80%
PAGE 7 Appendix 3 - Planned vs. Unplanned Downtime The following table depicts the Cerner Production system uptime and planned and unplanned downtime in minutes from March 1, 2013 February 28, 2014. This table does NOT include network downtimes that may have impacted access to onechart.