CareConnection upgrade and ICD-10 transition

There were no physician challenges about the CareConnection upgrade or ICD-10 transition that were reported to the medical directors. In many cases, physicians were changing the default opening screen (Workflow mPage) to what was available before (Results Review).

The CDI team has not yet started pushing our more queries, so we may see more complaints once that process is established. At least one medical director is having success using IMO to map to ICD-10 diagnoses for the site CDI team.

Transcription reduction

Rather than force individuals to choose a single technology for voice-to-text, the organization appears to be offering three options for our users:

• Desktop Dragon - most users only take advantage of a small subset of the available functions, but for most ED physicians and users with access to the enterprise license, this appears to be the preferred method. The biggest complaints appear to be:
  • Lack of computer with Dragon microphone
  • For those users without access to the enterprise edition, a noticeable error rate
• PC Touch with embedded Dragon - this option has the highest fidelity in converting voice-to-text. The biggest complaints appear to be:
  • Only available for iOS users
  • Inability to pull in information from other parts of the chart
  • Need Clinical Informatics to create user-specific templates
• Fluency Flex (M*Modal on mobile devices) - this option most closely aligned with the existing telephone transcription experience. The user speaks into a mobile device and the transcription is available in minutes for review and signature.

Although we've had desktop Dragon and PowerNote for many months at some of our sites, it seems that the transcription deadline was needed to push users to move from telephone transcription to other technologies.

One director argued to consider reassessing physician documentation after 60 days of deploying the Fluency Flex technology (probably December) and then choosing either a site-specific or region-specific target based on early adoption. For the South region, the sequence might be 1) H&Ps, 2) consults, 3) discharge summaries and 4) operative notes.

Anupam believes a stronger argument should be made for real-time availability of physician documentation and a reduction in total time spent documenting with corrections made in real-time. It should be less time for a surgeon to use voice-to-text technology for an operative note than to type an immediate post-op note and then dictate a full operative report later. This logic has not been clearly transmitted to our physician community.

If the target is to make documents available in real-time, we will need to push Cerner to develop technology to help physicians build discharge summaries over time rather than expecting someone to spend additional time on the day of discharge constructing the summary. Another medical director would like the ability to change a progress note to a discharge summary after it is saved as the patient's status may flip back-and-forth.

Value of site Physician Informatics Committees

Anupam notified the committee about the restructuring of clinical informatics across the sites. The value-maximization efforts will probably be directed toward this group in the near future. Much of the work medical directors are tracking include preparing for and attending their site Physician Informatics Committee (PIC). A few sites found the senior leadership attendance at their PIC to be helpful, but others felt the poor turnout and lack of information diffusion to other members of the medical staff to be challenging. Most medical directors agree that the sessions are difficult to increase engagement when many suggestions are not addressed.

Anupam should have more information to share with the group about Clinical Informatics support for the site PIC meetings in December.

Miscellaneous

The group agreed to the Ambulatory view for the workflow mPage.

Updates from earlier meetings

• Physicians can no longer enter physician consults in PC Touch.
• Alert with historical LET order is being developed.
• Atrial fibrillation PowerPlan is being developed with CHA2DS2-VASc risk assessment score

Issues to track from prior meetings

[] Chris to distribute a discharge summary built from key events.
[] The CareNet+ upgrade is still not ready for testing. Hopefully, we will have an update later this month.
[] The CareConnection team is investigating options to consolidate physician accounts so a physician only appears one time in the application. Once that work is complete, we should be able to reinstate Physician Consults in PC Touch.
[] If the signature + specialty request (with changing the resident's specialty with each rotation) and SmartTemplate work are performed by separate teams, then we will proceed down both paths simultaneously. Otherwise, we will work on the SmartTemplate request first before adding tropoinin in the daily labs SmartTemplate.
[] Anupam to update the website with tips & tricks on how to better use the documentation functionality within PC Touch
[] Anupam to investigate options to pull in patient diagnoses on demand in PC Touch
[] Anupam is still waiting to hear back from the Advance Care Planning Council about changing the requirement for a physical signature for LET orders.
[] Anupam to determine if there is a workflow to generate a patient's FIN for elective cases before the patient arrives at the hospital for an outpatient procedure requiring an H&P.

The next meeting is scheduled for November 12th at 0730 hours.

Minutes from other meetings