2016 KRAs

Only one group (Advocate Children's Hospital - Park Ridge) is making their transcription target. Good Samaritan's Health Information Management made a change in their transcription costing, so we will adjust their transcription target to a 20% reduction based on the projections from January to match the other sites' targets. Most sites saw an increase in transcription costs between February and March. Once the Clinical Informatics teams get past the Spring CareConnection upgrade, we will refocus their efforts on helping physicians reduce transcription costs. Two possible strategies:

• Encouraging physicians to try PC Touch as a dictaphone
• Focusing on specific departments with very similar notes (e.g., obstetrical delivery notes, ophthalmology cataract operative notes)

Lutheran General had a "soft turn-off" of consults on April 4th. There has been minimal pushback about this change. That site's VPMM has made a concerted effort to move physicians to site-wide Dragon use. Sometime this summer, Advocate is planning to sign an enterprise-wide agreement with Nuance to allow all physicians to use the voice-recognition technology regardless of their specific site. The profiles would be stored in the cloud, so users could use the software in their homes and offices.

Many physicians have noticed that telephone transcriptions continue to route to eClinicalWorks and CliniCare, but directly entered notes (including PC Touch notes) are not being routed to the appropriate outpatient EMRs. Without this technical change, it may be difficult to move our physicians off of telephone transcription.

[] Anupam to investigate what might be necessary to activate a feed for specific note types (e.g., consults, operative reports and discharge summaries) to our affiliated outpatient EMRs.

Medication CPOE 8 AM - 5 PM

Illinois Masonic and Lutheran General are already meeting their medication CPOE 8-5 targets for the year. Christ had their best performance in January and the other sites seem to be erratic in their performance improvement.

Tactic 1: Convert emergency department initial evaluations to per protocol.
Our two emergency department physicians agreed that making this change would not engender any patients.

[] Anupam to follow-up with the ED medical directors to see if we can have the site Medical Executive Committees approve this change.

Tactic 2: Encourage physicians to use CareNet+ to get into CareConnection without a second log-in.

Using CareNet+, only one login is required to get to CareConnection. The CareNet+ webpage can be accessed anywhere there is an internet connection. This is the fastest way to log into CareConnection when a physician is off-campus.

[] Medical directors to educate their site colleagues about this functionality.
[] Anupam to investigate if this functionality might be possible for FirstNet.

Several directors expressed frustration with the new Citrix Storefront functionality and had trouble saving the different applications as favorites.

[] Anupam to follow-up with Advocate's Citrix team.

Anupam-generated items

Spring CareConnection upgrade

Everyone saw the educational content planned for the Spring upgrade. There were no additional comments or suggestions.

Challenges with PC Touch

The directors agreed that PC Touch seems to keep failing during times when physicians tend to round on the inpatient service. Without an increase in stability, more physicians will choose not to use the application.

[] Anupam to follow-up with Cerner's Advocate representatives.

Director-generated items

Prolonged downtimes

We will continually be challenged to deliver safe care for our patients if we have downtimes that last for hours at a time. Sunday's downtime is expected to last for 4.5 hours.

[] Medical directors will look for unsafe behaviors that may be occurring during the prolonged downtime.

Duplicate medication alerts

The directors would support a targeted deployment of duplicate medication alerts for high-risk group of medications (e.g., anticoagulants).

[] Anupam to submit the request to Clinical Informatics to prioritize against the other change requests.

Standardized electronic discharge summaries

There appear to be some challenges when using the Advocate-created standardized discharge summary template to display medications correctly. At least one director did not experience those issues when use the Cerner discharge summary template.

[] Anupam to follow-up with Joanna Maurice, the person leading the Advocate standardized discharge summary template initiative, to see what might be changed to improve the end-user experience.

Creating a "Dispense as Written" box instead of a signature line

The group felt the two signature lines (one for "Substitution permitted" and the other for "Dispense as Written") was confusing. They endorsed moving to a checkbox for "Dispense as Written."

[] Anupam to follow-up with Pharmacy to make sure they agree before submitting a change request.

Change the default option for medications to be "Print" instead of "Handed to patient"

The group would like to move to ePrescribe but the patient's pharmacy is not reliably populated.

[] Anupam to submit a change request for the change to Print.
[] Anupam to request a report from CareConnection to track how often a patient's pharmacy is entered to facilitate ePrescribing in the near future.

Allowing inpatient physicians to see more than one patient chart at a time

There is a trade-off between efficiency and safety. Locking our inpatient physicians to a single patient is opening up different risks to our ordering providers when they get a phone call to address a patient's condition. The emergency department and obstetrics currently can access two charts at a time, but no more.

[] Anupam to update Kate Kovich and then submit a change request.

Issues from prior meetings

[] The CareConnection team will begin working on a single provider directory once the Cerner Revenue Cycle contract is finalized. This will allow physician accounts to be consolidated across sites. 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 troponin in the daily labs SmartTemplate.
[] Anupam is still waiting to hear back from the Advance Care Planning Council about changing the requirement for a physical signature for LET orders.

The next meeting is scheduled for May 12, 2016.

Minutes from prior meetings