2015 KRAs

Transcription reduction

Barring a marked increase in transcription volumes in November and December, the organization as a whole will make its transcription reduction target for 2015.

The transcription costs for most sites have stopped consistently decreasing month after month. Any further reductions in transcription use will either require adopting existing voice recognition technology in new use cases or introducing new technology to convert users who find existing technologies inadequate.

M*Modal has worked out most of the kinks in its Apple and Android applications. Anupam would like each medical director to identify two users from their site who are not using voice recognition technologies currently to see if they would find this application useful. The app may be most appropriate for physicians in operating rooms and procedure suites as the timely availability of the operative note would make the immediate post-op note unnecessary. Ideally, end-user feedback would be more effective if received before mid-December when the contract is scheduled to be signed. M*Modal has stated that the app is most effective for users with a high Q-score, a measure of how much editing is required after the company's voice-recognition algorithm analyzes the user's voice file.

The group recommended speaking with APP to include voice recognition as a Clinical Integration target. The APP endorsement would begin the conversation about how transcriptions is not a "God-given" right.

[] Medical directors to identify two users who would be willing to test the M*Modal voice recognition app.
[] Anupam to provide the group with a list of the users with high Q scores.

CPOE

Advocate has improved by 1.7% from January until now for an overall CPOE rate of 81.0%. Despite the majority of AMG hospitalists moving toward CPOE rates of 90% or higher, Advocate has not been able to document a marked increase in CPOE rates at the site- or organizational-level.

The system medication CPOE rate for October is 82.3%. The group had several reasons why CPOE is low, including

• Difficulty accessing CareConnection outside the hospital,
• After-hours admissions with lots of medications that are easier to reconcile over the phone with a nurse than to complete independently,
• Test results that are called to physicians in the early hours (potassium, magnesium, CRRT) with nursing requesting orders for replacement, and
• Inability to enter intravenous infusions in PC Touch.

Proposed 2016 KRAs

Transcription cost reduction

The organization has budgeted an additional $560,000 in savings from reduced transcription in 2016.

Lutheran General is the only site that has decided to move forward with eliminating consultations through telephone transcription. Based on the system feedback when trying to turn off consults in October, it seems unlikely that the organization will support a system-wide mandate to stop transcription unless there is greater adoption of voice recognition technologies. Doug believes Leo is leveraging the IT team's efforts on Dragon use to push through on reducing transcription further.

Conversely, Condell has had another episode of Dragon crashing, reducing credibility in the software. The Good Samaritan physician community felt that stopping consult transcriptions was important to prevent additional note types from being removed from the transcription service.

90% CPOE for medication orders among users with at least 100 medication orders a month

If medication ordering is the greatest safety gain that CPOE provides, it would be consistent with the organization's larger objectives to push for more medication CPOE. The group asked to consider limiting the metric to

• 7AM-7PM or 7AM-11PM, or
• Excluding overnight admissions.

Clinical Informatics Restructuring

Each site's clinical informatics team will be re-organized under Kristen Hagerman at the beginning of the new year. Most sites saw a reduction in the total number of associates within their teams. Rather than site nurse liaisons, the department will be organized into five regions, each managed by their own Director:

• BroMenn
• Central
• Christ (Christ and Childrens)
• North (Good Shepherd, Lutheran General and Sherman)
• Central (Condell, Good Samaritan and Illinois Masonic)
• South (South Suburban and Trinity)

The department will also have an optimization team focused on prioritizing end-user requests and developing electronic medical record improvements.

As a result of this restructuring,

• Each site's clinical informatics team will not be able to support monthly Physician Informatics Meetings. Each site may consider continuing their site meetings on a monthly basis, but the clinical informatics teams will only be available on a quarterly basis.
• Anupam will be working on developing on-line physician orientation materials that can be used in conjunction with face-to-face training. The on-line videos are meant to reduce the total number of hours a site clinical informaticist would have to spend training a new physician.

Miscellaneous

Pain medication GenView

One of the site pharmacy teams requested that all physicians get access to the newly developed pain medication GenView. The group felt that most physicians would not use the GenView. Rather than add one more screen to the physician's view, the group agreed to hold off on adding the Pain medication GenView.

Colors for abnormal test results

Currently in the desktop version of CareConnection, mildly abnormal test results are depicted in blue and markedly abnormal test results are depicted in red. For many users, the blue is easily confused with the normal values (black). The group felt there was some value in separating mildly abnormal values from markedly abnormal values. One suggestion was to make the mildly abnormal values orange.

[] Anupam to circulate the request with the CareConnection team.

Payment and contract updates

Anupam has been in conversations with Human Resources and Legal to expedite payments for those medical directors who have not received all of their 2015 payments. The organization has agreed to move forward on payments for 2015. With the transcription reduction efforts, Anupam believes the organization will move forward with the medical director payments for 2016.

Moving this meeting to quarterly

The group felt strongly that this meeting would lose its effectiveness if changed to a quarterly schedule. The meeting will remain monthly for 2016.

Updates from earlier meetings

• Anyone from a physician's office can call the hospital's admissions office to obtain a FIN within an hour. The FIN is not immediately available, so physicians dictating their pre-operative history & physical would need to wait for the FIN before using any voice recognition technology to enter the note.
• There are currently no options to pull patient diagnoses on-demand in PC Touch. Based on Anupam's most recent conversations with Cerner, that functionality may not be available until early 2017.

Issues to track from prior meetings

[] Anupam to make sure the default view for the workflow mPage is the Ambulatory view.
[] 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 troponin in the daily labs SmartTemplate.
[] Anupam is working with two interns to develop video educational materials on how best to use 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.

The next meeting is scheduled for December 10th at 0730 hours.

Minutes from other meetings