One CareConnection changes

As part of the migration to Cerner's registration module, Advocate's physician directory will need to be updated so all records include the physician's individual National Provider Identifier (NPI). Some clinicians may have to consolidate their order favorites and documentation templates. Once the clean-up is complete, we expect most physicians to only have one CareConnection login regardless of the site where their patient data may be located.

Sharing inpatient test results with outpatient providers

Anupam outlined a strategy for Advocate to use CareConnection Office to communicate with outpatient staff about shared patients who have concerning radiology findings that may require outpatient follow-up. CareConnection Office allows Advocate to speak with office staff who can review charts or follow-up with the physician at a convenient time rather than interacting with the physician directly. The staff could then vouch for patient contact and a follow-up plan when appropriate. This process would only be used for non-AMG ambulatory physicians due to the integration between CareConnection and CliniCare.

There was some concern that the process requires the clinic staff to pull the data rather than have it pushed to them. Advocate has already purchased DIRECT mailboxes for all affiliated physicians. Interested physicians could electronic transmit all relevant information without printing and scanning. Pushing could involve DIRECT or auto-fax. There may be a need to provide our physicians with multiple options to receive test result information.

Notification

At a more general level, the physician notification process has several opportunities for improvement.

Patient assignment

It is not clear how Advocate assigns patients to specific providers for notification. Some outpatient clinicians are still surprised when a patient tells them that they were recently in the hospital. One physician stated the notification process was occurred in fewer than 50% of patients seen over the last six months.

One solution could be to expose the list of patients who Advocate has assigned to a physician or practice and then allow the physician or practice to add or remove patients through an online process.

Notification method

Some physicians prefer direct notification within their electronic medical record (currently restricted to AMG and a few independent practices with a specific interface to CareConnection), others like CareConnection Office and still others prefer PerfectServe.

One solution would be to allow physicians a menu of options to be notified about patient events. Users could then update their preferences as their environment changes.

Thinking about Chart Review differently

As a follow-up to an earlier discussion, Anupam has been working with a vendor to help think about chart review in a more clinician-friendly way. The problem we are trying to solve is that many users are easily overwhelmed with significant historical records, potentially reducing the value of the interaction between the patient and provider. This is more germane for patients visiting a physician for the first time, where gathering prior information can reduce the risk of unnecessary testing and evaluation.

Here are some mock-ups that Anupam presented to the vendor:

Figure 1. An overall view of the patient's chart.

Figure 2. Only showing those notes related to hypertension.

Figure 3. Showing the actual note including hypertension.

The intent would be to track disease progression over time using natural language processing to highlight those notes that are relevant to a specific physician. For example, the review would look for impaired mobility and prior joint surgeries for an orthopedic surgeon in contrast to hypertension for a general internist or family physician.

The group wanted to see a live demonstration before making a commitment to develop the concept further. Regardless of how good the technology might be, if the user interface is difficult to use or requires multiple clicks, the adoption will probably be low.

[ ] Anupam to work with the vendor to have a live demonstration before the next meeting.

CareNet+ mobile app

Mark described a new CareNet+ app that would allow physicians to review patient data through their mobile device. The group struggled to come up with a use case where this might be useful. The group saw some value if the app could be linked to printing as reviewing data on a mobile device can be challenging.

[ ] Mark will look for users who might see value in using this app in their clinical work.

Logistics

The group felt that meeting every other month was the most reasonable given many physicians' clinical obligations and difficulty ending their practice by 6 PM. The meeting will be moved back to Tuesday.

Next meeting March 21st at 6 PM CST (Lync and teleconference)