Safety story

Anupam presented some work on copy-and-paste to the residency program leadership group (AGMEC) this afternoon. One of the physician leaders stated that challenges with physician documentation due to excessive copy-and-paste are leading to an unsafe condition where clinicians are having to find the sentence or two that is relevant to care for the patient within the pages of text that is copied forward from each prior day.

Kate has not noticed a subjective worsening of note quality from her perspective. The site safety champions seemed most engaged when discussing copy-and-paste in terms of fraud.

[ ] Anupam to pursue opportunities to address physician documentation as a fraudulent activity. Additional help may be required from our regulatory colleagues as many physicians may not understand the precise elements required to bill a particular code.

KRA progress

Medication CPOE 0800-1700 hours

For daytime medication CPOE, there does not appear to be a consistent pattern of improving CPOE rates across the sites. Anupam, Clinical Informatics and the CareConnection team will pursue the following tactics to improve the daytime medication CPOE rate across our inpatient facilities:
1.Obtain site Medical Executive Committee approval for Emergency Department protocols to be "per protocol"orders instead of "phone" orders.
2.Develop additional protocols for in-hospital care (e.g., electrolyte management, glycemic control).
3.Continue to develop system-wide PowerPlans.

Transcription cost reduction

Some sites have been more successful than others in reducing transcription costs. Lutheran General and Children's Park Ridge have already achieved their transcription targets as estimated on an annualized basis. For this KRA, the teams will try:
1. Increasing PC Touch use.
2. Deploying Nuance Dragon across the enterprise
- All sites will be migrated to the most recent version of Dragon Nuance before October.
- As a separate project, all users will be migrated to the cloud so each physician can access the same voice profile regardless of their physical location.
3. Support specific site initiatives to shut off specific transcription types.

PC Touch issues

Advocate physicians have experienced nine unscheduled downtimes since January 1, 2016 with this application. Seven of the nine downtimes occurred between 0700 and 1000 hours. Anupam is working with Cerner to develop a remediation strategy. The solution will probably include paying for Advocate to use Nuance's voice recognition technology on mobile devices when PC Touch is down.

[ ] Anupam to provide the group with an update at the next meeting.

Masking Social Security Number within CareConnection

Patients' social security numbers are fully visible in Allegra and CareConnection. Susan was able to confirm that no downstream systems have access to the social security number. If a user tries to print a facesheet from CareConnection, the social security number will be masked.

[ ] The CareConnection team is exploring what options might exist to mask at least some digits within the patient's social security number on CareConnection screens displayed to general healthcare workers including physicians.

Copy-and-paste update

Anupam demonstrated an improved user interface to identify copy-and-paste patterns for physician leaders to use to coach their colleagues on better documentation techniques.

Tracking physician activity in SmartRooms

A few physicians at Good Shepherd have been concerned about the new patient rooms enabled with SmartRoom technology that can identify the person entering the room based on the individual's badge. Laura mentioned some risks with identify theft and record storage that might affect how we track this information moving forward, especially for physicians who are not owned by Advocate.

[ ] Anupam to connect Laura with the relevant CareConnection and Cerner resources to explore this issue in more detail.

FYI

System-wide PowerPlan approval process

The PowerPlan Steering Committee meets weekly with nursing, pharmacy and physician leaders working together to build, validate and train users on new system-wide PowerPlans. The process is taking more time than most of us would like, but the steps help make sure nothing is overlooked. On last count, there were about 85 steps from PowerPlan inception to asking Health Information Management to approve downtime forms.

Revenue Cycle update

The Cerner Revenue Cycle contract was signed June 20th. Susan highlighted three elements that will be worth watching from this committee's perspective:
1. Patients may undergo biometric scanning (e.g., fingerprint) for identification.
2. Cleaning up of the Physician Master File.
3. Work to improve the physician's pre-encounter experience (e.g., documenting on patient encounters before the patient arrives at the hospital).

As offered

Data Governance Committee

Tina Esposito will be forming a data governance committee to help address challenges with how Advocate shares its data with external entities.

Healthcare worker access to all patient medical records regardless of credentialing status

Physicians already have access to all patient records regardless of the physician's hospital credentialing status.

[ ] Anupam to follow-up with the Clinical Informatics and CareConnection teams to obtain the date when all nurses will have access to patient records regardless of nurse location.

Next meeting September 13 at 1700 hours CDT (Telepresence, Skype and conference call).
Click here for access to minutes from prior meetings.