2017 KRA update

Sherman hospital also has an affiliation with Walgreens that will get discharge medications to patient rooms before discharge.

Change in Clinical Governance

Mary Kane, our new Chief Nursing Information Officer, has been tasked with developing a governance structure to manage the changes within our electronic clinical systems. From a clinical perspective, nursing, pharmacy and physician requests will need to be funneled through the same system to help prioritize change requests. Changes can be categorized as:

1. Production maintenance (e.g., new printer, change to a drop-down list based on end-user feedback)
2. Minor changes (e.g., updating a PowerForm or creating a specialty-specific PowerPlan)
3. Larger changes that address a system objective or KRA (e.g., OneCareConnection, sepsis management)

From a physician perspective, the overall clinical governance structure could be supported by various committees including:

• Chart review (within a single electronic medical record or across electronic medical records)
• Order entry (order sets, PowerPlans)
• Documentation (voice-to-text, Dynamic documentation)
• Handoffs (within and across care settings)
• Decision support

Donna asked that the governance group consider an ISO-risk based approach that considers risks along two axes: frequency and severity with each risk axis being classified as high, medium or low for a 3 x 3 grid. ISO methodology would suggest different actions based on different levels of risk.

Project Prioritization

Required projects

• Radiology decision support for CT scans and MRIs across all electronic medical record platforms using a single vendor (Medicare requirement starting January 1, 2018)
• Consolidating the physician directory (preparation for Revenue Cycle)
• ePrescribing controlled substances (funded through 2017 capital)

KRA or SVP-sponsored projects

• Sepsis - ED adult was completed late 2016. Design sessions have begun for ED pediatrics, inpatient adult and inpatient pediatrics
• ONE Patient Experience - electronic medical record documentation simplification to reduce nursing time entering admission history information

The group agreed with the system-level importance of these two projects.

Suggested projects

• Decision support for laboratory ordering - leveraging the radiology decision support platform to deliver lab-based ordering support information (Quality)
• Enhanced chart review - highlighting key components of physician documentation across notes from different care settings (Physician Satisfaction)
• Home Health documentation review - Home Health was recently instructed by their payors to shift their physician attestations from stand-alone documents to information within a physician's daily documentation (Revenue)
• Natural language processing to address clinical and regulatory challenges - as more physicians rely on free-text data entry instead of completing forms within the electronic medical record, our monitoring processes need new technology to help identify gaps in care or documentation deficiencies.
  • Safety report review (Safety)
  • Stroke (Quality, Public Reporting)
  • Anesthesia/Operative report data elements (Quality)
• Pool functionality to route orders, including the Level of Care order, for co-signature to an entire practice group instead of a single individual (Revenue)
• Two-way communication between nurses and physicians using PerfectServe (awaiting approval, Nurse/Physician Satisfaction)

Rather than work on all of these projects with minimal effort, Anupam asked the group to help prioritize the project to help drive a few of them to completion. The group suggested focusing on the Home Health documentation review, natural language processing and pool functionality projects.

Other projects that do not require dedicated Information Technology resources

• Educational efforts to use PC Touch with Dynamic Documentation for an improved documentation experience (Physician Satisfaction)
• Educational efforts for ePrescribing for 340B drug pricing (Patient Satisfaction, Revenue) Combivent has a retail price of $300/month. Using the 340B program, a patient would pay $5-10 instead.
• Routing abnormal test results across care settings (Risk Management, Safety)
• Standardize physician documentation deadlines across the organization (Quality)

Next meeting July 11, 5-6 PM (Lync and conference call)
Click here for minutes to prior meetings.