Emergency Room Informatics November 2015
November 2, 2-3 PM
| Attendees | ||
|---|---|---|
| Craig Bernat (Cerner) | Shabbir Kanji (Good Shepherd) | Dipul Patadia (Good Samaritan) |
| Katie Cleland (FirstNet) | Ron Lawton (South Suburban/Trinity) | Doug Propp (Lutheran General) |
| Anupam Goel (System Informatics) | Pat Lee (Illinois Masonic) | Bill Schroeder (Christ) |
Follow-ups from the last meeting
Abnormal vital signs on discharge
The group liked the idea of an alert firing on discharge if the patient's last vital signs were abnormal. Many nursing workflows are dependent on the "Dr. Done"flag to initiate the discharge process. To Anupam's knowledge, there are no other components of the physician's discharge workflow (e.g., discharge medications, discharge instructions, follow-up appointments) that could be used to trigger the abnormal vital sign alert to fire.
Several members were going to test the alert as it is live. The group would like to activate the alert when a bed request is placed in addition to discharging the patient as that is consistent with current workflows when admitting a patient. Before linking the discharge patient order to a "Dr. Done" action, the group would like more time to determine if this functionality is worth pursuing.
[] Anupam and Katie to request that the decision support be modified so that the abnormal vital signs fire for a patient on admission (bed request order) or discharge (discharge patient order).
Launchpoint
Several members of the group reviewed the Launchpoint functionality and have decided against moving forward with it for now. One member requested that a pilot group be allowed to test the functionality with real patients before activating it for all emergency room physicians. Since the build for one person is as laborious as the build for all emergency room physicians, we could pilot the functionality with the understanding that all users would go live with the functionality shortly thereafter.
Anupam expects Cerner to stop supporting tracking shells in the emergency department in 24 months or so as the vendor migrates its customers to Launchpoint.
Top five issues
- Inability to find nurses' and other physicians' notes in the medical record quickly
- Displaying important information in the banner bar, including vital signs
- Reviewing orders while entering new orders
- Viewing what medications were administered to a patient without using the Medication Administration Record
- Downtimes of any length
ED Workflow mPage
Craig demonstrated the ED workflow mPage to the group via Lync. The view allows users to view relevant ED and ED nursing notes. Users would still have to click on each note individually to open up the note or move from note to note. The mPage also allows additional functionality like graphing vital signs or view administered medications.
The group was amenable to a short video to help orient users new to the ED workflow mPage as it may address many of the workflow challenges encounters by our physicians. Ideally, most of the physician's work should be completed somewhere on the mPage.
A few members were interested in a multi-contributor note where nursing and physicians could share the same document. This would allow any user to see the patient's emergency room course in a single document. This work would require input from nursing.
[]Doug to bring this the possibility of a multi-contributor view at the next ED Clinical Excellence meeting in mid-December.
[]Craig and Anupam to determine how a training video for the ED workflow mPage could be developed to help introduce emergency room physicians to the new functionality.
Downtime
The group was concerned that any system downtime represents a significant safety risk for the emergency room and the organization. Previous attempts to push forward on this issue have led to discussions about the cost of redundancy. The group feels that this issue is more important than any of the other issues discussed during the meeting.
[]Craig and Anupam to investigate what might be possible to set up a zero- (or near-zero) downtime process for planned and unplanned downtimes.
Orderset to PowerPlan conversion
Anupam has been tasked with migrating the organization from order sets to PowerPlans. To improve the timeliness of PowerPlan maintenance, Anupam and the FirstNet team strongly encourage system-wide PowerPlans with sites making any necessary adjustments at the local level.
Next meeting: December 7, 2015, 2-3 PM via Lync and teleconference (773.296.5877, 135328)
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