Feedback from recent removal of multiple tabs in PowerChart

The directors have received considerable feedback about the views that were removed from PowerChart. Our communication with the physician community is an ongoing challenge. As people develop habits to access information within the EMR, it becomes increasingly difficult to change those habits as the software changes. Some specific issues include:

• Ability to track weights with I/Os
• Tracking ordering behavior using the 24-hour orders view - there does not seem to be an easy way to view what orders were changed in the last 24 hours and who changed them

The directors asked that we have a test environment that is as close to production as possible to help identify usability issues prior to deploying changes in the production environment.

[ ] Anupam to follow-up with CareConnection team about how we might better use front-line users to test changes to identify usability challenges.

Spring upgrade scheduled for next week

The group reviewed the educational document. Many of the changes will not be fully understood until the implementation is complete as many test patients do not have enough data points to make a meaningful assessment of the changes' impact.

• For the Medication Management mPage, displaying blood glucose values may help increase adoption along with listing the patient's steroid medications.
• Dragon Nuance has been causing some difficulty for users at Good Shepherd and Lutheran General. It's unclear if the issue has to do with migrating to the cloud version of Dragon or if the issue is related to multiple users logging into the same machine.

[ ] Anupam to reach out to Good Shepherd and Lutheran General leadership to investigate Dragon issues in more detail.
[ ] Anupam to follow-up with the medical directors at the next meeting to assess our end-users' experience with the upgrade.

Lab ordering challenges

The group believes the challenges around the new lab order priority will cause considerable frustration among our physician users. Most directors agree that TIMED orders will be adjusted by the end user, but STAT DRAW labs may not be. Upon further conversations with the CareConnection team, changing the lab order priority was not part of the testing plan. They would welcome more end-users testing solutions in the test environment to validate changes before they are implemented in our production environment.

Drug-drug and drug-allergy alerts

The directors expressed frustration around the existing drug-drug and drug-allergy alerts. The issues include:

1. The alerts do not always communicate what should be done. Instead of stating there is a contraindication, the alert would be more useful if it suggested another medication within the same therapeutic class that does not trigger the interaction.
2. There are still too many alerts for our end-users to address. When the signal-to-noise ratio becomes too low, the users ignore all alerts, reducing the system's effectiveness and potentially reducing patient safety.

[ ] Anupam to follow-up with the Pharmacy Informatics team to determine what, if any, steps could be taken in the short-term to improve the drug-drug and drug-allergy alerting process. Doug would be interested in participating in any testing of a new solution.

Dynamic Documentation

Anupam demonstrated Cerner's Dynamic Documentation module in conjunction with PC Touch. The ability to order encounter diagnoses so they show up in the note is a welcome development. Unfortunately, it is almost always easier to update the Assessment/Plan in a free-text field than manipulate text under each encounter diagnosis. The Spring upgrade will add the ability to "tag" elements that can pull into the note, further enhancing the functionality.

Efforts to merge voice-to-text into clinical documentation will continue as users complain about data entry usability issues around all electronic medical records, including CareConnection.

Medical education links within CareConnection

The directors liked the idea of including links to Advocate's educational resources within CareConnection. They asked that Anupam send out a survey to see what links would be most used to determine which buttons should be created in the electronic medical record.

[ ] Anupam to distribute electronic survey to our physician community for what library resources should be exposed within CareConnection.

Issues from prior meetings

[] 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 still waiting to hear back from the Advance Care Planning Council about changing the requirement for a physical signature for LET orders.
[ ] Anupam to present electrolyte management to the ED Clinical Excellence Council to determine if this protocol could be applied in that setting.

Next meeting May 11th 0730-0830 hours CST.

Click here to see minutes from earlier meetings.