Proposed KRA switch for 2015

The group agreed to substitute PC enrollment for order set & PowerPlan utilization for 2015 KRAs.

Proposed KRAs for 2016

No one objected to transcription reduction as a 2016 KRA goal.

There was some hesitation about moving forward with a discharge summary timeliness goal. The medical directors of informatics do not have the authority to mandate such a change. If a site's medical staff was interested in driving, physician informatics could support a mandate by simplifying the discharge process.

Focusing on specific deliverables may be appropriate. For example:

• Making user-friendly discharge templates that pull in the relevant information to reduce the time spent creating the discharge summary
• Completing medication reconciliation before the patient leaves the hospital
• DNR/POLST paperwork completed before the patient leaves the hospital
• Home Health/DME completed before the patient leaves the hospital

Another option would be use the "key events" functionality in Cerner to help collect the relevant data for a discharge summary each day to simplify the work of creating a discharge summary when the patient is ready to move to the next care setting.

Transcription reduction

Some sites have been working under the impression that the November 1st cutoff date is a suggestion, not a mandate. Anupam will work with the site VPMMs to help raise awareness about this hard deadline so we can have physicians come to Clinical Informatics for training well before the November 1st deadline.

[] By September 1st, site medical directors to identify a medicine and surgical champion for using PC Touch or Dragon for consults instead of telephone transcription to help motivate medical staff members to try the technologies.

Decision Support

Anupam outlined a framework for how decision support might be deployed across the organization. The risk of putting some alerts in a parking lot is that no user will address them until they are forced to do so (e.g., when the patient is being discharged). For those physicians who are covering for a day, they are as likely to ignore those alerts as alerts that pop-up at unexpected times.

Elliot believes there has been some success with VTE prophylaxis with the SCIP alert.

Specific requests

CHA2DS2-VASc risk assessment score for warfarin anticoagulation with atrial fibrillation
The group asked that allowances be made for

• All anticoagulants (e.g., Xarelto, Equilis), not just warfarin.
• Include a way for the physician to mark if the anticoagulation was for a new or historical indication. If there was a new indication, include a Y/N field for if the patient's risk score was greater than a specific threshold. The order (or PowerPlan) should include a hyperlink to the algorithm to allow users to determine the patient's score.

Alert for patients with a historical LET order without a current LET order
The group enthusiastically agreed to move forward. The alert should include some instructions to speak with the patient. The alert should fire for attending physicians, covering physicians and ED physicians.

Routing errors for consults in PC Touch
The group agrees that the multiple instances of the same physician in PC Touch is leading to errors on consult rounding. They proposed stopping "Consult Physician" orders to allow users to continue to use PC Touch for consults to Nutrition and other services.

Issues to track from prior meetings

[] Anupam to submit change request to withdraw "Reconcile and Plan" functionality. - This request was withdrawn.
[] Chris to distribute a discharge summary built from key events.
[] The CareNet+ upgrade may be ready by mid-September.
[] 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 tropoinin in the daily labs SmartTemplate.
[] Anupam to update the website with tips & tricks on how to better use the documentation functionality within PC Touch
H&P, operative notes and discharge summaries are now available in PC Touch
[] Anupam to investigate options to pull in patient diagnoses on demand in PC Touch
[] 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 determine if there is a workflow to generate a patient's FIN for elective cases before the patient arrives at the hospital for an outpatient procedure requiring an H&P.

The next meeting is scheduled for September 10th at 0730 hours.

Minutes from other meetings