Transcription reduction

Doug believes the two factors that led to the success in reducing transcription costs at Lutheran General were: 1) VPMM support to make this a priority and 2) Information Technology (Field Services) and Clinical Informatics support to help coach reluctant physicians as to how to use the Nuance Dragon technology to complete their work. He was not aware of any pushback from physicians when the decision was made to stop issuing telephone transcription numbers.

The group reviewed the option to use Nuance's Mobile Mic technology. The consensus was that the technology might work for a minority of physicians, but that it was probably too complicated for the average user. The organization should spend its resources on pushing out as many desktop microphones as possible.

[] Doug to investigate how the physicians are able to complete their pre-operative H&Ps without a transcription number.

CPOE

Some sites have seen month-after-month improvement in the medication 8 AM - 5 PM CPOE metric, but other sites have been more sporadic in their performance trend.

[] Anupam to investigate if there's a correlation between the age of the medical staff member and CPOE rate.
[] Anupam to investigate opportunities to better disseminate information about existing PowerPlans.

Leadership interest in mandating physician EMR education

Vince Bufalino has been pushing Bruce and other senior leaders to consider mandatory and ongoing training to help physicians better perform their tasks. The group was interested in knowing if there was actually any evidence that users actually need training. One member noted that he picked up new tricks by watching his colleagues at work, but that was a rare event. If given a choice as to how to set up the training the group suggested the following guidelines:

1. Whenever possible, set-up the training by specialty.
2. Have an initial training before the user sees any patients and then a follow-up training session after seeing patients for a few weeks. The second session will be infinitely more valuable as the user will have specific questions about workflows after seeing patients. Adding CME credit can be a further enticement for some physicians.
3. Use pre-tests to assess a user's ability to complete specific workflows within an EMR and then tailor the subsequent education accordingly.
4. Consider a separate training every two or three years (possibly with the re-credentialing cycle) to update users on new functionality.
5. Rather than hour-long sessions for refresher sessions, consider shorter training modules that include a brief video and a one-page pdf summarizing the described workflow.
6. Allow users to practice in an environment that is as close to production as possible. Gaps between the training environment and the production environment greatly reduce the value of the training.

DIRECT

The Medical Management Team/Physician Leadership Council has asked that we identify any physician users who might be interested in testing Cerner's DIRECT functionality to send patient information to any EMR participating in the directtrust.org bundle. Unfortunately, neither CliniCare (Advocate's version of Allscripts) or SynApps (Advocate's version of eClinicalWorks) is set up to send or receive DIRECT messages.

[] Medical directors to identify a few users at their site who might be willing to test this technology for two months before the system makes a decision about disseminating this functionality to all Advocate inpatient physician users.

ePrescribing

The Office of the National Coordinator has suggested that 25% of all prescriptions will need to be sent electronically to avoid Meaningful Use penalties in 2017. Even if the final ruling expected to be issued in November is half that number, the ePrescribing target may be challenging for some sites. At least one of our sites has noted a very high ePrescribing rate due to nursing ensuring that the patient's pharmacy is recorded and a patient expectation that medications will be sent electronically. Anupam suggested hospitalists as a primary target since any prescriptions sent by the emergency department would not count toward the Meaningful Use goal. The group recommended adding residents to the target audience. Barriers that should be addressed or acknowledged before making a larger ePrescribing push include:

1. Multiple owners of discharge medication reconciliation that complicate the discharge moment. Many specialists prefer to handwrite their own prescriptions and those medications are not tracked within CareConnection.
2. There are still some gaps in knowledge among most physician users around ePrescribing. A larger educational effort would be helpful to better share the nuances of the technology.
3. Enter the pharmacy could a viewed as a clerical function that does not require a nurse or physician to input. Developing workflows to have other healthcare team members perform this function would be well-received.
4. Once an order is "ePrescribed," the only way to rescind it is to call the pharmacy. The absence of an electronic process to cancel orders may reduce adoption.

[] Anupam to work with the Clinical Informatics team to determine what might be feasible to help drive ePrescribing rates higher before the federal mandate goes into effect sometime next year.

Decision support request

Doug was interested in some sort of pop-up alert for patients are fully capitated and those who have been readmitted in the last 30 days. The group discussed the pro's and con's of active versus passive alerts and the perception of increasing alert fatigue. The interest in these decision support elements appears to be restricted to the emergency room.

[] Anupam to work with Doug on how these requests might get processed through the ED Clinical Excellence Council.

Issues from prior meetings

[] Advocate signed the Revenue Cycle contract with Cerner on June 20th. The CareConnection team will begin working on a single provider directory as part of this contract. Anupam is serving on the committee overseeing the project. The single provider directory will allow physician accounts to be consolidated across sites. We will then be able to reinstate Physician Consults in PC Touch.
[] 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.

The next meeting is scheduled for August 11, 2016.

Minutes from prior meetings