Feedback from upgrade and unexpected downtimes (PC Touch and CareConnection)

CareConnection Upgrade

Most of the medical directors feel that the Spring upgrade went relatively smoothly. Good Shepherd expects to migrate to the system TPN ordering workflow in mid-June.

PC Touch

Even after two years of use, the software still seems unstable. Any efforts to push adoption are stymied when clinicians cannot rely on the program to work on a regular basis. At a minimum, downtimes should be measured in minutes, not days.

[ ] Anupam to follow-up with Cerner team about obtaining additional assurances about PC Touch stability.

CareConnection downtime earlier this week

As part of a planned Lutheran General data center migration to multiple Uninterrupted Power Supply (UPS) connections, the switches were not set up as expected from the written schematic. In addition, the programs designed to re-direct users to the Kansas City instance of our clinical applications did not work as designed. The result was an unexpected downtime during the evening shift, a group who usually does not experience downtimes and is unfamiliar with downtime procedures. In addition to CareConnection, PACS, phones and every other clinical information system was unable for the 60-90 minute period. Lutheran General actually considered going on diversion during the downtime. The downtime exposed a lack of processes to help improve the organization's resiliency against unplanned events. Remediations include:

• Advocate has updated its schematics so the switches reflect the reality of what's been put in place.
• Advocate's core networking team will follow-up with Cerner to determine what changes can be made to the monitoring software so our users will be directed to the Kansas City data center when the next unplanned downtime occurs.

[ ] Anupam to follow-up with core networking and update the group when the software change has been made.

Communicating with end-users about changes

We continue to struggle with reaching out to users about electronic clinical system events. Illinois Masonic has a working model where Physician Informatics Committee (PIC) members attend the monthly meetings and disseminate the information to their colleagues. Other sites have either phased out or are considering phasing out the PIC meeting given poor attendance.

Change to default quantity on discharge prescriptions

Currently, Advocate does not permit users to enter more than 40 tablets on any electronic discharge narcotic prescription. Anupam was asked about reducing the number to 20 tablets to reduce the risk of diversion and addiction. One challenge with reducing the maximum number of tablets given is that some patients may end up coming back to the emergency room for another narcotic refill if they cannot follow-up with an outpatient provider in a timely fashion.

After a discussion of risks and benefits, the group agreed to change the default sentences within Cerner to a maximum of 20 tablets, but allow users the option to prescribe up to 40 tablets based on their judgment. Doug has also reached out to one of his colleagues in addiction medicine to see if they may be any potential ramifications from an addiction perspective with this change.

Moving from "stipend" to "volunteer" status

June will be the last month when the group will meet as medical directors with payment. The group agreed to continue the meetings scheduled the second Thursday of the month for now. There was some conversation about the financial challenges Advocate is currently facing. Although the medical directors provided some value to the organization, there has been no discussion of restoring the funding at this time. Based on the conversations among our senior leadership team, it is not clear if the financial savings from removing the medical director stipends will be re-directed back into Clinical Informatics.

Issues from prior meetings

[ ] Anupam to follow-up with CareConnection team about how we might better use front-line users to test changes to identify usability challenges.
[ ] Anupam did speak with Pharmacy Informatics team about options to reduce the frequency of low-value drug-drug and drug-allergy alerts. There may be a software fix to address the issue, but it needs to be tested. Doug would be interested in participating in any testing of a new solution.
[ ] Anupam to distribute electronic survey to our physician community for what library resources should be exposed within CareConnection.
[] 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 June 9th 0730-0830 hours CST.

Click here to see minutes from earlier meetings.