KRAs for 2017

ePrescribing

No change from last month

Copy-and-paste

The expectation is that the site's VPMM will direct identified physicians to a resource (quality improvement, Clinical Informatics, or the medical director of clinical informatics) to reduce the number of notes that are 95% identical within a given week. Each site may have their own process to address this issue. Given the fact that this is the first year that the organization is reviewing this behavior, the focus should be on behavior change, not punishment. There may be an opportunity to educate physicians about the possible legal ramifications for the organization and the individual physician. There was some conversation about prohibiting copy/paste altogether for the assessment and plan, but that prohibition may unduly penalize physicians who find updating a prior progress note to be the best use of technology to help them get through a long list of patients.

• In a brief review of last week's notes signed by the current medical directors, attending notes that are entered independently of a resident's notes are not identified by the software and may artificially inflate copy-and-paste behavior.
• A focus on assessment and plan would be more meaningful for physicians than an overall analysis of the note, but high rates of copying and pasting the assessment plan and/or chief complaint should also be detected if the entire note is identical.
• Based on the site-specific findings of how prevalent copy-and-paste might be, a site target will need to be set against a high benchmark (e.g., >95% identical) with a target of reducing the number of physicians who exceed that benchmark over the calendar year.

PC Touch workflows coordinated with desktop CareConnection

Anupam demonstrated the functionality of using PC Touch to enter patient-specific information within the smartphone app in the patient's Review tab and then pulling that information into CareConnection. The user has to manually save each section within the tab (HPI, ROS, PE), but the macros to pull the information could be included in a CareConnection PowerNote template. The group felt the steps were more complicated than what most physician users could handle, but for those physicians who are seeing multiple patients before touching a desktop, this process may enable them to retain patient-specific details while completing documentation more efficiently.

PowerPlan consolidation

The Sherman integration is planned for the Spring of 2018. Sherman has over 400 PowerPlans that they would like to retain as part of their migration into CareConnection. Advocate has over 900 site-specific order sets and approximately 100 site-specific ED PowerPlans. The proposal is to use Sherman as a starting point to help consolidate order sets and PowerPlans.

The group felt two tactics that might add value might be to:
1. Determine how many hours could be spent supporting a specific number of PowerPlans. Once those plans are created, stop future development until an existing PowerPlan is not used or retired.
2. Accelerate the retirement of PowerPlans with minimal use.

In any event, PowerPlans with more than two options per diagnostic or treatment avenue makes the plan too unwieldy to use and decreases adoption. The group was divided as to the value of mandating PowerPlan use when many physicians are comfortable placing orders individually with similar patient outcome performance.

Retiring specific views in CareConnection

Anupam displayed the list of elements in the current Menu bar that include information that is available in other parts of the medical record. The group asked for input for the I&O tab, but most of the other tabs could be removed. One medical director appreciated the workflow mPage as a view that enables users to see multiple results and orders on the same screen in a more user-friendly fashion that Results Review.

[ ] Anupam to follow-up with CareConnection team about an easier way to track blood products outside of the iView/I&O tab.
[ ] Anupam to follow-up with Natalie about the pro's and con's of using the iView/I&O tab.

Highlighting tabs as abnormal in SmartTemplates

There is some difference in how laboratory values are displayed in CareConnection based on what SmartTemplate is summoned. The "..lab" function (24 hour labs SmartTemplate) will display abnormal values in red with an indicator if the result is above or below the reference threshold. Other SmartTemplates (e.g. Lab Results - xxx), only show a listing of relevant lab results in that category. The group did not reach consensus on doing anything additional with this discrepancy at this time.

Miscellaneous updates

Copy-and-paste

Although a preliminary policy was drafted, the VPMMs asked that we hold off on developing a formal policy until we had more experience with the copy-and-paste tool. Anupam has been asked to consider embedding this information into the physicians' OPPE reports.

Nuance contract

All of the current users will have to migrated to the new Dragon Medical One platform. Training details are still being worked out between Information Technology and Clinical Informatics. There is no plan to purchase more licenses at the system level, so any site who would like to obtain additional licenses would have to do so through their site budgets.

With the aggressive efforts to lower transcription costs, it may be more expensive to migrate users to Dragon rather than keeping them on telephone transcription.

Budget conversations

Anupam continues to be asked defend the medical directors' funding, especially given the limited number of hours submitted by the medical directors for reimbursement and the absence of any relationship between medical director involvement and KRA achievement.

If any budget changes do occur, Anupam will notify the directors at least 90 days prior to the change.

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.
[ ] Develop additional education around using PC Touch with CareConnection PowerNotes to leverage the best of both systems.

Next meeting December 8th 0730-0830 hours CST via Telepresence and telephone call.

Click here to see minutes from earlier meetings.