CareConnection upgrade

Anupam reviewed the major changes that would be affecting physicians as part of the upgrade scheduled for this Sunday, October 16th. A few thoughts from the group:

• Consider a component to review blood products administered in a similar vein to the Medication Management mPage. To the group's knowledge, the In's and Out's information is cluttered with too many Results Review is a place to see what blood products have been typed and crossed/matched and an ICU where nurses have an option to document blood products administered. Neither option will consistently provide information about blood products administered.
• Rather than educate each user on using SmartTemplates, a function might be used when a user first sets up their templates, consider updating the relevant documentation templates (e.g., discharge summary template) with the new content so the users see the benefit without having to do one-on-one configurations.
• Ongoing education can help address knowledge gaps that arise when functionality changes after formal training is completed.

To-do items:
[ ] 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.
[ ] Plan additional time to educate the medical directors about using PC Touch to facilitate inpatient rounding at our next meeting.
[x] Provide the group with screenshots/instructions on how to access CareConnection remotely without multiple logins. See below:

• Once you've logged into CareNet+, set up your Citrix and CareConnection credentials within your account (one-time only)
• Click on the "A" surrounded by a multi-colored diamond in the upper right corner and choose Citrix>CARENETPLUS2 Production PrP5
• CareConnection should open shortly without another login or password.

2016 KRAs

Anupam showed our transcription reduction efforts to-date. At a system level including Sherman, Eureka and BroMenn, our 2016 annualized transcription spend has decreased from $2.5 million in January to $2.3 million in September. It seems unlikely that we will be able to reduce transcription costs much further without a mandate to prohibit transcription completely. At this point, even a more palatable solution of removing all transcription types except operative notes is unlikely to lead to enough savings to justify the frustration our physicians will face around banning transcription.

For medication CPOE 8AM-5PM, three of our sites (Condell, Illinois Masonic and Lutheran General) had their best performance in August or September. As a system, our highest medication CPOE rate 8AM-5PM was 89.1% in August. Incidentally, our overall system CPOE rate for laboratory, medications and radiology was 82.4% in August. These improvements do not seem to be attributable to changes in PC Touch behavior.

2017 KRAs

The two physician informatics KRAs proposed for 2017 are

• Copy and paste behavior - the site safety champions identified copy-and-paste behavior as the primary opportunity to improve the care delivery to our patients. Some work needs to be done to establish a baseline, but once that is in place, site-specific thresholds can be set. For this metric, site medical leadership and quality committees may begin the process, but the medical directors and site clinical informatics resources may be asked to help educate physician users on how to make their documentation more distinct from day-to-day. This metric will highlight the fact that some physicians may be using the same documentation over multiple days, but that in and of itself should not trigger disciplinary action. A more intelligent system would move beyond a character-by-character comparison and move toward focusing on specific sections of the note (e.g., Assessment and Plan). In an ideal world, physicians would copy elements from other parts of the chart, but those elements would be labeled with appropriate attribution.

[ ] Anupam to work with other system leaders to draft a system-wide copy-and-paste policy for physician documentation. Each site's medical leadership team will need to determine escalation pathways and possible sanctions.
[ ] Anupam to leverage the work some of this group did several years ago when thinking about copy-and-paste for specific sections of physician documentation.

• ePrescribing - ePrescribing is expected to be an element of inpatient and outpatient Meaningful Use criteria and our physicians and hospitals may be at risk for incurring penalties if specific thresholds are not met. The targets are expected to be released in late November for 2017. Advocate will move forward with ePrescribing for controlled substances for a select group of inpatient physicians (emergency room physicians are excluded from the Meaningful Use metric), but that functionality will not be available until the Fall.

The group had several ideas for improving ePrescribing including:

• Allow medications to be in a "hold" state as many consultants make last-minute changes to the medication reconciliation list just before discharge. Preparing medication reconciliation ahead of time only seems to increase the physicians' work when the final discharge medication reconciliation is complete.
• Allow users to "save and reconcile" instead of sending the prescriptions at medication reconciliation.

System-wide Nuance (Dragon) contract

The Information Technology department has negotiated an agreement with Nuance for all Advocate users in the inpatient and outpatient settings. The agreement includes continuing payment for all existing licenses with an incremental monthly fee for new users. At a given price point, the contract converts to allow all users access to the software, regardless of their location.

Before the technology can be deployed across the sites, the corporate teams need to identify the resources that will train the physicians on how their profiles are migrated. Those details have yet to be worked out.

Anupam is working with the Margin Management Task Force to determine if there is an opportunity to recoup any transcription savings by converting our physicians off of telephone transcription to Nuance. Some of those dollars could potentially be used for physician trainers.

Some comments from the group:
* Verify that our physicians are actually using Nuance (latest upgrade will allow for this type of reporting).
* Consider assessing physician appetite for targeted training with dedicated FTEs before hiring the associates.
* The trainer resources should consider doing more than just training physicians on voice-to-text. There are other elements of the physicians' workflow that could be optimized by focused educational efforts.
* Consider deploying resources for more template development as most providers use some type of template to complete their work (e.g., discharge summary).
* Timeliness of documentation completion could be a future KRA.

Budget conversations

Advocate is aggressively looking for ways to reduce costs. Many departments have already had to freeze positions or lay people off. Questions continue to arise about the marginal value of having a medical director of clinical informatics at each site.

[ ] Anupam to update the group as more information becomes available.

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.

Next meeting November 10th 0730-0830 hours CDT via Telepresence and telephone call.

Click here to see minutes from earlier meetings.