Information Technology Report to Medical Executive Committee

Transcription

1 May 8, 2012 Information Technology Report to Medical Executive Committee Contents Cerner Code Upgrade Update 2 Radiology and Cardiology PACS RFP and Demos 2 Update on NHIQM Projects 2 Update on Fayette CPOE/EMR 3 mpages 3 Order Sets/PowerPlan Changes 6 PathNet/Lab Order Changes 7 ios Devices Updates 7 Windows XP Equipment Replacement Project Status 9 Appendix 1 MLH Metro Meaningful Use Objectives Readiness and Adoption Status As of April 30, Appendix 2 Enhancement Request Management Appendix 3 onechart (Cerner) Planned vs. Unplanned Downtime Charts 12 Appendix 4 one Chart Quarterly CPOE Inpatient and ED Adoption Rates Charts 13 Appendix 5 - Chart Search and mpages Quarterly Utilization Statistics Charts 2012 Cerner Code Upgrade Update In response to issues reported by physicians encountered during this downtime, IT and Facility Leaders conducted Lessons Learned sessions. Common areas of need identified and documented included: Periodic review of the downtime policy Training sessions on the 724 application Increased presence of Associates during a planned downtime Review of Lab Process to be followed during downtime Continue debriefing of downtimes with leadership Since this was sent to MEC the following actions have taken place: 1. The unacceptable level of performance has been escalated to the highest level executives in Cerner. 2. Cerner will have to pay penalties to MLH for the recent downtimes. 3. MLH is negotiating a new contract with Cerner and they have been warned that the service level agreements and performance metrics need to be updated to meet the needs of a large health organization that exists in a post CPOE world. 4. Prior to the recent unplanned down times IT was partnering with Germantown and Risk Management on a complete review of downtime communications and policies. A Report on Downtime Recommendations will be forthcoming. 5. Despite the recent frustrating downtimes and slowness the uptime for onechart is still >99%

2 PAGE 2 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE Radiology and Cardiology PACS RFP and Demos Four vendors submitted RFP responses in April for the Radiology and Cardiology PACS replacement. The four vendors are: Fuji, McKesson, Phillips, and GE. CMOs, Radiology Leaders, and Cardiology Leaders will receive appointments for the appropriate demos. Adult patient-focused demos by the vendors are being held at the Memphis Radiology Professional Corporation (MRPC) Office Listed below are the Radiologyfocused demos that will take place at MRPC. ( ) at 7695 Poplar Pike, Germantown (East of Germantown High School) April 30 through May 25. The pediatric-focused radiology demos are scheduled at Le Bonheur. Cardiology-focused demos are also being planned and will take place at University and Le Bonheur. Demos scheduled include: Fuji Demos: completed. McKesson Demos: o Monday, May 7: 12:00 p.m. 5:30 p.m. o Tuesday, May 8: 8:00 a.m. 5:00 p.m. GE Demos: o Wednesday, May 16: 12:00 p.m. 8:00 p.m. o Thursday, May 17: 8:00 a.m. 5:00 p.m. Phillips Demos: o Monday, May 21: 12:00 p.m. 5:30 p.m. o Tuesday: May 22: 8:00 a.m. 5:00 p.m. Update on NHIQM Projects Following implementation of NHIQM dashboard metrics for Stroke and VTE at University and Germantown earlier this year, an AMI dashboard will be piloted at North and South Hospitals on May 22. A system-wide rollout will follow in June. Update on Fayette CPOE/EMR Fayette Hospital will implement CPOE and emar on May 15, Key upcoming dates for Fayette: Training for clinical staff is on target and will be completed by May 10, 2012 Physician training push began on

3 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE 3 April 15, PathNet Blood Bank was implemented at Fayette on April 24, This is the last of the Cerner PathNet laboratory applications to be implemented at Fayette. Fayette will be using many of the same order sets and PowerPlans currently in use at the adult hospitals. mpages mp Radiology PACS The mp Radiology PACs implementation has gone very well. In the first full month of usage, over 600 associates have accessed mp Radiology PACS over 2500 times. mp Pulmonary Summary In April, the physician analysts presented the Pulmonary Summary mpage design to several physicians across the organization. We received positive feedback and excellent suggestions. Additionally, the respiratory therapy department stakeholders have developed several metrics that will be used to measure the effectiveness and efficiency of the mp Pulmonary Summary in their processes and workflow. Training material is currently being developed with an implementation date tentatively slated for May 29th. mpage Performance issues The mpage team continues to monitor the performance of the various mpages. As part of the initiative to improve the component load times, we are doubling the number of the mpage related servers. We will also be upgrading to the latest mpage code in May The latest code contains several enhancements that should also further improve the performance of various mpages. The mpage team will continue to closely monitor the load times and investigate other ways to improve performance. Order Sets/PowerPlan Changes Patient Status Orders The Admit Patient order has been redesigned to meet CMS guidelines. Effective May 8, 2012, three orders replaced the Admit Patient order: Patient Status Initial Inpatient - This order is used to place the patient in an inpatient status.

4 PAGE 4 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE Patient Status Initial Outpatient This order is used to place the patient in one of three potential outpatient statuses/services: o OP Ambulatory Surgery o OP Diagnostic Procedure o OP Observation Services Patient Status Change This order is used when changing from one status to another. For example, if the Patient Status Initial Outpatient order was entered and the patient condition or services being rendered warrant a change to inpatient, the Patient Status Change order is used. NOTE: There should be only one Patient Status Initial order per hospital encounter. The Admit Patient orders have been removed from ordersets/powerplans and replaced with the appropriate Patient Status Initial order. Transfer and Patient Status Order The Transfer order, which remains available, and the Patient Status order are both entered if the patient is being moved from one level of care to another (such as floor to ICU) and the existing patient status is changing (observation to inpatient). ID CareSets Removed - Adult Facilities ID CareSets, except for the PT Amphotericin B Bladder and the PT Lice Protocol, will be removed from onechart effective May 8, Drug to Drug Interaction Checking Alert - All Facilities Drug Interaction Checking is a core measure for Meaningful Use of electronic medical records. On April 17th, Methodist implemented drugdrug interaction checking as an enhancement of the medication clinical decision support in Cerner s PowerChart, FirstNet and SurgiNet applications. With this new functionality, the provider is alerted during order entry when a medication on the patient s inpatient or ambulatory profile has an interaction with the medication being ordered that is significant enough to generally be classified as contraindicated. The table below shows the number of order actions (new order or order modify) that occurred during a one week period of time (4/23 4/30) and the number of potential drugdrug interactions detected by the system.

5 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE 5 Day # Order Actions # Alerts / Interactions Alert Percentage Monday 16, % Tuesday 15, % Wednesday 16, % Thursday 15, % Friday 15, % Saturday 9, % Sunday 9, % Totals 99, % Some things of note from the data on the above interactions: A small number of medications are responsible for the majority of the alerts. Two medications in particular, ketorolac and ioversol were the triggering medication for the majority of alerts (35% and 23% respectively) Over half of the alerts occurred in the Emergency Department and Ambulatory Surgery venues of care (32% and 20% respectively) A little less than one half of the alerts were on patients admitted to inpatient nursing units (45%) but of those, a significant number (19%) occurred In procedural areas, based upon the role of the individual receiving the alert. There was no significant relationship between ordering provider and number of alerts Revision of VTE Orders Needed Alert - Adult Facilities Effective May 8, 2012, the VTE Orders Needed Alert will be updated to fire more appropriately. Additional orders are available from the alert window to accommodate CMS measures. If VTE treatments are not appropriate, please enter the Reason VTE Prophylaxis Not Received order, e.g. anticoagulation therapy not Warfarin, IV heparin and bleeding risks. Revision to Post Acute Transfer Report - Adult Facilities Effective May 8, 2012, the Post Acute Transfer Report was revised as follows: Last administered Dose Date/Time will be pulled to the report from the emar Nurse Signature line will be added

6 PAGE 6 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE Removal of the CBC, BMP and PT/INR orders Electronic Discharge Summary - Adult Facilities The Electronic Discharge Summary is a core measure for Meaningful Use of electronic medical records. Effective April 17, 2012, an electronic copy of the Discharge Summary became available to inpatients upon the patient's request ONLY. Clinical Summary - Adult Facilities and Le Bonheur The Transition Summary is a core measure for Meaningful Use of electronic medical records. Adult Facilities - Effective April 17, 2012, a Clinical Summary is printed and sent with patients transferring from the adult hospitals to non - Methodist Le Bonheur facilities. Le Bonheur - Effective May 1, 2012, a Clinical Summary is printed and sent with patients transferring from Le Bonheur to non - Methodist Le Bonheur facilities. Please review the education posted on CHEXWEB using the search word: Summary. PathNet/Lab Order Changes Lab Orders - Le Bonheur MedTox Reference Lab interface implemented on April 17, Effective April 17, 2012, results for the following Drug levels will post in the Referral Lab section: Clobazam Level Peds Felbatol Level Peds Lacosamide Level Peds Lamotrigine Level Peds Levetiracetam Level Peds Methsuximide as Desmethylmethsuximide Level Oxcarbazepine Level Peds Rufinamide Level Sulfonylurea, Ur Hypoglycemia Drug Screen Topiramate Level Peds Vigabatrin Level Peds Zonisamide Level Peds Lab Orders All Facilities Amniotic Fluid Profile and Fetal Lung Maturity are no longer available to order. An alternative test to help with the determination of fetal lung maturity is Phosphatidylglycerol, ordered as PG in onechart. It provides a positive or negative result.

7 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE 7 Effective April 16, 2012, the Order Hexosaminidase A will be reported as two results: Tay-Sachs DNA and Tay-Sachs Shared Assay Components. It was previously reported as Hexosaminidase A. Effective immediately, Hepatitis C Virus RNA Qualitative PCR, is no longer available to order. HCV RNA Quantitation by PCR is performed by Le Bonheur Molecular Diagnostics Lab. Effective April 30, 2012, Chagas Disease Antibody, will not be available to order. The recommended alternative order is Trypanosoma cruzi Antibody, Total. Effective May 1, 2012, a new order, Direct Thrombin Inhibitor Assay, is available to order. ios Devices Updates Information Technology continues to rollout MLH to personally owned devices. There are over 201 connected devices, and the number continues to grow. Please find the mobile device access request form under the Forms section on Molli for further information on connecting your ios device. Windows XP Equipment Replacement Project Status On April 16, Information Technology launched a Windows XP replacement pilot project at North Hospital. The goal of the pilot was to test the processes and procedures to be used during the project by replacing 50 Windows XP devices with new Windows 7 PCs. The pilot was an overwhelming success with all 50 target PCs replaced (including data migration from each old to each new device) by the deadline. No major issues were encountered. Under the guidance of the Desktop Support team, technicians from our vendor partner, ProTech, will work with facility Associates to evaluate each XP device and schedule its replacement.

8 PAGE 8 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE On June 4, the full Windows XP replacement project will launch at North Hospital where 195 PCs (40%) will be replaced by Friday, June 29. University Hospital will follow North replacements in the July and August. 800 Windows XP devices will be replaced. Le Bonheur replacements will be completed in September. All remaining sites (including South, Alliance, Sutherland Cardiology, etc.) are scheduled to be completed in mid-november.

9 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE 9 Appendix 1 MLH Metro Meaningful Use Objectives Readiness and Adoption Status as of April 30, 2012 Core Objectives Threshold Plan Status Adoption Status Record Demographics 50% Adopted 97% Record Vital Signs 50% Adopted 93% Medication Allergy List 80% Adopted 99% Smoking Status 50% Adopted 94% Problem List 80% Live 85% Medication List 80% Adopted 97% CPOE 30% Adopted 95% Drug-Drug, Drug-Allergy Checks NA Adopted NA Clinical Decision Support Rule NA Adopted NA Clinical Quality Measures Reporting NA In Process NA Provide Patients Electronic Copy of Health Information 50% In Process 96% Provide Patients Electronic Copy of Discharge Instructions Exchange Information Among Providers Electronically 50% In Process ---- NA Demonstrated NA Protect Electronic Health Information NA Adopted NA Menu Objectives MU Threshold Plan Status Adoption Status Drug Formulary Checks NA Adopted NA Lab Test Results in EHR 40% Adopted 96% Generate Lists of Patients with Specific Conditions NA Adopted NA Record Advance Directives 50% Adopted 98% Patient Education 10% Adopted 69% Medication Reconciliation 50% Planning Stage Provide Summary of Care Record 50% In Process ---- Submit Electronic Data to Immunization Registries NA Planning Stage 2 NA Submit Lab Results to Public Health Agencies NA Adopted NA Submit Syndromic Surveillance Data to Public Health Agencies NA Planning Stage 2 NA

10 PAGE 10 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE Appendix 2 Enhancement Request Management Chart Requests for enhancements to onechart (Cerner) coming from hospital Clinical and Technology Advisory Groups, Clinical Service Groups, Pharmacy and Therapeutic Groups and other governance groups are entered into an Information Technology SharePoint site which allows the requesting user and IT Associates to track the status of the enhancements. SharePoint automatically s the requesting user when the request is initially submitted. The user has the option to be notified by when there has been a change in the status of the enhancement request. For the month of April: Total Enhancement Requests submitted: 90 Total Physician Enhancement requests submitted: Total Enhancement Request closed: 66 Total Physician Enhancement requests closed: 6

11 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE Appendix 3 onechart (Cerner) Planned vs. Unplanned Downtime Charts Total Minutes Planned Downtime Unplanned Downtime Total Uptime % Cerner Uptime % January , % % February , % % March , % 99.57% April 2012 May 2012 June 2012 July 2012 August 2012 September 2012 October 2012 November 2012 December 2012 Total 131, % 99.86%

12 PAGE 12 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE Appendix 4 one Chart Quarterly CPOE Inpatient and ED Adoption Rates Charts Effective March 2012, orders entered by residents (house staff) will be included in the ED CPOE calculation reports. In recognition of the extended downtime for the code upgrade, all orders entered for the 24 hour period from midnight March 24 th through midnight March 25 th have been excluded from the inpatient and ED calculations. CPOE Inpatient Adoption Rates By Hospital February 20 - February % 95% 90% Percentage 85% 80% 75% 70% 65% 60% Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 12 Feb- 12 University South North Germantown Le Bonheur Month CPOE ED Adoption Rates By Hospital February 20 - February % Percentage 95% 90% University South North Germantown Le Bonheur 85% Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 12 Feb- 12 Month

13 INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE 13 Appendix 5 - Chart Search and mpages Quarterly Utilization Statistics Charts

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