Horace, Please send to your medical staff distribution list. Can you let Tracy Karp know which APCs that will include? Sahar, please make sure this gets to all residents peds and non-peds that rotate at PCH because the section on IF YOU DISCHARGE ADMITTED PATIENTS is relevant to all residents. Dear colleagues, Important icentra updates as follow. Please read. Items are called out with headings so you can know if particular items apply to you. ALL providers: We know there have been slowness and freezing issues and the Intermountain and University IT teams are engaged in addressing them. Tip: the U of U IT team recommends avoiding the use of Chrome browser to access icentra. See attached Autotext Freezing Issues document for more information. IF YOU DISCHARGE ADMITTED PATIENTS: As of March 13, there is a new summary document given to admitted patients upon discharge. This does not (yet) apply to ED encounters, and patients NOT admitted (i.e. sedated patients for imaging studies, cancer transplant short stays, infusion encounters). Nurses in the Same Day Surgery area will generate this document for those patients. The 1 sentence skinny on this: Do your usual stuff (discharge meds rec, followup, education, etc) and NOW in addition to doing your discharge summary, you also create this Discharge Instructions and Orders document Why? 1. The new document formatting simplifies readability to increase patient and caregiver understanding. 2. Ability to edit medication and instruction comments; allows use of Dragon commands and AutoText to individualize instructions for the patient. 3. Includes medication table to clearly outline route, dosage, frequency, and next dose due. 4. Provider ability to sign discharge instructions making it clear that they have been reviewed and approved. Upon signing this Discharge Instructions and Orders Document, the nurses will see it has been done here:
5. One document for discharge instructions and orders that can be sent to SNF and Homecare. 6. May create patient Discharge Instructions and Discharge Summary note simultaneously. What will you need to do? 1. Create the Discharge Instructions and Orders document from your Discharge workflow Mpage. This can be signed by a resident or APC and does not have to be forwarded to the attending to cosign. This is not a billing document. 2. IF you make any changes to the discharge medication reconciliation, followup, DME, patient education, or add other future orders AFTER creating this Discharge Instructions and Orders document, you ll need to refresh the affected sections of the document so those pull in. 3. Note: Surgeons with patients discharged from Same Day Surgery: continue to do the discharge medication reconciliation and followup and any education you select today, but you do not have to create this document the SDS nurse will. How will Care Transformation Services support this change? 1. Support teams will be rounding March 13, 14, 15. 2. Dr. Glissmeyer is giving noon conference in the 3 rd floor hospital auditorium March 13 for a Q&A. 3. We are working with resident and APC leadership as well to communicate this change. See the attached Job Aid document for additional information FYI: Non-disruptive enhancement: Improvement coming soon to the discharge summary note, section on post-discharge followup care: We anticipate that on or before March 13, an improvement will be made to the discharge summary note templates, causing improved display of the patient s followup instructions pulled into the discharge summary and will look just like what the patient sees in the Discharge Instructions and Orders document. For more information on this see the attached word document: Improved Follow-Up Section in Discharge Summary BOOKMARK THIS LINK: https://intermountainhealthcare.org/imass5web/altchangepassword.do This is 1-stop shopping for Intermountain password/account issues. Here's all the helpful things that can be done at this site: -Change Password -Change Remote Password
-Reset Forgotten Password -Activate Account -Activate Expired Account -Email Forgotten Username -2-Step Verification Re-Activation Step 1 Click on desired change. Step 2 Follow prompts. For additional questions, about passwords, call the help desk, x23456 option 1. If you order blood (not applicable to O- emergency release blood): See the Type and Screen Ordering Enhancements document attached. You will not need to do anything different when ordering blood than what you do today. Just know that as of March 6, the PED blood powerplans will be automatically ordering the T&S IF there is one needed. Note: this does not apply to favorited powerplans so a PED blood powerplan you ve favorited with the T&A checked, will not be affected by this change, so the process and function of surgery office staff proposing blood powerplans to surgeons for planned surgeries will not be affected. Outpatient/Ambulatory Providers FYI: March 6 improved wrong FIN alerts will go into place. See the attached Wrong FIN alert tip sheet if you want more information. Care Transformation Services is working reduce the number of FINs patients have especially to reduce clinic encounters where possible to a single FIN. But this is a complex project and no changes are imminent. Please let me know if you have questions or concerns Eric W. Glissmeyer, MD cell 8018603338 Assistant Professor of Pediatrics Division of Pediatric Emergency Medicine, University of Utah Director of Medical Informatics, Primary Children s Region, Intermountain Healthcare icentra Implementation Provider Adoption Lead, Primary Children's Hospital icentra Emergency Department Development Team, Intermountain Healthcare
Autotext Freezing Issue A special taskforce has been assembled to address slowing & freezing of icentra. The ambulatory clinic spaces have reported computers freezing up multiple times a day resulting in icentra crashing and closing. Items that have been resolved so far: Identified and replaced devices that did not have enough memory. I.S. continues to assess and replace as identified. U of U desktop team has reported that caregivers should access icentra from Internet Explorer and not Chrome as a version of Chrome is not compatible. This helps when the computer locks up. icentra freezing up when using Intermountain Powerchart Dragon DMO. Resolution to this is to exit dragon before exiting powerchart. You should hit the exit button before logging in again. We have started working on some of the Imprivata issues that are also causing slowness and freezing. These are device related and not icentra related and related to accessing the V drive. We will continue to work on these and a pilot has already started in some of the clinic spaces. What we need from you: One of the main causes may data that is coming in to the note from the auto text. It is helpful if you can call in a ticket. We are attaching the support algorithm so you know which number to call for which issue. For freezing issues you can Vocera icentra support (Vocera Line 801-662-6677) or can call x23456 (801-662-3456) and select option #2. We know you do not always have time to call in a ticket. By using the Vocera, you will get a Cerner Support Staff who can call in that ticket for you and will filter the info back to us. At bare minimum, please email the following to Mitch Perkins (mitch.perkins@imail.org) and Trevor Watson (trevor.watson@hsc.utah.edu) Please send us the following when this happens or when calling in the ticket: o Required information Name of the person documenting Approximate date/time this occurred o Additional helpful information- helps for faster resolution Patient/FIN Name of the auto text you had selected Computer ID & location if possible Screen shot
Wrong FIN Ordering Alert Ordering Caregivers What is changing/or what needs to be communicated? To better target alerts designed to prevent wrong FIN ordering, multiple existing alerts are being replaced with a new set of more specific alerts. See below for details on how the new alerts will work. Who will it impact? All caregivers that place orders When is it changing? March 6, 2018 Who to contact with questions? Local informatics support How do the new alerts work? You can expect to get an alert under the following scenarios: Scenario Alert Single inpatient or in-office medication order is placed on a History FIN (excluding future day of treatment or series PowerPlan orders). Multiple orders being signed (PowerPlan) on a History FIN and contain one or more inpatient or in-office medication orders (excluding future day of treatment or series PowerPlan orders). A warning alert (not shown) is also presented when the orders are first placed. Single non-medication order (excluding future visit orders) is placed on an active outpatient/lab FIN or on a discharged FIN (excluding clinic, history and outpatient message FINs). Multiple orders being signed (PowerPlan) on an active outpatient/lab FIN or on a discharged FIN (excluding clinic, history and outpatient message FINs) and contain one or more non-medication orders (excluding future visit orders). A warning alert (not shown) is also presented when the orders are first placed. February 2018 Page 1 of 1
Blood Products Orders: Type and Screen Intermountain Hospitals What is changing/or what needs to be communicated? To decrease duplicate Type and Screen orders and unnecessary blood draws, an enhancement will be made to the Blood Product PowerPlans listed below. This change will cause the Type and Screen order in the PowerPlans to automatically pre-check if the order is needed, and not pre-check if it is not needed. PowerPlans being enhanced (does not include favorited PowerPlans): Blood Products: Administer STAT ADULT Blood Products: Administer STAT PED Blood Products: Make Available ADULT Blood Products: Make Available PED Blood Products: Routine PED Blood Products: Routine Administration ADULT NICU Transfusion (Blood Products) Regardless of whether a blood product order is placed from one of the PowerPlans listed above or not, an alert will prompt the caregiver if a Type and Screen order is needed, but not included in the orders being signed. Conversely, if the system recognizes a sufficiently recent Type and Screen order, an alert will prompt the caregiver if a Type and Screen order is being signed, but is not needed. What determines whether a Type and Screen order is needed? The following criteria drive the PowerPlan and alert functionality described above: Blood Product Being Ordered Patient Age Type and Screen order is required on the current encounter within the last Packed Red Blood Cells (PRBC) Over 4-months-old 60 hours Fresh Frozen Plasma (FFP) Over 4-months-old 30 days Platelets Cryo Packed Red Blood Cells (PRBC) Fresh Frozen Plasma (FFP) Platelets Cryo Under 4-months-old 120 days Who will it impact? Providers ordering blood products When it s changing? Tuesday, March 6, 2018 Who to contact if they have questions? Local informatics support February 2018 Page 1 of 1
Improved Follow Up Section in Discharge Summary Modifying the Discharge Summary Note Template To Have An Improved Follow-up Section: What is Post-Discharge Follow Up Care section: It is a section under the listed Discharge Summary note templates. This section will include information from the Follow Up section of the Discharge Workflow M-Page. This information will match what is printed on your patient s discharge instructions. What is changing: The current follow up section in these notes will be updated to show a table. This section will auto-populate with information filled out in the Follow Up section of the Discharge Workflow page and will be called Post- Discharge Follow Up Care. Post-Discharge Follow Up Care section was updated for the following Specialties: BMT Discharge Summary Cardiology Discharge Summary CICU Discharge Summary Critical Care Discharge Summary Cross Encounter Discharge Summary Discharge Summary (IP) Hospitalist Discharge Summary Kidney Transplant Discharge Summary Liver Transplant Discharge Summary Neurohospitalist Discharge Summary NICU Discharge Summary OB Discharge Summary PED Diabetes Discharge Summary PED Discharge Summary PED Endocrine Discharge Summary PED Gastroenterology Discharge Summary PED Otolaryngology Discharge Summary Peds BMT Discharge Summary Peds Endocrine Discharge Summary Peds Nephrology Discharge Summary Peds Neurology Discharge Summary Peds Oncology Discharge Summary Peds Orthopedic Discharge Summary Peds Surgery Discharge Summary Peds Urology Discharge Summary PICU Discharge Summary Pulmonary Hypertension Discharge Summary Rehab Discharge Summary Stroke Discharge Summary. Who is affected? All providers who use any of the listed Discharge Summaries. When is it changing? The change will go in on Thursday, March 8th The Post-Discharge Follow Up Care section in the note fills in the following information arranged in a systematic manner and in a more logical/transparent sequence. The name of the provider under the With column. The date or date range under the When column. The address and phone number under the Contact Information column. Additional Instructions also has its own row. Beneath additional instructions there is a line for free text. Note: With, When, Contact Information, and Additional Instructions ARE NOT modifiable within the note. The free text section is available for your comments but if you need to make modifications it must be done from the Follow Up Section in your discharge workflow. Upon making those changes you must come back to the note and refresh the Post-Discharge Follow Up Care section and you will see the reflected changes.
The following is how it would appear in the Post-Discharge Follow-up Care: 2018 02/2018 Page: 2
Discharge Patient Instructions and Orders Hospitals What is changing/or what needs to be communicated? When completing the discharge workflow for patients within icentra, the provider will no longer click through the discharge door to produce discharge instructions and orders. A new Discharge Patient Instructions and Orders document has been developed. This document will provide patients and caregivers with a more clear and well-defined format while meeting regulatory requirements, policies and guidelines for discharge instructions. Who will it impact? All providers who discharge patients from the hospital When it s changing? Tuesday, March 13, 2018 Who to contact if they have questions? Dr. Adam Kraft, Jenny Sue Jorgensen, RN Visual Guide 1. Navigate to the Discharge MPage and complete required discharge components February 2018 Page 1 of 2
2. After completing the required discharge components, you are now ready to create the Patient Discharge Instructions and Orders. The Discharge Summary may be created at the same time 3. The Patient Discharge Instructions and Orders may be edited using the same functionality as other dynamic documentation notes. Key Information to Be Aware of: Required discharge components must be addressed by the provider before the Patient Discharge Instructions and Orders before they can be printed and given to the patient Patient Discharge Instructions and Orders should not be created until the day of discharge to ensure the patient gets the most up to date information. If any components are updated in the MPage Workflow after creating the document, the section for that document must be refreshed Individual sections of the Patient Discharge Instructions and Orders can be edited using an AutoText, Dragon Command or free text. The Patient Discharge Instructions and Orders may not be used as the Discharge Summary. The Discharge Summary may be created at the same time as the Patient Discharge Instructions and Orders document. Items from the instructions may be tagged to the Discharge Summary. The Patient Discharge Instruction and Orders document must be completed by the provider for patients going to a SNF or Homecare February 2018 Page 2 of 2