Northern California Go-live

There is a tremendous amount of information to pass along this week, including new capabilities in MEDITECH, information that you need to know and a couple of tasks that you need to complete. Much of that information is outlined below, but I will be sending out additional emails over the next few days. Northern California Go-live The Northern California Region of St. Joseph Health will be going live with the new version of MEDITECH on Saturday, February 1 st. Although the five Ministries in the Northern California Region have been up and running on the MEDITECH EHR, they have been using an older version of MEDITECH. They will join us in implementing the current version of the EHR. They will be in Go-live status for 2 weeks, the same as we were here in Texas in September. Some of our Regional IT and CI personnel are travelling to Northern California to support them, returning the courtesy that was shown to us during our Go-live, when both the Northern and Southern Regions sent their people to help us. The Northern California Region will also be requesting changes to the MEDITECH EHR (as we did, and continue to do) as they begin to use the new EHR. If their suggestions are improved and the changes made, they may impact us here in Texas. CH will have input into these change requests, as they may affect us. We anticipate that the majority of these changes will affect Nursing (PCS), however there may be suggestions for improvement on the physician side as well. We have developed a communication plan for any changes that could impact us here. CI will be working with Nursing to communicate any changes to them. Over the next few days the frequency of my emails may increase, as this will be one of the means that we will use to communicate any changes that our Medical Staffs need to know about. MEDITECH Outages CH continues to experience periodic MEDITECH outages, which have been occurring more often than we believe is sustainable. The cause(s) of these outages is under aggressive investigation by our Regional and SJH System IT Departments, working closely with MEDITECH. Once the reason(s) for these outages have been determined we will be working to correct any underlying problems as quickly as possible. Medical Records I have discussed Medical Record deficiencies and signatures here before. CH anticipates a return visit from the Centers for Medicare and Medicaid Services (CMS) inspectors in the near future. One area of attention for them will be Medical Records. Although most of us are diligent about staying current with out Medical Record signatures and dictation, some of us are not. Currently there are 48

physicians in the Texas Region who have 1000 or more outstanding signatures in MEDITECH. We must complete these in a timely fashion. The CH Administration has been working with the Medical Staff Leadership to help with this process. In order to assist you in this process, I will outline what we need to do below. There are currently two main applications where we complete Medical Record deficiencies, HPF and MEDITECH. HPF: Once legacy signatures and dictations are complete in HPF, the only new deficiencies that will be present will be scanned documents (written H&Ps and paper orders for Direct Admissions, Elective and Short Stay patients are sent in with) and dictations that are not complete at the time of discharge. MEDITECH: This is now the primary place to complete Medical Records. Everything generated in MEDITECH that requires a signature (primarily documents and orders) will be signed in MEDITECH. When you have a midlevel(s) that you work with, signatures, particularly orders, accumulate rapidly. Since all orders in MEDITECH are filed separately, even if entered as part of an order set, they must be signed individually. If you have not signed orders in MEDITECH since our Go-live in September, you may have a large number of outstanding deficiencies. If you have not signed orders in MEDITECH since Go-live there may be a number of issues that you will notice that have since been resolved, but must be cleared from the signature queue: - Transportation orders: Although these are no longer being sent for signature, if you have any old transport orders they must be signed off. - Incorrectly assigned midlevel co-signatures: If you notice any midlevel signatures that are assigned to you in error, contact Beverly Brooks or Gail Glenn in Medical Records and they will work with you to resolve them. - RxM orders: If you encounter one of these orders and the System will not allow you to sign it, skip it, note the MA number and contact Beverly or Gail to assist you in having it removed. - If there are other orders that are causing you are having difficulty completing, note the MA number and contact Beverly or Gail so they can research it and help you to get it cleared. One final note is that if you have a large number of signatures in MEDITECH, do them in batches of 50-60 when signing. If you try to sign off several hundred orders at the same time it will take a while for the system to process that number of records. It is much more efficient to sign them in smaller increments.

Favorites If you have any questions about the Medical Record deficiency process, please contact Beverly or Gail at 725-0503 or 725-4380. Order Set Favorites are now available and fully functioning at CH. Favorites allows us to perform a number of changes to our base Order Sets Using Order Set Favorites we can now: - Check/uncheck Orders that are not hard checked - Add laboratory and imaging orders - Add a medication for future use - Add Nursing (PCS) orders Contact the Physician Liaisons (725-4189) to schedule a session to learn how to use this new functionality. Perfect Serve CH and SJH are in the process of implementing PerfectServe. This is an application that allows secure physician-to-physician texting on our mobile devices, including our smartphones. PerfectServe requires us to sign up for the (free) service. At this time over 200 Texas Region physicians have enrolled. To get setup all you need to do is visit www.perfectserve.com/covenant and fill out the handful of questions. You can then download the PerfectServe app for you smartphone and begin secure texting. Anesthesia VTE prophylaxis is a Core Measure that is measured by CMS and reported publically. It is also a component of Meaningful use for the EHR. Patients who undergo surgery or invasive procedures must have their data captured accurately in order to be correctly included and excluded from the numerator and denominator of the metrics used for VTE prophylaxis. In order to assist us in accurately capturing this data additions have been made to some of the Anesthesia notes, including: Anesthesia Postop Note Anesthesia Postop OB Progress Note Anesthesia Postop Outpatient Progress Note This consists of five new fields:

Anesthesia Type Anesthesia Start Date Anesthesia Start Time Anesthesia End Date Anesthesia End Time These new fields are shown in the screenshot below: User Support/Unit Secretaries The Unit Secretaries have (and continue to) received training in the MEDITECH EHR to provide physician support on the floors. If you have a question about MEDITECH and there is a Unit Secretary on the floor ask him or her for assistance. They will likely be able to answer your question. If they are unable to answer your question, they will escalate it to one of the Physician Liaisons. We are continuing to work to provide additional support for our MEDITECH users at CH, and to make that support more timely and efficient. Order Set Progress When we made the transition from paper to electronic Order Sets a great deal of time and effort went into the process. Despite the efforts of all involved, the existing order sets have required modifications and gaps in the available orders sets have been identified. Although there is ongoing work to address these needs, the progress has not been as rapid as desired. Starting this week (January 27 th ) we have someone on site at CH who is will be dedicated to working with us to build our order sets. This is a valuable addition and we are optimistic that the order set creation and modification process will become more efficient. ICD-10 We are only 8 months from the October 1 st implementation of ICD-10. CH and SJH will be making a major effort to assist our providers with the transition to ICD-10. Watch for ongoing communications and educational opportunities about and for ICD-10. Until next time.