CMIO Major Topics: Andy Fowler, Chief Information Officer After a 17-year career with us, Senior Vice President and Chief Information Officer Andy Fowler has decided to leave Methodist Le Bonheur Healthcare to take on the role of chief information officer for Doctors Hospital at Renaissance in Edinburg, Texas. His last day at MLH will be Friday, September 2. Andy served as vice president and chief information officer at Le Bonheur and joined Methodist in 1995 when Le Bonheur became part of the Methodist family. Andy led a number of significant technology initiatives that supported improvements in clinical quality and positioned us well for success in a changing healthcare environment. The philosophy that consistently guided his work is that technology should be a tool to enable better medicine. In addition to his rich experience and technological expertise, Andy is a strong and collaborative leader who has helped MLH deliver outstanding care to our patients and families. A key part of Andy s legacy is the outstanding team of dedicated and highly experienced IT professionals that he developed over the years. While we will miss Andy, we know he is leaving us in extremely capable hands. Going forward, Chief Medical Information Officer, Alastair MacGregor and Donna Abney will work together to develop short and long term plans for IT leadership. Details will be communicated out in the weeks ahead. Dr MacGregor will assume overall responsibility for the whole IS Division in the meantime. I want to recognize Andy as being a visionary thought leader in leading the selection of Cerner in 2001 as the acute care EMR for MLH. At that time the US health industry was mired in a best of breed approach. It was not until the mid 2000 s that health organization realized the value of integration over interfacing best of breed solutions. As MLH faces the brave new world of aligned ambulatory practices and Appropriate Care Organizations MLH leadership will do well to reflect on the value of Andy s vision of a single integrated longitudinal EMR. Personally I will miss Andy s wise and mentoring counsel to me in my role as CMIO, the cultural history of MLH and his outstanding ability to negotiate contracts with vendors. Andy I wish you and Christine all the very best in your exciting new career. Please join me in thanking Andy for his outstanding service to his fellow Associates as well as our physicians, patients and families. 1
CPOE Go-Live at University Hospital CPOE Go-Live is on track for August 9. The table below shows the current training and competency of medical staff and physician extenders as of August 2, whose primary hospital is MUH. In my thirteen years of leading implementations of Cerner CPOE, these figures of trained and competent medical staff are amongst the highest I have seen five days before a CPOE golive. Thank you! Thank you also to all the Methodist University Hospital administrative and medical leaders who stepped up to ensure these high numbers were attained. I also want to recognize the support that was given by Drs. David Stern and Steve Miller from UT. MUH Physician CPOE Training Status Group Target Number % Trained and Passed Competency Target Attending Physicians Non-Target Attending Physicians 134 84% 111 87% PAs NPs 41 45% CRNAs 54 95% As part of the preparation for the University go-live, routine onechart change requests (especially for order sets and PowerPlans received after July 1) will be on hold until August 31. Change requests can still be submitted via the SharePoint Change Request site during this period but will not be processed until after August 31 unless it is an emergent patient safety change request. Medical Informatics and Clinical Education Services have agreed to collaborate and will cross-train in July to provide University Physician and Nursing Support for Go Live. Physicians will be able to receive assistance from any member of the two teams. 2
Universal Protocol A meeting was held to discuss the technology issues around the capability to have external radiology issue read in the peri-operative area. The meeting was not intended to develop MEC policy on universal protocol. There was representation from orthopedic and general surgery, OR nursing, CMO, Trauma, ER, Radiology and clinical and technical IS. Discussion highlights are as follows: Approximately 10% - 15% of cases have issues with diagnostic images not being able to be read in the peri-operative area. Issues are typically process related, versus technology related When there is an established MLH electronic patient record the MRPC radiology staff upload external images ahead of time. This occurs in over ninety percent of cases. There is a separate group led by the Quality Division to address process issues. Technology issues identified are: Problems with externally created CDs brought to MLH: Some CDs are blank. PACS Vendor variation in adhering to the DICOMM standard that impacts the ability to read images. Experience occasional errors reading CD discs. Some external sources of radiology images do not include an image reader on the CD. Administrative rights to workstations are required to read external CDs and there is variation across peri-op areas on which devices can allow access to external PACs, e.g. some LBH peri-op areas allow access to the Campbell Clinic PACs system other do not, resulting in CDs having to be couriered from the Campbell Clinic to LeBonheur. Giving full administrator rights to devices that are on the MLH network exposes the whole MLH network to malicious intrusion attacks. There are also non malicious risks when safe applications are download but without consideration of impact on MLH applications. A recent example was that Google Chrome was downloaded and then prevented the efilm application running when there was a PACs downtime. The number of CD burners is limited need an inventory per peri op area per hospital. An inventory of all peri-operative devices that can read radiology images needs to be collated for all hospitals and Same Day Surgery sites. There is a need to explore the feasibility of providing OR s with a laptop with elevated rights to be used to view images. Laptops will not have network connectivity which will eliminate possibility of impairing functionality by downloading malware, viruses, inappropriate software, from the Internet. Dr. MacGregor had previously suggested that data gathering would take more than one meeting. Thus, future meetings will review the remaining technology categories. 3
Cause of Death One requirement for Meaningful Use is capturing the preliminary cause of death. This is only a preliminary cause of death and is in no way connected to the final diagnosis on the death certificate. This information will be entered by nursing staff during the discharge process. A maximum of 8 very broad categories will be provided in a drop down box. Six (6) of the 8 that have been suggested are: No respirations, no HR Cardiac /pulmonary failure/arrest Cong. Anomalies, prematurity Multi-organ failure, sepsis Cancer Trauma If your Senior Leadership Committee has any comments regarding the above categories, please e-mail Meg McGill (Meg.McGill@mlh.org). mpages Mobile Clinical Summary The Mobile Clinical Summary is now available by accessing the following link from your Smart Phone providing it is an iphone, ipad, Blackberry or Android device: https://mthtnmpprd.cernerworks.com On July 25 an update was deployed that included: "New in this Version" Button The button will be highlighted green when there is new information about changes. Once a user views the updated information the highlight on the button will disappear. Save Username This user requested change provides a checkbox to allow saving the username thus avoiding having to type it in for each logon. Headers for Time Sensitive Data These were added to explain time constraints so there is no confusion among data for the life of the patient, data only for the current encounter, or data limited to viewing for a certain number of days. Improved Patient Search This was enhanced to help the user avoid opening up a blank search results document. Work continues to speed up last name searches. Resolution to PACS Downtime Issue In July a fix that GE implemented successfully at Memorial Hermann was applied to one node in our system. This was not successful for us as there have since been 3 downtimes 4
due to database locks. GE stated that this could be the result of a hardware unit that is running a different software revision from the rest of the devices in the system. On August 1 GE will test a workaround for this device in a non-prod environment. A meeting will be held August 2 to assess the results and determine next steps. Ambulatory EHR and Health Information Exchange (HIE) The Ambulatory EHR Task Force is going through due diligence prior to awarding a contract to Epic. Reference site calls are in progress including recent calls to Spectrum Health, University of Washington, University of Pittsburg, Franciscan Missionaries of Our Lady Health System, and NW Health System. MLH IS and Legal Department along with a third party consultant, Impact Advisors, are working on cost of the applications, resources and hardware and contract details. Andy Fowler and team have finalized the HIE RFP and that has been sent out to a select group of HIE vendors. Dictation System Replacement Two leading vendors were selected for demonstrations and reference calls. HcIS is working with them to schedule the events in early August. NHIQM (National Health Indicator Quality Measures) The project team is working to finalize the implementation date for NHIQM (Meaningful Use Quality Measures of Stroke VTE and ED throughput) at North. This is anticipated to be in the September- October time frame. HealthSentry This Cerner solution will meet Meaningful Use Lab and Syndromic reporting objectives. A kickoff meeting will be held August 11, 2011. The estimated go live time frame is early May 2012. Epiphany In July South and North Hospitals where converted to Epiphany Stress. All Stress studies at North, South, and University are now stored in Epiphany, interpreted and signed in Epiphany, and then interfaced into Cerner. Germantown and Le Bonheur will be converted during the month of August. HcIS Activities of the Last 30 days 5
Note: For more details and information about these changes, please contact the physician analyst at your facility. Orders 1) Implemented Updates to P&T Protocol Orders, Rasburicase. 2) Deployed PowerPlans for Radiology Exams, ADA Diets and VTE Protocol. 3) Lab Order Utilization Reports and Rules have been developed by the LIS team to facilitate assessment of over-ordering of BNP. CBC is the next order to be evaluated. Enhancement Request Management Requests for enhancements to onechart (Cerner) coming from hospital Clinical and Technology Advisory Groups, Clinical Service Groups, Pharmacy and Therapeutics Groups and other governance groups are now entered into a Healthcare Information Systems (HcIS) Share Point site which allows the requesting user and HcIS associates to track the status of the enhancements. Share Point automatically emails the requesting user when the request is initially submitted. The user has the option to be notified by email when there has been a change in the status of the enhancement request. For the month of July there were: Total Enhancement Requests submitted: 73 Total Physician Enhancement* requests submitted: 12 Total Enhancement Request closed: 23 Total Physician Enhancement* requests closed: 2* *Physician requests submitted through governance groups are not currently reported in physician total. HcIS Activities for the Next 30 days University/MECH CPOE Go-Live August 9! CIO Major Topics: DeRoyal Continuum System Live in North ED On Friday, July 22, the DeRoyal Continuum durable medical equipment (DME) distribution system went live in the Methodist North Emergency Department. The Continuum system is an alpha product that has been provided to MLH for free. It is anticipated that the system will help MLH recoup millions in uncharged ED DME orders in the next four years. The Continuum system resides in a room accessible only to ED Associates with proximity access. When an ED Associate enters the room, he/she selects the patient on the 6
Continuum ED and pulls the DME from inventory. All DME items are stored on weighted louvers, and Continuum automatically senses when a device is pulled and debits the device from inventory. The ED Associate then completes the order on the Continuum PC. A flat file containing information on debited inventory is sent back to DeRoyal daily, and when inventory reaches a set low point, additional inventory is ordered automatically. Likewise, corresponding DME charges are saved to a flat file that is transmitted daily to the CPR+ system at Alliance, which handles billing for the DME devices. When the Continuum system at North ED is stabilized and any issues identified and addressed, it will be pushed sequentially to the other adult EDs, starting with Germantown. Mosaiq Upgrade at University and Germantown The Mosaiq radiation therapy management system was implemented on Friday, July 22 in the University Radiation Therapy Center and on Tuesday, July 26 in the Germantown Radiation Therapy. Mosaiq is an upgrade for the Lantis radiation therapy system at University and a required component of the new linear accelerator being installed at the Germantown Radiation Therapy Center. The Mosaiq system allows both radiation therapy centers to be on the same server/ network, which will create efficiencies by centralizing planning and dosimetry. It will also decrease treatment time over 30%, creating 16 additional treatment slots in an 8-hour workday and enhancing patient satisfaction due to shorter treatment duration. Physician Practice Acquisition Projects Information Technology is assessing the technical infrastructure needs and requirements for five physician practices that will onboard within the next 60 days. A couple of these practices are moving into new office space, which requires both assessment and purchase/installation of all networking and phone lines, phone systems, time clocks, PCs, etc., to support use of the eclinical Works EMR and access to the MLH network. SergeMD, the IT support vendor for physician practices acquired by Methodist Le Bonheur Healthcare, is conducting technical infrastructure assessments of each acquired practice and preparing to begin providing full IT support within the next week. As soon as SergeMD support is implemented, acquired physician practices will rely upon SergeMD for all IT support needs. This single-source support solution should eliminate confusion at the practice level regarding whom to call for what and should speed response and resolution times. ipads and iphones Ten physicians are currently piloting the ipad solution. The IS Help Desk, Desktop Support, and physician analysts will be trained to provide ipad support in August, and the ipad solution will go-live by the end of August. 7
Plans for implementing a mobile device management solution and security policy for iphones and ipads have been approved. The device management solution will allow implementation of the security safeguards required to protect confidential Methodist business and patient data on mobile devices like the iphone. The security plan and policy will include wiping MLH email from personal iphones and ipads used to access the Methodist network when an Associate leaves Methodist. Information Technology is researching the top mobile device management vendors and will choose one in August. Ordering and configuring the system and installing the infrastructure will take until the end of September. Following the pilot in October, the device management system should be ready for production by the end of November. Planned vs. Unplanned Downtime The following table depicts the Cerner Production system uptime and planned and unplanned downtime numbers from July 1, 2010 July 31, 2011. Note: This table does NOT include network downtimes that may have impacted access to onechart. Planned Downtime Un-planned Downtime Total Uptime Percent Cerner Uptime Percent July 2010 0 0 100.00% 100.00% August 2010 0 0 100.00% 100.00% September 2010 180 0 99.58% 100.00% October 2010 0 10 99.98% 99.98% November 2010 0 0 100.00% 100.00% December 2010 0 0 100.00% 100.00% January 2011 360 0 99.19% 100.00% February 2011 0 120 99.70% 99.70% March 2011 0 0 100.00% 100.00% April 2011 0 0 100.00% 100.00% May 2011 300 0 99.33% 100.00% June 2011 300 24 99.25% 99.94% 0 0 100.00% 100.00% Total 1,140 154 99.77% 99.97% 8
Attached: Appendix 1 CPOE Inpatient and ED Adoption Rates 9
Appendix 1 CPOE Inpatient and ED Adoption Rates 10