July 8, 2014 z Information Technology Report to Medical Executive Committee Contents 1 McKesson Cardiology PACS 1 APACHE Outcomes for Critical Care 2 Bar Code Medication Administration 2 McKesson Radiology PACS 3 PowerScribe 360 Radiologist Voice Recognition System Upgrade 3 Patient Portal 4 Electronic Surveillance System for Infection Prevention and Antimicrobial Stewardship (TheraDoc) 4 Maternity and Fetal Monitoring in Powerchart 4 Concurrent Care Management 4 Direct Secure email 5 Problem Lists 6 Appendix 1 Orders Update for June 2014 7 Appendix 2 - Planned vs. Unplanned Downtime McKesson Cardiology PACS The Le Bonheur PACS cath go live is scheduled for July 8, 2014. Pediatric cath structured reporting is included in the go live. Proof of Concepts conducted the weeks of June 2 and June 23 received positive feedback from the cardiologists and operational staff involved. Due to reported intermittent slowness with the McKesson cardiology web client the issue has been escalated with McKesson. The slowness occurs primarily when accessing remotely, not on the MLH network. A McKesson support team is addressing the issue including sending an engineer onsite to shadow several of the cardiologists. A report on the progress will be provided in the August MEC report. APACHE Outcomes for Critical Care The Acute Physiology and Chronic Health Evaluation (APACHE ) application is scheduled for go live in all critical care units at University July 8, 2014. APACHE provides real time information using a dash-board format to aid in measuring and managing utilization and quality in the critical care units. It uses severity-adjusted predictions to anticipate patient needs and effectively allocate resources. Reporting capabilities will include ICU length of stay, ICU mortality, mechanical ventilator use, appropriateness of admissions to ICU and discharge readiness assessments. Benchmarking comparisons will be available with other facilities using APACHE.
PAGE 2 Bar Code Medication Administration University Hospital went live on February 11, 2014. North Hospital is on track for a successful go live scheduled for July 15. Percent of medication doses administered using bar code scanning at University: May 2014: 94% June 2014: 94% Even with University Hospital as the only MLH hospital live on BCMA, MLH is meeting the Meaningful Use 10% requirement for all medication orders: May 2014: 26% June 2014: 29% McKesson Radiology PACS McKesson Radiology PACS will be implemented in three phases beginning July 28. Each phase includes two weeks of onsite support by a combination of McKesson and MLH IT resources. Phase 1: Go live July 28 University MRPC Midtown Diagnostic Center Minor Meds Urgent Care Centers South Fayette Phase 2: Go live August 18 Germantown Germantown Outpatient Center Germantown Breast Center North North Outpatient Center Olive Branch Phase 3: Go live September 8 Le Bonheur
PAGE 3 PowerScribe 360 Radiologist Voice Recognition System Upgrade On July 12, we will upgrade the PowerScribe 360 Voice Recognition System used by radiologists. The upgrade requires a four hour downtime on July 12, 2014 from 1:00 a.m. to 5:00 a.m. During the downtime, radiologists will dictate with the original Lanier/RTAS dictation process used prior to implementing PowerScribe. The radiology reports will be transcribed directly into the onechart (Cerner) EMR until the upgrade is completed. MRPC will staff with an additional radiologist to prevent delays. If a report has not been transcribed yet, the EDs can call the Lanier review line (RTAS) at 516-8192, press 1 to review using Billing/FIN number, enter the 8-digit FIN number, and hear the report. These processes have been reviewed with the ED leaders and radiology leaders. RIS/PACS Coordinators will be onsite at the hospitals to provide support during the downtime. IT will provide a conference call line for users to report issues or obtain updates during the downtime. Patient Portal Over 1,200 patients have activated their Cerner Patient Portal. For the second quarter of 2014: 5.3% of unique MLH patients activated their Cerner Patient Portal. 5.8% of unique Fayette patients activated their Cerner Patient Portal. Improvements to make the portal more useful and user-friendly include: Medication List Patient Friendly Language (available July 8) - Medication list includes patient-friendly language for the route of administration and frequency. Radiology and Pathology Results Tab (available third quarter 2014) - Provide patients with a more direct way to find Radiology results. Pathology results will be new to the portal and available as a new section. Results Grouping (available fourth quarter 2014) - Provide option to display results through the Patient Portal in logical groupings. For example, all vital signs are grouped together and blood pressure displaying as systolic/diastolic instead of displaying as separate results. Improved Navigation and Mobile Patient Portal Experience (available fourth quarter 2014) - Provide an improved navigation experience that applies to all devices (desktop, tablet, mobile).
PAGE 4 Physicians are encouraged to discuss the patient portal with their patients. Portal adoption studies show that patients are more likely to use the portal when their physician recommends it. Electronic Surveillance System for Infection Prevention and Antimicrobial Stewardship (TheraDoc) TheraDoc is designed to provide a comprehensive and systematic approach to infection surveillance and antimicrobial stewardship using medical informatics and computer science technologies. Project kickoff occurred on May 28, and interface development between the onechart (Cerner) system and TheraDoc is now underway. Maternity and Fetal Monitoring in Powerchart The PowerChart Maternity/FetalLink project kick-off is July 7. PowerChart Maternity is designed to provide integration with our existing EMR for documentation and fetal strips. Physicians and associates from Methodist Germantown, South and Olive Branch are engaged in the project which is scheduled for implementation in the first quarter of 2015. Concurrent Care Management The Morrisey Concurrent Care Management (MCCM) project will kick off July 14, 2014 with a planned go live by mid- September. The implementation will occur in three phases. Case Management and Utilization Review modules will be implemented first at Methodist South and then rolled out to all other hospitals. The application is designed to focus on optimizing the day to day workflow for Case Management and Utilization Review. Direct Secure email The capability to use a secure email-like service to send encrypted medical information to follow up providers is now available via Cerner Direct. This process uses Cerner s Message Center to send electronic medical summaries, lab results and transition of care documents to follow up providers and facilities and allows incorporating the information into a provider/facilities EMR. Direct eliminates the need for faxing or mailing paper documents. We continue to look for physician practices and post-acute care facilities interested in using these tools. The use of these tools is required for successful attestation for Stage 2 Meaningful Use for physician practices and hospitals. Contact Marcia Wright at 516-0372 or Michael Dexter at 516-0263 for more
PAGE 5 information. The requirement states greater than 10% of the discharges will have transition of care documents sent to their follow up care provider. For the second quarter of 2014: 0.02% (20 of 11885) of unique MLH patients had their summary of care documents sent via Direct messages and with all requirements completed including problems, allergies and medication lists. 10% (4/40) of Fayette patients had their summary of care documents sent via Direct and all required elements completed. Problem Lists Beginning with the 2014 Stage 2 requirements each patient must have documented problems in the medical record using SNOMED nomenclature. All patients in practices and acute care must have at least one problem listed or have no known problems documented. During the second quarter of 2014: 14% (1170 of 11885) of MLH patients had problems documented. 92% (37/40) of Fayette patients had problems documented. Medical Informatics will be providing training and workflow reinforcement for physicians and nurse practitioners over the next few weeks.
PAGE 6 Appendix 1 Orders Update for June 2014 PowerPlan and Order Set Updates Insulin Sliding Scale Protocol has significant changes related to blood glucose and Novolog insulin. ICU Glycemic Protocol has modifications made to glucose levels. NICU Quick Admit Plan available at Le Bonheur. ED Initial Chest Pain/ACS Symptoms Protocol Orders now has aspirin prechecked. Peritoneal Dialysis Orders available at Germantown. Order Changes Added Nutritional to the supplement order name for more clarity. New diet order available, Post CABG Diet, for post op day 1 and 2 to assist in control of glucose levels. New order, Intermittent Catheterization Policy, allows nurse to follow new policy with physician order. Medicine Service Team details have been added to the Initial Status orders. When Home Health or HME is ordered on an Inpatient the physician will be able to complete the required documentation on a Power Form at that time.
PAGE 7 Appendix 2 - Planned vs. Unplanned Downtime The following table depicts the Cerner Production system uptime and planned and unplanned downtime in minutes from July 1, 2013 June 30, 2014. This table does NOT include network downtimes that may have impacted access to onechart. Total Minutes Planned Downtime Unplanned Downtime Total Uptime % Cerner Uptime % July 2013 44,640 0 0 100.00% 100.00% August 2013 44,640 0 8 99.98% 99.98% September 2013 43,200 0 197 99.54% 99.54% October 2013 44,640 0 0 100.00% 100.00% November 2013 43,200 0 0 100.00% 100.00% December 2013 44,640 0 137 99.69% 99.69% January 2014 44,640 0 0 100.00% 100.00% February 2014 40,320 0 0 100.00% 100.00% March 2014 44,640 0 0 100.00% 100.00% April 2014 43,200 0 36 99.92% 99.92% May 2014 44,640 0 214 99.52% 99.52% June 2014 43,200 0 0 100.00% 100.00% Total 525,600 0 592 99.887% 99.887%