May 12, 2015 z Information Technology Report to Medical Executive Committee Contents 1 Patient Transfer Project 2 Password Expiration and Security Update 2 Maternity and Fetal Monitoring in PowerChart 2 Morrisey Case Management 3 Clinical Decision Support 4 Leapfrog Hospital Survey 4 Cardiology PACS 5 Radiation Dose Tracking 6 Appendix 1 Orders Update April 2015 7 Appendix 2 Problem List and Direct Update April 8 Appendix 3 Planned vs. Unplanned Downtime 9 Appendix 4 Physician Advisory Group (PAG) Decisions April 11 Appendix 5 - Where Can Providers Send Secure Message for Referrals? Patient Transfer Project The Patient Transfer Project was initiated at the beginning of 2015. Chuck Lane is the Project Sponsor and Jennifer Phillips is the Operational Lead. This project is looking improving inter-facility transfer process and evaluating changes required to allow the patient information to continue with a single financial number with the patient transfer. If implemented, the goal is to alleviate some current process issues such as: Delays in patient care due to orders on wrong financial number. Delays in registration due to multi-step processes to register, transfer, and merge patient encounters. Several Guiding Principles are at the forefront of the initiative: Safe patient care is top priority. Accurate and timely patient information to ensure safe environment. Clear, accurate and reliable record of patient care for caregiver. The project team has engaged clinical and operational leadership to review and provide input to proposed workflow and system configuration changes. Additional review sessions will be held in the next 30 days to continue to validate feasibility of making this change. In addition, presentations at clinical leadership meetings will be scheduled for May and June. The scope will be limited to transfers between North, South, Germantown and University due to reimbursement requirements.
PAGE 2 Password Expiration and Security Update Keeping our patients data secure is a priority for Methodist Le Bonheur Healthcare. With cyber-attacks and data breaches on the increase, organizations are becoming painfully aware of the potential threats to their valuable data and intellectual property. MLH as well as other organizations are constantly under attack from hackers attempting to infiltrate our computer systems. To protect the MLH environment and be in alignment with the security best practices recommended by KPMG, our external auditors, MLH will begin expiring passwords for all MLH network accounts later this year. MLH IT is working with our vendors to determine the best timeframe, i.e. 60, 90, 120 days, as well as the impact this change may have on our end users experience so appropriate and timely communications can be sent before any passwords are expired. Other security solutions, such as two-factor authentication where users are required to enter a PIN before accessing external sites such as MethodistMD and MLH s Outlook Web Mail, are being investigated as well. Maternity and Fetal Monitoring in PowerChart PowerChart Maternity and FetaLink were successfully implemented on March 24, 2015 at Germantown and on May 5, 2015 at South and Olive Branch. Our command center and onsite support is complete, but we remain engaged with the physician and nursing leaders to identify any changes needed to optimize workflow and patient safety. In coordination with the implementation of the FetaLink fetal monitoring applications, plans are underway to implement FetaLink+. This secured application allows physicians to monitor active fetal monitor strips using their personal ipad or iphone device. A pilot with a small group of OB physicians is scheduled to begin on May 19, 2015. Morrisey Case Management We are in the midst of preparations for implementation of Phase 2, Transition of Care. This phase will include the coordination of post-acute placements such as nursing homes and long term care facilities. Methodist will utilize the new functionality to communicate the need for beds, types of care and information related to patients. The anticipated first go live for this phase is mid June. The integration of the Milliman Care Guidelines with the MCCM system to facilitate documentation and communication of care will be implemented after Phase 2 to
PAGE 3 accommodate the phased implementation of the Transition of Care module. Physicians will still be able to access Milliman as they do now to review pathways. Clinical Decision Support On May 26, we will implement Dose Range Checking and Therapeutic Duplication Alerts. These alerts will fire to the ordering practitioner at the time of medication order entry. Provided in the Cerner EMR through using Multum and Lexi-Comp content, these alerts provide additional tools for our providers and care givers to manage the care of our patients. These alerts are firing now to pharmacists who are working with IT to validate the alerting process. Dose Range Checking Currently 3.7% of all medication orders for patients over 18 year old and 12% of all medication orders for patients less than 18 years old will result in a Dose Range Checking alert. Below is an example of a Dose Range Checking Alert.
PAGE 4 Therapeutic Duplication Alerts Currently 7.9% of all medication orders will result in a Therapeutic Duplication Checking alert. All medication orders are checked for therapeutic duplication within their venue. For example, an alert for therapeutic duplicates will fire if therapeutically duplicate medications are ordered within the inpatient setting but not across home meds and inpatient medications. If two medications are therapeutically duplicate and ordered as discharge medications the alert will fire, but not if one order is an inpatient order and one is a discharge prescription. Below is an example of a Therapeutic Duplication Alert. Leapfrog Hospital Survey On June 11, 2015, Methodist Bonheur Healthcare will be conducting the annual Leapfrog Survey for all adult Hospitals. The survey assesses hospital safety, quality, and efficiency based on national performance measures. These measures and safety practices are of interest to health care purchasers and consumers, and cover a broad spectrum of hospital services, processes, and structures. The Leapfrog survey gives hospitals the opportunity to benchmark progress in improving the safety, quality, and efficiency of patient care. Cardiology PACS MLH IT, Biomed, and McKesson are continuing to address performance issues. The changes include: modality configuration settings to address the large images sending from specific devices and software updates to the McKesson PACS system.
PAGE 5 Radiation Dose Tracking The radiation dose for the procedure is now part of the Radiology Report for all DICOM compatible CT scanners. This dose is available for the radiologist to bring across from the modality in the reporting process. Biomed and IT are working to incorporate all compatible Radiology modalities and Cath labs. Conversion will continue over the next 6 months.
PAGE 6 Appendix 1 Orders Update April 2015 PowerPlans A new Adult PowerPlan titled CARD Right Heart Catheterization Plan is available.
28-Mar 4-Apr 11-Apr 18-Apr 25-Apr 2-May Overall 28-Mar 4-Apr 11-Apr 18-Apr 25-Apr 2-May Overall 28-Mar 4-Apr 11-Apr 18-Apr 25-Apr 2-May Overall 28-Mar 4-Apr 11-Apr 18-Apr 25-Apr 2-May Overall INFORMATION TECHNOLOGY REPORT TO MEDICAL EXECUTIVE COMMITTEE PAGE 7 Appendix 2 Problem List and Direct Update April A change was made to only include patients that are sent to other non-mlh facilities and Home Health. More of these facilities are being signed up to receive secure message from the acute facilities. This along with diligent work with providers to enter problems on all records is now showing an upward direction. Le Bonheur has dropped due to the low volume of transfers to long term care facilities. We will continue to evaluate closely. 120.00% 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% MLH Meaningful Use Stage 2 Measure 1 (Problems)- MET By Facility Germantown Le Bonheur North South University 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% Goal 0.00% MLH Meaningful Use Stage 2 Measure 2 (Direct) - MET By Facility Germantown Le Bonheur North South University Goal 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% Meaningful Use Stage 2 Measure 1 - MET By CCN Memphis Hospitals MEM Overall Goal 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% MLH Meaningful Use Stage 2 Measure 2 - MET By CCN Memphis Hospitals MEM Overall Goal
PAGE 8 Appendix 3 Planned vs. Unplanned Downtime The following table depicts the Cerner Production system uptime and planned and unplanned downtime in minutes from May 1, 2014 April 30, 2015. This table does not include network downtimes that may have impacted access to onechart. Total Minutes Planned Downtime Unplanned Downtime Total Uptime % Cerner Uptime % May 2014 44,640 0 214 99.52% 99.52% June 2014 43,200 0 0 100.00% 100.00% July 2014 44,640 0 0 100.00% 100.00% August 2014 44,640 0 0 100.00% 100.00% September 2014 43,200 0 0 100.00% 100.00% October 2014 44,640 0 90 99.80% 99.80% November 2014 43,200 120 0 99.72% 100.00% December 2014 44,640 420 102 98.83% 99.77% January 2015 44,640 0 0 100.00% 100.00% February 2015 40,320 0 136 99.66% 99.66% March 2015 44,640 0 0 100.00% 100.00% April 2015 43,200 0 142 99.67% 99.67% Total 525,600 540 684 99.767% 99.870%
PAGE 9 Appendix 4 Physician Advisory Group (PAG) Decisions April Ambulatory/Acute- Dose Range Checking (DRC) Medication alerts Functionality currently turned on for pediatric patients; recommendation is to enable functionality for adult patients. Pharmacy will also still receive the alert PAG Consensus: Approved with Recommendations: Requested additional information regarding frequency of alert as well as clarification of medications that will be impacted. Requested information will be presented at May PAG. Ambulatory/Acute - Therapeutic Duplication Checking Medication Alerts Recommendation -Enable functionality for all Adult and Pediatric patients. PAG Consensus: Approved with Recommendations: Requested additional information regarding frequency of alerts and to include PAG physician in testing. Requested information will be presented at May PAG. Ambulatory/Acute - Determine how Medication History technician/ interviewing nurse should handle orders on the Medication List that the patient is not taking or is taking in a manner inconsistent with the listed documented history or prescription order Recommendation: For orders that the patient states they have not been taking for greater than 90 days, the Med History technician / interviewing nurse will discontinue the history or prescription order. PAG Consensus: Approved with additional education and considerations that will be addressed by IT/Operations workgroup. Ambulatory/Acute -How will our Organization update or replace ICD-9 CM Diagnosis Favorite Folders? On October 1, 2015, all ICD-9 codes will no longer display in the Favorite Folders Recommendation: Due to the increased level of granularity in ICD-10-CM, IT and Cerner recommends removing ICD-9 favorite folders in Cerner OneChart and increasing the use of the Quick Search in Diagnosis/Problems and Consolidated Problems. PAG Consensus: Approved
PAGE 10 Appendix 4 Physician Advisory Group (PAG) Decisions April (continued) Ambulatory -Remove ICD-9 Diagnoses from Order Sentences Order Sentences that contain ICD9 diagnoses will not work after October 1, 2015 Recommendation: Remove ICD-9 codes from order sentences. Create communication and education for affected customers on how to make suggested changes to order sentences. PAG Consensus: Approved Acute/Ambulatory- PowerNote Remediation- ICD-9 Quick Picks will no longer be available Recommendation: Remove ICD-9 Diagnosis Quick Picks from PowerNote Import the latest PowerNote Content- which will automatically age out quick picks- PowerNote Upgrade TBD Remove Quick Picks from shared and user level Pre-completed Notes and Macros and Re-save (Update Existing). Coordinate PowerNote Update sessions with MLH Physician Analyst and affected PowerNote Providers ( June- September). Advise provider to discontinue adding any additional quick picks. PAG Consensus: Approved
PAGE 11 Appendix 5 Where Can Providers Send Secure Message for Referrals? Practice Amedisys Crockett Medical Clinic Crossroads Eye Center Extending Home Health of West Tennessee Cordova, TN Flannery Medical Clinic GastroOne Group GetWell Community Clinic, LLC Healthsouth IM & Ped Clinic of New Albany Intrepid USA Healthcare Services - Brownsville Intrepid USA Healthcare Services - Jackson Intrepid USA Healthcare Services - Lexington Intrepid USA Healthcare Services - Memphis John B Phillips Magnolia Cardiology Associates Magnolia Cardiovascular & Thoracic Clinic Magnolia Corinth ENT Magnolia General & Vascular Surgery Clinic Magnolia Medical Clinic Magnolia Pediatric Clinic Magnolia Professional Associates Magnolia Regional Community Care Center Magnolia Specialty Clinic Magnolia Surgical Group Magnolia Womens Center of Corinth McKnight Clinic Memphis Gastroenterology Group MidSouth Pulmonary MidSouth Infectious Disease Associates MLH Affiliated Services MLH Primary Care Group Morgan Cardiovascular NHC Healthcare North East Arkansas Homecare Olive Branch Family Medical Center Paris Henry County Clinic, SC Primary Care Specialists, Inc. Rehabilitation Center Home Health Home Health
PAGE 12 Appendix 5 Where Can Providers Send Secure Message for Referrals? Prime Care Medical Center Retrop and Greater Signature Healthcare Southaven Internal Medicine Sta-Home Health Sutherland Cardiology Clinic P.C. West Clinic Home Health Home Health