Promoting Interoperability Standards: Cerner FirstNet Updates 2018
Promoting Interoperability Formerly known as Meaningful Use In 2011, Centers for Medicare & Medicaid Services (CMS) established the Medicare and Medicaid Electronic Health Record (EHR) Incentive program to encourage hospitals to demonstrate the meaningful use of the EHR. PI is a set of standards required for an EHR. Additionally PI, also has several staged measures we must meet to ensure we are using our EHR to its fullest potential. There are several stages of incentives for Promoting Interoperability. KYOne Health s goal is to achieve Stage 3 of Promoting Interoperability in 2019. How does Promoting Interoperability Improve Patient Care? 2
Clinical Reconciliation of Outside Records What is Clinical Reconciliation of Outside Records? Clinical Reconciliation is compiling and reconciling of Medications, Allergies and Problems from outside records. Please note: this process is not to be confused with Medication Reconciliation performed by the provider. There are no changes associated with that process. What are Outside Records? Outside Records are summaries of care from other healthcare facilities and doctor s offices that contain the patient s Medications, Allergies, and Problems. What happens in Cerner when we receive an outside record? Cerner will automatically compare the data from the patient s outside record to data that is already in our Cerner System. Any information that does not match will require reconciliation with the patient. How will I know what information needs to be reconciled? Data requiring reconciliation will always display with a purple diamond. What are the benefits of outside records and clinical reconciliation? 1.) Less time required to obtain a patient history. 2.) Provides for safer, more effective care by sharing information. 3
New Clinical Reconciliation Task One of the first changes you will see is an additional task called Clinical Reconciliation. This task DOES NOT link to documentation, it is a Done / Not Done Task. After completing the outside records reconciliation for Home Medication, Allergies and Problems you will return to Activities / Events and complete the Clinical Reconciliation task. Check the box next to the Clinical Reconciliation task and choose Document at the bottom of the window. 4
You will now have the ability to change the date/time to the time that you completed the Clinical Reconciliation and click OK. This charts the task as Done and you are finished. Accessing the ED Workflow mpage You will need to click on the new icon (see screenshot below) on the FirstNet toolbar which will take you directly to the ED Workflow mpage where you will complete the outside records reconciliation 5
ED Workflow mpage One of the main updates that comes with Promoting Interoperability is the use of the ED Workflow mpage. This is a new section within the table of contents where nursing will complete outside records reconciliation. The ED Workflow mpage will contain the following sections: Triage Documentation, Triage Forms, Home Medications, Allergies, Histories, Systems Assessments, Labs, Diagnostics, Documents, Continuity of Care Goals / Interventions, and Health Concerns. 6
ED Workflow mpage Each section of the ED Workflow mpage has its own refresh section. Some sections of the ED Workflow mpage, such as Allergies and Histories will link to the control section. You will notice this functionality because when hovering, the header will become underlined. Clinking on the underlined link will take you to the control. 7
Home Medications First Reconcile Medications from Outside Records. Medications from Outside Records display with a purple diamond. Click on each medication line and choose Add or Decline. 8
Home Medications Once all Outside Record Medications have been addressed, select Complete History. Note: If there are no Outside Record Medications for Reconciliation start the medication history process by clicking Complete History. Clicking on Complete History does two things 1. Marks Medication Reconciliation of Outside Documents complete for Promoting Interoperability. 2. Launches the Document Medication by Hx window. Complete Home Medication Hx as you do today, ensuring all medications are accurate, as well as completing compliance and last dose taken. 9
Home Medications Once the Home Medication History is finished, Cerner will automatically bring you back to the ED Workflow mpage. You will notice the Meds History status has been updated, as well as the name of who completed it with a date/time stamp. 10
Allergies First Reconcile Allergies from Outside Records. Medications from Outside Records display with a purple diamond. Click on each allergy line and choose Add or Decline. 11
Allergies Once all Outside Record Allergies have been addressed, select Complete Reconciliation. Note: If there are no Outside Record Allergies for Reconciliation start the allergy history process by clicking Complete Reconciliation. Clicking on Complete Reconciliation marks Allergy Reconciliation of Outside Documents complete for Promoting Interoperability, as well as updates the Reconciliation Status Line. Next click on the Allergies Link 12
Allergies This will take you into the Allergies Control where you can add or update allergies as needed. Remember even if there are no additions or updates, you must select Mark All as Reviewed. Once you have selected Mark All as Reviewed, click the Back Button to return to the ED Workflow mpage. 13
Histories First Reconcile Problems from Outside Records. Problems from Outside Records display with a purple diamond. Click on each problem line and choose Add or Decline. 14
Histories Once all Outside Record Problems have been addressed, Click Complete Reconciliation. Note: If there are no Outside Record Problems for Reconciliation start the problem history process by clicking Complete Reconciliation. Clicking on Complete Reconciliation marks Problems Reconciliation of Outside Documents complete for Promoting Interoperability, as well as updates the Reconciliation Status Line. If additional problems need to be added, select the Histories link and add problems from the control as you do today. 15
Histories Remember to use the Back Button to easily return to the ED Workflow mpage. Next enter procedures by clicking on the Procedures Tab. The Procedures Tab allows for quick entry. Begin typing in the box and select the appropriate response. Fill in any additional data and select Save. 16
System Assessments Systems Assessment documentation can be accessed directly from the ED Workflow mpage by selecting the drop down arrow. 17
Documents This section contains easy access to high value documents. From this component you can access the following document types - ED Triage PowerForm - ED Physician Notes - Etc Select the document for easy viewing, access, or printing. 18
Continuity of Care Goals and Interventions Future State This is brand new section must be available for documentation as part of Promoting interoperability, however there is currently no usage requirement. At this point in time there are no plans to use this section in our daily practice. For detailed information on Continuity of Care Goals and Interventions see the tip sheet located in the back of this book. Health Concerns Future State This is brand new section must be available for documentation as part of Promoting interoperability, however there is currently no usage requirement. At this point in time there are no plans to use this section in our daily practice. For detailed information on Health Concerns see the tip sheet located in the back of your book. 19
Quick Tips A new Clinical Reconciliation task will be present in Activities / Events to remind you of the new workflow to complete the reconciliation of outside records. A new icon will be available on the FirstNet toolbar which links directly to the ED Workflow mpage where you will complete the reconciliation of outside records. The first step of obtaining home medications, allergies, and problems is to reconcile outside records. If no outside records exists, select the Complete History/ Complete Reconciliation buttons to continue. The Complete History / Complete Reconciliation buttons must be selected in all three areas: Home Medications, Allergies, and Problems to be included for the Promoting Interoperability measure. Use the Back Button to return to the Admission Workflow mpage 20