While the cat's away...

Since Dr. Kudler is out of town, I thought I'd use this golden oportunity to share some of the items we have been working on for the Hospital-based areas:

• Baystate Orthopedic Surgery Center (BOSC) - implementation of CPOE (order entry) and medication barcode scanning (PPID for those who know the lingo) on August 05, 2013
• NICU/NCCN at BMC - roll-out of INet (telemetry monitor information downloaded into CIS), nursing progress notes and plans of care in CIS.  We also have a couple items for the physicians in NICU/NCCN too!
• Forms Library and Concurrent Scanning - continued roll-out to the patient care areas at BMC over the next couple of months (with plans to move to BFMC, BMLH and DCCC by the end of the calendar year).  The use of Forms Library will help to eliminate the stock piling of paper documents used for patient care in all of those file cabinets, closets, stock rooms, etc.  Forms Library will provide all users of CIS to print medical record documents (i.e. Consents, etc.) and you can be confident it is the latest and greatest approved version (no more issues with version control).  Concurrent Scanning by our colleagues in HIM will allow all those paper documents to be scanned into CIS throughout the course of the hospitalization - no more rummaging thru those maroon-colored charts on the floors.  One more step towards being as paper-less as possible!

These are just three of the many initiatives we are currently sheparding thru to completion this fiscal year. 

And as we begin to look at planning for next year, we are reminded to always keep our eyes on a few things like Meaningful Use Stage 2, ACO, Health Information Exchange (HIE) and the ever-changing healthcare environment in which we all play a vital role.

Meaningful Use 2 Preview

Eligible Provider Core Objectives

Eligible Hospital Core Objectives

Medication Reconciliation: Entropy v. Order II

To follow-up from last week's post, I'd like to review the med rec workflow.

As I previously mentioned, it is critical to review the patient’s medication list at the time of admission.  Cancel medications that the patient is no longer taking. Add any medications not already on the list. If specific information about dose and frequency are unknown – add the medication name through the “document by history” tool.

You will frequently find that there are old and irrelevant medications on the list. Customizing your list view to include “start” and “compliance status” can help you filter the list.

Admission medication reconciliation can begin as soon as the medication list has been reviewed and updated.

Select “Continue”, to convert the ambulatory Rx to an inpatient medication order

Select “Do Not Continue”, to keep the Rx on the patient’s list as a Prescription without ordering for inpatient use.

Apart from facilitating a safe and accurate transition from home to hospital, admission med rec is not only required, but make discharge med rec a breeze.  It also promises correct formatting of discharge paperwork that the nursing staff uses for education and distribution.

“Do Not Continue After Discharge” - While these meds will not be prescribed at discharge, the inpatient medications will stay on the list of active medications until the patient until then, after which time it will drop off the list of active medications. 

“Continue After Discharge” is used to designate home medications that you want the patient to continue, but no new Rx is required.

“Create New Rx” for medications that you want the patient to take at home that do require a new prescription.  These can be electronically transmitted to the patient's pharmacy of choice, printed in the event of a scheduled agent, or prescribed but not sent in the event that a written Rx is preferred (a last and anachronistic resort).

Here's another version, another presentation mode:

Medication Reconciliation on Prezi

Medication Reconciliation: Entropy v. Order

A few weeks ago, the Depart Process was rolled out across the three Baystate hospitals.  The "depart" is basically a revamping of the discharge process that accounts for all pieces of information that need to be shared with the patient or transmitted to the patient's next care provider at the time of discharge.  This new method is comprised of a variety of tasks, but the most fundamental is one that has always been part of medical practice: Medication Reconciliation.  

When challenged about the importance or ownership of med rec, I've always responded that this is one of the cornerstones of being a good doc.  How can I provide even adequate care if I don't ask, record and reconcile what medications my patient is taking?  

So what is med rec?  It's a rather straightforward process that makes patient care more efficient:

1. At the time of encounter, whether the office or the hospital, review the list of current medications in the EMR and by asking your patient.
• REMOVE any medications no longer taken using Cancel/DC in the medication list or Do Not Continue in the Med Rec tool.
2. Document those medications, vitamins, supplements that the patient reports as active but not previously prescribed or documented.
3. Determine what new medications required for treatment of your patient, whether in the hospital or in the office, and prescribe accordingly.
4. Review the list and provide a copy to your patient, or enter orders per routine.

NB:  If the patient isn't taking the medication, then the medication does not belong on the list.  Do not hesitate to remove (unless these are protocol meds, e.g. chemotherapy cycles)

Next post: a pictorial review of hospital-based med rec

Sites & Apps

As anyone who knows me knows, I love gadgets.  I don't think it would be to my benefit were I to admit to all of the wasted dollars on the folly of early adoption.  However, I am glad to let you know of a few cool virtual things I've come across while playing with whichever web device I happen to have handy.

For those of you who have never come across zite, don't wait any longer.  Go straight to your iPad, iPhone or Android device and download immediately.  Zite is the ultimate news and information aggregator that is designed to be made in your own image.  While the Home page offers dozens of front page news, its customize functionality can't be beat. And yes, I also have StumbleUpon, Flipboard, and the second best info app, The NYT, but zite wins the game.

Here are my Sections:  Film & TV, Food & Cooking, Health & Exercise, Apple News, Philosophy & Spirituality, Politics, Sports, Technology, Wine & Mixology, World News, Analytics, Cult of Mac, eHealth, Infographics, Informatics, Information Design, Medicine, New York Knicks, Visualization, Social Media

I've been spending a lot of time in the second half of this list and have found some extraordinary sites, blogs, and tools.  And when I don't have the time or patience to read articles in their entirety, I save them instantly to Pocket, a web- and device-based app that holds and archives articles as you like them.  Check out the app or the website at http://getpocket.com.

And for your musical entertainment, check out the local talent - Gracie Vengco!  Soon to be found on:

http://femaledrummernewsletter.blogspot.com/p/top-100-greatest-drummers.html

Chart Search - from Cerner.com

As mentioned previously, BH's EHR, CIS, underwent a code upgrade that will enable the incremental addition of tools designed to enhance the user's experience.  I've been piloting Chart Search for the past few months and have discussed its utility with CMIOs at other Cerner sites.  My goal is to deliver this tool to you before the end of the calendar year.
_____________________________________________________________

From cerner.com:

Harnessing the power of semantics to improve care

By: David McCallie, Jr., MD, Vice President, Medical Informatics

In this data-driven age, the ability to quickly search and find pertinent information is invaluable. The fact that more than 50 percent of Internet users begin with a search gives a hint of the role that search can play in navigating the clinical record. Within health care, where clinicians collect information over a patient’s lifetime, the ability to quickly search through the patient’s record is imperative. New techniques, like performing a semantic search using Cerner’s Chart Search, are making it easier for clinicians to quickly find the information they need.

Because Cerner’s Chart Search uses semantic technology, it can understand the contextual use of each indexed clinical concept, and can intelligently match and rank the documents so that that the most important and useful documents will move to the top of the result list, reducing the time it takes to locate key pieces of clinical data. This allows clinicians to spend more time providing the best care for their patients.

A physician clinic note on heart disease management displays as the most relevant document following a Chart Search.

Chart Search was announced at the 2010 Cerner Health Conference. Dr. Karl Kochendorfer, director of clinical informatics at University of Missouri Health Care, captivated the audience with speed and accuracy as he searched for patient data. Fast forward to today—Dr. Kochendorfer is using Chart Search to make a difference in his practice. Here is a recent example from Dr. Kochendorfer:

“I recently saw a patient who was describing dizziness over the past two years while seeing another provider. The patient was very frustrated about these symptoms but couldn’t recall all of the details associated with his previous care. I was able to use Chart Search to find all instances of when he had it, when it started, what the specific symptoms were and what meds were changed because of them. It helped me to get an entire picture of the patient’s symptoms over the past two years within a matter of seconds, and then assisted me in providing the best care for the patient.”

David McCallie, Jr., MD, Vice President, Medical Informatics, is director of the Cerner Medical Informatics Institute. He is responsible for a research and development team focused on developing innovations at the intersection of computer science and clinical medicine. Prior to joining Cerner in 1991, McCallie was director of research computing at Children’s Hospital in Boston, Mass., and an instructor in neurology at Children’s Hospital and Harvard Medical School. McCallie earned a bachelor’s degree in electrical engineering and computer science at Duke University. He earned his medical degree at Harvard Medical School. McCallie has published numerous articles and presented frequently on the subject of healthcare informatics. He is a member of the American Medical Informatics Association.

Healthcare Informatics Primer

Prezi.com has become my new virtual toy.  It's an eye-popping way of creating presentations for audiences large and small, not only outdoing PowerPoint in terms of creativity, but also by allowing the user to swallow up and integrate .ppt files directly into the prezi template.  Here is how the folks at prezi describe their goods: 

Prezi is a cloud-based presentation software that opens up a new world between whiteboards and slides. The zoomable canvas makes it fun to explore ideas and the connections between them. The result: visually captivating presentations that lead your audience down a path of discovery. 

Yesterday, I had the opportunity to lead a 3 hour seminar at UMass's Isenberg School of Business at the invitation of a good old friend of Baystate's (and a new friend of mine), Eric Berkowitz, PhD.  His group of students consists of both MBA and MHP students as well as an organizational engineering student.  They were super-bright and engaged, curious to hear about the current state of healthcare.  We chewed on the business, policy and politics of the nation's predicament.  I was most gratified to hear that they were especially interested to hear how challenging it is to deliver high quality care to diverse populations while being mindful of cost, communication, and satisfaction.  

Now... to connect the dots... here is the prezi I used to drive the discussion:

UMass/Isenberg on Prezi