Transparent: secondarily defined as free from pretense or deceit; readily understood
Informatics: the science and practice of information processing, specially designed to enhance and enrich the practice of medicine

Saturday, October 20, 2012

New Sets of Eyes on CIS


CIS was first implemented at Baystate Health in 2004, first in the hospitals and then followed by an incremental rollout across over 70 Baystate Medical Practices.  To date, Baystate has achieved many successes with our electronic medical record.   We have been recognized as a HIMSS Level 6 organization, a measure of EMR implementation shared by only 4% of hospital systems across the nation.  And Baystate Health was one of the first integrated delivery networks in the country to have demonstrated Meaningful Use of the electronic medical record. 

But these are laurels bear no meaning as we work hard taking care of our patients day and night.  Just this week, many of us have been challenged with a new means of discharging patients from the hospital.  While the introduction of the Depart Process has bolstered completion of Medication Reconciliation, it has also added to the heap of EMR skills required to get our work done.  And these new tasks seem to come out of nowhere and without explanation or negotiation.  I wouldn't argue that this isn't stressful, but I do believe in the value of this new workflow.  I can only say that with time and proficiency, the logic of their necessity will be revealed. 

I recently started Rob Smith’s Mindfulness-Based Stress Reduction program, one that is specifically designed for physicians.  During both the introductory session and the first official session, the misery of the EMR was reported by more than a few colleagues when asked for their reason for enrolling.  While not all who shared this sentiment are CIS users, their preponderance was not lost on me. 

The clinical milieu is bogged down by administrative and data-driven tasks, often a result of electronic inefficiencies or shortcomings.  And, while we truly have had outstanding success with CIS, there is no doubt that your experience leaves much to be contented.  So, in an effort to improve these circumstances, we recently engaged the services of Aspen Advisors, a consulting firm with expertise in Cerner, to help us identify how best to optimize our automated electronic systems.  

A team of consultants spent a number of hours visiting four BMP practice sites:  South Hadley Adult Medicine, General Pediatrics at 3300 Main St., the Wesson Women's Clinic, and Thoracic Surgery.  I also escorted them through a number of BMC wards, including medical, surgical, pediatric and critical care units. In the practice sites, providers and staff were asked to both demonstrate current methods of use and also help to define the benefits as well as the weaknesses of CIS.   I also provided Aspen the complete set of results from the CIS Users Satisfaction Survey that over 1000 CIS users completed, including 75 pages of your comments.

It is our expectation that these visits, in addition to the dozens of spontaneous conversations held with house staff, physicians and nurses throughout BMC, will culminate in a constructive analysis of our EMR and a forward-thinking strategy to improve the usability of CIS for all patient care and clinical practice needs.  I will surely report on those results when they become available.  In the meantime, I invite you to contact me by whatever means of your choice with questions, comments and concern. 

Tuesday, October 16, 2012

The Golden Spike - The Commonwealth's Entry into Health Information Exchange

Today was truly a monumental day for Baystate Health as well as all patients, providers and health systems across the Commonwealth of Massachusetts. At about 11:30 this morning, Gov. Deval Patrick gave his consent for the private and secure transmission of his personal health information from MGH to Baystate Health. On the receiving end awaiting the receipt of this EHR-to-EHR communication stood our CEO and President, Mark Tolosky, our Chief Quality Officer, Dr. Evan Benjamin, and our new leader of IS and Chief Information Officer, Joel Vengco.  (Me?  I would've loved to have worn the white coat, but I was rescued from the bright lights and TV cameras by attending a Premier conference in Phoenix.  Too bad I can't stand 95 degrees, humid or dry!)

The establishment of secure delivery of patient health information between disparate electronic health record systems holds the potential of providing the right information at the right time and to the right providers for each and every patient, regardless of where they receive their care.  Even more importantly, HIE will play a major role in meeting the Triple Aim, not only by delivering data expediently to improve the care and "experience" of the patient, but by facilitating the identification and care of high risk populations and by decreasing the duplication or incidence of inappropriate clinical services.  (I'll have more to say about what I believe should be the Quadruple Aim, that fourth target of improving the physician/provider experience of our profession.)

I will surely be posting more about HIE in the coming weeks and months since we will be venturing into something considerably more robust that the state's point-to-point delivery of information.  In the meantime, check out the following:


Officials launch statewide health info exchange - CBS 3 Springfield - WSHM





Saturday, October 13, 2012

CIS 2012 Upgrade and The Depart Process

While I write this, the IS team is at work upgrading CIS to the 2012 code. It has been 3 1/2 years since we've had a major upgrade, (March 2009 Enhanced View led to integration of ambulatory and inpatient EMR) and this morning's is unlikely to rock anyone's world. There is a color scheme change that might take some adjustment, particularly for those of us who enter orders while wearing progressives or "cheaters". The user interface displays individual orders in gray, suggesting that the order is inactive. It's not and it should only take a moment to get over. But the text is gray on gray background. This didn't make me too happy, particularly since we weren't given a choice. I've spoken with CMIOs and medical directors at other Cerner sites who have had this installed for a while and they were reassuring. We will soon have the opportunity to judge. The 2012 upgrade is necessary because it is required for our transition to ICD-10 next October. In the near term, we will roll out a new tool, Chart Search, that will allow a Google-type search through an individual patient's chart. So, for example, you can search for documents that refer to a particular condition in Clinical Notes, easing chart navigation. This won't be ready this coming week; we are aiming for December if all else goes smoothly. I've heard that docs love it, especially for those complicated patients with hundreds of notes and results documents stacked in the database. Stay tuned for a tool so many of us have been waiting for - the ability to upload and integrate photos into the patient record and documents... What is coming our way, and hopefully without too much disruption to workflow, is the new inpatient Depart Process/Patient Education modules. The key to success is to perform Med Rec at admission which facilitates discharge Med Rec which, in turn, allows the Depart Process to be set in motion. Here is a brief video I created that covers the basics of this process:

Monday, July 23, 2012

CPOE and PPID Implementation today:

Congratulations to Chestnut Surgery Center at BMC and the Ambulatory Surgery Center at BMLH for implementing CPOE (order entry) and PPID (Medication Barcode Scanning) today!  Thank you to the entire Team for all your efforts in making this implementation a success!!

Wednesday, July 18, 2012

Ever expanding...

Hi! 
Welcome and thanks for checking out our blog. The Clinical Informatics Teams have been involved in many projects to expand electronic documentation at Baystate Health over the last few months. Here is a quick list of what the inpatient team has been up to and may be coming to a computer near you in the future:
  • Interactive Flowsheets (IView) and Progress notes for APTU/ MHU
    • Sally Irelan
  • Patient Education (Krames material) and Depart for all inpatient units
    •  Nicki McAvoy
  • CPOE(order entry)/ PPID (med scanning) for Ambulatory surgery at all 3 facilities
    • Steven Downs and Sally Irelan
  • Expansion of forms library to include ED and Surgical units
    • Steven Downs
  • Nursing Communication Mpage
    • Sally Irelan
Ever expanding... and always optimizing: We also continue to work with staff to make what already exists in CIS to be easier to access and help staff provide safer care:
  • Concentrated Potassium replacement in NICU - nurse witness task and care set
    • Nicki McAvoy
  • Standard Interventions in Nursing Care Plans 
    • Sally Irelan
  • Redesign of Skin/ Wound Documentation screens
    • Sally Irelan
This is of course a very short list of the projects and requests we are working on. Please feel free to contact any of us with questions or comments.