2015 International MUSE Conference Educational Presentations
1002 -‐ BMV and the Road to Success
Presenter: Don Carpenter Organization: St. Claire Regional Medical Center, Morehead, Kentucky This presentation will provide valuable insight into the preparation and implementation of the eMAR and BMV modules. The discussion will entail the complete procedure including team selection, planning, implementation, and post go live. During this presentation I will share with others the priceless knowledge that we have gained during our implementation process to help others have the easiest transition possible during their implementation of e-‐MAR and BMV. Don Carpenter, BS, CPhT III has a bachelor’s in Biology and has been a pharmacy technician at St. Claire Regional Medical Center in Morehead, KY since 1996. He has been a certified technician since 1997. Don is involved with the pharmacy core team and the BMV team. Learning Objectives: • The learner will gain tools necessary to assist with BMV equipment selection. We will discuss the importance of utilizing the vendors and creating a selection criteria for equipment that the end users will find useful. • The learner will be able to develop a road map to ensure BMV success at their facility. We will discuss the development of our road map and the importance of having one. • The learner will be equipped with the knowledge required for successful BMV implementation and maintenance. We will discuss the importance of staying active after go-‐live and how to monitor their success.
1003 -‐ There's a DTS for that! Oncology Module … the MEDITECH Module Less Traveled
Presenters: Trish Gilliam, Tony Huot, Kendra Waddell, Megan Gullickson, Beth Loomis Organization: St. Peter's Hospital, Helena, Montana This presentation offers the journey through implementation of the MEDITECH Oncology module at St. Peter's Cancer Treatment Center in Helena, MT. Implementation occurred in two phases over a 9-‐ month period. The implementation team consisted of two pharmacists, three nurses, one IT analyst, and two super-‐users; one oncology nurse and one scheduler/secretary. Trish Gilliam is the Clinical Informatics director at St. Peter's Hospital. She and her clinical informatics team oversee building, testing, implementation, and management of many MEDITECH modules including PCS, EDM, PCM, MPM, RXM, PHA, and now the Oncology Module.
1004 -‐ Top 10 Things You Should Know About 6.X Post Live Edits
Presenter: Susie Paszkiewicz Organization: Memorial Hospital, Belleville, Illinois While Post Live Edits are almost a daily part of maintaining accurate and effective documentation screens, they present several challenges and must be given the attention they deserve. If we do not use set guidelines for even the smallest of edits, the end result can be unnecessary cleanup to repair a whole new set of issues. Having a well-‐established Post Live Edit procedure will ensure proper maintenance and flow of information across all modules. Susie Paszkiewicz is a Registered Nurse with 20 years of Critical Care Nursing experience. She has been working as a Clinical Analyst for the past four years.
1005 -‐ The Journey to a Successful Implementation of Meaningful Use Core Measure 12 -‐ Direct Messaging Across the Care Continuum
Presenters: Jenni Peterson and Tricia Gall Organization: Avera Health, Sioux Falls, South Dakota Transition of Care/DIRECT messaging is a new concept to EHR vendors and health care organizations. Avera Health has been successfully walking the Transition of Care Meaningful Use journey across the care continuum. Avera Health will share their road to success by providing a workflow demonstration of DIRECT message exchanges in acute and ambulatory care settings as well as in the emergency department. Workflow best practices will be shared on how to automate the DIRECT exchanges in all care settings as well as importing DIRECT messages into the EHR. Through these demonstrations clinical value in exchanging CCDs with DIRECT will be reviewed. Avera Health will also share their process for sustaining and growing DIRECT messaging by keeping clinicians engaged and updated, on boarding process for new health care facilities and utilizing the state HISP to establish a DIRECT relationship with other health care organizations. Jenni Peterson is currently a Clinical Integration Analyst with Avera Health where she collaborates with the nursing, physician, and ancillary teams and provides clinical knowledge to support and implement electronic health record solutions. Her clinical knowledge is based on 12 years of Emergency/Critical Care nursing where she leads the Avera EDM team through the CPOM implementation, PDOC utilization, and bedside medication verification. Tricia Gall is a Clinical Integration Analyst. Learning Objectives: • The learner will demonstrate efficient workflow by demonstrating functionality to automate the process for sending DIRECT messages. • The learner will learn tools to keep clinicians engaged in the DIRECT message process and health information exchange through education, communication tools, and streamlining best practice. • The learner will identify clinical value in exchanging CCDs through DIRECT within the health system and externally and use the clinical value to engage end-‐users. Value in reviewing medications, allergies, and medical problems that will assist in clinical decision making.
1006 -‐ Safe Medication Practices from receipt in the Pharmacy to the Patient Bedside – Compounding, Downtime, and Beyond
Presenter: Charles J. Still Organization: Southwestern Vermont Health Care, Bennington, Vermont This presentation will highlight the necessary hospital workflows and processes from the receipt of medications in the pharmacy to their eventual administration at the bedside. Specifically we will speak to: • The challenges of constant NDC Dictionary Maintenance and solutions via: o Barcode scanning upon receipt. o Barcode scanning to ADC fill. o Barcode scanning at the patient bedside. • Positive Patient Identification enhancements with 2D Barcode direct printing from MEDITECH • Prescription Verification Scanning • Downtime Medication Administration Safety and HIPPA Security Challenges o Making data both available and secure during a system outage. • The appropriate use of Color Coding in IV and other Pharmacy Labels. o Printing color coded pharmacy labels direct from MEDITECH. At the end of this session attendee's will be able to: • Identify safe medication practices that will enhance patient safety. • Assess current hospital practices and identify improvements to increase their effectiveness. • Identify key patient confidentiality requirements of the HITEC act and HIPAA. • Identify measurement criteria and reporting strategies to foster continuous improvements. • Implement a secure and useable downtime medication administration safety strategy. Charles J. Still, MBA is an Information Systems Project Manager at Southwestern Vermont Healthcare and founder of the software company PatientSafeRx.com. He was part of the team presented with the 2011 Waypaver Award for Bedside Barcoding. His work has been published in the Journal of Healthcare Information Systems and Patient Safety and Quality Healthcare. His 2011 HIMSS International BPOC presentation was awarded the "best educational session of the conference" by Mr. HIStalk. He has presented at numerous conferences in the US, UK, and Canada. Charles serves as the Dean of Programs for the UnSummit University series of Monthly Web Education events on BPOC. • Identify safe medication practices that will enhance patient safety. • Assess current hospital practices and identify improvements to increase their effectiveness • Identify measurement criteria and reporting strategies to foster continuous improvements
1007 -‐ The IN's and Out's of Transfer Routine
Presenter: TJ Temple Organization: Ozarks Medical Center, West Plains, Missouri This presentation will show how the transfer routine was implemented at Ozarks Medical Center to help bridge patient care from the recovery room to the inpatient areas of the hospital and from ICU to units of lower acuity. The demonstration will be done in 5.66 PP8 CS software and will look at the process from the perspective of IT build, physician use, and nursing use. This presentation will not only look at set up and use of the transfer routine but will also cover the different processes associated with use of the routine. TJ Temple MT, MBA is the IT Applications Manager at Ozarks Medical Center in West Plains, MO. TJ has worked with MEDITECH for the past 10 years in both support and implementation roles. The latest project for TJ and Ozarks Medical Center was a big bang CPOE go live complete with utilization of the transfer routine. TJ currently serves on the MUSE education committee and is a Director at Large on the MUSE Board.
1008 -‐ Improving Patient Safety with Automated Lab Acknowledgements and Secure Texting
Presenter: Charles J. Still Organization: Southwestern Vermont Healthcare, Bennington, Vermont Accreditation from the College of American Pathologists is a key objective for hospital laboratories. The certification comes with strenuous and exacting requirements for Critical Lab Value notifications and documentation. This session will show how Southwestern Vermont Healthcare has leveraged MEDITECH to assist in meeting these requirements while reducing FTE time spent manually contacting physicians and documenting call back notifications, thereby improving patient safety. Charles J. Still, MBA is an Information Systems Project Manager at Southwestern Vermont Healthcare and founder of the software company PatientSafeRx.com. He was part of the team presented with the 2011 Waypaver Award for Bedside Barcoding. His work has been published in the Journal of Healthcare Information Systems and Patient Safety and Quality Healthcare. His 2011 HIMSS International BPOC presentation was awarded the "best educational session of the conference" by Mr. HIStalk. He has presented at numerous conferences in the US, UK, and Canada. Charles serves as the Dean of Programs for the UnSummit University series of Monthly Web Education events on BPOC. Learning Objectives: • Identify CAP requirements necessary for accreditation and methods for meeting them in the MEDITECH environment. • Assess different methodologies for meeting CAP Critical Lab Value notification accreditation requirements in the areas of: o FTE Resources required in the areas of Notification, Documentation, and Audit Response. o Notification Time from Critical Value Result to Physician Acknowledgement. o Patient safety outcomes.
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Take specific learning from this presentation to their home hospital laboratory and assess performance and metrics with those published in our presentation.
1009 -‐ Managing IT Staff in a HealthCare Environment. Can it be Done?
Presenter: Lynette Herzberger Organization: Arrowhead Regional Medical Center, Colton, California Managing an Information Management Department in the healthcare environment can be difficult with the diverseness of the staff needed to be successful. This presentation is designed to help attendees learn the management techniques to apply to aid your staff in increased productivity and successful project completion. Lynette Herzberger has a Bachelor of Arts in Information Management and a Master of Arts in Management from the University of Redlands. She has 15 years of experience in the IT field of which 13 have been in the healthcare environment.
1010 -‐ PPS to CAH: A Transition Story
Presenter: Elizabeth Cole Organization: Newman Regional Health, Emporia, Kansas After five years of successive losses, Newman Regional Health faced a difficult decision: change the structure of the business to improve reimbursement, or expect to shut down in the near future. This is the story of how they made the changes necessary to achieve financial stability and used the latest enhancements from MEDITECH accomplish it. Elizabeth Cole is the Senior Systems Analyst at Newman Regional Health in Emporia, KS. A 20-‐year veteran at the facility, 18 of which have been with the IT department, she has been an active part of numerous application implementations and process improvement projects over the years. She has presented a multitude of educational sessions and Show & Tells over the years and served as the MUSE Western US Regional Chair in 2006 to 2008. She currently supervises the applications team as they move forward with meaningful use for both the hospital and the affiliated clinics.
1011 -‐ Sharing Our Journey: Interoperability Strategies Since 2001
Presenter: Corey Tillyer Organization: Fraser Health Authority, Surrey, British Columbia In 1863 Florence Nightingale wrote, “in attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison.” And in 2014, “the message [is] clear on where the future lays … digitize health information and connect it to the existing digital health infrastructure in privacy-‐sensitive ways…
Digitizing, connecting, sharing and knowing is one path by which stakeholders can innovate and change how they interact with the health care system and each other”(Canada Health Infoway, Opportunities for Action, 2014.) In December 2001, the British Columbia Ministry of Health redefined healthcare into geographical boundaries by creating six Health Authorities. Fraser Health was born from the amalgamation of three previous health regions. The Fraser Health Authority services 1.56 million residents, along with those who access services from outside our geographical boundaries. Our health care services include public health, acute care, mental health, environmental health/licensing and continuing care. The annual operating budget is approximately $2.6 billion (Cdn) with services delivered by approximately 24 000 staff and 2 000 physicians. Early in our creation, we recognized that the three previous health regions had different strategies in moving toward electronic health records. We further recognized the need to create a strategic plan to support an authority-‐wide interoperable electronic health record for the people we serve and our care providers. Strategies developed included identifying opportunities to move forward electronic health information capture and distribution, maintaining a health authority-‐wide view of systems to support the adoption of the interoperable electronic health record and working with end-‐users to reduce dependence on paper-‐based health information. This presentation will highlight the challenges and opportunities faced after a major reorganization of the health care delivery structure in British Columbia, Canada and how the information management portfolio worked to create a flexible interoperable electronic health record strategy in support of quality health care delivery. The myHEALTHSystem program is a large part of that strategy. The vision of myHEALTHSystem is to, “integrate person-‐centred health information, across the continuum of care, in support of optimizing health care for Fraser Health citizens and providers.” In this session you will find out how we pulled together a single, reliable, birth to death health record for the citizens and providers residing within the Fraser Health Authority. Corey Tillyer, RN, BSN, MA is Director, Health Informatics – Advanced Clinical System for the Fraser Health Authority. Corey is a Registered Nurse with a Masters in Healthcare Leadership. Corey provides leadership in the development of the interoperable electronic health record and ensures that Fraser Health continues to move toward advancing clinical systems through the myHEALTHSystem program. Corey represents Fraser Health on several Provincial and National committees working toward a common vision of interoperable electronic health information that supports patients, clients, residents as well as clinicians and providers.
1012 -‐ Taking the Sting Out of Flu and Pneumonia Vaccine Documentation
Presenter: Lindsey Munguia and Charlene Schubert Organization: SwedishAmerican Hospital, Rockford, Illinois Influenza and pneumonia vaccination is an important part of both patient care and quality monitoring and reporting. SwedishAmerican Health System has strived to provide a process for nursing that will ensure our patients are receiving their vaccinations in a timely manner. In this presentation we will review the implementation of this electronic assessment from its beginning to present day form. We
will review the build, workflow, and our process of monitoring progress with the use of an NPR report. We will also discuss the successes, challenges, and barriers surrounding the use of a PCS assessment as a tool to drive nursing practice. Lindsey Munguia, MSN RN CMSRN is the Clinical Informatics Educator at SwedishAmerican Health System. Her past experience includes bedside nursing in telemetry and ICU/CCU. Prior to transitioning into Clinical Informatics, Lindsey was the Clinical Nurse Educator for Med-‐Surg. Charlene Schubert, BSN RN is a Senior Application Analyst at SwedishAmerican Health System. She has supported PCS and other clinical modules in Client Server 5.66 since 2009, and previously supported NUR in Magic. Charlene also has 19 years of clinical experience in NICU and Critical Care as a bedside nurse. Learning Objectives: • Identify at least three barriers to successful integration of the influenza and pneumonia vaccine in the daily workflow of nursing staff. • Recognize the strengths and limitations of using rules to drive decisions regarding ordering the influenza and pneumonia vaccinations for patients. • Describe one way to document necessary data for quality measures when a vaccine is unavailable due to a shortage.
1013 -‐ Trauma 101! Emergency Department Template Build Basics
Presenter: Tonya Girdler Organization: Ephraim McDowell Regional Medical Center, Danville, Kentucky In this education session, we will discuss template building for the Emergency Department. We will provide detailed instructions of our current build and share our current templates. We will also share our ED throughput times prior to electronic documentation and post electronic documentation. Tonya Girdler transitioned from a cardiovascular staff nurse into the role of Manager of Clinical Information Technology. She has served in this role for the last three years. With each passing day, Tonya gains insights into the complicated world of healthcare technology. Learning Objectives: • Information/Instruction for Emergency Department documentation builds. • Should they use more or fewer templates at their organization and where is a good starting point? • Advantages/disadvantages to utilizing electronic documentation in the emergency department.
1014 -‐ Comparison of Go-‐LIVE concepts: Big-‐Bang versus Rolling. Contrasting a Large Enterprise 5.66 Go-‐Live to CAC Implementation
Presenter: Chris Dickerman Organization: CHRISTUS Health, Houston, Texas This presentation is intended to be a lessons learned from two different go-‐live strategies. A comparison of big-‐bang for our 5.66 implementation versus a rolling go-‐live for our CAC implementation. Chris Dickerman has worked at CHRISTUS for 2.5 years in the Project Management Office. As the primary project manager for the 5.66 upgrade, he worked with over 500 team members across 26 facilities in 8 regions. The upgrade for CHRISTUS moved from 5.64 to 5.66 with over 48,000 DTS requiring review. Prior to working at CHRISTUS, he worked in consulting on CPOM and PDOC go lives as well as 6.0 optimizations.
1015 -‐ CPOE: Teaching the Teacher. “IT's” the Right Way!
Presenters: Catherine McCartney and Audrey Premdas Organization: Arrowhead Regional Medical Center, Colton, California This presentation will focus on the trials and tribulations, ups and downs of implementing CPOE at a teaching facility. From medical students to residents and attending doctors, and let's definitely not forget the nurses, from student nurses to nursing staff, to unit secretaries. All roles have changed or changed slightly. Errors and issues brought out unto the open. Our facility is unique; therefore our training and implementation methods were just as catered or unique; from the computer literate to the computer illiterate. Being a county/public entity, we work with what we have, we, the IT department, implemented, support and continue to train annually, CPOE to new staff. It's a challenge, but we succeeded and it's working. Catherine McCartney has worked in the healthcare field for 16+ years; 12 of those years have been spent at Arrowhead Regional Medical Center in the Information Management/Technology department. She is currently the project manager for the PCM suite, CPOE/POM, Pdoc, Discharge and Transfer. She also support a few of the fiscal modules such as BAR and PBR. Catherine possesses a clinical background as a Medical Assistant and Emergency Room registration clerk prior to Arrowhead Regional Medical Center. IT and healthcare is where her passion lies.
1016 -‐ Our Discharge Planning Journey
Presenter: Lori Schamback Organization: North Ottawa Community Hospital, Grand Haven, Michigan In this presentation, we will take you on the journey of our Discharge Process build. We will discuss the basic functionality, workflow processes, roadblocks, and DTSs that impacted our decision making along the way and the course of action our institution decided to take to meet the ARRA Stage 2 requirements as well as our end user needs. Lori Schamback RN, BSN is a Clinical Informatics Analyst at North Ottawa Community Hospital in Grand Haven, Michigan. She has 15+ years of experience in healthcare, the last five in healthcare IT. She supports a number of MEDITECH modules including EDM, PCS, POM, OE, PCM and RXM. She has also been involved in a number of MEDITECH IT projects including BMV, CPOE, ARRA Stage 1, ARRA Stage 2, and Discharge Process. Lori also navigates the complex build of the electronic discharge process; implement successful workflow processes; and manages a smooth transition and roll out to end users.
1017 -‐ EMPOWER -‐ A Canadian Hospital Experience with Implementation of an Electronic Medication System
Presenter: Alicia Stevens Organization: Huron Perth Healthcare Alliance (HPHA), Stratford, Ontario Huron Perth Healthcare Alliance (HPHA) and Alexandra Marine & General Hospital (AM&GH), hospital organizations located in southwestern Ontario, Canada, successfully implemented Version 2 Allergies, eMED Rec, and inpatient eMAR/BMV across five sites. In this presentation we will discuss implementation of these components of our electronic medication system that were implemented in less than one year, with limited financial resources. The importance of core project team members, training, go-‐live support, and lessons learned will be discussed. Join us for lessons learned of a Canadian hospital implementing V2 Allergies, RXM, and eMAR/BMV. Alicia Stevens, R.Ph.T. is the Regional Pharmacy Informatics Coordinator at Huron Perth Healthcare Alliance and Alexandra Marine & General Hospital located in southwestern Ontario, Canada. The Regional Pharmacy Informatics Coordinator is responsible for ensuring quality patient care and safe medication practice through the development and maintenance of a robust regional pharmacy information system based on industry best practices. Alicia has been a key member of several electronic medication safety projects and has provided ongoing support to the MEDITECH pharmacy module and other informatics systems within pharmacy, including Omnicell automated dispensing cabinets, Omnicell controlled substances management system, McKesson PACMED and Iatrics Paperless Pharmacy and Smartboard system.
1018 -‐ Change Control Management in a Multidisciplinary MEDITECH Environment
Presenter: Janis Yannotti Organization: Southwestern Vermont Medical Center, Bennington, Vermont Change control management within HIS/EMR systems is a formal process used to ensure that changes to an EMR system are introduced in a controlled and coordinated manner. It reduces the possibility that unnecessary changes will be introduced to an integrated system without forethought of how the change could affect another departments processes, introducing patient safety or data integrity faults into the system or undoing changes made by other users. The goals of a change control procedure usually include minimal disruption to services, end user notification and education needs, minimal downtime, and cost-‐effective utilization of resources involved in implementing change. Topics include: • How to select requests or ideas that are appropriate for change • Stratifying the priorities of requested and or approved changes • Solicit input from the stakeholders and test the downstream effect • How to implement the change • Communicating the change to the end user Janis Yannotti is an Informatics R.N. and Clinical Systems Analyst at Southwestern Vermont Health Care. She started as a bedside nurse in the I.C.U. and then transitioned to worked in the both I.C.U. and the Emergency Department. In 2006, she was the project lead for implementing computer documentation for nursing in the I.C.U., which started her path into the Information Systems world. The list of projects/implementations since then include the following: Implementation of Bedside Medication Scanning, Physician Computer Order Entry, Empower implementation, MEDITECH’ s EDM module, along with MEDITECH upgrades. She currently works per diem in the Intensive Care Unit, and the Emergency Room.
1019 -‐ Medication Reconciliation in MEDITECH 6.0
Presenter: Melissa Balizan Organization: Parkview Medical Center, Pueblo, Colorado Parkview Medical Center has implemented MEDITECH 6.0 functionality for Medication Reconciliation on admission with a documented success rate of 90% on acute care units. Custom reports are used to identify lack of compliance at critical points in the process and individual medications on the home med list or the reconciliation list that require attention. An ER pharmacist completes home medication lists when possible. Unit based pharmacists educate physicians and nurses about the process and the software interface and functionality and address issues with the home medication and reconciliation lists. Future plans include pharmacist discharge medication counseling for patients on four or more medications and integration of pharmacy technicians into medication history process. Melissa Balizan is currently the Informatics pharmacist at Parkview Medical Center in Pueblo, CO. She has been at Parkview for the last 15 years. She has been instrumental in developing many clinical programs and helping to streamline the medication reconciliation process at Parkview.
Learning Objectives: • Identify issues at critical points in the process. • Use of pharmacists to facilitate the process. • Potential for integration of pharmacy technician in the process so the pharmacists can concentrate on discharge medication counseling.
1020 -‐ Integration & Distribution of Patient Data – Mitigating Risks
Presenters: Dan Ross and Andrea Kulyski Organization: Health Sciences North, Sudbury, Ontario The purpose of the presentation is to raise awareness about the potential risk around assuming data is flowing fine 100% of the time. How do hospitals know everything is working as designed? Have they taken the time to audit the reliability of their service? Perhaps there is an opportunity to mitigate their liability and risk to patient care. In addition to the actual topic, we will provide examples of the risks our facility is faced with, the negative outcomes we have experienced and what steps we have taken to date to resolve or mitigate risk. A huge component of healthcare today is integrating, sharing and distributing patient data. Many risks are associated to ensuring the data is accurate (correct patient, correct recipient) and was the delivery successful. Regardless if sharing data with a clinician, health care community partner, ambulatory clinic or provincial/state repository; the topic is relevant. The presentation is not about the source HIS or the third-‐party service provider, it is about the monitoring tools, reporting services and service agreements that should be in place prior to reaching a production status. It really comes down to taking a moment to think of auditing. We will present de-‐identifiable examples of issues we recently dealt with, what countermeasures we have implemented and recommended next steps. By sharing what we have done to date to mitigate our risk, participants will see how technology like (SQL Reporting and NPR) can be leveraged for auditing and notification. Although we will display the coding behind our tools, this session should not be treated as a programming course. Basically we will share the concepts and thought process behind our tools. We will share the steps we took to implement our solution and further identify the challenges we are faced with as a service provider who hosts a shared MEDITECH installation for 21 independently operated hospitals. We will further highlight the complications with making tools available to community hospitals who are not part of our hosted install. Dan Ross provides hands on leadership and oversight to a team of resources responsible for providing application support and process analysis for a variety of integrated administrative, clinical, and financial applications with HSN. His portfolio is further complimented with interoperability services where we leverage an interface engine to share clinical data with over 100+ downstream systems. In addition to his local management duties, Dan is the operational manager for NEON a regional partnership of hospitals sharing one health care information system (MEDITECH) where his team is responsible to
ensure standards are adhered, lead inter-‐disciplinary teams and provide second level application support. From a provincial perspective, Dan also manages the North East LHIN's physician office integration service, where hospital reports/results are delivered electronically into health care providers private EMR's. Aside from keeping the lights on, we are always busy planning and leading new implementations based on funding opportunities.
1021 -‐ EDM Trackers: Make the Tool Work for You
Presenter: Kim Karn Organization: Memorial Hospital, Belleville Illinois Use of various trackers can improve efficiency of care and display the state of the ED. This presentation will share the goals of our trackers, standardization and access for staff, including the different types of trackers, their content, and how they are used. Kim Karn has been an RN for 34 years. She has worked as a Clinical Analyst since 2000. Memorial Hospital ran MEDITECH Magic 1997-‐2010 and MEDITECH 6.0 since 2010.
1022 -‐ Leading a Multidisciplinary Team
Presenter: Keith Jackson Organization: Arrowhead Regional Medical Center, Colton, California The current state of America’s health care system can be defined by one word: chaotic. New rules and regulations under the general umbrella of Meaningful Use are overwhelming healthcare providers in the public and private sectors. In this environment, leading healthcare IT projects is challenging. Success requires collaboration and partnerships throughout a healthcare organizations various departments and disciplines to implement project objectives. This presentation will examine the leadership and management of multidisciplinary teams in healthcare. It provides an overview of what constitutes a multidisciplinary team and the potential conflict inherent in teamwork is outlined. A brief overview of leadership styles is provided, with a more detailed description of the relationship between different leadership styles and team effectiveness and satisfaction in the Healthcare context. Finally, suggestions about effective leadership styles and practical tips for team building and managing team meetings are provided. Throughout the presentation, we will relate the information provided to the most current project, the implementation of the Patient and Consumer Health Portal application from MEDITECH. This project brought together a multidisciplinary team consisting of members from Patient Registration, Health Information Management, Scheduling, Fiscal, Pharmacy, Laboratory, Medical Imaging, Compliance, Marketing, Information Management and Administration. Keith Jackson is a Supervising Automated Systems Analyst at Arrowhead Regional Medical Center in Colton, California. He has over nine years of experience with MEDITECH and healthcare IT and over 16 years of experience in managing IT. In 2006, he completed graduated from the University of Redlands and obtained a Master of Science in Information Technology. He is a dedicated, results-‐oriented
professional with a proven background in evaluating and executing multimillion dollar cost reduction initiatives, successfully launching large scale technology enhancements and an unmatched ability to deliver results during challenging periods.
1023 -‐ Transitions of Care for Hospital and Clinics – Mission Possible!
Presenter: Karrie Ingram Organization: Citizens Memorial Hospital & Health Care Foundation, Bolivar, Missouri The CMS Transition of Care measure tasks your hospital and eligible providers to "provide a summary care record for each transition of care or referral." This is no small feat, as the objective has three measures, including an electronic component that requires either DIRECT or HIE capabilities. This presentation will include set-‐up, reporting, denominator considerations, and our experience with a 90-‐ day, Year 1 EH reporting period as well as our revision of the processes for Year 2's 365 day reporting period. We will also take a look at the Ambulatory Referral Desktop which will be utilized by our 75+ eligible providers to meet this measure during 2015. We will conclude with a 'wish list' of functionality that would streamline processes even further. Karrie Ingram joined Citizens Memorial Hospital (CMH) in 2002 to lead the MEDITECH implementation for their long term care facilities. She transitioned to supporting the MPM Suite for CMH's 25+ clinics in 2008 and led implementation projects including the LSS Patient Portal, e-‐Prescribing, and External Document Scanning. Prior to CMH, she spent several years in Project Management and attained her PMP certification in 2011. She managed a three-‐year HRSA Rural Health IT Network Development Grant focused on collaboration between rural healthcare network partners and meeting Meaningful Use. During this time she led the implementation of the Patient & Consumer Health Portal, public health interfaces, and CCD/transition of care implementation. In late 2014, she was named HCIS Manager and leads a robust team of business and systems analysts in supporting CMH's award winning EMR. CMH has utilized MEDITECH since 2002, across their continuum of care which includes a 74-‐bed hospital, seven Long-‐Term Care facilities, 30 Physician Clinics offices, as well as Homecare and HME Services. They were recipients in 2005 of the HIMSS Nicholas E. Davies Award, and are currently recognized by HIMSS Analytics as a Stage 7 level EMR. They have been on the Most Wired list for 10 years, and received the Missouri Quality Award in 2010 and 2014.
1024 -‐ Order Management: The Center of the Universe... Or Is It?
Presenter: Sandi Rottluff Organization: Memorial Hospital, Belleville, Illinois In this presentation, you will learn about the effects of integration between OM, PCS, ITS and LIS. Nursing, lab and diagnostic orders are initially created in their respective applications and are then “pushed” to OM. When edits or deletions are done in PCS, ITS or LIS, the impact in OM can be very challenging to manage and troublesome if not communicated appropriately. This presentation will describe the impact within OM in respect to this tight integration.
Sandi Rottluff, RN has worked at Memorial Hospital for 34 years. Her roles included staff nurse, charge nurse, nurse manager, nurse educator, and clinical analyst. She has been in the Clinical Analyst role for 13 years, working with MEDITECH Magic until 2010 when the organization moved to the 6.0 platform.
1025 -‐ Interface Integrate Innovate
Presenter: Sherry Montileone Organization: Citizens Memorial Hospital, Bolivar, Missouri Attend this presentation to see what Citizens Memorial Hospital is doing to use interoperability to promote EMR success. We'll cover some of the new interfaces we have (like LTC Pharmacy Packagers), how we are stretching existing interfaces (PACS to 3 OV systems including Dental), and how we used interfaces to migrate a clinic to MEDITECH. Sherry Montileone has been at Citizens Memorial for 15 years and in the IT industry for 34 years. She feels blessed to be in a position to make a difference every day.
1026 -‐ Ambulatory Meaningful Use Achievement – Overcoming Secure Messaging Obstacles
Presenters: Cheryle Rash and Karrie Ingram Organization: Citizens Memorial Hospital, Bolivar, Missouri By far, the most challenging Eligible Professional Meaningful Use measure to achieve is the goal for Secure Messaging. You thought Stage 1 was a challenge to engage providers? Ha! Ambulatory Stage 2 meaningful use achievement was a huge challenge for many of our providers! Getting patients engaged enough to send a secure message was painstakingly laborious! This presentation will outline the steps taken to lead 40 providers to achieve Stage 2 meaningful use in 2014. Overcoming obstacles such as low patient volume, elderly patient mix, proxy involvement, reporting issues, and the most challenging obstacle … patient engagement! Citizens Memorial Hospital (CMH) put patient and employee names in drawings for prizes, hired a person to make phone calls to patients walking them through the secure messaging process, and placed iPads in clinics to help patients sign into their portal while they were in the clinic. Reporting was a challenge as well. Firstly, the providers had to sign timely. Secondly, the note had to be coded and billed quickly. Finally, the data had to transfer from MEDITECH to the Data Repository to show up on the ARRA reports. If these three conditions were met the data would result in the ARRA report. We ran ad-‐hoc reports directly against ADM, SCH and PCM tables to count visits and messages that were not yet in the DR due to signing/billing delays. ARRA reports were run daily … sometimes twice daily … toward the end of the attestation period to gauge performance. Topics: • The Secure Messaging Measure • Reporting using DR ARRA SQL scripts • Marketing
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Clinic processes Provider / Staff involvement – it takes a village Reporting Issues Tactics to ensure achievement
Cheryle Rash joined CMH in 2008 as Clinic Manager of the one of their busiest rural health clinics. After five years, she was recruited by Information Systems as a Business Intelligence Analyst. Her expertise in DR and Meaningful Use was critical during the vetting of the new MT SQL reports for both Stages 1 and 2 of MU. She provides dashboard style data to our 75 eligible clinic providers and hospital as well as managers and administration. The ad hoc detail provided for measures needing attention was invaluable as Citizens Memorial’s eligible providers fought to meet some of the most difficult measures. Cheryle is also responsible for the organization/retention of measurement attestation data and for the actual attestations, including eCQMs. CMH has utilized MEDITECH since 2002, across their continuum of care which includes a 74-‐bed hospital, seven Long-‐Term Care facilities, 30 Physician Clinics offices, as well as Homecare and HME Services. They were recipients in 2005 of the HIMSS Nicholas E. Davies Award, and are currently recognized by HIMSS Analytics as a Stage 7 EMR. They have been on the Most Wired list for 10 years, and received the Missouri Quality Award in 2010 and 2014.
1027 -‐ The Puzzle: 6.1 – Standard Content and Making the Pieces Fit
Presenter: Gina Ruise Organization: Inland Northwest Health Services (INHS), Spokane, Washington Our recent experience with the "Robust Standard Content" delivered to Whitman Medical Center has given us great opportunity to share the key concepts listed above and how they "fit" together. It was discovered during our journey that many items impacted the integrated design but were not clearly defined, and each had to be addressed throughout the build. This was difficult but believe that we now have a good picture to go along with the design of "Robust Standard Content". Gina Ruise is a Lead Clinical Application Specialist with over 17 years of healthcare experience from direct patient care to clinical informatics. Gina has extensive experience with Magic, C/S, 6.x, and 6.1 platforms. Her primary expertise is understanding the clinical workflow of order entry and integration with ancillary modules. She most recently partnered in implementation of CPOE, OM 6.14, maintaining the sites successful reporting requirements for MU Stage 2. Her direct experience with hospital process workflow and knowledge of implementing clinical modules allows her to quickly develop and implement solutions for successful adoption.
1028 -‐ Sepsis Alert – From ED to ICU and Beyond
Presenters: Pam O'Quinn and Joan Lewine Organization: Halifax Health, Daytona Beach, Florida Patients meeting pre-‐established criteria are considered Sepsis Alert patients. These patients are identified as those that have a greater potential for significant morbidity and can benefit from early intervention. When Halifax Health Medical Center (HHMC) is notified by EMS that a patient meets the criteria, as defined in this policy, or if a patient who meets the stated criteria arrives by means other than EMS (e.g. private vehicle), a the Sepsis Alert Protocol is initiated. Pam O'Quinn is a Registered Nurse with a MA in Computer Resources & Information Management / Human Resource Development. She joined Halifax Health Medical Center as a Clinical Informaticist in 2011. They currently use MEDITECH 5.66 pp8 for electronic documentation. Most of her experience is workflow/process/PCS/NUR/EDM. She received Board Certification in Nursing Informatics (American Nurses Credentialing Center) this year. Learning Objectives: • Participants will be able to identify barriers to sepsis alert process through identified workflows. • Participants will be able to identify sepsis alert protocol candidates by specific criteria. • Participants will be able to apply principles of evidence-‐based practice to determine sepsis, and formulate and implement acceptable treatment modalities per protocol utilizing MEDITECH functionality. 1029 -‐ 1-‐2-‐3 – HIT from MU to Outcomes Presenter: Sandy Ebert Organization: Inland Northwest Health Services (INHS), Spokane, Washington The Building Blocks are in place for: Improved Health; Meaningful Use; Improved Outcomes; the Federal IT Strategic Plan. But what does it all mean? Health Care Information Technology; Collecting, Sharing, Using, Improving, Engaging, Reporting, Real Time PHI Data Exchange and Connectivity across EHR Platforms. Pulling it all together to realize the plan for improved health, reduced costs, and Meaningfully Using the information from all your work and efforts. Sandy Ebert CHTS-‐TS, CHTS-‐IM is a Systems Analyst 4 Leader Nursing with Inland Northwest Health Services (INHS). For the past six years, Sandy has served as the Lead Analyst for the Meaningful Use Program at INHS. In that role she has actively assisted: 24 hospitals achieve Meaningful Use Stage 1; 9 hospitals achieve Meaningful Use Stage 2; 12 hospitals to successfully pass a CMS Stage 1, Meaningful Use Audit. She has 30+ years of experience in Information Technologies, 27 of those years within the Health Care Industry. Sandy has successfully passed the Government Certification for Certified Health Care Technology with an emphasis on Technical/Software Support and Implementation Manager. These Certifications are a
component of the ONC Health Information Technology Exams, developed as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
1030 -‐ Electronic Fund Transfer Setup in MEDITECH
Presenter: Tammy Szczur Organization: CHRISTUS Health, Houston, Texas Setting up MEDITECH to use EFT includes: • Team task and MEDITECH dictionaries for bank setup at both the CMS and regional level • Setting up vendors to receive EFT payments and vendor participation for testing • The Penny test and testing issues encountered • Types of electronic payments within MEDITECH • Bank specifications Come and learn about the complete work flow from MEDITECH, to the bank, to the vendor. Tammy Szczur’s eight years of professional experience in financial information technology began with credit auditing for GE Finance and transitioned to IT support for GE Healthcare. Since joining CHRSITUS Health 2012 as an Analyst II, her concentrations broadened by supporting various Electronic Medical Records, Practice Management tools, and assignments to organization implementation projects as a subject expert within the business financial areas. Tammy’s education consists of Bachelors in Business Management and Masters in Healthcare Administration 2015.
1031 -‐ MEDITECH Oncology – An Integrated Approach to Cancer Care
Presenters: Sherri Charneski and Robert Hester Organization: ENGAGE This presentation will review recent experiences implementing MEDITECHs Oncology program. Program success from a multi-‐stakeholder project design approach will be shared. Key focus areas include timelines, roll out approaches, provider involvement, and lessons learned. Sherri Charneski is a System Analyst Leader with the Patient Financial Team at INHS. Sherri obtained her Bachelor of Arts degree in Interdisciplinary Studies from Eastern Washington. Sherri has been with ENGAGE since 2002 and has over 18 years of experience with MEDITECH both as a user and an analyst. Sherri has been the core team leader for multiple, successful, MEDITECH implementations and she has extensive experience with MEDITECH upgrades. Sherri has been a team leader for migrating clients from MEDITECH Magic platform to MEDITECH 6.0. Sherri’s invaluable core strengths include; strong leadership, project management, and implementation strategy.
1032 -‐ Discharge Routine Successes and Challenges
Presenter: Greg Hartman Organization: Avera Health, Sioux Falls, South Dakota This presentation will look at how Avera has navigated through the different challenges that we have faced since implementing the discharge routine over a year ago. We will also look at our success stories and changes that we have made since implementation. Greg Hartman has been a registered nurse for the last seven years. He has been working in the informatics department for the last three years. He has presented at a previous MUSE conference, MEDITECH conference, and been interviewed for the MEDITECH Journal. He is also a member of the MEDITECH International nursing advisory council.
1033 -‐ Query Links and Their Benefits for End Users
Presenter: Lydia Gutwein Organization: Jasper County Hospital, Rensselaer, Indiana Learn how to guide end users toward more thorough documentation and comprehensive patient care. Query links use assessment query responses to prompt the end user to initiate orders, interventions and patient problems. Examples of each of these three uses will be given, as well as comparisons to the older processes they have replaced. Lydia Gutwein earned her nursing degree and license in 2010. In 2012, she began working at Jasper County Hospital as an RN on the Medical-‐Surgical unit. She then joined the IS department as a Clinical Application Specialist in November, 2014.
1034 -‐ Consumer Patient Portal: Client and Family-‐Centered Care from a Client Server 5.66 Platform
Presenter: Ryan Kandasamiar Organization: Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario This project pushes the limits of the MEDITECH patient portal to really deliver a system that will cater to family centered care. By stage 1 of its staggered go live connect2care, our client and family portal, had already facilitated access to clinical information for clients and families. Our ambitious plans for stages 2 and 3 (February and March 2015) are to introduce a seamless process for requesting/cancelling appointments and to enable two-‐way messaging with all clinicians, not just physicians. A high degree of engagement by clients and caregivers in this project has informed the team’s approach and guaranteed a family centered product. Our challenges include a very tight delivery time line attached to our funding from Canada Health Infoway, the specific needs of our pediatric rehabilitation population and some significant product related limitations.
Key to success was the collaborative approach of all stakeholders: clients, family members, all clinical staff, family-‐centered care specialists, appointment services, health data records and information systems staff, as well as Canada Health Infoway representatives. While MEDITECH, with its integrated and secure system, was the clear winner in our RFP process, we continue to challenge them to improve their product so that, for instance, 2-‐way messaging can be directed at rehabilitation professionals, recurring accounts show a complete visit history, and PCS documentation can be made available via a script to ITS reports. This presentation will chart our high energy, high-‐speed ride towards the next frontier of health care: truly collaborative practice that places the client front and centre. Ryan Kandasamiar is Clinical Application Specialist supporting OE/POM and PWM modules. He has been working at Holland Bloorview Kids Rehabilitation Hospital since 2009. Ryan started at Holland Bloorview as a Pharmacy Technician. During his role as a pharmacy technician he was greatly involved with maintenance of all the pharmacy dictionaries as well as the upgrade to 5.64 from 5.54 client server. He moved to Information Systems in 2013. In his new role he has been providing in class training to all disciplines in various modules including eMAR, OE, POM, PWM and recently took on a lead role in the consumer patient portal project. Learning Objectives: • Integration of MEDITECH consumer patient portal on a 5.66 client server platform with 6.0 portal. • Understand how client and family-‐centered care works and the advantages of collaborative approach of all stakeholders to a project • The challenges involved in delivering a client and family-‐centered patient portal to a pediatric rehabilitation population.
1035 -‐ How to Manage a Successful Upgrade
Presenter: Jodi Frei Organization: Northwestern Medical Center, St. Albans, Vermont Upgrades can be challenging for many reasons of which include multi-‐module coordination, communication, testing, training, and downtime preparedness. This presentation will highlight tools and processes used by Northwestern Medical Center, a HIMSS Stage 6 organization that has hardwired a consistent, predictable, and successful means of managing upgrades. Jodi Frei is the Manager of Clinical Informatics at Northwestern Medical Center. She holds her Bachelors in Physical Therapy and Masters in Information Technology. She has been in the medical profession for 24 years and has spent the past five years focusing on EMR implementation and optimization. Learning Objectives: • The learner will gain awareness of new approaches to the upgrade process that facilitate consistent, predictable outcomes.
• •
The learner will become aware of new tools including E Manuals, Integrated Testing Templates and Downtime Drill Documents. The learner will understand the value that communication and collaboration bring to organizational buy-‐in and success associated with the upgrade process.
1036 -‐ Big Bang Across 500 Miles in One Day: Full Implementation at Five Different Facilities in North Dakota All at Once
Presenter: Karen Hicks Organization: Catholic Health Initiatives, Englewood, Colorado Bringing up one facility with an entire roll-‐out of all MEDITECH 6.x modules can be a challenge by itself, so when the decision was made to roll-‐out five facilities across 500 miles at the same time, careful planning, designing, and “dress rehearsing” was key. There were some “adventures” along the miles but rolling out multi-‐facility had its advantages for the organization. This presentation will be helpful for any organizations planning or considering a multi-‐facility implementation in the future. We will provide information regarding implementing 6.x across numerous facilities including useful strategies regarding go-‐live support, central command center, and many other factors that led to success. We will specifically discuss PCS, BMV, EMR and CPOE. Also the discussion will include how clinical standardization was managed along with the process to roll out ongoing changes viewed as optimizing the system. There will be time devoted to lessons learned and the hurdles that we faced and how they were overcome.
1037 -‐ ICD-‐10: How to Update Your MEDITECH System
Presenters: Dawn Bailey and Audra Shope Organization: ENGAGE This session will provide technical steps required to prepare your MEDITECH system for ICD-‐10. High level claims development will be discussed, as well as “how to” for loading codes, updating key parameters, code set overrides, and code set designation by payer and effective date. This presentation will also provide detailed instructions on how to use MEDITECH for both ICD-‐9 and ICD-‐10 code sets for dual coding. By the end of this session you will have the information needed to complete necessary ICD-‐ 10 updates within Abstracting, MIS and Billing modules, as well as an understanding of how to use MEDITECH for dual coding. Dawn Bailey has been with ENGAGE since August 2005 and has worked in patient financial for 19 years. Prior to coming onboard with ENGAGE, Dawn established her career in healthcare as a Commercial Billing Lead while working for a large urban hospital her previous experience also includes supervising billing operations. Currently Dawn is a System Analyst on the Patient Financial Team where she provides project management, leads MEDITECH implementations and updates, and provides system support to regional hospitals. Dawn excels in hospital billing and collections and has demonstrated her expertise in electronic claims submissions, timely follow-‐up, and research of unpaid or rejected claims.
Audra Shope has been with ENGAGE since September 2008 and has worked in the healthcare field for over twenty years. Prior to joining ENGAGE Audra focused her healthcare career in health information management working for a large, urban hospital. Audra is a certified RHIT; her vast experience in health information includes nine years of supervising clerical staff in the coding department. Currently Audra provides material and system support to critical access hospitals, regional facilities, and multi-‐specialty care hospitals. Audra also provides project management and develops training material.
1038 -‐ Engaging Clinicians in the Learning Experience Presenter: Patricia Korolog Mulberger Organization: Kalispell Regional Healthcare, Kalispell, Montana Poor training is often cited as a barrier to successful EHR (electronic health record) implementations. Core teams without educational experience are often asked to design and execute trainings that may not be effective. With the increase in implementations to meet meaningful use criteria, it is critical that providers and other care-‐givers receive effective educational sessions that address specific needs and interests of the particular group. This presentation offers a review of adult learning theory and innovative approaches that can be used as a foundation for designing an effective program that motivates caregivers to become engaged in their own learning. Patricia Korolog Mulberger, RN-‐BC, MSN began her informatics career as the project manager for an order entry implementation in a small rural facility in Montana in 1995. After implementing both clinical and financial systems Pat went on to informatics consulting in 1999. In 2001, she returned to a more stable hospital-‐based role in HIT. She obtained her Masters in Nursing with a clinical informatics focus in October of 2011 and was ANCC certified in Nursing Informatics in March of 2012. Pat has spoken at several international conferences and presented her capstone project on educating end-‐users at ANIA's (American Nursing Informatics Association) International Conference. Her most recent publication was in AONE's "The Voice of Nursing Leadership" in November, 2014. She is also a board member and the West Region Director for ANIA. Learning Objectives: • The learner will be able to describe the essential elements of adult learning theory. • The learner will be able to describe innovative approaches to education. • The learner will be able to articulate real life training scenarios for various types of care-‐givers.
1039 -‐ READY or Not Here Comes 6.1
Presenter: Marcia Cheadle Organization: Inland Northwest Health Services (INHS), Spokane, Washington This presentation will provide a high level overview of project management aspects of migrating from Magic to 6.1. Project schedule from beginning to Go Live will be reviewed including high-‐level milestones, key decision points, managing multiple work streams, and engaging strategies that positively position for success in meeting on time, on budget and adoption targets.
Marcia Cheadle, RN, Senior Director of Advanced Clinical Applications for Inland Northwest Health Services (INHS). She has over 30 years of direct health care experience serving in acute, ambulatory and home care nursing roles. Marcia is responsible for the implementation and integration of more than 30 hospital advanced clinical programs including transition to MEDITECHs 6.1 platform. She has directed multiple initiatives leading to EMRAM HIMSS Stage 6 and 7 recognition. Over the past four years, she has orchestrated multiple Meaningful Use, Stage 1 and Stage 2 Attestations. Marcia currently serves as Vice Chair of eHI Policy Steering Committee; a federal non-‐profit coalition whose mission is to drive improvement in the quality and costs of healthcare by promoting the use of technology and information through research, education and advocacy efforts. She teaches in the Health Care Administration graduate program at Eastern Washington University as well as continues her clinical nursing practice at a local emergency department.
1040 -‐ From Implementation to Adoption: Strategies for Focusing On and Supporting the End-‐User
Presenters: Kathie Schroeder, Rachel Hofmann RN, BSN, Marie Lincoln RN, and Julie Carlson Organization: Cascade Valley Hospital and Clinics, Arlington, Washington Your informatics team has worked hard analyzing new workflows, designing the configuration, building the dictionaries and custom defined screens, testing, and training the staff. All the details seem to be in order and the team is anxious to see their project come to life. Support resources are in place. Finally the go-‐live date arrives. As the plan gets underway, the processes start to unravel and things don’t go exactly as planned. What went wrong? Why is there such resistance to the new workflow? What‘s missing? After implementing eMAR/BMV, the Bed Board, and CPOE, staff struggled with end-‐user adoption, so Cascade Valley Hospital’s Clinical Informatics Team decided to take a different approach and increase their focus on understanding their end users and hospital culture in order to develop strategies that would improve acceptance and adoption of the new workflow required with the Multi-‐Disciplinary Discharge Desktop. This session will focus on how they analyzed their end users, and culture, investigated staff resistance to change, looked into adoption theories, motivation and feedback strategies, then developed and implemented concrete communication strategies to support their end-‐users to gain buy-‐in and successful adoption. Kathie Schroeder RN, BSN has been a nurse for 30 years, with 19 of it as an Informatics Nurse. She currently works at a small rural hospital in Arlington, WA leading a team of two Informatics Nurses and one System Analyst. She has worked in the hospital and software vendor environments as an educator and technical writer. Rachel Hofmann RN, BSN -‐ Informatics Nurse Marie Lincoln RN -‐ Informatics Nurse Julie Carlson -‐ Senior Analyst
Learning Objectives: • Describe three factors leading to end-‐user resistance to change specific to implementing an electronic health record. • List three principles of adoption theory specific to the implementation of an electronic health record. • Identify three new communication strategies that will improve end-‐user adoption in the acute care setting.
1041 -‐ MU and U – Advancing with MEDITECH is as Easy as 1, 2, 3
Presenter: Marcia Cheadle Organization: Inland Northwest Health Services (INHS), Spokane, Washington This presentation will review where the US is at in the overall Meaningful Use Strategies. Options for planning, preparing, implementing, reporting and attesting will be shared. The latest in preparations for Stage 2, Stage 3, audit updates (including recent legislative), and FAQ clarifications. Marcia Cheadle, RN, Senior Director of Advanced Clinical Applications for Inland Northwest Health Services (INHS). She has over 30 years of direct health care experience serving in acute, ambulatory and home care nursing roles. Marcia is responsible for the implementation and integration of more than 30 hospital advanced clinical programs including transition to MEDITECHs 6.1 platform. She has directed multiple initiatives leading to EMRAM HIMSS Stage 6 and 7 recognition. Over the past four years, she has orchestrated multiple Meaningful Use, Stage 1 and Stage 2 Attestations. Marcia currently serves as Vice Chair of eHI Policy Steering Committee; a federal non-‐profit coalition whose mission is to drive improvement in the quality and costs of healthcare by promoting the use of technology and information through research, education and advocacy efforts. She teaches in the Health Care Administration graduate program at Eastern Washington University as well as continues her clinical nursing practice at a local emergency department.
1042 -‐ Children Are Different: Adapting Adult Care CPOE Technology for Pediatric Care Deployment
Presenters: Leslie Stewart, Joannie Decker, Lilliana Saucedo, L. Stewart, V. Hill, J. Decker, L. Saucedo, M Skinner, D, Thomas, G.A. Gellert, and S.L Webster Organization: CHRISTUS Health, Houston, Texas Background and Objective The peer review literature has recognized the significant variability in the level of pediatric-‐specific medication dosing functionality provided in currently available CPOE applications. The literature has also noted a lack of rigorous reports on CPOE dosing rule development in the formal literature. This presentation outlines an alternative and product-‐specific approach to enhancing an existing CPOE system to address the unique needs of a pediatric population. In addition, this presentation assesses the success of the enhancements through an evaluation of provider adoption of the system within a freestanding children’s hospital.
Methods Children’s Hospital of San Antonio is a unique organization within the CHRISTUS Health system with over a dozen pediatric subspecialties. Serving the tiniest of infants to the unfortunate reality of having a significantly higher than average incidence of childhood overweight and obesity, our pediatric patient population in South Texas places unique demands on our system. This was an important consideration as we evaluated the provider order entry application in our existing EHR for pediatric specific functionality. During 2012-‐13, CHRISTUS Health rolled out the use of the Provider Order Management (POM) application within the MEDITECH Client/Server 5.6 EHR to its providers in 19 different facilities. The deployment of the POM application at Children’s Hospital of San Antonio was deferred until the end of the implementation cycle. A gap analysis performed in August 2012, identified critically needed system functionality enhancements in addition to a significant expansion of existing pediatric focused medication strings and order sets needed for safe and successful adoption by providers caring for our most critically ill pediatric population. In early 2013, representatives from CHRISTUS Health participated in a MEDITECH Focus Group for Pediatric Ordering that included other hospitals from across the nation. This allowed CHRISTUS to submit requests for specific enhancements as well as provide feedback on proposals that evolved from the work of the focus group. In March 2014, CHRISTUS Health received significant enhancements as part of its upgrade to MEDITECH C/S 5.66. Enhancements included but are not limited to: 1) weight-‐ based medication dosing strings with headers to clearly differentiate from non-‐weight based medication strings; 2) min/max dose for use in weight-‐based dose calculations; and 3) dosing sets with ability to limit availability by patient age and/or location. Additional enhancements resulting from continued work with the focus group are expected with future system updates/upgrades. In order to utilize the provided system functionality, it was essential to focus on clinical content development and computerized clinical decision support. Our Health Informatics team throughout the organization worked intensively over 30 months with our pediatric clinicians to create the following enterprise-‐wide, standardized content and functionality: • Comprehensive set of over 210 pediatric-‐specific order sets encompassing a variety of care settings and sub-‐specialty content • Over 1800 dosing sets associated with 372 medication profiles which enables providers with over 1800 weight-‐based medication dosing strings • Pediatric Medication Dosing policy which enables providers and pharmacists with defined guidelines for medication dose standardization/rounding to ensure the dispensation and administration of practical and accurately measured medication doses ordered based upon weight-‐based dosing calculations and recommendations • Approved list of PEDI-‐NICU Standard Concentrations including associated dosing guidelines, max dose, and rounding information to support build of clinical content within the EHR Results On November 4, 2014 the POM application was rolled out to the Emergency Department, Neonatal Intensive Care Unit, and Oncology/Hematology at Children’s Hospital of San Antonio. By Day 2, the hospital achieved greater than 50% of medication, radiology, and laboratory orders entered directly by providers. On December 3, 2014 the POM application was rolled out to the remaining units within the facility and has since consistently achieved greater than 80% of medication, radiology, and laboratory orders entered directly by providers. The clinical content and functional enhancements created through our systematic effort over the prior three years were received very well by the provider community of
Children's Hospital. Clinicians valued and felt at ease in regard to the safety and effectiveness of this Pediatric CPOE module. We contend that these efforts contributed substantially to provider adoption being so strong from the outset of the go-‐live, and then accelerating rapidly. Indeed, the pace of adoption of CPOE at Children's Hospital was the most dramatic and aggressive among all 19 prior CHRISTUS hospital implementations. Conclusions The highly differentiated nature of pediatric clinical care versus adult care warrants the creation of unique functional features within CPOE in order to treat children effectively and safely (in addition to the development of specialized clinical content/pediatric-‐specific order sets). The intensity and amount of effort required to accomplish the above was substantial; we estimate over 130 team meeting hours and over 2100 order set build hours were required. The impact of this project has been very far reaching, and particularly beneficial to providers far afield of Children’s Hospital of San Antonio and our affiliated pediatric specialties. By leveraging the center of pediatric excellence in our large care network (and region), we have created a system that is benefitting thousands of pediatric patients; historically accounting for 50% of pediatric care delivery outside of the Children’s Hospital. Now clinicians, who may not have pediatric expertise to quickly determine dosage for their youngest patients will benefit from the enhanced safety and functionality of our CPOE system. The rapid rate of CPOE adoption illustrated by this implementation at the Children’s Hospital represents the endorsement of this application as being accurate and facilitative. Future analyses to evaluate impact on medication error prevention and various patient outcome measures are planned. Dr. Leslie Stewart has worked at CHRISTUS Health for 15 years, the last four as System Director for Clinical Informatics. She graduated from the University of Arkansas for Medical Sciences in 1998 with her Doctor of Pharmacy degree. She then completed an ASHP Affiliated General Practice residency at DCH Regional Medical Center in Tuscaloosa, Alabama. She joined CHRISTUS Health in 1999 as a Clinical Pharmacist where she lead and participated in many projects and initiatives to improve patient safety and ensure compliance with Joint Commission medication management standards. In September, 2007 Leslie accepted the position of Associate Director of Pharmacy Informatics and Medication Safety with the QPSI (Quality and Patient Safety Improvement) department. As part of her focus to further the enterprise commitment to achieve safer, more effective medication use through the intelligent and cost effective use of new technology and drug information, she directed the maintenance, ongoing development and implementation of clinical standards in pharmacy practice and medication management within MEDITECH and its various modules through her leadership and facilitation of the Pharmacy Module Advisory Group, the BMV-‐eMAR Affinity Group, and the Pedi-‐Nicu Standard Concentration Working Group. In January 2011, she accepted her current position responsible for transforming care by analyzing, designing, and implementing clinical information systems and clinician workflows utilizing standardized clinical content, analytics, and appropriate clinical decision support to enhance outcomes and improve patient care across the continuum. Learning Objectives: • Identify potential barriers to CPOE adoption, including safety and workflow challenges to the existing adult focused Computerized Patient Order Entry (CPOE) system to support deployment in a Children’s Hospital. • Recognize the need for EHR vendors and customers to work together to adapt and enhance current systems to support the unique needs of a pediatric population. • Understand that focused clinical content development and computerized clinical decision support is necessary to fully utilize enhanced functionality provided by the vendor.
1043 -‐ Concrete Foundation to CPOE
Presenters: Ana Carrillo and Sandra Botts, RN Organization: George L. Mee Memorial Hospital, King City, California It is not the beauty of a building you should look at; it’s the construction of the foundation that will stand the test of time. We are a hospital with five ambulatory clinics in King City, CA. with an average of 24 providers and contracted locums as needed. Four sites in town and one site, 10 miles up north. Realize that the foundation of CPOE can make you or break you. To have a successful CPOE Go-‐Live, it’s critical that all positions’ workflows are laid out, reviewed, and followed. Identifying the many roles that are in a clinic will determine the amount of access that they will have in the MPM suite of modules to have a smooth CPOE roll out. It is vital that all medications administered, procedures performed and their billing codes are identified to determine the build in the MPM suite of modules. Consider: • Medications -‐ Who administers them? Is there a verification system that the clinics use? • Procedures -‐ Who processes the Procedure? Is it performed in-‐house or at an outside location? Is there an Interface in place? • Supplies -‐ Identifying the correct naming convention • Billing Codes Learn about retrieving results and result entry -‐ how will test results get into your EMR system? To have a successful CPOE Go-‐Live, it’s critical for all staff (from front office the coders) to be familiar with each other’s roles, to help them understand the significance of their own role.
1044 -‐ NPR Tips ‘n’ Tricks: Plug ‘n’ Play NPR Utilities
Presenter: Joe Cocuzzo Organization: Iatric Systems, Inc. The old joke is NPR (Non-‐Procedural Representation) stands for “No Programmer Required.” Actually, one of the great strengths of the NPR report writer is that you CAN use it to program. But not everyone likes curly brackets, so this we will present a set of NPR plug ‘n’ play utilities for C/S and MAGIC that you can use with your NPR reports or Customer Defined Screens to do the following: • Create a revisit report showing both the original encounter and the revisit with no need for fragments, line checks, or computed fields, using our flexible utility in a “start” macro • Add allergies to any page header • Add vital signs or lab results to any report • Add a “display-‐only” field showing a lab result on a MAGIC or C/S CDS • Add automatic auditing to any field on a registration screen • Add graphical features to a field with a CON utility:
o o o o
CON=%Z.zcus.is.con.M.greybox(0) CON=%Z.zcus.is.con.M.checkbox(0) CON=%Z.zcus.is.con.M.accent(0) CON=%Z.zcus.is.com.M.underline(0)
Attend this year’s Tips ‘n’ Tricks presentation to bring home helpful NPR plug ‘n’ play utilities. Joe Cocuzzo is a Senior Vice President at Iatric Systems and leads its Report Writing Services team. Before joining Iatric Systems in 2000, Joe was a Senior Programmer Analyst at Newton-‐Wellesley Hospital for nine years, where he did a variety of MAGIC NPR and $T report writing, VB scripting, and VB programming. Joe was also an Applications Consultant at MEDITECH, where he supported ABS/ADM/MRI/MIS and taught NPR RW classes.
1045 -‐ Our Journey Through the Discharge Process
Presenter: Audrey Premdas Organization: Arrowhead Regional Medical Center, Colton, California The patient discharge process has evolved from a disjointed activity years ago to what can be a well-‐ coordinated team effort. The team is essential to prevention of readmission and promotion of recovery and health in the home. This is even more vital with complex hospitalizations. This presentation will review Arrowhead Regional Medical Center’s (ARMC) process change from MEDITECH’s 5.65 platform discharge to 5.66 pp8 Discharge Routine. It will exam the provider acceptance, training requirements, and the vital inclusion of other team members into the discharge process. It is important to send the patient home with printed information as much of what is explained during the hours prior to discharge can be overwhelming, thereby not remembered. The new Discharge Routine provides a well-‐organized, comprehensive discharge packet that the patient can review at their leisure. Audrey Premdas has been a Registered Nurse since 1980 and started her career at UCLA Medical Center in an adult Medical/Dermatology unit. She devoted the next 31 years to working in neonatal nursing with 20 of those years practicing in the level III Neonatal Intensive Care Unit (NICU) at Cedars-‐Sinai Medical Center in Los Angeles. Seven years were spent in the NICU at Arrowhead Regional Medical Center when circumstances brought her to the Information Management department where she has been working for three years. Audrey’s main focus has been on the physician side of MEDITECH Client Server with Provider Order Management (POM) procedure and order set building, and Physician Care Manager (PCM) physician documentation template creation and the Discharge routine. She collaborates on PCS, ONC, EDM, MPM, and OR modules. Her most recent projects have been the Phillips monitor interface, re-‐working the process for entering telemetry monitoring billing process via CPOE, and collaborating on the patient portal.
1046 -‐ Get Your Patients into Bed! Using Bed Board at Your Facility
Presenter: CC Snyder Organization: Jasper County Hospital, Rensselaer, Indiana This presentation will demonstrate how to use Bed Board to request beds, reserve beds, admit and transfer patients. You will see how Bed Requests can be done from the built-‐in functionality in EDM and SUR, and how to do a Bed Request from Admissions. You will learn how to reserve a bed for patients by using Bed Board as a communication tool between nursing units to notify staff when a patient can be admitted. You will learn how to create worklists to include pertinent information so that staff can see important details when completing a bed request or creating a Bed Reservation. This will also demonstrate how Housekeeping can use Bed Board to be notified when rooms need to be cleaned and what precautions they should use when sanitizing the room. CC Snyder has been an employee at Jasper County Hospital for the past 14 years and has been a member of the Information Systems Department as a Clinical Application Specialist for the past two years. She has been involved in a number of MEDITECH projects on the Magic platform and more recently as a core team lead for several modules during the implementation of the 6.13 platform of MEDITECH. In the Magic Platform, she was involved with the Scanning and Archiving project and also the Electronic Data Interchange project with a third party insurance verification software. She has worked closely with staff for the recent implementation of 6.13 on September 1, 2014 and is actively involved with the following modules: ABS, ADM, ARM, BAR, CM, HIM, PCS, QM, RM, and SCH. She also provides support for the Maestro Home Care software.
1047 -‐ Bridging Gaps – The Next Generation of Integration
Presenter: Angela Twedt Organization: Kootenai Health, Coeur d’Alene, Idaho Whether a small community hospital or large integrated delivery network, all hospitals are faced with data exchange and interoperability needs. Today’s healthcare landscape has and will continue to change, demanding hospitals to share patient data throughout the continuum of care. Kootenai Health strives to be a patient centered, forward thinking facility that provides a comprehensive integrated range of medical services to patients in north Idaho, eastern Washington, Montana and the Inland Northwest. Integration is a priority reflected in our strategic plan, our Meaningful Use attestation goals, and continued focus as seen with increased requirements for interoperability. As we tackle integration projects they create unique challenges from assuring patient information and results are delivered to providers in an efficient manner, to delivering integration on time and on budget, as well as working to meet the many interoperability standards to ensure data can be consumed and of course is meaningful. In this session, you will learn how Kootenai Health was able to bridge the gap by implementing technologies, ensuring privacy and accessibility while improving information sharing to healthcare providers across all continuums of care. As with any project there are lessons learned, collaboration with our vendor partners to improve the process and software, and some stumbling blocks along the way. In this session, you will also learn how Kootenai Health met those challenges.
Learning Objectives: • Review of a strategic integration plan, how to prioritize and implement. • Technology: o How to implement successfully and communicate with your vendor partner(s). o What technologies make Kootenai Health successful? • Integration with our ancillary systems, physician community, state reporting, HIE, patient portals and the latest CCD data exchange. We’ll cover it all.
1048 -‐ Downtime Preparedness: Ensuring Patient Care Continues During MEDITECH and/or Network Downtime
Presenter: Justin Ryans Organization: Laughlin Memorial Hospital, Greeneville, Tennessee As organizations move toward paperless EMRs, the impact of system or network failure can be devastating. Many organizations are reviewing their plans and identifying how to ensure business continuity during both network or system downtime. As provider adoption increases, so does the reliance on EMR systems to safely care for patients. It is imperative to have a system in place to counter the inevitable downtime. During 2011 our organization, Laughlin Memorial Hospital, embarked on our CPOE journey and immediately identified that access to critical patient data was necessary to provide care. Information needs ranged from census data, to progress notes, to clinical documentation and medications. Without this information our physicians would quickly become frustrated during any downtime situation. Our organization developed a comprehensive downtime strategy which includes a technology platform to support us during any downtime situation. With monthly planned downtimes that range from 2-‐3 hours in length as well as preparing for unplanned situations, ensuring we have a plan in place was necessary. Join us as we present our story. Learn how we provide access to key, critical near real time report data to a large population of staff with access to 54 unique downtime stations. We’ll review our report selection, as well as process in choosing our data. We have our process defined for scheduled vs. unscheduled downtime including emergency access managed at our executive level and IT Management Team. Downtime can be costly from both a financial perspective and more importantly patient safety. Implementing technology to provide access to critical data during downtime will increase confidence in the provider, care team, and ensure patient care goes uninterrupted. Justin Ryans is the Applications Manager for the Information Technology Department at Laughlin Memorial Hospital, a 140-‐bed facility in Greeneville, TN. Justin has over seven years of experience with MEDITECH and 14+ years in Healthcare. Justin received his bachelor’s degree from Milligan College in 2001, and received his MBA from East Tennessee State University in 2005.
1049 -‐ Meeting MU Stage 2 with Direct Messaging and Adoption of a HISP While Setting Course for the Next Phase of CCD Data Exchange
Presenter: Rebecca Woods Organization: Porter Medical Center, Middlebury, Vermont Porter Medical Center is a 25-‐bed critical access hospital with 12 physician owned community practices both Primary Care Medicine and Speciality practices located in Addison County (Vermont). In order to meet our Meaningful Use Stage 2 Direct Messaging requirements, Porter Medical Center set forth on a plan to select a technology that would not only meet our immediate HISP (Health Information System Provider) requirement but also pave the way for the future integration phase of CCD data exchange. In our presentation, we will outline: • Steps in selecting the right technology platform for CCD data exchange. • Our implementation timeline which included an aggressive 3 month deadline to meet our Oct 1st attestation goal. • Success in getting your first CCD exchange to work! Lessons learned. • The challenges of owning your physician practices while still meeting your MU 2 requirement of sending a CCD to the outside world. • How to successfully work with your community HIE for CCD submissions for all transitions of care. • How to prepare for ongoing Meaningful Use efforts. Join us as we outline our process for communicate via direct messaging to over 60 physician mailboxes within our community. We will close the presentation with a review of our future plans to leverage our technology investment to support query based transactions to meaningfully and proactively solicit CCD’s upon patient presentation to our facility. Rebecca Woods, MHINF is the VP Information Technology & Compliance at Porter Medical Center in Middlebury, VT. Learning Objectives: • Steps in selecting the right technology platform for CCD data exchange. • Success in getting your first CCD exchange to work! Lessons learned. • The challenges of owning your physician practices while still meeting your MU 2 requirement of sending a CCD to the outside world.
1050 -‐ Using the Data Repository to Drive CPOE Adoption
Presenters: Donnal C. Walter M.D. Ph.D. and Michael F. Stefanchik, PhD Organization: Arkansas Children's Hospital, Little Rock, Arkansas User adoption of CPOE is enhanced when clinical users know how they and their peers are performing, but obtaining and analyzing this information through standard MEDITECH reports is cumbersome and impractical. During our phased roll-‐out of CPOE at Arkansas Children's Hospital we evolved data modeling tools for the Data Repository that allowed us to follow user performance longitudinally by
location, order source, and other variables. The components of these tools include SQL Stored Procedures (SP) on the server, Visual Basic spreadsheet macros connecting to the SP, Pivot Tables, and a series of spreadsheet charts for visualizing the data. We report our findings from December 2013 to December 2014 covering 813,711 orders over 52 weeks. After the Med-‐Surg units went live (weeks 6-‐21), the percentage of written or verbal orders hovered around 31% with considerable variation (SD 29%). Following improvements in the order-‐sets and bringing the Pediatric ICU online (Weeks 26-‐39), this number dropped to a mean of 21% (S.D. 24%). After all units went live (Weeks 41-‐52), including the CVICU and NICU, written and verbal orders dropped to 6.7% (S.D. 4.7%) and this trend has continued thereafter. Pareto analysis revealed that the top 10% of providers placed 40% of the CPOE orders, while the bottom 40% of providers placed only 3% of the orders. Order-‐set analysis revealed that 44% of CPOE orders were placed via an order set. Most frequently used were admission order sets followed by convenience sets (e.g. pain prevention), and high volume procedure sets (e.g. tonsil). Drill-‐down analysis identified problematic orders and problem users, and the need for additional orders and order sets. User adoption is influenced by many factors including changes in work flow, user engagement in preparation, training, user interface, and feedback to users. With the right tools, the DR is a rich source of information for identifying problems early, focusing attention on the areas that need work, and giving positive feedback to providers. Dr. Donnal Walter has been a MEDITECH user at Arkansas Children's Hospital since 1985, was the CMIO there for six years, and led the CPOE initiative in 2014. Dr. Michael Stefanchik has been a frequent presenter at MUSE conferences. As a senior consultant, he worked closely with Dr. Walter in the CPOE rollout and the development of the data analysis tools. Learning Objectives: • The learner will be able to explain the use of SQL stored procedures, spreadsheet macros, and pivot tables in the analysis of orders maintained in the Data Repository. • Compare and contrast: (1) one-‐way and two-‐way frequency distributions, (2) absolute and relative frequency distributions, (3) Pareto analysis of frequency. • Explain the strengths and weakness of Run Charts in the analysis of frequency data over time.
1051 -‐ No Worries: How the Right Testing Led to Successful Upgrades at Steward Health Care Presenter: Cheryl Menard Organization: Steward Health Care System, Boston, Massachusetts In this presentation, the head of IS Quality Assurance at the second largest health care system in New England shows how the right testing team and process can lead to worry-‐free upgrades, regardless of your size. In 2011, a Director of IS Quality Assurance was hired to tackle the task of successfully implementing the increasingly complex upgrades of the EHR and hospital applications at Steward Health Care. A testing team was built from the ground up. They were supported with customized tools and processes; and
continuously enhanced the process to fit Steward’s unique needs. This challenging and, ultimately, successful experience at Steward is an instructive case study in: • How and why to do formalized testing for application upgrades; • How to build (and justify) a testing team; • How to evaluate the costs associated with testing; • How to realize the significant benefits of this process. The presentation will identify the range of testing solutions available (including building a subset of testing processes) based on your organization’s needs, size and scale. Audience members will leave with the practical knowledge – and personal encouragement – that comes from the experience of someone who’s been there. Cheryl Menard is the Director of IS Quality Assurance at Steward. She has been at Steward for the past three years. Steward Health Care System is the second largest healthcare system in New England and is comprised of 17,000 employees, 11 hospital campuses, 24 affiliated urgent care providers, home care, hospice and other services. Prior to Steward, she was the Quality Assurance Manager at Mercer, a consulting firm focused around helping clients with health, retirement, and investments. Prior to Mercer, Cheryl was Quality Assurance Manager at Putnam Investments. Cheryl has over 20 years of leadership experience that includes both Quality Assurance and Project Management. She has a proven track record of establishing Quality Assurance groups within Fortune 500 companies, and has expertise in process improvement, resource management, offshore teams, budgeting, planning, and reporting.
1052 -‐ To Change or Not to Change: Change Management – How We "CHANGED" It
Presenter: Martha Sullivan Organization: Harrison Memorial Hospital, Cynthiana, Kentucky We barely have enough staff to do the projects. What do you mean we have to have a formalized documented policy on change management? Are you kidding me – how am I supposed to do this and then follow this process when there are 10 more projects I need to get started on? This is how we felt within the IT department about Change Management, but after two Risk Analyses, both identified the lack of a formalized Change Management policy and/or procedure, we began to look at what improvements could such a formalized process make to the overall success of our projects. We will present our Change Management Journey since December 2014. Martha Sullivan has worked for 36 years at Harrison Memorial Hospital. She is currently the Chief Information Officer. She is a graduate of Indiana Wesleyan University with a BA in Management and Associates Degree in Computer Programming.
1053 -‐ Up with CPOE! Methods to Increase CPOE Utilization Among Providers
Presenters: Jacquelyn Burrell, PharmD and Jodie Sharp, RN Organization: Harrison Memorial Hospital, Cynthiana, Kentucky Join us to learn about a focused approach to improving the percentage of medication orders entered by providers via CPOE following an analysis of Meaningful Use measure compliance. Also noted are opportunities for non-‐physician providers to better define order entry activities through revamped order sources. Jacquelyn Burrell, PharmD is a Clinical Pharmacy Analyst in the MIS Department, with 32 years of pharmacy experience; the last seven years in pharmacy informatics. Jodie Sharp, RN is a Clinical Analyst in the MIS Department.
1054 -‐ Setup a New Health Resource (HRS) Facility
Presenter: Jason Weathers Organization: Ephraim McDowell Medical Center, Danville, Kentucky We will explain in detail the steps it takes to create a new Health Resource (HRS) facility. This includes dictionary builds in various applications (MIS, PWM, and SCH) and how they all tie together. Jason Weathers has worked at Ephraim McDowell Medical Center in Danville, KY for five years as an Application Analyst. He has a strong background in PWM/LSS as well as other MEDITECH applications.
1055 -‐ Connecting the Gaps Between Inpatient and Ambulatory Care: Bi-‐directional Orders and Results
Presenters: Helene Gordon and Carol Pileggi Organization: White Plains Hospital, White Plains, New York and Phelps Memorial Hospital, Sleepy Hollow, New York Drivers: • Growing laboratory outreach services: competition with Lab Corp, Quest, etc. • Acquisition of ambulatory practices with diverse EHR platforms. • Multiple independent physician groups requesting the ability to send orders and receive results. • Future Stage 2: Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of electronic lab orders received. Existing Challenges: • Majority of interfaces through engine results only • Existing Third party solution for outreach orders exchange focused on web viewer and for lab only. • Customization of interface engine time consuming, not repeatable, complex.
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MEDITECH does not possess solution to address use case for both outreach (requisition and specimen processing) and physician orders (future order and later draw/test/result)
Future State Objective: • The ability to quickly implement and easily manage the integration • Cost Effective • Customizable – rules based • Support a variety of transport methods • Support variety of workflows within MEDITECH and EHR vendors • Meet security and transaction standards • Utilize HL7 standards • Support multiple, disparate EHR vendors (certified) Process to Current State: • Solution and Vendor selection • Implementation (Steps and Lessons Learned) o Required MEDITECH interfaces o Summit Provider Engine and Configuration o Interface Engine and Pass Thru Requirements o Customizations, Testing and Tweaking o Go Live and Support and Celebrations • Priorities: Bi-‐directional order and lab results (STATS and successes) o Hospital Owned Practices (ECW and Next Gen) o New Lab outreach clients o Migration of existing lab outreach clients o 2014: Non lab orders (rad, card, discharge summaries, etc.) Based in Armonk, NY Stellaris Health Network provides shared services to Lawrence Hospital Center (Bronxville, NY), Northern Westchester Hospital (Mount Kisco, NY) Phelps Memorial Hospital Center (Sleepy Hollow, NY), and White Plains Hospital (White Plains, NY). With nearly $850 million dollars in combined revenue and 1,100 in-‐patient beds, these hospitals account for over a third of the acute care bed capacity in Westchester County. It is one of the largest area employers, with over 5,000 employees and approximately 1,000 voluntary physicians on staff. The Stellaris hospitals provide multidisciplinary acute care services as well as a range of community based services such as hospice, home health, behavioral health and physical rehabilitation. White Plains Hospital is a leading healthcare provider in Westchester County and home to many renowned programs and services. The Hospital offers much of the technology and specialty care usually found at large teaching hospitals, and combines it with compassionate care close to home. Phelps Memorial Hospital Center is a 238-‐bed acute care community hospital, located in central Westchester County. Since its beginnings in 1956, Phelps has strived to provide its community with the finest quality healthcare. Helene Gordon MS, SC (ASCP) is an LIS Analyst at White Plains Hospital. Carol Pileggi is an LIS Analyst at Phelps Memorial Hospital.
1056 -‐ MEDITECH 6.14 – Challenges Post Implementation
Presenter: Jackie Rice Organization: Frederick Memorial Hospital, Frederick, Maryland Frederick Memorial Hospital (FMH) was the first hospital in the US to receive 6.1 in July 2013. It has been quite a journey to reach a steady state and we would like to share some of the celebrations and challenges of the journey. Jackie Rice has more than 25 years of experience within the healthcare industry, most recently as the IS Director of Clinical Applications for Frederick Region Health System leading application support teams and numerous software implementation projects. Since joining the IS department at FMH in 2004, Jackie has helped lead her staff through the implementation of various IS initiatives moving the organization from Stage 3 to Stage 6 on the EMR Adoption Scale. Jackie was helped her team successfully achieve the ARRA Meaningful Use at FMH through the Stage One attestation process for four consecutive years resulting in over $8 million in stimulus incentive payments for the hospital. Jackie also project managed the implementation of MEDITECH 6.1 at FMH – the first hospital in the United States to go live with that platform and the new financial applications.
1057 -‐ Oncology Implementation
Presenter: Seyi Ogunrinu Organization: Arrowhead Regional Medical Center, Colton, California Oncology Management is an application that only one other MEDITECH site had adopted, so when we began implementing this application it was a challenge. Working at a facility that has an Infusion Therapy and Oncology Clinic, it was important for our informatics department to provide clinicians with the tools that would assist them with managing the care of cancer patients. This presentation will go over the challenges discovered along the journey and our successes. As an analyst in the health care sector, Seyi Ogunrinu has been working for four years in the implementation of various MEDITECH Client Server clinical applications within our organization, including MPM, EDM, and ONC. Seyi’s background before entering clinical applications development includes working seven years in hardware/network support in the clinical enterprise setting.
1058 -‐ HIMSS Analytics EMRAM Stage 7: Ontario Shores Centre for Mental Health Sciences First in Canada
Presenter: Wendy Odell Organization: Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Purpose/Objective: Ontario Shores Centre for Mental Health Sciences (Ontario Shores) has been recognized by the Healthcare Information and Management Systems Society (HIMSS) for achieving Stage 7 in the Electronic Medical Record Adoption Model (EMRAM). Ontario Shores is the first hospital in Canada and
the first mental health hospital in the world to achieve the HIMSS Analytics EMRAM Stage 7 Award. Achieving Stage 7 reflects the high standard of quality at Ontario Shores and demonstrates efforts in advancing care for individuals living with mental illness. As a result, our electronic medical record system enhances patient safety, improves delivery and quality of care, and standardizes clinical documentation in an environment which is efficient, secure and collaborative. The objectives of this presentation are: • Discuss organizational strategies towards achieving HIMSS Stage 7 designation • Review the importance and benefits of being a HIMSS Stage 7 organization • Review outcome measures of key organizational initiatives contributing to HIMSS Stage 7 designation. Methodology/Approach: A multidimensional approach was utilized to ensure key components for Stage 7 were met. Key domains of focus included: pervasiveness of use, clinical decision support, governance, clinical and business intelligence, health information exchange, and disaster recovery and business continuity. Critical foci has been placed on areas of Computerized Physician Order Entry (CPOE), medication scanning and patient identification scanning, and key clinical practices to support quality of care and patient safety. Findings/Results • Medication and patient scanning rates consistently maintained at 95% or higher since April 2014 • CPOE rates have consistently maintained 90 – 94% since September 2014 • Medication reconciliation on admission has been maintained at 95% Conclusions/Implications/Recommendations • Consistent open communication with all clinicians on the importance of the use of data from EMR to enhance quality of care and patient safety • Develop infrastructures to create opportunities for surveillance on key patient safety practices (i.e. CPOE, medication and patient scanning) • Develop ongoing adoption strategies to support the use of EMR for quality of care and patient safety" to come later
1059 -‐ Ontario Shores HealthCheck Patient Portal
Presenter: Wendy Odell Organization: Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Purpose and Objective: Ontario Shores uses the Recovery Model towards patient care. The Recovery Model is based on the principles of empowerment, hope, recovery, collaboration, identity, responsibility and meaning in life. Central to this philosophy is the need for consumers of mental health services to be involved in their care. Accordingly, Ontario Shores implemented the Patient and Consumer Health Portal (PCHP). The goal of the Patient Portal is to provide seamless and system wide exchange of information, which ensures patients have timely and transparent access to their health information. Family members may also have access to the PCHP depending upon capacity and consent. Implementation of the Patient Portal aligns with the Central East-‐Local Health Integration Network’s vision of bringing technology into healthcare, supporting patient-‐centered care approaches. The PCHP was evaluated for its utility in
increasing patient satisfaction with services, decreased the number of missed appointments for outpatients, decrease and the number of requests for information that can be viewed in PCHP. Methodology/Approach: In order to implement the PCHP, a review of the current state of patient and family engagement was conducted in order to: (1) identify where patient involvement would be most effective; (2) improve patient overall satisfaction in care; and, (3) reduce the delay in sharing information among health care providers, patients and families. Also, a review of the MEDITECH 6.0 PCHP functionality was completed to understand how the aforementioned goals could be achieved. The implementation of the PCHP would allow patients and families to (1) send and receive notices to the primary health care provider and the physician, (2) review the patient’s health data and laboratory results, (3) request medication renewal, (4) view upcoming appointments, (5) update personal demographic information, and (6) review visit history of the patient at Ontario Shores. Next, patients and families are involved in the design, testing, implementation, ongoing marketing and evaluation of the patient portal. Findings/Results: Results will be to compare pre-‐implementation and post implementation data of (1) patient satisfaction via the patient satisfaction survey, (2) decrease the number of missed appointments or no shows, (3), decrease the number of requests for information by enrolling patients in PCHP. Conclusions/Implications/Recommendations: The results of PCHP will be discussed in light of adoption, usage and effectiveness after 3 months, 6 months, 9 months and a year after implementation.
1060 -‐ Henry Mayo and the Pursuit of the IT Holy Grail (Medical Device Integration)
Presenters: Ulla Lindsey and Ryan Molina Organization: Henry Mayo Newhall Hospital, Valencia, California Come join the Henry Mayo team as we journey towards the Holy Grail of patient safety and device integration. Hear our successes in our integration of the patient monitors in the ICU and ED, our current challenges in integration of the portable vital signs devices, and our future plans for our smart pump integration. Ulla Lindsey, RN, JD Clinical Informaticist Ryan Molina, RN, Clinical Informaticist
1061 -‐ State Statistical Reporting (aka KYIPOP in Kentucky)
Presenter: Jennie McWhorter Organization: Ephraim McDowell Health, Danville, Kentucky This presentation will go through the setup required to prepare for 5010 files to be sent to the state for statistical reporting. We will review the setup across many different dictionaries and discuss these topics: • MIS Insurances • BAR Claims • Claim Checks • Claim Check Data • Claim Maps • Queuing Claims • Creating the Outbox Message • Delivering the file to the "recipient" • Reviewing what the message looks like in the .txt format Jennie McWhorter has worked with MEDITECH for nine years since starting at Ephraim McDowell Health in 2006. She started as an Applications Analyst and was promoted to Operations Manager in 2010. Her strongest modules are all those related to MPM: APR, ADM, SCH, PWM, MIS, RXM. However, she has worked in all modules in some capacity in the past nine years.
1062 -‐ Building Assessments: Brick by Brick
Presenter: Judy Subora BSN RN Organization: Ephraim McDowell Regional Medical Center, Danville, Kentucky The purpose of the presentation is to teach the assessment building process. Assessments prepared for use in a timely manner are critical to the end user. The skills and techniques used in assessment building are essential to be successful in meeting the criteria purposed for reimbursements. The presentation will go through the process of building group responses and queries and adding them to assessments and appropriate modules. Judy Subora BSN RN Clinical Application Specialist worked as a bedside nurse for 20 years and then changed career paths to Information Systems. Learning Objectives: • The attendee will learn how to build a group response and insert into a query. • The attendee will learn how to attach queries into assessments. • The attendee will learn how to attach assessments to interventions and attach to appropriate modules.
1063 -‐ Closed Loop Physician Practice Laboratory Orders Interfaced to the Hospital
Presenter: Tim Wong Organization: Emerson Hospital, Concord, Massachusetts It’s true. A comprehensive physician practice laboratory orders interface to a hospital is harder than it sounds. With the myriad combinations of physician office relationship structures and software solutions; along with the requirements of Meaningful Use for laboratory ordering and NCQA test tracking, deploying a pragmatic laboratory orders interface solution is challenging; however, it can be done! A multi-‐disciplinary group made up of Information Systems, Laboratory and Registration Department leaders and support staff worked to implement a technology solution to expedite closed loop laboratory ordering and result reporting to physician practices. Laboratory orders that are submitted electronically from an Ambulatory Electronic Health Record are interfaced to the Hospital Information System for laboratory test completion. Once the results are interfaced and signed by the clinician the order is reconciled as completed enabling closed loop order to result patient review tracking. This provider and patient centered project expedites the automatic completion and reconciliation of hospital results for tests ordered from community physicians. The comprehensive workflow with this electronic ordering process has the opportunity to drive down call backs, reduce repeat patient blood draws while driving increased patient satisfaction. Timothy Wong currently serves as Manager of Application Services at Emerson Hospital in Concord, Massachusetts. He has led the organization through successful Computerized Provider Order Entry, Health Information Exchange and Meaningful Use Stage 1 and Stage 2 initiatives. Prior to joining Emerson Hospital, Timothy has worked in the Electronic Healthcare vendor, product implementation and management consulting firm domains. Timothy holds a B.S. in Medical Technology from the University of Vermont and a MBA from Suffolk University. He is an active member of the New England Health Information Management System Society (HIMSS) chapter and also has achieved Project Manager Professional (PMP), Certified Professional in Healthcare Information Systems (CPHIMS), and Information Technology Infrastructure Library (ITIL) certifications.
1064 -‐ Superbill Remediation: Professional Billing via PDoc
Presenters: Andrew Dubbels, Dr. Joel Brownell, and Frank Burns Organization: Children's Hospital Central California, Madera, California The upcoming transition to ICD10 is going to make current pamphlet sized paper superbills look more like novels. Our hospital has leveraged a tool that the physicians are already in daily, PDoc, to record their ICD9 soon to be ICD10 diagnosis codes and relevant CPT codes. We have then extrapolated this information and transmitted it electronically to our contracted billing company for professional fees. During this brief presentation we will highlight how we did this, the troubles that we overcame, and the reports that we are reconciling against to insure that we are submitting everything that we should." Andrew Dubbels serves as an IT Applications Consultant for Valley Children's Hospital. He works primarily on the Physicians Applications Team supporting the tools that the physicians use on a daily
basis. The team’s goal is to minimize the time that the physicians spend in front of the computer therefore increasing the time that they can spend in front of the patients. Dr. Joel Brownell is the VP & CMIO at Children's Hospital Central California.