Interesting week EMR-wise. We had a successful launch of EKG and stress test tracing images to the Clinical Notes as well as delivery of these results to BMP physicians ordering from the ambulatory setting. We're getting closer to making changes to the Table of Contents, as I reported earlier this week. But we also had something of a snafu with our attempted launch of the new Immunization Schedule.
Our intentions were good and, boy oh boy, did the IS team ever perform due diligence in terms of testing this new tool. Sometimes, though, all the testing in the world doesn't mean a thing when it can't be done in real time and space. To make a long night's story short, we ultimately decided to pull the schedule and reverted to the Immunization Profile, which really is just a plain text list of vaccines given.
For adults, the profile is fine, but for kids, whose MO is to be pin cushions through adolescence, the schedule was and will be a colorful enhancement. Expect to see it sometime in the TBD. For those of you whose patients are older than age 20, the schedule doesn't change things much except to lose the list and create a Historical Immunizations tab in the All Results band. All else functions as is including Health Maintenance and View Immunizations in the PowerNote. But for our younger patients, the schedule will provide visual cues and alerts that will improve the delivery of this essential component of care. You'll get the heads up when we are ready to give it another go.
In the meantime, one of my partners in crime, Pat Brown, created a couple of nice slide sets that I thought might be useful tips.
Friday, June 26, 2009
Monday, June 22, 2009
CIS Table of Contents (Menu bands)
This week will mark the end of the third month since the changeover to the unified version of CIS. Over the course of this time, we've had to overcome a variety of unexpected setbacks, but have also benefited from a host of changes that, when frustrated, go unseen in the midst of a rushed patient care session. Your voices have been heard and in response to suggestions made regarding the user interface, the Table of Contents (or Menu bands) will undergo an overhaul of a sort.
When we first made the changeover on March 24, a single TOC was designed for use by all. In the coming days, you will see a different arrangement, depending on where you spend the majority of your time. If, when you login to CIS, you see the Message Center with the Inbox, you will see the Ambulatory view as listed below; if you see the Message Center alone, yours will be the Hospital-based view; if you live in the ED and can login to FirstNet, then it's obvious what you'll be seeing.
Suggestions for modifications were culled from emails and less than formal conversations and were also sought from medical directors in order to better define site-specific designs. Check the lists below for what to expect in the coming days.
Ambulatory View
When we first made the changeover on March 24, a single TOC was designed for use by all. In the coming days, you will see a different arrangement, depending on where you spend the majority of your time. If, when you login to CIS, you see the Message Center with the Inbox, you will see the Ambulatory view as listed below; if you see the Message Center alone, yours will be the Hospital-based view; if you live in the ED and can login to FirstNet, then it's obvious what you'll be seeing.
Suggestions for modifications were culled from emails and less than formal conversations and were also sought from medical directors in order to better define site-specific designs. Check the lists below for what to expect in the coming days.
Ambulatory View
- Overview
- Documentation
- Clinical Notes
- All Results
- Laboratory (NEW)
- Micro
- Health Maintenance
- Histories
- Immunization Schedule (coming your way June 24)
- Growth Charts
- Diagnosis/Problems
- Medication List
- Allergies
- Orders
- Tasks
- other necessary, though not frequently used, bands
- Overview (take a closer look at the Since Last Time tab for new labs, results, documents since last date/time stamp. This can be helpful to look for new consults, etc.)
- Orders
- Documentation
- Clinical Notes
- Diagnosis/Problems
- Histories
- Medication List
- MAR
- MAR Summary
- Allergies
- All Results
- Laboratory
- Radiology
- Micro
- Interactive Flowsheets
- I/O
- Handover
- other necessary, though less frequently used, bands
- All Results
- Laboratory (NEW)
- Radiology (NEW)
- Allergies
- Clinical Notes
- Diagnosis/Problems
- Documentation
- Facesheet/Insurance
- Forms
- Histories
- Immunizations
- Medication List
- Micro
- Orders
- Patient Information
- Reference Text
- PowerNote ED (in anticipation of ED electronic documentation)
- other necessary, though not frequently used, bands
Friday, June 19, 2009
Imminent Improvements
Now that we've settled into the unified view of CIS (note the intentional avoidance of the word "enhanced"), the informatics team is able to circle back and make some changes to the interface that ought to improve your experience. First on the list is the rearrangement of the Table of Contents (or Menu) bands. These changes will be based on position (ambulatory-, ED- or hospital-based). Without going into too much detail, we will move the Documentation and Clinical Notes higher up the list and give lab results its own band to save you a few clicks. For ED docs and those who spend most or even part of their time in the hospital, the default opening page will be Orders rather than the Overview page. For ambulatory-based docs, you will see the removal of hospital-oriented entries like Med Rec and MAR Summary. Expect these changes to be evident in the next week or two.
We are also actively seeking a results to endorse solution that will enable a system-wide rollout towards the end of the summer. In order to make this happen smoothly, we are creating pools, (think "group proxies"), that will facilitate custom workflow design in every practice. While the usual routine in a primary care setting is for doctors to review results and communicate with patients accordingly, others choose to delegate this review and be made aware of abnormal results. My first thought is to create a results pool for each of the BMP practices. Pools will be posted at the same time that RTE will arrive in the clinician's Message Center inbox. A result can be reviewed and endorsed by the physician and will then drop off both their list as well as the pool's list. In the event that the protocol is for the medical assistant to endorse normal labs, then those results will also fall off the pool list as well as the ordering clinician's results list. It will be the responsibility of the practice to determine the proper protocol so as to avoid inadvertant endorsement of results that go unseen by the ordering clinician.
Other improvements:
We continue to work with Cerner to optimize the function of the Prescription Writer. If you haven't heard, two key points are to 1) Cancel/Reorder any meds that were last written with EasyScript. Thereafter, the Renew function will work well; and 2) when in doubt, fill in the Duration field. This will facilitate the easy completion of the Rx. Remember to click on the big downward yellow arrow found in the middle divider bar if you are unsure of what field needs completion to execute a script.
Med Rec is still in a tough spot, though we expect it to improve over the next few months.
We have a new Health Maintenance Redesign working group. The plan is to review current guidelines and bring the HM tool in line with the evidence and recommendations of sentinel task forces.
We are also actively seeking a results to endorse solution that will enable a system-wide rollout towards the end of the summer. In order to make this happen smoothly, we are creating pools, (think "group proxies"), that will facilitate custom workflow design in every practice. While the usual routine in a primary care setting is for doctors to review results and communicate with patients accordingly, others choose to delegate this review and be made aware of abnormal results. My first thought is to create a results pool for each of the BMP practices. Pools will be posted at the same time that RTE will arrive in the clinician's Message Center inbox. A result can be reviewed and endorsed by the physician and will then drop off both their list as well as the pool's list. In the event that the protocol is for the medical assistant to endorse normal labs, then those results will also fall off the pool list as well as the ordering clinician's results list. It will be the responsibility of the practice to determine the proper protocol so as to avoid inadvertant endorsement of results that go unseen by the ordering clinician.
Other improvements:
We continue to work with Cerner to optimize the function of the Prescription Writer. If you haven't heard, two key points are to 1) Cancel/Reorder any meds that were last written with EasyScript. Thereafter, the Renew function will work well; and 2) when in doubt, fill in the Duration field. This will facilitate the easy completion of the Rx. Remember to click on the big downward yellow arrow found in the middle divider bar if you are unsure of what field needs completion to execute a script.
Med Rec is still in a tough spot, though we expect it to improve over the next few months.
We have a new Health Maintenance Redesign working group. The plan is to review current guidelines and bring the HM tool in line with the evidence and recommendations of sentinel task forces.
Monday, June 15, 2009
PowerNotes Index on CIS Info Site
We continue to make the CIS Information Site the so-called "source of truth" for the what, where and how-to of CIS for all users. We will be posting an index of all PowerNotes that have been created thus far, organizing their titles by venue, that is, by the variety of areas in which they might be used. While I tried to define these divisions as broadly as possible, I would not be surprised if found additional ways of cross-referencing these templates. Let me know what you think.
Friday, June 12, 2009
RTE not ready for prime time
As a result of a logistical error yesterday, the Results to Endorse function was “turned on” for all ambulatory practice sites. For those of you who had not previously received these results, measures have been taken to discontinue this electronic delivery immediately. While electronic results to endorse remains a system goal for all BMP practices, yesterday's delivery was premature. We are currently in the midst of creating associated tools designed to streamline anticipated changes in workflow and expect to introduce these in the coming weeks. I expect that we will be able to formally roll out results to endorse for all ambulatory laboratory orders early next month.
In the event that you have received these laboratory results for the first time, you can discount them as your means of results review and expect that your usual protocols remain in place, i.e. paper reports. To clear them from your Message Center Inbox, double-click on the first report-->scroll down to view all results-->click OK & Next until the last result.
In the event that you have received these laboratory results for the first time, you can discount them as your means of results review and expect that your usual protocols remain in place, i.e. paper reports. To clear them from your Message Center Inbox, double-click on the first report-->scroll down to view all results-->click OK & Next until the last result.
Subscribe to:
Posts (Atom)