Yes, it seems like a never ending journey to get all electronically available results delivered to everyone's CIS Inbox. For months, I've been promising the simultaneous rollout of a new means a assisting in results management known as pools. The thought was that all results would be delivered to both the ordering clinician and members of a predesignated pool. This pool would be designed in advance of the onset of results delivery and would provide an alternative means of reviewing and endorsing labs, either by a covering doc or even by an MA, depending on practice protocol. For example, there are many instances where it is appropriate for normal labs to be signed by ancillary staff who can also create a correspondence letter informing the patient of their results. Abnormals could be left for the physician to later in the event that those results are not otherwise brought to their attention.
It turns out that the pools as described do not function as promised. After consulting with our IT colleagues at Cerner, we realize that we can best manage these results at the practice level by using the proxy tool. This, in fact, is a really good thing. Most clinical sites use the proxy tool for a variety of functions including patient list management, messages, and, in a number of sites, for results management.
In the coming days, I will create a quick video that will review the set up of proxies. I have heard from many of you who are ready to receive results and expect that we will begin delivery on Tues Sept 8. Stay tuned and look for emails related to this soon.
Sunday, August 30, 2009
Thursday, August 27, 2009
Preadmit Orders
I recently received an email from a rightfully frustrated colleague who complained that they had gone to great effort to schedule a daystay procedure, provided the necessary documentation, and entered an intricate set of orders in advance of the appointed time. In spite of these complete efforts, the orders were lost and had to be done over again late at night and over the phone.
The driving issue that led to this circumstance is related to our so-called "encounter logic". I may have mentioned this in earlier posts, though it deserves repeating. Every time a patient interacts with any part of the health system, a new encounter is created. So if a patient calls the office to make an appointment, a triage encounter is created. When the patient reaches the front desk at the time of that appointment, an office visit encounter is created. When the patient goes to the lab, another; to radiology, another; and so on. When a patient is scheduled for admission, say in the event of an elective procedure, a Preadmit encounter is created. This encounter then changes over to the appropriate admit encounter upon arrival to the facility.
In the case above, a transfusion was scheduled and orders were placed. Unfortunately, those orders were placed on an office visit encounter and not on the Preadmit encounter that is created during the scheduling and registration process. The key is to select the proper encounter in order to place those orders. I realize this might seem onerous (at best), particularly since you are able to review a patient's chart regardless of which encounter is opened. But this is more than data collection; the encounter logic facilitates a variety of tasks including ancillary services, charging and billing and patient location.
The following slide set reviews how to select the correct encounter in the event of a preadmit. This instruction also applies to direct admits and the like.
(Remember to click on the icon at the lower right to open to full screen.)
The driving issue that led to this circumstance is related to our so-called "encounter logic". I may have mentioned this in earlier posts, though it deserves repeating. Every time a patient interacts with any part of the health system, a new encounter is created. So if a patient calls the office to make an appointment, a triage encounter is created. When the patient reaches the front desk at the time of that appointment, an office visit encounter is created. When the patient goes to the lab, another; to radiology, another; and so on. When a patient is scheduled for admission, say in the event of an elective procedure, a Preadmit encounter is created. This encounter then changes over to the appropriate admit encounter upon arrival to the facility.
In the case above, a transfusion was scheduled and orders were placed. Unfortunately, those orders were placed on an office visit encounter and not on the Preadmit encounter that is created during the scheduling and registration process. The key is to select the proper encounter in order to place those orders. I realize this might seem onerous (at best), particularly since you are able to review a patient's chart regardless of which encounter is opened. But this is more than data collection; the encounter logic facilitates a variety of tasks including ancillary services, charging and billing and patient location.
The following slide set reviews how to select the correct encounter in the event of a preadmit. This instruction also applies to direct admits and the like.
(Remember to click on the icon at the lower right to open to full screen.)
Friday, August 14, 2009
Auto-text re-update (if you read the first version this morning)
Last week, I discovered that I was able to quickly build about 16 procedure forms that Pain Management had requested over three years ago (!) using the auto-text feature. By simply copying and pasting from Word documents, I was able to circumvent the creation of these fill-in-the-blank forms via PowerNote and have them appear as they always had in the paper world. Great stuff that I expect to apply to a variety of form-based requests. However, there is a catch.
When we first introduced auto-text, suggestions were made to begin each shortcut with a designated symbol, e.g. your initials, the letter z, or a period. I certainly didn't jump up and down to get the word out, so a number of folks have used logical abbreviations like "chol" for a cholesterol-related text. For myself, I've been using the letter z pretty seamlessly. Well, when the pain management forms were posted, they were saved across the system such that they will appear for all users of auto-text. Since they are system-based, they can't be deleted from an individual's list of auto-texts. Well, understandably, this created quite a nuisance for a number of folks. Thanks to Julio Martinez, we realized that, if we start the specialty forms with ~, these will sort to the bottom of an alphabetical list and so you will no longer even see these forms unless you are looking.
If you read the first version of this post, I suggested you rename your auto-text shortcuts. You no longer need to do this. Continue saving as you wish, though I'd still recommend starting with a symbol so that you can view your list, or even create a series of lists, each summoned by a particular symbol.
If you want to check out how you might want to create a form, check out what we've done for Pain Management. For the next few days, they will begin with "pm", though by early next week, they will start "~pm". Here's what you do:
Go directly to Clinical Notes, right-click on the open field and select Add, then type pmAxNB to add the Pain Management Axillary Nerve Block form to the page. From there, hit the Insert button on their keyboard in order to overwrite the lines and fill in the blanks.
As always, feel free to post a comment, anonymously or otherwise, or shoot me an email.
When we first introduced auto-text, suggestions were made to begin each shortcut with a designated symbol, e.g. your initials, the letter z, or a period. I certainly didn't jump up and down to get the word out, so a number of folks have used logical abbreviations like "chol" for a cholesterol-related text. For myself, I've been using the letter z pretty seamlessly. Well, when the pain management forms were posted, they were saved across the system such that they will appear for all users of auto-text. Since they are system-based, they can't be deleted from an individual's list of auto-texts. Well, understandably, this created quite a nuisance for a number of folks. Thanks to Julio Martinez, we realized that, if we start the specialty forms with ~, these will sort to the bottom of an alphabetical list and so you will no longer even see these forms unless you are looking.
If you read the first version of this post, I suggested you rename your auto-text shortcuts. You no longer need to do this. Continue saving as you wish, though I'd still recommend starting with a symbol so that you can view your list, or even create a series of lists, each summoned by a particular symbol.
If you want to check out how you might want to create a form, check out what we've done for Pain Management. For the next few days, they will begin with "pm", though by early next week, they will start "~pm". Here's what you do:
Go directly to Clinical Notes, right-click on the open field and select Add, then type pmAxNB to add the Pain Management Axillary Nerve Block form to the page. From there, hit the Insert button on their keyboard in order to overwrite the lines and fill in the blanks.
As always, feel free to post a comment, anonymously or otherwise, or shoot me an email.
Thursday, August 6, 2009
Trouble Connecting to CIS from Home?
Recently, I've had some troubles achieving a stable connection to CIS when at home. This seems to be unrelated to whether I'm on my Baystate laptop or whether trying to log on from my Mac or my kids' PC laptop. It turns out that the PC's dreaded operating system, Windows Vista, has Internet Explorer8 and I was recently told that CIS will not run through on anything higher than IE7. To make matters worse, Vista doesn't allow me to download this older version of Internet Explorer. On my Mac, Safari has been kind of iffy in terms of holding a connection. So...
If you are having trouble logging in from home, whether from a Baystate laptop or your own home computer, the best way to ensure a connection is to use the Firefox browser. If you don't have this on your home computer, download it. If you'd like to download it to your Baystate laptop, give the Help Desk a call and see whether they can facililate this for you. I make no promises, but this seems a reasonable request if you are accessing CIS from home. (Of course, when logging on to CIS, make sure you first login through baystateheath.org.)
If you are having trouble logging in from home, whether from a Baystate laptop or your own home computer, the best way to ensure a connection is to use the Firefox browser. If you don't have this on your home computer, download it. If you'd like to download it to your Baystate laptop, give the Help Desk a call and see whether they can facililate this for you. I make no promises, but this seems a reasonable request if you are accessing CIS from home. (Of course, when logging on to CIS, make sure you first login through baystateheath.org.)
Wednesday, August 5, 2009
VNA Forms
July was a pretty sparse month for posting. I guess I have the summer to blame.
We continue to develop new tools that will advance our progress towards a paperless medical record. Recently, electronic versions of the VNA HCFA 485 (certification/recertification) and Physician Interim Orders forms have been created. These forms can now be sent to the Document to Sign folder in the Message Center inbox. We've been piloting this delivery and sign-off process with docs over at the D'Amour Center for Cancer Care (high volume users) and, by all reports, this is going very well. We are hoping to roll this out to all practices shortly.
Here's a preview:
Let me know what you think.
We continue to develop new tools that will advance our progress towards a paperless medical record. Recently, electronic versions of the VNA HCFA 485 (certification/recertification) and Physician Interim Orders forms have been created. These forms can now be sent to the Document to Sign folder in the Message Center inbox. We've been piloting this delivery and sign-off process with docs over at the D'Amour Center for Cancer Care (high volume users) and, by all reports, this is going very well. We are hoping to roll this out to all practices shortly.
Here's a preview:
Let me know what you think.
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