Message Center

So here's my first attempt at a new technology: an animated (well, that seems a bit of a stretch, but not my term!) Power Point presentation. What I've tried to do is give a quick taste of what the Enhanced View looks like. This presents a brief tour of the Message Center, the updated version of what has been called the Inbox. Check it out to find out what's new.

The IS training team is doing a tremendous job of turning over a vast library of dated tools in order to populate our new CIS Enhanced View Info site with a compendium of training and reference materials. We hope to be able to catalog of slide sets, text aids, and short single-content videos to help you pick up tips and tricks with the click of the mouse.


Uploaded on authorSTREAM by nrk99

With this slides below, I suggest opening the view to full screen by clicking on the box-inside-a-box icon at the right side of the lower banner and then pointing the mouse at the arrow in the left lower hand corner to advance to next image. Give it a look and let me know what you think.

Become a Physician Superuser - Sign Up Now!

If you've made it to this site, you are probably aware of the CIS Enhanced View Info site and the opportunity to sign up for an Enhanced View physician superuser class. These 2 hour sessions will be directed towards physicians, nurse practitioners and physician assistants who have relative facility with CIS. No need to be an expert. We're hoping to turn into one.

Classes will be offered mornings and evening on March 3-5 and again on March 10. These classes are being held in the Baystate Health Sciences Library computer training room with simulcasting via the internet and conference call at BFMC with a trainer onsite. Classes will focus on features analogous to the current state and new features that truly enhance the clinician's experience with the EMR.

• Message Center: slick new appearance that serves as a great new CIS homepage
  
• Inbox, Proxies & Pools: manage your work on your own and with your clinical team
  
• Results, Documents & Reminders: ready access to the information you need
  
• New Family History tool: import into PowerNotes and carry across the patient record
  
• New Procedures History tool: enter accurate terminology and details
  

So make sure to sign up and join us for this instructional session. And keep an eye on the the Info site for a growing catalog of tips and tricks.

Enhanced View is Coming!

Come one, Come all. The new and improved CIS Enhanced View will arrive in a big bang rollout across Baystate Health on Tuesday morning March 24. Three hospitals, three community health centers and over 50 BMP ambulatory care practices will be introduced to this new interface and find the look and feel of the web and new tools that will serve clinicians and patients alike.

The Enhanced View not only provides advances in efficiency and function, but also serves up what its moniker promises. This new design unifies CIS Office and Hospital into a single interface making chart navigation more fluid and intuitive. A single point of entry allows for easy retrieval of results, schedules and patient lists. And, with design and development close at hand, computerized provider order entry (CPOE) will soon be available for the ambulatory setting.

Another exciting feature is the Message Center. This replaces the Inbox and is much cleaner and better designed for communication between users, be they physicians, nurses or support staff. Proxies and Pools will facilitate new, more efficient workflows for all clinical sites. One of my favorite features is the new Reminders tool. Here, we'll be able to create patient-specific reminders that will pop up when you need them where you need them. Reminders do everything that Sticky Notes couldn't.

Most important, though, is for folks to get trained and ready for this new view. While we are very excited to introduce the Enhanced View, it will take some work and investment of time to get accustomed to the change. Click on the CIS Enhanced View Info Site banner on eworkplace to follow developments and sign up for Physician Superuser classes. And follow along as we provide sneak previews and instructional tips.

Upcoming Changes to Health Maintenance

I've mentioned that the Health Maintenance tool will become more user-friendly with a major upgrade later this year. In the meantime, I will be working with the CIS team to enhance the effectiveness of the tool as it now exists. The next task at hand is the building of more disease-specific expectations.

During the past week, I've submitted cardiovascular disease diagnoses that will trigger yearly lipid profile testing. To give you an idea of why it can be something of a technical chore to make this "simple" health maintenance expectation possible, I searched using multiple terms and arrived at 341 distinct diagnoses. Each of these must then be associated with each component of the lipid profile. While hundreds of CVD diagnoses have been identified, I'm sure some of you have found others in the SNOMED code system that should qualify a patient for the FLP requirement.

We will be working to add triggers for all forms of cardio-, cerebro-, and peripheral vascular disease as well as hyperlipidemia diagnoses in the coming weeks.

Let me know how we're doing and any other ideas you have.

Health Maintenance and the Diabetes Registry

You may be aware that quarterly diabetes registry reports were recently sent to all BMP adult primary practice managers and medical directors. Admittedly, we are still working out some of the core and composite calculation quirks that are used for global and group assessments. Assuredly, the demographic and lab details are accurate and clearly defined in the tables. What is lacking, however, are many of the features that are used to assess quality and, ultimately, pay-for-performance. These include:

• date of last diabetic retinal exam
• date of last comprehensive diabetic foot exam
• date of pneumococcal and influenza vaccines

The first two of these need to be manually entered into the health maintenance tool. Depending on the work design of a particular practice setting, this might be done by the MA upon patient's arrival to the office, by practice associate (PA) when a letter comes from the ophthalmologist/optometrist, or the physician upon review during chart review or during an office visit. My personal preference has been to enter the data during the patient visit as I spend time reviewing the health maintenance profile. Depending on where the retinal exam letter is buried, the entry of these two data items takes considerably less than a minute.

The vaccinations are, or at least should be, fed into the health maintenance tool as a consequence of the procedure being documented by the MA/RN. In other words, if you see a red mark in the HM tool, then the patient likely needs the vaccine.

It may be the case, however, that a patient received a vaccine at another site, e.g. VA, CVS, senior center. If another member of the staff has not entered that information, this can be done by entering into the immunization profile and attributing the procedure to "Historical Data" with an approximate date. If this profile is unfamiliar territory, I'd recommend asking your staff to enter this data when vital signs and other such information is entered.

The bottom line is that your engagement with the Health Maintenance tool will help make the registry reports, and thus quality & P4P measures, accurate and meaningful. I'd be glad to give more detailed instruction for those who are not comfortable with manual data entry.

More on Health Maintenance

Another sometimes problematic health maintenance issue is the time frame for each of the preventive measures. I am in complete agreement that the current HM tool is painfully inflexible in that one cannot change the time frame in the event of an (often common) exception. For example, if a patient has a history of colon adenomas, the timing of the next exam may be anywhere between 1 and 5 years, depending on pathology and physician judgment. While the colonoscopy can be documented in the Procedure Profile, the date of the next expected colonoscopy cannot be altered in the Health Maintenance tool.

The following is the list of time frame defaults for preventive measures. They are based on the guidelines I alluded to in my first post last month. I don't doubt that a couple of these are debatable, and not just for special populations. For example, bone density tests are often performed every 2 years depending on age and clinical judgment.

Mammogram: every 365 days
Cervical cancer screening: every 365 days
Bone density testing: every 5 years (1825 days)
Prostate DRE: every 365 days
PSA: every 365 days
Colorectal screening: if postponed, then 365 days; colonoscopy - every 10 years; flex sig - every 5 years; stool occult blood - every 365 days
Chlamydia screening: every 365 days
Tobacco exposure: every 365 days
Influenza vaccine: every 365 days
Pneumococcal vaccine: once
Tetanus booster: every 10 years
Zostavax: once

In the same way that a red mark can drive us crazy, so too can the inflexibility of the time frame. Keep in mind that the HM tool was built both to meet the minimal standards of care for all patients and to maximize opportunities for quality measures performance. In this way, the tool is really an aid; it can help facilitate best practice. Ultimately, though, it is the physician, and not the guideline, that provides the exemplary care our patients expect of us.

I do have some good news: by the end of 2009, CIS will undergo another upgrade (that is, in addition to the Enhanced View upgrade to be rolled out across Baystate Health on March 24). In the later upgrade, there will be a number of significant improvements to already extant tools as well as the introduction of new and quite excellent tools (more on that later). One major improvement that I have seen demo'd is of the Health Maintenance tool. This new design will include the customizability we are all wanting for...

Health Maintenance Age Ranges

While I've got a file that contains all the minutiae of the Health Maintenance tool, from satisfier categories to time frames, I'm going to start the piecemeal review by outlining the various expectations and their associated age parameters. Let me know what you think.

Mammogram: 40-100 years
Cervical cancer screening: 21- 65
Bone density testing: 60-100
Prostate DRE: 50-100
PSA: 50-100
Colorectal screening: 50- 80
Chlamydia screening: 16- 26
Tobacco exposure: 0-100
Influenza vaccine: 50-
Pneumococcal vaccine: 65 once
Tetanus booster: every 10 years
Zostavax: 60 once

Note that these expectations are set for ALL patients and do not include disease-management build that is currently in place for diabetes, asthma and heart failure.

Another thing to keep in mind is that, in the event that you do not agree with the screening measure, e.g. mammogram 40-49 years, the so-called expectation can be satisfied by selecting deferred or another relevant rationale. Alternatively, you can leave that expectation as is, though many of us have a hard time tolerating RED.

Happy New Year!