Health Maintenance Working Group

The original intent of Health Maintenance tool was to account for both established clinical guidelines and local community practice. Since its initial posting, guidelines and practice have changed such that there is a need to re-evaluate the current design of the tool. I am interested in pulling together a group of interested docs to review the current design and determine the contents of a revised version. I’d like to kick off the project with an informal meeting within the next month. Given the nature of the work, I think we can accomplish much of the task thereafter via email, blogging or other electronic means.

The goals of this project include:

• Selecting and reviewing the latest clinical practice guidelines
• Reviewing the literature for some of the more controversial screening measures
• Determining the appropriate HM elements
• Determining appropriate time intervals
• Reviewing and editing verbiage of the alerts

Secondary goals include:

• Piloting various electronic means of communication: email, blog, wiki, twitter, web-conference
• Previewing developments in HM too

I expect that, if we are successful with the electronic communications, there may only be a need for an introductory meeting and possibly a final meeting for sign-off. Please let me know whether you would be interested. At minimum, I’d like a group of 4-6 docs to take part in this project.

I’m looking forward to a lively and fruitful discussion.

Correct Function a vulnerability

After a great deal of thought and investigation, the Clinical & Medical Informatics team has decided to remove the Correct function from CIS documentation as of May 27, 2009. The team has consulted with HIM (Health Information Management) and Baystate Health Risk Management. All entities agree that, until the proper notation regarding any updates appear in corrected documents, the Correct function should not be used. The tool will be re-introduced when its function is modified to meet best practice.

Health Maintenance...again

So I've think the IS team has struck paydirt. After hours, days and weeks of techno-struggle, it seems the Health Maintenance performance dilemma has been solved. In fact, it may finally be working as designed (see 4/22 post).

I give you fair warning that it can take up to 45 seconds or a minute if you are loading a patient record with a great deal of information for the first time since the fix. Go back to it in the future and it should load quickly, finally relying on the HealthFacts tool I've alluded to in previous posts.

Now that the Health Mainteance tool appears to be functioning again, I will be looking for folks to join in a working group to consider a revamp, taking into account the various practice guidelines and latest evidence. Anyone interested knows how to find me... or I'll come find you.

Report from Kansas City

Tom and I have been here in KC at Cerner headquarters for the last few days at the Cerner Physician Community conference. As you might imagine, Prescription Writer has been a hot topic and a source of pain across Cerner's clientele. While I think we've had some improvements in function since we went live with it in March, it still requires considerable reworking until there is uniform satisfaction. A few lessons learned:

• the addition of sentences for the sig have helped to fill in required detail fields
• though promised to be an efficient transition, data from EasyScript should be ditched
• Consider delete all old favorites from EasyScript
• Rather than using Renew for refills of Rxs written on EasyScript, use Cancel/Reorder to reformat the Rx and allow Renew next time around
• Build new Favorites within the new Ambulatory Meds favorites folder and, if you have the patience to do so, build a specialty- or class-based subfolder structure within that larger folder
• DO NOT CHANGE your Home folder from the Durable Medical Equipment (DME) catalog to anything else. You risk losing this catalog if you move it.

Our pleadings for a return to an EasyScript user interface have been heard. While we can't expect to see a return to this anytime soon, I will be part of a working group with the Cerner engineers who are working on this important project. They demonstrated a mock-up of something similar to EasyScript and so I am hopeful.

That's it for now.

Health Maintenance trial fix

I mentioned a week or two ago that we are working on improving the loading time of Health Maintenance. Today we ran a "proof of concept" trial to see whether our strategy would work. While I haven't heard from more than just a couple of folks, it seems that the HM tool is loading more quickly.

It was quickly discerned by these docs that the creatinine expectation loads as though never satisfied. As this was just a test run, the creatinine deficiency will not be part of the fix. Once Josh is able to write new code to shift the Health Maintenance tool back into gear, you will find that the creatinine measure will accurately load re: expected vs. satisfied. However, not all that is accurate is precise! The creatinine will show as expected if it had not been done in >365 days, but whether displayed as satisfied or expected, will show the current date and not the date it was last performed. This might have to be the compromise we choose to live with until a real fix comes with future Cerner upgrades.

The bottom line is that you will be able have this health maintenance measure flagged and be logged accurately (and precisely) in the diabetes registry; you will just have to make sure that it has the correct date when running your screen. For the most part, I would assume that virtually all HbA1c measures have an associated creatinine, so that would be a place to start.

Prescription Writing Woes

Sorry for another long absence. Last week, we spent three days with folks in from Cerner headquarters in Kansas City to hear out and evaluate our disappointment with the Prescription Writer, Medication List and Medication Reconciliation tools. For the most part, we were pleased with the team's receptivity, though less than excited about what can be fixed quickly. The long and the short of it is that we will not see any major changes in the layout and appearance of the Prescription Writer for the time being. However, we will be putting together some documentation to help you optimize the function of what currently exists.

One crucial discovery I have made over the last week is that, in spite of being promised a seamless transition from EasyScript to Prescription Writer, many of the refill/renew and favorites woes are derived from an obvious lack of seamlessness. In fact, I am beginning to untangle myself from the older scripts and will also be building new Favorites folders. This is a major drag since I have about 350 favorites that came over from Easy Script. The problem is that all those extra terms in the sigs and all those problems with renewing and changing doses are a direct result of using old commands to create new prescriptions.

My advice is this: when renewing a med that was originally written in EasyScript, DO NOT use Renew. USE Cancel/Reorder. This will rid of the old version of the Rx, allow you to make changes to the dose and the sig , and should present the mandatory fields in a somewhat more logical fashion. It is definitely worth it. Then, save the new Rx as a Favorite if desired. This new favorite, whether written in the office or on discharge from the hospital, will end up in the Ambulatory Meds favorite folder where you can then organize a brand new folder set based on disease states, medication classes, organ systems, whatever you like. The favorites that fall outside of the Ambulatory Meds folder are all imports from EasyScript. Feel free to delete them as you build new ones.

Keep your eyes peeled for emails and updates on the CIS Info site. We will be getting out details for change in the coming days.