Removing the Adhoc Charting Functionality from Immunization Schedule

When:  8/25/2021

What:  The Adhoc charting button from the Immunization Schedule tab in PowerChart is being deactivated and will be dithered.  This form of documentation is no longer appropriate.  Instead, please continue to order immunizations from caresets and document administration on the tasklist.  Continue to use the Registry Import process to properly document the administration of vaccinations outside this organization.  If the vaccine is not available via registry import, please document the vaccine using the History button.

Why:  Using this functionality does not incorporate charging for medication or the administration.  It also does not properly capture all necessary information when administering vaccines causing failures when sending information to ImmTrac.

Changes to the Diabetic Ketoacidosis (DKA) Plan

Please see below for DKA Insulin Infusion Protocol changes that will change the Diabetic Ketoacidosis (DKA) Plan: 

With the multiple changes in this plan, ALL FAVORITED PLANS will be blown away/removed from folders on August 23rd, 2021.

Please click the DKA Insulin Infusion Protocol button below to access and print detailed information about these important changes.

Change to Discharge Patient (Outpatient) Order

Starting Wednesday, August 11, 2021, the Discharge Patient (Outpatient) order will no longer have the required ‘Discharge Diagnosis’ field.

It will now look like this:

The plans that use this order are shown below. This change will not affect your favorited plans. The field will simply not be there anymore.

Cerner Maintenance Event Tuesday, July 20, from 8:00pm – 10:00pm

During this time, Cerner will be available. There will NOT be a downtime; however, there will be brief interruptions in service during the following time periods:

8:00pm – 10:00pm

Document Viewing

o   Document viewing via Clinical Notes, PowerNotes, DynDoc, PowerForms, etc. may be affected

o You will continue to be able to create/document PowerNotes, DynDoc, PowerForms, etc. as normal

o   Camera Capture and e-Signature will be impacted

 Document Scanning

o   Single document scanning will not be available

o   Batch scanning will not be available

o   Camera Capture, e-Signature, Report Request, Manual Expedites, Multimedia Manager, and Images for Access Management Office will not available

 You may be prompted to log out at least once during this event.  If you receive this notice, then please log out.  You will be able to log right back in without issue.

 With the system being available during the maintenance event, there is a potential for issues to occur.

 If you experience any issues, please call the IT Helpdesk at 59109.

Referral Management: Change from "Urgent" to "Stat"

GO LIVE: July 14, 2021

A request has been made to change the verbiage on the Referral Ambulatory order.  The verbiage for a high-priority referral will be changed on this order from Urgent to Stat on the highlighted field:

The functionality in Referral Management details will still show as High Priority

The indicator will still show as red and high priority

*NEW* Smoking Cessation and Tobacco Treatment Program Consult Order and PowerPlan

GO LIVE: July 15, 2021

New Consult Order:

New PowerPlan:

Adult and Pediatric Discharge Plans

GO LIVE: August 5, 2021

Starting August 5, 2021, the Adult and Pediatric Discharge Plans will expire 45 days from the date they are planned, if not initiated.

S - Discharge Plans from prior admissions are inadvertently being activated on a patient’s current encounter. Patients can be sent home with inaccurate discharge information.

B – Discharge Plans are placed on admission by the provider or nurse.

A - Patient is discharged and discharge plan is not initiated. This leaves the plan in a “planned” state for 365 days from the date it was originally ordered. If the patient readmits to the hospital within this time frame, the “old” discharge plan is active on the chart. This can lead to staff documenting on and initiating the discharge plan from the previous encounter instead of the new encounter’s discharge plan.

R – Technical Suggestion, shorten the plans expiration criteria from 365 days to 45 days. After the 45 days have passed the EHR system will automatically void the old discharge plan. The only identified risk associated with this recommendation is for patients who stay longer than 45 days. Their discharge plan will be discontinued by the system prior to their discharge, at which time the nurse/provider will need to re-order the discharge plan.

Cerner CAMM 7 Prod Storage Database Upgrade / Downtime

IT Alert Number: Alert-2021-0714

Subject:

Cerner CAMM 7 Prod Storage Database Upgrade / Downtime

Impact: Patient Care

Summary:

Cerner CAMM 7 Team will be upgrading the Oracle database, which will result in a ~4-hour downtime event.

 Solution Category:

 Cerner CAMM 7 Archive

 Event Time / Date:

 Start:    Wednesday, July 14, 2021                   01:00

 End:     Wednesday, July 14, 2021                   05:00

 

Role(s) Targeted:

All Radiology End Users, Physicians, EC Staff

Service Now Details:

CHG0038291

Description:

On 7/14/2021 at 1AM CDT Cerner will be upgrading the Oracle database in a downtime event. Event is expected to last 4 hours and end 7/14/2021 at 5AM CDT.

Impact Details:

The solution will be unavailable for the duration of the event. Studies ingested during the event will be re-directed to a non-prod storage location.

Workaround:

Studies ingested during the downtime event, and priors up to 3 days, will be viewable via the SkyVue Downtime Viewer, which has been installed on marked workstations throughout the hospital.

Recovery:

Once the database is back up, then studies will be sent from the non-prod storage location to CAMM 7 for verification.

Support:

Please contact the UMC IT Service Desk (806) 775-9109 for further assistance.

Updated MAR Summary Defaults

Approved by PIC on 6.15.2021

Currently, MAR Summary defaults are set as:

Hours Forward: 8

Hours Back: 48

Based on a request from residents & approved by PIC on 6.15.21, we are updating these defaults.

Future MAR Summary Defaults:

Hours Forward: 8

Hours Back: 168 (7 days)

Current View: 48 hours back by default

Future View: 168 hours back by default

Discharge Med Rec for Patients with Chemotherapy Orders

When completing a Discharge Med Rec for patients with chemotherapy orders, you will receive this Discontinue Protocol Order pop up box if you choose “Do Not Continue Remaining Orders”:

When you see this, you should choose Continue to keep the protocol order active.

If you choose Confirm, you will be discontinuing all future scheduled chemo orders for that patient, and the oncologist will have to re-enter the protocol.

Upcoming Radiology Orderable Changes

These changes will go live as they are individually completed.

New Orders:

CT TEVAR Protocol

-          Dynamic Aortic Evaluation in planning Thoracic endovascular aortic repair (TEVAR) is important to provide optimal stent graft sizing for aneurysm repair in chest

-          For any questions, contact the Cat Scan department (775-8715)

CT EVAR Protocol

-          Dynamic aortic evaluation in planning endovascular aortic repair (EVAR) is important to provide optimal stent graft sizing for aneurysm repair in the abdominal aorta.

-          For any questions, contact the Cat Scan department (775-8715)

CT Bone Biopsy/Aspiration

-          Bone marrow aspiration and bone marrow biopsy can show whether your bone marrow is healthy and makes the normal amount of blood cells. Interventional Radiology performs these procedures.

-          For any questions, contact Interventional Radiology (775-8770)

CT Guided Cyst Aspiration

-          When Fluid abnormally fills a cyst or collects in the body it may be removed with a very thin needle guided by a computer tomography (CT).

-          For any questions, contact Interventional Radiology (775-8770)

SP Biliary Drain Removal
SP Cholangioscopy with Biopsy
SP Cholangioscopy with Stone Removal
SP Diagnostic Cholangioscopy
SP Sclerotherapy Single Vein (varicose vein treatment)
SP Sclerotherapy Multiple Vein (varicose vein treatment)

-          To reflect new procedures performed in Interventional Radiology

-          For any questions, contact Interventional Radiology (775-8770)

DX EOS Full Spine 2 views

DX EOS Full Spine 4 views

DX EOS Lower Limb

DX EOS Full Body

-          To clarify the new orders for the new EOS machine.  ALL these "EOS orders" can only be done with the new "EOS machine."

-          For any questions, contact Amanda or Rachel in the diagnostic radiology department (775-8415)

Order Changes:

DX UGI (Contrast, Air)                                   >>           DX UGI Double (contrast/air)

DX UGI (w/o Contrast, Air)                          >>           DX UGI Single (contrast)

DX UGI w/ SBFT (w/ Contrast, Air)           >>           DX UGI w/SBFT Double (contrast/air)

DX UGI w/ SBFT (2/o Contrast, Air)         >>           DX UGI w/SBFT Single (contrast)

-          Improving clarification on the terminology for the exam because some have barium contrast and some have contrast with "fizzy" AKA air

-          Contact Amanda or Tim if you have any questions (775-8415)

CT Guided Cryo Ablation Bone     >>        CT Guided Cryo/Microwave Ablation Bone 

CT Guided Cryo Ablation Liver     >>        CT Guided Cryo/Microwave Ablation Liver

CT Guided Cryo Ablation Lung      >>        CT Guided Cryo/Microwave Ablation Lung

CT Guided Cryo Ablation Renal    >>        CT Guided Cryo/Microwave Ablation Renal

-          To reflect which body part and the option to perform cryo or microwave based on IR provider assessment and discussion with ordering provider

-          For any questions, contact Interventional Radiology (775-8770)

DX Thoracolumbar 2vw     >>    DX Thoracolumbar Junction

-          To clarify the procedure that is being completed by the diagnostic department

-          For any questions, contact Diagnostic Radiology (775-8415)

NM Gastric Emptying Study (4 hr study)     >>    NM Gastric Emptying Solid (4 hr study)

-          This is to clarify for ordering providers the difference between similar exams

-          For any questions, contact Nuclear Medicine (775-8768)

NM WBC SPECT/CT Local   >>   NM WBC Whole Body/SPECT/CT

-          This is to clarify the procedure that is being completed in Nuclear Medicine

-          For any questions, contact Nuclear Medicine (775-8768)

Order Removal:

NM Renal Scan (Pedi)

-          For greater clarity among ordering physicians and offices the Nuclear Medicine Cerner orders now have:

                NM Renal Flow/Scan MAG 3 (Pedi) & NM Renal Scan with Lasix (Pedi)

-          This clarifies if a physician requests a with or without Lasix Renal scan for pediatric patients.

-          For any questions, contact the Nuclear Medicine Department (775-8768)

Procedures tab in Histories Changing from Review Mode to Reconciliation Mode

Currently, the Procedures tab within the Histories component of Provider View Workflow MPage is set to default to Reconciliation Mode if an outside record is available.

Records that normally appear under "Surgical Records" do not show when the component is in Reconciliation Mode. These Surgical Records will only show in Review Mode.

To reduce the risk of procedures being overlooked by providers, we are updating this tab to default to Review Mode.

If there are outside records, clicking on Reconcile will change the tab to Reconciliation Mode.

Example: EGD done on 5/24/21

Reconciliation Mode: current default.

Review Mode: future default.

CMS Admission, Discharge, and Transfer Event Notifications

Go Live for this change is 6/16/2021.

On May 1, 2020, the Center for Medicare & Medicaid Services (CMS) published the Interoperability & Patient Access Final Rule in the Federal Register. The Interoperability Final Rule contained a new Condition of Participation (CoP) requirement, effective May 1, 2021.  CMS’s Interoperability and Patient Access Final Rule was published in conjunction with The Office of National Coordinator for Health Information Technology (ONC) Cures Act in furtherance of federal efforts to increase interoperability and eliminate information blocking practices.

The Admission, Discharge, and Transfer Event Notifications requirement of the CMS Interoperability and Patient Access final rule requires health IT systems capable of sending / receiving ADT messages provide the ability to send ADT event notifications to patient-designated providers and organizations. The compliance date, May 1st, 2021, for requirements is based on the hospital’s compliance plan. Each hospital must have a plan to be fully compliant by this date.

What notifications are required?

Events Notifications for a patient’s admission, discharge, or transfer.

·         Inpatient admissions

·         Emergency department

o   Presented

o   Discharged

·         Observation admission/registration

·         Transfer

o   From outpatient to inpatient

o   Unit Transfers are not required.

·         Discharge

Failure to comply with the CMS Rule by the May 1, 2021 deadline can result in loss of certifications and reimbursements.

Who will receive notifications when initially enabled?

·         Primary Care Physician (PCP)

Who potentially could receive notifications based off the ruling in the future?

·         Primary Care Physician (PCP)

·         Admitting

·         Attending

·         Consulting

·         Referring

·         Informed Provider or Organization (i.e. Case worker, Skilled nursing facility, Social worker, Informed PCP)

Opt-out Notifications

Providers or informed providers can opt-out of ADT event notifications. Opting out of ADT event notifications disables notifications for all patients where the provider is the PCP or associated to the patient with the specific relationships mentioned in the ruling.

The provider will no longer receive a notification for any patient that is admitted, discharged, or transferred when opting out notifications.

How to opt-out notifications?

Providers or informed providers must submit a request to UMC IT or TTP Clinical Transformation department with the following required information:

·         Provider’s Name

·         Provider’s NPI

Postponing External Portal Deactivation

Based on the feedback from our test user group, our internal UMC IT testing group, and discussions with Cerner, we are postponing the deactivation of the Cerner external portal (Cerner Physician Portal) website originally scheduled for 6/8. This means you may still access the following link when documenting offsite/externally: 

https://umctx.cernerworks.com/Citrix/PRODweb/

If you have already configured your devices to use the AppVPN solution, you may continue to use this solution, or access the portal directly at this URL.

We currently do not have a new ETA, but we are working closely with Cerner on an alternate solution and will provide further updates as they arise. If you have issues connecting, please contact the UMC IT Service Desk at (806) 775-9109. 

We deeply value your feedback and greatly appreciate your patience. Thank you.

Cerner Maintenance Event, May 27, 2021

During this time, Cerner will be available. There will NOT be a downtime; however, there will be brief interruptions in service during the following time periods:

8:00pm - 9:00pm

·    Pyxis

• No new or transferred patients or orders will show

• Pyxis machines will be placed on override during this time

  Radiology Imaging

• No new or modified radiology orders will cross to McKesson PACS

• No new reports will be available in PowerChart

• OnRad reports will be faxed

• A radiologist will be on standby for any STAT requests

·    RapidComm blood gas and RALS/Sofia results will not populate in PowerChart

·    Quest results will not populate into PowerChart and orders will not send to Quest.

·    Orchard Orders and Results will not post for TTU Student Health.

·    South Plains Rehab-Encompass, Lubbock Heart Hospital and Montford orders will not populate into Cerner and results will not pass to the vendors.

·    Telemetry strips will not show in Clinical Notes

·    Kronos will not show new or transferred patients

·    ePrescribing   

• Prescriptions will queue up and be sent once the interfaces are back up

• If a prescription needs to be sent immediately, please print or call in the prescription

·    Teletracking will not show new, updated or transferred patients

·    EasyID will not show new, updated or transferred patients

·    IDX will not show new, updated or transferred patients

·    Hill-Rom Dashboard will not show new or transferred patients and beds cannot be associated in Cerner.

** By 9:00pm, all patients and orders will be released and the above systems will be updated.  Radiology systems will receive the updates and the reports will cross over once the orders are reconciled.**

·    Scheduled reports will need to be printed manually (ex. Dietary reports)

·    Batch label printing (Meds/Labs) will be ran early, but any new orders during that time will need to be ran manually

       ** At 10:30pm, all scheduled reports and batches for label printing will resume as scheduled **

You will be prompted to log out at least once during the upgrade.  If you receive this notice, then please log out.  You will be able to log right back in without issue.

With the system being available during the upgrade, there is a potential for odd issues to occur.  If you experience issues, we will have to wait until the upgrade is complete to troubleshoot.  

IT staff will be available during the upgrade. If you experience issues, please call the IT Helpdesk at 59109.

Inmate PHI Dissemination

WHO is impacted by the change: Clinical staff caring for inmate patients.

WHEN does the change take effect: June 11, 2021

WHY is the change being made: Ensure the safety of our frontline clinicians, reduce time and work effort addressing multiple requests for clinical updates, comply with hospital policy and protocol for PHI dissemination and the care of inmates.

WHAT is the change:

Changes to Consult for Sitter/Telesitter Orders

The Go Live date is May 19, 2021, for this change.

There will now be two separate orders for Consult for Sitter and Consult for Telesitter. When you search for ‘sitter’ in the orders search bar, they will both show up. Please choose the appropriate order.

There will be a drop-down box added to “Reason for Consult:” This a required field.

If ‘Behavioral Concerns’ is chosen from the list, please fill out freetext box with specific behavioral concern (i.e., pulling at lines or tubes)

Upgrade to Demographics for Dynamic Documentation Users

We have come up with a way for providers to see who the referring provider is in the Demographics screen in Dynamic Documentation:

During intake the nurses have the ability to populate the fields so that this information is stated in the Demographics page for all providers to see the referring provider. 

The nurses would populate the information in the Ambulatory SWCC Visit/Intake Powerform

1. Click Referring Provider

2. On Referring Provider choose NONE, NONE

3. On 'If you can't find the physician in the list, choose 'None, None' and enter the name here

This will then populate in the Demographics page for all UMC Cancer Center providers to see who the referring provider here: