User-Level Priority Preference in PowerChart

Effective: 7.26.22

Positions Affected: All Providers using the Consolidated Problem List Component on an Inpatient Encounter

Summary:

Starting the evening of July 26th, you will now be able to set priorities at a user level versus a patient level on all inpatient encounters.  This means that each user can choose those diagnosis that are applicable to their specialty.  This will not cross to any other users, even if they are in the same specialty.  Once the preference is applied all current priorities for inpatient encounters will be removed and will need to be re-addressed.   This will only impact the Consolidated Problems Workflow MPage component and not the Problems and Diagnosis Control on the TOC/Dark-side.  You can still leverage the control to see what the priorities were prior to this change.

Key Points:

∙ Each user can now set their own priorities in the Consolidated Problems List Workflow Component.   If a priority is added, only those diagnosis with a priority will pull to the Assessment and Plan.

If no priorities are added, all diagnosis will pull into the Assessment and Plan, in alphabetical order, as it does currently.

NOTE:  This is what all patient’s with an inpatient encounter will look like right after the change.

This will not impact the priorities set in the problems and diagnosis control, nor will any priorities from the consolidated problems list workflow component flow to the control, moving forward.

Change for OR schedule requests

Effective: 7/12/2022

The date that you are wanting the surgery on now needs to be entered in the appointment attributes box that comes up after you select the order and is required, you will not be able to move past this point without a date.

**time is not as important as the date and will default to 00:00 if you do not enter a time.

The OR schedulers will no longer be able to see the dates in the ‘Request for Book’ box.

Update on Behalf of Speech Therapy

PRIMARY CONCERN:

SPEECH THERAPY HAS NOT BEEN RECEIVING ALERTS/MESSAGES FOR PATIENTS WITH A LARYNGECTOMY.

ISSUE:

Speech Therapy has not been receiving alerts/messages for laryngectomy patients when they are admitted or transferred in the hospital.

SOLUTION:

A rule has been created that will alert Speech Therapy, Nursing and Respiratory Users when a Laryngectomy Code is added as a Chronic Problem within the Consolidated Problem List in the Patient's Chart. Once this diagnosis is listed as chronic, the necessary teams will be notified each time the patient is admitted or transferred in the future.

HOW SPEECH THERAPY IS CONTACTED:

1. ADD PROBLEM TO CONSOLIDATED PROBLEM LIST(REGARDLESS OF REASON FOR VISIT)

2. ENSURE PROBLEM IS LISTED AS CHRONIC.

3. SPEECH THERAPY WILL RECEIVE A MESSAGE IN MESSAGE CENTER AND A SMART ZONE ALERT WILL BE SENT TO NURSING AND RESPIRATORY USERS.

PROBLEMS THAT WILL TRIGGER RULE:

• H/O laryngectomy

• H/O partial laryngectomy

• H/O radical laryngectomy

• History of laryngectomy

• History of parital laryngectomy

• History of radical laryngectomy

• Hx of larygectomy

• Hx of parital laryngectomy

• Hx of radical laryngectomy

• S/P laryngectomy

• Status post laryngectomy

• Laryngectomy

CT Contrast Shortage

Due to the nationwide shortage of iodinated contrast, restrictions on ordering imaging studies with contrast have been implemented.

• Imaging orders that require contrast will be reviewed and prioritized according to availability and need

• The following notification will come up when ordering contrast CTs to remind providers to consider alternative imaging studies (non-contrast CT, MRI with or without gadolinium or ultrasound)

If you have any questions, please contact Radiology at 806-775-8445.

Viewing Risk Indicators Component in PowerChart

Effective: 5.25.22

Positions Affected: All Inpatient Provider Positions and their workflow MPages

Summary:

The Risk Indicators component (which contains the TOC recommendation) will be moved 'off view' in the inpatient provider MPages.  There have been reports that the recommendation provided may not truly show the full patient picture. While this component is a recommendation only, we want to ensure providers don't feel that it's required to reference while we continue this investigation of the data that the recommendation is being qualified off of.  If your patient population has not been having issues with the TOC Recommended and you wish to move it back on-view, it will be available for you.  PT/OT will continue to make recommendations for therapy needs, as they do now, and will not make recommendations for disposition or placement. Please continue to use their documentation as you make your final discharge recommendations

Key Points:

∙ Risk Indicators component no longer face-up in your workflow MPage table of contents.

Can still add it back on, if you still want access to it.   Components (upper right-hand corner of MPage) > Select Risk Indicators > Will populate at the top of your WF TOC > Can move it back to the bottom

Alteplase Intra-Pleural Plan Enhancement

1.  Request from pharmacy:

-alteplase start time for both frequencies updated to T;N+2hours. Remove priority "NOW" as changing to q24h/q12h drops a now dose. the +2hr offset is to allow time for preparation & delivery of dose

-dornase start for both frequencies updated to T;N+4hours. Remove priority "NOW" as changing to q24h/q12h drops a now dose. the +4hr offset is to allow time for preparation & delivery of alteplase, then will time it for 2 hours AFTER alteplase task as the alteplase has to dwellx1hr, drainx1hr, then admin dornase.

ON the alteplase 10mg doses that are currently ordered as 2 x5mg syringes. We now have authorization to send instead 1 - 10mg/50mL syringe. so, the 10mg section only needs 2 orders total, 1 for leur lock and 1 for catheter tip syringe. Remove the red bars & duplicated order sentences. Change the verbiage on the 10 mg dose gray bar to "For a single 10 mg dose please select ONE of the following based on syringe type needed:" Reach out with any questions.

2. Also linked the current policy in Alteplase Intra-Pleural Policy to this plan for reference.

Pediatric Central IV Flush Update

A new section has been added to the Pediatric Central IV Flush powerorder. You can now find PICC Lines under Medications if you need a flush.

Update to the Social Services for IV Therapy order

Go-live May 9, 2022.

To provide discontinue orders for IV access after home health IV therapy is complete.

 This order will allow the Home Health agency to either discontinue the PICC line themselves or to send the patient to UMC radiology to remove a tunneled line if appropriate. UMC radiology is able to see these patients M-F during normal business hours.

New field added to the Social Services for IV Therapy

Discontinue IV Access Once IV Therapy Complete: yes/no

Changes to the Adult Discharge Plan

On Wednesday, April 20, 2022, there will be some changes made to the Adult Discharge Plan. If you should have any questions, please reach out to your Clinical IT representative.

1. The Quality Measures section will be removed:

Current:

New:

2. The “Discharge Scheduled Procedures” and it’s correlating note “The order below is for OR procedures scheduled by BICU/BIMC” will be removed.

Current:

New:

Important Update - Imprivata issues

Imprivata ID Serial Number Changing:

When upgrading to to the latest Imprivata app (v7.8) some Imprivata ID serial numbers changed. You will not be able to search for the App at this time in the App Store, but Imprivata asks that you do not delete the app from your mobile device. If you do delete it, you will not be able to download and install the app for some time.

If your Imprivata ID serial number was changed, you will need to enroll that new token.

Imprivata is working to resolve the issue with the app and will repost it to the App Store.

Referral Management: Updating List that had a Priority Saved

We have two new features in Referral Management (see previous post for more information):

• Provider gender and language

• New status options for ‘When Referral Needed’

Now that the new statuses are available for When Referral Needed this caused some discrepancies in current Worklists.

The following errors may present to the end-user:

In order to resolve this issue, navigate to

1. Referral Management

2. List Maintenance

3. Open each of your worklists where you are receiving these errors and put a ‘.’ (period) behind the name of the Worklist

4. This will allow the Save button to open and the Worklist can be saved again.

Referral Management Update: Provider Attributes

Now you can search an external provider by specialty, gender, and language

To find a specific gender and/or language of a provider click the + sign to the Provider Search screen.

You can then look up the provider by clicking the qualifiers listed by specialty, gender and language.

Once you have chosen a combination of qualifiers and clicked the ‘include external practices’ a list of providers will be available.

Referral Management Update: New Referral Needed Field

New options when making a referral Stat, new field is called ‘When Referral Needed’ and the options now available are:

• (None)

• STAT – Today

• ASAP – Within One to Two Weeks

• Within 1 Month

• First Available

Please use these options if your referral is time sensitive

Note: in the Referral Management mPage the only two statuses that will show with a red flag are:

1.       STAT - Today

2.       ASAP – Within One to Two Weeks

eCoach is Coming Soon

eCoach is COMING SOON!

eCoach is a Cerner solution that provides you with learning assets relevant to your role and workflow and data around how efficiently you are using the EHR. eCoach is meant to improve your experience when using Cerner solutions and is comprised of the following segments:

LearningLIVE

LearningLIVE provides relevant messaging and learning assets based on your role. Assets are also suggested based on your most recent actions in the EHR or can be searched for using key words.

Insight

The Insight component of eCoach provides personalized usage data in regards to your efficiency in the EHR. Insight will also provide suggestions on Focused Learning to help improve your behavior metrics and give you more time to spend with your patients.

When

End of March.

Where

On your toolbar (or in the Table of Contents) in PowerChart®, FirstNet®, and SurgiNet®.

Learn More!

Click on the link below to watch a short video demonstration of eCoach.

Watch this video to learn more...

RL6:Mobile: RL Solutions Mobile App - Instructions for TTUHSC / TTP

Using the RL6:Mobile App from the Apple App Store/Google Play Store please use the following links in order to login to the respective environment:

Instructions to Login:

1.       Navigate to the Change Server screen.

2.       Select Manual Entry (see screenshot below)

a.       Enter the below URL (do  not include https://) 

umcrl6prod.teamumc.com/RL6_Prod_Mobile

3.       Select a RL6 Server

4.       Select Connect

5.       In the Select Account Type screen, ensure that the correct Domain is    

           selected.

Utilize your TTUHSC eRaider account login for the RL6:Mobile Solutions App, same as logging into your desktop version.

Q&A:

I’m getting the message: “Configuration successful. Your version of RL6:Mobile is newer than the base supported version of your hospital’s RL6 server.”:

Ignore this message and proceed by pressing OK

I get a timeout error when I try to connect to a RL6 Test or Training Server:

Make sure you are connected to the hospital office wifi not the guest network.

When I login for the first time I see “My Incomplete Tasks”:

This is the default page when a user logs in for the first time. You can start navigating in the app by pressing the hamburger symbol.

TTUHSC users utilize the UMC’s RL6 server.  Login process for both UMC and TTUHSC users are different. The appropriate “Account Type” (Domain) must be selected before a user can login to RL6.

Please see the below screen shot on how to select TTUHSC as the Account Type to login. There are different ways to access the “Select Account Type” screen depending which screen you are currently viewing. If you see the menu (hamburger icon) symbol on the top left you can select “Change Account Type” from there. The “Select Account Type” screen also appears once you press on “Connect” in the Where is your RL Server?” screen.

If you have any questions or need assistance, please feel free to call Lacy Phillips, Director of Performance Improvement @743 2883 or Paige Howell @743 1815.

SWCC to UMC Cancer Center Orders

The above orders will be changed to UMC Cancer Center to prevent mistake of entering SW for request for Social Services referrals on 2/23/22.

Social Services for Hemodialysis Order Change

Change to Social Services for Dialysis with the above fields added to the order.

Anticipated Change Date: 2/23/22

Social Services for IV Therapy Order Changes

Frequency field added as free text that is required to be completed on this order.

Anticipate to Go live on 2/9/22.

PHQ2 Answer Choice Update

In relation to our Vital Sign 6 project for screening mental health, the PHQ2 question choices needed to move from the Yes/No answer to the four options you see on the PHQ9 assessment.

As these are the first two questions of the PHQ9, and for the measures to pull in appropriately, the answers needed to change. We are currently working with Cerner to update the Smart Template to pull in the new answers.

Intake and Output Update

This will occur on Wednesday, January 19th.

IMPORTANT INFORMATION

We have discovered that two of the commonly used I/O Smart Templates is miscalculating the total I/O balance for the encounter and is reporting incorrect data in the note (screenshot below).

We are going to remove this from any note that contains the template as well as remove the autotext from being available for use. The I/O data you view within the chart in either the Intake and Output component or in INet remains accurate. The only thing that was affected is the Smart Template that brought the data into your DynDoc note. In the meantime, we are developing strategies for how to display I/O data in clinical notes in the future.

We apologize for any inconvenience this may cause.

The following note templates will have the intake and output section removed:

• Progress Note PICU

• Derm Progress Note

• Family Medicine ICU Progress Note

• Family Medicine Progress Note

• Orthopaedic ICU Progress Note

• Orthopaedic Progress Note

• Palliative Care Consult Note

• Palliative Care Progress Note

• Pediatric Oncology Progress Note

• Surgery Admission H&P

• Surgery Progress Note

In addition, the public autotext below will be removed for use from the system.  Please note that if you have duplicated this autotext for personal use, it will no longer function as well but will display as “no qualifying data”.