It’s Not About The Box Improving Care at Group Health with People, Process and Technology

May 31, 2006

“Copy and Paste” – Humor

Filed under: e-health news — admin @ 5:16 am

This editorial appeared in the May 30, 2006 issue of JAMA. It seems we are not alone in understanding how to integrate electronic documentation into our lives. Thanks to Jason Wong, MD, and Anita Ross, MD for picking this up.

Link to “Copy-and-Paste,” JAMA

May 30, 2006

The New Face of Medication and Allergy Reconcilation

Filed under: Medications,Safety — admin @ 5:49 am
Hospital Encounter

Using a hospital encounter to record significant events during a hospitalization, and update the medication list

Acive Medications Report

An active medications report that can be used on discharge to know what medications the patient is taking by any of their care providers.

I am working with Bruce Wilson, MD, and Chris Cable, MD, diligently, on the topic of allergy and medication reconciliation. For our patients’ benefit, this must be done across our system, wherever and whenever patients are seen.

Our first pass is on discharge from the hospital. Chris and I tested out the idea of hospitalists updating the problem list and medication list on discharge in Epic, so that the chart is accurate for use by the patient and their care team as soon as they leave the hospital.

What do you think?

May 26, 2006

AVS Redesign – Member Feedback

Filed under: After Visit Summary — admin @ 12:11 pm

Last evening 15 current Group Health members gave their time and energy in a forum asking for honest and frank feedback on After Visit Summaries that they received in office visit and urgent care encounters over the last year. Behind one way mirrors at Consumer Opinion Services we were able to observe and hear about how patients use these forms and what they want improved. A few take home points:

  • Patients strongly stated that AVS is an outstanding tool that improves care and improves quality. They directly associate this with a strong patient – provider relationship and excellent care and service. They read them carefully, keep them in their records and refer to them long after at the office visit. Interesting, the AVS was an important information tool that family members read to understand what happened in the visit. It is a communication tool beyond the patient.
  • Consensus was clear that the content of the AVS should include:

1. Diagnosis discussed at the visit
2. The name and explanation of the condition.
3. AVS should be personal and detailed. i.e. ‘My AVS’
4. Name, Date, Time and vital signs clear and easy to see.
5. Define what tests were ordered, what studies were done and why.

  • Contingency should be a major component of the document. Members want to know what to expect. Many wanted a ‘If this happens …. then the plan is to do that….’ Clearly articulated next steps were vital to these groups.
  • Patient Education that is germane to the person is needed. Avoid general terms like ‘moderate’ alcohol consumption and exercise’ were thought not specific enough to be helpful.
  • Additional information is often asked for. Links to good web information that is trusted and patient centered with language that is clear.
  • Specialty Referrals need more information. When to call, what to do if you don’t get through or if there are long delay times to visit. Again, next steps were wanted.

The extent of patient appreciation of this tool was remarkable. It both frames and colors the Group Health experience only the best ways. It reinforces the primary healing relationship and serves as a communication tool and permanent record. Rich text format and moderate redesign will make them still better. Full documentation from these opinion groups is forthcoming.

Planning and Execution Kaizen – complete

Filed under: Kaizen,Planning and Execution — admin @ 9:31 am
Qist Planning And Execution Kaizen Newsletter[1]

Planning and Execution Kaizen Newsletter

The last kaizen for our Quality Improvement Support Team (QIST) happened last week. The purpose of this workshop was to iron out a lot of details that haven’t been clear or developed on the fly. Our first 6 QIST event hosts allowed us to figure out what worked, what didn’t work so well, and what we can do differently. We were allowed to fail in some areas so that we can succeed overall. That alone is a great gift to get.

A toolkit on how to do a QIST is one of the big deliverables from this week. It is extremely well thought out (in my humble opinion as someone who watched it get developed) and will really help clinical teams maximize this experience to:

  • Grow and develop EpicCare
  • Empower staff
  • Improve quality and service

It was even decided to keep the “QIST” name – there was/is an idea that this should not be thought of as a project – it is the way we will do our work from this point forward. It is a huge advantage that we’ll have in the health care industry – the input of patients and those who care for them to make the health system better.

May 25, 2006

30 minute time out of computers

Filed under: Technical Issues — admin @ 6:05 pm

With the upgrade to Microsoft XP on computer workstations, the “timeout” for securing the workstation dropped from four hours down to 30 minutes which has certainly caused providers some angst.  We are going to review this at the next meeting of the Security and Confidentiality Committee on June 13, but I don’t see that this decision will change and I believe it is the right one.  We have had actual incidences of people, using a provider’s computer in their office, put disparaging remarks and information in the patient’s chart. Protecting the privacy and integrity of our patient’s chart is something we all see as important, and actual occurrences speak to the need for a higher level of security in terms of access to workstations. I’ve copied and e-mail that was sent out to Steve Lagerberger at Burien as they were the first clinic that had the XP upgrade. This was sent out from Sheila GreenShook, Ernie Hood and myself.

 “Hi Steve,

We would be happy to come to Burien to talk with you further about the time out issue. We wanted to make sure you understood the background and constraints on this. The underlying goal is protecting the privacy and the medical record of our patients. We obviously want providers to be as efficient as possible.

Unattended computers with Epic open and running represent a risk to patient privacy. The standard in the community is as follows:

          Evergreen 10 minutes

          Overlake 6 minutes

          Fransciscan health systems 15 minutes (controlled areas-offices) 5 minutes(uncontrolled)

           UW 15 minutes

           Swedish 15 minutes

When GHC began exploring auto lock options and time out standards, we were wanting these to be as least disruptive to the provider as possible. After polling the community, we chose to go with a “windows” lock, so that all open applications would be accessible once the user entered their window password. Although this may seem disruptive to the workflow, it was the least disruptive option available. Other options would have required the user to log back on to all open applications. The option we chose takes the least amount of time.

There has been an actual case here at GHC of someone entering disparaging information in a patient’s chart through an unattended workstation in a provider office. There are also documented complaints that the privacy office has received where patients were able to view anther patient’s information because a workstation was not secured.

We have a technical constraint that locking the computer requires reentry of the password. Note: the devices can be set to “log out” which would requires rentry of user ID and password as well as opening the applications. The way the devices are set to time out was to make it as easy as possible for a provider to get back into their workstation by only needing their password.

Attached is the report that was sent to Burien aministration after a privacy walk-through assessment completed in October, 2005. As you will note, unattended, unsecured work stations was identified as a high risk.

We respect your time (and ours) and don’t want to come down there to just review the same material. If you have some other ideas on how this can be accomplished and prevent in the future what has already happened, we’d love to talk about that. For now, we do need to work within the framework above.” 


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