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

October 31, 2006

Pap Smear Release on MyGroupHealth

Filed under: MyGroupHealth — admin @ 2:51 pm

On November 2nd, EpicCare will begin releasing abnormal pap smear results (WWA only) to MyGroupHealth.  Each result will have patientfriendly text explaining what the diagnosis means and what the patient can expect to happen next. (This does not replace the protocol for contacting patients within 1 business day of receiving an abnormal result)  Columbia Care Teams can use the SmartPhrases when releasing abnormal paps to help patients understand the diagnosis. Our Patients have been asking for this for some time and it is exciting to further increase the transparency in health care.  A heartfelt “thank you” to the leadership and technical colleagues in Pathology and Laboratory, without them we wouldn’t have been able to provide this great service to our patients. 
There is a full spectrum of Smartphases that will be attached to the pap result. Normal paps will go out in real time and any abnormal will be held for a full business day and not released on the weekends.   If you have any questions on this new reporting policy, please contact your CIS Specialist. The full list of all the phases is extensive and complete, the look of it is clear and patient centered.  Please look them over in the CIS Newsletter that will come out tomorrow and on the CIS Website.  
Here is just one example of the information that will accompany a pap result:

Atypical Squamous Cells of Undetermined Significance (ASC-US) 


This Pap test result means that some abnormal cells were seen on the slide.  These are minor cell changes on the cervix sometimes caused by inflammation or infection from a virus. One common cause of this type of abnormal Pap test is the human papillomavirus (HPV).  Some strains of this virus cause genital warts, and others may cause cell changes on the cervix.  There is no treatment for HPV, but in most cases, the virus usually goes away on its own.  It was not clear from your Pap test if you have HPV. 
One of the following things will happen next:
1) Your provider may recommend repeat Pap tests in 6 months and 12 months OR
2) Your original Pap sample may be tested for high-risk HPV.  If the HPV test is positive, you will be recommended for a colposcopy.  If the HPV test is negative, you can return to regular Pap screening.  Only women with ASC-US testing positive for high-risk HPV need further evaluation with a colposcopy.  HPV infection that persists is the most important factor for developing precancerous cervical cell changes and cervical cancer.
Please call your provider’s office, or send a secure message through the Your Messages area, if you have any questions.
See the Abnormal Pap Test topic in our Healthwise® Knowledgebase for more information.

October 26, 2006

KP HealthConnect Decision Support Summit

Filed under: Innovation Adoption — admin @ 3:14 pm

I am representing Group Health at a national meeting sharing regional experiences in building and using clinical decision support tools. There is both great energy and evidence mounting on the benefits of these tools. Recently, JAMA, March 2005 reported clear improved provider performance using BPA’s. Patient safety has improved by leaps and bounds. Patient outcome studies are lagging behind and in some studies reveal inconsistent results. There is currently insufficient evidence to show that we have changed patient outcomes for specific disease states. I am more optimistic than that and believe we will find the supporting publications, if they exist, that we are benefiting clinical outcomes. Group Health is leading the way in the adaptation and implementation of these tools.

It is encouraging to see that there is more to Decision Support than Pop-ups in Epic. The scope of initiatives that aid providers to provide correct care at the right time takes many forms. The notion of Non-Intrusive alerts and Solicited Alerts broadens our behavioral options for getting information. Interesting, the use of AVS’ in many of the KP medical centers is in the 12 – 15 % range, below our roughly 50 % at GH. Also interesting is that it was quoted that 68% of physicans override alerts but 90% feel they are very important in patient care. That is a gap that needs our attention and I wonder how that plays out at GH.

Like bees to honey. The buzz here is QISTs.  The group is very interested on how to both create leadership support and how to meet both individual medical center needs and organizational initiatives. We could have spent the day talking about Kaisens and QISTS. Having to simultaneously channel both Ted and Matt is not sustainable with life but it is sure fun trying. A few take home points from the morning session:

Person to person communication better than electronic in getting the message out

Set the context of why decision support is needed in the medical record

Sponsor needs to set the clear agenda and develop outcome analysis

    More to come….


CC’d charts to primary care –seeking input

Filed under: Information continuity — admin @ 2:56 pm

Seeking ideas from (mostly) PCP’s, as the Chart Etiquette Committee begins to discuss CC’d charts and provider to provider communication.

Under what conditions do you want to receive CC’d charts? For instance: all specialty visits, all followup consultations, all significant illnesses (such as cancer F/U visits), all new diagnoses, all medication changes, significant change in diagnosis, needed action, etc.

Do you want to be notified of medication changes made by specialists (the changes would be in Epic)? All? Some (which)? None?

Do you want to be notified when a specialist requests transfer of a prescription to you?

Which CC’d charts that you now receive would you rather not receive?

If we could designate certain CC’d charts as high priority, would that be helpful? If yes, under what circumstances would you like a CC’d chart designated as high priority?

Under what circumstances would a staff message be required instead of a CC’d high priority chart?

Tangential comments and ideas welcome too!

October 24, 2006

Radiology Renaming – Report on Progress

Filed under: Radiology — admin @ 10:35 am

The full lists of re-named plain films were loaded into the Radiology database last week. Most of them were also placed on the Primary Care preference list and a few of the specialty lists.  The most common naming conventions used the identification [STD] to identify the films used most commonly. Process instructions ore many of the studies added much more clinic information and guidance on how to order and schedule exams.

The rollout, given its scope and complexity has gone very well. From where I sit in my clinic, I have heard of few problems or confusion.   There have been a couple of issues that should be called out to make the process run even better.

Several exams need to be removed from the list of choices (deactivated), these are exams that are not used any longer and have no radiology interface code.  This list is has essentially been removed and clinicians will no longer be able to order these.

Several exams were just plain ol’ confusing, like a ‘Stansogram’, and those along with a combination Ankle/Foot film have been swiftly removed from the preference lists.  Others may be on the chopping block as we here more from providers and radiology technicians who are doing incorrect exams.

One of the upshots of this work is the process by which we can modify and fix the lists of available radiology exams. What once took weeks, now often takes a day or so. That is born out of the great synergy between the departments of Radiology and Clinical Informatics.  If there are other problematic radiology studies that you see or wrongly order, please let us know right away.

After the upgrade, next year will bring more work in this area, specifically for CT and MRI exams.  These processes will continue to grow and improve. We have seen phenomenal success already that improves patient safety an clinical care.  Keep us posted as to how the system can even work better for you.

October 20, 2006

Reduced publishing schedule and feedback from the Emergency Room

Filed under: Rollout — admin @ 12:21 pm

There will be a reduced publishing schedule over the next week as I head out of the office for a bit. Other members of the Informatics Team will be posting in my absence.

Before I go, though, I want to relate an experience I had just today when David Kauff, MD, and I went over to Eastside Hospital, and stopped by our colleagues in the Emergency Room to ask how things were going and what EpicCare meant to their patient care experience. Cindy Catlin, RN told us that it has made a difference in her practice in the ability to coordinate care right from the patient’s bedside. She also mentioned that patients appreciate that when they provide her history and other information, she can record it right there in front of their eyes.

Group Health also received what I consider a very nice compliment from one of Cindy’s colleagues, who works not only at Group Health but at 2 other medical centers in the area that use competing EMR products. She said that Epic is the most “nurse friendly” and the easiest to use of the systems she works with in practice. I have heard this from other nurses that practice outside our system. It’s nice to know that a benefit of our technology work is that it helps us attract staff talent as well as members.

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