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

June 29, 2007

New and faster PACS access

Filed under: PACS — admin @ 3:21 pm

With much hard work the PACS and Epic teams have brought you all a better way to access PACS images just in time for Central go-live. While the old process required a new login every time you accessed it out of the “Apps-link” in Epic, the new process logs you in to the images of the patient you’re seeing automatically. Once you’re in the Epic record for a given patient you just have to click on a link in one of their imaging results to launch the viewer. The viewer launches with the latest image showing, and the timeline of all available images visible. Staff who use PACS a lot will love this as it does away with having to log in with every patient encounter. Staff who DON’T use PACS a lot will love it as you don’t have to remember how to log in to access your images. This process will also work for accessing images via Citrix. I’ve attached a screenshot to illustrate the link.Access Screenshot

After Visit Summary Repgramming – coming along

Filed under: After Visit Summary — admin @ 7:30 am
Avs 062807-2

Draft, New After Visit Summary

One of the purposes this blog was created was to allow staff to see into what we are doing in Informatics, even if we’re not finished, even if we don’t have it right.

It’s in that spirit that I’m posting the latest iteration of our After Visit Summary reprogramming. This is where the rubber hits the road, and we see what Epic can do compared to what our patients dreamed up. We gave our build team a copy of the designer-created product. Now they are doing the programming to make it work. The team is being led by Colby Voorhees, and they are doing great work together.

When this goes live, it will affect all AVS’s across Group Health, and will retro back all AVS’s on MyGroupHealth. Keep that in mind.

We are making progress. I want you to notice a few things that are coming:

1. Visit Diagnoses. These will start appearing on the After Visit Summaries. Our members asked for these, in the proper medical terminology, so that they can do more research.
2. Medication Reconciliation. There will now be a list of active medications and the date they were last checked and by whom. This will be an opportunity for the patient to compare what we have for them and what they are taking. This may prompt us to clean up the list with them. This is the goal.

Anxiety reduction message: this is not the final product. This is a step forward in our journey. Your input is valuable. Tell us if you like it, too!

I will just point out those two areas in this post. Take a look. What do you think?

June 28, 2007

Informatics Rounds: Bridging two worlds in the Group Health Operating Room

Filed under: Information continuity — admin @ 2:52 pm

Bridging two worlds
This morning I toured the Group Health Operating Room at Eastside Specialty Center, hosted by an adjunct member of our Informatics Team, Bobby Samanta, MD. He’s an adjunct member because he’s the physician champion of one of Group Health’s “other” CIS’s, PICIS, which is our intraoperative clinical information system.

(images below, click any to see as a slide show)

I have talked about Bobby’s work for Group Health previously on this blog. He and the team that implemented PICIS, including Jensine Winther, CRNA, have been successful in the systemwide implementation of PICIS, on a smaller scale than the Epic team, but no less impressive, and without any less fanfare in the Anesthesia community nationally (their work is well respected).

My visit today is part of the observation I am doing around care coordination and care management. What we know is that having an operation is similar to being admitted to the hospital, from an information perspective. Our patients transfer their care to an inpatient system and then back to the outpatient system (their personal physician) on discharge. There’s a need to maintain safety in the inpatient setting and to have a safe discharge. As with all hospital care, patients expect that the information about them is available to their care team at the same time, or in advance of, their arrival. And this is the origin of my visit.

The Operating Room is placid before the day begins; it fills up quickly, though.

Recruiting a consultative specialist for the Group Health Informatics Team

Filed under: Informatics Team — admin @ 11:45 am
Ghp Specialty Informatics Position Announcement

Job Opening, Consultative Specialist, Group Health Informatics Team

Quality & Informatics Physician Workplan Wiki - Ruth Krauss Workplan First Quarter 2007

Workplan, Ruth Krauss, MD, First Quarter 2007

Quality & Informatics Physician Workplan Wiki - Ruth Krauss Workplan Second Quarter 2007

Workplan, Ruth Krauss, MD, Second Quarter 2007

2007 is Ruth Krauss’ last year with the Group Health Informatics Team. She has demonstrated the value of consultative specialty input into our work, as a surgeon, a Group Health pioneer, and as an overall excellent teammate and role model. She represents the best of Group Health Informatics physicians, challenging stereotypes about health informatics. We strive to hire great physicians with an interest in technology, rather than the other way around. From that perspective, being “great” at Epic is not a core requirement of this position, being “great” as a physician is, and this is what we will be looking for. What we all know is that when a great physician comes into a room, people can identify with them. The same is not true for a great Epic user coming into a room (both are necessary and wanted, to be sure!).

With that in mind, Group Health is now recruiting for a 0.2 FTE consultative specialist to join our team, beginning in 2008. I am attaching the job announcement here.

I am also attaching Ruth’s past two quarters’ of workplans so you can get a sense of what her work has been for Group Health. Feel free to also ask Ruth questions directly.

It will be very important for Group Health to have consultative specialty experience in our Informatics work moving forward. Even though I am a family physician, in my role outside of the exam room, I am a Group Health physician and am interested in supporting all of the care provided in our system. This is the expectation of all of the physicians on this team.

For those of you interested in applying, and if you are interested, you should apply, please contact Jenelle Van Assen. Her contact information is in the attached announcement. Our team is looking forward to interacting with those of you who would like to consider this opportunity to serve Group Health. This process will be open to all who meet the basic requirements, as written in the job announcement.

I am also available for any questions as well. Feel free to contact me. The deadline is next week, July 6. The Informatics Team is a great one to be a part of – crossing specialties and disciplines to help all of you help our members succeed.

June 27, 2007

“GHC.04” on Epic Charts

Filed under: Quality / Affordability — admin @ 5:24 am

Several of you have asked me/us about the “GHC.04” on Epic charts. I’ve alluded to ways in which it works previously on this blog but have not put an explanation of how it gets there.

I’m posting this today because one of our colleagues, Chris Thayer, MD, noticed that a patient of his was not flagged as they should have been. We found out that the routine that is run to flag new patients had not been. It has been run as of yesterday and so patients who are newly diagnosed should be flagged. This routine is scheduled to be run once a month.

This problem list code is a bridging of the old to the new. It utilizes the exact same programming that put patients on the old registry system. It uses these criteria to determine if a patient is diabetic or not:

The patient is currently taking, or has taken in the last three years, any of the two diabetes therapeutic drug classes:  insulin or oral agents.  If the patient is identified because of metformin use and no other corroborating identification applies AND the patient has a diagnosis of polycystic ovarian disease, the patient should not be considered a “diabetes registry patient”.

The patient has had a HbA1c > 7.0% in the previous 12 months.
The patient has had ≥ 2 fasting plasma glucose tests > 126 mg/dl in the previous 12 months.
The patient has had ≥ 2 random plasma glucose tests > 200 mg/dl in the previous 12 months.
The patient has had any combination of 2 fasting plasma glucose tests > 126 mg/dl and random plasma glucose tests > 200 mg/dl in the previous 12 months.
The patient has a hospital discharge diagnosis of diabetes at any time during their medical history with Group Health Cooperative.
The patient has had ≥ 2 outpatient diagnoses of diabetes at any time during their medical history with Group Health Cooperative.

You’ll notice that some of the criteria above include data not housed in the Epic system. The information that is used to populate this code comes from more than one place, which is why we are still using it. It is not 100% accurate, but it is the best we have. We want to incorporate physician control in determining who is identified in the clinical care arena and that’s why we use the problem list for this condition.

The Epic client base uses different techniques to do this identification, because currently, there is no part of this system designed to store “chronic condition coordination status.” Group Health pursues an automated approach in the interest of not missing patients. There may be some false positives, though. We’ll work with individual caregivers in looking at charts to see what’s going on in a specific case.

What does the future hold? A few things – 1. We are hoping to have something of a bifurcation or additional “list” that identifies patients (what a registry does) in Epic that is not necessarily the “problem list.” It would be a “list of conditions that this patient is receiving extra coordination for.” 2. We are supporting the Enterprise Information Management project, which is a bit farther in the distance, but is set up to consolodate all of the data sources we have to leverage them for our patients’ benefit.

In the meantime, we’ll be counting on GHC.04 to be the signal to EpicCare to fire reminders related to diabetic care.

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