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

September 30, 2008

Dragon Update

Filed under: Voice Recognition — John Kaschko @ 8:17 am

Dragon usage continues to expand, more licenses were approved earlier this year and the wait list is being worked down.  A number of significant “technical” process improvements have happened this year: 1) The application is being routinely pushed out via Radia to designated computers without glitches, 2) our Field Engineers and Help Desk know how to configure the needed roaming settings, 3) for many of the common issues that come up when a provider reports “Dragon isn’t working….” our Help Desk has developed standard processes and knowledge about how to fix them or who to contact, and 4) our Health Information Management folks have taken over the training for Dragon.  In short, the application is much more a “standard application” at GHC with much more system wide support and knowledge.  There is still more to do, for example, we still need to set up a “Dragon Advanced” training program to maximize skills and efficiency….but much good work has been accomplished this year.

In terms of using Dragon a home, a common request, that is still not something we’re able to do yet.  Dragon version 9 is “Citrix enabled,” which means it can run on Citrix (which is what Epic is doing when you access it from home)….but our current version of Citrix is older and this won’t work with Dragon.  There are currently plans to upgrade our version of Citrix later this year, the newer version will be compatible with Dragon and has the potential that it can used at home. Obviously, there will still be technical work that needs to happen after a Citrix upgrade, but this needed upgrade is the current limiting factor.

We are also exploring an upgrade to Dragon version 10 which was released about a month ago.  There a number of new features including further increases in accuracy. Most of the new features don’t “jump up and grab me” as “gotta haves” but the one that caught my eye is the ability of Dragon to work in a window behind the desktop.  Currently, if you are using Dragon and move somewhere else (for example, go to Chart Review to look at lab data), when you shift windows, Dragon loses it’s orientation for the documentation window you were it. In other words, you need to stop talking if you want to move somewhere else in Epic. This new version is reported to keep that orientation, so that you can be talking, move somewhere else in Epic while still talking, and Dragon will keep working.  This would be a helpful feature if it works “as advertised.”  We hope to get a copy of version 10 this fall and do testing with our version of Epic and our technical architecture to see how it really works.

September 23, 2008


Filed under: User Group — Marc Lowe @ 4:13 pm

With the exception of some uncertainties, I generally anticipate that first experiences will end up more positive than bad. This past week, first experiences came in a package. It all started with the EPIC Users Group Meeting (UGM), I was scheduled to attend. Like a ball gaining downhill momentum, the first experiences grew:

First User’s Group Meeting (annual meeting hosted by EPIC); First exposure to the EPIC campus; First trip to Madison Wisconsin (location of EPIC campus and well known college town); First trip to The Essen Haus (semi–famous restaurant in Madison Wisconsin, known for serving large quantities of beer); First trip to the tree house on the EPIC campus; First visit to The Princeton Club gym in Madison; First introduction to Judy Faulkner (CEO of EPIC).

The annual EPIC User’s Group Meeting, reminded me of medical specialty meetings; many talks on various subjects, hosted dinners, vendors, sponsors, lots of food, and daily entertainment. Some of the talks were given by EPIC employees (what’s new, or what’s on the horizon), some were given by EPIC customers (reviewing their experiences with EPIC products). Being a neophyte myself, I found the majority of the talks to be enlightening and informative, albeit a little overwhelming. This year they had over 7,000 attendees. The EPIC campus is quite impressive. It’s a small city in itself. Over 300 acres large (one acre is a little smaller than a football field), with over 3,000 employees. (more…)

Problems with Diabetes, decision support and problem list management

Filed under: Epic,Improvement News,Quality / Affordability — Tags: , — Matt Handley @ 4:11 pm

A great challenge has presented itself in how we use a problem list entry to manage alerts and reminders for diabetes.  Years ago we created a “dummy” diagnostic code for diabetes (GHC CIS CARE COORDINATION: DIABETES [GHC.04]) so that Health Maintenance and Best Practice Alerts can be turned off for the rare patient with diabetes for whom the alerts are not clinically appropriate (e.g., hospice/palliative care).  The alerts fire based on this dummy code being in the problem list, rather than the presence of the specific diagnostic codes we use for documenting and coding diabetes care.  Because the diagnosis is assigned by an algorithm it isn’t perfect – it is wrong about 3% of the time, implying that a patient has diabetes when they do not.  It is possible to remove the dummy code from the problem list for the two circumstances where it is clinically appropriate (when the algorithm got the diagnosis wrong or when it is clinically inappropriate to continue to monitor their diabetes) in two ways:

1. Delete GHC CIS CARE COORDINATION: DIABETES [GHC.04] from the problem list – removes it, but the algorithm will add it back next month, or…
2. Resolve GHC CIS CARE COORDINATION: DIABETES [GHC.04].  This suppresses Epic from adding the dummy diagnosis back to the problem list forever (or until the problem is “un-resolved”)

Some clinicians may delete or resolve the dummy code inappropriately in their efforts to clean up the problem list, not understanding that the dummy diagnostic code is the tool that we use for managing alerts.  Good intent (love that attention to the problem list), but most of the time that this happens it is not for clinically appropriate reasons.   This has happened about 500 times, and most of these have been in patients who very clearly have diabetes.

We all need to work together to manage problem lists, but need to exercise care in how we do that.  We are working on a way to both “un-resolve” the problem list entry for patients whose diabetes is being actively managed, and set up a regular system to make sure that when the GHC.04 code is resolved it is on purpose.  We are looking to the Diabetes Expert Team as a stakeholder to assist in this work, under Dave McCulloch’s direction.

EMR vs. EHR – A Nice Summary

Filed under: Uncategorized — David Kauff @ 1:39 pm

Here is a good review of the similarities and differences: EMR vs. EHR

September 17, 2008

ER Visits and the AVS

Filed under: Optimization — David Kauff @ 6:25 am

Interesting and reaffirming article in the NYT on the importance of the AVS.  The information supports our  need to encourage the use of the tool in ED/UC and all touch points in the delivery system.
Please see the attached link:

NYT ER pt information article

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